Sprains and Strains 3
Over the last couple of issues we have looked at the nature of sprains and strains. Along the way I defined the indicators of severity and talked about initial care. When you sustain an injury you have two stages of damage, the initial damage and the collateral damage caused by inflammation. Proper care and rehabilitation are important in returning back to competition safely and effectively.
There are three phases to rehabilitation, the acute phase, the recovery phase and the functional phase. The approach to rehabilitation depends on the severity of the injury. Usually you can work through mild injuries on your own. With more severe injuries you should enlist the help of a professional, especially in the acute and recovery phases. Professionals utilize electrical therapies, like ultra sound, micro-current and ionization. They will also use massage and specialized muscle techniques that help speed up the healing process. Strains are easier to self manage. Sprains, especially serious ones, are more difficult and more painful. The objective of all rehabilitation is to return to pre-injury status as quickly as possible.
The acute phase, the first 48-72 hours, is the most important. Icing is the simplest thing to do and should be done aggressively and with diligence. I recommend using an herbal anti-inflammatory, because you can load up on herbals with minimal side effects. There are many herbals that have anti-inflammatory properties, but good herbals like Boswella Serrata can make a huge difference in the first few days. If possible, try to not use any pain meds. This way you get a better feel for how the injury is healing and can gauge how hard you can safely push your rehabilitation. Pain meds should be used strictly on an as need basis.
The recovery phase begins once the inflammation has subsided enough to begin active movement. If the inflammation is not too bad, but there is pain and stiffness you may want to start with contrast therapy where you use heat and ice therapies back to back. Warming an area up brings in a fresh blood supply, then immediately icing it down helps remove the inflammation. This can be performed in 10 to 15 minute intervals three to four times a day. If there is significant swelling you want to avoid heat so don?t use contrast therapy.
Mobilization and stretching are the next things to start doing. Mobilization should be done as much as you can tolerate it. Mobilization consists of slow consistent movements with out much stress on the joint or muscle. Stretching exercises should be performed two to three times a day, with a minimum of three repetitions held approximately 60 seconds for each muscle group. The objective here is to improve flexibility. If the injury is real stiff it may be necessary to warm the area up with a heating pad or a warm bath prior to therapy. Always end a session with ice therapy.
Resistance exercises can start when flexibility begins to improve. Start easy with very low weight or elastic exercise tubing. Work the muscle in both ranges of motion, contraction and elongation. Gradually increase the range of motion. Once you have good range of motion start increasing the resistance. Once you can increase the resistance, start increasing the repetitions so you can begin increasing the oxygen exchange in the muscles. Oxygen is a vital component to promoting healing and rebuilding tissue.
The functional phase begins once you have good range of motion and strength with minimal pain. This phase is important, because it prepares you to return to competition. The exercises should become more functionally oriented and simulate the demands of your sport. An important aspect of this phase is to also strengthen the nervous system. This is accomplished by focusing on coordination type exercises. These would be things like jumping rope, working out on an exercise ball, balancing on a wobble board, doing pilates or even shooting baskets with a basketball. In this phase you should concentrate on building strength, endurance, and most of all flexibility and agility.
Never settle for anything less than how you were before the injury. This is especially true if the injury was bad enough for surgery. Stick with your rehabilitation plan even if it takes a year. If you have suffered some nerve damage it may take several years. A side effect of injury is that it often changes the biomechanics of function. This change can set you up for future problems like tendonitis and osteoarthritis. Tendonitis alone can be debilitating enough to take you from a front-runner to mid pack or even force you to take early retirement.
Dr. Mark utilizes the highest quality supplements and products available. For more information:
drmark@proactivehealthcare.net or 408-294-4074
Copywrite 2007 Dr. Mark Lucas, D.C.