Preventing Common Injuries and Caring for the Lower Back

1. Preventing Common Injuries and Caring for the Lower Back

2. INJURY PREVENTION • Prevention is the key to reducing the frequency of injuries. Ninety percent of injuries include slow wear and tear, strains, sprains, and inflammations. Understanding the causes of injuries allows you to stop minor problems before they turn you into the "walking wounded." Prevention is far more conducive to wellness than is any patch and repair job. There are four main reasons injuries occur: • 1. Overuse: doing too much too soon or too often, causing a breakdown at the weakest point—ankle, Achilles tendon, shin, knee, or back. • 2. Footwear: wearing improper or worn-out shoes. • 3. Weakness and inflexibility: muscles so weak or tight that the slightest unusual twist strains them. • 4. Mechanical problems: the result of biomechanical/anatomical problems (the way the foot hits the ground, body build, etc.) or using poor form while exercising. • An individually adjusted workload, well-made and well-kept shoes, supplemental toning and stretching exercises, and mechanical improvements will prevent the majority of injuries.

3. Overuse • The goal is to exercise so that you improve but not so much that you cause overuse, excessive overload leading to injury or illness • Overuse problems commonly occur at the beginning of a new exercise program and account for the majority of injuries. It is estimated that 25 to 50 percent of athletes visiting sports medicine clinics have sustained overuse injuries. The first 2 months of a new program are the most critical. • Other aspects of daily life, such as poor nutrition; emotional tension; job, social, or family problems; and lack of sleep, can contribute to chronic fatigue. There is a difference between the pain of injury and the pain of hard effort.

4. Footwear • Good footwear can prevent many injuries and is the best investment you can make in an exercise program. • Shoes should provide good shock absorption, support, and stability yet maintain a reasonable degree of flexibility.

5. Common Muscle Imbalances Many exercisers who neglect flexibility exercises cannot pass this test for minimal flexibility. Their legs are too tight, and this increases susceptibility to muscle and tendon injuries. Aerobic activities are great for the cardiorespiratory system, but they alone do not develop balanced fitness. They tend to shorten and tighten muscles that are used repetitively, leaving opposing, relatively unused muscles weak. This can lead to muscle imbalance. If some muscles are too tight, joint movement is restricted.

6. Mechanics Biomechanical difficulties often arise in the feet. The foot is a marvelous structure of 26 bones, with almost double that number of ligaments and muscles. It strikes the ground about 80 to 90 times a minute during exercise. When a weak foot pounds the ground several thousand times a day, the potential for injury is great. Slight pronation of the foot is natural-that is, your foot will roll inward slightly after the outer edge of the heel strikes the ground. All bodies are not created equal, and so different foot types, gait styles, and body mechanics vary in susceptibility to injury.

7. Recommended Treatment for Common Injuries P.R.I.C.E. Acute injuries to muscles, joints, and tendons are often accompanied by swelling. Swelling causes pain and decreased range of motion. Rapid recovery requires keeping the swelling to a minimum. The aim of treatment is to assist the healing process. The recommended treatment for many injuries, whether mild or severe, is protect, rest, ice, compress, and elevate, or P.R.I.C.E

8. P = Protect • The classic advice of old-time coaches was to "run it off." On the contrary, it is important to protect the injured area from further tissue damage. Don't let the problem get worse. Look for the cause of the injury and remedy the situation. • A few days of rest from the activity in which the problem occurred might be sufficient to protect irritated tissue from reinjury while healing from a minor strain. • A medical professional might recommend that a more severely injured limb be protected with crutches, a splint, or sling. • The aim is to minimize irritation, tissue bleeding, inflammation, and pain and provide optimal healing conditions.

9. R = Rest • The injured area should be rested for 24 to 72 hours or more, depending on the severity of the injury. Switching to a different activity, such as swimming, cycling, or deep water running, can rest a sore area and maintainyour conditioning. A minor complaint can become a major problem if you keep aggravating the situation. • Healing progresses more rapidly when stress to the area is reduced. Frequently, people will start back into their usual activity before they are ready, and will reinjure themselves. Wait until most of the pain and swelling have subsided and you have regained 80 percent of your normal range of motion compared with the uninjured side. If you are unable to exercise for a week, when you return to your usual workout routine, reduce your duration, frequency, and/or intensity by at least 25 percent. Do not resume your normal workout level until you are free of pain during and after exercise.

10. 1 = Ice • Apply ice to the injured part immediately. A convenient way to apply ice is to put ice cubes or crushed ice in a plastic freezer bag and place it on the injured area. Reusable gel ice packs, chemical cold packs, or a pound of frozen peas also work well. • Do not apply the ice directly to the skin. A layer of wet toweling or plastic wrap between the ice and the skin effectively transmits the cold to the area without risking freezing the skin. • Apply the ice for 15 to 20 minutes, stop for 10, and ice again if time permits. The ice may make the injured part ache for the first 5 to 10 minutes. Keep it on! After 10 minutes, the part will become numb. • This will give immediate pain relief and reduce swelling, inflammation, and tissue damage. In deeper blood vessels, circulation increases, bringing blood, nutrients, and healing cells to the injured area. Ice the injured area three times a day for 48 to 72 hours or longer if pain and swelling persist.

11. C = Compress • When not icing the injury, wrap the part with an elastic wrap to prevent fluid buildup in the injured area. • Wrap it snugly but not tightly enough to interfere with circulation. • If the part starts throbbing, the wrap may be on too tight. Remove the wrap and reapply it more loosely. • Do not sleep with the wrap on.

12. E = Elevate • Raise the injured area above the level of the heart whenever possible. This will reduce the swelling by combating the effect of gravity pulling blood and fluids down to the injured area. • Most people with an injured ankle or knee will place it on a pillow for elevation when going to sleep. • However, you may move during the night and lose the elevation. Instead, place three or four books under the mattress to raise it approximately 6 to 8 inches.

13. Bursitis • Bursitis is inflammation of a bursa, a fluid-filled sac that lies between tissues and allows tendons, ligaments, muscles, and skin to glide smoothly over one another during activity • When a bursa becomes irritated because of overuse or training, it begins producing extra fluid and the sac swells, often within 24 hours, causing pain in the affected area. The recommended treatment is to protect the area, rest from activity, ice, compress with an elastic bandage to reduce swelling, and take anti-inflammatory medication.

14. Chafing • When skin rubs against skin or against clothing, it becomes irritated and can crack and bleed. The most common problem areas are between the thighs, under the armpits, and on the nipples (runner's nipples). • While chafing can happen to anyone, its frequency increases with greater body fat percentage. Treat chafing by applying petroleum jelly to the affected area. To prevent chafing, select clothing of smooth, nonabrasive material with few or well-covered seams. Synthetics are best. Avoid cotton because it stays wet, causing friction. Avoid clothing that is tight or that bunches under the arms or between the legs. Wearing tights or kneelength exercise shorts can protect chafed thighs. Nipple chafing can be decreased by going shirtless in warm weather or by applying petroleum jelly and adhesive bandages to the nipples. Women should select a good exercise bra that has flat or covered seams.

15. Heel Spur • A heel spur is a bony growth on the underside of the calcaneus (heel bone) at the insertion of the plantar fascia. They do not always cause pain unless there is significant fat pad atrophy or unless they are caused by chronic irritation of the plantar fascia at its insertion. • Treatment involves rest; anti-inflammatory medications; and insertion of a heel pad in the shoe to protect the heel, alleviate inflammation, and distribute impact during activity.

16. Iliotibial Band Syndrome • Tightness, burning, snapping, and pain on the side of the knee or hip may be related to inflammation of the iliotibial band, a long tendon that begins in the buttocks, runs down the side of the thigh, and attaches to the side of the lower leg just below the knee. This is primarily an overuse injury and can be treated with decreasing or changing activity, ice, antiinflammatories, and stretching the iliotibial band, hamstrings, and quadricepsю.

17. Muscle Cramp • A cramp is a sharp, involuntary muscle contraction. Muscle cramps may be caused by fatigue, which causes the nervous system to overstimulate muscles. • Cramps can be treated with fluid intake and with gradual stretching of the muscle. A calf cramp may be treated by extending the foot to a 90-degree angle. Occasionally, gentle massage may help.

18. Muscle Soreness • Muscle soreness is discomfort or tenderness after an increase in workout level. It may be fairly mild and usually is just a reminder that you had a good workout. • After several sessions of the same activity, soreness will diminish or disappear. • Muscle soreness is thought to be caused by microscopic tears or spasms of the connective tissue. There is no long-term damage from this. • Muscle soreness may develop immediately or over a 24- to 36-hour period following unaccustomed exercise and will usually disappear within 2 to 4 days.

19. Muscle Strain • A muscle strain is a tear of muscle fibers or a tendon and is sometimes referred to as a pull. Symptoms include sharp pain, weakness with possible loss of function, spasm or extreme tightness, and tenderness to the touch. • There are many different causes, but it most often results from a violent contraction of the muscle. A strain may be caused by fatigue, overexertion, muscle imbalance or weakness, or electrolyte or water imbalance. • A strain may range from mild (more painful than just soreness) to a complete rupture of the muscle. The muscles most likely to be affected are the hamstrings, gastrocnemius, Achilles tendon, erector spinae, groin, and the rotator cuff muscles of the shoulder. • Rest, ice, and anti-inflammatories are used to treat muscle strain. • To prevent strains, complete a full warm-up before working out, take care not to overdo it, and work toward balancing the strength and flexibility in opposing muscles.

20. Patellofemoral Syndrome • Pain around and under the kneecap, along with knee stiffness, is characteristic of patellofemoral syndrome. • Symptoms include a dull pain when walking up and down stairs or after sitting with the knees bent for a period of time ("theater sign"), and occasionally mild swelling or a feeling that the knee is "giving way." • It is associated with overuse, worn-out shoes, always running in the same direction on the track, excessive downhill running, and rapid ballistic movements such as those done in aerobics. • One common cause is structural. Wide hips tend to make the quadriceps pull the kneecap out against the femur, producing inflammation. • Loose kneecaps or a quadriceps muscle not strong enough to keep the patella in its groove also may lead to patellofemoral syndrome.

21. Plantar Fasciitis • Plantar fasciitis causes heel or arch pain. • It is most painful when a person takes the first few steps in the morning, but in severe cases, pain may continue throughout the day. It results from inflammation of the plantar fascia, a long thick band of connective tissue on the underside of the foot that attaches the base of the calcaneus to the base of the toes. • Inflammation may result from excessive impact, worn shoes, or poor foot mechanics. Anatomical problems frequently cause plantar fasciitis-tight Achilles

22. Shin Splints • A shin splint refers to pain in the front of the lower leg (shin). • Early signs are acute burning pain or irritation in the lower third of the anterior tibialis. • This may progress to slight swelling, redness, warmth, and inflammation. They often come early in an exercise program and are particularly common in those who are out of shape, overweight, wide-hipped, knock-kneed, or duck-footed. Working out on very hard or very soft surfaces can bring on shin splints even if a person is well conditioned.

23. Side Stitch • A side stitch is a sharp pain just under the ribs, typically on the right side. • It may result from participating in vigorous activity before the body has had a sufficient warm up. • It may be related to a lack of conditioning, weak abdominals, shallow breathing, consuming a meal too near the time of exercise, dehydration, excessive exercise intensity, or ischemia (inadequate oxygen) to the diaphragm. • To prevent side stitches, warm up well, increase exercise intensity gradually, and avoid eating 1 to 2 hours before a vigorous workout. • Side stitches can be treated by stopping activity and stretching, massaging, or pressing on the painful area. • After cessation of the activity for a few minutes, the pain and spasm should subside. Taking a deep breath may also break the spasm. Once the pain has dissipated, activity may resume.

24. Stress Fracture • A stress fracture is a microscopic break in a bone caused by overuse. While it can occur anywhere in the lower legs and feet, it is most common at the end of the tibia near the ankle and in the metatarsals of the feet. • Unlike a broken bone, which occurs with a distinct traumatic event, a stress fracture is the result of cumulative overload that occurs over many days or weeks.

25. Tendinitis • Tendinitis is the inflammation of a tendon from repetitive stress. • Common signs of inflammation include pain, redness, heat, and swelling. • Tendons are the fibrous cords that connect muscles to bones. • They are vulnerable to inflammation because the force of muscle contractions is transmitted through them. • The most commonly affected in runners, walkers, and aerobic dancers is the Achilles tendon, which connects two calf muscles, the gastrocnemius and soleus, to the back of the heel bone. Other areas commonly affected are the knee, shoulder, and elbow ("tennis elbow"). • A regular program incorporating stretching and strengthening can help prevent tendinitis.

26. WHEN TO SEEK MEDICAL HELP • Not all injuries can be self-treatedюYou should seek medical assistance for an injury if you experience any of the following symptoms: • 1. The injury is extremely painful or the pain has not decreased in intensity within a day or two. You are unable to bear complete weight on that part or are unable to walk more than three or four steps without significant pain. • 2. There is joint pain lasting more than 2 days or significant tenderness when you press on a specific spot in a joint, muscle, or bone, such as a bony part of the foot. • 3. There is a loss of strength or range of motion (compared with the uninjured side) and loss of the ability to do normal tasks. • 4. The limb gives way when you try to use it • 5. You heard a distinct "pop" or "snap" when the injury occurred. • 6. The injured area, compared with the uninjured side, looks misshapen or has unusual lumps (other than swelling). • 7. There is numbness or tingling in the injured area, which may indicate nerve compression.

27. Common Injuries, Symptoms, and Treatments Injury Specialists

28. CARE OF THE LOWER BACK • Back problems are rarely caused by a single, isolated factor. • During high school and college years, our bodies are relatively flexible. As we age, muscles begin to shorten and tighten, decreasing flexibility, especially in the back. • Combine this with possible weight gain and declining overall fitness and it becomes evident why back pain afflicts millions. • With few exceptions, back problems can be prevented with improved fitness, living and work habits, and posture. • The most important key to preventing lower back pain is maintaining strong abdominal muscles and back flexibility. • The fetal position is the best sleeping position for maintaining a healthy back.

30. Exercises for the lower back