The main challenge that I find in treating injuries within this ‘gym-going’ population is that it is not a uniform group of individuals. People of every age group—from teenagers to seniors—and of every body type—slim, athletic, overweight or morbidly obese—go to the gym for a variety of workouts. It is therefore important to classify these people into a few categories:

• Senior citizens
• Weight-loss aspirants and fitness enthusiasts
• Muscle-building aspirants
• Eager beavers wanting to achieve quick results

While there is a lot of overlap between these categories, the last category of people is found in abundance. They join a gym a few weeks before a wedding or some other important event with the aim to ‘look good’, and it is this faction that is most prone to getting injured.

Senior citizens

People above 60 usually go to the gym to maintain and improve their cardiac fitness. They mainly do exercises like walking on motorised treadmills, cycling or elliptical cross trainers.

Injuries in this group

Senior citizens have a lot of age-related wear and tear in their joints and spine that already creates a strain when they workout.

• Knee pain, back pain and shoulder impingement are the commonest problems seen in this group.
• Knee pain is usually aggravated knee arthritis and responds well to a treatment of Rest, Ice application, Compression and Elevation [commonly known as RICE]. However, if your knee pain is accompanied by swelling, it may be a sign of cartilage tear in the knee.
• Similarly, back pain is most often just an arthritic spine that has been aggravated due to strenuous activity and responds well to rest and ice fomentation. However, if it is accompanied by radiating leg pain and the RICE treatment doesn’t produce relief, consult a medical professional.
• Shoulder impingement is another common problem, especially amongst people who train with weights. Overhead elevation of the affected arm during exercise becomes painful with this condition. RICE therapy is the best way to treat this and your weight training should be suspended during the therapy. If there is weakness in the shoulder or you have severe pain, see your doctor immediately as it may be a sign of a torn tendon in the shoulder.
• Pain due to degenerative arthritis tends to improve with an increase in activity. However on rare occasions it can get aggravated.

Weight-loss aspirants and fitness enthusiasts

Weight-loss and fitness fanatics also tend to focus on cardio-centric workouts. Some of these people also do other routines like aerobics, Pilates and spinning.

Injuries in this group

Foot and ankle injuries are fairly common amongst gym enthusiasts. Ankle sprains, shin splints, Achilles tendonitis and plantar fasciitis are frequently seen injuries.

• Ankle sprain is due to a torn ankle ligament. Low grade sprains are treated by RICE therapy and taping the ankle. If you have severe swelling and an inability to bear weight on the injured leg, you should seek medical attention to rule out a fracture.
• Shin splints are pain in the shins, which occurs post workout. It is usually found in runners. To heal this type of injury, you need to have your running technique evaluated, as it might require modification along with a reduction in the intensity of your training.
• Achilles or heel pain is result of inflammation of the tendon due to repetitive workouts like running or skipping. Modification of training and reduction in intensity with proper rehab exercises usually works well for this type of injury.
• Knee injuries are common too. Usually Patello-femoral joint pain syndrome is the main culprit for knee pain. In this condition, the pain subsides after modification of your training and rehab exercises. Red flags to watch out for are: swelling in the knees and instability while walking, as these may indicate a torn cartilage and need surgery.

Muscle-building aspirants

People that fall into this category want to look like Sylvester Stallone, so they have long workout sessions.

Injuries in this group

Besides all the injuries mentioned above, people in this group are also prone to muscular strains of the thigh, calf, triceps and shoulder tendonitis.

• Unsurprisingly, foot fractures stemming from people accidentally dropping weights on their feet are one of the commonest injuries in this third group. This is because people continue to exercise despite being tired.
• Due to an aggressive regime, fitness buffs end up pulling different groups of muscles and experience severe pain. If the initial RICE therapy doesn’t improve symptoms, you should go to a doctor as most of these injuries need supervised rehabilitation.
• Also, rupturing of tendons like the Achilles tendon and high-grade muscle tears are seen in some people, especially the ones who abuse anabolic steroids to gain muscle mass. These are major injuries, which require immediate medical attention.

Eager beavers

Finally, the group of eager beavers are prone to all the injuries mentioned above. They also have the highest incidence of new injuries.

Injuries in this group

• Stress fracture to the legs and feet are common injuries in this group; these happen due to excessive running or skipping.
• Signs of a stress fracture are pain while applying pressure on the affected area and swelling. A stress fracture requires urgent medical intervention but it can be treated with extended rest and rehab. However, severe cases may need surgery.

How to stay injury-free

Staying injury-free is obviously the best way to make the most of your workout. You can prevent acute injuries by simply being safety conscious. Follow exercise progressions in a logical way and work with experienced trainers rather than attempting to exercise on your own—this will reduce injuries to a minimum. Other strategies are:

• Know how to appropriately use the mats, trampolines and other equipment, before embarking on your workout
• Do not goof around with the equipment
• Don’t workout when you are fatigued.

Injuries can happen in spite of precautions; but with the advances in sports medicine no injury can put a dent on your active life.

This was first published in the November 2014 issue of Complete Wellbeing.

The post A Quick Guide to Treating Workout Injuries appeared first on Complete Wellbeing.

In my short span of practice here and in the USA, I have worked with and treated athletes at all levels—from weekend warriors to professional NHL and NFL players—and the one thing common to all of them is their passion for sports. They don’t want to give up the sport and life they love. There is an old joke in the medical community…

Patient: “Doc, it hurts only when I move my arm like this.”

Doctor: “Then don’t move your arm like this.”

In sports medicine, however, we take every restriction in movement seriously.

Most serious runners have to deal with some niggling aches or pains almost all the time and it is really the passion for running that keeps them going. In sports medicine, the goal is to achieve the ideal scenario, where every step of every mile is pain-free and more often than not, this is achievable with the correct approach.

The most common reasons for injury in runners are usually one or more of the following: sudden increase in the intensity, change in running surface, change in footwear, or flaw in the running technique or form.

There are two main types of injuries sustained during running:

1. Acute injuries, which include fractures, dislocations, ligament tears and tendon ruptures. You should always seek urgent medical help here.
2. Chronic injuries like aches in the hamstrings, heel or groin.

Here, I discuss about the common injuries, mostly chronic, seen in runners, and enumerate the red flag symptoms where urgent medical help should be sought.

Heel pain

The most common reason for heel pain in runners is plantar fasciitis, which is the inflammation of the tissue in the sole of the feet. It is experienced in both feet. Usually, the pain is severe during early morning hours and after a period of rest, and improves with activity. This
condition is usually seen in runners who run with a heel strike. The best approach for treating this condition is to reduce the intensity and duration of running and maintain fitness with other non-impact exercises like cycling and swimming. Use proper footwear and supervised rehab exercises. It is alright to run through pain in this condition.

Red flag symptoms: Inability to bear weight on the affected side, swelling or discolouration of the foot and ankle.

Pain in the heel cord

This is also called Achilles tendonitis. Achilles is a major tendon in the body that connects calf muscles to the heel bone. The most common reasons for Achilles tendonitis are: the sudden increase in the intensity of running and uphill running. Usually, the pain is severe enough to restrict the training. The best way to treat it is to take a break from running. Have a physiotherapist supervise your rehab, avoid walking or running uphill and use shoes that fit properly.

Red flag symptoms: There is a more sinister variety of tendonitis, where the pain does not subside after rest, there is a thickening of the heel cord, and day-to-day activities become painful. Seek medical help urgently in this situation as the tendon is prone to rupture.

Shin splints

Shin splints are one of the commonest pains experienced by runners. It is an innocuous condition in which pain is felt in both the shins only after running a certain distance. Treatment for shin splints usually includes rehab and modification of running technique. It is however, tough to treat. Most of the serious and passionate runners who get this condition keep running despite the pain. It is fine to adopt this approach as well since there is little or no risk of damaging any tissues.

Red flag symptoms: Shin splints must be differentiated from the more serious situation, which is stress fracture. In stress fractures, pain is more severe and does not get relieved after rest. There might be swelling as well. In case of these red flag symptoms, seek medical help immediately. Stress fractures can occur in other parts of the foot and ankle as well. The main symptom is pain with weight bearing and swelling. Treatment for stress fractures includes complete sabbatical from running and switching to other flexibility exercises to maintain fitness. Sometimes, complete immobilisation in a cast or boot and surgery may also be needed.

Knee pain

According to a recent survey almost 50 per cent of all runners have knee pain at some stage of training. Though a variety of conditions can cause knee pain, the most common ones are patellar tendonitis, IT band syndrome and patello-femoral pain syndrome. Treatment for all of the above is supervised physiotherapy, assessment and modification of the running technique and reduced intensity of running. Uphill running relieves patellofemoral pain syndrome as well.

Red flag symptoms: The red flag signs in knee pain are swelling of the knee, painful clicking, and locking of the knee. These are signs of possible cartilage tear in the knee, which sometimes needs arthroscopic surgery.

Hamstring and calf pain

Another very common injury in runners, it may range from niggling pain in the buttock to a full-blown tear, which is thankfully rare in runners. Poor flexibility and poor strength are usually blamed for this condition. If the pain is mild, rehab and supportive clothing reduce the pain but in severe cases, running and impact activity should be stopped along with appropriate rehab. Healing may take few weeks to months as this is a tough injury to treat.

Back/buttock pain

The most common reason is degenerative intervertebral disc. Usually a break from running or reduced intensity and proper rehab will help to improve the symptoms.

Red flag symptoms: The red flag signs are radiation of the pain to the whole leg, and severe stiffness of the back. Seek medical attention as it might be a sign of prolapsed intervertebral disc.

Pre-participation evaluation

Pre-participation evaluation includes a complete medical and musculoskeletal check up of the athlete specific to each sport. This concept was born in the USA to avoid catastrophic situations on the field and keep sport managers legally safe, but it has now evolved. Today, it not only serves its original purpose, but also helps athletes and coaches understand and improve the areas of deficiency in training. The musculoskeletal exam includes evaluation of the kinetic chain. In this concept, the body is thought to be a chain or complex system of multiple joints and ligaments, muscles and bones. The weakness of muscles away from a certain area can also lead to injuries in that area, for example increased incidence of knee and foot injuries due to weak hip muscles. It sounds counterintuitive at first but makes perfect sense when you really think about it. In the recent years, a number of studies have implicated weak core muscles as cause for many a sports injury.

First aid is the common antidote for most sports injuries. It includes:

1. Rest [to avoid aggravating activities]
2. Ice pack application [15 minutes, 2­­ – 3 times a day]
3. Compression dressing [crepe bandage]
4. Elevation of the limb

Muscles, joints, ligaments, and tissues repair as you sleep. If you don’t get enough rest and sleep each night, your body takes some time to bounce back from an injury. The key is not rushing your recovery. Avoid strenuous activities temporarily and give your body sufficient time to heal completely. Of course, the time frame will depend on the severity of your case.

Ice application constricts your blood vessels in the affected area, decreasing blood circulation to the site of injury to reduce swelling. Aside from this, the cold temperature can reduce pain. You may also want to cover the ice pack with a light absorbent towel to prevent frostbite during ice application.

Compression wrapping can reduce the swelling of the injured body part. A compression wrap controls blood flow and pushes out excessive fluid to reduce swelling. Doing this first aid is especially critical for players who suffer from leg wounds as gravity makes moving fluid out of the wounded area difficult. Make sure that compression dressing is snug but not too tight to stop or interrupt the blood flow.

You also need to elevate the limb during the ice application when treating sports injuries. Ideally, it should be at or above the level of the heart. Elevation makes it difficult for the blood to reach the injury, thus, reducing the bruising and inflammation of the area.

Over-the-counter painkillers can also be used. But if the pain persists even after all these measures, do not hesitate to visit the competent authority.

The various techniques used for treatment of sports injuries are:

• Physiotherapy [Rehab]
• Immobilisation
• Injection
• Surgery

These techniques are used in a variety of combinations depending on the nature of the injury. Surgery for sports injuries was revolutionised after the introduction of arthroscopy or key-hole techniques with small incisions. The recovery period is shortened after these minimally invasive procedures—a very important factor for injured athletes eager to get back to the sport and life they love.

Finally, all the running injuries are just hurdles to be crossed to reach the finish line, sometimes with the helping hand of your sports medicine expert. These experts can be your allies to speed up your recovery and prevent further injuries in the future.  So, when the need arises, reach out immediately to experienced therapy clinics, or reliable sport medicine experts in your area.

This was first published in the January 2014 issue of Complete Wellbeing.

The post How to Deal with Common Running Injuries appeared first on Complete Wellbeing.