It’s a beautiful day. You’re on the ballfield, the mountain trail, the tennis court, doing what you love. And you’re hurting. What went wrong?
“You probably are experiencing an overuse injury,” says Dr. Joe Bernard, a family practice physician, fellowship trained in sports medicine, at Exeter Hospital. Lynda Kuhne, physical therapist and director of the hospital’s outpatient rehabilitation program, adds, “Overuse injuries are the primary problem in sports medicine.”
“The usual cause,” says Dr. Bernard, “is failure to warm up. Too many of us want to jump in and go, whatever the favorite activity may be.” Warm up means doing your activity at a reduced pace for a few minutes. “You see many people stretching before a game or a run,” he says, “but this is stretching a cold muscle. You will perform better and be less prone to injury if you first warm the muscles with light activity. Then stretch, if you wish.” There is debate about the value of stretching before an activity, he says. The greater value of stretching comes at the end of the activity.
Overuse injuries include several familiar problems, such as muscle strain, tendon problems, stress fractures, torn ligaments, hamstring strains, rotator cuff and knee pain. Shin splints and tennis elbow are the most frequent.
Shin splints are experienced as tenderness, perhaps swelling, and pain along the inner part of the leg below the knee. Called medial fibial stress syndrome, the condition is the result of overload on the shinbone and tissues that attach to muscles on the bone. Runners are at risk, as are people who roll the foot inward a bit, or pronate.
Recommended treatment will likely be RICE — rest, ice, compression and elevation. Non-prescription pain medications may be helpful. Cross training and/or strength training may be suggested, to build strength in other muscle groups. Sturdy, properly fitted shoes also help to prevent shin splints.
Tennis elbow is the result of repeated contraction of the forearm and wrist. Pain will be felt where the tendons of the forearm muscles attach to the bony protrusion on the outside of the elbow. There may also be pain in the forearm and wrist, inflammation and tiny tears in the tendons.
Tennis elbow, as the name suggests, is often the result of too much tennis, too quickly. The condition may also result from other repetitive activities, such as painting, hammering, playing a musical instrument or gardening. Golfer’s elbow is similar, but the pain is on the inside of the elbow.
One can lessen the strain on the forearm by learning to keep the wrist straight, putting more of the work on the big muscles of the upper arm. It is important to warm up and to gently stretch the forearm muscles at the wrist.
RICE therapy should be familiar to every athlete. Here are the guidelines. REST the injured area. If there is continuing pain, don’t use that area until evaluated by a health care provider. Apply ICE to the affected area, to prevent or reduce swelling, for 20 minute periods, 4 to 8 times a day. For a handy ice pack, a one-pound bag of frozen peas or corn, wrapped in cloth, works well. COMPRESS by wrapping the injured area with an elastic bandage to further prevent or reduce swelling. The bandage should be snug, but not tight. It should be removed and reapplied every four hours. ELEVATE the injured arm or leg to several inches above the heart. Stack pillows to achieve a comfortable position while resting.
The sooner RICE therapy is begun, the better the results. There are, however, exceptions. Anyone who has diabetes, Raynaud’s syndrome or any medical condition that includes reduced blood flow to the arms and legs should not use RICE therapy.
Dr. Bernard notes a trend that increases the risk of sports injuries among both youth and adults. “Stress injuries may result from year-round focus on a single sport,” he says. Children and adolescents used to play a variety of sports. This practice develops and strengthens different parts of the body. Now, with the focus on competition, “there is no off-season.” Some young ballplayers play with two or even three leagues, he says, which can result in shoulder, elbow and ligament problems.
Another trend is the increased participation of older people in sports. There are senior softball leagues and basketball tournaments. Runners in their 70s and beyond are no longer rare. This is a positive trend, but Dr. Bernard says that caution is needed. An older person is more likely to have knee problems or the beginning of arthritis. She or he may need to spend more time strengthening muscles and improving flexibility than a younger person. Resist the temptation to just hop on the bike and go for a 25-mile ride. Learn about your chosen sport and do the essential conditioning.
Dr. Cherie Holmes, an orthopedic surgeon and an avid cyclist, recently held an evening program on bike safety at Cheshire Medical Center in Keene. She covered several biking topics, including shoe selection, assessing the fit between cyclist and bike, ways to prevent chaffing and saddle sores and biking for people with asthma. Talk to a biking expert for guidance on issues of fit and comfort.
“Don’t forget to drink plenty of fluid,” Dr. Holmes reminded participants. “Drink water about two hours before your ride (or run or game) and re-hydrate frequently. Don’t wait until you feel thirsty.” She recommends water or a diluted sports drink. Distance bikers should be prepared for bee stings and insect bites. Carry a bite stick or an oral antihistamine. Wear sunscreen with a high Sun Protection Factor (SPF) and replace every hour and a half.
Sports medicine centers around the state offer such educational meetings. Check with your area hospital to find out about such workshops.
More serious injuries will require time away from your sport, but extended rest is almost never a good idea. Exercises specific to the injury will be prescribed. Sometimes the program will begin with exercising in water, to minimize stress. It’s tempting to stop exercising when the pain is gone and one feels better. But it is important to continue, says Dr. Bernard. “My goal is to get the person back to his sport, not to bench him.” NH
This article appears in the July 2007 issue of New Hampshire Magazine