Muscle, Joint, and Shoulder Injuries

[Eric3237]

The repeated running cycle of pounding and push off results in muscle fatigue, which may then lead to higher forces being applied to the fascia, the attachment of fascia to bone, and finally the bone itself. Respectively, this represents a spectrum from mild to severe. On the relatively more severe end of the scale the injury may progress from stress reaction within the bone to an actual stress fracture.

In the early stage of shin splints a runner will describe a pain that is present when the training run first begins, but then disappears as running continues. The pain will often return after exercise or the following morning. As the injury progresses the athlete will experience more time with the pain, and less time without it. There is frequently a tender zone along the medial edge of the tibia that one can map out by pressing with the fingertips as they “march up” along the bone. Eventually, if ignored and training continued, the pain may become quite sharp and may focus on a very small area of the bone. If this happens a stress fracture should be considered.

The treatment for shin splints is rest. Depending upon severity it is often necessary to completely stop running for a period of time. Generally this is done until day-to-day activities are pain free. When running is resumed – and this is where many injured runners make a mistake – it must be significantly different from the routine that lead to the injury. The concept of relative rest employs lengthening the interval between training as well as decreasing the volume and intensity of training. One can often substitute cross-training activities (e.g., bicycling) for running to help increase the interval between running days. There should be a graded and gradual increase in run training, keeping an eye out for the return of any shin splint symptoms.

Stretching and strengthening the calf muscles can help prevent the injury from returning. However the most important preventive strategy is not to repeat the mistakes that lead to the injury. Examine all the training variables – surface, shoes, training volume, intensity, workout type, hills, weather conditions, etc. Seek help from a qualified trainer or coach. This all takes time and effort, but it is well worth it.

Now skip on your heels
Once the skipping exercises are comfortable, try some light skipping on your heels. Gradually build up your ability to heel-skip with toes straight ahead, pointed out, and pointed in for 20 metres at a time. Heel skipping is a great way to build dorsiflexor strength, but carry it out only on a padded or grassy surface to avoid impact injury to your heels.

5. Once you've completed your walking, jogging, and skipping routines, it's time for rhythm bounding. This isn't the kind of bounding you're probably envisioning - we don't mean progressing forward with extra-long strides, at least not at first. Rather, you should jog along with very springy, short steps, landing on the mid-foot area with each contact and springing upward after impact. As you rhythm bound, your ankles should act like coiled springs, compressing slightly as you make your mid-foot landing and then recoiling quickly - causing you to bound upward and forward. Move along for 20 metres or so with these quick, little, spring-like strides, alternating right and left feet as you would during running. After 10 to 20 metres of regular jogging, rhythm bound for 20 more metres, alternating three consecutive spring-like contacts with the right foot with three with the left. After 10 to 20 more metres of regular jogging, close the set by bounding along for the full 20 metres on your right foot only, followed by 20 metres on the left (making certain that you land on the mid-foot area with each ground contact and that your ankle area, not your knee or hip, is doing most of the work). Make sure (at least at first) that all of this is done on a padded surface or soft grass. As you become stronger and more skilled, you can increase the length and amplitude (vertical height) of each bound and include additional sets of bounds (work your way up to four sets).

6. Complete some 'dorsiflexion bounces'. To do these, simply begin jumping vertically and repetitively at close to maximal height, landing in the mid-foot area with both feet and then springing upward quickly after each contact with the ground. The interesting part of this exercise is that you should dorsiflex your ankles - pulling the tops of your feet toward your shins - on each ascent, before plummeting back toward earth and plantar flexing your ankles just before making contact with the ground. Do 10 dorsiflexion bounces, rest for 10 seconds or so, and then repeat. Over time, you can add additional sets and increase the number of reps to 30. When you are really strong and skilled, perform this exercise on just one foot at a time, but only on a low-impact surface.

7. Finally, carry out rhythm bouncing. Rhythm bouncing is actually just jumping around, but what jumping! You should start with 10 jumps in place, moderately fast, with medium height, and with maximal motion at the ankles - but little flexion and extension at the knees and hips (over time, you can work up to 30 jumps). Then, after resting for a few seconds, change the amplitude (height) of your jumps to less than an inch, and complete 20 jumps as fast as you possibly can (pretend that your feet are hitting a hot stove - so that you must minimize your impact time with the ground). Again, almost all of the action should take place at your ankles, not at your knees and hips. As you become more skilled, work up to 40 quicksilver jumps.

After resting for a few seconds, complete five 'high-impact' jumps, increasing the amplitude (vertical height) of your jumping as much as possible. Over time, progress to 30 of these maxi-jumps.

So far, all of the rhythm bounces have been carried out in place, so make things interesting by jumping forward and then backward as quickly as possible. After you have made 20 'contacts' (each time your feet strike the ground is one contact), rest for a few seconds and then jump from side to side for 20 contacts. Rest again, and then jump in a direction which is about 45 degrees from straight ahead, alternating directions (first towards the right, then towards the left) for 20 contacts as you move ahead in a zig-zag manner. Remember to use your ankle muscles to propel you, not the big muscles at the knees and hips.

As you gain skill and strength, you can increase the number of sets of each type of rhythm bouncing from one to three, and then - the fun part - carry out each type of bouncing on one foot only. Moving in different directions as you bounce increases the ability of your shin muscles to handle all of the forces created during running - the side-to-side and rotational stresses, in addition to the less-overlooked front and back forces.


Other considerations
Of course, carrying out these exercises doesn't mean that your risk of MTSS is zero. If you suddenly change your weekly volume of running from 25 to 75 miles because you've been bitten by the marathon bug, for example, something will have to give, and it might well be your shin muscles and tendons. So, be certain to avoid dramatic changes in the frequency, volume, or intensity of your training; always gradually progress to more difficult levels of work.

Sports-medicine experts often recommend stretching the ankle area by slowly moving the ankle to 'each' end of its range of motion in the straight-back and straight-ahead plane, eg, to the fully dorsiflexed and then completely plantar-flexed positions, holding each position for anywhere from five to 60 seconds. The problem with that, of course, is that you are only stretching your muscles in one plane of motion and thus not adequately mimicking the stretching which takes place during running. At the very least, in addition to carrying out the plantar-flexed and dorsiflexed stretches, you should also stretch each ankle by fully rotating it outward and inward - and by plantar flexing and dorsiflexing the ankle while the foot is pointed both outward and inward to various degrees - not just straight ahead.

The experts also recommend strengthening the ankle area by adding resistance to the above stretching movements with the use of surgical tubing or elastic bands. That is indeed a way to increase general strength of the ankle, and it will certainly make you stronger when you carry out surgical-tubing exercises in the future. The problem, of course, is that you run with your feet on the ground - not poised in the air in the clutches of elastic bands. So, to fully prepare your ankles and shins for the rigours of running, you're better off focussing on the specific exercises we are recommending.

Does stretching actually help to prevent MTSS? No scientific evidence indicates that it does, but the idea that stretching might be protective is a logical one (overly taut muscles seem more likely to be damaged by pulling forces, compared to relaxed fibres). Don't stretch your ankle area until after your muscles are warm, however; a good time would be after a warm-up and/or at the end of your training session.


Other lower-leg injuries
Of course, all problems in the lower part of the leg are not necessarily examples of MTSS. In particular, two conditions - compartment syndromes and tibial stress fractures - can sometimes be confused with shin splints.

Compartment syndromes owe their name and origin to the fact that the leg muscles are not simply loose straps which run from bone to bone. In reality, the muscles are often grouped together into little sections of the leg which are enclosed by a tough wrapper of connective tissue. Such an arrangement of muscles tucked into a wrapper is called a 'compartment'.

During the act of running, excess fluid can build up within one of these compartments, putting pressure on muscle fibres, nerve cells, and blood vessels - and also causing a great deal of pain. Frequently, the pain will be so severe that a runner must curtail a workout or come to a standstill during a race. And the pain will usually be accompanied by the two telltale symptoms of a compartment syndrome - numbness and weakness.

Numbness occurs because the excess pressure within a compartment hampers the activity of sensory nerves carrying messages to the brain. As a result, the runner with compartment syndrome may lose feeling in the 'web' of the foot - between the first and second toes, or the insensitivity may extend up the foot toward the ankle. Weakness is experienced because motor nerves carrying impulses towards the muscles are also damaged by the high pressures within the compartment. If a compartment in the front of the leg is involved, a runner may have trouble dorsiflexing the ankle, and the foot may seem to flop loosely. In a posterior-compartment problem involving muscles in the back of the leg, there is often weakness when an individual tries to 'toe off'.

If you truly have a compartment syndrome, you will usually observe swelling in your lower leg which tends to subside when your leg is elevated. A doctor can tell for sure if you have this troubling problem by placing a catheter into one of your compartments and measuring pressure before, during, and after running (you will usually have to run long enough to produce pain during this test).


What about stress fractures?
Stress fractures are small breakdowns in bony tissue, and tibial stress fractures, which are sometimes confused with MTSS, are the most common of all stress fractures in athletes, accounting for about 50 per cent of the total. In addition to producing a lot of pain, stress fractures can actually progress into dislocation fractures, in which two parts of the bone actually separate. Stress fractures also may be 'warning signals' for an underlying nutritional or hormonal problem.

Unfortunately, traditional X-rays often fail to detect stress fractures, so a more costly procedure called a bone scan must frequently be performed to confirm the diagnosis. In a bone scan, radioactive material is actually injected into the blood. Bony tissue which is remodelling and rebuilding itself at the site of a stress fracture will accumulate more of this infused radioisotope, causing the affected bony area to show up as a dark splotch on a 'scintigram'. While it's often said that stress fractures take two to three months to heal, up to six months may be required to restore the bone to normal and remove most traces of pain, and a few athletes need more than a year to fully recover.

Sometimes called 'crescendo pain,' the agony associated with stress fractures tends to build up steadily during running, beginning as an annoying irritation and becoming a throbbing torment as an individual continues to run. There is usually little of the numbness, weakness, and swelling associated with compartment syndrome, and pain is usually not present when an athlete is at rest. Often, the bone will hurt when it is tapped near the damaged area, and occasionally a hard nodule will appear on the surface of the bone at the trouble site.

If you're diagnosed with a stress fracture, you should be sure to have a nutritional analysis carried out (your problem might be the result of inadequate calcium intake or poor calcium absorption). In addition, athletes who develop stress fractures should get their sex-hormone levels checked (adequate testosterone concen-trations in males and oestrogen levels in females are required for optimal bone maintenance).

How can you differentiate MTSS from stress fractures and compartment syndromes? The pain of MTSS is usually less localized, compared to stress-fracture pain (it tends to run up and down a region of the lower leg near the tibia), and usually can't be produced merely by tapping on the tibia. In addition, MTSS produces none of the numbness associated with compartment syndromes.


How long does MTSS last?
If you are unfortunate enough to come down with MTSS, your recovery period will usually last from one to six weeks, depending on how severely you are stricken. If you have a mild case of MTSS (your shin hurts moderately, and only after workouts), immediately cut your weekly mileage by about 30 per cent, and start doing our recommended exercises (we're assuming that your busy schedule prevented you from carrying out the routines faithfully, allowing MTSS to crop up). Start easily with the exercises, doing only one set of each, and stop if you feel any pain. Ice the affected area down thoroughly after activity, and of course keep the whole area as loose and flexible as possible. Within a week or two, you should be able to get back to your normal training, but be sure to carry out the shin-splints-preventing exercises steadfastly.

If you have a somewhat tougher case of MTSS (mild pain crops up during workouts but doesn't seem to slow you down much), trim weekly mileage by around 50 per cent, ice and stretch religiously, consider taking non-steroidal anti-inflammatory medications (but only if you are not prone to the gastrointestinal upsets which have been linked with these compounds), and become a devotee of our shin-strengthening exercises (start gradually with them, though, since they can further inflame tender shins if overdone). Use bicycling workouts to maintain fitness. In two to three weeks, you should be ready for regular training.

If your MTSS produces sharp pain while you are training, stop all running workouts, ice and stretch, take NSAIDS as directed by your doctor, and - when pain subsides - systematically begin utilizing our exercises, starting with a few two-legged wall shin raises at first and gradually progressing to the others. Use the exercise bike to maintain fitness, and return to normal training in four to six weeks.

Remember that if you carry out our shin splints treatment routine several times a week and refrain from making bizarre and sudden changes in your training, your encounters with MTSS should drop to a frequency rate of zero.

Owen Anderson and Walt Reynolds

[Eric3237]

Here are some in depth articles on shoulder pre-hab:

Shoulder Savers Part One
Shoulder Savers Part Two
Shoulder Savers Part Three

http://www.t-nation.com/readTopic.do?id=538204

[Eric3237]

Giving Injuries the Cold Treatment
Bryant Stamford, PhD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 3 - MARCH 96

When you sprain your ankle or have a similar injury, tissue is stretched and torn, and swelling occurs. Swelling interferes with healing, so anything that will prevent or reduce swelling should help you recover from a minor injury more quickly.

The sooner you attend to swelling after an injury the better, and the best approach is to apply cold directly to the injured area right away. (See "A Time for Cold, a Time for Heat") Cold shrinks the blood vessels, which reduces bleeding in the area and helps to prevent swelling. It also helps prevent the muscles from going into spasm (involuntary contractions) and relieves pain.

The use of cold as a treatment is as old as the practice of medicine, dating back to Hippocrates. Today, methods of applying cold are more advanced than they were in 400 BC, but the principles and the need for precautions are the same. When you apply cold, the skin will initially feel cold, often followed by relief of pain from the injury. As icing progresses, you will feel a burning sensation, then pain in the skin, and finally numbness.

To avoid skin damage, stop when the skin begins to feel numb. (This is different, though, from the "numbness" you feel early on as the cold relieves injury pain. Keep icing after this pain subsides.) Applying too much cold for too long can cause frostbite or even nerve damage. Also, cold treatment is not for everyone (see "When to Avoid Cold Therapy").

The length of time you apply cold will vary depending on the method and location of the injury (see specifics below). Areas with little body fat (like the knee, ankle, and elbow) do not tolerate cold as well as fatty areas (like the thigh and buttocks). So, for bonier areas, keep to the low end of the recommended application ranges listed below.

For best results, apply cold at regular intervals throughout the waking hours of the day, allowing a few hours between treatments. Time off will keep cooling effects from accumulating and will allow the skin to return to normal temperature. An ice bag remains—for good reason—the cool treatment of choice for most people, but several options exist:

Ice Bags
Strengths: Ice bags are the old standby for applying deep, penetrating cold. Fill a bag made of thick plastic, rubber, or moisture-proof fabric with ice and apply it directly to the skin. The cooling effect of ice bags lasts long and is more effective than some of the superficial methods like ice massage. If you use a regular plastic food bag, place a thin towel (like a dish towel) between the bag and your skin.

Weaknesses: A shortcoming is getting the bag to contour to the curves of the body for maximum application. The bag will mold better if you don't fill it completely with ice or if you use crushed ice. An alternative is to use a bag of frozen peas or corn. The bag will conform nicely to the injured part of the body. Place a thin towel between the bag and the skin.

Application time: 10 to 30 minutes, depending on the body part and comfort.

Gel Packs
Strengths: Cold gel packs contain a special gel that can be frozen and refrozen. Just store the packs in the freezer until needed. The gel remains flexible when frozen, allowing it to contour to the injured body part.

Weaknesses: Cold gel packs will cool the skin faster than ice bags and so deserve greater caution. Never apply them directly to the skin—always wrap them in a towel.

Application time: No more than 10 minutes at a time.

Chemical Cold Bags
Strengths: Chemical cold bags stay at air temperature until squeezing the bag and mixing the chemicals produces cold. They work well on the field or in the wilderness.
Weaknesses: The degree of cold produced by the chemical reaction is not great. Even so, the bags provide a good first-aid approach.

Application time: Because the temperature is not that low, a 30-minute application should not be a problem, and the bag can be applied directly to the skin.

Immersion
Strengths: Immersion entails placing the foot, hand, or elbow in icy water filled with crushed ice or ice cubes. This technique provides very complete and concentrated cold exposure to the entire injured area.

Weaknesses: Body parts besides the foot, hand, and elbow do not lend themselves to immersion, because too much of the uninjured area is exposed to the cold.

Application time: 10 to 20 minutes. Let comfort be your guide.

Ice Massage
Strengths: Ice massage involves rubbing ice on the skin with a circular motion. It is easy to apply and focuses the cold on the injured area. A useful approach is to fill a paper or foam cup with water and freeze it until needed. Then peel away the top to reveal the ice and hold the bottom of the cup to apply. Ice cubes or chunks can also be used.

Weaknesses: The cold tends not to penetrate as deeply nor last as long as the methods listed above.

Application time: When applying to bony areas such as the ankle, apply for only 7 to 10 minutes. Double the time when applying to fatty areas such as the thigh or buttocks.

Combination Treatment
To maximize the benefits of cold therapy, think RICE: rest, ice, compression, and elevation. So in addition to cold therapy, rest your injury, apply elastic wrap snugly, and keep the injured area raised. New technologies combine RICE aspects. Cold tape, for example, compresses and-because of a chemical reaction-applies cold to an injured part.

Putting Injuries on Ice
Whichever method you choose, remember to ice early, ice often. But not too often. To avoid harmful effects like frostbite, let your skin recover between cold applications, and listen to your body.

A Time for Cold, a Time for Heat
There has been controversy over the years as to when to apply cold and when to apply heat. Because heat stimulates blood flow, it promotes healing just as cold does. It can also relax muscles and ease pain.

But heat can make swelling worse. That's why cold is best right after an injury and heat is recommended for later, when swelling abates. As a rule of thumb, use ice for at least 48 hours after injury. Then, when the swelling is gone, you can apply heat.

When to Avoid Cold Therapy
Using cold therapy may not be a good idea for some people. Those who are very sensitive to cold will not be able to tolerate icing long enough to do any good. Conversely, those who have a high tolerance to cold-or who pride themselves on being "tough"-open themselves to injury by applying cold therapy too long.

People with problems in the blood vessels near the skin should avoid cold therapy, especially those with Raynaud's phenomenon (a condition in which the blood vessels in the fingers, toes, ears, and nose constrict dramatically when exposed to cold and other stimuli). If you suspect you may be at risk because of diabetes or another condition that can diminish blood flow, check with your doctor before applying cold to an injury. (Back to article)

[oldnatural59]

Did i miss it, or is there no reference 2 topical analgesics..?

I, personally, use a combination of DMSO (Dimethyl Sulfoxide) and aspirin. DMSO is a solvent derived from wood pulp with known (documented) analgesic and anti-inflammatory properties. It is also approved by the FDA for treatment of a certain stomach ailment.

After reading the above, i agree that the inflammatory response is necessary and helpful, but only 2 a point, as stated. If i'm digesting this correctly, if the infammation is caused by scar tissue, from an old, recurring injury, for example, a topical analgesic/anti-inflammatory like DMSO, which penetrates cell walls, and transports other elements, such as the ingredients in aspirin, to the affected cells, can be useful while undergoing deep tissue massage 2 get rid of scar tissue buildup. In this case, the inflammatory response can b at least partially counterproductive, and needs 2 b mitigated by some type of treatment/therapy.

Of course, if it hurts, don't do it, is always the best advice. But that (choosing exercises wisely), coupled with DMSO treatment has helped me tremendously, while allowing me 2 continue training, without further aggravating my injuries. In fact, my left shoulder, AC strain, has nearly healed in the span of 3 weeks.

Granted, my left forearm flexor is another issue. DMSO does seem 2 b more effective on joint injuries, as research has shown in regards to the studies done on arthritis but, nevertheless, it has made a noticable difference in this area too.

Anyone else have any experience with or knowledge of DMSO..?




-jaems

[Eric3237]

I've heard of DMSO but have never used it. If you have anything on it (and aspirin) feel free to post it!

The inflamation question is really one of those on-going questions. Like you said it would seem necessary up to a point. The problem is where that point ends is not clear. What seems to happen is that when inflamation is blocked you seem to get faster healing and a quicker return to activities. BUT where the natural process of inflamation is allowed to run it's course you get a better long-term outcome. Provided of course proper treatment and re-hab was adhered to. Better mobility, etc. This is by no means definitive as I said.

On old injuries with build up of scar tissue you've hit the nail on the head. You have to break it down and get rid of it. But it would be more accurate to say it has to be "remodeled". And that's the rub. It could be that this remodeling process, i.e. the laying down of healthy functional tissue, if this can be accomplished at all, is mediated by the inflamatorie process.

Anyway, i'm just talking. Anything you have you feel would be of use, lay it on us!

[oldnatural59]

Hey, Eric...

Here r some refs 4 DMSO...


just use the menu at left to navigate:


http://www.dmso.org/index.html


http://en.wikipedia.org/wiki/Dimethyl_sulfoxide


someone else said they had used it but with no results...since it is a solvent, and efficient at tranporting other substances to the cells, even as a topical application, i combined it with aspirin and found it 2 b effective as both an analgesic and anti-inflammatory in treating my AC strain.


-jaems

[Eric3237]

Thanks!

[sweilem]

i had a wrist joint injury 3 weeks back while bench press, i took care of the injusry and wraped it, i tried ice, and later heat treatment, but still nothing seems to work, i had to skip workout for days, the worst of the pain come when i wake up, and diferent movements in my hand i cant do without massive pain, im reallly puzzled, could it be a bone injury? anybody experienced this, i would apreciate your help

[Eric3237]

Sounds like it's time for a doctor. It could even be a fracture. Keep in mind that first aid is not a replacement for a doctor. First aid is just first aid. It's not guaranteed it's just the thing you need to do first to stabilize the injury preventing further damage.

I'd say if it was a mild sprain it should have improved.

Was there swelling and/or bruising? How long did you rest it?

Anyway wrist injuries can be hard. There are a ton of little bones in there and even a common sprain can be problematic for a long time.

[sweilem]

Originally Posted by Eric3237

Was there swelling and/or bruising? How long did you rest it?

Anyway wrist injuries can be hard. There are a ton of little bones in there and even a common sprain can be problematic for a long time.

Thank you Eric for the reply, there was no swelling or bruising, and i did rest it for 11 days, i think i should visit a doctor and get it xrayed.
lets see.