Working it out

Exercise-related injuries and how to manage them

39-Working-it-out

Raghav, like many in their 20s, decided to take charge of his health, and was following a nutritious diet and regular exercise plan. He always wanted a well-toned physique and knew that a good mix of weight training and cardio exercises would help him reach his goal. Compound movements like squats, chest press and dead lifts were his favourites, and he was setting personal best marks in each as he progressed over the months. On one 'back day', he was in his last set of dead lifts, when he felt a sharp shooting pain his lower back, towards his right buttock. This pain was so bad, he ended the day's workout session. It worsened over the next few days, hampering his travel and work schedule.

Back injuries can range from muscle strains to disc herniations with nerve compression. Keeping a neutral spine during heavy lifts is a protection from these injuries.

When I first saw him in my clinic, a few days after the incident, he was in significant pain and had spasms. All his spinal movements were restricted by pain and he had popped painkillers on a need basis till then. I immediately realised that this was an acute lumbar strain with mild nerve root irritation. He was given a short course of anti-inflammatory medications along with some sessions of pain management modalities at a physiotherapy centre. More than the pain, he was worried about the future of his fitness plan which was going so well. I explained to him that in any exercise programme, there is always a very fine line between intensity and injury and he should not let a setback like this weaken his resolve. Over the next few weeks, he gradually got back his spinal mobility and was put on to a rehab programme that involved strengthening his back and core muscles.

It is widely accepted that physical activity can enhance overall health and prevent numerous chronic diseases. No matter what your level of experience or fitness, workout related injuries can happen to anyone. And, this might result in disruption of daily life, loss of income or even temporary or permanent disability. They may be acute in nature or more commonly slow aggravations due to repetitive strain. Rather than getting disheartened by them, one must rest adequately and analyse the situation and formulate ways to ensure they never happen again. The following are a few common injuries I have encountered in my clinical practice.

Shin splints

Also called medial tibial stress syndrome. There is sharp pain along the inner leg from knee to the ankle (shins) and is felt when running and jumping. It is more often caused by running on hard surfaces and slopes and with sudden increase in intensity or frequency of training. It usually settles with rest and ice compresses.

Runner’s knee

There are vague pains around the knee cap related to poor tracking of the patella (knee cap). There will be creaking and grating sounds when bending or straightening the knee. Compromised posture during heavy training like squats, leg press and lunges causes bad alignment of the knee cap. The inflammation of the patella cartilage and surrounding tendons causes pain. It can be controlled by:

■ maintaining proper knee form during ower body training

■ hip and knee strengthening exercises balance patella tracking during bending

■ glucosamine and vitamin D supplemen tation help quicken recovery

IT band syndrome

The Ilio-Tibial (IT) band is a strong ligamentous sheet running from the pelvis to the knee along the outer side of the thigh. It comes under strain and gets inflamed due to repetitive hip and knee movements like in cycling and running, especially on uneven surfaces. In severe cases, this can be very painful, causing a limp while walking. It is best treated with regular icing, IT band stretches and foam rolling. Runners should gradually increase their run intensity and try different routes and terrains to avoid constant strain on one leg. Cyclists must adjust their seat height to optimise hip and knee alignment during each cycling stroke. Gluteal (buttock) exercises like squats, dead lifts and side leg raises help strengthen the IT band.

Rotator cuff injuries

The rotator cuff is a group of four muscles that form a hood around the shoulder joint to stabilise this highly mobile and unstable articulation. Any overhead activity like power lifts and throwing or service sports like javelin, badminton and tennis can strain these small muscles. Repeated strains lead to progressive tears and pain in the shoulder called impingement.

Regular rotator cuff strengthening exercises and shoulder stretches help keep the rotator cuff healthy and strong. Avoid lifting weights that are difficult to control—machine exercises are safer—and keep to proper exercise form and range.

Elbow pain

The commonest cause of elbow pain is the tennis elbow. It is an inflammation of the forearm muscle that originates on the outer side of the elbow joint. It is usually seen in racket sports like tennis and badminton due to backhand power strokes. It also occurs in the gym, when lifting heavy weights causes overstrain on the wrist extensor muscles and produces micro tears at their origin. Try and maintain your wrist in a neutral position even if this means lifting lighter weights. Wrist extension and grip strength exercises help prevent this problem.

Lower back injuries

Back injuries can range from muscle strains to disc herniations with nerve compression (sciatica). Keeping a neutral spine during heavy lifts is a protection from these injuries. Core (abdominal) muscle exercises also help stabilise the spinal column when loaded. Only do heavy exercises once you have mastered the proper form and use a lumbar belt for external support. Having a good trainer's guidance is important.

Prevention

Here are some golden rules that help prevent exercise related injuries:

■ Always warm up prior to any exercise. This would involve general body warm up like 5-7 minutes of cycling or a light run followed by part-specific dynamic stretches

■ Gradually increase the intensity of your workouts

■ Focus on strength, endurance and flex ibility. This keeps joints supple and muscle strong

■ Split your weight training into body parts or movements; like push, pull and legs. This allows muscle groups to ecover and grow to strength

■ Rest days once or twice weekly are es sential for your body to recuperate

■ A weak body is injury prone. Always fuel your workouts well with food and fluids

■ Suitable footwear for cardio and train ing days limits stress on the knees and spine

■ Know your trouble areas and avoid ex ercises that hurt

■ Take the help of a qualified trainer till you are confident on your own In the eventuality of facing injuries, re member the acronym 'RICE', which has the basic principles of managing them:

■ Rest to the injured part. Stop working out

■ Ice application to reduce inflammation

■ Compression to keep the limb from swelling

■ Elevate the part to help in blood flow return and avoid swelling

Those who have been working out for long know the difference between the good pain of muscle soreness and the bad pain of injury. When in doubt, do not hesitate to consult a medical specialist to identify the problem and rectify it. Judicious use of investigative modalities like ultrasound and MRI are helpful in diagnosing soft tissue injuries. Be open to a short course of physiotherapy to guide you back on track.

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