Down (But Not Out)

Injury doesn’t have to mean the end of an active lifestyle.

Following a back injury, John Holzer traded running for swimming and weights.When John Holzer injured his back in a fall six years ago, doctors put a rod in his spine and fused several vertebrae together. Both physicians and therapists told him he was lucky to be able to walk.

Holzer, however, wanted more. A lifelong runner, he’d already started tapering down his routine after a pulled hamstring. But the notion of never being able to run again was difficult to swallow. “Eventually, I found the pool,” says Holzer.

Whether you’re a marathon runner, a gym rat or a golfer, exercise can be addictive. Given its health benefits, that’s a good thing. But if an injury prevents you from returning to a normal exercise routine for weeks, months or even longer, the effect can be physically and psychologically devastating.

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“I’d never encourage someone to stop exercising altogether,” says Dr. William Emper, an orthopedic surgeon at Bryn Mawr Hospital.

Still, many of his patients have to completely rethink their fitness routines. Water exercise—whether it’s swimming or aerobics—is easy on joints and bones, and can be a great first step back to an active lifestyle. Waterproof casts make it even easier.

For others, bike riding (stationary or otherwise) is another means of aerobic exercise. An upper-body ergometer—found in most gyms—can also provide a great alternative workout.

Despite myriad options, convincing anyone who is partial to high-impact, high-adventure sports that a walk, swim or modified gym workout is an adequate substitute can be tough. “It’s especially difficult with runners,” says Emper, who treats many hardcore athletes. “There really is no substitute for that wind-in-your-face feeling.”

Nonetheless, a key part of the recovery process is accepting one’s limitations and learning to enjoy new routines. Of course, those routines must be developed in consultation with a doctor and a physical therapist. The risk of re-injury rises exponentially, and great care must be taken to protect and strengthen the body after injury.

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The first one to two days after an injury are critical. There should be no “getting back to exercise” or “working through the pain” during this first stage of healing. “We like to refer to R.I.C.E.—rest, ice, compression and elevation,” says Caroline Hughes, a physical therapist with Main Line Health. “For the first 24 to 48 hours, you want to reduce inflammation and become exactly aware of what the injury is. That’s where a physician steps in.”

Once the injury moves more fully into a recovery stage—when swelling lessens and the pain begins to subside—the patient needs to seriously assess the situation and develop a proper recovery plan. Often, people can start some form of physical exercise two to three days after injury (depending on the type)—usually of the non-impact variety, such as swimming or biking or chair aerobics.

“This is where people tend to either want to go right back to where they were and over-train too soon, or they decide they want to rest more than they need to and lose some ground with their fitness level,” says Hughes.

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Setting realistic goals is imperative. And since the risk of re-injury is so great, proper warm-ups and correct form are more crucial than ever. “It’s particularly important after an injury that the muscles are warmed up—that you’re stretching the soft connective tissue surrounding the joint,” says Hughes.

Instead of doing higher-level, higher-load activities, dial back your workout in ways that maintain your fitness level. If you lift weights, do more reps with a lighter load—and remember that building muscle promotes healing. “The stronger the muscles are around the joint, the more protected it is from injury,” says Hughes.

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In the final phase of the healing process, patients can assess where they are and, if possible, work toward returning to their previous fitness levels. “If you’re a runner, you can start with light jogging and build on that,” says Hughes.

If you can’t return to old activities, embrace what you can do rather than dwelling on what was.

“I try and swim every day for at least 25 minutes, and it really works for me,” says Holzer, whose bad back continues to keep him off the pavement. “I can’t recommend the pool more.”

Sports Injuries: a Healing Primer

By and large, sports injuries are the result of either traumatic injury, or overuse of muscles or joints. Most involve minor trauma to soft tissue—injuries that affect the muscles, ligaments and/or tendons. There are three basic types:

Contusion (or Bruise): An injury to the soft tissue, often produced by blunt force like a kick, fall or blow, resulting in pain, swelling and discoloration. Treatment includes rest, ice, compression and elevation (R.I.C.E.). More serious contusions may need to be examined by
a physician.

Sprain: An injury to a ligament, often caused by a wrench or twist. It affects the ankles, knees or wrists. Treatment includes rest, ice, compression and elevation (R.I.C.E.). If the ligament is torn, surgical repair may be necessary.

Strain: An injury to a muscle or tendon, often caused by overuse, force or stretching. Treatment includes rest, ice, compression and elevation (R.I.C.E.). If a tear in the muscle occurs, surgical repair may be necessary.

Source: Main Line Health

Three Stages of Recovery

First 24-48 hours: Apply ice and elevate extremities to prevent swelling. Get lots of rest. In some cases, compression or anti-inflammatory drugs like ibuprofen can help.

First six weeks: Some form of exercise is crucial to help maintain fitness level, making a return to more rigorous activities easier. Often ice and elevation continue during this phase.

Six weeks to one year: Patients can work with physical therapists to create more rigorous exercise routines. Some may not be able to return to impact exercise. Ice and elevation also are common, especially after activity.

Source: Main Line Health

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