Treating modest gym injuries

Volume 1, Number 49 | The Weekly Newspaper of Chelsea | Aug. 24 - 30, 2007

By Greg Rothman, M.S. P.T.

In last week’s column, I wrote about the simple things you can do to minimize the risk of injury when exercising: They include warming up, stretching, maintaining proper form and avoiding dangerous exercises. This week, we’ll look at what you should do in the event you do sustain an injury, looking at problems that do not require medical intervention. Next week, we’ll examine more serious injuries for which seeking medical attention is recommended.

To start out, making a distinction between actual injuries and DOMS (delayed onset muscle soreness) may be in order. DOMS is a generalized soreness that occurs in muscles that have been stressed by exercise, when either muscle myofibrils (the smallest unit of muscle tissue) that were torn during exercise begins to heal, or lactic acid is released into the muscle (a byproduct of energy production).

DOMS typically occurs 24–48 hours after a workout and can range in intensity from mild to severe (that “I can barely walk” feeling). Regardless, it is natural and will dissipate gradually without any need for intervention. Beyond DOMS, overstressed tissues can evolve into actual injuries.

The most common gym injuries involve the connective tissue: muscles, tendons, ligaments and fascia. When muscles or tendons (the end-part of the muscle that connects the muscle to the bone) are overstressed, a strain can result. Frequently, strains occur in or around the lower back, shoulder, elbow, knee or ankle.

Wherever they occur, strains can range from mild to severe, producing pain, which is usually localized to a very specific area (as opposed to DOMS, which is more diffuse). It is generally recommended that when a strain occurs, you try to limit use of the painful area. Icing the area as soon as possible and for the first 48 hours afterward can help to alleviate any pain. Using an ice-pack 15–20 minutes every few hours is recommended. If soreness persists beyond 48 hours, it is suggested that you switch to using a source of moist heat on the area several times each day until the pain is gone. One good way to do this is to fold a hand towel, soak it in water and then wring it out until it is no longer dripping. Then heat it in your microwave for an average of one minute (microwaves are all different; so, make sure that it is not so hot that it burns the skin).

Similarly, if a ligament (the structures that connect bone to bone) is injured, this is called a sprain. The symptoms are very similar to that of a strain, although with sprains, swelling is often present as well. And the initial treatment is similar: Resting and icing the area is recommended. If swelling persists, it is also suggested that you compress the area with a bandage (such as an Ace bandage) and elevate it. A good way to remember the treatment for a ligament sprain is by using the acronym RICE (rest, ice, compression, elevation).

If the swelling or discomfort from a strain or sprain persists for more than one week, seek advice from your physician. These injuries can get worse, developing into tendonitis (inflammation of the tendon) or a more severe grade of sprain that might require medical intervention.

These kinds of injuries are fairly common in the shoulder, mainly because there is limited space in the shoulder joint, and it is easy for tissues to get impinged by the moving parts (bones), causing tendonitis or bursitis (inflammation of a bursa, a fluid-filled sac that provides cushioning within joint structures).

These injuries are also pervasive in the elbow. Lateral epicondylitis (tennis elbow) is an inflammation of a structure on the lateral (outside) part of the elbow. Similarly, medial epicondylitis (golfer’s elbow) involves a ligament or tendon on the medial (inside) part of the elbow.

When these types of injuries occur in the lower back, the conventional wisdom is to get in bed and rest until it feels better. This actually can be counterproductive and cause muscle spasm, as the injured muscles contract and tighten further. Rather, it is recommended that you maintain fairly normal activity while being careful not to do anything that puts stress on the lower back.

Other lower back problems are more serious and require medical attention, such as injuries that impinge upon nerves, as in the case of sciatica, where pain can radiate down the back of the leg.

I hope the information provided here will help you to know what to do about the minor (and not uncommon) soft-tissue injuries that can result from strenuous exercise. But following the advice from last week’s column can prevent them from occurring to begin with. In general, let your body be your guide: If something does not feel right to you, it probably isn’t. If you are concerned, seek the advice of your doctor.

NOTE: The information presented here is not intended to diagnose or treat an injury. It should not be construed as medical advice. Always consult with a medical professional prior to beginning a new exercise program.

Greg Rothman, M.S. P.T., is the owner of emPower Fitness Studios (emPowerFitnessNYC.com). He received his masters degree in physical therapy from Columbia University and has 15 years’ experience in the rehabilitation and fitness fields, most recently as the personal training manager and top-level trainer for Equinox Fitness Clubs in New York City. SEND YOUR QUESTIONS about nutrition, fitness and sports injuries/rehabilitation to Greg at emPowerFitness@aol.com.