Ouch! I hurt myself!
December 27, 2011
TAHOE/TRUCKEE and#8212; The medical legal answer is seek help. The reality, for the Tahoe Truckee athlete is use these guidelines and your common sense.
How long has it been since the injury? If it has been less then 36 hours the inflammation will tend to still be accumulating and you might have an increase in pain and swelling, so answer question 7 with that in mind. Inflammation is felt as pain, stiffness and swelling. Swelling can also be seen. Also if you continue to move you may be repetitively reinjuring the tissues, which will cause additional inflammation. The time of day and your activity level will effect the amount of inflammation. When you stay still for a while the inflammation will start to accumulate in the tissues and this will increase symptoms. So when you sleep or go for along car drive, you will have an increase in pain, swelling and inflammation.
If the injury did not happen from a single event but came on slowly over hours or days it is probably what we call a repetitive micro trauma injury. This is a small injury you do not feel when it is happening. That is repeated over and over again. Usually a hundred to several thousand times a day. This could be moving improperly, prolonged sitting, poor posture or a combination of these. What often complicates this is previous injury, bad bio-mechanics, instability, decreased strength or flexibility. Repetitive micro trauma injuries are the most common reason to see a professional for pain relief. You must find out the cause of these and not just treat the symptoms with medications or they will come back over and over again and tend to worsen and/or affect other body parts due to abnormal altered movement.-
So you decided self management is the road for you. The first thing to do is get the ice out. Crushed or snow is best because it will conform to the body part. Put it in a zip lock bag with a little water, cover with a thin moist towel and apply for 15-20 minutes once per hour. More is not better. If you have trouble feeling or have a medical condition seek additional guidance so you do not get frost bite. The most import time for you to ice is immediately after the injury and before and after you are going to be still i.e. bed time. Ice should be used until you no longer feel stiffness and pain increase after staying still, this usually happens after two-seven days. If it is longer then this, you are somehow reinjuring, most often with the repetitive micro trauma. Also realize inflammation in the joint alters the firing a pattern which makes the area less stable, which makes you more susceptible to re-injury. Ice will help with this.
I think heat should be used sparingly especially with a new injury or a re-injury because it opens up blood vessels, which will promote inflammation.
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The next thing to consider is how to use rest. If the injury is more on the sever side rest for 24-48 hours. If not try to move it gently as soon as possible in a pain free range, body movement and muscle contraction tend to move the inflammation out of the injured tissue. If this feels bad or worsens the pain seek medical help. I then like to use elevation if the injured part can be elevated. Putting your legs up the wall like the classic yoga pose Viparita Karani, while keeping your back on the floor, with your butt on a small pillow close to the wall is great for leg injuries to thigh, knee, ankle and foot. Too much rest can prolong an injury due to the de-conditioning. This happens rapidly in the muscles, bones ligaments and tendons. A study gave people 48 hours of bed rest and then measured the calcium in their bones and found a measurable loss during that time, making the bones weaker.
When and what to take medication wise is the hard decision due to side effects. If the pain and inflammation are great, anti-inflammatories like Ibuprofen are worth considering. These over-the-counter medications are safer but do not think they are safe. Injuries to the stomach, intestines, kidney and liver are common. One of the things not widely appreciated is they may interfere with healing. Anti-inflammatories stop the production of prostaglandins which cause pain and inflammation. These prostagladins also stimulate repair and healing in muscles, ligaments, bones and tendons. If you take them pre-activity as a strategy to not hurt as much during or after, you are causing additional damage and making your chronic injuries worse. The risk of death as a result of use of NSAIDs like Ibuprofen is 1 in 12,000 for adults 16and#8211;45. The risk increases 20-fold for those over 75. So the general guidelines are use as little as possible. I find people do best with decreasing the dosage rapidly during the time they are moving around and slowly decreasing use before and after time you will not move much, i.e. sleep or go for a car ride. Limit there use to seven days. If you are not better by then seek medical help.
If you have chronic pain and it is not decreasing with your current care, seek alternative care/opinion from another of the same type of providers i.e. different chiropractor or from a different type of provider i.e. physical therapy. If you do not correct the problem and get rid of the pain then your body will ware out prematurely. This could lead you to go see one of our orthopedic surgeons for a joint replacement. Also if you have chronic pain and it is not improving there could be a nutritional component. The most common nutritional problem with healing I see is not enough quality protein.
and#8212; Dr. Barry Triestman practices chiropractic, sports medicine, active release techniques, and Pilates based rehabilitation in Truckee. Call 530-550-1688.