Monday, August 02, 2010
Image by Frankenstoen.
Earlier this year I asked our readers what issues they'd like to see covered here on Obesity Panacea, and one topic that came up repeatedly was injuries. It was a great idea, but as an exercise physiologist I don't really deal with injuries on a regular basis. So I decided to interview two good friends of mine who do.
Jessie Moser is a Certified Athletic Therapist working with a number of high level sports teams in British Columbia, while Liz Henderson is an Occupational Therapist working for a school board in northern Alberta, and who has also worked extensively in a hospital setting. We did our undergraduate degrees in Kinesiology together at the University of Calgary, and the ladies were nice enough to answer a few of my questions. Pay special attention to some of Liz's "things to think about", which makes a great checklist of important questions that may not come immediately to mind in the doctor's office. As always (and as both Liz and Jess mention), be sure to talk to your physician if you are concerned about an injury. Enjoy the interview!
TS: What are the types of injuries that you see most often?
JS: Working with hockey I see a wide range of musculoskeletal injuries. Injuries range from minor strains and sprains (AC sprains and groin or hip flexor strains) to lacerations, concussions, dislocations and fractures.
LZ: I am assuming you mean orthopaedic injuries (involving muscles and bones). I saw a lot of broken tibia/fibula (post surgical repairs) and people with broken radii/ulna (again post surgery). I also saw a lot of post acromial space decompressions. Less common were broken femurs and hips (post repair surgery) and post tendon repair surgeries (a lot in hands and some Achilles tendon repairs). But at the hospital I also saw people with strokes, people whole deep vein thrombosis, people with mental health concerns, people with acquired brain injuries, people with amputations and people with dementia.
TS: What types of injuries are the easiest to deal with, and which ones tend to be give people trouble over the long-term?
LH: Injuries in healthy people who have no underlying health concerns (ie highblood pressure, diabetes, smoking or dementia) are the easiest to deal with. I also find injuries of the lower leg (broken tib/fib) easier to deal with. The restrictions that are place on you when you have that kind of injury impact your daily life less. Sure you are unable to drive, and walking with crutches/a cane is a pain but with an arm injury everything you used to do with two hands is now a challenge, getting dressed, cooking, packing up your briefcase/office bag. Just try not using one hand for a day - IT'S HARD.
That all being said, broken bones where peripheral nerve damage occurs, there tends to be long lasting effects. Sensation is lost to an area, small muscles in the area can develop contractures ( permanently shorten). Peripheral nerves regrow at a rate of .2mm/day, if they regrow at all.
JS: Strains seem to give people the most problems over the long term. This is mostly because they are the ones that athletes try to push through and never let heal properly. Easiest injury to deal with is a fracture, you splint them, take them to the ER and then they are casted - pretty simple.
TS: If you could give someone one or two tips on how to stay injury-free, what would it/they be? Anything that people should definitely avoid? Anything that people should be doing to prevent injuries in the first place?
LZ: Be careful on ice! [Travis' note: it gets really cold in northern Alberta, even by Canadian standards] A lot of broken hips/wrists occur in early winter on icy surfaces! Know your limits when skiing/snowboarding! We could always tell when it was class trip time to the local ski hill, our paediatric ward became very full with broken upper limbs.
If your job requires sitting for long period of time - make sure your getting exercise somewhere in your day and you can give your body a break from being in the same position all the time. If you notice a set of muscles are tight/painful all the time, talk to your occupational health and safety worker (it's easier to help overuse injuries in the early stages!!).
For the nurses, OTs and PTs out there, don’t be a hero when transferring/moving patients, know the policy on lifting, use mechanical lifts whenever you can, and get help from other people! Also make sure your stretching and doing regular core-strength training to help prevent injuries. Most facilities provide training of lifting techniques, attend these and PRACTICE.
For those out there who perform very physical jobs, ensure your still getting regular exercise, this will develop the muscles that you might not use everyday at work and prevent over use injuries. Be aware of your surroundings and safety protocols are there for a reason!
TS: As you may remember, I've never been terribly fond of stretching, resulting in very poor flexibility in my legs and lower back. Should I be worried about this?
JS: You should be worried about any muscular imbalances. You need to be flexible enough that you are mobile and functional for your particular sport or activity. I deal with a lot of athletes that simply want to lift a lot of weight and get "jacked". You can be the strongest person but if you are unable to move on the ice through the range of motion intended for that joint, you are not only going to be ineffective playing but you will also make yourself more prone to muscle strains and joint damage.
Not everyone needs to have the same flexibility. For instance, a goalie must be more flexible then a player due to the demands of their position.
LH: How much do you like your achillies tendons in one piece Travis? As we get older the flexibility in our muscles decreases, making us more susceptible to tendon tearing injuries.
Your lower back shouldn’t really be “flexible”, it's designed to transfer the weight of your body to your pelvis. If you look at a model of the spine your lumbar vertebrae are less mobile then thoracic and cervical vertebrae. So I wouldn’t worry about lower back flexibility.
Tight hamstrings on the other hand are 1 part of the 2 part combo that most commonly causes lower back pain (there are many cause of lower back pain! Please go see your family doctor if you are experiencing chronic lower back pain, there could be scary dangerous things going on, besides what I say here). The other part of this combo is weak core muscles. Being overweight also increases your risk of having chronic lower back pain.
So, Travis: Stretch!
TS: Shin splints suck. How do you deal with them once they develop, and how can you avoid them altogether?
LH: Physiotherapists usually deal with them once they develop (not my area of expertise). To avoid, ensure well fitting, lace up shoes. If you get them from running, or another repetitive activity slowing increase your activity level, don’t go from not running at all to running every day of the week!.
JS: "Shin splints" is an umbrella term that means anterior shin pain. It covers conditions such as stress reactions of the tibia, stress fractures, periostitis, compartment syndromes and so on. General guidelines to avoid them are to make sure that you have proper footwear and training surfaces, avoid over training and increase training gradually if you are prone to develop "shin splints". It is also important to find the cause of your pain - is it a foot up [eg. between the foot and knee] or hip down [eg. between the hip and knee] problem. Make sure you see a doctor as x-rays or a bone scan may be in order. Most of the time dealing with "shin splints" means finding the cause, correcting it, resting, decreasing inflammation and gradual return to play.
TS: What should people do when they first think they have an over-use injury? Who should they call?
JS: Doctor is always a good way to go. They have the tools at their disposal to diagnose (MRI, bone scan etc). Athletic injuries should come to a Sport Physio or Athletic Therapist as they are trained in this department. Depending on the complications of the injuries other health care professionals may be helpful.
LH: Call your doctor! And if it is work related contact occupational health and safety at your work place. Other possible causes of the issue need to be ruled out, make sure there is no bone damage/nerve damage. This is where you might have to become a pain in the Doctor’s side and advocate for yourself. Ask for x-rays of the area. At most doctor’s offices no news from tests is good news. In this case make an appointment to go and get the test results and form a plan with your doctor. Ask if a referral to physio/massage therapy/occupational therapy is appropriate.
TS: I've talked with friends about the importance of knowing the difference between soreness (as a result of a workout) and pain (as a result of an injury). Do you have any tips on how to tell one from the other?
JS: A big line in the hockey world is "are you hurt or are you injured?". Honestly can't count how many times I've heard that from the coaches I've worked with. The difference between being sore and being injured is that when you are sore you have not created damage limiting your ability for normal function. If you are injured you have decreased function.
LH: 1st rule of thumb is: know your body! Be aware of what post workout muscle soreness feels like to you.
2nd rule of thumb is: if the pain lasts for 1 week or more go to your doctor.
3rd rule of thumb is: if your heard pops or cracks in your body, and now a body part if a funny shape or your have a funny “lump” on a muscle, go see your doctor.
TS: Is there anything else you'd like to add?
LH: If you have had an injury (broken bone/tendon especially), write down questions you have for your doctor about what you are / are not allowed to do and for how long and don’t leave until they have answered the questions. Surgeons are busy people - they are really good at fixing body parts, but sometimes they are not the best at explaining in non-medical terms what restrictions there are on a post surgical body part.
Some things to think about:
-can I get it wet?
-can I have sex?
-can I drive?
-can I walk?
- when can I run or ( insert favourite leisure activity here)?
-Will drinking/smoking slow my healing? (the answer is yes, alcohol is like poison to healing bone, smoking restricts blood flow to the area)?
- How much can I lift?
- Do I need to see OT/PT? ( in my experience, they will forget about this unless you ask, especially if your in the ER)
-What movement can I do/not do?
TS: Thanks ladies!
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