EXERCISE INJURIES, REACTIONS AND THE ENVIRONMENT

Introduction

The following sections describes a number of injuries and syndromes that can befall the exerciser. While this information can be useful in determining appropriate first aid or symptomatic relief methods, it is important to be aware of the distinction between first aid and relief of symptoms vs. diagnosis and treatment.

As will become evident in the sections ahead, a single symptom (such as knee pain) can have a variety of causes, many of which are not immediately obvious and require the diagnosis of a physician, who can prescribe treatment.

Individuals are strongly encouraged not to use the information below to "self-diagnose", but merely as guidelines for appropriate first aid/symptomatic relief and when to see a physician.


Legal Issues for the Exercise Professional

Exercise professionals are strongly encouraged to refrain from the process of diagnosis and/or prescription of treatment or rehabilitative exercise. Our scope of practice is limited to encouraging rest, RICE, and a visit to the doctor.

(RICE stands for Rest, Ice, Compression, and Elevation.)

Statements such as "that sounds like chondromalacia - why don't you try and strengthen the medial quad to help out" or "you've got low back syndrome" involve a judgment by the exercise professional that can be construed in a court of law as a diagnosis and/or prescription of rehabilitative exercise.

If such advice causes the individual to sue at a later date, the charges can be much more serious than mere negligence - the exercise professional can find themselves in the position of being charged with practicing medicine without a license.

Exercise professionals are best advised to speak in general terms without reference to an individual's condition, to focus on general preventive behavior, and to refer individuals to a physician when a diagnosis needs to be made or an injury does not respond to first aid/symptomatic relief (such as RICE).

An appropriate example: "well, there are a number of causes for the shin pain you're experiencing. You can apply RICE to relieve the symptoms, but if it doesn't feel better within a day or two you should consult with your physician." Here we sidestep the issue of diagnosis, stress symptomatic relief, and incorporate a physician referral in one sentence.

Or: "Now we're going to do some exercises for the back. It is believed that strengthening the low back can help prevent low back pain." In this case, only a general discussion on preventive (not rehabilitative) exercise is provided.


What should I do for an acute injury?

If you feel that you have "pulled a muscle" or have an inexplicable pain after exercising, the immediate treatment is RICE (rest, ice, compression, elevation). Icing for 48 hours, every 2 hours for about 10-15 minutes, should help the injured area. However, if you've got an injury that doesn't respond to RICE in a couple of days, you should see your physician.


What should I do for a chronic injury?

It is important to remember that the people here on misc.fitness.aerobic have varied backgrounds, but are primarily fitness professionals. As such, we're really not qualified to give out rehabilitative exercise. You must see your physician or other qualified person to find out what you should do if an injury persists.


What are some common exercise injuries?

Common exercise injuries:

Overuse Injuries

The heading of overuse injuries is a broad one, into which the vast majority of exercise-related injuries fall. Generally overuse injuries are chronic ones, meaning that no single event causes them (as with a sprained ankle or a broken leg), but a long series of events over weeks, months, or years of training gradually weaken or irritate the area in question until exercise becomes difficult or impossible, or other symptoms appear.

The vast majority of overuse injuries can be avoided by proper attention to form and technique, appropriate rest, proper equipment (especially footwear), and gradual increase of exercise frequency, intensity, or duration.

The best cures for an overuse injury are rest followed by a gradual return to activity coupled with an awareness of the problem activity, and appropriate corrective measures (be they more gradual return to exercise, appropriate strengthening, or avoidance of certain forms of activity).

Patellofemoral Syndrome ("Runner's Knee") / Chondromalacia

Chondromalacia literally refers to the wearing away of the cartilage on the back surface of the kneecap, which might be first exhibited as a "clicking" or "grating" sound, and knee pain under the patella (kneecap).

Chondromalacia refers to the condition, and not a specific disease state, as a great many possible causes exists for damage to the cartilage.

Patellofemoral syndrome, likewise, refers to generalized knee pain, often associated with runners, but not limited to runners alone. In this context, the cause is usually improper running mechanics over a period of time, though in many cases the cause is unknown.

Once chondromalacia has occurred, the process is irreversible, and attention is paid to achieving the maximal amount of pain-free activity, and avoiding activities which will cause further damage to the joint.

Note that patellofemoral pain is of a more general nature, and may or may not be due to the pathological condition of chondromalacia.

It is best to consult a physician or a physical therapist when any sort of knee pain is encountered.

Plantar Fasciitis and Neuromas

Plantar fasciitis is literally an inflammation of the plantar fascia, a web of tough, fibrous connective tissue on the bottom of the foot. Neuromas are irritated nerve endings, but can cause pain in the foot (or other places, depending on the nerve in question).

Either condition should be examined by a physician. While both are commonly caused by overuse, the question of whether the condition is due to poor technique, simple overuse, or an orthopedic problem should be explored.

In the case of the latter, orthotics (inserts for shoes designed to help maintain proper impact cushioning and support for the foot) can play a major role in the prevention of future episodes.

Lateral Epicondylitis ("Tennis elbow") and the more general Tendonitis/Arthritis/Bursitis

Any "-itis" condition refers to inflammation or irritation. In the cases of tendonitis, arthritis, and bursitis, the sites of inflammation are the tendons, joints, and bursae (fluid-filled sacs provided cushioning between tendons and bones), respectively.

Again, any of these conditions should involve a physician referral. Tendonitis and bursitis are common overuse injuries, and rehabilitation will generally involve rest, and enhancing flexibility and strength of all muscles surrounding the joints near the area in question.

Arthritis can be caused by two distinct disease processes - osteoarthritis is essentially "wear and tear" on joints, in which the cartilage covering the articulating surfaces of the bones becomes worn, and the joint reacts, often by swelling and filling with fluid. It can become quite tender, and motion can become difficult.

Rheumatoid arthritis is an autoimmune disorder in which the body launches an attack on its own joint tissues. While much less common than osteoarthritis, it can be severely debilitating.

Rehabilitation for arthritis generally involves activities that are low-impact in nature, and strengthening exercises. Activities are carried out through a "pain-free range of motion" (ROM limited by the onset of discomfort), and no activity is recommended during periods of active inflammation.

Shin Splints and Compartment Syndromes

Shin splints are a common name for pain felt in the anterior portion of the calf, which can be due to a variety of causes, from muscle imbalances to something as serious as a compartment syndrome.

Generally, treatment for shin splints involves RICE, strengthening exercises for all of the muscles surrounding the ankle joint, and flexibility exercises.

Compartment syndromes are a much less common, but more serious problem, where one of the compartments between muscles which contains blood vessels and/or nerves becomes swollen, compressing the blood vessels and/or nerves. This can lead to pain, swelling, and discomfort, and in severe situations can be an emergency situation requiring surgical intervention.


What are some common exercise reactions?

Some number of people experience reactions to exercise, ranging from uticaria, a harmless red blotchiness on the neck, face, or arms, to exercise induced asthma or bronchospasm, to anaphylaxis.

Exercise-induced asthma (EIA) is most likely to strike individuals exercising in cold, dusty, or excessively humid environments, and can range in severity from mild coughing to severe discomfort. Individuals who suspect that they have exercise-induced asthma are encouraged to seek medical attention to rule out other possibilities, and to ensure the best possible treatment for their condition.

General recommendations for persons with EIA include an extended warm-up, avoidance of cold, dusty, or extremely humid environments for exercise, pursed-lip breathing, and keeping an inhaler handy for use during exercise (if recommended by physician).

While very rare, it is possible for someone to have an allergic reaction to exercise, called exercise-induced anaphylaxis. This is a life-threatening situation, and requires immediate medical attention. People prone to EIA can, at the advice of their physician, carry a bee-sting kit to use in such situations. Any person suspecting that they are prone to EIA should consult with their physician before resuming exercise.


What are some common environmental concerns?

Extremes of temperature and humidity pose special problems for the exerciser. In hot weather, care must be taken to wear clothing that is light, breathes well, and allows for the evaporation of sweat.

"Sauna suits", "tummy wraps", and other products designed to encourage quick weight loss through sweat are particularly dangerous - the body can reach dangerous (or even fatal) core temperatures in very short periods of time. Weight lost by these methods will be regained as soon as water is ingested again, and so the risk outweighs any "benefit".

On extremely humid days care must be taken to exercise at an appropriately lowered intensity, out of the high heat/humidity, or even to postpone exercise until the heat/humidity diminish. As exercise intensity increases and more heat must be dissipated, evaporation of sweat becomes the principal means by which cooling occurs. In a high-humidity environment, evaporation becomes less effective at cooling, and the risk of heat-related injury is greater.

Adequate hydration is also key to safe exercise in the heat, as the body will produce large quantities of sweat. 1-2 cups of water before exercise and 1/2-1 cup of water during exercise are recommended, though more can be ingested.

It is important to remember that the thirst mechanism lags behind the body's need for fluid - by the time one is thirsty one is already substantially dehydrated. Even small amounts of dehydration can affect performance, and severe dehydration can be life-threatening.

Contrary to popular belief, water consumed during exercise will not contribute to cramping, so "swish and spit" should be avoided in favor of consuming small amounts of water steadily during the exercise session, especially during periods of prolonged exercise.

In the cold, care must be taken as well. It is best to dress in layers that will wick sweat away from the body - many of the "high-tech" fabrics that are now available will do this admirably. Outer layers can be used to keep the body warm during warm-up, and removed as exercise progresses to allow the body to cool itself, and then be replaced during the cool-down to avoid an excessive chill.

Garments made of fabrics like wool, which will insulate even when wet, are superior to garments made of materials like cotton, which will contain sweat and can contribute to heat lost by evaporation and conduction as the activity level decreases.


Heat-Related Problems and Injuries

(from Jennifer Robles (Neefer) oaktree@aimnet.com)

Heat related ilnnesses:

Who is at risk for heat-related illness?

People at risk for heat-related illnesses include those who work or exercise outdoors, elderly people, young children, and people with health problems. Also at risk are those who have had a heat-related illness in the past, those with medical conditions that cause poor blood circulation, and those who take medications to get rid of water (diuretics).

People usually try to get out of extreme heat before they begin to feel ill. However, some people do not or cannot. Athletes and those who work outdoors often keep working even after they begin to feel ill. Those living in poorly ventilated or poorly insulated or poorly heated buildings are at risk of heat emergencies Many times, they might not even recognize that they are in danger of becoming ill.

What are heat related illnesses?

Heat cramps, heat exhaustion, and heat stroke are conditions caused by overexposure to heat. Heat cramps are the least severe, and often are the first signals that the body is having trouble with the heat. Heat cramps are painful muscle spasms. The usually occur in the legs and abdomen. Think of them as a warning of a possible heat- related emergency.

HEAT EXHAUSTION is a more severe condition than heat cramps. It often affects athletes, fire fighters, construction workers, and factory workers, as well as those who wear heavy clothing in hot, humid environments. Its signals include cool, moist, pale or flushed skin, headache, nausea, dizziness, weakness, and exhaustion.

HEAT STROKE is the least common but most severe heat emergency. It most often occurs when people ignore the signals of heat exhaustion. HEAT STROKE develops when the body systems are overwhelmed by heat and begin to stop functioning. HEAT STROKE is a SERIOUS medical emergency. The signals of heat stroke include red, hot, dry skin; changes in consciousness; rapid, weak pulse; and rapid, shallow breathing.

How do you treat heat cramps?

To care for HEAT CRAMPS, have the victim rest in a cool place. Give them cool water or a commercial sports drink. Usually, rest and fluids are all the person needs to recover. Lightly stretch and gently massage the area. The victim should NOT take salt tablets or salt water. The can make the situation worse.

When the cramps stop, the person can usually start activity again if there are no other signals of illness. She should keep drinking plenty of fluids. Watch the victim carefully for further signals of heat-related illness.

How do you treat other heat-related illnesses?

When you recognize heat-related illness in its early stages, you can usually reverse it. Get the victim out of the heat. Loosen any tight clothing and apply cool, wet cloths. If the victim is conscious, give cool water to drink.

Do NOT let the conscious victim drink too quickly. Give about one glass (4 ounces) of water every 15 minutes. Let the victim rest in a comfortable position and watch carefully for changes in her condition. The victim should not resume normal activities the same day.

When do you call 911?

Refusing water, vomiting, and changes in consciousness mean that the victim's condition is getting worse. Call 911 (or emergency services). If the victim vomits, stop giving fluids and position the victim on the side. Watch for signals of breathing problems. Keep the victim lying down and continue to cool the body any way you can. If you have ice packs or cold packs, place them on each of the victim's wrists, ankles, groin, armpit, and neck (a.k.a. pulse points). Do NOT apply rubbing (isopropyl alcohol).

At what temperatures and humidity are heat-related illnesses likely?

These curves approximate the figure in the 1993 American Red Cross Standard First Aid manual.

Reference, 1993 American Red Cross Standard First Aid Manual


Specific Cold-Related Injuries - Hypothermia and Frostbite

Frostbite involves the freezing of tissue, and can range from mild to fairly severe. The skin will generally look yellowish, and will be cold to the touch. First aid generally involves warming the affected area using moderately warm water - remember that sensation will be reduced in the area, and the temperature of the water should be verified by running it on unaffected skin! Do NOT rub the area, as this can cause further tissue damage.

Frostbite should be examined by a physician to assess the extent of the damage. It is best prevented by proper clothing and limited exposure to cold.

Hypothermia is a life-threatening condition wherein the core body temperature has become dangerously low. Many of the same symptoms as heat exhaustion, including dizziness, nausea, loss of appetite, vision problems, etc., may be present. In the case of hypothermia it is important to call 911 immediately, and use any means present to warm the victim, such as removing excess clothing and putting them in a sleeping bag with an unaffected person who can provide body warmth until help arrives.