Injury

Do You Want Ice With That?

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Several years ago I was working with an elite marathon runner who was training for the Olympics here in Flagstaff. During one session, I noticed that her legs were very cold to the touch. When I asked her about this she replied, “Oh, I just got out of an ice bath”. I commented that an ice bath sounded painful. She said, “My legs get so heated during a 26 mile run that the ice feels wonderful”. At the time I couldn’t understand how that could be until I ran my first marathon, after which I tried the ice bath. What I can tell you is “the ice feels wonderful!”

I noticed that after running 26.2 miles and an ice bath, my muscles felt better then when I did a shorter training run of only 16 or 18 miles without an ice bath. Without the ice, I felt more ache and stiffness in my muscles causing me to hobble around later in the day. After the ice bath, my muscles felt more revived and resilient (albeit still a bit achy) even though I ran about 10 miles farther! Was it just my imagination? The fact is there is some science to support my experience.

By now most people know to treat a muscle injury with ice.   But the ache and irritation post workout isn’t really an injury, so common sense would say there is no need for ice.  This is true for the average type of workout.  But if you are in a prolonged training regimen, like training for a marathon run, ice is indicated for post workout recovery.  Here’s why.

Prolonged and continuous muscle use like in distance running and cycling that lasts longer than two hours, generates so much heat that increased blood flow to the muscles is needed to bring additional oxygen to the tissue, as well as provide cooling during the workout.  The increase in blood flow causes the surrounding tissues to stretch which creates additional irritation and is the cause of much of the post workout muscle ache.  When ice is applied within 30 minutes of the workout, the swelling of the muscles related to the increased blood flow is reduced thereby minimizing the secondary tissue irritation.

Additionally, studies have shown that ice is effective in reducing the sensation of muscle pain.  This is likely the reason why I felt so much better after running the marathon followed by an ice bath.  The effects of the ice on the muscle inflammation was what enabled me to feel relatively normal the next day, rather than hobbling around.

There is a problem with ice however.  It’s when ice is used during a workout or competition to treat muscle pain with the hope or expectation of returning quickly to physical activity.   A new study shows that using ice during an event (like in football, or baseball), where there is a break in the action (like half time or between innings), using ice to mitigate muscle pain can reduce physical performance and possibly increase the risk of muscle injury upon returning to the action.

Studies have found that athletes experienced reduced muscle strength as demonstrated by not being able to jump as high, spring as fast, or throw a ball as far up to 20 minutes after icing.  The theory is that the ice slows the speed of the electrical impulses running through nerve cells and thereby reducing the effectiveness of the muscle.

The study used an icing period of 20 minutes and the researchers concluded that if ice is used during physical activity, it should be followed by a period of slow warming for at least 15 minutes before resuming the activity.  The researchers caution that relying on ice to reduce muscle soreness to get an athlete back into a game is inadvisable.   They recommend sitting out the rest of the game so you can be ready for the next game.

But if it’s the end of the event, feel free to jump into the ice bath and enjoy it.  Just don’t plan on moving too quickly for a while after.

 

 

Paul Kulpinski is a licensed massage therapist, holistic wellness educator and co-founder of Mountain Waves Healing Arts in Flagstaff, Arizona. Information contained in this blog should not be taken as medical advice. Readers are advised to validate the information presented here with other sources including your personal physician for information specific to you.

Biking While Lying Down

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Rider on a recumbent bicycleRecently I’ve become more aware of the number of bicycle riders who are riding recumbent bicycles, which allow them to  ride while basically lying down.   I also remembered a 2006 study which revealed the best bio-mechanical sitting position which lo and behold was pretty close to the recumbent bicycle positioning.  A few months ago I wrote about how the traditional bicycle saddle can impact rider’s genitals and reproductive health and why experts are recommending using a split saddle.  Perhaps, the better solution lies in, lying down.

The word recumbent comes from the Latin word recubere which refers to the state of lying down.   With a recumbent bicycle, the seat positions the rider in a reclining position usually situated between the two wheels, with the feet activating pedals that are at the same height as the knees.  One of the most often cited reasons that riders mention when switching to a recumbent bicycle is comfort.  The reclined position eliminates body weight on the hands, arms and shoulders and allows for a more comfortable neck position because the head is in a more natural position for better forward visibility.  Additionally, there is reduced pressure on the base of the pelvis (or sits bones), because more of the body weight is absorbed along the lower back.

This is verified in the 2006 study, conducted in Aberdeen, Scotland.  That study compared three different sitting positions:  upright 90 degree position, slouched forward position, and a 135 degree reclining position, similar to the alignment on a recumbent bicycle.  Measurements were taken with a positional MRI that measured spinal angles, vertebral disk height and disk movement related to each position.

The research found that the position where there was a 135 degree angle between the thighs and the body produced the least amount of disk movement indicating that there was less strain placed on the disks and corresponding muscles and ligaments.  Additionally, the reclined seated position produced the least amount of compression of the vertebral disks.

To tie this in with the split seat post mentioned earlier, having less pressure on the floor of the pelvis will also relieve the incidents of reproductive issues associated with a standard saddle on an upright bicycle.

So while there are differences in riding characteristics between an upright and a recumbent bicycle, the clear winner with regards to comfort and lower risk of injury to the spine and genitals is the recumbent bike.

Paul Kulpinski is a licensed massage therapist, holistic wellness educator and co-founder of Mountain Waves Healing Arts in Flagstaff, Arizona. Information contained in this blog should not be taken as medical advice. Readers are advised to validate the information presented here with other sources including your personal physician for information specific to you.

Why Do We Stretch?

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Toe touch stretchLet’s start with a full disclosure:  despite being a massage therapist and given all of the advice I provide to clients for the benefits of stretching, I don’t stretch as much as you might think.  Phew.  Glad that’s off my chest.

But stretching is supposed to be good for you, right?  It’s one of the fundamental components of fitness and is supposed to decrease your risk of injury during exercise, right?

Maybe.  Maybe not.

Increased flexibility can certainly help improve your balance, coordination and mobility.  When combined, these contribute to your ability to react to changes in your environment – like an uneven sidewalk, or a strong gust of wind.   But there are other factors, including muscle strength and joint stability that also come into play.   The confusing part is that stability is in opposition to flexibility.

Flexibility is a double edged sword.  Too little flexibility contributes to lack of mobility that inhibits coordination, balance and such, while too much flexibility creates instability in joints that also compromise coordination, balance and such.  It’s safe to say that hyper-flexibility is just as unhealthy as inflexibility.

As for injury prevention, there is no research that links stretching before exercise with a reduced risk of injury.  In fact there is research that demonstrates a connection between stretching and an increase for injury during workouts!  At best, other research indicates that stretching has little to no impact on reducing injury, nor on reducing muscle stiffness!  That’s a shock, because I always figured that it was the muscle stiffness that actually triggered someone to spontaneously stretch, like when we wake in the morning or after sitting for prolonged periods.

So if researchers have been unable to detect a physiological benefit to stretching, why do we stretch?  Think about it.  Stretching is not un-natural.  Every animal on the planet stretches.  Why?  My questions aren’t rhetorical, I honestly don’t know and neither do any of the researchers I’ve read.  It’s like the mystery of the yawn.

Now, I do have a theory as to why we stretch.  But it’s just that: my theory.

My theory is that we stretch because it feels good.  Releasing the bound up protein in the myofibrils of the muscle (which is what stretching does) must trigger some hormonal response in the hypothalamus to release dopamine, that wonderful neuro-transmitter that gives us that euphoric feeling that we associate with intense exercise, sex and chocolate.  Well, if I’m right, judging by the other activities that trigger the release of dopamine, stretching might begin to rank a little higher on people’s list for a quick feel good pick-me-up.

So maybe that’s the real reason to stretch.  Not because it might prevent injury, or improve range of motion, or increase blood flow; but because it simply feels good!  But if you know of any solid research that answers the question of why we stretch, please let me know.  In the meantime, I’m going to do a little yoga and maybe release some dopamine!

Resources:

Sports Injury Bulletin

Runner’s World

About.com – Sports Medicine

Journal of Athletic Training

University of California San Diego – Muscle Physiology

Brian Mac – Sports Coach

Paul Kulpinski is a licensed massage therapist, holistic wellness educator and co-founder of Mountain Waves Healing Arts in Flagstaff, Arizona. Information contained in this blog should not be taken as medical advice. Readers are advised to validate the information presented here with other sources including your personal physician for information specific to you.

Ski Season Safety

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SkierSki season is here once again with the scheduled opening of the Arizona Snowbowl tomorrow, December 17th!  While I’ve been skiing, both alpine and cross country for the past 35 years, this is my year to learn how to snowboard!  With that prospect comes the realization that I’m going to do a lot of falling and with that the potential for injury.  But how dangerous is skiing and boarding?   The results might surprise you.

Despite the high profile ski related deaths of celebrities over the past several years, only about 40 skiers on average die on the slopes each year, with even fewer borders meeting that fate.  Perhaps it’s what doesn’t kill you that we need to worry about.  Again, the reality is that with improvements in equipment injuries have been cut in half during the time that I first learned how to ski.

In an article published in the November 2009 issue of Sports Health:  A Multidisciplinary Approach, researchers who have studied skiing injuries for nearly 40 years debunk 12 myths about skiing injuries.  Some highlights include:

1. Myth: Skiing is among the most dangerous activities.
2. Myth: Buying new ski equipment is safer than renting.
3. Myth: Exercise can prevent skiing injuries
4. Myth: If you think you’re going to fall, just relax.
5. Myth: Formal ski instruction will make you safer.
6. Myth:  Children need plenty of room in ski boots for their growing feet.

Yet, there are some common factors to skiing injuries.  A study of risk factors was published in the September issue of the British Journal of Sports Medicine.  Some of the findings might surprise you and others are pretty obvious.

Factors in the “pretty obvious” category are:

1. Male skiers between 18 and 50 years old are most likely to be injured, especially those who are eager to get into challenging terrain like moguls and jumps (who would have guessed….)
2.  Drug use combined with skiing increases your risk of injury (I’m shocked….!)

I do find the factors that follow interesting because at first glance the risks might not be so obvious.

3.  Many injuries actually occurred while the skier was moving slowly.
4. Using new ski equipment
5. Skiing on “old” snow.
6.  Many injuries occurred late in the day when the skier was fatigued.

So if you’re planning to hit the slopes tomorrow, here are some things you can do to improve your safety.

1.  Have your equipment professionally fitted and set.  Don’t think that you can re-set your binding release settings yourself.
2. Warm up at the beginning of the day with some easy runs.
3. Rest when you are tired and fatigued and try to avoid that “one last run” mentality when your body says it’s time to hit the lodge for some hot chocolate.
4.  Probably most importantly, learn how to fall.

Yup, it’s that last one that I’m not looking forward to for myself in learning how to snowboard – but isn’t that what snow is all about?  It’s about getting down in it and rolling around!   Yeah, that’s what I’ll try to remember with each fall – right after the “Ouch”!

Sources:

British Journal of Sports Medicine

Sports Health: A Multidisciplinary Approach

Sports Medicine

Ski Knees

New York Times

Paul Kulpinski is a licensed massage therapist, holistic wellness educator and co-founder of Mountain Waves Healing Arts in Flagstaff, Arizona. Information contained in this blog should not be taken as medical advice. Readers are advised to validate the information presented here with other sources including your personal physician for information specific to you.

Football and Brain Injury

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Super Bowl 43 is less than a week away, an entertainment spectacle guaranteed to please from the commercials to the hard hitting action.  Maybe too hard hitting.  New reports surfaced this week linking the head traumas associated with playing football to a degenerative brain disease called Chronic Traumatic Encephalopathy (CTE).

Tom McHale a 45 year old former Tampa Bay Buccaneer who died last year, was the latest to be diagnosed post-mortem with CTE.  He is the sixth deceased former NFL player, aged 50 or younger,  to be diagnosed with CTE.  This has fueled the debate of the impact of football related head injuries, including concussions, on the long term brain health of players.

This is in addition to the number of former NFL players from the 60′s and 70′s who are still alive and suffering from dementia.   But the problem may start long before the players turn pro.

The Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine (BUSM) has discovered early stages of CTE in a deceased 18 year old football player who suffered multiple concussions while in high school.  This is the youngest person yet to be diagnosed with the disease.

Robert Cantu, MD, chief of Neurosurgery and director of Sports Medicine at Emerson Hospital in Concord, Mass, and clinical professor Neurosurgery at BUSM wrote the first “return to play” guidelines for players following a head injury.   In reference to the discovery of the 18 year old’s symptoms, he says  “Our efforts to educate athletes, coaches, and parents on the need to identify and rest concussions have only been moderately successful because people have been willing to look the other way when a child suffers a concussion. I hope the discovery of CTE in a child creates the urgency this issue needs. It is morally and ethically wrong to allow our children to voluntarily suffer this kind of brain trauma without taking the simple educational steps needed to protect them.”

Personally, I know of a couple of local families who have children playing high school football.  Recently, after receiving several concussions during games, one family noticed some initial cognitive impairment in their child and then wisely removed him from the team.

So as you watch the game this Sunday, whether you’re rooting for Arizona or the “other team”, keep in mind the true “impact” the game is having, not only on the players, but also on our children.

Sources:
Boston University (2009, January 27). Football And Progressive Brain Damage: Tom McHale Of NFL Suffered From Chronic Traumatic Encephalopathy When He Died In 2008. ScienceDaily. Retrieved January 28, 2009, from http://www.sciencedaily.com­ /releases/2009/01/090127165938.htm

http://www.nytimes.com/2009/01/28/sports/football/28brain.html?ref=health

http://www.nfl.com/

http://www.braininjury.com/injured.html

Paul Kulpinski is a licensed massage therapist, holistic wellness educator and co-founder of Mountain Waves Healing Arts in Flagstaff, Arizona. Information contained in this blog should not be taken as medical advice. Readers are advised to validate the information presented here with other sources including your personal physician for information specific to you.

Treating Muscle Injuries

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Neck and Shoulder PainImmediately after suffering a muscle injury, is it ice or heat?

The rule of thumb is captured in this acronym:  RICE.

Rest
Ice
Compression
Elevation

First, stop all activity that involves the the injured area to provide rest.  Second, apply ice for at least 20 minutes to reduce swelling that can cause secondary injury to the muscle fibers.  Apply compression with a wrap to the injured area to prevent swelling.  Finally elevate the injured area to prevent blood from pooling and creating additional swelling.

If you have severe pain, broken skin, or are unable to use the injured area at all, seek medical help immediately.

So when would you use heat?  Heat is useful in non-acute situations or after an injury is well into healing (usually after 72 hours).  Notice that the main intent of the RICE treatment is to reduce swelling.   Heat increases blood flow and swelling, so is counter productive with an acute injury.

Overworked, fatigued and tired muscles respond well to heat.  The additional blood flow helps to free up muscle fibers and increase movement for these conditions.   The key in using heat is to move the affected area by gently stretching or walking after the application of heat.  This helps prevent the return of the original condition after the heat is removed.

If you’re using heat as part of your rehabilitation of an injury (after the 72 hour acute phase), always follow up the application of heat with a round of ice therapy.

There’s more information on hot/cold packs available at Mountain Waves here.

Paul Kulpinski is a licensed massage therapist, holistic wellness educator and co-founder of Mountain Waves Healing Arts in Flagstaff, Arizona. Information contained in this blog should not be taken as medical advice. Readers are advised to validate the information presented here with other sources including your personal physician for information specific to you.