Managing Your Wrist Pain

Wrist pain will humble even the toughest of athletes.

With a painful wrist, suddenly simple tasks becomes painful.  Opening a door, picking up our kids and shaking hands becomes a painful event.

As a Sports Medicine Expert for Spartan Race, I write posts for fellow Spartan racers and SGX coaches related to important sports medicine topics.  Recent posts include topics such as injury prevention, rehab, injury management, smart workouts and heat illness.

Here’s a link to a recent post on Spartan.com to keep you “In the Game”!

Click Here For:  YOUR WRIST OWNERS MANUAL

Keeping you healthy, happy and a helluva lot easier to live with, Mike

Appreciating Assistant Athletic Trainers

John Norwig has the right to be proud.

Playoff football’s in the air. I’m here in Kansas City with NBC Sports’ Sunday Night Football crew to cover this weekend’s AFC divisional playoff game between the Kansas City Chiefs and the Pittsburgh Steelers.

Here’s one story line which probably won’t make the headlines: During Sunday’s clash at Arrowhead Stadium, Steelers’ long-time Head Athletic Trainer John Norwig will be working across the field from one of his former assistants Rick Burkholder, now the Chiefs’ Head Athletic Trainer.

Wait, it gets better.

Last weekend during Pittsburgh’s 30 – 12 Wildcard playoff win over Miami, John watched another one of his former assistants Ryan Grove at work on the opposing sideline. Grove is in his 3rd season as the Head Athletic Trainer for the Miami Dolphins.

By all accounts, this is the first time in NFL history two head athletic trainers (AT) faced their professional mentor in back to back games. Seeing it happen in playoff games makes it that much cooler.

Some may read this and say; “So what!”

I’m willing to bet those same individuals have never spent any time in an Athletic Training Room or had an injury requiring the care of a certified athletic trainer. If he/she had, they would have a greater appreciation for the skills needed to keep elite athletes healthy.

Being Grateful

I could not have done my job as the head athletic trainer/physical therapist for the Jacksonville Jaguars for 20 years without the efforts of my loyal and hard-working assistant athletic trainers. I owe much of my success and blessings to my talented assistants and interns who, from July to January, literally spent more time with me than we did with our own wives and children.

My assistants and interns were part of my family.

Every “head guy” in a professional or college settings will tell you the same thing: Assistant athletic trainers are the backbone of the day-to-day work needed to keep athletes safe.

My Reward

I was thrilled to see two of my assistants – John Burrell (Washington) and Joe Sheehan (Cleveland) – move on to become head athletic trainers in the NFL. They worked hard for the Jaguars and me and I owed them my very best efforts to help them succeed in reaching their professional goal of becoming an NFL head athletic trainer.

I firmly believe this responsibility also applied to interns who have proven themselves worthy of becoming full-time AT’s in the NFL.  An NFL internship is not an easy job. The low-paying position is filled with long thankless days and endless To Do lists.

I’m proud of my two former interns – Marco Zucconi (San Diego….I mean the Los Angeles Chargers) and Doug Quon (Washington) – who are employed as assistant AT’s in the league. A 2009 Professional Football Athletic Trainers Society (PFATS) survey of its members found 88% of head athletic trainers served as interns in the NFL and 86% of assistants were previously NFL interns.  Needless to say, an internship is a proven path into an NFL athletic training room.

Time For Athletic Trainers to Move On

A common goal for most head athletic trainers who truly appreciate and respect their assistants is to help their loyal protégés to move up the food chain.  That means helping their assistants to become a head athletic trainer in the NFL or the college ranks. It’s only fair.

Most of us who were fortunate enough to lead our departments previously worked as interns and assistants doing the same crappy jobs no one else wanted to do. Who do you think is cleaning the storage rooms late at night, packing the travel trunks, taping a majority of the ankles, bringing the injured rookie ice bags at 3 AM and setting up the road game athletic rooms at 5 AM? It’s the assistant athletic trainers!

When I asked John Norwig to describe his feelings when he looks across the field to see his former assistants in the role of head AT in the NFL, his reply was filled with passion and admiration. It’s a common trait of John, which makes him so genuine and likeable. “Proud,” Norwig replied, “I’m so proud to have helped them become successful.”

I think Rick Burkholder, Chiefs’ Head Athletic Trainer and current President of the Professional Athletic Trainers Society (PFATS) says it best; “Assistant athletic trainers are the life blood of the sports medicine teams in the NFL.

Like Rick, I was an assistant in the NFL before I headed south to join the expansion Jaguars in 1994. I was so fortunate to learn and grow under the guidance of my mentor and friend Ronnie Barnes with the New York Giants for 6 amazing years.  It was a wonderful opportunity for me and I’m forever grateful to Ronnie for his trust and guidance.

Stay the Course

I applaud assistant athletic trainers at all levels of sports medicine. You work extremely hard for others. It may not seem like it at times but everyone from the head AT’s, players, coaches, families and co-workers see your tremendous efforts and appreciate the positive impact you have on your athletes.

Assistant athletic trainers Note-to-Self:  WHEN you become a head athletic trainer, take care of your assistants and help prepare them to someday move up the food chain as you have done.

Inside the NFL Concussion Protocol

football-pro-21561452_1920You hear it every Sunday, watching an NFL player escorted to the locker room after taking a big hit to the head: “He’s in the NFL concussion protocol”.

Concussions increased by 58% in the 2015 regular season games compared to 2014.  There were 182 reported concussions in NFL regular season games last season.

Game Day Concussion Questions

How are the players evaluated in such a chaotic environment? Who makes the call to determined if the player returns to the game or to hit the showers?  These questions remain a mystery for most NFL fans.

Let me share with you what the NFL game day concussion management plan looks like from inside the NFL medical departments.

Player takes a concerning hit the head….

Step 1:  Intervene

The team medical staff is notified of a potential head injury by themselves, the player, the ATC Spotter(s) in the skybox, teammate, game official, or coach.

Step 2:  Screen

Player is removed from the game and a sidelines evaluation is initiated.  This involves at least one of the team physicians and the Unaffiliated Neurotrauma Consultant (UNC).  The UNC is easy to spot, sporting the now mandatory blue hat.  Typically a team athletic trainer is included in this discussion as well.  The medical staff has access to the sideline Injury Video Review System monitor.  This allows the medical staff to visually review slow-motion angles of the injury play.

Step 3:  Decide

If no concussion, neck injury or concerning injury is confirmed, the player is cleared by the team physician to return to the game.  If the medical staff and UNC have any concern for a potential concussion, the player is escorted to the locker room with the UNC.  When the injured player leaves the field with the UNC for a concussion evaluation, by definition, he is now “in the NFL Concussion Protocol”.

Step 4:  Evaluate

Now in the quiet team Athletic Training Room and away from the stimulus-heavy game field, the UNC and team medical staff performs a more comprehensive neurological evaluation.  This phase of the assessment includes a sophisticated concussion tablet-based test.  This test takes approximately 10 minutes to complete.  Every NFL player has taken this test previously during the non-contact off-season.

This tablet concussion test grades key brain variables such as visual memory, processing speed and reaction speed along with assessing concussion-like symptoms.  The player’s new game day grades are compared to his previous baseline test scores to quickly determine if his brain functions have been altered in any way.

Step 5:  Diagnose

Based on the results of the tablet concussion test scores, physical examination tests such as balance, eye tracking and verbal recall and the subjective feedback from the player, the team physician and UNC will answer one simple question: “Does the player have a concussion?”

  • If the answer is YES:  The player is ruled “Out” for the game and he remains in the locker room area accompanied by a medical staff member.
  • If the answer is NO:  The player is allowed to return to the sideline for continued evaluation, skill drills and discussions with the medical staff about his symptoms and his play status.

Return to Play?

The ultimate decision on the NFL player’s return to play status is not made solely by the Unaffiliated Neurotraauma Consultant.  The final call on whether the player is given back his helmet and allowed to return to the game is made by the Head Team Physician and, ultimately, the player himself.

 

 

 

Spartan Race Recovery Made Easy

Spartan Asheville 8-2016 cI competed in the Asheville (NC) Super Spartan Race with my buddies last weekend. From the 7 hour ride north with my friends, to the jokes at the rental house to the tough race itself, it was a great time for all of us. Now it’s time to focus on my Spartan race recovery.

It was a great race loaded with challenging obstacles, amazing athletes and all the passion that makes Spartan Races so special.

Getting out of the car after the 7-hour ride back home to Ponte Vedra Beach, FL, two things were crystal clear to me:

  1. I’ll be racing plenty of Spartan Races in the near future.
  2. I will be stiff and sore in the morning.

After 26 years as a physical therapist/athletic trainer in the National Football League, a certified Spartan SGX Coach and a veteran mud racer, I’ve learned plenty of sports medicine tricks to accelerate an athlete’s recovery.

I’d like to share some of those Spartan Race recovery tips with my fellow Spartans.

Why am I sore?

I think we’d all agree that obstacle racing isn’t easy. Reflecting back on your race, you may focus on the obstacles themselves but there are plenty of elements during a Spartan Race which factor into why you’re walking like 70 year old on broken glass the next morning!

  • Soft tissue inflammation – from prolonged stress on tendons, muscles, ligaments and fascia.
  • Scrapes, scratches and bruises – from climbing, crawling and falling.
  • Increased joint stress – arches, ankles, knees, hips, low back, necks, shoulders, elbows, wrists and fingers are all stressed with ever yard on ever-changing surfaces.
  • Lactic acid  – your body’s “exhaust” or waste product produced during intense muscle activity.

Sports Medicine Tips to Accelerate your Spartan Race Recovery

Joint Motion – Almost all 360 joints in your body are used in an obstacle course race. Many of those joints were stretches and twisted in a very different manner than how they move during your 9-5 job. During your recovery, simple and slow stretches and movements from your neck to your big toe will enhance vital inner-joint lubrication and help restore normal joint motion.

Hydrate & Eat Healthy– Drinking lots of water with healthy foods will help your body flush out the “bad stuff” while replacing the “good stuff” such as inner muscle fluids, healthy calories, sodium (salt) and important electrolytes.

Drain your Legs – Elevate your legs straight up in the air for 5-10 minutes while pumping your ankles and toes 3x/day.  Gravity was not your friend in the race but now it’s time to take advantage of gravity to help your lymphatic system to drain “the bad stuff” from your loyal legs.

Just Run – “What?!”  Trust me on this one….running the next day after a race is a key part of your recovery.  It only needs to be an easy 1 mile trot on the soccer field or a 10 minutes of light side-shuffles and agility drills in the back yard. Your legs will thank you two days from now.

Massage and Stretch – Get your feet, legs, hips and low back massaged and stretched as soon as possible to minimize the amount of waste products from embedded in the membranes of your muscles.

Ice and Compression Are Your Best Friends – Sure Ice hurts but ice a valuable tool for serious athletes training and racing hard.  If you have localized pain or swelling in a muscle or joint, ice the area for 15 minutes followed by a compression sleeve.

Wound Care – Like friendly reminders, the flesh wounds are there. They range from simple scrapes to the deep cuts to the bloody blisters to “where-did-that-come-from?” battle marks. Take care of open wounds quickly to avoid complications by cleaning the open wounds thoroughly with soap & water, applying an antibiotic ointment and, if needed, covering them with a sterile dressing.

Spartans Heal Fast

Doing a better job with your Spartan Race recovery will get you back to what you want to do: Living a healthy and active lifestyle. Challenges await you and having a plan of attack for the aches and pains that come with those challenges will surely make you stronger.

AROO!

Avoid Sports Injuries With 1 Simple Question

Tire big 87I flipped a giant tire today during my Spartan workout.  Flipped, as in singular.  One.  Uno.  Eins.  Once was enough. I’m allergic to sports injuries.

I didn’t need to flip it a second or a third time for both the physical therapist and the athlete in me to know the risk of an injury with this exercise was way too high.  I had plenty of other safer leg and low back strengthening exercises in my daily workout routine.  Checking my ego at the door while keeping my body injury-free was a much smarter plan than trying to keep pace with the impressively tough athletes I workout with, many of which are half my age.

“Fun”-ctional Fitness?

I quickly dropped my butt low and aggressively dug my fingers under the black beast as it angrily tried to anchor itself to the humid Florida asphalt. I hadn’t flipped a 400 lbs tire in about 15 years but I was ready!  Under the eager watch of my Spartan Race buddies, I pried the rubber behemoth from its nest with a loud groan and awkwardly wrestled it upward.  My low back creaked, my hips moaned and my knees griped as the round monster slowly rose to its tread.  As I thrust the dominated creature onto it’s back as it moaned a hollow “thud”, I convincingly announced: “….last #*@% time I’ll do THAT!”

Painful Hindsight

How many times have you injured yourself only to regretfully say: “What was I thinking?”  It’s a frustrating predicament and, as we age and hopefully we get wiser, it’s a situation we eagerly try to avoid.

Avoiding Sports Injuries Start With One Question

My solution: Before engaging in a new exercise, activity or event I ask myself one powerful question:

“Is the RISK worth the REWARD?”

It’s that simple.  Only you can answer the question because only you have to live with the outcome.  For me, the reward of flipping a tire was minimal because the risk of an injury was at way too high of a cost.  It was an easy answer for me.

Reward Outweigh Your Risk of a Sports Injury?

Looking back at previous injuries in your life, how would you have answered the Risk – Reward question prior to the injury?  With some overuse injuries or freak accidents there is no way to predict something in your body was going to tweak, pop or tear.  But more times than not, we do have an opportunity to alter our path to the doctor’s office.

Ask the Question

By no means am I trying to divert any of us away from cross training workouts to avoid all risk.  Lord knows most couches in today’s society have reached their seating capacity!  My message is to think before you blindly jump into new exercises or workouts to help reduce your risk of an injury.  Asking yourself the powerful Risk – Reward question before you start will help you avoid careless injuries as you gain strength and conditioning while you enhance your health.

Smart Exercises

Maximizing the long-term benefits of your workouts starts with avoiding sports injuries.  As you increase the volume of your workout routines, it’s wise to substitute lower risk activities for higher risk exercises such as tire flipping.

Here are some smarter alternatives for athletes interested in reducing the risk of more aggressive exercises:

   Higher Risk     >>     Lower Risk

Tire Flipping   >>   Body Squats, Kettle Bell Swings, Med Ball Wall Throws

Box Jumps   >>   Lunges, Burpees, Star Jumps, One-Legged Box Squats

Dead Lifts   >>   Wall Sits, Dumbbell Cleans, Bear Crawls

Hanging Knee Tucks   >>   Crunches, Leg Flutters, Med Ball Throws

The Bottom Line

Asking yourself the question “Is the RISK worth the REWARD?” before major changes in your workout and your life can help you avoid sports injuries and heartache.  It’s a simple way to help you to stay in the game of life by saving you pain, $$, stress, downtime and sleep.   MDR

Thanks for sharing this blog with active friends like you!

Simplify Your Health and Wellness

Image Source: Pixabay

How many of us overthink our wellness, fitness exercises and health maintenance plans?

“Guilty as charged!”

Wake-up Call

I’m writing this blog post from the deck at a special friend of mine’s cabin on Washington Island overlooking Lake Michigan while on vacation with my loving wife and our two active young children; my son is 7 years old and daughter is 5 years old.  It’s been an awesome vacation for all of us.  No phone reception but plenty of wildlife, fresh cool air and the time to run, explore, exercise and play in the cold lake waters.

What does this have to do with sports medicine?” you’re saying to yourself.  Plenty….it has everything to do with enhancing our health and wellness in the simplest of ways.

Value of High-Tech?

I’m here in the woods with no fancy gym, no high-tech workout equipment, no warm ocean waters for long-distance swims, no tough-guy workout buddies or 90+ degree heat/high humidity weather to sweat my butt off in.

Instead, I’m in the beautiful wilderness with long days to have fun with my family while mixing in my daily workouts.  Brag time: my wife Samantha is a 2x Ironman triathlete so I’m certainly not the only parent in our home focussing on fun and fitness with our children!

Keeping it Simple

So much of our professional lives are busy and complicated yet we can’t do a damn thing about it.  With that being said, why do we choose to make our wellness/health/fitness plans equally as complicated?

It’s times like this vacation that wake me up to the reality that I need to lighten-up on my over-thinking and tighten-up my intensity on getting stronger, better conditioned and more limber.

“Simplicity is the ultimate sophistication.” ~ Leonardo da Vinci 

What I Learned at Summer Camp

I don’t need fancy equipment to kick my own ass to get a legitimate workout.  I simply used what I had access to while adding in a combo of creativity, grit and a playful attitude.

  • Logs to cut, lift and carry.
  • 52 degree lake water to swim and recover.
  • Rolling country roads to run and bike.
  • Trees for TRX, pull-ups and stretches
  • Children for resisted carries, pushups and shoulder presses.
  • Fields for burpees, crawls, planks, lunges, star jumps, crunches, agility drills and sprints.
  • Picnic tables for box jumps, dips and low crawls.
  • And my favorite training partner was here waiting for me: Mr. Gravity

Tips to Simplify our Healthy

Eat Better – More plants, veggies, water, fruits and lean meats.

Simplify – Add simple wellness exercises to your routine that force you to work hard for long periods of time while opening up your joints and muscles like crawling, rock climbing and  swimming.

Play Games – Smart phone off, smile on and sweat glands on…..playing fun sports like a teenager.

Do More – Change at least 50% of your present exercise routine, stop counting reps and shorten rest phases while focusing on generating lots of muscle fatigue, not joint pain.

Stop Feeling Sorry for Ourselves – Hundreds of millions of people with handicaps and injuries can only dream of having the physical abilities that we presently have.  Therefore, we all need to stop feeling sorry for ourselves so we can maximize the healthy blessings we currently have.  Amen.

Recovery Harder – If it hurts, ice it.  If it’s tight, stretch it. If it’s stiff, move it.

Set Hefty Goals Then Quickly Share Them – Dream bigger than big to set a physical goal(s) that will change your life. Before your find the how’s or the “what if’s” creep in, quickly post your goal on FaceBook and email your family and friends with the details so they will hold you to that goal.  Sure you’ll have sweaty palms typing the words but that person looking back at you in the full-length mirror will thank you for the rest of your life.

It’s time to get busy….

Microfracture Surgery for NFL Players

Source: Pixabay

As we await for the bright lights to begin Round 2 of the 2016 NFL Draft, the big looming medical question on the minds of the football fans is:  Will UCLA’s star linebacker Myles Jack’s knee injury negatively impact his career in the NFL and will he need microfracture surgery?  Everyone agrees that his knee was the reason he remains un-drafted after the 1st round.

The issue needing clarity relates to the potential need for a microfracture surgery on Myles’ injured right knee.  The whispers regarding such a procedure quickly became screams when Myles himself reported that he may require microfracture in the future.

Jack has not played since his September 2015 knee injury that required a repair, not simply a trim, of the lateral meniscus cartilage in his right knee.  A meniscus injury is not unusual in football but two key elements make his particular injury concerning to NFL teams.

  1. His injury involves the lateral or outside meniscus.  This lateral “compartment” bears more weight than the medial or inner compartment, therefore, it is often more symptomatic when injured.
  2. A repaired meniscus is less common for football players compared to the typical “trimming” of a torn meniscus.  Only a small area of the meniscus cartilage actually has a blood supply so that is the only part of the tissues that actually has the potential to heal.  Repairing the meniscus is wonderful, in theory, because it preserves the all-important meniscus.  With that being said, if the repaired cartilage fails to heal or is reinjured, the results are concerning.

Pothole in a Joint…Needing Microfracture Surgery

Unrelated to the meniscus cartilage, the articular cartilage at the ends of bones that come into contact with each other to form the knee joint is smooth and solid.  The slick surface of the articular cartilage protects it’s underlying bone, which has both a blood supply and nerves.

When the articular cartilage is damaged, from a high-force trauma or over time with arthritic changes, the articular cartilage can break away exposing the bone to the joint surface.  Unprotected and exposed bone in a joint is painful.  It often bleeds into the joint resulting in a chronically painful and swollen knee.

A defect in the articular cartilage and bone is similar to having a small pothole in the road.  The remainder of the road is fine and you can still drive your car over the hole.  Both the size and location of that pothole will ultimately determine how deep and impactful that pothole becomes.

Only when excessive pain and/or impaired function of the joint cannot be controlled by standard physical therapy techniques, will a microfracture procedure be considered as an option.  Microfracture surgery is an aggressive procedure and its rehabilitation is extensive.  In other words, no one rushes into a microfracture procedure until it is absolutely necessary because the recovery is long and the outcome is undoubtably cloudy.

What is Microfracture Surgery?

Don’t confuse the simplicity of the procedure with the complexity of the healing steps following a microfracture surgery.  The surgical procedure is almost barbaric in nature.  It consists of picking and drilling into the exposed bone in the base of the articular cartilage “pothole” with one simple objective: promote the bone to bleed to stimulate a healing response.

The healing, stated in very simple terms, consists of the production of a different type of cartilage to fill in the existing hole in the articular cartilage.  This new filler is mostly fibrocartilage, similar to the cartilage in your external ears and the tip of your nose.  It is not as strong or as smooth as the original articular cartilage.  If given ample time and the appropriate physical therapy care, the new pothole filler serves a valuable role.  It can improve both the mechanics and the symptoms of the injured knee.

Recovery From NFL Knee Surgery

A common myth with microfracture surgery is a lengthly recovery but the athletes will recovery 100%.  I’ve rehabbed dozens of NFL players following microfracture surgery and I can tell you that the first part of that myth is true.  The athletes are not allowed to put any weight on the injured leg for 6 to 12 weeks.  The rehab protocol is slow and methodical for good reason: the healing of that pothole is #1 factor related to a healthy knee 6 months after the surgery.

As for the outcome, it ranges greatly based on the size of the athlete, the extent of the lesion and the length of time since the initial injury.  With that being said, with the players that I have been fortunate enough to rehab following microfracture surgery I have never had a player tell me that he was ever greater than 90% of his pre-injury abilities.

In closing, knee microfracture surgery is a proven technique to improve the function of a damaged joint for high-level athletes like NFL players.  It is not an option for every knee injury nor is the decision to perform the procedure ever rushed into.  Lastly, when the surgery is performed, the recovery is long and the end results are optimistic yet always in question.

Calf Strain: A Running & Jumping Athlete’s Nightmare

Source: Pixabay
Source: Pixabay

He sits on the bench with an ice bag on the back of his lower leg.  A calf strain is a common sight with athletes young and old.  Everyone wants to know why.

Looking at athletes at every level of athletics, calf strains have become the Great Equalizer. It’s an injury that is way too prevalent.  One of my favorite running buddies is wrestling with a strained calf and I know, as both a certified athletic trainer and a competitive athlete, calf injuries suck!

In the NFL, last year was a bad year for injuries to the calf.  Fans, coaches and players were frustrated to consistently see way too many calf injuries on the NFL injury reports each week.  These slow-healing injuries negatively impacted NFL fantasy football rockstars like Victor Cruz (NYG), Crockett Gillmore (Balt) and Sammy Watkins (Buff).

The hamstrings on the back of the thigh get all the hype when it comes to what we call “soft tissue injuries” in the NFL.  But when you ask skilled players like wide receivers, running back and defensive backs what muscle injury frustrates them the most, calves and groins typically head up that list.

What is a Calf?

A small cow?  Yes, but that’s not important right now.Calf cow 22

The “calf” or calves (plural) is made of two long muscles on the back of the shin bones.  The gastrocnemius or “gastroc” is the bigger of the two muscles and it’s the more superficial of the two.  When you look at a calf “belly,” you’re looking at the gastroc.  It starts from two tendons above the back of the knee and it extends over the backside of the knee and anchors into the top of the Achilles tendon.

The deeper of the two calf muscles is the soleus.  It starts below the knee and it extends downward joining the gastroc at the top of the Achilles tendon.

Simply stated, the two calf muscles merge together to form the Achilles tendon, which we know attaches to the heel bone below the ankle.

The next time you look at a fast player’s calves, you’ll notice that most of these skilled players will have smaller muscle bellies that tend to be closer to the knees.  The bigger, slower players will typically demonstrate a bigger and lower gastrocs.

What Does the Calf Do?

Here comes the fun part.  The calf is not a big or powerful muscle but it’s a very important muscle group.  When running or pushing, the calf transfers all of the power from the legs, hips and back to the ground in a timely manner.  If the timing of that transfer of power changes ever so slightly, which can easily happen due to injury, fatigue, change in the surface area and/or a change in body mechanics, the calf muscle(s) can tear.

Because the calf crosses both the knee joint and the ankle joint via the Achilles, it raises the heel when running and it assists in bending the knee.  Both of these actions are vital when running fast and changing directions.  THAT’s why a calf strain can quickly bring fast players to a screeching halt.

What to Do When a Calf Goes Pop

Tear = strain = pull

When a muscle is injured, the small muscle fibers that make up the muscle belly pop or tear similar to cutting small rubber bands.  The more fibers that tear, the worse the injury. These fibers have a blood and nerve supply so when muscle fibers tear, they bleed into the wound and create pain.

NFL fans saw first hand in the 2014-15 playoffs how Aaron Rodgers’ ability to move and throw quickly changed because of his calf strain.

Initially, an injured calf muscle needs more rest than it needs fancy physical therapy techniques.  Scar tissue is a calf’s best friend.  Scar tissue fills that new injury wound/hole in the muscle and, in a sense, pulls the healthy fibers together.  A common mistake in aggressive sports medicine settings is to over-treat a calf strain by doing too much too soon.  As with a fresh calf injury, being too aggressive early will cause more bleeding, more pain, weaker scar tissue and a longer recovery.  NFL players are in great hands because NFL athletic trainers are exceptional at properly treating these injuries.

I strained my calf three times within two months as I trained for an Ironman triathlon in Austria in 2009.  It was a frustrating and painful injury for me.  It proved to be very valuable for me as an athletic trainer and physical therapist.  It positively changed how I treat NFL players with calf strains.

Truth be told: Rehabbing athletes is much more enjoyable than rehabbing yourself!

The Bottom Line for a Calf Strain

Calf muscles heal slowly.

The key physical therapy pearl that I learned from rehabbing my own calf and dozens of NFL calf strains since then:  When you think the athlete’s calf is ready to return to full speed with no limitations, give the healing calf one more week.  Your calf will thank you.

Eliminating Your Pain: Finding Your CONTROL – ALT – DELETE

control alt delete 28When your computer locks up, what do you do?  The CONTROL – ALT – DELETE key combo is probably your go-to plan to put your computer back in business.  How cool would it be if you could quickly fix your body when unexpectedly pain locks you up?

I’m here to tell you that you can do just that!

Unwelcome Guests

We all get them so it shouldn’t come as a surprise to any of us.  Their disguises may vary while their locations tend to be a bit more consistent.  Meanwhile, they are rarely welcome and we never quite know when they plan on leaving.

Who are these mystery intruders?  They have many name such as aches, stiffness, joint catching, shooting pain, throbbing, spasms, stabbing tendon pain and/or deep-bone pain.  Do any of those different forms of pain sound all too familiar?

Onset of Pain

Some of these mild to moderate pains, although not enjoyable by any means, can be justified based on your history.  An old injury or surgery can add merit to why a joint is stiff or why a muscle is not as strong as its counterpart on the  other side of your body.

But what about the sudden stabbing pain in the front of the shoulder when you reach into the frig to grab the milk or when your kneecap catches as you bend down to pick up your shoes?  An injury is almost understandable when it occurs while you lift a heavy weight or run hard up a hill but “…how can I hurt my damn back just sitting at my desk?!”  Those are the pains that frustrate us; athletes and non-athletes alike.

Injury vs Pain

If you have a legitimate injury, get it checked out by a sports doctor, physical therapist or certified athletic trainer.  These quick fixes I’m about to tell you about don’t pertain to serious injuries.  If you’re dealing with a mild to moderate pain, as noted above, you may be able to eliminated it quickly and effectively.

Delving into a deep sports medicine diagnosing injury lesson is well beyond the scope of this article.  Keeping it simple: If your pain started without involving an accident of any sort, a significant change in your activity level and/or is not accompanied by swelling/redness and/or an increased warmth in the area of pain, you might be able to promptly improve your symptoms.

If you have any questions or concerns about your symptoms, see your doctor ASAP and get a firm handle on your injury.

Finding Your CONTROL – ALT – DELETE

When my shoulders hurt, somewhat common after many bike crashes, falls and a shoulder surgery, my Go To Fix-It move is: Pushups.  90% of my shoulder throbbing, stabbing and impingement pain will disappear after a quick set of 25 pushups.  I’m literally smiling as I type this because I love pushups!  They are my shoulder CONTROL – ALT – DELETE solution.

I personally have six (6) of these body pain eliminating routines in my personal toolbox which are awesome quick-fixes for my many orthopedic ailments.  They take no more than 5 minutes to complete and they keep me very active, almost pain-free and, as my wife will agree with, much easier to live with.

My question to you: What are your CONTROL – ALT – DELETE’s?

Tips to Finding Your CONTROL – ALT – DELETE’s

Go With What Works – what have you done in the past that helped you with this type of pain with this joint/body part?  Start with what has worked in the past and work on modifying your technique to improve it’s effectiveness and prolong its benefits.

Stop Looking for the Why – When in pain, the WHY is far less important than the HOW.  Eliminate your pain now and worry about your selfie-in-pain FB picture later.

Bilateral Movements – Your body likes balance.  Doing bilateral (both sides of your body) movements like twists, double arm stretches, bike riding, arm circles and crunches are typically the best moves to start with.

Slow Movements & Deep Breaths – Unless you’re a chiropractor, keep all you movements slow and methodical.  Slow and deep breathing relaxes your body and allows you to listen to the message your body is sending to you, be them good or bad.  Remember, you’re trying to “reset” your body to be balanced and pain-free so allowing for ample time in these new positions is crucial.

Posture, Posture, Posture – Poor posture is a very common source of pain in adults.  Viewing front, side and back photos of you standing and sitting will quickly show visual cues to problem areas in your body.  Focus on stretching stronger/short muscles and strengthening weaker/longer muscles.  Head and neck posture is a common problem in our sit-friendly society.

Examples of Simple Pain Eliminating Solutions

Shoulder Pain – Pushups, door stretches, resisted external rotations, ice massage, thumb-up dumbbell side raises, pool water movements, and seated rows.

Low Back Pain – Crunches, hamstring stretches, laying on hard floor with pillows under knees, hip flexor stretches, bike riding, groin stretches, rolling tennis ball into front/side of hip, Yoga downdog stretches and double arm pull-up bar hangs.

Knee Pain – Roller on front/side of quads, quad stretches, controlled quad strengthening, ice massage, hamstring stretches, massaging and mobilizing kneecap, hip flexor stretches, wall sits, Yoga downdog stretches and bike riding.

Ankle Pain/Heel Pain – Yoga down dog stretches, barefoot walking on soft surfaces, arch & calf massage, ice massage, duck walks on grass on heels only, resisted ankle motion: outward and upward, eliminate shoes with moderate to high heels, picking up marbles/rocks with toes and a heel lift if legs are not equal length.

Key Point to Remember

Your body does not want to be in pain.  Your objective for this endeavor is to put your symptomatic body part(s) in a position which is pain-free and strong to allow your body and mind to reprogram all your associated muscles, tendons, joint capsules and fascia to maintain this “happy place” allowing you to move with less resistance and less pain. Period.

I know this concept sounds very different from the all too common; “medicate to reduce pain” philosophy.  Personally, my physical therapy motto is simple:  Trust your body to know what it needs to do its job!

Being active and healthy is NOT a passive process.   There’s no better time than now to get busy eliminating your pain so you can get busy living.

Self-Care Tips for Athletes with Joint Swelling

Source: Pixabay

I saw a physical therapy patient this week with a chronic knee injury.  His knee was swollen and stiff, much more than normal.  I know his knee well and it typically has only mild swelling with good muscle tone.  His diagnosis is Grade 1 chondromalacia or irritation behind his kneecap.  It’s an issue which most of us, myself included, over 30 years old commonly have behind our patella or kneecaps.

Puzzled with how his knee looked, I asked: “What have you done to make your knee so cranky?”  “Nothing different Doc,” the 42 year old cross-trainer said frustratingly, “Same damn workouts I’ve done for the past 6-7 weeks.”

Here comes my big question: “What did you do after your workouts in regards to cooling down, rollers, stretching and ice?

There it is….the look of a cow looking at a new fence post!

The answer was clear even before he embarrassingly replied: “I didn’t do anything…I didn’t have time.”  It’s a lame excuse and a common practice for athletes of all ages.  It’s my mission with MikeRyanSportsMedicine.com to change that mindset and behavior.

The Truth about Joint Swelling

There are many sources of joint swelling or effusion.  The extra fluid inside a joint can come from the inner lining of the joint, the bone itself or from an infection.

It’s much easier and less painful to keep swelling out of a joint than it is to get the swelling out of a swollen joint.

The important part to note here is to minimize the reason for the swelling instead of trying to convince your body to reabsorb the fluids after they have filled the joint.  I think of process as similar to a flooded bathroom: fixing the leaky pipe under the sink is a much easier solution than mopping up 20 gallons of water covering the floor and soaked under the cabinets.

Tips to Control Joint Effusion

  1. Roll – using a roller on your muscles before and after a workout is a simple relax muscles and to allow your joints to move normally and to do their job.
  2. Stretch – Five minutes of lengthening muscles and fascia before and after a workout improves blood flow and promotes the drainage of waste products from your hard-working muscles.
  3. IceIce is your best friend so start spending more time with it.  If a joint or soft tissue is either overly warm, red in color or sore after a workout, ice it for 10-15 minutes.  Ice quickly decreases the metabolism or joint activity while also decreasing pain.  Both are important.
  4. Posture – As most of us do after our workouts, sitting in a car or at a desk for prolonged periods of time is not good for our spine or joints.  Sitting shortens some of our major muscle groups like our hip flexors and chest muscles. If you have to sit after a workout, make a point to do some of the following:
  • Use perfect spine posture
  • Consistently engage your core muscles
  • Kneel on one knee every 20-30 minutes
  • Sit on a large therapy ball instead of a chair
  • Get up every 20-30 minutes to stretch hamstrings, hip flexors and chest muscles

These are simple steps which don’t require much time or effort. Keeping our bodies healthy is important for many reasons.  Controlling inflammation and swelling should be a top priority for athletes with the common bumps & bruises and wear & tear that comes along with aging and the sports we love.