By: Dr. Hillel Z. Harris, M.D.
Every athlete will inevitably suffer some type of injury. The goal, of course, is to reduce the chances of this occurring. What are the factors that predispose towards injury, and what can be done to lessen the chances of one occurring? What happens inside the body during injury, and what types of things can one do during that time? Finally, what is the best way to recover?
Lack of adequate rest both from limited sleep and limited recovery time between training sessions can predispose to injury. Muscles undergo intense breakdown and rebuilding after exercise. If the body is asked to perform at an intensity or duration that pushes itself past its comfort zone, it will break down. It is usually the weakest link that becomes disrupted, whether it’s a muscle, a tendon, or a ligament. These 3 structures are referred to as the soft tissues.
Soft tissue injuries are some of the most common injuries, and will often occur in areas of previous tightness. They include diagnoses such as “strain” or “sprain”, or colloquially as a “pull”. For this reason, it is important to loosen up the soft tissues prior to exercise.
Foam rolling for a few minutes works well to prepare the soft tissues for exercise. A dynamic warm-up has been shown to promote better performance than traditional static stretching, which instead should be performed after exercise. A dynamic warm up may include lunging across a floor, high knees, or hops. An additional benefit from this type of warm up is the promotion of neuromuscular connections. The body “rehearses” how to fire the neurons that cause muscle contraction, so that when it is called to do so during exercise or competition, it is more efficient at doing so.
If an injury occurs, the area swells. This is caused by a rush of inflammatory cells and blood racing to limit the scope of damage. Cells such as cytokines and interleukins attempt to debride and rebuild the area affected. These cells are pro-inflammatory. This cascade of inflammation leads to an increase in the metabolic rate, thereby leading to increased nutritional requirements. It at this point in time that it becomes even more important to incorporate adequate nutrition, especially protein and hydration.
Common over the counter anti-inflammatory medications, also called NSAIDs, are often prescribed or taken during recovery. However, there is some evidence that this longstanding treatment may not be as helpful as once believed. The reason is that NSAIDs can inhibit some of the natural pro-inflammatory innate responses that occur. While decreasing swelling through icing is usually prescribed, this too has come into question. It is now believed that early heat therapy can promote enhanced healing as well.
One of the best ways to recover from injury is by getting treatment from an Athletic Trainer (AT). ATs can promote early return to sports through a combination of movements increasing blood flow to the affected area, clearing debris, and rebuilding strength. This is done by direct pressure, resistance contraction, and isolated stretching.
Additionally, rebuilding the neuromuscular connections through balance training re-teaches muscle memory. Commonly, the cause of injury is a tight tendon or ligament adjacent to the injured area, and therapy will target these areas of tightness. Beginning with light resistance exercises and eventually progressing to full strength, athletic therapy can return an even greater range of motion to the affected part than what was present previously. This leads to an impressive earlier than expected return to sports, and stronger supportive tissues less likely to break down in the future.
Dr. Hillel Harris, M.D. and his staff of Athletic Trainers treat athletes and all patients at The Sports ER and Urgent Care Center in Boca Raton, FL. Dr. Harris has been practicing emergency medicine at JFK Medical Center since 2009. He taught snowboarding for the United States Snowboard Association, coached the Breckenridge Snowboard Team, and has taught tennis for the United States Professional Tennis Registry.