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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Man to Man Man to Man

Don't Be Sidelined By Exercise Injuries

January 24, 2013

By Harvey B. Simon M.D.

Harvard Medical School

On many days, reading the sports page can feel like reading The New England Journal of Medicine. Exercise puts the body under stress, and stress can lead to injury. It's all in a day's work for competitive athletes, but ordinary guys get hurt, too. The good news is that you can prevent many exercise-induced injuries. And even when prevention fails, you can handle common problems on your own.

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How Common Are Exercise-Related Injuries?

A study of 6,313 adults who exercised regularly found that 21% developed an exercise-related injury during the course of a year. Two-thirds involved the legs; the knee was the most frequently injured joint.

Don't forget...

Before you start an exercise program see your doctor for a check-up. Exercise rarely triggers serious heart problems, but if you have chest pain, a racing or erratic pulse, shortness of breath, and light-headedness during a workout, get help immediately or call 9-1-1.

It sounds grim, but it's not. First, injuries are much more common with intense exercise and competitive sports than with moderate exercise for health. Second, people who exercise actually have a lower long-term risk of disability than sedentary people. A 13-year study of 370 exercisers ages 50 to 72, for example, found that exercise was linked to less risk of disability and a lower death rate, even among older folks who ran, which is a high-impact activity.

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Preventing Injuries

Here are a few key tips for preventing injuries when you exercise:

  • Get into shape slowly. Don't be a "weekend warrior" who exercises intensely on the weekends without proper conditioning. It's a growing problem, particularly as Baby Boomers come of age. In fact, doctors have coined a new diagnosis for the issue called "boomeritis." Use a graded exercise program to get into shape gradually, and then stay in shape the year round.
  • Warm up before each exercise session and cool down afterwards.
  • Stretch regularly. Exercise makes muscles strong. But they also get tight and short. Stretching keeps you flexible and reduces the risk of injury.
  • Use good equipment. It's particularly important to have supportive, well-fitting shoes for weight-bearing activities.
  • Use good technique. A few lessons or a little coaching can improve your mechanics as well as your performance.
  • Don't overdo it. Fatigue and dehydration sap concentration, which can lead to a misstep or fall. Overuse is the major cause of injuries; give your body a chance to rest and recover after workouts, particularly when you're first getting into shape. Alternate strenuous sessions with easier ones. Vary your routine so that you use different parts of your body. For example, walk one day, play tennis the next, and garden the third. A day off now and then doesn't hurt either.

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Spot Problems Early

If you can't prevent injury early detection is the next line of defense. A bit of soreness and stiffness is normal, but pain, swelling, diminished strength or mobility, and discoloration of the skin is not. Spot small problems before they become big ones. If your problem seems small, treat it yourself. But if you don't improve — or if you have a major injury — get expert help.

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The PRICE Is Right

Treat minor injuries yourself using a 5-point program called PRICE: Protection, Rest, Ice, Compression and Elevation.

  • Protection – Injured tissues must be protected against further injury. Apply bandages, elastic wraps or simple splints. Something as simple as taping an injured toe to its healthy neighbor can do the job. See your doctor for problems that require precision splints or casts.
  • Rest – Give injured tissues time to heal. It seems obvious, but once you're hooked on exercise you may be tempted to ignore the advice. Don't give in to temptation — you'll shortchange yourself with shortcuts. Instead, rest selectively: You may have to give up tennis while your serving shoulder recovers from tendonitis, but you can still walk, jog or hike. In a curious way, an injury is often a blessing in disguise: It forces you to vary your workouts and acquire new skills.
  • Ice – It's the cheapest, simplest, yet most effective way to reduce swelling and pain. Ice is an excellent anti-inflammatory. For best results, apply an ice pack for 10 to 15 minutes as soon as possible after an injury. Repeat the ice treatment each hour for the first four hours, then four times a day for the next two or three days. Protect your skin with a thin cloth, and don't allow your skin to become red, blistered or numb. After 48 to 72 hours, switch to heat treatments. Use the same schedule and principles.
  • Compression – Pressure will help reduce swelling and inflammation. In most cases, a simple elastic bandage that is snug but not tight should work fine. Remember that swelling may develop slowly over several hours after your injury, so you may have to loosen your wrap. Another trick is to place a small piece of foam rubber directly on the injured area before you wrap it; this will allow you to put gentle pressure where it's needed without constricting an entire joint or limb.
  • Elevation – Let the force of gravity help to drain fluid away from injured tissues, reducing swelling, inflammation and pain. Keep your sore foot up on an ottoman or put a pillow under it in bed. Elevating an injured area will help you get back in the game faster.

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PRICE is the key to the early management of most kinds of injuries. But you may also need medication for pain or inflammation. Acetaminophen (Tylenol and other brands) may be the best choice for the first day because it will reduce pain without increasing bleeding. After the first day or two, consider aspirin or other non-steroidal anti-inflammatory (NSAIDs), such as ibuprofen (Advil and other brands) or naproxen (Aleve). These fight inflammation as well as pain. NSAIDs can irritate the stomach; take them with milk or food, and always follow directions for use.

The PRICE program relies on using cold first, and then heat along with anti-inflammatory medications or pain relievers if needed. Instead of an ice pack or warm pack, you can rub in an ointment that will make your tissues feel cool or warm. And you can also buy liniments, gels and ointments that contain anti-inflammatory medications. Topical anti-inflammatory are available without a prescription. They are much safer than oral anti-inflammatory medications, but they're also less effective.

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The Role of Rehabilitation

Your pain is gone and your swelling is down — but your treatment is not yet over. You need to plan your rehabilitation and return to exercise with the same care that you used to treat your injury. As a rule of thumb, give yourself two days of rehab for each day of inactivity.

Start with gentle range of motion exercises. If your injury involves your leg or foot, go slowly as you resume weight-bearing. When you are ready, add resistance training (calisthenics, light weights or equipment such as Cybex or Nautilus) to build back muscle tissue. If all goes well, you can be stronger than before your injury. This can help reduce your risk of re-injury.

Stretching exercises can improve your flexibility. Use heat or massage to warm up your injured tissues before you start your rehab exercises. Afterwards, apply ice to the area to reduce inflammation. Aspirin or other NSAIDs may also help your rehab program.

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Get Help

You can manage many injuries yourself, but don't be stubborn. If you have a major injury — or if your nagging woes don't clear up — get help. An experienced exercise buddy who has "been there, done that" may be all the help you need. Primary care physicians can handle many exercise-induced problems. But more difficult issues require orthopedists, physical therapists and sports podiatrists. These specialists usually practice at sports medicine clinics.

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Bottom Line — Get Going

The most dangerous thing about exercise is not doing it. Injuries do happen, but don't let the possibility of getting injured become an excuse for staying on the couch. Instead, follow the simple steps that will reduce your risk of exercise-induced injuries, become able to spot problems early, learn how to handle minor injuries on your own, and be prepared to get help when you need it. It's easy to overcome simple injuries — but very difficult to treat the major illnesses that may stem from lack of exercise — heart disease.

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Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.

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