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


Focus on Fitness Focus on Fitness
 

Returning to Exercise After Injury


July 09, 2013

By Howard LeWine M.D.

Brigham and Women's Hospital


Whether you are a competitive athlete or someone who exercises regularly to stay in shape, you will almost surely have to deal with an injury that interrupts your daily routine. And too often the tendency is stop exercising once an injury occurs.

Injury refers to the loss of function of a body part with or without some visual disruption of the part's structure. The injury may be very obvious. For example, if you rupture your biceps tendon, you will often see an obvious lump in your arm. You will lose power but may have no pain. Or you have pain that decreases function but you can't localize it to one spot. With biceps tendonitis, moving the muscle results in pain around the shoulder and upper arm. Yet looking at the arm and shoulder, everything appears normal.

Whatever the injury, there are three basic phases to getting yourself back to where you were prior to the injury: the immediate post-injury phase, the recovery period, and the functional phase. You may move through these phases quickly for minor problems or it may take months for severe injury.

I will discuss the three phases in relation to minor injuries, such as muscle strains, ligament sprains, and tendonitis. The same three phases also apply to major injuries that require emergent action or surgery.

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The Immediate Post-Injury Phase

Doctors refer to this as the acute phase. During the first 24 hours to 48 hours following a minor injury, think R-I-C-E – rest, ice, compression, and elevation.

  • Rest refers to minimizing movement of the injured body part to prevent further harm to the tissues.

 

  • Ice should be applied as soon as possible following the injury or onset of inflammation. Ice the area for 15 to no more than 20 minutes. Experts differ on how frequently to apply ice. You should wait 30 minutes before applying ice again, and there may not be any advantage to repeating ice treatment more frequently than every two hours. Ice helps to decrease pain and swelling.

 

  • Compression with an elastic bandage will help reduce swelling if wrapped immediately over the injured area. Do not wrap it so tightly that the area beyond the bandage throbs. Redo the wrap as it loosens.

 

  • Elevation of the body part should be above the level of the heart, allowing gravity to drain fluid from the injury. Elevation is best started immediately, but it is still effective even after significant swelling has occurred.

Even during the acute phase, you can and should continue to remain physically active. If the injury is to any part of the leg, aerobics may not be possible during the early post-injury phase unless you have access to an arm cycle. However, you can still do upper body and arm strength training. In addition, you will want to start very gentle stretching of the muscles in the affected limb and you can perform regular stretching of the rest of your body. Stop stretching if it causes pain. To maintain muscle tone around the injury, do sets of repetitive isometric contractions (no active joint movement).

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The Recovery Period

Once swelling is subsiding and pain diminishes, you move into the recovery phase, during which you regain range of motion, strength, and endurance. At the same time you are working on the affected area, continue exercising your other body parts.

Go slow as you begin active movement of the injured area. Stretching intensity can increase gradually, but most important is improving range of motion. During this stage, warm your muscles with heat or by aerobics if possible before stretching and joint movement. Use ice following the routine if you have pain or swelling afterward. Stretch two to three times a day; do range of motion more frequently.

Muscle power diminishes rapidly when muscles are not used; the proteins in surrounding muscles start to break down within 24 hours if a joint is completely immobilized. Start to add a couple pounds of resistance to active joint movement. The goal is to do more repetitions per set (12 to 20) with less weight. Slowly increase the amount of weight, keeping the number of repetitions on the high side. Back down if pain or swelling recurs. Use ice as needed after exercise routines.

Keeping up your endurance after an injury is often the most challenging task, especially for runners. Swimming and water aerobics will usually put the least amount of stress on an injury to the leg.

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The Functional Phase

This last phase is the time to build towards regaining your full exercise capacity. You will be testing the injured area as you work your way up to your previous fitness level. For example, if you have sprained an ankle, start with quick-paced walking and light jogging for 10 to 15 minutes. Again use pain and swelling to guide you on how quickly you can increase the time and intensity of exercise that puts pressure on the ankle. If you can, ice the injured area after exercise for at least the first week or two, especially if there is any discomfort or swelling. Preventing repeat injury is an important component of the functional phase. Consider using a simple elastic brace or consult with your doctor about other devices and orthotics to provide a little extra support. Despite the injured area not causing symptoms, the tissues may not have healed completely.

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A Continuum With Overlap

The three phases, starting from time of injury to return to full exercise capacity, are a continuum, but it should not be viewed as a strict one. One phase will overlap the next. For some arm injuries, you may be able to immobilize the arm while riding a stationary bike or exercising on an elliptical runner, maintaining cardiovascular fitness.

The bottom line: Start some form of exercise the day after the injury, no matter how minor the activity. Just try to do a little more on each succeeding day.

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Howard LeWine, M.D. is chief editor of Internet publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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