I Think I’m Injured—Now What?

By Martha Pyron, M.D. – March 1, 2014

You’re exercising; you have an injury.  What do you do?

Let’s break this down:

So, there are two different types of injuries, and they are caused by different things and treated very differently. The two categories are “acute” and “chronic.” Chronic may also be known as “over-use.” Understanding these two types of injuries will give you a basis for when to see a doctor.  

Acute injuries are caused by a specific environmental factor. You step wrong on the trail and twist your ankle, you are tackled in football and injure your knee, you are hit in the head by a flying baseball and sustain a concussion. Those are all types of acute injuries. Acute injuries usually involve a tearing or breaking injury to some type of tissue in your body—bone, tendon, ligament, muscle, or other soft tissue (brain).  

The tear or break may be big or small, but there is a structural injury to the tissue. Once the tissue is injured, your body kicks into healing mode. Your circulation to the area increases, and it brings healing factors that first cause inflammation and swelling; then, little cleanup factors come to the area and break down the damaged tissue and take it away; finally new growth factors are brought in, and new tissue is created over the damaged area. And voilà, you are healed.  

So, if your body is going to do this anyway, why go see a doctor? The primary reason is to make sure the tissue heals in the manner and position you want it to. An exaggerated example is having a bone that has been broken and is crooked. The break will heal no matter what you do—and if you do nothing to help it, it will heal crooked. You will eventually no longer have pain, and it is “healed,” but did it heal in a way that allows you to walk on it again, run on it again, live your life normally again? The vast majority of injuries to bones, ligaments, tendons, and muscles will heal on their own; the question is, will it work the way you want it to after it is healed? For this reason, it is a good idea to see a sports medicine doctor to make sure this is occurring. You may need a brace, a cast, physical therapy, or even surgery to help this process along. Or, your doctor may tell you it will heal just fine as it is.  

A secondary reason to consider seeing a doctor is that the injury may heal faster if it is managed a certain way. So, if you don’t want to be held up for too long in your training, get that injury looked at right away. And hopefully, you will heal fast and be strong and ready to run or play again sooner because you took prompt care of the injury.   

Third, your physician can help you figure out ways to continue training in different ways, if necessary, to protect the injury and allow it to heal as fast as possible. Exercise is medicine, and I know you want to get back out there and run or play, but you may need to exercise specifically after an injury to help it along. And finally, you don’t want this acute injury to turn into a chronic injury.  

In conclusion, for acute injuries, see your physician to make sure the injury heals in a way that will be ideal for you in the future, reduce your time away from training, help you cross-train during the healing process, and prevent the injury from turning into a chronic injury. My general rule of thumb for acute injuries: If you are treating the injury on your own with relative rest, ice, over-the-counter medications, or your own version of healing, and it is improving rapidly, it was a mild injury and is recovering without need for further intervention.  
But if the injury lasts more than just a few days, is more severe, or interferes with your training, it may not heal properly without specific care, and you may need the help of your doctor for it to heal in a way that is best for your future.   

If the injury is so severe it is interfering with your normal daily activities, such as getting out of bed, walking to the shower, lifting your baby (or the jug of milk), working your job, thinking normally, or even resting comfortably, consider seeing your doctor that day (or going to the emergency room). Our bodies are truly amazing in their ability to heal—sometimes you just need help to ensure the healing is exactly how you want it to be.

So what about chronic injuries or over-use injuries?These are unique and frustrating types of injuries to have. The general process is this:  You have an acute injury that you do not take care of.  The pain isn’t that bad, but it persists; you keep doing things that hurt (because they don’t hurt that bad and you are a badass), and then the pain eventually gets worse, affecting more of your life and slowing you down. Now you have a chronic injury.

Chronic injuries can go on for months or years, slowly affecting your ability to use that area of your body without pain. Sometimes there are other medical factors contributing, such as dietary deficiencies, thyroid problems, diabetes, heart disease, anemia, and more. The difference between acute and chronic, to a large degree, is the number of environmental factors.

Chronic injuries usually imply there is an internal problem, not so much of an external one. Yes, the original injury may have been the twisted ankle on the running trail, but it becomes chronic and “not healing” because of internal factors. Such factors include stubbornness (yes, I am talking to you, runners); other medical issues mentioned above, over-training, improper nutrition, “no pain, no gain” mentality, and poor coaching (your own or from someone else) and imbalances in your strength/flexibility. (Forgive me, runners, for picking on you a bit, but there just are so many of you in Austin, I figured I’d try for the big audience. For all of the rest of you—this applies to you, too, so don’t point the finger at the runners with a smug smile; you do this too. We all do.)

It is very likely there is in imbalance somewhere that is causing excess stress to the injured area.  This happens when you do a lot of the exact same type of exercise (because you love it and are good at it) and little to none of any other (because you don’t love it and you aren’t good at it).  For example: Runners who do nothing but run long distances have strong quads and hamstrings and little butts. Little butts may be desirable for your jean size, but not so desirable for overall fitness. Those little butts may represent weak hip and core muscles, which will contribute to knee, hip, back, or calf pain or injury down the road. That is one reason why adding sprint workouts to your running routine helps prevent injury; you use different muscles in different ways when you sprint than when you run/jog. By doing different exercises, you balance out the strength and flexibility needed for full body health.  Ideally, a well-rounded exercise or training program includes strength training, flexibility training, and endurance training. Without all three, imbalances occur, and injuries happen, eventually.
In summary, chronic injuries are acute injuries gone bad. The bad comes from an internal imbalance (mechanical, medical, or psychological) that keeps the area from healing. Most chronic injuries need the help of your sports medicine physician to identify what medical or physical imbalances are present and keeping the area from healing. Sometimes, you also need the help of a sports psychologist to help you listen to your body talk when it is injured so you make the right decisions early, and to deal with the life changes that must occur to get this thing finally healed when it is taking longer than you want.

The treatment of chronic injuries may not be that different initially. Give it some rest, work the tissues through physical therapy and massage, and hopefully healing will occur. This becomes more of a mental challenge than a physical one—be patient, do what is needed, and stop doing the thing that causes pain. In other words, change your life to some degree. For some, this is very challenging; others adapt quickly when given proper instruction. “Change your life” doesn’t mean stop exercising; it means stop doing the things that cause pain.
And then there are the injuries that just aren’t healing despite your awesome mental attitude and excellent fitness balance. With further investigation, such as an MRI or ultrasound, your physician can see if the injured tissue has chronic changes. What this means is that the tissue around the injury has actually changed because of the long-standing injury and repeated injury to the area. This is a problem. Tissue that has changed in this way does not heal well and needs to be treated in different ways to get it to heal.


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