Applying RICE to Acute Injuries

Acute Injuries

A strain to a muscle or tendon is the most common type of acute injury. It occurs when tissue fibres become torn or damaged and causes bleeding and swelling due to overloading or stretching.

Another common injury is a joint sprain, where a ligament that supports the joint is torn. This occurs if a joint is forced beyond its normal range. There will be considerable swelling and bruising, pain and dysfunction with any attempt to put movement or pressure through the joint.

Depending on the severity of the injury, during the first 24-48 hours the RICE principles should be used.

• Rest Immediate rest from any movement or load-bearing enables the fibres to begin to knit together quickly before any more damage is done. Movement will continue to open and aggravate the tear and cause more bleeding.

• Ice Ice slows down blood circulation and so reduces the amount of bleeding and swelling in the tissues. Ice should be wrapped in a cloth to prevent skin burning. Ten minutes is a good guide to the length of time ice should be applied for. The body will send more blood to the area to prevent the skin from freezing if ice is left on too long, reversing the effects. Ice also chills and numbs the pain receptors. By reducing the pain sensation it also reduces the protective spasm around the injury and the area becomes more relaxed. This allows the swelling to dissipate more quickly.

• Compression The pressure of a compression bandage, compresses the blood vessels so preventing blood from escaping through the open ends of the torn fibres.

• Elevation Elevation of the injured area allows gravity to assist the removal of swelling from the area and so aids recovery.

Massage and Acute Injuries

Massage should not be applied directly to an acute injury as the movement it will create
within the tissues can re-open the tears in the fibres. And, by increasing the circulation, it
will also encourage more bleeding. General massage techniques away from the injury
can be beneficial.



Post-Acute Treatment

When the signs of inflammation have gone and swelling, heat and redness are reduced
(usually after about 48-72 hours) the MICE procedure can be followed.

• Mobilization This is an active movement by the client of the injured part, through its full pain-free range. This works the muscles and prevents atrophy. After 3-4 days the client should be encouraged to try and gently start to actively increase this range, within pain tolerance.

• Ice Should be continued for about a week, especially if discomfort following mobility exercise.
  

Heat can be applied after 5 days providing inflammation has stopped. Heat helps promote
healing by stimulating the circulation. Contrast baths also stimulate the circulation, and the
contrasting sensory nerve stimulation can be highly relaxing and can release muscle
tension. Use hot and cold alternatively for one minute at a time.

• Compression Can be continued for a few days until condition improves.

• Elevation Can be continued until all swelling has gone.

Massage

Gentle, superficial stroking techniques can be applied directly to strains or sprains after
about three days. Deeper stroking and light friction can be started after about five days.
Treatment should not cause too much pain, otherwise it may caused further damage. The
aim of massage at this stage is to:

• Reduce swelling.
• Stimulate circulation (promote healing).
• Prevent excessive scar tissue forming.
• Prevent, or break down, adhesions.

Pre-Event & Post Event Massage

PRE-Event Massage

Pre-event massage can be performed from two days to two minutes before an event. Two days before an event, the massage can be deep, thorough and relaxing. Specific problem areas may take a day or two to recover from, so should therefore not be given too close to the event (no closer than five days). Just prior to the event it may be necessary to relax and calm the athlete down a little with rocking and shacking movements rather than working deeply into the tissues, as the muscles should not be relaxed too much. For someone who is well trained and properly prepared for his event the effect of the massage should be more psychological than physical. Treatment may be given through clothing.

Slow techniques will have a relaxing and calming effect, working vigorously will be stimulating.

Massage should not be a substitute for a proper warm-up.


POST-Event Massage

Massage after an event can be an adequate substitute for a warm-down, as it can achieve much the same effect by removing muscle waste and stretching the tissues. Superficial stroking should be used first to help identify any acute problems. Ice can be placed on an affected area while massage is applied around and away from it. The ice can be removed after a few minutes and light massage applied over the injured area to dissipate swelling, the ice can then be re-applied. Although massage is believed to be contra-indicated in the acute stage, the method of ice/massage/ice so soon after the injury can be remarkably effective. Gentle passive stretching of the muscles can be carried out at the end.

Getting Started on the Fitball (Swiss Ball)

Before you start any exercises on your fitball, you must make sure you are sitting correctly.




Sit on your ball and find your neutral position (as explained in the previous entry). This in itself is a good exercise to start with. You can hold this position for a few seconds, release and repeat.

Once you are comfortable with sitting on the ball the first exercise you can try is a balancing exercise. With your hands on your hips, slowly lift one foot off the floor, ensuring you have activated you core muscles. You can then change and use the other foot. Keep alternating feet as you maintain your neutral position.



To make this simple exercise a liitle harder, try circling your foot in the air, and then lift the opposite arm up, as shown above.

Strengthening the Lower Back by using your Core Muscles

Your core muscles comprise of the Transversus Abdominis & Multifidius muscles. To achieve good core stability you must learn how to effectively contract these muscles. These muscles can be effectively activated by using an exercise ball, also known as a swiss ball or fitball, but you can also activate these muscles well in a lying position.

To do this you need to be able to find your neutral position for the spine and pelvis, and this is best achieved by first finding out what the extreme opposites feel like. The neutral position can then be more easily found in the middle of these two extremes.


To do this, use the following method.

• Start by lying on your back with knees bent.

• Imagine a compass on your lower abdomen.
Your belly button is north
Your pubic bone is south

• Tilt your pelvis up northwards - doing this will:
Have caused your pelvis to tuck under
Flattened your back into the floor
Loose your lower back curve
Tightened your stomach muscles
Tail bone has lifted off the floor

• Now do the opposite, tilt your pelvis down southwards
Your lower back becomes very arched
Your ribs have flared
Your stomach sticks out

• The neutral position is between these two extremes.

• The compass should now be like a spirit level, balanced between North and South
The pelvis is tilted neither north or south or tucked under
The back is not excessively arched
The tail bone remains down on the floor
The pelvis is lengthened not scrunched up
There is a small natural arch in the back


In this neutral position you can control the contraction of these key muscles, and perform the following exercise that will target these muscles. This exercise can progress to being effectively performed on an exercise ball, which may help to ensure a healthy lower back.


Start by lying on your back with knees bent. Remember your lumbar spine should neither be arched up nor flattened against the floor; but aligned in the neutral position with only a small gap between the floor and you lower back.

• Breathe in deeply
• Relax all your stomach muscles.
• Breathe out and as you do so:
• Draw your lower abdomen inwards as if your belly button is going back towards the floor.


Think of the key muscles acting like a corset as you 'suck your belly button in'. Or think of scooping the lower abdomen back towards the spine. Alternatively think of struggling into a tight pair of jeans by sucking your belly in and zipping up.


Some other useful tips when first starting this exercise:

• Place one hand under your lower back to ensure that you do not tilt you pelvis nor arch or flatten your back, as this means you have lost the neutral position you are trying to learn to stabilize.

• Use your fingers to feel for tension in your lower abdomen, which indicates tension in the Transversus Abdominis. Do this by placing your fingers and inch in towards your belly button from the bony protrusion of your pelvis and an inch down towards your groin.


Once you have mastered this exercise while lying on your back, practice it lying on your front, sitting and standing, and progress by holding the tension for longer. In each position ensure that your pelvis, and therefore your lumbar spine, is in the neutral position.

These guidelines are for information purposes only.
I recommend seeking professional advice before beginning these exercises.

Neuromuscular Technique - (NMT)

When musculoskeletal problems occur there is a change in the tension of the tissues concerned. Tension also increases around a trauma to protect and contain the damage. It can also build in specific areas of tissue that are habitually held in a shortened position.

Once local hypertension within a muscle has developed, it becomes uncomfortable to relax and stretch it, because the tight area pulls on the normal tissues around it.


Applying NMT

1. Warm up and soften the area as much as possible first.

2. Using palpation, explore the area.

3. If a point is found that is harder and denser than is normal, NMT can be applied here.

4. Slowly increase pressure on the area and hold for up to 90 seconds.

5. Check with the client throughout that the pain is not increasing.

6. Pain should diminish while applying this technique.


How does it work?

The tension that can develop is a natural reaction (reflex) controlled by the nervous system and the client may not be aware of a particular point of actual pain. This technique will break the unconsciously controlled tension and break the reflex pattern.


Points to remember

• If pain increases this may indicate inflammation so technique should not be applied.
• Can repeat technique up to 3 times.
• Area may be very tender for the client.

Muscle Architecture

Skeletal muscle fibres (cells) are arranged in bundles called fascicles within the muscles. The arrangement of these bundles will affect the muscle’s power and range of motion.There are several types of arrangements of muscle. These are:

Parallel
The fascicles run parallel to the longitudinal axis of the muscle

Convergent / Triangular

Fascicles spread over a broad area and converge at a thick central tendon.




Fusiform – Fascicles are nearly parallel to the longitundinal axis of the muscles. The muscle tapers towards the tendons, and the belly of the muscle is wider, i.e. the biceps muscle.




Pennate Muslces



Unipennate

Fascicles are arranged on only one side of the tendon.

Bipennate

Fascicles are arranged on both sides of a centrally positioned tendon.



Multipennate – Fascicles are attached obliquely from many directions to several tendons, i.e. the deltoid muscle.



It is the arrangement of the fascicle in relation to the tendons which determine the power or range of motion of a muscle.



Pennate muscles have a large number of fascicles distributed over their tendons. This gives these muscles greater power but with less range of movement. The strength of a muscle depends on the total number of fibres it contains.



Parallel muscles have fewer fascicles, and therefore have a greater range of motion but less power. Therefore, the longer the fibres are in a muscle, the greater the range of motion.

The FITT Principles

Principles of Training

When prescribing an exercise prescription to someone, there are certain principles of training that should be taken into consideration. These include:

Frequency
How often should your client workout? A guideline to improve general fitness would be to exercise for 30 minute sessions, 3 times a week.

Intensity
How intense should the workout be? An assessment of the clients current fitness levels will give an indication of the level they should work at, i.e. lower intensity for a beginner, and a higher intensity for someone who already does some form of exercise, such as playing a regular sport.

Type
The type of exercise that should be given to the client. Again, the appropriate exercises should be given depending on whether the client is a complete beginner or not.

Time
Time taken for each period of exercise should also be considered.

Of course, there are other individual differences that should also be taken into account. These include:
• Sex.
• Age.
• Any health problems.
• Any current injuries.
• If the person already exercises regularly or not at all.
• Lifestyle – fitting an exercise regime around work and other commitments.
• Aim – what the client wants to achieve from a regular exercise regime.


Other Considerations

When preparing your exercise programme for your client, you must also take into consideration if they are training specifically for a chosen sport.

The programme should also show progression of exercises to ensure that your clients fitness improves, and more importantly that they can see an improvement as well.

If your client usually exercises regularly but has been unable to due to injury, you must be aware of reversibility. Although your client may have been reasonable fit (they may think that they still are as fit) you must be aware that fitness levels decline during sustained periods of inactivity. (You lose fitness 3 times more quickly than you improve fitness.)

An exercise programme that offers variety will help to prevent boredom while exercising.

Delayed Onset of Muscle Soreness (DOMS) - Part Two

THE REHABILITATION PROCESS

The easiest option (not necessarily for a sports person) would be to rest, as the soreness will go away in 3-7 days with no special treatment. But there are something’s you can do that may reduce the soreness and speed your recovery to some effect.

Initially, you should avoid any vigorous activity that increases pain, though you may work the unaffected areas of your body. By exercising unaffected areas or by performing low-impact aerobic activities such as biking or walking at a moderate pace, blood flow can be increased to the affected muscles, which may help diminish soreness. Other measures include applying ice, gently stretching and massaging the affected muscles, which may be helpful for some people and poses little risk if done sensibly. There is some evidence that Vitamin C may decrease soreness.

Finally, you should allow the soreness, weakness, and stiffness to subside thoroughly before vigorously exercising the affected muscles again.



MINIMISING THE RISK

Certain tactics may enable you to avoid delayed soreness altogether, or at least keep it to a minimum. One step is to warm up thoroughly before activity and cool down completely afterward. This can be done by stretching the muscles that you will be using and by doing a few minutes of light, low-impact aerobic activity, such as walking or biking.

It is also important to give your muscles time to adapt to your activity. For instance, if you have been inactive and your goal is to walk 3 miles in 45 minutes, start by simply walking a mile or so, and then another quarter-to-half-mile at each workout until you can comfortably walk 3 miles. Then you can begin to increase your walking pace to achieve your goal.

These principles to avoid DOMS can apply to any activity, especially weight training. Begin with a weight that you can comfortably use to perform 3 sets of 10 repetitions for an exercise. Continue to use this weight until you can perform 3 sets of 15 repetitions. At the next workout, increase the weight to one that will allow 3 sets of 10 repetitions, and increase the repetitions to 15 as with the first weight. This process should continue until you reach the level of resistance that is appropriate for your training goals.

Even if you’re exercising regularly, any unaccustomed activity may cause delayed soreness, so, if possible, avoid making sudden major changes in the type of exercise you do or how you do it.

You can also condition the body to prevent DOMS in the future. Preventive conditioning usually includes exercises designed to improve general as well as sports specific fitness, often focusing on areas of the body that are at high risk of injury, either because of the sport, or what the individual brings to the sport (in term of fitness, joint mechanics, etc).

Delayed Onset of Muscle Sorness (DOMS) - Part One

What is DOMS? - causes and effects



THE CAUSES

Delayed onset of muscle soreness (DOMS) can be painful and sometimes incapacitating, and typically occurs 48 hours after vigorous and unaccustomed physical activity.



DOMS is the result of microscopic tearing of the muscle fibres. The amount of tearing depends on how hard and how long you exercise and what type of exercise you do. DOMS is most likely to occur when high forces are developed during eccentric contractions (when muscles forcefully contract while they are lengthening). They occur in activities such as descending stairs, running downhill, lowering weights, and performing the downward movements of squats and push-ups. It can also be the result of too much activity, too soon, or a change in activity, form non-impact (such as cycling) to high impact (such as running) that necessitates a change in muscle recruitment and force production.




THE PHYSIOLOGICAL EFFECTS

The result of DOMS is what is known as temporary, repairable muscle damage, accompanied by inflammation, pain and tenderness. Swelling can also take place in and around the muscle, which can also contribute to delayed soreness. Such swelling increases pressure on the neighbouring structures, resulting in greater muscle pain and stiffness.




THE PSYCHOLOGICAL EFFECTS

A person’s perception of pain and discomfort can be very different. A sports person may fear the public assessment of his performance and potential failure to do well, so will prevent him from competing. Others may not regard it as an injury, and after a little rest, but still sore, will continue with their sport, even though their performance and technique will not be as good. This very much depends on the individual, and the pressures to perform from outside influences.

For someone who just exercises to stay fit, but who has over-done it in training, may will be put off by exercising until the soreness has gone completely, depending on the severity. Mild to moderate DOMS usually resolves itself within 3-7 days.




EFFECTS ON PERFORMANCE

Continuing with your sport while still recovering from DOMS will affect your performance, depending on the severity of soreness. With very mild soreness you may be able to carry on almost as normal without noticing a significant effect on your performance. If soreness is much greater, you will find it very difficult to train or perform as usual. For someone who plays a sport that relies on a certain amount of speed, they will feel ‘slower’ and generally be more ‘careful’ how they move, not being able to put the effort in they would normally. For anyone who weight trains, they will find that they will be unable to lift their usual weight. You may also find that muscles will get tired much more quickly than normally resulting in poor technique, and even after proper warming up and stretching, it does not help your performance greatly.