Seeing as how I have been plagued recently with a variety of minor injuries, I figure it might be nice to post an article about how to deal with a variety of injuries common to fitness/athletics.

Here it is:

“He who preaches patience has never known pain,” declares the old proverb, and ain’t it the truth. When you’re hurting, you want what that old commercial promised: fast, Fast, FAST relief.

But the treatment you seek—and the degree of relief you get—may vary depending on what the hell you did to yourself. Are we talking about a sharp burn in your elbow during that second doubles match? Stabbing back pain after a lateral dive for an errant volleyball? Or morning-after aches from your first attempt at supersets?

Let’s begin with the burn. Tendinitis, an overuse injury of the fibrous tissue that connects muscle to bone, can strike any major joint, says Lynn Millar, Ph.D., a professor of physical therapy at Andrews University in Berrien Springs, Mich., and a fellow of the American College of Sports Medicine. It’s a sign that the muscle attached to the affected tendon isn’t strong enough to handle the demand placed on it. (With tennis elbow, which can happen in the weight room as well as on the court, it’s the forearm muscle that’s affected.) The tendon has to help out, but shouldn’t, so it becomes overworked, inflamed and very painful. Sprains cause similar pain and inflammation in ligaments, which attach bone to bone. Then there’s bursitis, the inflammation of small, fluid-filled sacs around the major joints.

Straining or “pulling” a muscle is a traumatic injury caused by hyperextension, usually during a quick move (like the V-ball plunge, or less dramatically, falling down the stairs like the klutz that I am) that the affected muscle isn’t conditioned to handle. Muscles are like cloth, Millar explains. If a substantial number of the fibers in a muscle rip, you have a pulled muscle. If they all go, you have a “torn” muscle.

With tendinitis and pulled and torn muscles, the pain typically appears suddenly and feels sharp, severe and weakening, says Scott Hasson, Ed.D., a professor of physical therapy at the University of Connecticut at Storrs. Such pain announces that something is very wrong, and requires immediate treatment by a physician.

A happier, if still painful, option occurs 12 to 72 hours after exercise. Delayed-onset muscle soreness results from overexertion or when new workouts tax different muscles (or muscles differently). When pushed beyond their conditioning, a small number of muscle fibers tear. These micro-injuries are not severe enough to cause immediate symptoms. But the body responds to any injury with inflammation, hence that dull, aching soreness that kicks in the next day or two. You know ... the "good sore", right?

For better or worse, those tiny tears are key to muscle development, because the fibers regenerate somewhat bigger than they were to begin with. “To build large, well-defined muscles,” Hasson explains, “you have to tear some fibers—ideally during carefully planned workouts that cause minimal DOMS and no other injuries. That’s why you should increase your workout slowly. If you feel any pain or muscle weakness, stop. You’re overdoing it.”

INSTANT RICE

For the sudden, sharp pain of tendinitis, sprains and pulled muscles, halt what you’re doing and begin “RICE” treatment: rest, ice, compression and elevation.

Rest is the one that hangs up many enthusiasts, who think that suffering is all part of a good workout. “Forget ‘no pain, no gain,’ ” says Robert Moore, Ph.D., professor of pharmacology at Samford University in Birmingham, Ala. “Playing hurt is stupid. Pain is the body’s way of saying you need rest. Take it seriously.”

Don’t compare yourself to pro athletes who hobble off for a pain shot and get right back in the game. “The pros are in significantly better condition than even daily gymgoers,” says Millar. “And they make so much money that they are under tremendous pressure to keep playing—and their coaches and trainers are under tremendous pressure to keep them playing. In the short run, they’re doing their job. But in the long run, playing hurt is the reason why so many former athletes have chronic musculoskeletal problems.”

After you’ve stopped doing what caused your pain, quickly apply ice to the affected area. This is especially important during the first 24 hours. “Icing constricts local blood vessels, which minimizes swelling,” says Richard Holm, R.Ph., a pharmacist in North Pole, Alaska, and a spokesman for the American Pharmaceutical Association. To make an ice pack, place a few ice cubes or a commercial ice substitute in a plastic bag and wrap the bag in a clean cloth. If you want to wrap the ice pack around an injured area, Millar suggests using instead a large bag of frozen peas. Apply it for 20 minutes, then remove it for 10 minutes before reapplying. Do not place ice directly on the skin.

Compression also helps keep swelling down. It’s like squeezing a sponge, Hasson explains. The pressure pushes excess fluid out of the affected area, minimizing discomfort. Finally, elevating the injured body part above the heart restricts blood flow to the area. Less blood means less swelling. For leg injuries, put your feet up. For arm injuries, try a sling.

You can’t eliminate swelling entirely, and you wouldn’t want to. “The extra blood promotes tissue repair,” Millar explains. “But unchecked swelling becomes too much of a good thing, causing unnecessary pain and movement restriction.”

After swelling has begun to subside—usually in 48 to 72 hours—try a heating pad or warm- or hot-water soaks. “Heat feels soothing,” Millar explains, “and it promotes blood circulation.” Massage (self or otherwise) can also bring blood to the area at the appropriate time.

OVER-THE-COUNTER MEASURES

Pills: There are a lot of pain relievers on the market, but they’re not interchangeable. “Tylenol [acetaminophen] works well to relieve things like headache pain,” Moore explains, “but it has no anti-inflammatory action. Athletic pain—tendinitis, sprains, pulled muscles, and DOMS—all involve inflammation.”

Better choices are aspirin, ibuprofen, naproxen or ketoprofen. Collectively, these medications are referred to as nonsteroidal anti-inflammatory drugs. Which NSAID should you take? It’s a matter of personal preference, Holm says. The standard dose of each provides roughly equivalent pain relief, though aspirin and ibuprofen must be taken more frequently than naproxen and ketoprofen.


There’s also the question of side effects. Aspirin is notorious for causing upset stomach, which is why some brands are “buffered” with antacids. If you’re sensitive, even short-term treatment can cause gastrointestinal reactions or trigger asthma attacks. In addition, because it thins blood, aspirin impairs blood-clotting; you might notice that shaving cuts bleed longer than you’d like, and that you bruise more easily. If you develop hives shortly after taking aspirin, you’re allergic to it.


Ibuprofen is gentler on the GI tract than aspirin, but stomach distress, heartburn and nausea (and some impairment of clotting) are still possible. If you have kidney disease or diabetes, don’t use it. If you’re allergic to aspirin, you’re probably allergic to ibuprofen as well. Naproxen and ketoprofen have side effects similar to ibuprofen; they may also cause constipation, diarrhea or headache.


It all comes down to your physiology. “The conventional wisdom is that aspirin causes more side effects than the other OTCs,” Holm explains. “But I’ve seen plenty of people take large amounts of aspirin with no side effects, and others take standard doses of the other drugs and suffer significant distress. Experiment to see how you tolerate these drugs.”

Brand names for the different types of pain relievers follow:

ASPIRIN: Aspergum, Bayer, Emprin, Genprin, Norwich, St. Joseph,
Zorprin

BUFFERED ASPIRIN: Adprin-B, Ascriptin, Asprimox, Bufferin, Cama Arthritis Pain Reliever, Magnaprim

CAFFEINATED ASPIRIN: Anacin, BC Powder, Excedrin (also contains acetaminophen), Summit Caplets, Goody’s Headache
Powder

IBUPROFEN: Advil, Genpril, Haltran, Motrin, Nuprin

NAPROXEN: Aleve

KETOPROFEN: Orudis


Liniments and Topicals : For muscle strains and DOMS, Holm also suggests such liniments as Ben-Gay and Tiger Balm, which “produce a feeling of warmth that helps relieve pain and soreness.” A number of topical ointments contain capsaicin, which is believed to block pain messages traveling from nerve endings to the brain. (Remember to wash your hands after application and before touching any sensitive areas, or you’ll get more “relief” than you bargained for.) Or try an adhesive pad, such as Icy Hot Patch, which isn’t as messy and has longer-term delivery.

For homeopaths, topical arnica gel is available at pharmacies and health-food stores. Study results have been mixed, but arnica is very popular with athletes. “Personally,” Holm says, “I think it works.”

Beyond OTC treatments, Hasson advises, “Don’t veg out. Rest, but don’t immobilize painful muscles or joints. You want blood flow to bring oxygen and nutrients to repair the damage. To the extent that you’re able, gently move injured muscles and joints through their range of motion with light stretching or walking.”

STRONGER MEDICINE

Prescribed Pharmaceuticals . If OTC drugs don’t provide sufficient relief, a doctor can give you stronger NSAIDs. But their extra power comes with greater risk of side effects, particularly GI distress and bleeding. A new class of NSAIDs, selective cox-2 inhibitors Celebrex and Vioxx, acts against an inflammation-related enzyme. The cox-2s are better tolerated and have proven highly popular in treating arthritis; your doctor may think it’s appropriate to prescribe them for athletic injuries.

For severe sprains, tendinitis or bursitis, a physician might inject the inflamed area with corticosteroids and anesthetics, which provide rapid relief from severe pain and inflammation. “But they’re a temporary fix,” says Francis O’Connor, M.D., director of the sports-medicine fellowship at the Uniformed Services University of the Health Sciences in Bethesda, Md. “Steroids and anesthetics don’t cure the problem. They just mask the pain for a while.”

O’Connor warns of the downside of corticosteroids: Repeated injections weaken tendons and ligaments and retard healing. He limits injections to three times a year in the context of a good conditioning program. “To heal, you have to increase your flexibility and strength in the injured area,” he says. Physicians, trainers and physical therapists can recommend specific exercises.

Eastern Medicine . You might also seek out a practitioner of acupuncture, which the National Institutes of Health deems a safe and effective method of pain assuagement. In one recent study reported in the Journal of Rheumatology, German researchers gave 48 people with tennis elbow one treatment of real or sham acupuncture. Significant relief was noted by one-fourth of the placebo group vs. 79 percent of the real-treatment group. On average, the former perceived a 15 percent pain reduction that lasted 90 minutes, while the latter reported pain reduction of 56 percent that lasted 20 hours.

HURRY UP AND WAIT

Road Back to Training. After a training interruption, most guys want to return to the gym as quickly as possible. Bad idea. “Don’t rush it,” Millar advises. “That just sets you up for reinjury.” Continue light, recuperative workouts: gentle stretching, walking, and range-of-motion exercise. How do you know when you’re fully recovered? “It’s usually two or three weeks after you think you are,” Hasson says.

Meanwhile, take a look at your diet, which can impact your recovery. Saturated fats convert to inflammation-linked chemicals in the body, while omega-6 fatty acids (found in vegetables, safflower and peanut oils) and omega-3 fatty acids (abundant in cold-water fish, flaxseed and walnut oils) convert to chemicals with anti-inflammatory properties.

Trans-fatty acids (rampant in margarine, fried foods, and packaged cookies) can block production of anti-inflammatories as well, but antioxidant vitamins C and E can inhibit inflammation promotion. Bromelain, an enzyme found in pineapple, may help speed the removal of inflammatory waste products.

However you treat painful injuries, don’t be fatalistic about them. They may feel like they happened out of the blue, but chances are that you overdid it in some way, lost your concentration, or forgot to warm up—all mistakes that can be avoided in the future. As another old proverb declares: “If you are visited by pain, examine your conduct.”

BONUS TIP:

Mix Caffeine With Your Pain Pills
Put away the water and juice. You’ll get more relief if you wash down your pain pills with coffee, sugar-free Coke or Red Bull—anything that contains caffeine. Many studies have tested aspirin by itself against aspirin-caffeine combinations, and the latter have been shown to provide greater pain relief. In fact, to obtain the same results provided by a combination of aspirin and caffeine, you’d have to take 40 percent more than the standard aspirin dose, according to a report in the Journal of the American Medical Association.

Caffeine boosts the pain-relieving power of ibuprofen even more. In one study of dental pain, published in Clinical Pharmacology and Therapeutics, the drug plus caffeine more than doubled participants’ relief compared to ibuprofen by itself.

There have been no studies of caffeine’s effect on naproxen and ketoprofen, but some speculate a similar benefit. “Caffeine is a stimulant and mild antidepressant,” says Robert Moore, Ph.D. “Those actions appear to contribute to pain relief. Since caffeine boosts the pain relief of aspirin and ibuprofen, I’d expect it to have the same effect on naproxen and ketoprofen.”

Mocha and Motrin, anyone?