How to maintain their physical condition despite an injury that may be serious
"Hi, Gary,
The article is awesome, even if I was not to be featured in it I would find it very informative.
You never know when you may need those skills so it is like a free first aid course and then as a cream on top of it you get all the info for a sports person about what to do and a thinking perspective if you get injured and how to go through it.
Mate, I am super pleased to be part of an article that will help many people.
You had a great idea and I’m glad you brought it to life"
Cheers,
Brian"
Injuries are part and parcel for an athlete and not all injuries happen during training and competition. My friend, Brian King, who is just weeks away from competing in the iconic Coast-to-Coast Multi-sports race, suffered his most serious and painful of injuries for a very long time just a few days ago when he slipped while on a ladder! Ouch! He is lucky not to have broken his neck.
What I am writing here may be a little too late for Brian's benefit, but his misfortune is the opportunity to prepare the rest of us for the inevitable - injury!
Warning! Some of the photos that follow are a little gruesome.
First Aid
The first action for an injury like this is to immediately lie down and elevate the leg and to do so for a good half hour.
If the patient can be kept warm and comfortable for just the first ten minutes, that is better than trying to move him. Apply constant elevation and compression for at least ten minutes then move to more comfortable surrounds.
If the elevation is not enough to stem the bleeding then apply pressure with the palm of the hand on the wound over a clean cloth or paper towels.
Keep the patient warm and as comfortable as can be for about half an hour or longer before transporting him to the hospital.
Elevating the leg stops the bleeding while avoiding the risk of passing out from the pain and shock.
Half an hour should be sufficient for the pain to settle and for the blood to clot, thus reducing bleeding.
Apply a dressing with compression. A clean cloth like a facecloth will do the job then bandage quite firmly, covering well above and below the wound.
Handy Tip: if you know or suspect there is a fracture or joint dislocation try wrapping a soft pillow around the injured limb then tape or bandage it firmly into place. If the neck needs stabilising, carefully wrap it with a rolled towel or jersey while being sure to keep the neck in the neutral position. Doing so can be remarkably effective for securing the limb and even pain-relieving.
Give the person time to get over the shock and assess before moving the person
With injuries like these, the pain is excruciating and there is always a degree of shock involved with a massive surge of stress hormones. Make them as comfortable as you can and keep them warm. Lying down with the legs elevated a little helps keep blood flowing back to the heart and to the brain. It will take 10 or more minutes for the pain to settle and for the heart and mind to begin to calm. You can triage the injuries as best you can, assessing their severity and stability before making any attempt to move them. Do not move them if you have any concerns about doing so, especially if there is any suspected spinal injuries. Call the ambulance and let the paramedics do the moving.
In this case, falling off ladders often results on damage to the spine.
Handy tip: Ask the person to describe exactly what happened, including how they landed and what they heard and felt. Recreate the actions in your mind. With a good knowledge of anatomy and biomechanics, I am usually on the mark in figuring out what may be damaged and the care to be taken.
Transport to hospital
It is now time to go to the hospital Accident and Emergency Department. In Brian's case, he can do so, while being thank full that his incident with the ladder did not result in much worse injuries such as a broken neck!
Brian can go by car to the Accident and Emergency Department, assuming that the first aid as described has been done and enough time given to settle him down before commencing the journey. His leg must be kept propped up in the back seat, especially since the journey is about an hour from home.
If there are any concerns about the severity of the injury, call the ambulance. Here in Wellington, the service is free, so there is no excuse for not using them.
One benefit of going by ambulance is the patient is more likely to be seen earlier, including being able to lie down during the journey and while waiting in the treatment cubicle for the busy doctor to get to him. There can be nothing more frustrating and distressing than trying to explain the severity and urgency of an injury during peak hours at an Accident and Emergency reception.
This leads to the next point.
Elevate, Elevate, Elevate!
From the moment of the injury and for the next several days, elevate the injured limb. Elevation reduces bleeding and swelling. The less bleeding and swelling there is, the quicker the healing and the fewer complications.
This includes elevation during transport to the hospital and while waiting to be seen to by a doctor.
Elevating the injured limb is most important for the following 3-5 days depending on the injury.
Assessing the severity of the injury to then plan his recovery
Listen very carefully to the doctor and take note of the advice given. In Brian's case, the injury is to the shin bone and overlying flesh. This is very painful but the good news is that no
critical structures such as tendons, ligaments, muscles and major blood vessels are directly involved.
The downside of a shin injury is the shin tends to be a slow healer and any standing will cause considerable pain for a few weeks due to the increased blood pressure while standing stressing the damaged tissues. Hence the need for elevation for several days while the initial healing stabilises the damage.
Damaged bone does not like jarring. It hurts. A lot. Bear this in mind when thinking of the best exercises to do when recovering.
Working out when to resume activity
"First, do no more harm!"
Important: everything that I am recommending here are general Rules of Thumb. The patient must listen to the medical experts who are treating them and follow their advice.
This is where things get a little tricky. Deciding when and how to resume activity and how to progress back to full duties without compromising recovery first starts with understanding what structures have been damaged and the severity of the damage.
Some Rules of Thumb for healing:
Tendons and ligaments take 8-12 weeks to be strong and resilient.
Broken bones require 6-8 weeks to be strong and stable.
Muscle injuries, such as severe bruising and tears are well on the way to healing by 2-6 weeks.
Skin grazes and cuts usually take 10-24 days to heal
There are a number of factors that may slow healing, such as the severity of the injury, the location of the injury, the age of the person, their nutritional status, infections and some medications which may interfere with healing.
Big gains can be made in not just expediting the healing but also avoiding complications, by doing the first aid I'm outlining here and making sure that you get medical treatment that is both timely and expertly applied.
Rest for 3-5 days
There is absolutely nothing at all to be gained by trying to exercise for the first 3-5 days following an injury, even if it is relatively minor. Give yourself a break and give the injury site time to stabilise. That means lying back in a deck chair for several days and, in Brian's case, keeping his leg elevated.
Resting longer than five days is not beneficial for healing. Any longer and hard-won physical conditioning begins to be lost. This loss of condition is unnecessary and unhelpful in the long run. Deconditioning may leave the athlete more prone to re-injury or to fresh injuries, later on.
There may be a loss of confidence and loss of contact and parity with team-mates who are now much fitter and who may already have replaced him. Injury with excessively long lay-offs is the precursor for early retirement.
Protect the injury
Do what I have done and make your own special pads to protect the damaged area from re-injury such as from accidentally bumping the shin on something.
The pads shown here are made from two layers of a special merino wool fabric that has a foam layer laminated between the wool layers. I have cut these to size so that they will cover an injury and a swathe of surrounding tissue. To replicate the impact protection of a helmet I have taped a cut out of corrugated plastic from a drink bottle.
If you are to make your own, use a soft high-density foam to which you tape a flexible plastic outer layer.
Tape your creation, securely but gently over the wound. In Brian's case, this will look like a soft football shinguard. He can wear this over the wound from Day One, including when sleeping to protect the wound from things that may go bump in the middle of the night.
Change the dressings daily
In these days of antibiotics, we have become very lazy with regards to the dressing and cleaning of wounds. Bacteria love dead tissue. Cleaning superficial wounds daily ensures quick and uncomplicated healing.
In the case of deep wounds such as Brian's, the dressing may be left on until the stitches are removed, then daily cleaning and dressing of the wound may begin. It is usual to prescribe antibiotics for wounds such as Brian's. This is where antibiotics are completely justified.
My favourite dressing is the Elastoplast silver-impregnated bandaid. The XL size. Change it daily and clean the wound if necessary.
For more about wound healing, read these:
Have confidence in your physical fitness and ability to bounce back
In the overall scheme of things, losing a week or two of training is neither here nor there. By this stage, with less than a month out from an event such as the Coast-to-Coast, most athletes are in a state of total over-training to the point of exhaustion. A few weeks of semi- rest such as what I am recommending will do most athletes a lot of good.
Take me for example. Five years ago I suffered what should have been a career-ending ankle injury but was still fit enough to contest a mountain bike race just eight weeks later.
Last year I almost put myself in a wheelchair but was able to recover and win the UCI Masters Mountain Bike Champs just three months later.
You can read about these here:
If one leg is damaged, that does not mean that the rest of the body, the remaining 95% has to be idle as well. The healthy remainder can be worked hard. Really hard when you think about it. But not until you have had the compulsory 3-5 days of complete rest.
Injuries are the opportunity to be creative when it comes to exercise. It becomes the opportunity to try out or resume other forms of exercise. It is the opportunity for you to work on your weaknesses such as your flexibility or upper lack of body strength.
Years of training, including all of the last 12 months of near-unbroken training are not going to be undone by a few weeks of relative inactivity. Think of the injury as giving you a welcome and well-earned rest. Think of an injury as giving you an extended taper into what is going to be the most intense and the most exhausting event of the year!
Resume activity after 3-5 days
This is where we have to be careful. But it is important to make a start.
In Brian's case, he does not want to pop the stitches or risk getting an infection. Standing for more than a few minutes will be uncomfortable due to the blood pressure in the raw flesh wound and bruised bone.
The Coast-to-Coast which he has been training for involves cycling, running and kayak. This is good because he is very fit and has several exercising options. In his case he can gradually do these:
Stationary cycle and row/paddle (he has the equipment for these). These can even be commenced with one leg only after about 5 days but rowing and paddling with both should be fine. When cycling with one leg prop the injured leg on a chair or stool.
Upper body workouts. Everything from press-ups, abs, lat pull-downs, seated presses and more! There is no limit. Brian just about can do the lot. Keep the injured leg propped up as much as is practical. Walking and running involve jarring so it is best to keep walking to the minimum until the stitches have been removed and no running at all for two weeks. Stationary cycling and rowing are best, along with upper bodywork.
After about 7-10 more days
This is usually possible about two weeks post-injury, with stitches out and the wound well on the way to sealed with new, healthy skin/scar.
Get into the pool Swim, do hydrotherapy exercises, join an exercise class. Warning! Only enter the water if the wound is 100% healed. If not, stick to dry land exercises for now.
Gradually resume "normal activities" other than running in Brian's case. This means paddling and cycling but keep within comfort levels and in conditions that have a high safety margin. Keep the wound dressed, protected and dry if there is still skin to heal. In Brian's case, he should be able to resume cautious jogging after 14 days and the enforced rest will have done him some good. There will be little or no loss of condition. Actually, he should be raring to go.
Tip: keep your first outdoors workouts close to home. It is better to paddle, cycle or run about in large circles, rather than do an out and back route. Murphy's Law dictates that you will seize up at the furthest point from home and usually without cell phone coverage!
Should Brian be doing the Coast-to-Coast?
Only Brian can answer that question.
He injured his leg on the 16th of January. The race is on the days of 7th and 8th of February. It is possible but at a stretch. Fitness will not be an issue. The running leg over mountainous terrain and boulder-strewn alpine rivers is the challenge with lots of jarring and the risk of hitting shins on rocks.
If I were Brian, who I am not, I would probably give this year's race a miss but would hold off making the call until the last moment. If it was just one more week away, I would be into it without any hesitation.
For details about the Coast-to-Coast:
Which brings up another issue.
Do not put all of your competition eggs into a single basket
I've learned the hard way. The mistake of putting months of training, or even a year or more into preparing for one event - the BIG ONE! The problem with this strategy is anything can bring the best of plans undone.
You may fall ill or get injured at a crucial stage.
The airport may be closed due to fog (this is the case today in Wellington and we are supposed to be flying to Dunedin for the Oceania and NZ Champs!).
You may wake up ill on the day of the race, you may have a flat tyre, fall out of the kayak or go the wrong way.
Make regular competition your training
The best strategy is to add plenty of less gruelling or important competitions into your training leading up to the Big One and to always have your next event planned for after it. This way you avoid huge disappointment if the unexpected comes along to disrupt successful completion of the Big One, in this case, the Coast-to-Coast.
Benefits of doing so:
You get race-hardened and experienced.
You get to practice and hone to perfection your pre-race and in-race routines.
It is hard to remain focused and motivated if there is only one event that is a year away. Having lesser events to aim for every three or so months way keeps the fire in the belly and the focus, laser-thin.
Avoid the "Post Olympics Blues"
Even if you win, there is the risk of the post-competition letdown or crash. This may be felt as feeling depressed, grumpy, anxious, or all of the these at once.
Avoid the blues by having your next goals in place well before the contest begins and ends. This could be an adventure holiday or another sporting competition that excites and focuses you. Just make sure that there is not a void waiting for you on returning home.
I write a bit about this topic of post-competition blues in this article:
Postscript
Brian has sensibly decided not to race the Coast-to-Coast. The risk of aggravating the injury is just too high. Things might have been different if he had just one more week to play with.
Instead, he is using his travel and accommodation bookings take the family on a South Island holiday. Good on him!
