Adarq.org

My 2 Cents Guide to Sprains/Strains and Rehab

Hopefully this guide may be useful to some of you guys

I was planning to write something like this for a few days now and thought I don't have anything else to do I might as well put pen to paper (metaphorically) and start. Just note this is just my 2 cents o

A problem I have like some other people is that we over look stretching past it's specific purpose and use it as a be all end all method for getting rid of pains we suffer whether it's through injury i.e sprains or strains or not, which can lead to further problems if used incorrectly.

To begin this off let's look at some definitions:

Muscle Sprain:
A sprain occurs when one or more ligaments have been stretched, twisted or torn, usually as a result of excessive force being applied to a joint. Ligaments are strong bands of tissue around joints that connect bones to one another.¹

Muscle Strain/ Pull:
A strain occurs when muscle fibres stretch or tear. It's usually the result of the muscle being stretched beyond its limits or forced to contract (shorten) too quickly.¹

A video of the basics of what happens when you pull a muscle, sprain it or rupture it.
<a href="http://www.youtube.com/watch?v=nMZVIb5U5fI" target="_blank">http://www.youtube.com/watch?v=nMZVIb5U5fI</a>

A video of the difference between sprain and strain
<a href="http://www.youtube.com/watch?v=mPeNOb2eIyA" target="_blank">http://www.youtube.com/watch?v=mPeNOb2eIyA</a>

As mentioned in the above definition and videos, sprains and strains can occur through various ways such as causing your joints to extend past it's range of motion i.e. twisted ankle or overuse of a muscle more than it's capable of. But also when a muscle has been inactive for a while, can cause muscle's to become stiff and when it is worked on can cause a muscle tear similar to that of a rubber band when it loses it's elasticity, stretching it would tear it whereas if you had stretched it dynamically can reduce the stiffness and therefore avoid any possible chance of injury, which I will get to in a moment.

As a common rule when at the early phase of a sprain/strain, we follow the PRICE rule, which an updated acronym as become POLICE, where OL stands for over load, meaning when the pain has subsided it is best to try and put some weight or load on it lightly to rehab it's functionality.

P - Protect
R - Rest / OL - Over Load
I - Ice
C - Compress
E - Elevate

The problem a lot of us face is dealing with muscle strain's, such as the one I faced recently of straining my hip flexor muscle, which had occurred from placing excessive loads on an impinged hip. So an incorrect mindset I had was foam rolling the hip flexor muscle, deep tissue massage using a tennis ball to dig deep in, which you will probably understand that digging away at a muscle, which has been strained, where some muscle fibres have become torn can only result in further fibers being torn and in the end causing major muscle ruptures.

That is what there is a time and place for massages/foam rolling and stretching.

When a muscle has become stiff due to inactivity or muscle knots (myofascial trigger points) it can cause pain and sometimes we incorrectly generalize a lot of pains to be the same as this one. Below is a video of what muscles knots are and how they are formed.

<a href="http://www.youtube.com/watch?v=luxeF31ntdg" target="_blank">http://www.youtube.com/watch?v=luxeF31ntdg</a>

So we wrongly assume that because we have a pain in the muscle, we wrongly treat it with massaging, stretching, foam rolling, which can cause further problems if wrongly diagnosed like my hip problem above. But as for muscle knots, myofascial trigger points, massages and foam rolling can release this points and help remove some of them knots.

But if a muscle has been strained, then what one should do is to let it heal for a couple of weeks, before starting stretching and the purpose of stretching is to rebuild the strength rather stretching for flexibility or mobility. This is what I did, I let it rest for around 2 weeks, I wrapped the injured area with a bandage for support as throughout the day with a lot of walking and running. Just by leaving my hips alone it is starting to heal up and now I can start to do body squats and slowly move on to the gym.

Video below explains different types of stretching and when it should be used.
<a href="http://www.youtube.com/watch?v=IWI2KgieQhM" target="_blank">http://www.youtube.com/watch?v=IWI2KgieQhM</a>
 
Injury Pain
Follow the price procedure without any stretching, until the pain has settled down fairly and then what you want to do next is strengthening that muscle slowly by slowly via stretches, but you don't want to do stretches, which will aggravate the pain. Just because it is causing pain doesn't mean it is helping as we currently misunderstand it, with injuries avoid anything, which aggravates injury or causes discomfort.

Muscle Stiffness Pain
Do you sit for long period of time? If yes this can cause muscles, which are at a relaxed state when seated to be come stiff i.e. hip flexor muscles and therefore can cause pain when it is stretched when standing, for this type of pain it's best to stretch it preferably dynamic, also using tennis ball or myofascial release can help reduce the stiffness or massaging it.

Medication can be taken to control the pain but along with medication it is best to address the issue such as isolate the injury to let it repair and following the other part of the PRICE protocol because absence of pain doesn't necessarily mean the injury has healed but rather the pain receptors have been numbed.

Dehydration and stretching
Another important thing to also mention is the importance of hydration (credit to adarq) and it's importance when it comes to stretching.
When your muscles become dehydrated, flexibility and elasticity are lost, making them more susceptible to strains and tears if you push your body too hard. You may experience a delay in muscle tightness as much as 24 to 48 hours after an intense workout, particularly if you don't consume enough water after working out. If your muscle tightness goes beyond a little discomfort and to the point of becoming painful, you run the risk of muscle damage if you continue or resume exercising with that tight or cramped muscle.

Drinking plain water before, during and after your workout is the best way to stay hydrated to minimize muscle tightness. Check with your doctor or pharmacist to see if any of prescriptions you're taking can cause dehydration. If you're taking a prescription that can cause dehydration, you need to drink extra water. Eat a balanced diet so that you have an adequate amount of sodium, potassium and other electrolytes at the start of your workout, and then replenish your stores afterward with a healthy snack such as orange juice, nuts or a banana.

So what you should take away from this is that not all pains are the same and therefore they cannot all be treated the same way, if it is a muscle injury/ sprain or strain, avoid any stretching or any types of activity to that muscle, just rest it up and let it heal, that way it will heal quicker then stretching it and causing it further injury and then going through all sorts of difficulties if it is tight muscle due to being inactive then stretching it to loosen it for flexibility would be a good idea or myofascial release and remember that just because stretching it/ massaging it causes pains doesn't mean it's good for you, for stiff muscles dynamic stretching would be good but for injuries leave it alone. Hydration is also just as important as it is necessary in order for a healthy working muscle.

I hope this helps and is useful to some. Just my 2 cents. 

good stuff man!

ya what interests me is our "response" to sprains and strains. With sprains, I feel like our default response is to shift into "rest" and maybe "ice". Though, we may try and get back to our training/competition too soon: but the default response seems to be not to "mess with it". Ice is obviously (most likely) a learned response. With strains, our default response seems to be to stretch it, roll it, massage it etc. The thing i'm wondering about is, if that's innate behavior or something we've learned. My dog strained some muscle in his leg once and he just left it alone. If I strain a muscle in my leg, i'm stretching it & trying to actively fix it.

so yea, our response might cause more harm than good. Need to be careful in the early stages of injury. IMHO, ice is usually a great bet.

I remember learning lots of this stuff initially from martial arts and a basketball training book I had - a solid book that had Doc Rivers in it (when he was a player), so that tells you how old it was. I just don't recall any kind of "prolonged stretching/mobility" mindset in response to strains and such, when I was younger. Maybe a few quick stretches with very short holds, and that's it. That seems more "natural" (to me).

I've definitely made strains worse by messing with it immediately after, and the few days following. I'd have been better off just leaving it alone.

Also, one thing that doesn't get talked about alot is hydration. A few strains/tears i've accumulated over the years were probably made more likely to occur because I wasn't hydrated optimally. Stretching and dehydration are probably a bad combo, just like training and dehydration are a bad combo.

As far as my hip flexor injury is concerned, poking at it (stretching, massage, trying to roll it etc) only made it worse. Rest "fixed" it, maybe not entirely, but far better than anything else. Hip flexors/adductors are tricky to begin with, they are already usually very tight.

I really like the PRICE acronym.. actually never heard of it. much better than RICE because of the P=protect aspect of it.



pc!

Thanks I hope it is of use to some people. You are correct about hydration because of dehydration it can cause muscles to become tight and prone to sprains when stretched.

^^ np! and yup!

Also, I think maybe "re-thinking" stretching to include just the "signal you are sending to the brain/nervous system", could potentially help a bit. My latest bout of stretching was mostly successful for one main reason: I didn't push the ROM. Instead I was simply thinking, once I "feel" that initial stretch, to just stay there. That was the point at which my nervous system was sending feedback, so I figured I didn't need to go any further. Subsequent stretches usually improved a little. When I did push the rom, I ended up paying for it.

I guess what i'm saying is, maybe try and forget about the idea of actually stretching the myself itself, and instead just performing controlled movement (the stretch) until the moment you experience feedback. At that point, you know you're sending signals to "whatever mechanisms understand them", so maybe just leave it there.

I mean, you do a dedicated flexibility session, achieve significant ROM improvements short term, then the next day you're anywhere from slightly more flexible, to no difference, to worse/tighter than had you not stretched. So I think the idea of actually stretching the muscle & whatever else itself, might be less effective than the idea of simply generating the signal/feedback itself. Some people can create alot of noise (push the ROM), some people need to keep it quiet/gentle. I know I fall into the latter category.

Achieving flexibility gains through full ROM/deep movements is still the best bet IMHO. But those days following such movements/sessions, where soreness can be worse, need to be careful when stretching at that point.

more 2cents!

I understand what you are saying. But when I think of trying to incorporate that into the article I go blank. so all the response here will be part of the article (sort of) something that can keep on being updated. But man you know a lot, there is no way I would've thought along those lines.

Great stuff man.