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General Articles

Acute Sports Injuries II

The last column discussed what sports injuries are and how to assess their severity. This column will tell you what to do when you have an acute sports injury. The three main goals in treating acute soft tissue injuries are
1) To relieve pain
2) To reduce swelling
3) To return to full activity as soon as possible

We can accomplish the first two by immediately treating with M.I.C.E. - M-We protect the injury with controlled Motion which keeps the joints mobile while protecting the joints from further injury. I-Ice is applied for 15-20 minutes every 1 1/2 to 2 hours to limit swelling. This is especially important in the first 24 -48 hours. A bag of frozen peas, frozen unpopped popcorn, or a commercial ice pack can be used. Always protect the skin from the ice with a tea towel or paper towel to prevent frostbite. Be careful with icing if you have any circulatory problems.

C-Compression has been shown to be one of the most important things to limit swelling an injury to the area. Wrap the injury in an elastic bandage moderately tight. The wrap should not cause undue pain or be tight enough to constrict the circulation. Always wrap from the point farthest away from the heart towards the heart. (ie. toes towards the knees) Remove and carefully reapply the bandage every four hours. E-Elevate the injured area to a level above the heart in an attempt to allow gravity to help limit swelling. (ie. toes above the nose) The next column will talk about the chronic injuries.


Acute Sports Injuries

Acute Sports Injuries are traumatic in nature. Some are very dramatic such as when Mike Foligno broke his leg at centre ice the season before last. Although his was a bone injury most acute sports injuries are not. A sudden force to the body damages muscles, tendons, ligaments, bones, or joints. Most acute sports injuries fall into the sprain or strain category.

A STRAIN is an injury to the muscle tendon unit. (Rickey Henderson has STRAINED his hamstring) A SPRAIN is an injury to a joint and its surrounding structures such as ligaments. (Wendel Clark has SPRAINED his knee) Sprains and strains are classified by degrees depending on their severity.

A first-degree injury is a mild injury which an athlete may even play through, but generally takes 7-10 days to full recovery.

A second degree injury is more severe and involves partial tearing of the structures. There will be more swelling and bruising with this injury. The athlete will not be able to play or compete with this injury and with good treatment will return to their sport in three to six weeks.

A third degree injury involves more severe or even total tearing of the tissues. Although the athlete will usually be back playing in six to eight weeks the injury may take many months or even surgery before full function is restored. The next column will tell you what to do when you have an acute sports injury.


Helmets Helmets Helmets

As spring approaches we see everyone outside being active. Along with the walkers and joggers I see a lot of cyclists and the new fad rollerbladers. The streets and parks are filled with people going faster and faster on their wheels. This brings me to the topic of this column; HELMETS. The most important part of our body and the most vulnerable is the head. Although we do all of our thinking with the head it is the part that we often least protect. This somehow does not make sense. We have to protect ourselves and our children. I will discuss the use of helmets as it pertains to the following sports.

HOCKEY: The season is ending but recent events make me want to mention a few facts. Recently Michel Goulet suffered a severe head injury when he struck his head into the boards. He was wearing an uncertified helmet. Certainly if he was wearing better head protection the injury would not have been as severe. Luckily the injury was not even worse. Dr. Tom Pashby and the rest of us who work for the Canadian Standards Association(CSA) have worked very hard to define a standard for hockey helmets. Although the children playing organized hockey have to wear certified helmets the old timers and those playing unorganized hockey do not. I encourage everyone to wear a C.S.A. certified helmet all the time and not be as foolish as some of the professionals.

CYCLING: This is the largest group I want to get through to today. Cycling has become more and more popular over the last few years. Each year in Canada there are between 100-130 deaths to cyclists. Not all of these involve collisions with other cars as there have been serious accidents from cyclists hitting other cyclists or other obstacles such as the road and trees. The bicycle makes the rider even more at risk than a person riding a motor cycle. Head injury accounts for 70% of all hospitalizations from cycling injuries. Head injuries are the major cause of death in 70-80% of all bicycle related deaths and cycling is the single most common cause of head injuries in children. Wearing an approved helmet reduces the risk of head injury by 85% and brain injury by 88%. The bicycle death rate rises rapidly from age 5 and peaks in the 13-16 year age group. Deaths are not the only serious outcome of head injuries from cycling. Those that survive may suffer from epilepsy, permanent intellectual and memory impairment, and personality changes. In recent reviews from Calgary and Florida none of the patients who had brain trauma were wearing a helmet. An estimated FIFTY deaths and 6000 injuries could be prevented in Canada if helmets were worn by all cyclists. With great hoopla Bob Rae announced the mandatory use of helmets in cycling a couple of years ago. We are still waiting for the legislation. Think of the number of lives that would be saved let alone the savings in health care. Educational campaigns have shown only limited increase in the number of helmet wearers while legislation has shown large increases. What is our government waiting for?????

ROLLARBLADING: This is perhaps the fastest growing leisure activity in the streets of Canada. It is hard to drive around any suburbia without seeing people blading around. Very few if any are wearing helmets. Although I have not heard of any statistics on head injuries in rollarbladers it is my suspicion that we will start hearing about them soon. As they roll through the city streets without being able to stop or turn quickly, it is only a matter of time before we see some serious injuries. It is with this in mind that I feel that the same rules should apply to bladers as applies to cyclists. In conclusion, until the government legislates the use of helmets I encourage all of you no matter what your age or ability to wear a CSA, ANSI, or SNELL approved helmet for the above activities. 


Golf Injuries

As the snow melts the grass starts to turn green and many of us turn our eyes to the greenest of all grass which exists on the golf course. Golf has shown a large increase in participation in the last several years. Therefore in this article I will discuss golf injuries and some tips on prevention. Although golf does not seem that strenuous there are many overuse injuries that I see that will affect an individuals game and enjoyment of the game. Very few injuries are from direct contact but golf does have its risks. Deaths on the course although rare can occur from lightening, heart attacks , or being hit by an errant ball or club. A golfer was killed in Ontario last year when a broken club acted like a spear. Most of the injuries we see in golf are due to overuse. They can occur to a previously injured body part or the injury can be directly related to the golf game itself.

Golf, more than any other game is a game of virtually the same body movement repeated over and over again. This can lead to microtrauma to the most used parts of the body and hence injury. Very keen golfers have been known to practice their swing over 400 times per day. The basic premise of the golf swing is to transfer as much energy from your body to the club and knock the ball as far and as accurately as possible. The body coils and then recoils around the axis of the spine. It then follows through as the momentum carries the body forward.

Research has shown that the greatest number of injuries occur on contact with the ball while the deceleration follow through phase is the second most common part of the swing to cause injury. The most common problem I see in golf is back injuries. Golf is particularly hard on the back. On the long drives the back is extended then quickly brought through a flexion rotation movement only to be brought back to extension on the opposite side. Biomechanical studies have shown that trunk rotation and flexibility were critical to generate force to transfer momentum to the ball. In less skilled players or older players, lack of trunk flexibility decreases the arc through which energy can be transferred to the ball. When we putt, we stand over the ball in an exaggerated forward flexed position, which is supported by the lower back.

The second most common problem I see in golfers involve the shoulder. This is usually a form of rotator cuff tendinitis which causes the pain. Ironically, I have seen many golfers improve their game with this injury. One of the main treatments for this injury is to decrease the back swing and follow through while slowing the swing down. The golfer may lose some yardage, but more than makes up for it in accuracy. Remember, as my golf pro has told me ""Golf is a target game, not a distance game"". The other common upper extremity injury I see is the so called golfers elbow.

Pain develops on the inside of the elbow on the back arm ie. the right arm on a right handed golfer. I also see a variety of wrist and thumb injuries which will affect the golf game. I see very few lower extremity injuries that are directly related to golf. Commonly an individual with an old knee or ankle injury will develop arthritis in their joint which will make it very difficult to walk the course. 


Tips on Prevention of Golf Injuries

1/ A good warm up including a stretching program should be done before you start to play. This should concentrate on the lower back and shoulders.

2/ A daily routine of a back flexibility and strength program incorporating the abdominals and the hips.

3/ An overall fitness program will help prevent fatigue and allow your to maintain your proper swing.

4/ Golf lessons by a seasoned pro to improve and maintain your swing mechanics. This perhaps is the most important thing to prevent injuries. The future is computerized biomechanical analysis to help you develop and maintain your ideal swing.

5/ If you are having problems seek help early as opposed to latter as it is harder to treat a chronic injury as opposed to an injury which you have had for only a short period of time. 6/ Finally, another quote from my pro""You play golf to RELAX, you RELAX to play golf 


Exercise and Air Pollution

As spring is here and summer is not far behind we now look more for outside exercise as opposed to the indoor work outs we did to avoid the cold and snow. For those of us who live in the larger or industrialized areas we have to think of another hazard. The air pollution problem has gotten worse in the last couple of decades and although there are measure to help control the pollution, it is still a big factor. The air we breath on a daily occurrence is filled with various pollutants. These include carbon monoxide, ozone, hydrocarbons, and other industrial waste. As we exercise and we increase our breathing rate we therefore increase the amount of pollutants we inhale.

The two main pollutants that we have to be concerned about is carbon monoxide and ozone. The main source of carbon monoxide in the environment is automobile smoke and cigarette smoke. The main problem `with carbon monoxide is that it loves red blood cells. Once in the body it competes with oxygen for spots on the red blood cells. The red blood cells deliver the much needed oxygen to the exercising muscle. Therefore if the spots on the red blood cell which are normally reserved for oxygen are taken up by the carbon monoxide their is a decrease in exercise potential.

The heart is then asked to work harder to deliver more oxygen to the muscles. This results in a decrease in maximum cardiac output and a decreased work output. People who liove in rural areas obviously have lower blood carbon monoxide levels than city dwellers(about one half). If you merely stand near heavy traffic you will increase your levels 5 times, and exercising for 30 minutes in heavy traffic will increase it ten fold or the equivalent of smoking one half pack of cigarettes a day. In the worst case scenario, a study done in New York had runners run down the New York streets during rush hour. The amount of carbon monoxide in their lungs was the equivalent of smoking TWO AND A HALF packs of cigarettes a day.

The carbon monoxide lingers in the system for a long time where it is only half eliminated from the body in five hours. This can be expedited by breathing pure oxygen. Be aware that carbon monoxide can linger long after the traffic is gone especially if their is no wind and in shady areas which seems to trap the bad air. Ozone results from the sun acting on nitrogen dioxide and other hydrocarbons. It causes increased airway resistance producing a asthma type situation or making someone with asthma that much worse. You are forced to breath harder to get the needed oxygen to the lungs. It can reduce your exercise capacity 10%. Worse than that, long term exposure can lead to chronic lung disease. Ozone levels are worse on bright sunny days. The final complication is that pollution is said to make you more prone to colds. 


Tips of Minimizing The Risk of Exercise and Pollution

1/ Avoid exercising in peak traffic hours.

2/ Avoid exercising when the sun is brightest and the ozone levels are up. Pollution is lowest at sunrise or late in the evening.

3/ Listen to Air Pollution reports in the media and exercise appropriately.

4/ Exercise in open areas where there is better air circulation.

5/ Avoid exercising in shaded areas or resting in shaded areas after exercise as pollutants are trapped in these shaded areas.

6/ Avoid first and second hand smoke just before exercise and after exercise.

7/ Be extra cautious if you have a pre-existing lung condition such as asthma.

8/ Vitamin C and E might help to neutralize the effect of pollution.

9/ Competitive athletes might consider breathing pure oxygen one hour before a competition where air pollution is a problem. 


P.L.A.Y.

How would you feel as a parent if this happened to one of your kids playing sports?........How would you feel as a kid who is told to play the way these kids were told to play?......... Last season I was at a local arena to watch a group of eight year olds play a game of house league hockey. As I watched the game I soon realized that something was wrong. One of the coaches had instructed his defenceman to STAND about 3 feet above the crease. I asked a parent what was going on. The parent was obviously seething mad and explained that it was the coaches decision to have the defenceman play a stationary game as the way to win.

The parent was incensed by the policy of the coach, but felt a bit helpless by not wanting to be an interfeering parent. Albeit the team was in fact winning more games than before this strategy was implemented, but what are the reasons for playing house league hockey and what message was this for the kids. It appears to me and this is certainly one of the big issues that I am personally concerned with is childrens fitness. The level of childrens fitness has no doubt decreased in our society. Even with the bigger emphasis on fitness the children are watching more TV and living a sedentary life. The physical education programs at the school level are in trouble.

It seems that the support for daily phys-ed and good structured programs is diminishing. This is the reason for Q.D.P.E. This stands for quality daily physical education which will be the topic of a future article to discuss the issues and the work of the Q.D.P.E. group. When I was young we would be out playing all day. We would leave for the local outdoor rink and barely get back for meals. We would play a variety of different sports and games. We would constantly keep our minds and bodies active by constantly inventing games and keeping moving.

What is the benefit to this young eight year old who is told to stand vitually stationary for his three minute shifts every six minutes where he or she sits on the bench. As far as I am concerned the purpose of these kids is to get exercise, learn skills, and have fun. Although there is some fun as being part of a team, I do not see these children developing skills, getting exercise(let alone break a sweat), and mainly developing life long exercise habits. Beyond that; this coach is teaching these kids a game that I do not recognize.

I do respect the time committement by these volunteer coaches, but should they not be teaching the game they are supposed to be demonstrating ot these kids. I have never seen hockey played that way and I do not think it will ever be played that way. I sure hope Booby Orr was not watching. My other concern and one in which I will not get into in this article, is what message is this to the players both on this team and the other teams. Is winning a house league game above denying the children the opportunity to get exercise and to develop skills?

How are these "" less skilled"" players going to get any better? Is it fun enough to win for these kids? They actually lost this game. Is the coaches ego above the reality of the situation? What does this teach them about life in general? We need to be promoting positive attitudes toward exercise in children. Is that child who is told to stand stationary for every shift going to want to play the next year. We have to expose our children to aerobic activities which are fun and that they can continue into adult life. Maybe we are placing our kids into programs that are too structured.

There seems to be an emphasis on kids specializing in one sport at an early age. They often do not play a variety of sports to develop other skills and interests. This can lead to injury and burn out and not many life long interests. We have to remember that it is very few who have a career in sport and the main emphasis should not be on directing their whole life on a dream which is very unlikely to come true. SO, how did this scenario make you feel. Lanny McDonald who is an assisstant coach with his son's team says,""Everyone wants what is best for their son or daughter. We try to improve and continue on that path. We encourage kids to be the best they can be, but not necessarily the best. There's a real difference."" We know that they will live happier and healthier lives if we can get them and keep them involved. Let us not lose sight of the reason kids play sports. Active motion is inate. Let us adults not discourage the childrens need to move. 


Cycling

As the snow melts, the first thing people often think of is to get out their bicycle and experience spring. Their is nothing like cycling to get out those winter cobwebs. The wind in your face as you cruise along. Their are a few things you can do to prevent injury on your bicycle and that is the purpose of this article. Initially their was basically one type of bicycle. Now their are differnt varieties of bicycles and it is important to buy the right one to fit your needs. The three basic types are 1/ Racing/ Touring 2/ Mountain 3/ Hybrid The racing/ touring models are the 10 or 12 speed traditional bicycles with the handlebars curved maround like longhorns. These bicycles are meant for driving on roads on long tours and for cycle racing and triathlons.

They are fast but their narrow tires are far from ideal for city streets. The mountain bikes are generally made for off road cycling. The wide knobby tires while good for traction and stability are far from efficient on the roads. These sturdy bikes can also be used in the city and are a favorite with bike couriers. The hybrid bikes look more like a touring bicycle but have a little bit wider tire and a little more stable and more efficient on streets than the mountain bike. The first thing to do in the spring is to get a tune up of your bicycle. A good bike shop will go through your bike and make sure all parts are working efficiently. They will replace any worn parts such as brake pads which could cause serious problems.

This all in all make your riding safer and more enjoyable. If you are purchasing a new bike make sure you are buying the proper bike for your needs. The next most important thing is the fit of your bicycle. A knowledgable salesperson is invaluable to sell you not only the correct size bike frame for your body, but be able to set the bike up properly for you. The majority of overuse injuries I see in riders are from improper bike fit. The most important things are seat height, pedal arm length, and height and distance of the handlebars from the seat. The next important thing is to wear the proper accessories. As mentioned in a previous article the most important thing is the helmet. No matter where or how far you are going it is important to always wear your helmet.

Depending on how far you are cycling, cycling shorts are needed for comfort and to help prevent saddle soars. Cycling gloves can make the ride more comfortrable and prevent hand and wrist injuries while cycling. If you happen to fall the gloves will also protect your hands from the road surface. It is important to maintain your hydration and cycling with an easy place to store your water bottle is perhaps the easiest sport to do this. Like any sport it is important to start off easy early in the season and increase as your body adapts. In cycling this means not going out for too long a distance. Early in the season you should ""spin"", meaning pedalling at low gears at a high cadence or leg speed(90-100 RPM).

As your body adapts you can increase the intensity and distance you ride in a controlled manner. Be also aware that your technical riding skills will also be rusty so you will have to be more careful both on and off the road. It is important to follow the rules of the road ont hte road and the rules of the trail if you are off-roading. Their have been serious injuries from violations of these rules. Also be careful on the bike paths where you are sharing space with not only other cycists but with joggers, walkers, and now the ever increasing rollar bladers. A future article will talk about cycling injuries, but the main thing is to follow the above principles and go out and enjoy yourself and keep active.


Exercise Induced Asthma

As we exercise in the cold winter air we some of us will have difficulty breathing. Soon after we begin to exercise we start to wheeze, cough and have problems breathing so that it is difficult to continue to exercise. What can be the problem? It may be that you have a form of exercise induced asthma or as we doctor's like to call it ""hyperactive airways"" It is most common in children especially those that have asthma on a regular basis or are very allergic type individuals. It is an extremely common problem with over 16 million people in North America suffers from(12-15% of the population). How serious is it for the athlete? Well, in 1984 the United States looked at their Olympic Team and to their surprise they found that 11% of their athletes in the Olympics had this problem.

Interestingly, over 60% of these athletes including Jackie Joyner-Kersee won medals in their events. What happens to the athlete with this form of asthma? As they start to exercise there is an increase in breathing rate. In the asthmatic person the body 'has a reverse response than the normal individual. As opposed to the airways being made larger to get more air into the lungs the airways suddenly constrict. The restriction of oxygen flow causes the athlete to struggle and grasp for air. There are three phases of exercise induced asthma. The first is called the early response phase which occurs 8-15 minutes after exercise starts. This is a period of airway constriction that lasts one to three hours but is at a maximum after 15 - 30 minutes.

Phase two is the refractory period where little or no restriction occurs. This is the best time for the asthmatic as the lungs now seem to function fairly normally and this can start at 30 minutes into exercise and last 3-4 hours. The final phase is called the late phase which may occur if the person undertakes a second bout of exercise several hours later. The first important thing is to make a proper diagnosis of exercise induced asthma. On the one hand there are many people out there that may have the symptoms and ignore them thinking they normal for them and they must simply be out of shape. On the other hand there are many people out there who think or have been inappropriately told that they have exercise induced asthma and are crippled by this fact when in fact they may not have this problem.

Therefore it is important that you see a doctor and have the appropriate lung function tests to determine if you or your child are having a problem. The following are some tips for those with this common malady. 1/ Take proper medication prescribed by your doctor. This is one condition in medicine where we can control this problem extremely well with inhalers. 2/ A pre exercise warm-up and a post exercise cool down will help to warm the airways. A gradual change in air temperature will less likely invoke a response. 3/ A warm humid environment is the best to prevent asthma(swimming) 4/ Wear a scarf or mask to keep the air you breath warm and moist. 5/ Breath slowly and deeply through the nose as much as possible.

This warmer air that gently reaches the airways will be easier on the airways. 6/ Increase your daily fluid intake to help keep the airways moist. 7/ Avoid overly polluted areas or areas with a high content of allergic plants like pollen. 8/ Become more physically fit. 9/ Several short sprints of less than 10 seconds may induce the refractory period where the athlete can exercise during with almost normal lung function. 10/ Exercise on a regular basis. 11/ The best sports are those that consist of short bursts of activity like tennis or volleyball. So, if you are having problems breathing during sports especially in winter, don't sell the farm. See your physician and follow the above guidelines so that you can continue to exercise and you can win your own medal.


 


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