Man Alive - and Kicking!

While we may be able to point out our Achilles tendon, we may not know where our Achilles heel is. A slight vulnerability—an inflexible shoulder or bad posture at our desk—could lead to injury. The key to prevention, and to successful recovery, is identifying our weaknesses and accepting that none of us is invincible.

Acute versus chronic: the chicken or the egg?

A sudden twist, an awkward turn, or a gradual strain—under extreme stress the body is bound to break down. Acute injuries, such as a fractured bone or torn ligament, are the kinds that make us wince. Brought on by a single impact or incident, they can cause unbearable pain and immediate loss of mobility. Chronic injuries can be just as debilitating, but develop gradually with repeated stress in one area of the body.

While these two categories provide a useful description of injury, understanding the links between acute and chronic tissue damage is just as important as distinguishing between them. A chronic problem left unattended can weaken a bone, wear down a joint, or lead to compensating posture, leaving us vulnerable to acute injury. In turn, acute damage that is not treated correctly can have long-term consequences for our vitality.

Because of this chicken-and-egg relationship, it is important to take preventive action, address early signs of injury, and change harmful health habits.

Charlotte Loaring, a physiotherapist who practices acupuncture, believes a consistent, lifelong approach to injury prevention and therapy, called “prehab,” is key.

“Because we see a patient for a short period of their life, even when they are actively in treatment, we need to determine what they can do outside of the clinic. We need to change behaviours and habits contributing to injury, such as sitting and standing postures, and the way people move, reach, lift, and run. By finding the root cause of the problem, we can determine how best to self-manage it,” says Loaring.

Don’t wait for pain

Successful self-management requires ongoing lifestyle change. Alleviating symptoms is one aspect of injury treatment, but preventing recurrence and improving overall health are also necessary. By seeking therapy only when in pain or discontinuing treatment at the first sign of recovery, we may set ourselves up for re-injury.

Lowell Greib, a naturopathic doctor specializing in sport nutrition, believes pain is a double-edged sword: “If you treat and decrease pain, a patient might resume previous activity even if the problem still exists. By eliminating the symptom and not addressing the source of the injury, you could run into more problems.”

An advocate of the prehab approach, Dr. Greib believes in treating problems before symptoms even arise. Says Greib, “You don’t necessarily have pain when you have a problem. There could be a structural issue, low-grade swelling, or mild bruising without any discomfort. You might brush them off, but these are warning signs that something is wrong.”

Inflammation: a primal response

An early indication of injury is inflammation. The inflammatory response is the first-line response to tissue damage, regardless of its location or severity. The 24- to 48-hour process begins with increased blood flow and fluid release, resulting in warmth, redness, and swelling. An army of white blood cells concentrates in the affected area, protecting from infection. Proteins that promote clotting, preventing further loss of blood and fluid, also gather in the injured area.

Acute inflammation is beneficial and healing, but it can be painful. Cold therapy, also called cryotherapy, can reduce discomfort and assist the inflammatory response. However,
never apply ice directly to skin. Instead, use an ice pack or bag of frozen peas wrapped in a damp cloth or towel for up to 10 minutes.

At this stage, arnica can be applied as a creme or taken orally to minimize bruising. Ginger and turmeric are natural anti-inflammatories that can be incorporated into the diet or taken as supplements.

Following the initial inflammatory response, the body enters a phase of early repair, lasting from two days to six weeks. This is followed by long-term tissue remodelling, which can take as long as two years. Occasionally inflammation becomes chronic, limiting mobility and causing a compensatory injury. It is important to address swelling and fluid accumulation if it persists.

Do your homework

While inflammation is a universal response to tissue damage, treatment and prevention should be tailored to the individual and the injury. A health practitioner can help isolate and improve problems that predispose us to getting hurt. Examining biomechanics and joint range of motion, as well as static and moving body posture can reveal imbalances and weaknesses that need attention.

Professional guidance is crucial to injury prevention—but we have to do our homework. If what happens in the clinic, stays in the clinic, any gains will be lost. In addition, there are remedies that can easily be adopted at home to maximize recovery and stay injury free.

Common injuries, simple remedies

Men are prone to certain injuries for several reasons. They have higher participation rates in competitive sports, particularly those involving body contact and high impact. Also, a larger proportion of men are engaged in physical labour. Tissue damage as a result of these activities can affect muscles, bones, ligaments, and joints alike. The examples below provide some guidance for dealing with injuries that are common among men.

Shoulder impingement: not just for swimmers
Repeated motion, tight muscles, and poor joint alignment are common causes of shoulder tendonitis. Once inflamed, the tendons connected to the group of muscles forming the rotator cuff become compressed within the narrow subacromial space where they pass through the joint. This space can be reduced by as much as 50 percent. The resulting pain, weakness, and loss of mobility are collectively known as impingement syndrome, or swimmer’s shoulder.

The best therapies for shoulder impingement are active and mobilizing, which aim to restore range of motion. Manual therapy combined with home-based or therapist-led exercises can reduce early symptoms and improve function over time. Before exercise, passively warm up muscles with a heat pad to prevent further injury. At rest, cryotherapy can be administered to help reduce swelling.

Combine exercise with a diet that nourishes joint capsules, including a balance of omega-3 and omega-6 oils, flaxseeds, and vitamin E found in wheat germ and avocados. Common anti-inflammatories can help alleviate swelling and compression. These include bromelain, Rhus tox, and curcumin, which is found in turmeric. Also, Boswellia can be mixed with ginger to stimulate circulation to the joint.

Sprain drain
Once an ankle has been sprained, there is a good possibility it could happen again—and again. Ligaments are like elastic bands, and if overstretched sometimes never regain their original shape and tension. You might be predisposed to sprains if your ankle is inherently unstable. In turn, a past injury may have left the joint chronically unstable. Practising yoga and tai chi regularly will improve balance, and orthotic supports can boost stability.

Although it is an acute injury, a sprained ankle can become a chronic problem when scar tissue forms at the site. Immediately after a sprain, rest is vital, and the joint should be supported with an elastic wrap or sling. Boost healing with Rhus tox, and if there is also damage to the bone, use Ruta. After two to five days, gentle finger-kneading massage and range of motion exercises can be introduced.

Mild strengthening activities can be done at home using an elastic exercise band for resistance. Two weeks into recovery, test your balance with single-leg standing, and challenge the joint by walking on varied terrain. If the joint remains weak, prolotherapy, which involves the injection of natural tissue-growth stimulants such as dextrose, may aid by
reducing ligament laxity, improving range of motion, and decreasing pain.

Soreness, strains, and cramps
We stress and damage muscle routinely during exercise and everyday activity. But when tissue is overloaded, soreness, cramps, and occasionally debilitating strains can result. Delayed onset muscle soreness (DOMS) is residual pain occurring 24 to 48 hours following unaccustomed, intense activity. As we shift to warm-weather activities, we sometimes find we’ve lost fitness over the winter months. Relieve soreness by stretching, and if DOMS persists, try therapeutic massage. Replace protein within 30 minutes of strenuous activity, and take magnesium and calcium for cramping and lactic acid buildup.

Muscle strains are usually minor, but if neglected, they can repair improperly, causing permanent scarring and impaired function. A strain can result from direct trauma sustained, for example, in contact sports, in a motor vehicle accident, or indirectly when tissues are cold or unstretched. Muscle can respond to gentle exercise as well as passive therapy, including massage. According to Dr. Lowell Greib, myofascial trigger-point therapy is a form of acupuncture that targets tender spots in the muscle. This generates a micro-stretch that stimulates circulation and inhibits pain receptors, and can be applied as a preventive measure.

The golden arch
The carpal bones in the wrist form an archway, through which a band of tendons pass just above the median nerve. Compression of this nerve is the cause of carpal tunnel syndrome, characterized by numbness, burning, and tingling throughout the first three fingers and over part of the fourth. Compression can be due to swelling of the overlying tendon sheaths following repeated activity or a narrowing of the tunnel itself.

Carpal tunnel develops gradually, long before painful symptoms appear, making prehab crucial. Deep friction massage is a good preventive measure if you play high-risk sports or work on a keyboard all day. Wear a wrist support during activity and ensure your workstation is ergonomically fitted so that your wrists are not flexed while typing. During early stages of injury, the wrist should be placed in a stabilizing splint to minimize pressure within the tunnel. Ultrasound treatment and acupuncture combined with TDP irradiation can also reduce pain severity. Supplement your diet with B vitamins, including B₁, B₆, and B₁₂ to facilitate healing.

A pain in the neck
Whether sitting at a desk all day or labouring strenuously on the job, the back is vulnerable to overuse injury because of postural or repetitive stress. Tension on one side of the spine will inhibit and weaken muscles on the other side, gradually shifting the curvature and causing compensatory problems throughout the body.

Building strength and flexibility around the back and neck is the key to prevention. Forgo intense sessions at the gym and opt for controlled exercises that target problem areas. By observing your static and moving postures, a specialist can guide you in performing functional home-based exercises.

Body awareness is vital to spinal health. Activities such as Viniyoga, which is tailored to your individual condition, can also help improve posture and flexibility. Acupuncture has long been applied as a therapy for back injury, and the deep trigger-point method is particularly helpful in reducing pain and improving quality of life.

Include foods rich in calcium or potassium in your daily diet, or supplement with magnesium. Devil’s claw can lead to short-term improvements in pain, while white willow bark and cayenne are also beneficial.

Mind over matter?

One final point to note is that many injuries result from a failure to apply knowledge about prevention, rather than a lack of knowledge itself. Men can be especially reluctant to admit injury and seek treatment. Be careful not to overestimate your skill or fitness level, and always be alert to signs that your body is being overstressed.

Identify the chink in your armour that leaves you most vulnerable and you are sure to stay healthy—from head to toe, including the heel.