What to do when you get hurt

What is the FIRST thing you should do when you get hurt?

Most people are familiar with the 'RICE' acronym, of Rest, Ice, Compress, Elevate... but what if I told you that RICE was outdated and could even hinder your healing ability? 

Whether it is a new knee sprain, back injury, or shoulder strain, you can use these simple principles to speed up your recovery. Gone are the days of bed rest, ice, and immobilization. 

Don't believe me? 

Let me make my case. 

RICE is based on out-of-date research and does some of the exact OPPOSITE things we need for healing. In order to heal, our body needs stress and inflammation. Rest and Ice actually decrease the body's ability to heal, if used for an extended period of time.

Healing occurs in 3 phases:

Phase 1) Inflammatory Phase (a few days)

Phase 2) Repair Phase (1-2 weeks)

Phase 3) Remodelling Phase (Months)

If you want to optimize your healing during all of these phases, you need to follow the PEACE and LOVE protocols. The goal of the PEACE phase is to calm everything down. Let the inflammatory phase run its' course. The LOVE phase is to start building things back up. 

Here is the summary of PEACE and LOVE:

Day ~1-3: PEACE

Protect: avoid excessively painful and aggravating activities

Elevate: when at rest, try and keep the injured limb above your heart

Avoid anti-inflammatories: avoid ice, ibuprofen, and other anti-inflammatories whenever possible

Compression: use a tensor wrap, compression wrap or other compression tools to clear swelling

Education: learn about your injury and the typical healing times (that is where we come in)

Day 3+: LOVE

Load: start injury specific exercises as early as possible to promote proper healing

Optimism: stay positive. Injuries suck, but you will get back to it.

Vascularization: keep training cardio as often as you can to maintain your cardiovascular fitness and

Exercise: start reintroducing normal activities and get back to regular exercise as tolerated without a significant increase in pain 

How long does it take to heal?

This depends on the body part injured, the severity of your injury, and your overall health.

For example, a Grade 1 Ankle Sprain? Typically resolved within 2 weeks.

A Grade 2+ Hamstring Strain? Can take MONTHS to fully resolve, or longer without proper rehab.

Anxious and afraid of your pain? Fearful or every little twinge? That will slow your rehab and prolong your recovery.

There ARE a few things you can do to speed up your recovery:

• Move OFTEN: keep moving within pain-free range (or tolerable increases in pain)

• Manage SWELLING: swelling can limit your activity and cause considerable discomfort

• Stay OPTIMISTIC: a positive outlook is extremely valuable and can actually speed up your recovery

Not sure where to start?

That is where a qualified Chiropractor or Physiotherapist in Vernon, BC can help. A good Chiro or Physio will put you through a thorough assessment and help identify the extent of your injury and your pain triggers. Then, they will help you put together a rehab plan to get you back in action.

Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Book an Appointment with Dr Murdoch: book here

Instagram: Base.Camp.Doc

Training to fight a dragon

With Spring running right around the corner, I am starting my prep. I am going to be participating in the Bush Babes and Bros Race Specific Training Clinic (Dragon's gonna be SLAYED this summer) and I am STOKED!

But I also know that it means I am going to be running more km than ever before, so I want to be prepared.

Going into the spring, I am focused on 3 things:

1) Building my Aerobic Base. It has been a long time since I have done extended cardio, and having decent cardiovascular fitness goes a long way in training for a long run. For the past two weeks, I have been putting in about 20-25 minutes of moderate level aerobic (cardio) training (heart rate usually the 140-160 beats per minute range). March 1st the plan is to start 30-45 minutes of steady-state cardio at an intensity that keeps me in the 135-155 beats per minute.

2) Tendon Prehab (specifically my Achilles). As a mid/forefoot runner, I know my ankle and Achilles are going to take a lot of that load (especially with the hills that I know Dawna has in store for us) so I want to be prepared for it.

3) Managing a mild hip-flexor strain. Right now it is an annoyance, but I know if ignored it has the potential to wreak havoc on my training, so I am starting the rehab process. Since the pain is mild, I am focusing on adding STRESS to the muscle, which both stimulates healing and helps build my capacity, making me less susceptible to hip flexor strains and pain in the future. Add in the additional benefit of improving running muscular endurance and foot turnover, and it’s a no-brainer.

This week I add-in my rehab/prehab plan which currently looks like this:

A1 - Calf Raises (3-Direction) to prep my calves and Achilles. 15 repetitions with feet pointing in each direction (forward, outwards, inwards)

A2 - Psoas (Hip Flexor) March to rehab my hip flexor (and then improve my foot turnover/cadence). 10 repetitions per leg of concentric marches.

Want to follow my training journey? I will be documenting my training on both the Adventure Athlete Podcast (coming soon) and on social media (Instagram)

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Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Book an Appointment with Dr Murdoch: book here

Instagram: Base.Camp.Doc

Dealing with a new knee injury

The first thing I recommend doing if you think you have injured your knee is to get a proper assessment. I can help you if you are looking for a sports medicine oriented chiropractor or physiotherapist in Vernon, BC.

Sometimes, though, getting in to see someone you trust can be a challenge. Your chiro doesn’t have an opening, your physio is off, or your athletic trainer is busy. It is helpful to have some strategies to manage your knee injury in the meantime.

IMPORTANT NOTE:

If you have severe swelling, heard a pop/snap followed immediately by pain, or you have any reason to suspect it is fractured, you need to get an x-ray as soon as possible. Visit your local emergency room or urgent clinic.

ACUTE knee pain just means that you had a recent injury that might be responsible for your pain. A slip and twist, or a fall and catching yourself. Even just a long day of skiing or hiking hard can lead to an incident of acute knee pain.

When a patient comes to me with acute knee pain, we have 3 goals:

1. Limit or reduce swelling

2. Maintain active range of motion

3. Preserve muscle mass and strength, especially in the quads (front of the thigh)

Managing Swelling

Swelling leads to pain and stiffness, which usually leads to inactivity, which always leads to loss of muscle mass and strength. So in essence, managing swelling is already starting to accomplish the other two goals.

Here is how we manage swelling with acute knee pain:

• Keep the joint in motion as often as possible within pain-free (or manageable pain) range of motion. Keeping the ankle and hip moving is also helpful in pumping out swelling.

• Elevation to take advantage of gravity to clear swelling

• Compression to increase clearing of fluid and limit swelling

VIDEOS: 

Maintaining Range of Motion

Motion is the lotion. You don’t use it, you lose it. Same same. We want to keep moving as much as possible, within reason, immediately following injury. That might mean you are literally moving your knee joint 5 degrees, or your knee doesn’t even move but you are pumping your ankle through range of motion. Do as much as you can within PAIN-FREE RANGE (or at least tolerable pain). 

Here are the exercises I recommend to my patients to maintain range of motion:

1. Quad Sets

2. Passive Range of Motion

Maintaining Strength and Muscle Mass

The key to maintaining muscle mass after an injury is: movement and nutrition. If left immobilized, the leg muscles can atrophy (i.e. shrink) by ~5% in a single week. Atrophy tends to slow over time (since there is less muscle to waste away), but it is not uncommon to have upwards of 15% muscle loss in a month of mobilization. That is a big deal.

Here are the first things we do to prevent as much muscle mass and strength loss as possible:

1. Nutrition:

   1. Immediately increase protein consumption. Your body NEEDS protein to heal your injuries, and even though your activity level may decrease, your protein needs often INCREASE

   2. Avoid highly inflammatory foods whenever possible (even though I know how tempting it is to finish that pint of ice cream to cope with the frustration)

2. Isometrics or low-load movements - keep the injured joint moving as often as possible with as much stress as you can handle.

   1. Isometrics: activates the muscle without moving the joint through range of motion, and is often tolerable even when in a lot of pain

   2. End range limited range of motion exercises like Quad sets

   3. Contralateral leg training: i.e. exercising with the OPPOSITE limb can actually maintain both muscle mass and strength (pretty cool, eh?)

Exercise for Acute Knee Pain:

Not sure where to start?

That is where a qualified Chiropractor or Physiotherapist in Vernon, BC can help. A good Chiro or Physio will put you through a thorough assessment and help identify the extent of your injury and your pain triggers. Then, they will help you put together a rehab plan to get you back in action.

Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Book an Appointment with Dr Murdoch: book here

Instagram: Base.Camp.Doc

House Cats

Here is something we know about house cats: they don’t often tend to last very long when they escape the comforting confinement of our house. Unless they have experience in the great outdoors, they quickly get scooped up by meat eaters or find themselves a new couch with the lady down the road. 

Cats are tough critters who have the capacity to be successful killing machines that have the capacity to be a royal nuisance to ecosystems. But when Mr. Jingles slips past you, his chances of survival drop dramatically. Why? 

Conditioning and exposure

Consider being unprepared to handle load in a new environment. House cats are anatomically and physiologically designed to succeed in challenging situations. However, without conditioning and exposure, these tools are often useless. Mr. Jingles quickly finds himself in trouble. 

Congrats, you made it past my cat metaphor.

Sedentary lifestyles can leave us in a similar situation to the house cat. As unconditioned people, we are not conditioned or exposed to enough athletic variety to maximize our inherent biomechanics thus making physical challenge that much more difficult.  

We get hurt more easily, our athletic variety drops dramatically and we often become afraid to try new things.

And we just don’t feel as good. That is no way to live. 

When the body does not have a consistent varied load, it loses adaptability. Reduced adaptability to different types of load or positions predisposes the body to injury. Muscles and connective tissue require load to maintain proper cellular turnover. We also need our nervous system challenged to create a steady connection between the requests of the brain and the response of the body. If these functions are not challenged often, we cannot expect to get by on shear anatomy alone. 

Cross training or varied physical activity improves our overall health as well. We know that physical activity improves things such as blood pressure, regulates hormones and improves digestion. What we also know is that different types of exercise improve our health systems in varied amounts. For example; hot yoga makes us better at temperature regulation while mountain biking will improve heart rate variability. Both are excellent ways to stay active but combined, they tone different systems for a far more toned overall picture of health.

When we forget how adaptable we are, we miss out on trying new sports, meeting new people or getting after totally attainable goals. By forfeiting physical challenge, we lose touch with our bodies. It becomes easy to forget what we are capable of. If you know you can run 5k, you are a lot more likely to sign up for a 10k or go on that boys skiing trip. Life gets a lot more fun when we have confidence in our bodies.

CrossFit is a sport that is really good at making people overall more adaptable. Barbell, KB, gymnastics and mobility programming that makes it’s members more ready for life outside the gym. Gyms like CrossFit Vernon work hard to provide programming with a wide range of physical demand and coaching staff so knowledgable, the members have the confidence to try new exercises and challenges.

But you don’t have to do CrossFit to have varied exercise. If you like to run, try a yoga class to improve your mobility. If you like to riding your bike, try kickboxing for more ____. And if you like your couch, try going for walks outside.

The goal is to become more versatile. When we have a higher capacity for cardiac, weight or neurologic load, we become more athletic overall. Things like moving heavy furniture, carrying kids around, joining a run club and skiing all weekend become far less taxing. When we aren’t taxed, we feel more athletic. Athletic is adaptable.

Wrapping it up

House cats generally lack the adaptability required to succeed outside. They aren’t good at trying new things and they get hungry quick. People who don’t challenge themselves on a regular basis have a similar response to physical challenge. That challenge can look like learning a new hobby or having to shovel snow out of your driveway. If our bodies are conditioned and exposed to a variety of loads and situations, we get more athletic and life gets easier.

Shots Fired Blog: This may come across as shaming people for not being active or only having time for one way to stay moving. Instead it’s a cute metaphor to convince you to try new things. Your limits are only those that you build for yourself. You keep yourself inside. You owe it to yourself to stay moving because life is a lot less scary when you do.

And in injuries keep you from trying more activities, make an appointment with your local Vernon chiropractor or physiotherapist to get the issues sorted out.

Don’t be a house cat. They don’t have nearly as much fun as outdoor cats and they don’t have nearly as many stories.

Skiing and ACL injuries part 3

This is PART 3 of a three-part series about skiing and your ACL

Part 1: What is the ACL Sprain? Check it out here

Part 2: What to do if you think you injured your ACL? Check it out here

How can I prevent ACL injuries?

This is the golden question. Unfortunately, the answer is unclear.

Can you 100% guarantee you will not have an ACL injury if you do “these 3 exercises!”? No. Can you reduce your risk of an ACL tear? Probably.

The principles outlined below are no guarantee that you will stay injury-free, but they are what I recommend if you are worried about injuring your ACL.

1. Get Strong

Leg strength does not guarantee you won’t get injured, but it will help you power through tough terrain, maintain your form and technique throughout the day, and improve your chances of keeping your balance.

Pair it with core strength, and you have a better chance of handling anything the mountains have to throw at you.

Below is a basic strength program you can use to help strengthen your body for ski season.

2. Hit the technical stuff while you are fresh

Fatigue leads to decreased strength, worse technique, more mistakes, and worse balance. If you are trying to hit technical terrain and really pushing your limits, don’t wait until the end of the day when you are starting to get tired. When you ARE getting tired, stick to runs you are really confident in.

3. FOLLOW THESE TIPS

These tips put out by Vermont Ski Safety Equipment Inc and can be helpful for avoiding knee injuries. For the full article, check out: https://vermontskisafety.com/research/tips/

TIPS: 

Recognize Potentially Dangerous Positions

If you find yourself in this situation, it is important to take a second and correct your position before panicking and potentially putting yourself at risk:

• Your uphill arm is back.

• You find yourself ‘in the back seat’ (off-balance to the rear).

• Hips are below your knees.

• Your uphill ski is unweighted.

• Most of your weight is on the tail of the inside edge of the downhill ski.

• Upper body generally facing downhill ski.

If you do find yourself in this position, here is the solution:

• Stick your arms out in front of you.

• Bring your feet together.

• Keep your hands over skis.

TRAINING FOR SKI SEASON

Before ski season, I like to focus on 3 things:

• Single-Leg Strength/Control/Balance

• Core Strength

• Aerobic Base

Single-Leg Strength, Control, and Balance:

• Train 2-4 times per week

• Use a mix of moderate and heavy loads

• Limit your reps and weight to your weaker side to limit the development of asymmetry

• Make sure you still have a decent base of bilateral strength (traditional squats, deadlifts, etc.)

My favourite single-leg exercises for Skiing:

• Single-Leg Deadlift

• Hip Airplane

• Hamstring Sliders/Single Leg Glute Bridge

• Bulgarian Split Squats (aka Rear Foot Elevated Split Squats)

• Single-Leg Bounding

• Pistol Squats to a Box

• Adductor Plank

Core Strength

• Train 2-5 times per week

• Emphasize movements that keep the core stable, while moving the limb

My favourite core exercises for Skiing:

• Pallof Press (single leg if capable)

• Side Plank

Aerobic Training

• The goal is to increase your aerobic capacity so that it is not limiting you when you hit the slops

• Train 3+ days per week, 30-45 minutes of moderate-intensity

• Train 1-2 times per week of high intensity

• The activity itself doesn’t matter too much. Choose one or a couple that you enjoy and rotate between them (e.g. running, rowing, cycling, hiking, etc.)

I put together a sample 4-week program for prepping for ski season you can use and adapt to your own training

Get the 4-Week Training Program for Skiing

4-Week Ski Training PDF

TRAINING DURING SKI SEASON

During ski season we can still train and improve strength, but we don’t want to do anything that compromises our day on the hill. Your training regiment will be highly specific to your experience, injuries, skiing ability, and skiing frequency.

If you only ski occasionally (once or twice per month) then you can train as if you are leading up to ski season, but refrain from heavy training a couple of days before you plan to hit the slopes.

The goal DURING ski season is to maintain the strength you already have and stay sharp. If your training compromises your fitness on the mountain, then we have screwed up the program and forgotten what the goals are.

Generally, I recommend strength training 1-4 times per week, but limiting heavy lifting or really taxing training 1-2 days leading up to putting the skis on.

For cardio and aerobic fitness, this is a great time to increase your volume with low impact activities such as rowing or cycling.

My recommended schedule is:

3 days of strength training at moderate intensity. Focusing on general physical preparedness. Most of my sessions look like this:

• 1-2 Upper Body Pushing Exercises (e.g. push up and military press)

• 2-3 Upper Body Pulling Exercises (e.g. bent over row and pull-ups)

• 1 Knee Dominant Exercise (e.g. lunges or goblet squats)

• 1 Hip Dominant Exercise (e.g. Romanian Deadlift or Hip Thrust)

• 1-3 core exercises (e.g. Pallof Press and side plan)

Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.

Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.

www.BaseCampClinic.com

Contact: drmurdoch@basecampclinic.com

Instagram: Base.Camp.Doc

Disclaimer: This blog is intended for general informational purposes only and is not intended for the delivery of medical advice. No doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog and website is not intended to be a substitute for medical advice.