10 Tips for reducing the risks of ski and snowboarding injuries

Winter is here and skis and snowboards are being polished up for weekends spent on the hill. Both skiing and snowboarding are excellent winter activities for adults and youth to enjoy as a recreational pastime or competitively. Propelling yourself down a mountain at high speeds does have its share of risks, so we're sharing some tips for keeping yourself and your family safe on the hill this holiday season.

1. Wear proper protective equipment such as helmets, goggles and wrist guards
2. Ensure your equipment has the proper fit and know how to properly care for it - loose or poorly adjusted bindings increase the risk of foot, ankle and lower leg injuries
3. If you are a beginner, get some lessons from a professional before tackling the hill
4. Be aware of your surroundings, many serious injuries result from colliding with trees, poles or other skiers and snowboarders
5. Be aware of the weather and slope conditions - the lowest risk of snowboard injury is on deep snow, such as powder, fresh snow or groomed slopes
6. Ski and snowboard on hills that are at your ability and skill level 
7. Stay on designated marked trails 
8. Never go out on the hill alone
9. Learn how to fall. Relax and if on skis, keep your knees together. Cruciate ligament knee injuries are one of the biggest problems in skiing. 
10. Skiing and snowboarding are physically taxing to the body, be honest about your fitness levels and do some training before you hit the slopes. When you are out there, be sure to warm up and cool down at the beginning and end of your day.

There is a 35% reduction in head injury risk with helmet use while skiing or snowboarding - Think First Canada

Skiing and snowboarding are great winter sports which can offer fun and exercise for the whole family. With a little preparation, injuries can be avoided with some professional instruction, properly fitted protective equipment, and a little common sense.

References from the SIRC Collection:

1. Bladin C, McCrory P, Pogorzelski A. Snowboarding injuries: current trends and future directions. Sports Medicine. 2004;34(2):133-138. 
2. Fuselli P, Hagel B, Stanwick R. Vancouver Charter: bringing ski and snowboard helmet legislation to Canada. Injury Prevention. September 2, 2010;16:A88.
3. Kim S, Endres N, Johnson R, Ettlinger C, Shealy J. Snowboarding Injuries: Trends Over Time and Comparisons With Alpine Skiing Injuries. American Journal Of Sports Medicine. April 2012;40(4):770-776.
4. Kim S, Lee S. Snowboard Wrist Guards-Use, Efficacy, and Design. Bulletin Of The NYU Hospital For Joint Diseases. April 2011;69(2):149-157.
5. Langan M. Ski and snowboard injuries - reducing the risks. Sportex Health. December 2000;(7):33-35. 
6. Rebecca M H. Are there risk factors for snowboard injuries? A case-control multicentre study of 559 snowboarders. British Journal Of Sports Medicine. September 2010;44(11):816-821.
7. Sakamoto Y, Sakuraba K, Ohbayashi O, Kawakita K, Inoue T. Snowboard and skiboard injuries in recent years: a comparison with ski injuries. Japanese Journal Of Clinical Sports Medicine. April 2006;14(2):218-227.

Stress Fractures

Stress fractures are a common injury in athletes and are most often associated with participation in sports involving running, jumping or repetitive stress. A stress fracture is a micro fracture of a bone that results when the rate of healing is unable to keep up with the rate of breakdown that is being caused by repetitive stress placed upon it. Stress fractures occur most frequently at the beginning of a sports season due to the increase in physical activity that is required. Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are particularly susceptible to this type of injury.

Stress fractures can occur in two ways:

1. The redistribution of impact forces resulting in increased stress at focal points in bone.
2. The action of muscle pull(s) across bone.

The tibia, which is the larger and stronger bone of the lower leg, is the site of approximately 50% of all stress fractures in athletes. - Running & Fitnews

 Symptoms of a stress fracture:

• Localized bone pain
• Pain is aggravated with physical activity and relieved with rest
• Area may be tender to the touch, with occasional swelling and redness

Recovery

One of the biggest mistakes athletes make after being diagnosed with a stress fracture is returning to training too quickly. It's important to let the body heal and if it's rushed, there is a greater risk that the injury will reoccur. Depending on the severity of an injury, the healing process can be anywhere from eight to seventeen weeks. Clinicians recommend that training begin slowly with a low intensity and be pain free. Cross training is a great option for recovery and may include deep water running, cycling and gym work.

Prevention

Stress fractures are managed best by taking preventative measures. Stress fractures are directly related to training loads and how fast an athlete increases the frequency, intensity, and duration of their activity. Bones can adapt to repetitive stress but extreme stress, if it occurs too often, can overwhelm the body's ability to adapt. Having a varied training schedule is essential for prevention as well as having the proper athletic gear. Distance runners are particularly susceptible to this type of injury and it's recommended that athletes replace athletic shoes as they wear out, approximately 700-1,000 kilometres or 6-12 months.

Other risk factors beyond training schedules and loads are nutrition and gender. Calcium and vitamin D deficiency decreases bone density which can increase the chance of injury. For female athletes, amenorrhea (infrequent menstrual cycle), osteoporosis and/or an improper diet can all contribute to the occurrence of stress fractures.

Coaches and athletes should be aware of the effects of overtraining and the importance of taking rest days. If you think you may have a stress fracture, keep in mind that this type of injury should not be self treated. Proper diagnosis should come from a physician and depending on the location and severity, recommendations for treatment will differ.

References from the SIRC Collection:

1. Avoiding a Stress Fracture is Largely up to You. Running & Fitnews. July 2012;30(4):9-13.
2. Dawson-Cook S. STRESS FRACTURES. American Fitness. September 2010;28(5):56-57.
3. Ekstrand J, Torstveit M. Stress fractures in elite male football players. Scandinavian Journal Of Medicine & Science In Sports. June 2012;22(3):341-346.
4. Hunt A. IT'S JUST SHIN SPLINTS... RIGHT?. Triathlon Life. Winter2009 2009;12(1):54-56.
5. Moran D, Evans R, Hadad E. Imaging of Lower Extremity Stress Fracture Injuries. Sports Medicine. February 2013;43(2):345-356.
6. POLLOCK N. STRESS FRACTURES IN SPORT. Sportex Medicine. October 2011;(50):20-24.
7. Poynton E. Stress Fractures. Modern Athlete & Coach. January 2011;49(1):16-17.
8. Smith R. Stress Fractures of the Hip in Young Athletes. Hughston Health Alert. Spring2007 2007;19(2):6.

Rotator Cuff Tears - Symptoms and Treatment

Injury to the shoulder is common in sport especially with athletes who depend on regular and heavy use of the shoulder joint, for example: baseball, tennis, badminton, weightlifting, football, golf and swimming. The rotator cuff is a group of four muscles that work together to stabilize the shoulder joint. It is a ball and socket type joint where the top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula and controls movement of the shoulder joint. A rotator cuff tear is quite simply a tear of your shoulder’s rotator cuff tendons.

A rotator cuff tear can occur in two ways: 

1. Sudden or accute trauma - which can occur through falling or being hit in the shoulder
2. Repeated micro-trauma - is a tear of the rotator cuff tendon that occurs slowly over time through repeated actions and overuse.

What are the symptoms of a rotator cuff tear?

  

Rotator cuff tears may be partial or full thickness tears and the symptoms vary for each.

Partial thickness tear - is when a tear does not completely sever the attachments to the bone. Symptoms may include a mild soreness in the shoulder, clicking and weakness when lifting your hand above your head or your arm behind your back.

Full thickness tears - are complete tears that include a full detachment of the tendon from the attachment site. Symptoms include severe shoulder pain and an inability to lift your elbow away from your body.

What are my treatment options?

Treatment will vary depending on the severity of the injury with most patients recovering from rest and physiotherapy. For more serious injuries, treatments may include corticosteroid injections or surgery. 

After an injury or surgery, adopting an exercise conditioning program will help you with your recovery. A typical program will last 4 to 6 weeks and should include exercises that improve strength and flexibility, and increase range of motion. After your recovery, it may be a good idea to continue performing the exercises two or three times a week as a prevention measure against further injury.

There are many exercises you can perform to help your shoulder heal and all should be performed under the supervision of a doctor or physiotherapist. Some online examples include:

• Physical Therapy Protocol for Patients Following Shoulder Injury
• Rotator Cuff Shoulder and Conditioning Program
• Rotator Cuff Home Program 

If you suspect you have a rotator cuff tear, it's important to seek the advice of your health care practitioner.

the rotator cuff, a group of four muscles that work together to provide the shoulder joint with stability. - See more at: http://www.bidmc.org/YourHealth/BIDMCInteractive/HealthyIs/BonesandJoints/Shoulder/CommonSportsInjuries.aspx#sthash.WRSKxOfj.dpufThe

the rotator cuff, a group of four muscles that work together to provide the shoulder joint with stability. - See more at: http://www.bidmc.org/YourHealth/BIDMCInteractive/HealthyIs/BonesandJoints/Shoulder/CommonSportsInjuries.aspx#sthash.WRSKxOfj.dpuf

References from the SIRC Collection:

1. Gudmestad J. Arm yourself against injury: a torn rotator cuff can mean searing pain, slow healing, and even surgery. But yoga can strengthen your shoulders and help prevent problems. Yoga Journal. December 2003;(178):129-131.
2. Grossfeld S. A BODY IN MOTION. Cross Country Skier. December 2007;27(3):12-13.
3. Martinez K, Tymon G, Lentz D. THE CLINIC: Weight Training Around Shoulder Pain. Running & Fitnews. September 2011;29(5):18-19.
4. Molloy L, Robertson K. The Throwing Shoulder: Common Injuries and Management. Modern Athlete & Coach. October 2007;45(4):15-19. 
5. Petersen C. Posterior cuff training: keep the shoulders healthy with these basic and effective rotator cuff exercises. Fitness Business Canada. March 2005;6(2):52.
6. Wang R. Don't Shrug Off Shoulder Pain!. Black Belt. November 2011;49(11):42-43. Williams K, Kilroy R. Rotator cuff injuries. Swim Magazine. November 1994;10(6):11.

Balance Training

Balance training is a form of training that develops agility, flexibility, power, reaction time, speed and endurance. It is often overlooked because the training results are not always readily apparent. Balance and coordination should be developed through a variety of methods - exercises on wobble boards, balance beams and stability balls are typically used for this type of training.

Why is balance training important?

1. Good balance can increase performance
2. Reduces risk of injury - specifically anterior cruciate ligament (ACL) and ankle injuries
3. Improves coordination between nerves and muscles as well as increasing stability and movement efficiency
4. Creates a sense of body awareness, body positioning, postural alignment, and movement confidence
5. Develops the body's ability to stabilize and generate power from the core

Focus on quality - not quantity

When involved in training it's common to focus on how much weight a person can lift or how many goals they can score. For balance training, the focus must be on the quality and control the athlete has over their movements. Typical balance training goals include increased proprioception (awareness of the position of one's body), better muscle coordination, and reduced reaction times.

Types of balance training

Of course, balance training should be geared specifically to the needs of the sport whether it be static or dynamic balance.

Static balance - requires the ability to maintain equilibrium while at rest.

Dynamic balance - is considered more difficult since it requires the ability to maintain equilibrium while moving.

Balance training can be easily integrated into a training program without have a major effect on energy or time requirements. Performing this type of training has many benefits that ultimately add up to the end goal of improving athletic performance.

References from the SIRC Collection: 

1. Bressel E, Yonker J, Kras J, Heath E. Comparison of Static and Dynamic Balance in Female Collegiate Soccer, Basketball, and Gymnastics Athletes. Journal Of Athletic Training. January 2007;42(1):42-46.
2. Butler R, Southers C, Gorman P, Kiesel K, Plisky P. Differences in Soccer Players' Dynamic Balance Across Levels of Competition. Journal Of Athletic Training. November 2012;47(6):616-620.
3. Gioftsidou A, Malliou P, Godolias G, et al. Balance training programs for soccer injuries prevention. Journal Of Human Sport & Exercise. October 2012;7(3):639-647.
4. Hrysomallis C. Balance Ability and Athletic Performance. Sports Medicine. March 2011;41(3):221-232.
5. Pafis G, Ispirlidis I, Godolias G. Balance Training Programs for Soccer Injury Prevention. Physical Training. November 2007;:2.
6. Ricotti L. Static and dynamic balance in young athletes. Journal Of Human Sport & Exercise. December 2011;6(4):616-628.
7. Twist P. PERFORMANCE BALANCE. Cross Country Skier. October 2009;29(1):28-53.

Identification et prévention des blessures aux ischiojambiers

Aucun athlète n’est à l’abri d’une blessure aux ischiojambiers.* Le risque d’élongation des ischiojambiers est plus élevé si on pratique une activité comportant de la course, des sauts, des arrêts et des départs. Le sprint, les haies, le handball, le football, le baseball/softball, la course et le soccer sont de bons exemples. Les ischiojambiers comprennent trois muscles* : le semi-tendineux, le semi-membraneux et le biceps fémoral. La contraction de ces trois muscles a pour effet de lever le talon vers la fesse et d’en contrôler le retour.

Sévérité de l’élongation*

1. Premier degré : La douleur est légère et l’athlète peut ne pas sentir la blessure jusqu’à ce que le retour au calme soit effectué. Généralement, cette blessure se guérit en moins de sept à dix jours.  
2. Deuxième degré : La blessure prend plus de temps à guérir et empêche l’athlète de s’entraîner. Les symptômes sont : œdème, douleur et claudication. Un programme de réadaptation est de mise.  
3. Troisième degré : La gravité est telle que la moitié ou le muscle en entier présente une lésion. Les symptômes sont : douleur, œdème et incapacité de marcher. Ce genre de blessure exige généralement des mois de réadaptation. 

Causes possibles des lésions des ischiojambiers 

• Surentraînement* ou fatigue 
• Nouvelles chaussures de course ou modification de la surface d’entraînement 
• Blessure antérieure 
• Piètre technique* ou manque d’amplitude articulaire spécifique 
• Absence ou insuffisance d’échauffement/étirement 

Prévention des blessures

• S’échauffer suffisamment* puis effectuer des exercices d’étirement des groupes musculaires ciblés. Effectuer des exercices d’étirement durant la phase de retour au calme s’avère aussi facilitateur. 
• Intégrer un programme d’entraînement à la force* visant la prévention des blessures aux ischiojambiers pour améliorer la résistance à la fatigue, accroître la capacité miométrique et pliométrique de contraction des ischiojambiers et corriger le déséquilibre intersegmentaire. 
• Éviter le surentraînement et l’augmentation drastique de l’intensité et de la durée des séances d’entraînement.

Les exercices réalisés sur le terrain de jeu, la piste et dans la salle de musculation s’avèrent tous utiles à l’amélioration de la performance de l’athlète en le rendant plus vite et plus fort. Une bonne méthode de prévention* consiste à préparer un programme d’entraînement* efficace incluant des exercices de prévention des blessures, particulièrement aux ischiojambiers.

* Seulement disponible en anglais

Références de la collection de SIRC:

1. Bell L, Cianca J, Erickson R. What Underlies My Hamstring Pain?. Running & Fitnews. November 2007;25(6):11-12.
2. Cissik J. Hamstring Injuries And The Sprinter. Track Coach. Fall2012 2012;(201):6405-6407.
3. Hamilton B. Hamstring muscle strain injuries: what can we learn from history?. British Journal Of Sports Medicine. October 2012;46(12):900-903.
4. Opar D, Williams M, Shield A. Hamstring Strain Injuries: Factors that Lead to Injury and Re-Injury. Sports Medicine. March 2012;42(3):209-226.
5. Robertson K, Molloy L. Hamstring Muscle Strains. Modern Athlete & Coach. April 2007;45(2):10-14.
6. Rosania J. TRAINING HAMSTRING REHAB EXERCISES. Swimming World. November 2007;48(11):26-27.
7. Snyder B. Hamstring Strains: Prevention and Treatment. Handball. February 2012;62(1):61.
8. Thames C. Low Back Pain and Hamstring Stretching: CAN STRETCHING EVER BE A BAD THING?. Hughston Health Alert. Winter2010 2010;22(1):5.
9. Understanding Running Injuries. IDEA Fitness Journal. February 2007;4(2):103.

Hamstring Injuries - Identification and Prevention

Hamstring injuries can affect any athlete, at any time. You are more likely to get a hamstring strain if you perform sports that involve a lot of running and jumping or stopping and starting. Sprinting, hurdles, handball, football, baseball/softball, running and soccer are all good examples. The hamstring is formed from three muscles - the semitendinosus, semimembranosus and the biceps femoris - all of which perform the job of pulling the heel up toward the butt and control the decent.

Grades of strain: 

1. Grade One - Little pain occurs and the athlete may not be aware of injury until the cool down. Usually these strains clear up within a week to ten days.
2. Grade Two - These strains will take more time to heal and usually will prevent the athlete from training. Symptoms are swelling, pain, and limping; a rehabilitation program is recommended.
3. Grade Three - Severe injury involving a tear to half or all of the muscle. Athlete will experience pain, swelling and an inability to walk. This type of strain usually takes months of rehabilitation.

Possible causes of hamstring injury:

• Over-training or fatigue
• New running shoes or a change of training surface
• Previous injury
• Poor technique or lack of specific range of mobility
• Incorrect or no warm-up/stretch

Injury prevention:

• Warm up sufficiently and then perform stretches to targeted muscle groups. Stretching during the cool down may also help.
• Include strength training that is aimed at preventing hamstring injuries. This includes making the hamstrings resistant to fatigue, strengthening the hamstrings, increasing the eccentric strength of the muscles and addressing any deficiencies between the limbs.
• Avoid over-training and dramatic increases in training intensity or duration

Work performed on the playing field, track or weight room can all be used to improve an athlete's performance by making him/her faster and stronger. A good prevention method involves preparing an effective training program that will use this work to prevent potentially avoidable injuries, specifically to the hamstring.

References from the SIRC Collection:

1. Bell L, Cianca J, Erickson R. What Underlies My Hamstring Pain?. Running & Fitnews. November 2007;25(6):11-12.
2. Cissik J. Hamstring Injuries And The Sprinter. Track Coach. Fall2012 2012;(201):6405-6407.
3. Hamilton B. Hamstring muscle strain injuries: what can we learn from history?. British Journal Of Sports Medicine. October 2012;46(12):900-903.
4. Opar D, Williams M, Shield A. Hamstring Strain Injuries: Factors that Lead to Injury and Re-Injury. Sports Medicine. March 2012;42(3):209-226.
5. Robertson K, Molloy L. Hamstring Muscle Strains. Modern Athlete & Coach. April 2007;45(2):10-14.
6. Rosania J. TRAINING HAMSTRING REHAB EXERCISES. Swimming World. November 2007;48(11):26-27.
7. Snyder B. Hamstring Strains: Prevention and Treatment. Handball. February 2012;62(1):61.
8. Thames C. Low Back Pain and Hamstring Stretching: CAN STRETCHING EVER BE A BAD THING?. Hughston Health Alert. Winter2010 2010;22(1):5.
9. Understanding Running Injuries. IDEA Fitness Journal. February 2007;4(2):103.

Treating Tendon Injuries

Tendon injuries are common in the sport community and can affect amateur and professional athletes alike. Tendon injuries are most often the result of gradual wear and tear to the tendon from overuse, incorrect movement or aging. As debilitating as they can be, the good news is that when treated properly, minor to moderate tendon injuries can heal on their own.

While almost any tendon can sustain an injury, the most commonly occurring tendon injuries in sport are:

• "Swimmer's shoulder"- occurs when the tendons in the shoulder muscles become weakened and inflamed, sometimes resulting in a rupture.
• "Tennis elbow" - is a condition when the tendons in your elbow are overworked, usually by repetitive motions of the wrist and arm.
• "Jumper's knee" - also known as patellar tendonitis or patellar tendinopathy is an overuse injury that involves the patellar tendon, the cord-like tissue that joins the patella (kneecap) to the tibia (shin bone).
• "Achilles heel" - probably the most well-known injury, involves inflammation of the large tendon at the back of the heel.

There are three stages of injury progression:

1. The reactive phase, where no overt signs of injury are apparent but if an athlete is training heavily, good prevention measures mean allowing adequate rest and recovery. 
2. The second stage is tender-to-the touch, tendons are progressing into a state of disrepair, usually coupled with inflammation and pain. Pro-active methods for recovery are recommended, icing and a longer recovery period is required. 
3. The third stage occurs when the tissues start to degenerate and are more likely to rupture with continued demand for force. If left to this state, it is not likely that an athlete will be able to progress in their training. Proper treatment requires a clinical diagnosis and a strict recovery plan.

When recovering from a tendon injury, full immobilization is not recommended - some movement is necessary for repair (depending on the severity), therefore allow relative rest, meaning minimal load bearing and reduced activity. Any activity that causes pain to the injury should be avoided while allowing the body to heal. If pain persists or becomes chronic, please contact your physician for treatment.

References from the SIRC Collection:

1. Bjöörnsson H, Norlin R, Johansson K, Adolfsson L. The influence of age, delay of repair, and tendon involvement in acute rotator cuff tears. Acta Orthopaedica. April 2011;82(2):187-192.
2. Lin W, Weiwei G, Kaiyu X, Ning L, Bo W. The effects of an early return to training on the bone-tendon junction post-acute micro-injury healing. Journal Of Sports Science & Medicine. June 2012;11(2):238-244.
3. Nessel E. Athletes Needing to Treat Sore Muscles and Tendons. ASCA Newsletter. April 2010;2010(4):24-27.
4. Tonoli D, Cumps E, Aerts I, Verhagen E, Meeusen R. Incidence, risk factors and prevention of running related injuries in long-distance running: a systematic review. Sport & Geneeskunde. December 2010;43(5):12-18.
5. Teramoto A, Luo Z. Temporary tendon strengthening by preconditioning. Clinical Biomechanics. June 2008;23(5):619-622.
6. Witvrouw E, Mahieu N, Roosen P, McNair P. The role of stretching in tendon injuries. British Journal Of Sports Medicine. April 2007;41(4):224-226. 
7. Wren T, Beaupre G, Carter D. Tendon and ligament adaptation to exercise, immobilization, and remobilization. Journal Of Rehabilitation Research & Development. March 2000;37(2):217-224.

Core Training - Not just for your abs!

We've all heard fitness experts claim that core training is important for overall fitness and health. Health clubs offer core training exercise groups and physio therapists recommend it for those recovering from injury. Your core is the collection of muscles that stabilize the spine, this includes the hips, pelvis, abdominals, lower back, mid-back, and neck regions of the body. These muscles are extremely important in all sports, so why do so many athletes overlook core training?

The reason most athletes skimp on this vital part of their workout is because the benefits are simply overlooked.

Benefits of core training:

• Develop better posture
• Decreases back pain
• Helps injury prevention and rehabilitation
• Increased flexibility
• Greater physical strength
• Improved respiration and lung capacity
• For seniors, it can help to improve balance, reduce injury, and maintain mobility

It's important to note that performing a few crunches is not proper core training. Since your core involves many different muscles groups, a variety of exercises are needed to ensure you work them all; some exercises to explore include, but are not limited to, lunges, bridges, planks, and crunches. Pilates and Yoga classes are also excellent for strengthening your core muscles while also improving balance and posture.

When your core is strong, your whole body works better. Core training isn't just for athletes, it's for anyone who would like to have their body working at its greatest potential. For anyone just starting an exercise program, be sure to talk to your family physician first.

References from the SIRC Collection:

1. Aggarwal A, Kumar S, Kumar D. EFFECT OF CORE STABILIZATION TRAINING ON THE LOWER BACK ENDURANCE IN RECREATIONALLY ACTIVE INDIVIDUALS. Journal Of Musculoskeletal Research. December 2010;13(4):167-176.
2. Han C, Wang W, Cheng B, Liu S. Basic Issues of the Core Strength Training: The Core Area and Core Stability. Journal Of Tianjin Institute Of Sport / Tianjin Tiyu Xueyuan Xuebao. March 2012;27(2):117-120.
3. LaRue L. Wave of the Fitness Future: 3-D CORE TRAINING. Volleyball. May 2011;22(4):26-29.
4. Nelson N. Diaphragmatic Breathing: The Foundation of Core Stability. Strength & Conditioning Journal (Lippincott Williams & Wilkins). October 2012;34(5):34-40.
5. Sudicky A. Core without the Crunches. Volleyball. April 2012;23(3):24-27.
6. Yu J, Lee G. Effect of core stability training using pilates on lower extremity muscle strength and postural stability in healthy subjects. Isokinetics & Exercise Science. June 2012;20(2):141-146.

Walking on pins and needles?

Nerves that get stuck and irritated by swollen muscles or ligaments can be a torment to athletes.  The ultimate goal for any athlete experiencing the pain of a pinched nerve is to alleviate any pain or discomfort you are feeling, all while working within your boundaries and keeping up a comfortable range of motion.  As an athlete it's important to know what to look for so you'll have a better chance of getting the proper treatment.

The symptoms of a pinched nerve are more intense than a mild soreness and athletes experiencing the pain of a pinched nerve will often complain that the area has:

• numbness
• tenderness to the touch
• pins and needles
• burning
• tingling
• an aching pain that won't go away

Common nerve injuries for athletes are Tarsal Tunnel Syndrome, Morton's Neuroma, and Piriformis Syndrome.  Depending on the severity, a pinched nerve can be treated a number of ways, such as supportive braces, anti-inflammatory drugs, injection therapy, massage, chiropractic manipulation, physical therapy and sometimes surgery.

Once diagnosed, a good practice along with the various treatments above, is to keep moving but at a minimal or modified level.  As soon as pain will allow, it is recommended that rehabilitation starts as soon as possible.  Take the time to review your exercise regimen, revise your fitness goals to accommodate your recovery and make sure you give yourself extra time for warm ups.  Focus on building up and stretching out core muscles like the chest, back, legs and abdominals. 

Most people that have nerve injuries will improve in time with rest, heat, limited activity and anti-inflammatory drugs.  The problem can reoccur but can be avoided if you apply the treatment methods mentioned above.  It's important to keep in mind that with all pain that lasts between 7-10 days and doesn't respond to self care measures, it's a good idea to consult a doctor or physiotherapist about possible treatments.

References from the SIRC Collection: 

1. Alshami A, Babri A, Souvlis T, Coppieters M. Strain in the Tibial and Plantar Nerves With Foot and Ankle Movements and the Influence of Adjacent Joint Positions. Journal Of Applied Biomechanics. November 2008;24(4):368-376.
2. Beare S. Pain in the Butt! Piriformis Syndrome. Sportsaider. 2004;20(4):9
3. Filley A. Piriformis syndrome: don't let it become a pain in the backside!. Peak Performance. June 15, 2009;(277):1-4.
4. Hariri S, McAdams T. Nerve Injuries About the Elbow. Clinics In Sports Medicine. October 2010;29(4):655-675.
5. Kinoshita M, Okuda r, Yasuda T, Abe M. Tarsal Tunnel Syndrome in Athletes. American Journal Of Sports Medicine. August 2006;34(8):1307-1312.
6. LeRoux M. FEELING THE PINCH. American Fitness. November 2006;24(6):32-33.

Icing on the Ache!

Icing an injury is one of the oldest and best known injury treatment strategies, yet there is often confusion among athletes and coaches as to what injuries they should ice, how often and for how long.  Based on current research there are no definite answers to these questions however here are some basic guidelines you can follow:

1. Always ice an acute injury involving muscle tears and joint sprains.  Acute injuries are those that occur suddenly, such as an ankle sprain, which usually result in swelling and inflammation.  Although inflammation is a natural response to an injury, excessive inflammation can cause further damage.  Once an injury has happened, the faster you can get ice on it, the better.

2. How long do I ice it for?  That will depend on the whether the injury is superficial or deep.  The important thing to remember is that the tissues of the injured area must reduce in temperature in order for the icing to be effective.  It is recommended that if the injury is deep you may need to ice it for up to 20 minutes.

3. The first 48 hours is when you need to be the most diligent; icing every two hours is ideal.  The cold will help to dampen the pain so icing 15-20 minutes four or five times daily would help immensely.  Once the initial inflammation has gone down, icing is less effective and can be performed less frequently.  Many people switch to heat too quickly so give yourself 3-5 days before applying heat.

4. Chronic and long-term injuries to tendons, joints and bone do not usually involve an inflammatory response and therefore icing these injuries is not very effective.  Instead, those 20 minutes can be better used by performing rehabilitative exercises that try to address the injury.

5. When icing, always make sure that there is a barrier to the skin to avoid frostbite; keeping the ice in a thin towel is generally sufficient.  There are also many other commercially available alternatives such as gel packs, Cryocups or Mojiknees that can also be very handy.

If you get hurt stop playing, since continuing to play could cause more harm.  Keep in mind that limiting your mobility, elevating the affected area and pain relievers all help the healing process, so make sure you treat your body well and let it rest.

References from the SIRC Collection: 

1. Bleakley C, Costello J, Glasgow P. Should Athletes Return to Sport After Applying Ice?. Sports Medicine. January 2012;42(1):69-87.
2. Clover J. I.C.E. Can't Do It Alone. Coach & Athletic Director. September 2001;71(2):58.
3. How to return FROM INJURY. Athletics Weekly (Descartes Publishing Ltd.). January 15, 2009;:30.
4. Johar P, Grover V, Topp R, Behm D. A COMPARISON OF TOPICAL MENTHOL TO ICE ON PAIN, EVOKED TETANIC AND VOLUNTARY FORCE DURING DELAYED ONSET MUSCLE SORENESS. International Journal Of Sports Physical Therapy. June 2012;7(3):314-322.
5. Plaster L. A BETTER WAY TO ICE AN INJURY. Runner's World. August 2004;39(8):44.
6. Speed up recovery from injury. Athletics Weekly (Descartes Publishing Ltd.). May 22, 2008;:31.

Sport Safety and Accessories

SIRC Newsletter now available online: Sport Accessories and Safety

With all the kids back in the classroom, try outs for school sports and classes for phys-ed will be starting up again. Many of you may have already received a note from a coach or phys-ed teacher requesting that students remove all jewelry and accessories before participating in any kind of sport. As a parent or coach, it's essential to know why this is important, what equipment children should be using and any safety measures to be aware of in case an injury occurs.

Read more: http://www.sirc.ca/newsletters/mid-sept12/index.html

Managing Calf Strains

Whether you are a high performance or recreational athlete, you have all probably experienced cramps in your calves at one point or another.  The main cause of calf strain comes from muscle fatigue and can happen while participating in a variety of different sports.  It is commonly believed that cramps can be caused by low electrolytes/sodium but so far there has been no evidence to support that claim. 

If your muscles start cramping from fatigue it is usually associated with training errors.  Sudden increases in exercise intensity before you've given your body time to adjust is one of the main reasons people injure themselves.  When the calf muscle is put under too much strain, it goes into protection mode, shortens, and the result is pain and a muscle cramp.  Often this pain will go away given a bit of time, but if pushed again too soon you increase the risk of tearing the muscle.

A common mistake for beginners is to try to do too much too soon. Completing the same workout every day without rest, causes your body to fatigue and makes it more prone to injury.  If you wish to train everyday, go for it, but keep your workouts varied and add some low intensity exercise for a good balance.

What do I do if my muscles start to cramp? 

If your feel your calves seize up, you should ice for the first 24 to 48 hours.  Follow the RICE formula: rest, ice, compression and elevation.  It's good to note that if the pain persists longer than 48 hours you should consult a doctor or physiotherapist. 

How long does it take to recover?

Recovery can be anywhere from two to four weeks which can be a big interruption to a training routine.  If the tear is severe, it can take up to eight weeks for a full recovery.  For treatment, a combination of physical therapy, massage therapy, and cross-training are recommended.  Once you feel like you can move with minimal pain, take it slow and try cycling, swimming, or pool running since they are all low impact exercises which will lower your risk of re-injury.

References from the SIRC Collection: 

1. Calf strain. Cycling Weekly. September 8, 2011;:46.
2. KREDA A. Get a Leg Up. Tennis. April 2011;47(3):60.
3. Millar A. Early stretching routine for calf muscle strains. Medicine & Science In Sports. Spring 1976;8(1):39-42.
5. Stephenson C. In the second part of our non-technical injury guide for athletes, we look at muscle and tendon injuries. Sports Injury Bulletin. July 2002;(21):10-12.
6. Wright P. Common injuries: calf strain. Australian Fitness Network. 2003;16(2):48-49.