Exercise With Care - Fitness Is Not Risk-Free

by Food and Drug Administration (FDA)

Early one morning you're out jogging along your favorite path, getting the heartbeat going a little faster and feeling good, when suddenly, your ankle twists and your leg gives way. You groan in pain and mutter something about that hole you stepped in not being there yesterday.

What next?

Should you walk on that sore ankle? Should you rush to a doctor, or treat the injury yourself? Should you apply heat or cold to the injury? Should you take something for the pain? Which medications are safe? Which are helpful?

First, just stop, advises Gabe Mirkin, M.D. According to this author of several books on physical fitness and sports medicine, pain is a way your body talks to you. Stopping whatever you are doing prevents further damage and allows you to assess the situation.

Robert Nirschl, M.D., assistant professor of orthopedics at Georgetown University, in Washington, D.C., offers this advice: "Look for signs of inflammation such as swelling, redness, tenderness, fever — generalized or local — or pain that persists with or without continued activity." Any of these signs — or others, such as decreased mobility or weight-bearing ability of the affected limb, or a "popping" or "snapping" sound — indicates the need for immediate treatment.

Mirkin advocates the "RICE" program for a traumatic injury:

Rest-Ice-Compression-Elevation. Stop the activity, cool the injured area with ice or a coldpack, wrap an elastic bandage around it, and elevate the injury above the head to reduce swelling.

There are exceptions to the RICE regimen. Ice or coldpacks should not be used on people who have problems with arteriosclerosis (hardening of the arteries), or on an extremity that may become gangrenous, such as a foot injury in someone with poor blood circulation.

But aside from those exceptions, the RICE treatment should begin immediately after an injury occurs to reduce swelling to the area and promote healing.

Writing in The Sports Medicine Book, Mirkin and Hoffman advise consulting a physician after beginning RICE if one or more of the following conditions exists: traumatic injury to a joint; severe pain; pain in a joint or bone that persists for more than two weeks; infection, signaled by pus, red streaks, swollen lymph nodes, or fever; or injury that you feel should be checked.

As Mirkin and Hoffman point out, these are only guidelines. Your own intuition is often better and more relevant to the particular situation than anything in a book or magazine. When in doubt, have it checked out. It is far better to consult a physician needlessly than to hesitate and suffer permanent injury.

In general, cold is highly recommended for treating sports injuries. By constricting the blood vessels, cold decreases swelling by inhibiting blood flow to the injured area. With decreased swelling there is less inflammation, and more rapid healing.

Heat has the reverse effect and therefore should be avoided in case of traumatic injury. The hot bath that feels "oh so good" relaxes the walls of the blood vessels, increasing the flow of blood and fluid to the injured area, making the inflammation worse. "If there is swelling," cautions Nirschl, "no heat, no warmth, until the injury is healed."

Over-the-counter pain relievers for minor sports injuries get a rather mixed review. Vincent Karusaitis, M.D., a medical review officer in the Food and Drug Administration's Center for Drug Evaluation and Research, explains that aspirin and related drugs are helpful for short-term relief for minor sports injuries.

"Aspirin and aspirin-like compounds reduce temperature and inflammation, and relieve pain," says Karusaitis. "Some people, however, are allergic to aspirin, so they can take an analgesic that doesn't contain aspirin, such as acetaminophen, to reduce the pain and fever, though it has no anti-inflammatory action."

Lee Geismar, a chemist with FDA's division of over-the-counter drug evaluation, voiced concern over any medication's potential to "cover up" pain and allow people to ignore a serious injury. Geismar explains, "That's why the label says '10 days.' After 10 days, if you still feel pain, it's not a minor injury. It might be serious, and should be seen by a doctor."

Mirkin went even further in cautioning injured athletes about using pain relievers at all. "They stop the pain," he explained, "but the prostaglandins that cause the pain are part of the healing process. There have been studies indicating that blocking prostaglandins may inhibit healing. . . . You're better off taking nothing." He recommends rest and keeping in shape during recovery with a sport that stresses uninjured parts of the body.

A warning note: Aspirin — even children's aspirin — should not be given to children and teenagers suffering from or recovering from flu, chicken pox, or other viral illness. Use of aspirin in such cases has been associated with Reye syndrome, a rare but serious — and sometimes fatal — condition.

Experts are even less enthusiastic about topical treatments such as creams, ointments and liniments in treating injured muscles. FDA categorizes these treatments as "topical counterirritants": "externally applied substances that cause irritation or mild inflammation of the skin for the purpose of relieving pain in muscle, joints, or viscera distal to the site of application." In other words, the burning of your skin takes your mind off your aching muscles. As Geismar puts it, "It's like pinching your big toe so that you forget about your headache."

There is no scientific proof that topical treatments, even those that contain aspirin, ease aching muscles, though the rubbing or massaging of the area can itself be soothing. Since the medications often contain irritants, such as menthol, the labels caution against bandaging the applied area tightly or for too long.

If your sports injury is a blister, be sure to keep the top layer of skin in place for faster, less painful healing and to lessen the chance of infection. The Complete Sports Medicine Book for Women, by Mirkin and Mona Shangold, M.D., recommends removing the fluid by making a small hole at the edge of the blister with a sterilized needle, gently pressing the fluid out, applying antiseptic ointment, and bandaging the area. If redness or pus develops, consult a doctor.

Whatever treatment you choose, fitness experts are unanimous in agreeing that the injured area must be rested until the pain is gone, then gradually rehabilitated back to normal. "Unless the area of the injury is properly rehabilitated," cautions Nirschl, "you are at high risk for the same problem recurring."

With foresight, planning and care, you can prevent most sports injuries and treat some yourself. Sooner than you think, you can be out jogging on that favorite path once again, cautiously avoiding that pesky hole.

About the Author

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