Adressing serious gym injuries

Volume 1, Number 50 | The Weekly Newspaper of Chelsea | Aug. 31 - Sept. 6, 2007

By Greg Rothman, M.S. P.T.

Exercise programs entail risk. Two weeks ago, I wrote about the simple things you can do to minimize your risk of injury while working out. Last week, I addressed what to do about some of the common, minor injuries that can result from strenuous exercise. This week, I’ll address some of the more serious injuries: how to recognize them and when to seek the advice of a medical professional.

First, there are the minor soft-tissue injuries (like inflammation of tendons or ligaments, which I discussed last week) that just don’t get better. If the pain and/or swelling from these injuries do not resolve within one week, seek the advice of your physician.

Next, certain body parts are more prone to serious exercise-related injuries than others. The elbow is prone to tendon and ligament injuries that do not heal quickly, such as ligament strains and tendonitis. If these injuries do not get better on their own, treatments that may be helpful are cortisone injections or even acupuncture.

The knee joint can also become injured because of muscle imbalances or the constant pounding from running on hard surfaces (serious runners often have “bad” knees). One common injury is chondramalacia patella (knee cartilage grinds or gets worn down). Symptoms include pain when sitting for long periods of time or walking down stairs. Consult a doctor for this injury.

Another common knee injury, patella-femoral syndrome, results when the combination of a tight outer thigh and a weak inner thigh causes the patella (knee cap) to move to the side and impinge on the knee cartilage. While this can often be treated with a stretching and strengthening program from a knowledgeable physical therapist or fitness professional, seek advice from your doctor first, to rule out other problems.

The shoulder is also a common site of injuries ranging from mild to disabling. One problem results when the moving parts (bones) press into tendons or bursae (tendonitis and bursitis). While these sometimes get better on their own, often the inflamed areas are re-injured due to the limited space within the shoulder joint. Shoulder pain that does not go away quickly should be checked out by a doctor.

Another shoulder problem involves the rotator cuff, which is actually a series of four small muscles that not only have to rotate the shoulder but also stabilize the joint. Because of their dual responsibility, these muscles often become overstressed, resulting in rotator-cuff tendonitis (inflammation of the parts of these muscles that connect to the bones of the shoulder). These muscles are also prone to tears. When this happens, depending on the extent of the damage, medical attention is required. Treatments include cortisone shots and physical therapy for less serious tears, or surgery for more extensive tears.

The lower back area is probably the most common site of exercise-related injury; problems range from very minor to extremely serious. When lower-back soreness occurs after exercising, it often goes away after a few days. Soreness or pain in the area that lasts more than a week should definitely be examined by a physician.

Lower-back spasms can be disabling, although they often resolve on their own. When the smaller muscles (there are dozens of them) attaching to the vertebrae (back bones) are overstressed, they can react by contracting or shortening, making movement very difficult and painful. With this type of injury you can often, though not always, feel the muscle spasm if you put your hand over the area that is painful. Sometimes rest alone will allow the spasms to subside, but your physician may prescribe drugs that act as muscle relaxants, followed by a bout of physical therapy.

You’ve no doubt heard people say that they “threw their back out” or “slipped a disc.” This is a potentially serious injury known as a bulging, protruding or herniated disc. Think of the discs that lie in between and cushion the vertebrae as jelly donuts. When the donut gets compressed between the two bones, all of the jelly can get pushed to one side (a bulging disc). If the injury is more extensive, the jelly can protrude outside the donut (protruding disc) or even separate from the donut and press on the nerves that lie alongside (herniated disc).

When the latter happens, the nerve can become irritated and send shooting pains along the entire path of the nerve. Most commonly, it is the sciatic nerve to which this happens (in which case, the injury is referred to as sciatica). This is a large nerve that exits the spine along the lower back and goes all the way down the back of the leg to the foot. The pain can be disabling and often requires intervention, which can range from treatment with oral corticosteroids to surgery to open up the space along the vertebrae and decompress the nerve.

There are other causes of sciatica, such as when the nerve becomes compressed under tight muscles in the hip (often the piriformis muscle, in which case the injury is called piriformis syndrome). This can often be treated by a physical therapist. But in order to know the cause of the sciatic nerve pain, an MRI may be needed. In any case, “shooting” pains are a cause for concern, and you should always consult your physician if these symptoms occur.

I hope that, with this three-part series on injuries, you’ll be able to avoid most of them by following the simple preventative measures outlined in the first column of the series, and know what to do if you do sustain an injury (serious or otherwise). In my next column, I’ll answer reader’s questions regarding injury prevention and management. So, please send me your most pressing concerns.

NOTE: The information provided here is meant to be informative and provide a general framework regarding exercise-related injuries. It should not be construed as medical advice. Always consult a medical professional with any questions and before beginning a new exercise program.

Greg Rothman, M.S. P.T., is the owner of emPower Fitness Studios (emPowerFitnessNYC.com). He received his masters degree in physical therapy from Columbia University and has 15 years’ experience in the rehabilitation and fitness fields, most recently as the personal training manager and top-level trainer for Equinox Fitness Clubs in New York City. SEND YOUR QUESTIONS about nutrition, fitness and sports injuries/rehabilitation to Greg at emPowerFitness@aol.com.