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Injured - What to do?

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kiteboarding crash and rice after injuryNo matter how hard we try not to, we sometime have to deal with injuries as a kiteboarder. If the injury is minor, such as a minor strain (injury to muscles) or a minor sprain (injury to ligaments), it should be treated with RICE normally from 6-48 hours. After 48 hours RICE doesn't really have an effect. After that heat can be good and maybe MSA (look at the bottom)


If the injury is severe, if there is severe pain, if there is persistent pain, or if there is severe swelling, it's time to see a doctor or a physiotherapist. Also if there is a major drop in your performance, see a professional. The rest of what follows explains RICE and what you need to do.


When you are injured, fluid accumulates in the injured area causing swelling. Swelling limits motion of the injured area and may contribute to paint if it is severe enough. RICE is important because swelling is hard to reverse once it's been there awhile. You want to prevent it in the first place.


Rest

RICE resting after kiteboarding injuryRest is necessary to keep an injury from getting worse. This doesn't mean you have to totally stop. You can try continuing an activity if pain allows. If the pain persists stop the activity.

Rest does not necessarily mean total immobilization, or weeks on crutches. However, it is important, especially within the first 24-48 hours following injury. Whether you have suffered a sprain or a strain, the actual injury involves tearing of either muscle, tendon, or ligament fibers.

Your body's first reaction is to begin the repair process by stopping the bleeding at the site of injury. It does this by forming a clot around the injured tissues. This fibrin clot is very fragile, and rest is important to allow for both the clot formation, as well as preventing disruption of this clot after it is formed.

Once the clot is formed, your body immediately starts to repair the damaged tissue. Initially, a scar matrix is formed of very weak fibers. Good formation is generally achieved in just a few days. So following the RICE principles and resting the injured area helps to protect the damaged tissue while your body starts the repair process.


Ice

Ice on a injured knee from kiteboarding. RICEIce can effectively decrease pain from an injury. Icing deadens pain and increases blood circulation to the skin which is OK and decreases circulation to deeper areas where bleeding may be occurring. Apply ice as soon as possible. Ice for 20 minutes and then remove the ice. Place a thin layer of material between the ice and the bare skin. Repeat icing for 20 minutes every two hours at least. see how to use ice here

There are many therapeutic properties of ice. First off, it cools the injured area, and creates a numbing type of effect. This is handy in reducing pain, and making things feel a little bit better. Ice provides pain relief by slowing down the transmission of pain signals along the nerves from the injured area to the central nervous system.

While pain relief is beneficial following injury, the most important function of ice has more to do with its effects on the actual cells in the injured area. This can get a bit complicated, so stay with me...

When your body is injured, there are several things that happen. First off, you get bleeding internally, from the injured ligaments, tendons, or muscles. This bleeding causes swelling in the area. As more cells move into the area to begin the repair process, the need for oxygen and nutrients at the injury site is greatly increased. However, because of the swelling in the area, the actual supply of oxygen and nutrients is greatly decreased. So you have cells that do not get enough oxygen, and end up dying. This is referred to as secondary hypoxia. One of the major benefits of ice is to limit this secondary hypoxia, or secondary tissue death.

This is achieved by reducing the need for oxygen. Ice has a cooling effect, and in turn, reduces the metabolism of the cooled tissues. This reduced metabolism decreases the need for oxygen. Cells that would normally die because of a lack of oxygen can now survive. Preventing excessive secondary tissue death is the number one reason that ice should be used immediately following an injury, and why it is an important part of RICE.

If the skin turns white or blue during icing stop at once.


Compression

Compression on a injured knee from kiteboarding. RICECompression can prevent fluid from accumulating (prevent swelling). Use an elastic wrap or stocking. Compression should be applied at once. Compression needs to be firm but not too tight. If the part of the arm or leg farthest from the heart throbs, the wrap is too tight and should be loosened. Ice over compression. Reapply compression wraps every four hours.

Compression is the most important part of the RICE principles. Applying some type of compressive wrap to an injured area can greatly reduce the amount of initial swelling. Swelling is a major factor in prolonged rehabilitation. Swelling will occur very rapidly, however, it takes a much longer to get rid of it. It has to be removed through the lymph system, and this is a very slow, passive process.

Compression helps to control swelling by not allowing extra fluid to pool in the spaces between the cells. Above, I told you about secondary tissue death, which is primarily caused by swelling. So it stands to reason that if you have less swelling, then you will have less secondary tissue death. I cannot stress enough how important the compression component of RICE is following an injury. For example...

Lets say we have two ankle sprains, both having the same amount of initial damage. One is left without compression, while the other is wrapped within the first hour after injury. The compressed ankle sprain will have much less overall swelling, and will most likely have a rehab time that is 1-2 weeks shorter than the sprain that wasn't treated with compression. When you are talking about a high school season that only lasts for 10-12 weeks, 2-3 weeks more in rehab can make a huge difference. So please, don't forget the C in RICE.

My students and clients often ask which is more important, ice or compression. And I reply - both. However, sometimes it is hard to get both at the same time.

A compression wrap applied underneath the ice decreases the cooling effect, and ice applied under the compression wrap reduces compression.

There is an answer though, and one that I highly recommend. It is a ice compression wrap. Comprised of a cold gel pack encased in a fabric wrap, it allows you to ice and compress a body part, and is the perfect way to apply the R.I.C.E. principles.


Elevation

RICE tretment on knee injury from kiteboardingElevation of the injured area limits swelling by draining the fluid. It's the final component of the RICE principles. It simply refers to keeping the injured body part in a position higher than or equal to the level of the heart. For an ankle sprain, this would mean propping your foot up while lying down or sitting.

Elevation works on a simple premise. Gravity. Gravity pulls things down, and this is especially true with swelling. Remember, swelling is removed through the lymph system. This passive system can be greatly aided when gravity is taken out of the picture. So while you are resting to protect that newly formed clot and scar matrix, and are icing and using a compression wrap, keep that injured part elevated.


What about heat?

Because there is controversy about applying heat, I've looked at several sources on the web for information on when to use heat and when to use cold. Heat promotes healing because it promotes blood flow. It also relaxes muscles and eases pain. The disadvantage of heat is that it can increase swelling. That's why cold is recommended right after an injury. Heat is recommended for later when swelling is gone. Heat can be useful after about 48 hours, when RICE is completed.


Then what?

Once the injury is under control and most of the swelling is gone, you need to get back in shape. Remember that just because the injured area doesn't hurt doesn't mean that everything is OK. You need execute a conditioning program to restore motion and strength to the injured area. Until you do, you risk further injury.

Remember that this information is not a substitute for medical advise. If the pain is severe or persists see a doctor or a physiotherepist.

Once the injured area begins to heal, do MSA. techniques. MSA stands for movement, strength, and alternate activities.

  • Movement - Work at establishing a full range of motion as soon as possible after an injury. This will help maintain flexibility during healing and prevent the scar tissue formed by the injury from limiting future performance.
  • Strength - Gradually strengthen the injured area once the inflammation is controlled and a range of motion is re-established.
  • Alternate Activities - Do regular exercise using activities that do not strain the injured part. This should be started a few days after the injury, even though the injured part is still healing.



You should also look in the prehab section. Prehab is how to avoid getting injured again or getting injured in the first place.




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