Injuries are a very common occurrence in sport or the workplace and there are a multitude of factors that play a role for an injury to occur. Injuries can be niggling and can threaten to derail your sports season. Injuries also play a role when it comes to limiting you at work and your everyday life and therefore I feel injuries are very important to manage correctly.
Below will outline what the most recent and up to date research says about how you should go about your rehabilitation so you can recover in the quickest time possible with the best outcomes possible.
Have you heard of RICE ( Rest, Ice, Compression and Elevation)? Or what about POLICE ( Protection, Optimal Loading, Ice, Compression, Elevation)? These 2 acronyms have been used throughout the years as ways to help people manage injuries and at the time were based on the latest research.
These practices are still very commonly used when someone suffers an injury. But is this what the latest research says? Are we providing the best management for our injuries?
In 2019 new research emerged and with it, a new acronym for us to live by when managing injuries, PEACE & LOVE. This new acronym helps us manage directly after an injury has occurred, but also gives us a framework for management to get back to pre-injury capacity.
What does this mean for us who are trying to manage an injury? Well I will go through step by step.
The word PEACE helps us understand what the necessary approach is directly after an injury has occurred.
P for protection
It is recommended to minimise movement and load on an injury for the first 1-3 days to reduce the risk of aggravating the injury, minimise bleeding to the area and prevent distension to the injured muscle.
E for elevate
Elevate the limb or body part higher than the heart to be able to remove any unwanted fluid around the injury.
A for avoid anti-inflammatories
The body’s way of repairing an injury is through inflammation. Inflammation carries all the right things for your body to go through the process of repairing itself. Therefore taking anti-inflammatories which are designed to stop this process could affect long term healing.
What about ICE?
It has been a stalwart in the injury management space for many years now but according to the most recent research it is unknown whether ice helps the healing process of an injury. It is believed ice reduces inflammation which we know is very beneficial and necessary to healing. In fact the researcher, by the name of Dr Gabe Mirkin, who invented the term RICE back in 1978, has retracted his research and now has the view that ice and rest may actually delay healing not help it.
Ice is thought to have a pain relieving effect on an injury and therefore does have a role in injury management but not as initially first thought.
C for compression
Compressing an injury with external pressure like a bandage or compression garments you can buy these days assists to reduce swelling and muscle bleeding
E for education
Correct education from a health professional helps to avoid overtreatment and should give you the confidence in your body’s healing mechanism. You should be trying to stay away from passive treatments especially in the long term and try to use more active approaches to management. The mentality “I need fixing” is detrimental to your recovery.
If you don't understand your specific injury or don't know how to rehabilitate it, speak to a health professional for help and education on correct treatment and load management for a full recovery.
After the initial management of an injury, all it needs is some LOVE.
L for load
Load should be added early on in your rehabilitation and you should try and resume your normal activities as soon as you feel comfortable doing so. Loading that does not exacerbate pain assists repair and recovery of your muscles, allowing you to regain the capacity and strength you previously had.
O for optimism
Psychological factors play a larger role in a person's recovery than people release. Factors such as catastrophizing your injury and fear or anxiety over your injury can prevent optimal outcomes. It is believed that psychological factors may drive the variation you see in certain injuries, more so than the injury itself.
Stay positive, be optimistic and believe in your body’s healing process.
V for vascularisation
Aerobic exercise is a fundamental aspect of any injury rehabilitation process as it promotes blood flow to the injured area and is proven to improve mood, psychological well being and motivation.
So find a pain free aerobic exercise that you enjoy and begin with that.
E for exercise
Exercise is thought to be the gold standard in terms of treatment for injuries and research has demonstrated positive outcomes for all types of injuries. Exercise has many different mechanisms of improving the capacity of an injured body part or an injured person and it is important to continue to exercise any way possible through an injury period.
There is plenty to understand and to cover when you get an acute injury however remember to use the acronym PEACE for directly after an injury has occurred and use love for the rehabilitation process. Bottom line is you want to stay as active as you can and in the beginning phase of an injury be guided by your pain to what you can and can't do. Loading the injury to a tolerable level is only helping healing, not hindering it.
Accredited exercise physiologist
1. Strength Training improves muscle mass, which can help us in our everyday lives
Looking like the incredible hulk or the next bodybuilding queen are not the only reasons to strength train, and for probably around 98% of the population, these are not the reasons we strength train. Some might strength train to improve their athletic performance, improve flexibility and reduce incidence of injury or chronic disease. However, at the very least improving your strength can help with everyday tasks such as moving the lawn, lifting the groceries, shifting furniture, and cleaning your house. For most people these jobs are not the most enjoyable in the world, therefore having good strength and stamina to get them done quicker and with less effort is a great outcome.
2. Strength training improves bone mineral density
As we age, and particularly for females who are post menopausal, our bone mineral density can decline. There is evidence to suggest that we can lose as much as 3-5% per decade after the age of 30. This can increase a person's risk of a fracture if they were to have a fall, and lead to reduced quality of life. In a study of people living with Osteoporosis who undertook a specific strength training program to improve bone density, results showed that 86% of patients increased bone mass in their lower spine, and 69% of patients increased their bone mass in their hip - which is great results for people living with this condition.
3. Strength training can help to preserve lean muscle mass during weight loss
Generally when you restrict our energy intake with the goal of losing weight, not only do you lose fat mass, but also some lean muscle mass, which is not ideal. Although aerobic exercise generally forms the basis of your training if your goal is to lose weight as this form of exercise burns a greater amount of energy during your exercise session compared with strength training. Strength training does help you to maintain and preserve your muscle mass during weight loss, and can increase your excess post-exercise oxygen consumption, meaning your metabolism remains active and your body continues to burn calories after you have completed your workout. Therefore, adding resistance/strength training exercise on top of your aerobic training is beneficial when losing weight.
4. Strength training can improve your flexibility
When most people consider improving their flexibility, usually yoga, or undertaking specific static stretching exercises comes to mind. Both of these activities are effective in improving the flexibility of a joint, however undertaking full range strength training has also been shown to be just as effective as flexibility training for a specific joint, and not surprisingly both are superior to doing nothing (reference). Therefore, adapting your program to include some full joint strength exercises can effectively kill 2 birds with one stone, and reduce the need for a specific flexibility program for those strength trained joints.
Accredited Exercise Physiologist & Credentialed Diabetes Educator
1. Check what you are drinking
Many people know they need to watch what they eat, but what about what you are drinking? There may be loads of hidden sugar in lots of drinks that you are not aware of.
For instance a 250ml glass of wine has about half a teaspoon of sugar; a glass of OJ or cordial contains about 6 teaspoons of sugar; and a can of coke contains around 9 teaspoons of sugar.
One way to reduce the amount of sugar and energy you are consuming during the day is by reducing these sweet drinks, and reaching for our water bottles.
2. Increase your NEAT exercise
NEAT stands for Non Exercise Activity Thermogenesis. Basically this is the energy that we burn when we are undertaking any activity that is not considered to be exercise.
So .... taking the stairs rather than the lift, parking the car further away, walking to work, etc are all increasing our NEAT.
This is a really neat way to increase the amount of energy we burn throughout the day without actually undertaking any planned activities.
However, planned activities are also essential for our health and well-bing.
3. Check your portions
Maintaining a healthy weight is not just about what you eat, but how much you eat; and too much of a good thing isn’t always a good thing!
Meat is one area, that particularly men, tend to overeat.
It is recommended that men between the age of 51 and 70 limit themselves to 2.5 serves of lean meat each day. A serving size of cooked lean meat for a male aged 51-70 is 65g, that’s no more than the size of your palm. If you are eating poultry it is 80 grams and 100g for seafood. Many men eat double this at dinner, let alone adding in what they also have for lunch, and other protein sources such as eggs and nuts.
4. Take a walk after dinner
Our blood glucose levels generally peak about 2 to 3 hours after we eat. For those people who have pre-diabetes or type 2 diabetes, exercise helps to use the glucose in our blood without the use of the hormone insulin. And this is a great thing for our bodies because exercise can help to reduce our blood glucose levels post meal, therefore decreasing the demand on pancreas to do the job all by itself.
The effects that exercise has on improving this process, lasts up to 72 hours post exercise session. A great reason to exercise at any time, but it is also really useful after a big meal.
5. Get a good night’s sleep
Sleep may be just as important as eating healthy and exercising. Studies show that poor sleep is one of the strongest risk factors for obesity, as it’s linked to an 89% increased risk of obesity in children and 55% in adults.
However the good news is that there does appear to be a positive influence of exercise on sleep disorders. Quality of life and/or severity of sleep disorders appear to be positively impacted by regular exercise. Adopting a physically active lifestyle may be a key intervention for the treatment of sleep disturbance and obesity, and may be a long-term solution to improved quality of life and decreased risk for the chronic conditions associated with these Sleep disorders.
Accredited Exercise Physiologist & Credentialed Diabetes Educator
What is Bone Mineral Density and how does it cause Osteoporosis?
Bone Mineral Density (BMD) refers to the amount of bone mineral in bone tissue. When experiencing Osteoporosis or Osteopenia BMD can decrease, placing individuals at a higher risk of fractures or breaks in bone.
Osteoporosis is more common in post-menopausal women as their BMD levels continue to decline with age. BMD levels have shown to be lowest in the spine and the neck of the femur (thigh bone), and these are 2 of the sites tested when you have a bone mineral density scan. When you have a BMD scan, you will be provided with a T-score for each of the bone sites tested. This T score is compared to the T-score of a healthy 30 year old, and gives and indication of how high or low your bone density is.
The table below shows the T-scores and their classifications for normal bone density, osteopenia, and osteoporosis.
How can I improve my bone mineral density?
There are a few different methods in which your BMD can be increased;
How can exercise make my bones stronger?
Studies have shown that therapeutic based exercises that include resistance and load bearing movements are able to MAINTAIN OR IMPROVE BONE MINERAL DENSITY LEVELS in healthy individuals and those diagnosed with Osteoporosis.
These exercises have been reported to STIMULATE BONE GROWTH AND PRESERVE BONE MASS. These processes occur through a mechanical stimulus on the bone and both anti-gravity loading, and stress exerted on the muscles that surround it. Quite simply, this means that movements involving repetitive and loaded (heavy) exercises cause the working muscles involved to pull on the bones they are attached to, which in turn stimulates bone growth. When this is completed on a regular basis over a long period of time it can have a significant effect on BMD levels.
What type of exercise is best?
There has been a large amount of research conducted into which exercise type provides the best results when trying to increase bone mineral density. The Onero program has collated and completed multiple studies to determine which exercise type reigns supreme and designed a program to specifically include these exercises.
They research found that IMPACT AND RESISTANCE-BASED TRAINING THAT IS BOTH SUPERVISED AND TARGETED provides the highest improvement in BMD. The Onero program ongoing data has shown that 86% of participant’s had an increase in lumbar spine (LS) BMD, whilst 69% had an improvement in femur BMD. Results have also shown a significant improvement in participant’s posture and a decrease in falls risk, preventing potential fractures.
Overall, high intensity loading and impact-based exercise undertaken in a safe and supervised setting are the most optimal types of exercise to increase BMD.
These exercises are an example, however all exercises are safely prescribed for the individual at the entry level appropriate for their health, conditions, fitness and confidence.
Who can help me increase my Bone Mineral Density safely?
Accredited Exercise Physiologists are the most appropriate people to assist you in increasing your BMD. The great news is that Optimum Exercise Physiology, runs a Strong Bones specific class twice a week that has TAILORED AND SPECIFIC EXERCISE PROGRAMS THAT ARE SUITABLE TO YOUR CURRENT NEEDS AND GOALS.
Can't make a class, that's fine too. We can develop a program for you to undertake independently at the gym or for home.
Would you like more information ...?
If you would like more information about how exercise can help improve your bone mineral density and reduce the risk of developing or progressing Osteoporosis/ Osteopenia further, please get in touch on 8873 0628 or, firstname.lastname@example.org.
By, Aleisha Michael,
Accredited Exercise Physiologist.