Care and feeding of an injury
NOTE: This post is based on my own personal research and experience, and is not intended to replace medical advice.
Due to the nature of what I do for a living, I can’t help but turn injuries into anatomy lessons.
(They have to serve some purpose, right?)
Several days ago, I turned my ankle. I would love to be able to share how I did it - but it was one of those freak incidents that involved carrying a pile of stuff, moving too fast up a step, one misstep backward, and I would swear, a sickening popping sound.
As I lay there on the floor, howling in pain and humility amidst the paperwork that went flying everywhere, All The Things that go through one’s head in these moments went through my head.
What the hell just happened!??
I’m alone. My phone is in another room. I’m on the second floor. I'll be stuck here for hours. What if I have to pee?
Will I be able to stand? Will I be able to get down the stairs? Will I be able to go grocery shopping that afternoon, work on that evening’s client, get my car in for the oil change tomorrow, work on that day’s client … OR WILL I BE LAID UP FOR WEEKS???!!!
Okay, calm down, Gina.
As the pain subsided, I was able to start with smaller questions. (I’ve learned that anxiety for me often comes from trying to mentally take everything on all at once.)
Can I move my foot?
My mind had already entertained the scenario that I’d fractured if not shattered several bones. I was relieved to be able to rotate my ankle at least a little in one direction.
Can I put weight on my foot?
I winced at the thought. But, finally rising up off the step I had collapsed on, I found that yes, my foot could bear light weight.
I hobbled to the bathroom to retrieve an Ace bandage, only to find that the heavily painted cabinet door was stuck closed in the humidity of the day. So, I hobbled to another room, sat down and took stock of the damage.
A tiny, painful swelling emerged just below my outer ankle, and it was pretty impossible to lift my toes.
But, to my relief, even then it seemed that the injury was pretty localized to a tendon, and not a ligament.
My husband did come home after about an hour, retrieved the bandage and wrapped me up.
I found that I could navigate around the house, including the stairs, though with a lot of usage of my other leg for stability. (The next day, my left quads were hurting me more than anything…!)
I was able to get the groceries, work on my client, walk to the mechanic’s to get my car, and pretty much use my normal gait after the second day.
It was a blessedly mild injury, as I said; the bruise has spread all over the top of my foot making it appear worse than it feels, and so I believe I escaped with a near-miss.
Between my own knowledge and experience, that of my massage therapist husband’s, and the chiropractor I saw yesterday (as I already had him on the schedule), here are some insights I want to share, if and when you ever find yourself in a similar predicament.
My own injury was mild, but the same tips can apply in similar situations.
Of course, everyone’s situation will be different, and I will include my movement teacher Katy Bowman’s famous reply to most questions she gets asked, “IT DEPENDS!”
1) Try not to panic. :)
I mean, if it hurts, yeah … yell, scream, curse - whatever it takes to discharge that initial shock (which is often an equal mix of pain, embarrassment, frustration, impatience ... you get the idea…).
2) Assess the damage.
Does the pain become more localized after the impact, or does it spread? When I fractured my wrist in 2017, the pain was radiating up my arm, and no amount of movement at the wrist was tolerable. Note swelling, bruising, bones protruding from skin … etc.
3) What happens next will depend on what body part and extent of injury.
Again, in my case this seemed to be a strain or possible small tear to a tendon.
Tendons are the fibrous parts of a muscle that attach it to a bone. Ligaments are much more fibrous straps that attach bones to each other. Tendons and muscles are elastic, meaning they can stretch and return to their original length. Ligaments are barely elastic - they can stretch, but they don’t come back.
Ligament tears tend to be way more painful, take longer to heal, and can often leave hyper-mobility and instability of the joint in their wake, i.e. be more prone to injury in the future.
4) RICE, anyone?
The conventional treatment protocol for injuries of this sort are: Rest, Ice, Compression, Elevation.
A simple enough recommendation, but I want to break this down, because it warrants further qualification.
Rest.
Of course, we want to be able to allow the injury to heal, and not risk further injury.
As my chiropractor said, these kinds of soft tissue tears - even if they feel better - can take 6, 8, 10 weeks to be fully healed. For folks who have found that their particular issues took longer to resolve, it’s likely because they kept re-injuring the area.
However.
Getting movement into the space is essential for blood and lymph flow, and the prevention of adhesions - which is when the scar tissue that is forming to heal the damage starts glomming together onto nearby tissues, nerves, etc, and can create some chronic immobility. (Think: ‘frozen shoulder’…)
Also, compensatory movement strategies (moving your body in a way that avoids creating pain or further injury) can become lifelong patterns if one isn’t consciously moving to prevent that from occurring.
I noticed that it would have been easy for me to keep hobbling for a few more days, as I was timid about using my injured foot normally, so I carefully tested it, and when it was comfortable made sure I resumed my regular foot mobility as soon as I could.
Ice.
The application of ice to an injury is recommended for reducing the swelling that occurs.
I have read differing opinions on this, and again, I would apply an “it depends” here.
Swelling and inflammation are part of your body’s first-aid kit. The damaged tissue becomes flooded with white blood cells and other fluids as the repair process begins immediately. (Isn’t the body amazing??)
This is normal and necessary, although the swelling can produce greater pain and immobility.
So, there’s some debate about whether the immediate application of ice to arrest this process is necessary or even helpful. I’m sure there are occasions where it is important (and it can feel good), but my first impulse would be to ride it out initially and let my body do its thing.
This would definitely apply to NSAIDs (aspirin, ibuprofen, naproxen) as they can mask pain that might leave one vulnerable to further injury, as well as harm to gut if taken too long.
I applied ice briefly, and it did feel nice, but as I could more readily move my ankle, I used that as very gentle massage to move the fluid (and the ‘stagnant’ Qi, if that makes sense to you.)
Another note about ice:
We are often recommended to apply ice to any kind of soft tissue injury, including muscle.
Logically, however, muscle fibers contract when they’re cold to generate warmth, which is why we tense up or shiver in the winter.
A muscular condition like a spasm will respond to ice by contracting more, which is not really what you’d want to do ... in which case, moist heat is better.
(However, muscle spasms are another one of the body’s brilliant first-aid techniques to guard a potentially more serious injury, like a vertebral displacement - in which case you want to be very cautious before relaxing this innate ‘splint’. Same applies to muscle relaxers.)
So, rule of thumb (again IT DEPENDS). Tears with inflammation = ice. Tight, contracted muscle = heat. (I’ll probably get comments about this one…:)
Compression.
Bandaging (or bracing) is for support.
Again, as an injury is healing, we would rather not keep injuring it, especially as it’s likely one has to go back to dealing with life, and so we’d need to protect the area.
Applying a compressive support will allow and support movement around an area without putting undue loads on the injured soft tissue.
I wore the bandage for a couple days, and removed it for the time after that, except for when I gave a shiatsu session on the floor. As my chiropractor recommended, it was really there for me as a reminder to move slower as I navigated the kneeling and squatting positions.
Use of an external support requires finding the sweet spot between protection and healthy mobility.
In any case, you’d want to remove the bandage or brace when you are at rest (if it’s comfortable) to allow for blood and lymph flow, and for the skin to breathe.
Elevation.
Self-explanatory.
But, as we’ve discussed how fluid builds up around the injury site, and in the absence of ability to move as vigorously as before, elevating the area will allow for gravity to move the fluids away from the injury site, and back into the system.
If you’ve felt pulsing around a swelling, you know how uncomfortable this can be. Elevation can provide a little roominess and relief.
The takeaway.
One of the key things to remember in the case of most garden variety injuries such as this is to keep moving what we can.
It’s easy to succumb to staying laid up - especially with lower body injuries, and especially when they affect one’s mental and emotional state. Having one’s plans suddenly disrupted in a painful way can feel discouraging, and questioning one’s physical capabilities.
Of course, sometimes it takes events like this to get us to slow down - if we’re the kind of people who otherwise ignore the body’s polite requests to do this before taking drastic action.
Movement-wise, the rule of thumb is to keep as much of your whole body moving in a way that doesn’t exacerbate the injury, while also applying targeted corrective exercises (like my ‘restorative movement’) to the injured area, until it can rejoin the orchestra.
This will also serve to keep your spirits up, your mind occupied and your Qi flowing. :)
What are your experiences, tips, anecdotes with minor injuries? Share below!
I’m Gina Loree Bryan, bodyworker, movement & meditation teacher, human.
I hope you enjoyed reading my blog. Feel free to forward to a friend, and thank you for respecting the thought and time I put into these writings by sharing them with all credit due to the author. :)
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