Rehab the Right Way

With the exception of professional athletes, few people know where to turn after suffering an injury that limits their ability to exercise, perform daily activities - or in worse-case scenarios, even move. The rehabilitation process may seem complicated, but it's actually fairly straightforward (depending on the injury) once you know the basics. Here's a little insight on how to rehab right.

A patient once told me that to really understand their pain and difficulty in getting better, all doctors should experience the same pain so they are more sensitive to what it's really like. Now that I have been undergoing rehab for several months following knee surgery late last year, I can see her point. Rehab is not simply about doing a group of exercises and getting better. It's about knowing what works, what doesn't, what you should avoid, and what you can expect with your rehab. Do you know how to rehab right? Let's review a few of the most important rehab points to remember if you're ever faced (or are currently suffering) an injury, particularly one that causes pain in the low back, the shoulder or the knee - three of the most commonly injured areas of the body.

What Is Rehab?

Without relying too much on medical terminology, rehab essentially involves any sort of exercise or exercises that will help get you back to as normal as possible following an injury. For most people, this usually consists of basic stretching and strengthening exercises. But did you know that it also involves proprioception (balance) training, endurance exercises, and functional training (training that improves activities of daily living that may have been compromised by your injury)? Rehab also requires a step-by-step system that builds on your successes for you to get to the next level.

Successful Rehab: Six Steps to Remember

1. Control the pain naturally. To do this, some say use ice; some say use heat. Just remember one thing: If you are exercising and experience pain and swelling afterward, use ice to take the swelling down. If you feel your muscles are too stiff and painful before you start exercising, use a few minutes of heat to warm up the area. Using ice or heat during rehab is a good way to control pain and discomfort.

2. Increase flexibility. Everyone is infatuated with stretching. However, in some cases, it may not be the most important part of your rehab. There are a few things to remember with stretching. Don't try to become the next Olympic gymnast. Overstretching is just as bad as not stretching. Also, it's not just about stretching the areas where you're experiencing problems. It's also about stretching the tight muscles around the area, because the whole area works together. If one muscle stays tight, it will just pull the other ones into getting tight again. Your doctor can help evaluate which muscles are tight and recommend appropriate stretching exercises.

3. Improve endurance. When we think of rehab, most people think of lifting more weights and getting stronger. However, in some cases, your success in rehab has more to do with doing something at less intensity, but improving your ability to do it over and over again.

For example, building up endurance is probably one of the most important goals in the initial stages for those with back pain. Concentrate more on doing a higher repetition of exercises with frequent breaks in between, rather than trying to do one thing for a longer period of time. When we overdo it, we fatigue. When we fatigue, we start doing things the wrong way, ruining all the improvements we've made with our rehab and risking re-injury.

4. Regain balance. Regardless of whether you have ankle, knee, or low back pain, or even headaches, balance training is very important. You can train your body by lifting more, or by stretching until you can wrap your legs behind your head. But what happens when you get off balance and your back goes out? What happens when your knee is strong when you walk straight, but it can't handle a quick change in direction to the side? That's why balance training is just as important as any of the other rehab strategies. The basic balance progression involves doing things on stable surfaces first and then moving to unstable surfaces.

5. Develop strength. This is probably the most popular goal of all rehab programs. However, make sure you build up your strength while always staying within weight ranges that do not elicit pain. The "no pain, no gain" mentality should be abandoned. Also remember to work on balance and flexibility with strength, not just by itself. Most strengthening exercises begin with isometric exercises - an example is pushing your arm against a wall. Isometric exercises should always be performed in angles at which there is no pain. Once you can do the isometric exercises at all angles, then you can progress to using elastic bands, light weights, vibration platforms, and overall weight training.

6. Functional training. Remember, this just means practicing activities you did every day prior to the injury. For workers, this means practicing how to lift, or even how to sit properly if your job is sedentary. For athletes, this means practicing the movements of your sports. All too often, people forget everything they've learned and overdo it in trying to get back to where they used to be. It's a typical response because we can see the light at the end of the tunnel. Be patient! Practicing the movements repetitively with lighter loads is more important. Remember, build up endurance with proper form first. Functional exercises are similar to balance exercises in that you need to stress your newly rehabbed body in all directions and all positions; in so doing, you'll be confident that you can go back to your normal activities of daily life and not worry about re-injuring yourself.

Keep in mind that these are just guidelines to increase your knowledge of the various elements involved in successful rehab. Which exercises will work for you will depend on the precise injury and a comprehensive screening process by your doctor. Hopefully, you now understand some of the goals of rehabilitation and can better appreciate the steps necessary to get on the road to recovery. Remember, always consult with your doctor whenever you suffer an injury and before beginning any rehabilitation process.

Joint and Muscle First Aid

When to Use Ice and Heat

You're at the park on a glorious Saturday morning playing a friendly game of basketball with your fellow weekend warriors. You jump for a rebound and land awkwardly, twisting your knee, and drop to the ground in pain. Moments later, you've been helped off the court by teammates and are watching your knee slowly but surely start to swell.

What should you do next? Too many people essentially shrug off the pain and return to the game after a few minutes of "rest," hoping everything will return to normal. That attitude can turn a simple strain or sprain into a chronic injury that limits your activities for weeks or even months.

When joint and muscle injuries occur, immediate application and continuation of first aid is vital. Delayed or incorrect first aid will slow the healing process dramatically. What do you do when you or someone you know suffers this type of injury? Here are a few things you can do immediately to start the healing process.

The R.I.C.E. Recovery Formula

Remembering the acronym R.I.C.E. is of great help whenever joint or muscle first aid is needed. The acronym stands forRest, Ice, Compression and Elevation. Immediately following an injury involving the muscles or joints, these four steps should be taken:

Resting an injured area reduces the stress and strain which, in turn, reduces the chance of further injury. When an injury occurs, immediately stop using the injured area.

Ice applied to an injured joint or muscle reduces swelling and bleeding by slowing blood flow to the area.

Compression (wrapping or taping the area of injury) reduces swelling and gives extra support to injured tissues. Compression applies primarily to the extremities (arms and legs).

Elevation of the injured body part above the level of the heart slows blood flow to the area by forcing the heart to pump "uphill." Reducing blood flow reduces swelling. Elevation applies primarily to injuries involving the extremities (arms, legs, feet and hands).

Heat or Cold: Which to Use?

Actually, heat and cold are both important components of recovery following an injury, but it's important to understand which to use and how to achieve maximum benefit. Remember these general rules when considering whether to apply ice or heat:

Applying Ice Properly

WHEN: Ice or gel packs are the first choice of care during the first 48-72 hours following injury.

HOW: The application of ice directly to an injured or painful area of the body can be quite a shock at first. To avoid this, apply the ice pack as follows: Apply the ice, or gel pack over a towel which will allow for a gradual cooling and more comfort. Place the towel under hot (but not scalding) running water, wring out the excess water and place the towel on the affected area.

FREQUENCY: Each application of ice/gel packs should be 20-30 minutes, with 3-5 applications per day.

WARNINGS: Never apply ice for longer than 30 minutes at a time, and not at all if the injured party is suffering from any of the following: frostbite, areas of decreased sensation, Raynaud's disease, severe circulation problems,rheumatoid or gouty arthritis, or a worst-case scenario such as coma. Also do not use chemical ice bags that require shaking or have to be struck to be activated. Shaking and striking these bags may result in leakage of the active chemicals. The chemicals are usually caustic and may result in burns or other injuries.

Applying Heat Properly

WHEN: Moist heat may be applied 48-72 hours after injury. Heat increases circulation by dilating blood vessels and letting more blood into the area.

HOW: Moist heat provides more soothing relief than dry heat. Gel packs, hot towels, hot baths, hot showers, whirlpools, steam saunas, and moist heating pads are examples of heat with moisture.

FREQUENCY: Each application of moist heat should be 20-30 minutes, with 3-5 applications per day.

WARNINGS: Never apply moist heat for longer than 30 minutes. Never sleep on a heating pad.

Gel Packs: Two Treatments in One

The most versatile piece of home therapy equipment you can own is a gel pack. Gel packs can be utilized for both cold and hot applications. Most are stored in the freezer until the need arises for cold application. If heat is needed, the pack can be transferred from the freezer to the microwave and heated as directed. Gel packs come in a variety of sizes and stay flexible at all temperatures. Constant flexibility allows the pack to be molded to the area of injury. Remember, it is always a good idea to place a towel between your skin and the gel pack.

Cut these instructions out and tape them on the inside of a medicine or kitchen cabinet so they will always be readily available whenever you or someone you know suffers a joint or muscle injury requiring first aid. Remember, the type, severity and circumstances surrounding the injury can impact the precise course of treatment to be pursued. For example, joint or bone deformity, uncontrollable bleeding associated with injury, loss of consciousness, loss of feeling in the area of injury, convulsions, etc., require immediate medical attention. Always consult with your doctor if you are unsure of the severity of an injury or if you have further questions regarding appropriate first-aid treatment.

Putting Health Into Motion

Every single bone forms some type of joint with another bone
because joints allow us to have motion. When motion is normal at
a joint, life is good. But daily activities or injuries can
cause improper position of the bones, resulting in abnormal
movement at the joint. This can lead to problems like swelling,
pain, muscle spasms and arthritis later in life. The point is,
from head to toe, your joints occasionally need a tune-up. Let's
take a look at some of the more common trouble spots and what a
chiropractor will do to get the healing process started.

Head and Neck:
When patients have headaches, they almost always have a lack of
normal movement of their skull and the first two cervical
vertebrae (bones). By restoring alignment to these bones, muscle
tension is released. This allows blood circulation and nerve
information to flow better.

From Shoulders to Hands:
You probably know a lot of people who have shoulder injuries.
Well, our shoulder is made up of more joints than just the ball-
and-socket joint. Anyone with shoulder pain likely has one or
more of these joints that need to be realigned. Moving down the
arm, we can find elbow tendonitis (golfer's elbow, tennis elbow),
carpal tunnel syndrome and other repetitive-use injuries that can
cause considerable pain, swelling and muscle spasms. In general,
pain in any of these joints can be treated quite effectively with
chiropractic care.

Hips and Knees:
Hip joint arthritis is very common these days, and you might even
know someone who has had their hip replaced. When a hip is not
in good alignment, the same pattern we have talked about exists.
It can lead to lack of normal movement, arthritis and pain. And
ligament injuries in the knee and knee cap pain often arise due
to the leg bones being malpositioned.

Feet and Ankles:
Did you know we actually have three arches of the feet that are
supported mostly by a large ligament and secondarily by the bones
and muscles? When we have a collapse of these arches, which
happens in eight out of 10 people in the world, we can have a
variety of painful conditions.

The moral of this story is this:
No injury or pain is ever just muscular. You know now that
muscles attach to bones and bones make up joints everywhere in
the body. It may be the muscles giving you pain, but unless you
have the joints examined, you could be setting yourself up to
have a relapse or a flare-up down the road. Ask your
chiropractor for more information or contact me directly at
Anza Pain Treatment Center