PhysioMonkey

A letter to all:

Hello everyone!

I've had a few emails recently asking for advice which I'm always happy to offer but they seem to follow a pattern.

Here's a made-up example:

Hi PhysioMonkey

I've got a pain in my wrist from doing juggling.  What can I do about it?

Thanks

This letter doesn't really help me much.  If you're going to ask for info then please put some detail in.

For instance in this case: Does it hurt all the time or just when you juggle? Does it only hurt if you do certain things but not others?  Does the whole wrist hurt or just one part of it? And any other details you can think of.

If you don't put the detail in then I can't give you any good answers so I'll just have to write back asking for more which delays things for you.

Cheers.

Alan

[edit: reposted 4/7/06 as new info re anti-inflammatories added] 

Most injuries will be minor and may not even affect your ability to continue with whatever.

Here are some photos from a friend

• Unicycle injury.  This was a basic "turning" of the ankle.  You can see the aftermath being a decent amount of swelling, bruising, some pain and this one caused problems with walking.

• Another unicyle injury.  This was a "leg meets Muni pedals" incident.  Just some cuts with little bleeding.  It didn't need any treatment beyond some ego-massaging oohs and aahhs.

• This was a snakeboard injury.  Eye meets pavement!  Some swelling and bruising. 

Basic Advice

DO get R.I.C.E.

• Rest - Stop putting any pressure on the injured area.  If you've turned your ankle don't go for a 10km joggle.
• Ice - Whack an ice pack on it.  Don't make it too cold and don't leave it on for more than 10 mins.  The old favourite is a bag of frozen peas - be careful with this as modern freezers are far too cold for this purpose.  Wrap the bag in a thin and slightly damp towel - if the dampness starts freezing then it's too cold.  DON'T use ice if you have heart disease.  If you start to get chest pain whilst using ice then stop using the ice and go and see a doctor.
• Compression - Use a compression bandage if you have one.  Good chemists should have them.  These are often referred to as "supports"; they are not.  They simply restrict the amount of swelling.
• Elevation - If possible put the affected bit up above heart level.  Have a lie down.

DON'T do H.A.R.M.

• Heat - People like warmth but these injuries don't.  Heat promotes swelling by opening up the blood vessels in the vicinity of the heat.  Don't do it for these injuries.
• Alcohol - 2 reasons not to drink after an injury.  Firstly; if you get tipsy you're more likely to hurt it more as you drunkenly stumble away from the bar!  Secondly; the alcohol acts as a vasodilator (opens up the blood vessels) so making swelling worse.  (Incidentally this is why rescue dogs in the alps don't carry brandy - it would lead to hypothermia).
• Repeating - if you've just tried something which caused an injury don't do it again.  Does this seem too obvious?
• Massage - firstly this will be painful if someone is putting pressure on an acutely swollen area.  Secondly it also acts as a local heater leading to more swelling.  Thirdly if the tissues are badly injured then it might not take much to damage them further.  This advice relates to acute injury (ie within the first 24-72 hours post-injury)

There has been some controversy about whether NSAIDs (Non-steroidal anti-inflammatories) such as Ibuprofen and Diclofenac should be used after a recent injury.  The positives were that they reduce swelling and hence relieve pain.  The negative was that the swelling is actually rather important to healing so stopping it happen would slow down your recovery time.

Recent evidence is leaning towards the suggestion that taking NSAIDs does not really slow down healing that much.  Here's a quote from "Nonnarcotic Analgesics in Short-term Pain: Musculoskeletal Disorders" by Dr J Markenson in his review of lots of studies about this topic.

Accumulating evidence suggests that they neither delay healing nor interfere with the repair of soft tissue or cartilage following acute injury. Furthermore, in the nongeriatric population, the use of NSAIDs as short-term therapy appears to be associated with neither short-term nor long-term side effects.

This has changed my practice.  I'd previously given the advice to avoid NSAIDs.  Now I'll tell people that there has been controversy but it's leaning towards this view.

Related Posts

One-off Injuries - Major

Back from BJC and a wonderful time was had (apart from the nasty case of tonsilitis I have).

Workshops:

1 - Injury prevention and advice - I'm now quite sure that this workshop is probably not needed.  The advice can be offered as part of other workshops.  Too much talking from me and not enough to do practically.  Would work as part of a day long session.

2 - Control and stability - Ooh this was a good one.  I enjoyed it.  The Chocfest one lasted 90 minutes.  This one ended up at 2.5 hours.  The majority stayed for most of it too.  Some interesting shoulders (one in particular) and lots of time taken to show what's going wrong.  If you were at this then I'd love some feedback on how you felt it was for you.  The responses I had afterwards were all positive.  If you didn't find it useful or interesting then I'd like to know how to improve it further.

Clinic time: Met loads of folk and gave plenty of advice out to all.  One or two odd cases and some pretty basic stuff.  If you asked me anything and want more info then get in touch.

Have fun.