Hi, all! This is the first installment of “OH, MY ACHING BODY”. Today’s focus is foundational. We’ll start with some basic definitions, which will apply to virtually every installment from here on.
The vast majority of what causes our bodies to ache after physical activity can be narrowed down to problems with ligaments, tendons, and muscles. Someday I’ll branch out to address problems with bones, bursae, cartilage, intervertebral discs, and maybe even cataracts, but for now I’m just addressing the majority of sports injuries.
Muscles: move the skeleton and give it support.
Tendons: attach muscles to bones.
Ligaments: connect one bone to another bone.
Strain: tearing of a muscle or tendon.
Sprain: tearing of a ligament.
Acute: an injury that starts suddenly and usually heals within weeks (sprained ankle)
Chronic: an injury that takes a long time to develop, and takes a long time to heal (tennis elbow)
This article talks about muscle strains, and the best and worst things to do when you get one. But this information can be applied to muscle strains, ligament sprains, and almost every other acute injury you’ll ever have.
Let’s say you’re out on the court paying close attention to Coach Mo, and you’re trying to keep your knees bent and shuffle side-to-side like she does. The next morning you notice that your thighs are sore. Muscle soreness is a natural part of muscle development. When body builders talk about “getting ripped,” they’re referring to a phenomenon where muscles that are being trained actually go through micro-tearing, and in that process the number of muscle fibers multiplies. It’s like when Hercules pulled off the head of the hydra and seven grew back.
That’s what the muscle does. Physical effort tears, or “rips” the muscles, and the muscle fibers multiply, which causes the muscle to get bigger. It’s one of many miracles we encounter when we study physiology. Anyway, that muscle soreness is normal after a good workout, and it isn’t injury yet. Body builders and weight lifters will wait two days before stressing that muscle group again, in order to allow those muscles to heal from the exertion. They are always chasing soreness, but never pushing to excess.
But you go out with your sore muscles the next day, instead of waiting two days before another workout, because it’s pickleball and you’re addicted. You lower your hips into an impressive squat at the kitchen line, and suddenly you feel a pain in your right thigh in a specific spot. Now the muscle is strained. You start to feel what everyone always refers to as a “knot” in the muscle. The knot you feel is the (also miraculous) process of muscle guarding. Cavemen didn’t have splints or casts. They had the body’s own internal immobilizing process, which is where the healthy muscle fibers contract in order to keep the injured caveman from running, thus allowing the muscle to get some rest and heal.
Back to that kitchen line. Inside your injured quadricep you’ve got a few torn fibers, out of thousands and thousands of muscle fibers. Those little torn fibers are bleeding a little, and that blood is irritating to the surrounding muscle tissue when it leaks out, and that irritation triggers the muscle guarding “knot” response.
The initial injury - muscle fibers being torn - is what we refer to as the “primary injury.” Think of a break in a water pipe in your house. That water pipe is the primary injury. Everything else that is affected by that burst pipe is “secondary injury”. The damage to the walls, the floor, the ceiling caving in, the valuables that get ruined are all secondary to the burst pipe. If you can fix the leaky pipe quickly, you’ll have less damage to everything else. As an Athletic Trainer we do what we can to prevent the primary injuries from happening. We’ll fit football players in shoulder pads and helmets, and we’ll inspect a soccer field to make sure there’s no holes where a player might twist an ankle. But once an injury happens we are really focused on preventing secondary injury. The primary injury (broken water pipe, strained muscle fibers) might take days to overcome, but the secondary injury (caved-in ceiling, completely bruised thigh) might take weeks to remedy.
Back to your thigh again. You have a tight, irritated muscle that’s bleeding a little, you can feel a knot around the strain, and you’re limping a little. But you keep playing, because it’s pickleball, and you’re addicted.
Playing warms the muscle. Warming up the muscle makes the blood less viscous, so it leaks out more quickly. It’s like putting syrup in the microwave so that it will flow more quickly. Warming the area also dilates the blood vessels, which also makes the blood leak out a little quicker. It’s like taking the cap off the syrup bottle, because syrup doesn’t want to flow through the tiny hole in the cap. Exercising those muscles keeps your heart pumping, and staying on your feet lets gravity take the blood to your thigh. It’s like squeezing the bottle hard to force the syrup to come out, because when you just hold the bottle upside-down, the syrup isn’t flowing.
After playing on a strained thigh for several hours, you sit down to watch your friends play for a while. When you try to get out of your camp chair, WHOA! That hurts! You think to yourself, “I’d better use a Thera-gun on this,” or “I’d better take a warm bath” or “I’d better get this into the rec center jacuzzi” or “I think I’ll put a heat pack on this” or “I’ll just massage that tight muscle,” or “I’d better stretch this out real good.” All of those ideas are horrible. Every time you add heat before the tear closes, more blood will leak into the area. The secondary injury is just getting worse.
Going back to that initial quadriceps strain again, what if your first decision had been to lie down with ice on your thigh right after you felt it the first time? The ice makes the blood more viscous, and if it isn’t as runny it can’t leak out of the blood vessels so quickly. (The syrup is cold.) Ice also constricts the blood vessels, making it difficult for the thicker blood to move through the skinny tubes. (The cap with the tiny hole is on the bottle.) Lying down stops the exercise, and gravity isn’t bringing blood to the muscle as. (No one is squeezing the syrup bottle.) Instead of dealing with a very bruised and knotted quadricep muscle that will take weeks to heal, in this scenario we’re dealing with a few torn muscle fibers. You can add heat and light activity to the area after 48 hours, because that’s when the cap on the syrup bottle will be closed. You might even be well enough for pickleball by next week!
I can hear you now. “A WHOLE WEEK?!?!”
I know how you feel. I’ve been that athlete. I’ve treated hundreds and hundreds of those athletes. Science tells us that it takes six weeks for soft tissues to heal. So playing next week isn’t the best idea, but you can try it if everything feels good. It would be smarter to sit in the rec center jacuzzi or take a warm bath next week, but if you do play, warm up well, stretch slowly, try not to play like Coach Mo for another week or two, and force yourself to stop after an hour even if you don’t want to. But if you feel that “twinge” in your muscle, it’s time to stop and ice. If everything feels okay during and after playing, you can come back in two days - not the next day - and do an hour with a little more knee bend - but not a lot more knee bend. Don’t hurry the healing. Think about it, if Caitlin Clark can sit there and watch other people play her favorite sport, so can you.
Gradual return to activity is the key to a successful return that won’t cause you to be sidelined constantly for weeks and weeks. This is true if you strain your quadricep, twist your ankle, or feel a pull in your back. Ice and rest for two days, then take it slow.
That’s all for the inaugural article. When it comes to our aching bodies, what do you want to know about? Is there an injury that you’d like to understand and manage better? I’d love to hear from you!
