Introduction: Here's another edition of the BayCare Health System’s podcast series, BayCare HealthChat with Melanie Cole.

Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole and today we're discussing recovering from an exercise injury. Joining me is Dr. Ted Farrar, he's a Family Medicine and Sports Medicine Physician at BayCare. Dr. Farrar, I'm so glad to have you with us. This is a really great topic. Tell us about the most common exercise injuries that you see every day in your practice.

Dr. Farrar: The most common injuries we'll see generally revolve around overuse injuries. More specifically, you might see things like plantar fasciitis, sore Achilles, sore calf, maybe some hip strain. However, sometimes we have those athletes that like to do a little more upper body activities like swimmers for example, or gymnastics. You might see a little more shoulder soreness with those athletes and I would say that it's not really just limited to athletes. My clinic takes people from all walks of activity, so you do see rules of thumb regardless of whether they're athletic or just an everyday person. You definitely see patterns of these overuse injuries in the lower extremities like the calf and the foot very frequently.

Host: Well, that's certainly true and like plantar fasciitis can affect someone even going on the treadmill on an angle for too long or running and hitting the ground too hard. These are things that happen. Please distinguish for us the difference between acute injury, something that really a torn hamstring something and these chronic ones that you just started to discuss.

Dr. Farrar: Well, the acute injury is going to happen to somebody who is going about their daily business. Let's just take for example, somebody who's a regular runner. They'll be going about their daily run or activity and then they'll have some kind of discomfort that will occur either during or shortly after. So now these injuries can be a result of an accumulation of small problems that finally raise their ugly head to create an acute injury. And that's the kind of thing that we in sports medicine try to get to when we're evaluating these patients. For example, you might have a patient come to your office who says, doc, I've got these blisters on my foot. And so you ask, when did they happen? Then they'll tell you, well I bought some new shoes. Well, that might sound like that's the end of it. But for most of us we're going to ask why did you buy new shoes? Are the old shoes worn out or were you having a problem? And the patient will say, well, you know, I was having some shin pain. So somebody thought that maybe some new shoes with a little more cushion would help out.

And so then the next question for me is why are your shins hurting? And you get to the next level of answer, which is Doc, I'm training for my first half marathon and I've been increasing my running for three straight weeks and I'm pretty new to this. And so for me, I take the 10,000 foot view, which is well the patient is here for blisters, that's easy enough to handle. But the bigger issue is how do we help their running program so that they can stay injury free going forward? Because the key to getting over these injuries is to think about preventing it from occurring the next time. And that's a big thing that we like to work on in sports medicine is prevention.

Host: Beautiful segue, tell us about prevention and recovery advice. As people start to notice these little things that start to kind of, you know, annoy them but are not severe yet. What do you want them to know about prevention? Changing things up a little bit and if they do have some of those, what do you want them to do to kind of stop it in their tracks?

Dr. Farrar: That's a great question. And an hour and a half would be enough time to maybe take care of that. But we're going to distill this down for people. This is what I like to say, which is if you're having some nagging injuries, try not to be a “uni-tasker”. And what do I mean by that? If you're a runner, don't just run. Think about doing some other things so that your body has opportunities to recover. So things like cycling might help as an adjunct to a runner. Swimming might be an excellent adjunct to a runner or a cyclist so that you have other ways to continue to build your strength and endurance while at the same time allowing other areas of your body to recover. And I find that to be real important as time goes on because if you take up exercise as part of your lifestyle, as you begin to get a little bit older, the nagging injuries start to pile up. You can't run as much as you used to. You can't cycle as much as you used to and you need this cross training to help you stay fresh and to help you stay strong.

One of the other things I like to mention to people is, especially for injuries that might be a little bit more significant, say for example, recovering from a rotator cuff injury, you need to think about setting small goals. Small goals are important. I like to think of it as the analogy of putting jelly beans in a jar. Every day you do a little bit of rehab, you do a little bit of strength training. It doesn't seem like a lot compared to what you used to do, but it's just one more jelly bean in the jar and in six months when you're back to your old self, that jar is full and you're ready to go. And when you're getting over these small injuries, I would tell you that you want to stick to the rehab plan. So for example, if you have a torn hamstring or a sprain or strain and you end up going to physical therapy, listen to your therapist, you might have to start with simple things that almost seem beneath the level of where you are. For example, simple range of motion, simple stretching, simple Thera-Band exercises. For a lot of people, these things don't even approach the level of activity that they were doing before they got hurt.

But you got to go back to the original analogy. You just got to put one more bean in that jar and build things up. You don't want to get cavalier and jump ahead. That's how you get re-injured and you don't want to be negligent of the simple things early because you think you're better than that. Just build it up slow. Control what you can control and you'll see the improvement over time. Furthermore, when you talk about having the right outlook, when you go through rehab, this controlling what you can control. You know, if you're going to be out for awhile, watch your diet a little bit more. Think about doing exercises in other areas that aren't injured. Think about a yoga class. Think about doing something else that's social and collaborative with other people so that you can still feel that social engagement that people oftentimes strive for when they exercise and stay positive. Things will get better.

Host: Great advice. And what a comprehensive answer, Dr. Farrar. So if someone does feel those injuries and maybe they don't run off to a doctor just yet, things that they can do at home to help them recover. And you've given us great prevention and great cross training advice, but people hear this term, rice, they hear rice some they don't know if they should ice or heat or brace or wrap. What do you want them to know about that?

Dr. Farrar: Yeah, it's very confusing. And then you go on Google and put the search in and it gets even more confusing. Simple overuse injuries. Let's just say your ankle is sore after a long weekend run, what's the first thing you might do? Maybe place a little ice on that. That will help reduce some of the immediate inflammatory cycle that goes on in the body. I don't ordinarily recommend using heat first. I think that's generally not a reasonable thing to do after an acute injury. Ice is your better bet, and I would tell you that we like to instruct patients on kind of 20 minutes of ice and then take it off for 20 to 30 minutes. Don't keep it on continuously. The second thing you want to do is if it's a simple overuse, the following day, you're going to just see how it feels. So are you going to walk a little bit? Probably. If it was a running thing, you definitely going to start with walking. Can I walk pain-free? That's good. Try a few simple exercises to see if that's pain-free, and if you pass that test then you can move on to the next.

And then you decide, well, you know what? I think I'm feeling better, so I'm going to try and run on this. What do you instruct the athlete or the patient to do? I usually tell them to start with half the distance or weight that you were doing before to see how you tolerate that. So if it's a three mile run, you might run a mile or a mile and a half, and if you were cycling 50 miles, you're going to cycle maybe 20 to 25 miles. You want to see how that feels and then as you proceed through your recovery, we like to use something called the 10% rule. So as the weeks go on, you increase about 10% the mileage or the cycling time or the swimming distance, or even the weight reps of the week before. And try not to go beyond that. That allows your body to recover and strengthen without being overused and put you right back in the same place that you were before.

Host: Great advice. Now before we get to our wrap up, Dr. Farrar, listeners, a lot of them, the weekend warriors, the golfers, the tennis players, we talk about athletes and overuse injuries and sports specific training. But the golfers, they hit the ground, they feel their shoulder, they feel their elbows, they feel their back. Speak to those people for just a minute about things they can do. Because if you're going to tell a golfer, take some days off, that's not what they want to hear. So give us a little of your best advice for the golfers, the tennis players, the people that like to get out there and play a sport, but they're not really considered an athlete.

Dr. Farrar: So golfing is definitely athletic, that's for sure. And I would tell you that whether they're a golfer or a swimmer or anything else, nobody wants to be told to take a few days off. That's for sure. So for those people who know themselves well enough to know that taking time off is either something they can't do, won't do, or will drive them crazy if they do it. My best advice is to be proactive in the prevention side. Think about what sport you like to do and what kinds of things you can do to help keep your body where it needs to be so that you can do it. So for example, we want to talk about having some flexibility training built into that because of the torque that's put on the back. You want to make sure that you're limber, so maybe that means a stretching or a yoga class. Additionally, the golfer with a lot of grip issues and shoulder forces, you want to talk about a cross training strengthening program so that the shoulders stay strong and so that they can tolerate the use of swinging the club on a regular basis. We see tons of people and it does not matter what skill level they think they are. Those people that like their exercise definitely don't like to be told to take a few days off. And so that's why I'm really strong in as time goes on. I've noticed myself being more aggressive with asking patients to think about the cross training. So the swimmers, shoulder program, the runners need a core program. The golfer's definitely a core program, and a physical therapist can help you with that and it will definitely lead to longer, more healthy activity, which makes everybody happy.

Host: It certainly does. Then wrap it up for us. This is a great segment and such important information. Wrap it up with your best advice, what you'd like us to know about recovering from an exercise injury and hopefully preventing it in the first place.

Dr. Farrar: The first thing I'm going to say is during your recovery is try not to do too much too soon. Go a little bit slower than you want to so that your body can recover and while you have time to think about that. Trying to think about why the injury happened in the first place. Was it because I was doing too much? Was it because I was doing something new? Have I been neglecting other parts of my body that set me up for this injury? And if you can answer yes to those, then you can address them while you're recovering. I also would tell you that you always want to look at the equipment that you're using. You know, if you're a runner, check your shoes out. If you're a golfer, check your grips out. Check the club weight. If you're a swimmer, are you using too many paddles or too many aides in the pool? If you'd like to cycle, check your seat and your cleat adjustments. Probably most importantly, for those of us in sunny Florida, certainly consider skin and special sense protection. I'm a fan of using some sunblock, fan of using sunglasses so that you can protect while you're out enjoying yourself.

Host: Thank you so much, Dr. Farrar. What great information and so important for listeners to hear. Thank you for coming on and sharing your expertise. To learn more about BayCare Sports Medicine Services, please visit BayCareSportsMedicine.org. That wraps up this episode of BayCare HealthChat. Please remember to subscribe rate review this podcast and all the other BayCare podcasts. For more health tips like you're hearing here. Please follow us on your social channels and be sure to share this show with your friends and family. That way we all learn from the experts at BayCare together. I'm Melanie Cole.