The Ultimate 5 Step Recovery Guide: Step 2 - Diagnose
By Scott Hogan, Certified Trainer
STEP 2: Diagnose the type and severity of your injury
Here, I need to state the obvious disclaimer again. You and I are not doctors (well, you might be). So if you think you need medical treatment, by all means, seek it out.
But the reality is everyone self-diagnoses their injuries.
You may not run your own MRI or determine exactly which bones are broken after falling off a ladder, but you do analyze the severity and type of injury to determine what should happen next.
Is your foot pointing in the wrong direction?
Yep, that’s pretty serious. Better call a doctor.
Are you feeling a dull ache in your elbow when performing pull-ups?
That’s likely something you can fix on your own.
My point is that it’s helpful to understand the types of injuries and be able to estimate severity. That will help you decide what to do next. Including how much rest to employ, the types of movement you can safely do, and even your timelines for a full recovery.
If you’re experiencing any of the following, you need to get help immediately:
- Abnormal joint or muscle positioning (e.g. joint or bone has moved outside its normal range of motion, or muscle has changed shape or position)
- You’ve lost the ability to put weight on the joint
- Excessive swelling, bruising or bleeding (or, dark colored bruising that appears within minutes of the injury)
- Sharp or excruciating pain
- The injury is not improving after 2-3 days of implementing the R.I.C.E. strategy
Though we always recommend getting medical help if you have any doubts — here are some signs that you have a minor injury that you can self-treat:
- Minor pain or discomfort during a specific range of motion
- Dull throbbing in joint site
- A “tweak” feeling when performing a weight bearing movement or in the stretched position (that still allows you to put weight on the joint)
...The Key: You can still complete the movement, even if it hurts. The joint does not “give away” or feel “loose” when performing a previously comfortable movement.
From here, you should be able to roughly determine whether you’re experiencing an acute injury (traumatic event) or overuse injury (resulting from repetitive movement).
Now let’s look at the types of injuries.
According to WebMD.com, the seven most common sports injuries are:
- Ankle sprain
- Groin pull
- Hamstring strain
- Shin splints
- Knee injury/ACL tear
- Knee injury: Patellofemoral syndrome (overuse injury resulting from kneecap rubbing against thigh bone)
- Tennis elbow (epicondylitis)
This is pretty close to what I’ve seen. Although I think low back and shoulder injuries should be #1 and #2 on this list.
What’s interesting is that virtually all of the top 7 injuries listed above have an overuse component. They result not only from a sudden and dramatic injury, but repeated damage overtime.
Sure, sprained ankles can occur during sports activities even if you have rock solid musculature around your lower legs. But most likely — an imbalance, mobility issue, or muscle weakness led to the injury.
Soft tissue injuries (damage to muscles, ligaments, or tendons) fall into two main categories: acute and overuse.
Acute injuries are caused by a sudden trauma. A fall that tears ligaments in your shoulder. Or a misstep that rolls your ankle. All sprains, strains, and contusions (bruises) fall into this category.
Overuse injuries occur over time from repeated stress. Shin splints are a good example. The repeated stress of running on hard ground (and/or with bad form) causes damage to the muscles around the shin and tendon insertion points.
Here, we need to get into the weeds for just a bit.
We'll look at the common types of acute AND common overuse injuries. Understanding these types will aid you in recognizing and treating future sprains and strains.
Sprains, Strains & Contusions
“Sprain” refers to an overstretching or tearing of a ligament — a type of tissue that connects a bone to another bone.
The areas most vulnerable to sprains are ankles, knees and wrists. Sprains are classified by severity:
Injury Severity: By Grade
Grade 1 - Mild Sprain: Slight overstretching has occurred with some damage to the ligaments (not substantial tearing).
Grade 2 - Moderate: Partial tearing of the ligament has occurred. The tell-tale sign that you have at least a Grade 2 Sprain is a “loose” feeling in the joint, or sudden instability in the joint.
Grade 3 - Severe: Complete tearing of the ligament. You’ll usually know if this occurred because the joint is unusable and extremely painful. You can’t put weight on it without it giving way.
While Grade 2 and 3 sprains require medical attention — potentially even surgery — you can usually resolve Grade 1 sprains on your own. Pain, swelling, and bruising will likely occur in all three grades, to different degrees. So the key to determining the grade of injury lies in how much stability in the affected joint has been lost.
“Strain” refers to minor injuries directly to muscles or tendons — the tissue that connects muscle to bone. If you are experiencing sharp pain when attempting to perform a previously pain-free movement, you may have a severe strain (tear) that requires medical attention. For severe injuries, an MRI (Magnetic Resonance Imaging) scan will help your doctor understand the severity of the tear. If you experience a dull pain or twinge when performing a previously pain-free movement, but are still able to complete the movement, you likely have a partial tear. If you play your cards right, these types of strains can be resolved within a few weeks. The key is to not let a minor strain turn into a partial tear, or let a partial tear turn into a full-blown tear.
Finally, contusions (a.k.a. bruises) are injuries to tissue resulting from a direct blow. They cause damage to muscle fibers and connective tissue — often without breaking the skin. This is why bruising occurs — it’s essentially bleeding under your skin. Because contusions, sprains, and strains can all appear the same on the outside — purple bruising, swelling, etc. — it helps to understand what caused the injury in order to classify it. If you banged your thigh on a metal bench, you’re likely just dealing with a simple contusion. You can continue training and moving normally, even if it hurts. But if you experience bruising near a joint or where a muscle inserts into the joint, you might be dealing with more than just a simple contusion.
Unlike sprains, strains, and contusions — overuse injuries are caused by small stresses that repeatedly aggravate tissues.
According to Dr. David Geier, renowned orthopedic surgeon and sports medicine specialist, around 50% off all sports injuries are the result of overuse.
The percentage of overuse injuries in the general population (versus a trauma) are even higher.
While there is plenty of work that can be done to prevent sprains and strains, knowing how to prevent and manage overuse injuries is one of the most important capabilities an athlete can possess.
Tendinitis is the most common overuse injury. It’s caused by repeated stress that aggravates and damages a tendon, or the sheath surrounding the tendon. Golfer’s Elbow, Shin Splints, and Jumper’s Knee are all essentially tendinitis.
Initial symptoms include discomfort and intermittent sharp pains. Those symptoms can quickly escalate as the tendinitis worsens, leading to more intense pain, swelling, and loss of mobility and strength.
There are two keys to conquering tendinitis:
- Intervene early and actively.
- Fix the imbalance, weakness, or fault in your posture that caused the tendinitis.
Most people think you can train your way through tendinitis. But this is rarely the case. Once it sets in, it’s difficult to get rid of without a strategic, focused plan.
And if you ignore it, your tendinitis can turn into tendinosis. And you don’t want to deal with that. Trust me on this one.
Tendinosis is separate from tendinitis. It refers to the degeneration of the tendon’s collagen in response to chronic overuse. This condition generally occurs after tendinitis has been present for a number of weeks. If you have had tendinitis for more than 6 weeks — you’re likely dealing with tendinosis.
At this point, your body’s initial inflammatory response has come and gone. So you likely won’t see advanced swelling and redness. But you’ll still feel pain when performing movements. And without intervention, it can become totally debilitating.
Tendinosis is characterized by abnormal collagen formation (aka scar tissue) — which is your body’s attempt to repair the injury. Scar tissue is composed of the same protein, collagen, as the tissue it replaces during the repair process. Problem is, scar tissue doesn’t form in the same way that the initial collagen fibers were aligned.
Instead of the optimal basket-weave formation where the fibers cross over each other — scar tissue forms in crude, parallel layers. Not only is this new abnormal formation less flexible, it’s also weaker and more prone to further injury.
The terms "tendinitis" and "tendinosis" have been largely replaced by a new term: tendinopathy. Tendinopathy is a broader term that describes the degeneration of connective tissue over time. Experts now believe that tendon injuries are usually the result of long-term overuse rather than inflammation. This means that tendon degeneration (tendinosis) is not simply the result of unchecked, chronic inflammation (tendinitis). They are two separate outcomes from the same injury.
The degeneration and weakening of connective tissue in overuse injuries has a separate cause, or pathology, from inflammation. This is why the term “tendinopathy” is now the preferred nomenclature. It more accurately describes the sliding-scale, continuum of injury outcomes. But this is more than just a shift in wording. Many therapists and medical practitioners are moving away from recommending inflammation-blocking treatments. To get past tendinopathy, tendons need to become stronger and poor tissue formations need to be reinforced. This can only happen with progressive, load-based exercise.
I’ve found that two tactics, in combination, do wonders for healing tendinopathy: self-myofascial release and eccentric training. Both help break down scar tissue so your body can rebuild the collagen matrix in an optimal pattern.
Bursitis is not as common as tendinitis. And is typically easier to diagnose. In this condition, the bursae (soft, fluid-filled sacks that surround and protect joints) become inflamed. It’s usually caused by performing repetitive movements with bad form or by general overuse. Although it’s rare to have an inflamed bursa the size of a golf ball sticking off your elbow or knee, you’ll likely notice a round protruding sack from the area of injury.
Though bursitis can resolve itself, you should seek medical attention if you think you have bursitis. The inflamed bursa can become infected, or it may require a minimally invasive surgical removal. Your doctor will likely recommend a mix of NSAIDs and corticosteroid injections to get rid of the pain and swelling.
...OK... we got through it! Those are the common types of injuries you should be aware of.
At this point, you’re just about ready to put together a rehab plan. But first, you need to understand what caused the injury.
Stay tuned for Step 3 of The Ultimate 5-Step Recovery Guide.
Scott Hogan is an NCCA accredited Certified Personal Trainer (American Council on Exercise) and Certified Orthopedic Exercise Specialist. His specialties include corrective exercise programming and pain-free movement. Scott is the founder of SaltWrap.com, an online resource for therapeutic sports nutrition supplements. Learn more about the author at https://saltwrap.com/scott-
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