Category Archives: injury prevention

Jelly Filled Doughnuts

Posted on by
Reply

donut

By Emma Maaranen

This slushy morning my dog and I braved the elements and found a beacon of Sunday morning warmth and ritual on our walk – the doughnut shop.  With powdered sugar on my lips, I bit into the pastry and caused the jelly filling to shoot out the back, leaving me with a gooey mess.  Being me, a therapist who sees anatomy everywhere she looks, this reminded me of a disc injury in the back.

The jelly filled doughnut is a great analogy for a spinal disc.  Spinal discs are puck-shaped shock absorbers sandwiched between every vertebrae of the spine.  The vertebrae protect the spinal column and allow spine motion between each segment.  Each vertebra has a pair of nerves that exit the spinal column next to the disc to innervate a specific region of the body.  Discs are made of tough rings of cartilage, called the annulus fibrosus, which look like a cross-section of a tree.  Their layered circular fibers resist compression in all directions.  Discs have a squishy middle, called the nucleus pulposus, which absorbs forces put on the spine.  This is the jelly center of the doughnut.  If too big a force or a constant force is applied, the nucleus pulposus can push into the annulus fibrosus and damage it, much like a big bite into a doughnut causes the filling to escape.

disc anatomy illustrationCommon Disc Injuries

Disc Herniation – This is where the nucleus pulposus tears through the annulus fibrosus and escapes the disc; the jelly filling has exploded out of the pastry.  Pain and numbness are caused by the torn disc or extruded nucleus pulposus pressing on the nerve nearby as it exits the vertebrae.  The body will absorb the nucleus and the torn disc often will mend over time.   If the disc continues to irritate the neighboring nerve, surgical intervention may be required.  However, the nucleus is gone and can never return to the middle of the disc.  This disc will not be able to resist compression in the same fashion in the future, and care (a strong core and good biomechanics) will be needed to keep the disc healthy in the future.

Bulging Disc – In this case, the nucleus pulposus is being squished on one side and is pressing on the opposite side of the rings; the jelly is oozing into the pastry and with a little more force may burst out.  The nucleus pulposus is tearing the inner rings and expanding the disc.  This disc bulge can put pressure on the nerve causing pain and numbness.  By removing the pressure on the disc the nucleus can reabsorb into the middle of the disc and the tears in the disc can repair.  A bulged disc is quite delicate and too much force on the injured disc can cause it to herniate.

Degenerated Disc – Long-term pressure or a history of trauma to the disc can cause the nucleus pulposus to disintegrate and/or the annulus fibrosus may flatten; your doughnut is drying out and the jelly filling is turning to a dense paste.  The disc is no longer able to cushion compression in the spine as it used to.  Pain will generally come from the muscles trying to protect the spine in that location or from the spinal joints (facets) smashing together now that the flattened disk has reduced the space between the affected vertebrae.  Disc degeneration is often accompanied with arthritis of the spine in that area.

You may hear people referring to their disc injury as slipped, ruptured, compressed or prolapsed.  These terms loosely refer to a bulged or herniated disc.

If you have injured your back, there are several things to consider on how to proceed.  It the pain is sudden and is accompanied with numbness down the arm or leg, especially if numbness is present in both limbs, you need to go to the ER!  If pain comes on gradually and is accompanied by numbness down the arm or leg you should see a physician.  If any pain in your back continues or worsens over three days you should see a physician.  Once your doctor has diagnosed your disc injury a plan to heal it can be made.  Surgery is rarely performed on new disc injuries unless there is damage to the vertebrae above and below the disc (such as a displaced fracture) or the spinal column is compromised and paralysis is a concern.  Disc injuries typically heal with therapy, anti-inflammatory medication and time (six months to two years).

Therapy for disc injuries involves changing postural habits such as sitting at a desk and lifting mechanics.  Muscle imbalances will be addressed and joints will be mobilized to restore normal range of motion.  A physical therapist that specializes in spine injuries (we know a few fantastic ones we can recommend) is critical to healing a disc.  Massage therapy will address muscle tension at the injury site and can help with nerve generated pain down limbs.  Acupuncture reduces nerve pain in many people.  Healing from disc injuries is a slow process.  As an athlete it is important to have a team of professionals guiding you in return-to-play parameters and to be creative and open to new activities (like swimming or Pilates) to keep you active while supporting the healing process.

When a disc has healed it is important to continue thoughtful training and biomechanics forever!  Honestly, anyone who would like to reduce their chances of disc injuries should do this.  Discs are the most vulnerable when the spine is in flexion (forward folding) and a twisting action is done; such as sitting in a slouched position and twisting the legs to the side to get up from a workstation.  This is made more tenuous by adding a heavy object into the equation; such as bending over at the waist to pick up a backpack and twisting while straightening the spine.  It has been said over and over, but it is true – a strong core will support the spine and make it more resilient!  There are many methods to do this: Pilates, specific weight training programs, personal training, home videos, kettle bell, etc.  I’ve even seen a “spin your core strong” class advertised!  Find something you enjoy and add it to your weekly routine.  Even two minutes of targeted dynamic core strengthen exercises as part of a warm-up routine will yield excellent results.  With a strong core, you may even indulge in a doughnut now and then.

Just Run Through It?

Posted on by
3
Holly's beautiful running form at the end of the Mid-Mountain Marathon

Holly’s beautiful running form at the end of the Mid-Mountain Marathon

By Emma Maaranen

It is prime time running season with runners all over the Wasatch Front training for the Wasatch 100, Mid-Mountain Trail Marathon and St. George Marathon.  At Focus Bodywork we are often asked how to decide if a pain experienced during a run is okay to run through or not.  First, pain is your body’s way of letting you know that something is not okay and needs to be investigated.  Listen to your body!  I lump running pain into two categories: pain that develops while running and pain that develops after or continues several hours after a workout.

Pain That Develops While Running

Discomfort while running is part of the game; if you run you will experience pain now and then.  There are times, however, when you need to listen to your body and call it quits. When running pain causes you to alter your gait, it is time to call it a day.  Your compensated gait is a sign that there is a problem, and to run through it in this odd gait will most likely cause more problems and/or usher the painful site into full-blown injury status.  If the pain is not altering your gait, slow down for five minutes and focus on good running technique.  At the end of five minutes check in to see how the pain has changed.  If is the pain has reduced, pick up the pace and see what happens.  If is the pain has stayed the same, try another 5-minute technique period.  If at the end of this second test period the pain has increased or your gait has altered, it is time to walk home.

Pain That Develops or Persists Several Hours Post-Workout

You need a rest day! If the pain has subsided after a day of recovery try an easy run and see how it goes.  If you do not have pain while running and it does not return a few hours after rest, you can resume training.  If not, start with some good home therapy.

Home therapy:

1.)    Day 1 – Take a rest day- a real rest day!  Don’t even go to that yoga class.  RICE (rest, ice, compress, elevate) as often as you can.  Sit in a hammock (with your legs up and iced) and catch up on some reading (If you NEED to call this day a training day I recommend reading “The New Toughness Training for Sports: Mental, Emotional and Physical Conditioning from one of the World’s Premier Sports Psychologists” by James Leohr.)

2.)    Day 2 – If your pain is still hampering you, try a regiment of OTC anti-inflammatory, such as Ibuprofen.  Initially this will mask pain symptoms, but if taken as prescribed for 5 days you will reap the anti-inflammatory benefits of the medication.  RICE.  I know you are panicking about your fitness diminishing already (it is not, this takes two weeks), so try some cross-training, such as swimming or biking.  If your cross-training sport increases any of your pain symptoms, you need to try something else.

3.)    Day 5 – If your pain has not resolved, it is time to see a professional.  A sports massage therapist (like the ones at Focus Bodywork), a physical therapist or sports medicine doctor can help you develop a plan to get back to running pain free.

Endurance sports regularly require athletes to push through discomfort.  Should you “just run through it?”  It is important to evaluate your pain keeping in mind that cutting a training day short may save you several weeks of being side-lined.

Since your egg can be in only one basket, it might as well be a helmet!

Posted on by
1
Will this helmet make me faster?

Will this helmet make me faster?

By Emma Maaranen

It is spring, and after a cold and inverted winter along the Wasatch Front the bikers have taken to the streets again.  As I pedal around town running my errands, I cannot help but feel love for my fellow cyclists: the serious commuter bogged down in panniers, a hipster on a fixie, the matching-kit roadies headed up Emigration, and the mountain biker dusty from the just-dry bobsled trail.  But many of these cyclists are testing heart by not wearing helmets!  This appears to be a new trend, and it terrifies me.

I have heard all the excuses and arguments against wearing a brain-bucket. “It will flatten my hair”, “I’m just riding on the sidewalk to the corner market”, “I’m a careful rider.” I’ve even been in a debate with a guy who thinks buying and wearing helmets prevents more people form riding bikes and therefore a “critical mass” is not being reached.  A critical mass of cyclists, he believes, would change motorists driving habits thus alleviating auto/bike accidents.  I say that even a careful driver can be surprised by a cyclist from time to time, but fear of auto/bike accidents is not the only reason to don a brain bucket.

A tire puncture on a steep descent, a railroad track that grabbed a wheel, sand, ice, operator error… I have been victim to each of these, and once I walked off the sting of the ground I was able to ride home with only a rattle to my noggin and a renewed apprehension of gravity.  My ER doc friend has seen minor plops to the ground from bikes lead to concussions, traumatic brain injuries, strokes, comas and deaths that he believes a helmet would have prevented.

Some facts from the CDC (Center for Disease Control and Prevention):

* Head injury is the most common cause of death and serious disability in bicycle-related crashes; head injuries are involved in about 60 percent of the deaths.

* Many nonfatal head injuries from bike accidents produce lifelong disability from irreversible brain damage.

* Bicycle helmets are a proven intervention that reduces the risk of bicycle-related head injury by about 80 percent, yet bicycle helmets are not worn by most riders. Only 19 percent of adults and 15 percent of children use helmets all or most of the time while cycling.

Much research has been published in the past year about the long term effects of head trauma, and stories about athletes experiencing serious neurological and psychological diseases believed to be a result of repeated head trauma are surfacing.  Early onset Alzheimer disease, dementia and depression are believed to be directly related to a history of head trauma.  What’s frightening is that these diseases are turning up at high rates in athletes who experienced only a few hard head hits over their careers or who experienced many mild ones.  This is not a consequence of boxers and football players alone.  There is also evidence that brain deterioration is more profound if the individual is younger and if there are repeat injurys before the brain has completely healed.  For example, a mild (grade 1) concussion, which causes temporary amnesia but not loss of consciousness, will reduce motor control and the ability to focus while the brain is healing.  This may take up to as long as three months!  With these afflictions, the individual is at greater risk of another trauma.  Another head injury in this window is likely to have more severe symptoms and increased future consequences.

I think the new research into head injuries and especially repeat trauma may be enough to inspire any intelligent cyclist into the pro-helmet camp.  I’m going to invest in a few more helmets and see if I can start a fashion forward health trend!