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COMMON SPORTING INJURIES
JOHN PETROZZI: Hi. Welcome to “Living is Easy” with John and Josh. I’m John Petrozzi.
JOSHUA HARPER: And I’m Josh Harper.
JOHN PETROZZI: We’d love to welcome you to our show. This show is really about you, it’s about health, and it’s about wellness.
JOSHUA HARPER: What’s on the show today, John?
JOHN PETROZZI: Josh, today, we’ll be talking about common sporting injuries. We’ve had lots of questions from our listeners and we’ll be covering topics including sprained ankles, tendonitis, heat versus cold, and the last we’ll be talking about is core strength and core stability.
JOSHUA HARPER: Our first question was from Jane from [0:00:43]. She writes, “I’m an amateur athlete and I compete in beach swimming events. Over the last few months, I’ve noticed that my shoulder has started to become sore. I went to the doctors and they said that I have shoulder tendonitis. What does this mean and what can I do about it?”
JOHN PETROZZI: Thanks for your question, Jane.
Tendonitis – it’s a really common sporting injury. I think a lot of athletes who have been playing sports for a long time have probably suffered with tendonitis in some part of their body throughout their sporting career.
JOSHUA HARPER: Right.
JOHN PETROZZI: Tendonitis is really an inflammation of the tendon. The tendon is a really strong material.
JOSHUA HARPER: How strong is it?
JOHN PETROZZI: Really strong – very, very, very strong – probably stronger than you’ll probably need. It’s job is to basically attach the bone to the muscle and allows you to move around, allows your body to become fast or slow, and it allows you to move.
JOSHUA HARPER: Do we have tendons all over our bodies?
JOHN PETROZZI: Yeah. Basically, wherever you got a muscle, you’ve got a tendon there as well that attaches itself into the bone. Tendonitis occurs from overuse or underuse.
So maybe, Jane, your stroke may need some correction or may need some attention because if your arm continuous to move in a certain direction that your joint isn’t meant to. For instance, if you got an over arm stroke and if it’s turning in or turning out slightly, if it’s not suppose to be doing that, overtime, that could become overused and inflamed as well.
JOSHUA HARPER: How long does it take to get tendonitis?
JOHN PETROZZI: Sometimes, it can take half a day. If you’re not used to a certain activity, for instance, if you’ve got a big pair of cutting scissors and you’re cutting fabric all day, you’re making a sale or you’re making costumes or something; and you’ve got this big pair of scissors in your hand, making massive cuts into heavy fabric. If you’re not used to doing that – the muscles in your hand wouldn’t be developed as strong as they should be – you may find by half a day, you’ve got some sort of tendonitis or inflammation of tendon in through your hand.
It doesn’t mean that it’s a permanent problem to the hand. It just means that because you’re not used to it, the body is saying, “Hey, I’m not used to this. Because of this load and force going through this tendon, I’ll become inflamed for a while because I’m getting a little bit damaged.”
JOSHUA HARPER: How do we prevent it?
JOHN PETROZZI: Preventing tendonitis can be quite easy.
- You’ve got to firstly look at – in Jane’s case – you’ve got to look at your stroke.
- You’ve probably got to look at the amount of exercise that you’re doing as well. Are you overdoing it? Are you letting your body rest in time for your body to start to heal and rest and recuperate?
If you’re not doing any of those things, take a look at them and see if you can improve any of those.
JOSHUA HARPER: What can we do once it’s happened?
JOHN PETROZZI: Well, once you’ve got a tendonitis, the first thing you want to try and do is minimising control of the inflammation. The most natural way to do that, drug-free way, is actually to apply an ice pack. As soon as the injury starts to flare up or as soon as you start to feel it, apply an ice pack onto the area. We’ll be talking about ice versus heat later on in the show so stay tuned to that, please.
So what actually happens to the tendon when it gets damaged or overused is that little fibers, tendon fibers, start to tear, and once they start to tear, the first thing the body starts to do is produce the inflammatory response, which is actually part of healing it. It’s a normal healing phase.
JOSHUA HARPER: What do you mean by this?
JOHN PETROZZI: Well, if you get a little tear, the first thing that starts to happen is you get damaged cells around that tendon and those damaged cells start to produce little chemicals that aren’t meant to be there. So the body starts to highlight these chemicals and what it does is start to produce more inflammation to the area. It opens up blood vessels so that more circulation can get to that area to heal. By doing that, overtime, the body will get all the nutrients and all the good things to that area so it can start to heal.
Once the healing process has gone on for a little while, the body starts to lay down little fibers, hard fibers, of collagen called “scar tissue.” Have you heard of scar tissue before?
JOSHUA HARPER: Yep.
JOHN PETROZZI: Scar tissue can work in our favor; it can work against us as well. What the scar tissue does is it starts to lay down across the damaged tendon and allows the area to become strong again. But sometimes, that scar tissue process can go overboard so you can get too much scar tissue sometimes.
JOSHUA HARPER: What happens then?
JOHN PETROZZI: Well, then the tendon starts to become stiff, less flexible, and overtime, more prone to accident and injury.
JOSHUA HARPER: Can you prevent this?
JOHN PETROZZI: You can prevent the scarring, and that’s by using ice. We’ll talk about that later. But you can also prevent most tendonitis as well. The thing to look out for is to stay flexible. If you’ve got a pretty stiff shoulders, for instance, with Jane, if you got a stiff shoulder joint or a stiff elbow, it means that your shoulder has to start to reach around and provide more stability for itself; which means overtime, if there’s too much muscular activity happening at the joint, the muscles become overused and so will the tendons as well.
JOSHUA HARPER: And you can balance this by stretching it.
JOHN PETROZZI: That’s right – yes, stretching it out and also strengthening it, too. Whenever you get a tendonitis, for instance, at the shoulder, in Jane’s case, the best sorts of strengthening exercises to do would be exercises to strengthen the front of the shoulder, the back of the shoulder, as well as the outside and also the inside portion of the shoulder as well.
You can get most of these exercises just by asking your local doctor or chiropractor, physio or osteopath, or exercise physiologist or trainer. So there’s lots of information out there and it’s quite easy to find as well.
So I hope that helps, Jane. Good luck with your swimming and thanks for your question.
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JOSHUA HARPER: Jacob writes, “I play school sports and I often sprained my ankles. It happens a lot and my PE teacher says that I should strengthen my legs and core muscles so that my ankles get stronger. I’m confused. How can strengthening my core muscles make my ankle stronger? First of all, John, what are core muscles?”
JOHN PETROZZI: Yeah, good question. Thanks for your question, Jacob.
Core muscles are those muscles around your tummy, so that’s your abdominal muscles, the muscles in your back, lower back. It’s also including your diaphragm and it also includes your perineal muscles or the muscles underneath your pelvis.
You can imagine like a drink can or a coke can or something like that, you know when it’s actually full of liquid and full of gas, it’s very hard to squash that. You could actually probably drive over it with your car and still not squash the can. But as soon as you open the lid on the can of drink, it lets all the gas out, and even if the liquid is in there, you could still squash that, couldn’t you?
The core works exactly in the same way, actually. Because you’ve got a strong abdominal wall, a strong back, a strong roof, which is the diaphragm, and a strong sort of lower section of the abdomen as well, it means that the whole abdominal area is almost encased in a cave of strength. It’s a vessel. And you, you know when you bear down on the toilet or you go to the bathroom, you’re straining downwards. What that’s actually doing is increasing your inter-abdominal pressure. That’s all well and good – it increases inter-abdominal pressure; but what does that mean for Jacob?
What it means is that if you’ve got a strong core of muscles in through your abdomen, it means that you’ve got a stronger base of support for your limbs, which means your legs can move a lot easier and stronger because they’ve got a very stable base at the pelvis. It also means that your arms will become stronger as well, because again, you’ve got a really strong core or trunk girdle muscle group.
It’s really important in lots of sports. The main sport that I can think of that requires that really strong core is javelin throwing.
JOSHUA HARPER: Why is that?
JOHN PETROZZI: Well, you know in javelin throwing, you’re holding on to this big, long spear thing, and when you need to throw the spear or the javelin, your body winds backwards, outstretched, and then you throw it over your head and out into the distance. Your body basically flings open like a slingshot – like an elasticised slingshot.
Now, you can imagine, if there wasn’t really a strong abdominal group or core to the body, all the strength from the arm through the javelin, going through the body means all that weight has to be dissipated somewhere. Most of that weight and strength and force will be dissipated through the joints in the lower back. So if you’re not strong in your core, it means that you might be prone to accidents later on.
JOSHUA HARPER: What is the connection between the core and the ankles?
JOHN PETROZZI: With your ankles, whenever you’re walking, you’re basically placing your heel on the floor. All of your weight goes through the outside of the foot right off to the toe.
JOSHUA HARPER: Right.
JOHN PETROZZI: So, heel-toe-heel-toe-heel-toe as you’re walking and running along. If you’ve got a weak abdominal muscle or a weak core, it means that you’re pelvis also rocks forwards and backwards. Kind of like a camel. You know, when a camel walks, it sort of jerks forward and jerks backward – or a giraffe or any sort of animal that’s got really long legs. Their pelvis jerks forwards and jerks backwards.
All that jerking movement in the human being will cause the ankles and knees and hip joints to move out of their normal range of movement. So, they’ll actually move more than they can actually move, which means overtime, if your body does more than it can actually do, it will start to wear away and become degenerated overtime.
JOSHUA HARPER: What sort of exercises can you do to improve this?
JOHN PETROZZI: Some excellent exercises you can do on the Swiss ball. Those Swiss balls are great for increasing abdominal strength; it’s an easy exercise to do – you can do it anywhere at the home or at the gym. I actually got some exercises organised on the website and you can find those on the website. It’s www.petrozzihealth.com.au. Just go to the, I think it’s in the “Brochure” section or something like that. You’ll find a section in there with Swiss ball exercises.
Those exercises are designed to strengthen the abdominal muscles. You’ll find things in there that include a sort of modified sit-up. There will be some back arching exercises. There’ll also be some strengthening exercises for the glut muscle as well, which is that hip muscle – the back part of your hip, basically your bum. The one you sit down on. They’re really excellent for strengthening the core. And there are some exercises for Jacob to do.
In that manual, there’s also some exercises for the chest and I think there’s also some exercises for the legs as well.
JOSHUA HARPER: How often do we need to do these exercises?
JOHN PETROZZI: If you’re serious about getting a strong core, do them about four to five times a week. If you feel that you’ve got a fairly strong core and all you want to do is just tone it or strengthen it up a little bit, then two to three times a week is sufficient. But it’s really important to have a strong core.
Thanks for your question, Jacob.
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JOHN PETROZZI: Welcome back to Living is Easy.
JOSHUA HARPER: Beverly from Padington writes, “I love playing basketball. I am 45 years old and I have just taken up the sport again after not playing it for 15 years. I often would sprain a finger joint or a back muscle, which forces me to rest for a week or so. Some of my teammates tell me to use ice packs and others say heat packs. I’m a bit confused. What would you recommend?”
JOHN PETROZZI: Yeah, great question, Beverly. Thanks a lot for seeing that one through.
It’s a really common question. Actually, I get that a lot with patients. They say, “Shall I use ice or should I use a heat pack?”
JOSHUA HARPER: What’s the difference, John?
JOHN PETROZZI: Well, the difference is you use an ice pack for an acute injury.
JOSHUA HARPER: Which is?
JOHN PETROZZI: An acute injury is an injury that you have just incurred. So as soon as an injury occurs, the first thing you want to do is place an ice pack onto it. You use heat pack for an old injury or a chronic injury. The reason why you use ice on a really fresh injury is because you can imagine, as soon as you’ve caused an injury to a joint, for instance, Beverly, as you’ve caught the basketball and if it’s clipped the tip of your finger and made your finger go backwards, the joints become sprained and inflamed.
What happens is actually, with that sprain, you’ve actually got some cells that have been damaged and they basically break up. You’ve got tissues that aren’t meant to be outside the cell, they’re now outside the cell and they’re going to irritate all the other cells around them as well, which produces a healing or an inflammatory reaction.
An inflammatory reaction is basically the body’s way of healing itself. But sometimes, it goes a bit berzerk and the joint swells up so much that it doesn’t move anymore. It becomes very, very stiff.
JOSHUA HARPER: So, what does the ice do?
JOHN PETROZZI: What the ice does, basically, is it takes away some of that blood from the area. So as soon as you’ve caused damage to the joint, blood vessels start to dilate, which means that they start to expand, which means more blood and more fluid can actually get into the area to swell it up. The ice pack basically reduces the swelling of blood vessels and reduces the flow to the area as well.
JOSHUA HARPER: Does this affect the health of the sprain at all?
JOHN PETROZZI: Yeah, it does because if you got a sprain stay there for too long, say, Beverly for instance, is if you’ve had a sprained joint and you’re really interested to keep playing the game, and you had another sprained joint and still you want to keep playing the game, and you sprained your joint the third time, what would happen is you’ll start to create so much damage to the joint that the inflammation would become so great that the joint would become very, very stiff and probably stiff for a long time as well. So get the ice on there as soon as possible.
The flip side to that is heat. Think of this, if you had a really fresh injury like a swollen finger joint, like in Beverly’s case, and if you apply the heat pack to that, logically, what’s going to happen is the heat produces warmth to the area, which means blood vessels start to become dilated and big as well. It’s just like getting a fire hose. You know, when you’ve got a normal garden hose compared to a fire hose, you can get more water out of a fire hose, can’t you?
So applying heat to the area means that all the blood vessels become massively dilated like a massive fire hose, which means, more and more fluid can pump into the area, potentially. So, if you apply a heat pack onto the fresh injury, it means that you’ll get more inflammation in there.
JOSHUA HARPER: Now, things like deep heat – is that the same thing as a heat pack?
JOHN PETROZZI: It is – kind of. Yeah. It works in a different sort of way. The deep heat – what that does is basically tells the brain that there’s warmth happening down there but it won’t necessarily heat the area up. So it’s really a trick for the brain to say, “Hey, you’re not feeling the pain. You’re actually feeling the heat.”
JOSHUA HARPER: So, do you recommend things – the creams like that?
JOHN PETROZZI: Sometimes, I do. But I would say it would be more for an older injury or a chronic injury.
For instance, hamstring injuries – you know the hamstring muscle at the back of the thigh, it could often become strained when someone’s running, trips, overstresses, or overstrains that particular muscle, and you’ve got tearing into the area.
If you apply heat to a really old injury, like an old hamstring injury, what would happen is you would basically dilate the blood vessels, get more and more circulation into the area, which means it becomes less stiff and more flexible. That’s the benefit of using heat on an old injury.
JOSHUA HARPER: What would happen if you place an ice pack on-
JOHN PETROZZI: Well, the ice pack, specifically, what that does is it tightens the area up, which is not really what you want to do.
JOSHUA HARPER: So, it’s the opposite-
JOHN PETROZZI: It’s the opposite to what you want to do – yeah. So, if you’re applying an ice pack to stiff and sore shoulders that you’ve had for years, then what would happen is the ice would probably irritate you a lot and maybe give you a bit of headache. Also, the muscles in the shoulders would become more stiff – not the end of the world but just not the right cure for it.
We hope that answers your question, Beverly. It’s a really good question because it comes up a lot – ice versus heat.
[break]
JOSHUA HARPER: We’ve received another question from Daniel. He writes, “I was playing rugby a few days ago and got tackled and fell onto my elbow. I went to the hospital emergency department and they said that I sprained the elbow joint. They said to be careful and avoid lifting, and that it would heal in a few weeks. It’s starting to feel better now. What can I do to speed up the recovery?”
First of all, what is it – spraining a joint?
JOHN PETROZZI: Well, a sprained joint is basically a joint that’s gone past its normal limits or normal barriers. So in Daniel’s case, what would have happened is as he fell over, maybe he landed on an outstretched hand and his elbow basically went into extension. So it basically was straight and probably got forced even straighter.
JOSHUA HARPER: Right.
JOHN PETROZZI: So what happens in that case is the joint goes past its normal barriers. It may cause some tearing to some of the actual joint fibers around the capsule, which means that you start to develop an inflammatory response again.
Exactly the same as in the tendonitis case – you would develop inflammation around the joint. That’s what a sprain is.
JOSHUA HARPER: What could we do to speed up the recovery?
JOHN PETROZZI: Well, in Daniel’s case, he said he’s starting to feel better, which is a really good sign. A sprained ankle should generally last in an acute stage or in a really hot stage for roughly about a week to a week and a half. If they’d last for any longer, then you should really go and seek some professional advice.
Most of the information we give you on radio is just information – just for people’s concerns. But if you do have a concern about your health, pop along to see you GP and get another recommendation.
In Daniel’s case, the best way to promote healing is firstly, to apply ice pack to reduce some of the inflammation.
JOSHUA HARPER: And that’s the acute stage?
JOHN PETROZZI: Exactly right. Yeah, as soon as it happens, pop an ice pack on there. The next thing you want to try and do is basically try and avoid moving the joint too much. I wouldn’t recommend that you go and get it plastered or braced or anything because you still want some sort of movement to happen at the joint.
So for instance, in Daniel’s case, Daniel, with your elbow, the best way to probably keep that is just to tuck it in by your side. I wouldn’t put a bandage or anything across it unless you feel that you really wanted to, because what studies have found is that if you brace a joint that’s been injured and if you brace it for too long, what happens is it starts wasting your muscles around the area.
JOSHUA HARPER: What does that mean?
JOHN PETROZZI: Well, you can imagine you’ve got well-developed biceps in the arm, triceps, and you’ve got forearm muscles as well. If the area’s been braced for a while – by “a while” I mean two weeks or so – you’ll actually start to get some of those muscles in the area wasting away. So it basically starts to wither away and the arm will become visually smaller. What that means is the recovery and rehabilitation phase will be that much tougher because it means you need to strengthen those muscles up again.
JOSHUA HARPER: So, do you recommend some light movement?
JOHN PETROZZI: Yeah, I’d definitely recommend some light movement. If you’ve got, for instance, half of your movement back after about a week or so, that’s good. You can actually use half of your range of movement back again. But I don’t mean grabbing hold of weights and lifting weights. All I mean is basically placing your elbow up on to a desk or bench top and allowing the elbow to start to straighten out slowly and then bend in slowly as well.
JOSHUA HARPER: So, it’s just light stretches.
JOHN PETROZZI: Just light stretches – yeah. No fast or jerky movements.
JOSHUA HARPER: What can we do after this stage, about a week and a half in?
JOHN PETROZZI: About a week and a half in, the best thing to start to do is do some gentle stretches, as well. For instance, a stretch for the elbow would be to try to straighten the area out. If you can, reach across to your fingers and pull the fingers backwards. What that does is it causes a stretching to happen in through the forearm and maybe a little bit into the elbow as well.
JOSHUA HARPER: Okay – but not to force it?
JOHN PETROZZI: Not to force it – no. Because if you force it, all you’re doing is re-damaging the area.
Another good exercise would be to go for a swim. I say that almost hesitantly, because I don’t mean going and jumping into the pool and doing a kilometer straight out because you’d be really sore after and you probably would have caused some damage, especially at the week-and-a-half to two-week mark.
What I mean by some water therapy is just go into the water. Just waddle around, wade around in the water for a while. Just have a bit of fun, really, letting your elbow become straight. What it does is it causes some contraction and strengthening to occur in muscles around the elbow.
Other things that you should probably try and do or look at is your diet, too, because the food that you put into your mouth is also going to either cause more inflammation in your body or less inflammation.
JOSHUA HARPER: What doesn’t and what does?
JOHN PETROZZI: Well, things that tend to produce more inflammation would be meats and dairy as well, so try and have those sparingly. The things to try and really stay on top of with the nutrition when you got inflammation are basically fresh fruit and fresh vegetables, and lots and lots of water as well. So, fresh juices fall into that category as well.
JOSHUA HARPER: So, what does these do?
JOHN PETROZZI: Well, what they do is- fruits, vegetables, and juices – they’re very, very high in antioxidants. Antioxidants are basically these little scavengers that are good scavengers and they go and mop up all the free radicals, which are basically cells or molecules that are produced by sick and dying cells. They mop them out of the system and excrete them through your waste.
So, if you’ve got inflammation in a certain joint, you’ll be producing lots and lots of these cells and molecules that shouldn’t be in your body, and you want to try and get rid of them as soon as possible.
JOSHUA HARPER: How can we prevent it from happening in the first place?
JOHN PETROZZI: A sprained joint? Well, in Daniel’s case, I think you couldn’t really avoid that. Well, he sort of fell over and fell onto his elbow. But most of the time, you can prevent sprained ankles by making sure you are in good shoes, making sure you’ve got strong and flexible feet, ankles, and limbs as well. So, being flexible and stronger would probably be the biggest points in prevention.
The other thing that Daniel can do is, Daniel, you can do some self massage to your elbow as well. What I mean by that is just get some olive oil or some moisturizing cream, just rub it over your biceps or maybe on the back of your elbow and just start to massage and rub the muscle and skin tissue. What that does is it helps to improve some of the circulation in the area, and overtime, it will help in the flexibility and healing, too.
JOSHUA HARPER: Not straight after or?
JOHN PETROZZI: Not straight away. No, it will be too sore to start off so maybe on the second or third week. A sprained ankle should really have healed up by the four- to six-week mark. At the sixth week, it should be fully healed and strong as ever.
Well, that’s the end of the show. Thanks for listening and thanks to all those people who sent in their questions and contributed to the show. We hope it was worthwhile for you.
You’ve been listening to Living is Easy with John and Josh. We’ll be seeing you next week on Wednesday night from 6-6:30. We look forward to it.
Until then, stay well and stay happy.
