Treating injuries

This is how I handle moderate injuries, like strains, sprains, muscle and ligament pulls and tendinitis, etc. At 50+ I seem to get a lot! I use the I.C.N.H method adapted from R.I.C.E since I almost never rest or stop unless the injury hurts sufficiently whilst playing to stop me from enjoying playing. I have stopped on occasions for a sore back, jumpers knee and wrist fracture, and more recently for golfers elbow. The N stands for NSAID or alternatively Novasonic and the H stands for Heat. So, Ice first, then compress, then apply an NSAID externally, then in the later stages of healing use Heat, but see the link below on cool packs for a further discussion.

The application of ice immediately after an injury occurs, and for the next 2-3 days is aimed at reducing inflammation, and this does reduce short term stiffness, swelling and pain. I have a stock of cool packs that I keep in the freezer, much to my wife's annoyance, and often make use of them after playing.

To keep playing with small injuries or niggles I swear by the Movelat and Voltarol gels. Other players at the club say that the various Ibuprofen gels, an example is Ibuleve are effective. The sports injury book I use from the U.S recommends BENGAY and I remember the smell of Tiger Balm, still available in the UK, from my youth. The drugs or active constituents in these are NSAID's. It is not clear if the external application of NSAID's actually aids healing, and most strain or sprain type of injuries will heal themselves if you rest. The ointments I mention do appear to ease the pain in my case, possibly by reducing the inflammation or maybe just by the massage effect of rubbing it in.

However there is a school of thought that suggests the reduction of inflammation inhibits healing and instead recommends the deliberate aggravation of inflammation using a technique called prolotherapy. This is possibly more suitable for long term injuries which are not responding and the inflammation has become the cause of some debilitation. I have never tried prolotherapy since AFAIK it is not available in the UK. For long term chronic injuries I have been to see physiotherapists for help.

Some physios, including in the UK, are now offering variations on forms of Extracorporeal Shockwave Treatment for tendon related injuries. For example Marat Safin's website talks about his treatment for Jumpers Knee. However the American Academy of Family Physicians has published some papers in 2003 and 2005 that discount the effectiveness of this form of treatment. I have no personal experience of the effectiveness of this but would be prepared to try it if other forms of treatment were unsuccessful.

Whilst on my recent four day non-stop tennis vacation at Windmill Hill, my arm already suffering from golfers elbow got quite sore. One of the other players introduced me to BIOFREEZE. This is marketed as a cooling analgesic gel and not as an NSAID although it does contain herbal anti-inflammatory extracts from a Holly plant. I have to say it seems to be quite effective as a pain killer. After application it does not work immediately but I noticed reduced pain in my arm 30-40 minutes later, certainly enough to continue playing. My view is that it can be used as an aid to healing, by reducing pain sufficiently to allow normal movement, rehabilitating stretches and moderate exercise. I strongly believe in strengthening the muscles in the area of the injury, especially if a joint is affected by using eccentric muscle exercises.

Although I own a Novasonic device and occasionally use it, I am not yet convinced of its therapeutic value. I got one because the physiotherapists I have visited used an ultrasonic device, so I assume there must be some benefit. I also noticed that the physios use some sort of electrical stimulation device, rather like but not the same as a TENS device, which is instead aimed at pain relief. There is a list of the types of electrical simulation therapy here but the actual article is off topic for tennnis.

I did once borrow an infrared lamp for the heat phase of treatment, but usually just use a hot water bottle. Update: I have just discovered Helios heat pads, useful both at home and away. As a contrast to BIOFREEZE cooling gel there is Fiery Jack cream which is a warming muscle rub. It's a bit too smelly for my liking but it is good to use if you play with a slight injury and put a neoprene wrap over it, for example an arm band or knee support; then it really fires up and soothes away the pain.

Most chronic injuries I have had in the past have been related to some form of tendinitis, for example: Jumpers knee, wrist RSI, tennis and golfers elbow, and head of the biceps. There is a useful and interesting article on the treatment of tendonitis by the American Academy of Family Physicians here.

The Physician and Sportsmedicine Online is another excellent resource for research and articles covering sports related injuries.

In an earlier blog entry I discuss typical tennis injuries that I've had and their treatment.

Tags: Voltarol, Movelat, BIOFREEZE, Novasonic, Tiger Balm, NSAID, Fiery Jack, Ibuprofen, Physiotherapy, Extracorporeal Shockwave Treatment, tendonitis