The New Rules of Overcoming a Sports Injury

Featured in Best Health Magazine, May 2017
You did the weekend-warrior thing and now you’ve wrecked your knee. Sound familiar? Here’s how to safely and strategically overcome injury.
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by Diana Ballon Riding the waves off the shore of Tofino on Vancouver Island had always been a fantasy of mine. And for a while — well, maybe for a few moments — I realized that dream. Moving with the strength of the current, against the backdrop of blue water and sky, I actually stood up on the board—felt myself gliding forward. That was until I fell. My body turned in the water, and pop, my arterior cruciate ligament (ACL), the central of four ligaments in my knee, snapped. I tore another ligament and the meniscus at the same time. It was the first big physical injury I’d sustained, which is pretty good for a 51 year old. But spending weeks on crutches, followed by limited mobility, put me into a funk. I’ve certainly learned some lessons along the way about injuries, about coping when your body fails you, and about figuring how to strengthen body parts that do work when others let you down. These are good lessons to learn. As we age, we become more prone to injury and these injuries can take longer to heal. After menopause, our estrogen drops, our bones become stiffer and more brittle, our muscle mass bulk and strength decline slowly. Our total body water decreases and the collagen in our tendons and ligaments loses elasticity. None of this is good. Our metabolic rate also slows down, which can often lead to weight gain and put more pressure on our joints. Fortunately, there’s much we can do to help prevent injury, or work through injury when and if it does our. But learning how to manage injuries isn’t just about learning to cope with physical complaints. That’s because “injury starts out as a biological event but very quickly becomes a cognitive and emotional experience as we appraise and interpret the event,” says Jill Tracey, an associate professor of kinesiology at Wilfrid Laurier University in Waterloo. Whether we injure a knee, ankle or shoulder, the ramifications can be the same. We may find ourselves isolated and unable to do the activities we once enjoyed. We may feel less invincible or simply “old,” like our bodies are failing us. And it can make us depressed: I rely on exercise as a kind of mood stabilizer so being forced to withdraw cold turkey from endorphin highs brought me, well, very low. The Good News / Bad News Cycle Because women are more active than ever before, there is more research on ways to cope with aging. We’ve developed better diagnostic tests, better rehab – with shorter recovery times, better surgical and rehabilitation techniques and training over the past 15 to 20 years, says Tracey. “We live in an age of replaceable parts,” says Tracey. But this has mixed blessings. Artificial joints can last for approximately 20 years in people with sedentary lifestyles, but it’s unclear how long they will last in people who return to more active lifestyles, and do activities like tennis, running and downhill skiing,” says Dr. Christine Walton, an orthopaedic surgeon based in the Toronto area. When we do get hurt, sometimes family doctors don’t have time to give us the attention we need. It’s hard to get in to see a specialist. And physiotherapy and other forms of health care can be very expensive. Unfortunately, there are no quick fixes. “Instead, people need to take more ownership over their own bodies,” says Dr. Walton. WHAT WE CAN DO New rule #1 Don’t ignore the pain If you’re experiencing pain or inflammation, either chronically or intermittently, talk to your family doctor. Once you have undergone the proper tests, and know what kind of injury you’ve sustained, you can opt to see a physiotherapist, chiropractor, osteopath or other health practitioner. While you’re in the acute phase of an injury, you’ll need to apply cold and compression to reduce inflammation. Ice penetrates much deeper than heat, says Walton, and cryotherapy devices that use compression and cold can be very helpful during early stages of recovery process, she explains. But avoid heat during the acute phase of an injury, which usually lasts for about five days, Watson warns. New rule #2 Consider the injury as a challenge Your attitude toward injury can affect how you heal. You can  confront stress with either instrumental coping, such as problem solving,  or with maladaptive coping, such as abusing alcohol or other drugs, says Tracey.  “You need to ask yourself, ‘What can I do?’ she say. “If you’ve felt a loss of control, particularly if it was a freak accident, it’s vital to regain a sense of control. Aging doesn’t necessarily mean slowing down. “It’s about being smarter about how you approach activities,” says Tracey. Avoid buying into stereotypes or alarmist headlines that women need to stop doing the activities they have always loved to do due to aging. New rule #3 Focus on holistic training  An injury may often mean temporarily slowing down or stopping one form of activity. But in many cases you can gradually modify or vary your exercise regimen as you regain mobility, allowing injured parts to rest while building up strength in areas around the injured area. Varying your exercise routine is particularly crucial if you’re preparing for surgery, but being well rounded in your approach to physical activity is a good rule of thumb, says Tracey. That means developing core strength and muscle control, combined with weight- bearing exercise, such as walking briskly. Stretching is also important, either after exercise or when you are at the point of sweating, as well as balancing exercises, says Dr. Walton. With my knee injury, I wasn’t able jog or play tennis during the first six months. But over time, I’ve been able to swim, do upper body strengthening, ride my bike, then practise yoga, and do the elliptical (in that order), all while doing daily physiotherapy exercises. New rule #4 Be mindful of your body “How we bring awareness, like our attitudes, toward an injury affects how we experience it,” says Dr. Catherine Phillips, founding director of the Edmonton-based Mindfulness Institute and an assistant clinical professor in the department of psychiatry at the University of Alberta. “Approaching an injury with resentment or resistance may create a very different internal experience than approaching it with openness and acceptance and perhaps even inviting kindness and compassion for yourself and how challenging it is to deal with this injury.” Regular mindfulness meditation develops intentional awareness in the present moment, with attitudes that are nurturing and supportive. While mindfulness apps provide short-term guided meditations, Dr. Phillips says they are not a replacement for an experienced mindfulness teacher. One of the more recognized mindfulness meditation programs in Western medicine is mindfulness based stress reduction (MBSR). It’s an eight-week program based on the teachings of Jon Kabat- Zinn that introduces body scans, yoga, breath awareness and “loving kindness” meditation as a way to help people work through pain, stress and illness. It has been shown to have a range of benefits, from improving anxiety to producing measurable positive changes in immune function. MBSR programs are offered across Canada. (You can check the UMass Medical School Center for Mindfulness website to find a certified MBSR teacher or inquire about mental health professionals who offer MBSR or other forms of mindfulness-based programs as part of their private practice or hospital affiliation.) Some people find that yoga classes not only help clear the mind but also offer physical benefits. Restorative yoga classes, in particular, tend to be very gentle. They involve holding five or six poses for an extended period, and are geared to people who experiencing stress, healing from injury, or looking for relaxation.  New rule #5 Use common sense This means watching what we take into our bodies. Remember to eat properly, avoid smoking and take at least 1,000 IUs of vitamin D every day, says Dr. Walton. “It’s the most important thing you can do over the age of 30 to maintain bone mass,” she says. Also, ask your doctor or naturopath about calcium and magnesium supplements. And get a bone density test if you are over 50 or have a history of osteoporosis in your family, have a lower weight, have rheumatoid arthritis or take medication that increases your risk of bone loss. The biology of injury and healing “Probably the biggest reason why we get injured and don’t heal like we used to are due to errors in the duplication of DNA, which increase with age because of random damage that occurs over time,” says Walton; for example, from wear and tear, and the effects of radiation from free radicals,” says Dr. Walton. Also women have a heightened inflammatory response compared to men, which seems to attenuate after menopause, she says. How long healing takes really depends on the extent of the damage, and the structures that have been affected. Genetics, age-related markers and medications can  influence the healing process. As people age, they may be more susceptible to certain types of injuries, such as hip fractures, tennis elbow, golfer’s elbow, sprained ankles, plantar fasciitis and, particularly for women who have had babies—sacroiliitis pain (where the pelvis attaches to the sacrum).