Any NBA fans watching last night’s game must have winced to see Paul Pierce lying on the ground in such severe pain that he had to be carried off the court by 4 others. I thought for sure he had done some serious damage to cartilage in his knee, though none of the replays gave a good angle to see exactly what happened. To say I was surprised when he returned to the court only a few minutes later is an understatement. And the fact that with a sprained knee (where the ligaments that stabilize the knee get overstretched and partially tear) he went on to score another 11 points and help lead the Celtics to victory, with the aid of a Neoprene sleeve, is not typical!

This type of performance following such an acute injury is certainly an exception. First, he’s an elite athlete. He’s highly motivated to win an NBA championship (especially given the Celtics record in the past 2
decades) and adrenaline can work wonders to get you through certain situations. He also has a team of athletic trainers, physical therapists, massage therapists, and chiropractors who can give him very intensive treatment following last night’s game and over the course of this series.

My point here is that most of us aren’t Paul Pierce. For even a good, non-professional athlete, continuing to run and jump on a sprained knee is not a wise choice and not worth the risk of sustaining further injury to the knee. The steps to take following an injury such as the one he sustained would be to:

1. Protect
2. Rest
3. Ice
4. Compress
5. Elevate

Seeking emergency medical attention if you find yourself needing to be carried off a field/court would also be recommended to ensure there is not a fracture or injury requiring surgical correction.

Let’s keep our fingers crossed the Pierce’s knee holds up for the remaining games. Go Celts!

When I was in college I had my fair share of running injuries…mostly because I didn’t stretch enough. I developed Achilles tendinitis, which is an inflammation of the Achilles tendon, the thick, fibrous tendon that travels from the calf muscles along the back of the ankle.

When the Achilles becomes inflamed, there is less space within the connective tissue sheath that surrounds it. It can feel squishy, or even like it gets stuck as you try to flex and point the foot, due to adhesions that develop. These prevent the tendon from gliding smoothly. The pain can be mild or severe, and is worse during the push off phase of walking or running, or any time you point the foot and toes downward.

Often, there is associated weakness in the Achilles and possibly weakness in the anterior muscles of the shin, with tightness in the calf and Achilles. Both stretching and contracting of the calf muscles may reproduce pain.

Managing this type of injury requires frequent icing to reduce inflammation. Rest is also key. High impact activities, particularly any sports that involve running or jumping should be avoided. Cross friction massage is also very beneficial to improve circulation and reduce adhesions and promote optimal alignment of collagen fibers. It may be that flat feet or high arches contributed to the problem, and orthotics may be helpful in restoring better alignment to the foot and ankle. There are also braces and night splints available for more severe cases that allow the calf muscle to rest and have a gentle sustained stretch. Frequent active stretching of the gastracnemius and soleus, the 2 muscles that form the Achilles tendon, is also essential.

Seeking treatment early will help prevent a chronic inflammation from developing. Physical therapy can be very helpful in correcting any muscles imbalances, retraining the joint receptors, and helping to reduce inflammation with various modalities (such as ultrasound, iontophoresis, and electric stimulation). A PT can also help develop a sports specific rehab program to help get you back to your sport safely and as quickly as possible, teaching you ways to avoid the same condition in the future.

The wrists are very complex anatomically, with lots of little bones, ligaments, muscles, and nerves running through it. It is also subject to a lot of use, particularly in our age of technology. I remeber from the old Jetson’s cartoons George Jetson used to get a big swollen finger from all the button pressing, and we’ve seen that really happening..well not so much with fingers, but more often with wrists.

If due to trauma or overuse you begin to experience acute wrist pain, it’s important to follow the RICE protocol.

Rest: try to limit motion at he involved wrist. This may be best accomplished by wearing a wrist splint, which will immobilize and protect the wrist as it heals.

Ice: Using an ice pack or performing ice massage to the affected area using ice cubes will help to reduce both pain and swelling.

Compress: compression helps to provide warmth, comfort, and protection to the wrist and limits swelling. Some neoprene splints provide compression. You may also use an ace bandage or the self adhesive ace wraps available at most drug stores.

Elevate: If there is very significant swelling, such as from a fracture, it’s important to elevate the wrist and hand above the level of the heart (after emergency medical treatment and care are administered). This will help prevent complications during healing and speed up the recovery process.

If possible, try to prevent wrist injuries by keeping the wrists in a neutral position, using good posture, and taking frequent breaks to stretch the muscles of the wrist and elbow.

Plantar fasciitis is the inflammation of the connective tissue that runs along the bottom of the foot. I’ve had this in both feet, probably because I have flat feet and like to run. (And at the time over 15 years ago, did not do a whole lot of stretching.)

If you have pain along the bottom of your foot, most notably first thing when you get out of bed or after prolonged periods of sitting, plantar fasciitis may be the culprit. The best things you can do to help alleviate the pain and swelling associated with this is to rest, stretch, and ice it.

• Rest means you should stop high impact exercise, such as running to allow the tissue to heal.
• Stretching of the plantar fascia as well as the calf muscles is also crucial for this type of injury. I usually recommend that my patients stretch 3-5 times per day. In addition, prior to getting up in the morning, flexing, pointing, and circling the ankle helps loosen up the arch of the foot so the first few steps aren’t quite so agonizing. If the pain is severe or chronic, a night splint can be helpful to keep the calf muscles stretched to prevent tightening overnight. You can also massage along the plantar fascia with a tennis ball or a one inch dowel to break up scar tissue along the bottom of the foot.
• Ice the bottom of the foot with a cold pack. If you can tolerate it, you could use an ice cube on the bottom of the foot and do an “ice massage” to the area. You can also roll your foot along a frozen water bottle to get the benefit of massage and icing simultaneously.

People with flat feet or high arches may benefit from orthotics to help provide some support and/or shock absorption to the feet. Wearing well-fitting, sport specific footwear is another way to help prevent and treat plantar fasciitis. Plantarfacsiitis can be persistent, but if you are faithful with stretching, resting, and icing, and commit to wearing proper footware, relief within your reach.

Shoulder pain is a common complaint among athletes, men, women, people who sit at computers, and people who work with their hands. I’m referring to the kind of shoulder pain that’s not a result of trauma which would be different in many regards. I’m talking about the kind of shoulder pain from overuse, poor posture, weakness or tightness in the shoulders or of an unknown cause. This type of shoulder pain can be frustrating and significantly limit day to day function, particularly if the dominant side (if you’re a righty, your right shoulder) is affected. Here are a few suggestions to help ward off and relieve the burden of shoulder pain.

1. Be proactive. As soon as your shoulder starts to feel sore, ice and rest it. This will relieve any acute inflammation and may prevent you from developing a more serious or chronic problem.

2. Be mindful and aware of your posture. The majority of people with non-traumatic shoulder injuries have associated postural dysfunction. Slouching, rounding of the shoulders, and the head jutting forward are all abnormal postures which place stress on the muscles that connect the nec, shoulder blades, collar bone, and upper back to the shoulder. This can cause an abnormal pull/tightness or stretch/weakness. When any of the mechanics in the shoulder are altered, pain and injury are more likely to occur.

3. Strengthen your rotator cuff…particularly the external rotators. These muscles which are not usually strengthened in an isolated way with typical exercise programs help orchestrate the movement of the shoulder and when weak can contribute to tendinitits, impingement, and rotator cuff tears. Click here to learn how to strengthen the rotator cuff.

4. Do not carry bags, packages, or a purse on the involved shoulder. The weight of the item and the pressure it places on the shoulder can contribute to increased pain, swelling, and imbalances in the muscles surrounding the shoulder. An ergonomically designed backpack worn with the weight evenly distributed between both shoulders may be a safer option if you need to carry things with you.

5. Avoid any and all activities that reproduce or increase your pain. Certain activities, such as yard work, cleaning, blow drying and styling hair may best be left undone until your shoulder pain resolves. If it isn’t possible to postpone these tasks, do short periods of activity followed by rest and ice to limit inflammation and irritation.

As with any injury or painful condition, it’s always best to consult with your health care provider to rule out a more serious condition and to get an accurate diagnosis for treatment. And an earlier diagnosis and path to relief means a lower likelihood of suffering with a chronic condition. Be proactive and get it taken care of.

There is often confusion about whether to use ice or heat for pain relief. Ice is typically used to reduce swelling and block pain signals in the affected joints and muscles. Heat is more commonly used to increase circulation, reduce muscle spasm, and increase the ability of the tissues to stretch, thereby providing pain relief. Here are some guidelines to follow if you’re unsure which to use:

Use ice if:

• It’s within 48 hours of an acute injury
• You have visible swelling or redness at a joint
• You have tendinitis, bursitis, or arthritis (inflammatory conditions)

Use heat when:

• You have stiffness or tightness in your muscles or joint
• After the first 48 hours of an injury in the absence of visible swelling (heat, because it increases circulation to tissues, can increase swelling)
• Using ice would cause you to tighten up more (for example, ice on the neck for some individuals causes them to tense up, which counteracts the pain relieving effects)

Many times it’s a personal preference as well. I prefer ice for any injury and very rarely use heat. I especially like to use ice packs that fit into ace wrap or neoprene sleeves that Velcro around the involved joint to provide gentle compression and ice simultaneously. (These may also make it easier to ice frequently as you can be mobile with the ice pack fastened on.) On the other hand, I have colleagues who favor heat much more. If you’re unsure, I encourage you to experiment with both and see which gives you the most relief.