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Muscular Strains

Avoid muscle strains by training properly.

See Matt's section on training.

Back Strain

Scenario:
We've all experienced the backache that starts after you've been grinding uphill for two long without a break. And we've all had sore back muscles. What we're talking about here is back pain following an injury -- for example, from wrenching your back during a fall.

Description:
Back strain is a stretching injury to the muscles and ligaments of the back. It's treated with the same principles as other orthopedic injuries: rest and ice, then early activity and strengthening exercises. Think of it as a "sprained ankle" in your back.

Concerns:
If you hit hard enough, you could break your back. Or if you've crunched a disc in your back, it could put pressure on a nerve. Symptoms of nerve compression include pain radiating in a stripe down your leg into the ankle or foot, weakness of the ankle, and numbness in the foot or lower leg.

See the doctor if:
    - pain is severe and prevents motion
    - there's radiation of pain beyond the thigh, numbness, or tingling down the back of the leg or weakness in the leg
    - there are problems control your bowels or bladder

Immediate care:
Rest on a firm surface. Avoid lying on your stomach. It's usually most comfortable to lie on your back with a couple of pillows under your knees, or on your side with the hips bent forward and a pillow between the knees. Ice pack the painful area. Take an anti-inflammatory medicine such as ibuprofen 600 mg four times a day.

Ongoing care:
After a few days, gentle heat may be used intermittently to relax the area. Don't overdo the heat -- it can make you more sore. Limit it to about 20 minutes four times a day. Get back to your activities as quickly as you can. After a day of activity, an ice pack in the evening can reduce the next-day stiffness.

Back rehab:
As quickly as the pain allows, you should begin exercises to restore mobility and strengthen the back.
PELVIC TILT: Lie flat on your back with knees bent. Tighten your stomach and buttock muscles so it flattens your lower back against the floor. Hold 10 seconds. Repeat 10 times, twice daily.
KNEE RAISE: Lying on the back with knees bent, raise one knee to your chest, then the other. Hold both knees against the chest 10 seconds, then lower one knee at a time. Repeat 10 times, twice daily.
PARTIAL TRUNK RAISE: Lie face down, arms at your sides. Keeping your waist on the floor, use your arms raise your chest up. Support yourself on your elbows for 30 seconds. Repeat twice daily, increasing the time to two minutes as you recover.
PARTIAL SIT-UPS: Lying on your back with your hands behind your head and knees bent up, crunch your abdominal muscles so it raises your shoulders off the floor. Hold for ten seconds, then lower down. Repeat 20 times, twice daily.

Muscle Strain

Scenario:
You're sprinting for the finish line in the big race, and suddenly there's a sense of ripping in your calf muscle. Next comes a horrible calf cramp. You coast to the finish line and limp over to sit down.

Description:
A muscle strain is a rip or a damaging stretch in the muscle. Typically, there's sudden pain during violent physical exertion. The muscle becomes hard or knotted, and painful to move. Over the next few days, swelling and bruising may appear over the muscle.

Concerns:
At its worst, a big rip in the muscle creates permanent weakness (it's impossible to repair a torn muscle to its pre-injury condition). Even for more minor tears, the scar that forms in the area is prone to rip again.

See the doctor if:
    - you can't move the injured area fully
    - pain is severe
    - there's severe swelling or bruising

Immediate care:
Apply an ice pack to the painful area. Compress it with an elastic bandage. Rest. Take an anti-inflammatory pain reliever, such as ibuprofen 600 mg four times a day.

Ongoing care:
Ice-pack for 1/2 hour, every two hours during the day, for two days. Keep compression on the injured area with an elastic bandage for about four days. As the injury starts to improve, begin range-of-motion stretching exercises to prevent formation of stiffening scar tissue within the muscle. Expect around a month to heal. There may be occasional problems with the muscle for many months.

Muscle rehab:
Stretching exercises: Warm up the muscle so stretching will be more comfortable. First get your circulation going by exercising other (uninjured) areas of your body. Now warm up area with a warm soak or a heating pad for about 15 minutes.
Look at the course of the muscle. You'll be bending the joint above the muscle and the joint below the muscle. You'll bend these joints in the direction that stretches the muscle. For example, for the front thigh muscle (quadriceps), you'll bend the hip backwards and bend the knee back. For the back thigh muscles (hamstring), you'll straighten the knee and bend forward at the hip.
Stretch the muscle until it starts to become uncomfortable. Hold it there for 30 seconds, then relax for a minute. Repeat this 10 times. If the muscle is aching after the stretches, cold pack it for 1/2 hour. Repeat the stretches twice a day.
Active exercise: Begin active strengthening after three or four days of rest. Tighten the muscle against resistance. Start in the fully stretched position, and slowly contract until the muscle is fully shortened. Start with a light amount of weight or resistance. Do 10 repetitions. Increase the weight, then do 10 more. When the weight makes you feel discomfort from the injury, back off. Do the active exercises about every other day.

Neck Strain

Scenario:
You're dropping of the thousandth ledge of Porcupine Rim when your front tire hangs up. As the front shocks compress, your head flips forward before the bike bounces free. Ouch. Your neck hurts.

Description:
Neck strain (cervical strain, sometimes called "whiplash") is a stretching injury to the muscles and ligaments of the neck. It can occur when the head is forcefully bent forward, back, or sideways. Or the neck can be strained when the head simply bobbles back and forth from a sudden stop. It's treated with the same principles as other orthopedic injuries: rest and ice, then early activity and strengthening exercises. Think of it as a "sprained ankle" in your neck.

Concerns:
If you strike your head hard enough, you could break your neck. Or if you've crunched a disc in your neck, it could put pressure on a nerve. Symptoms of nerve compression include pain radiating in a stripe down your arm, weakness of the elbow, wrist or hand, and numbness in the arm or hand.

See the doctor if:
    - pain is severe and prevents motion
    - there's radiation of pain beyond the shoulder, numbness, or tingling in the forearm or hand
    - there's numbness or weakness of the legs
    - there are problems control your bowels or bladder

Immediate care:
Rest. Lie back with an ice pack wrapped around the painful area for 30 minutes. Take an anti-inflammatory medicine such as ibuprofen 600 mg four times a day. Repeat cold packs 30 minutes, four times a day for two days.

Ongoing care:
After a few days, gentle heat may be used intermittently to relax the area. Don't overdo the heat -- it can make you more sore. Limit it to about 20 minutes four times a day. Get back to your activities as quickly as you can. After a day of activity, an ice pack in the evening can reduce the next-day stiffness.

Neck rehab:
Stretching: After two days' rest, begin to restore the neck's mobility. Begin by warming the neck for 10 minutes. Some light aerobic activity may help loosen the muscles. While sitting, tilt your neck forward until you begin to feel the stretch. Hold there for 30 seconds, relax a minute, then repeat 5 times. Do the stretch in the backwards direction, then tilting to each side (ear towards shoulder), then rotating (chin towards shoulder). Hold each stretch for 30 seconds, repeating 5 times. If the discomfort has increased after the stretches, cold-pack the neck for 30 minutes. Repeat the exercises twice a day.
Active exercise: Use the palm of your hand as a "graded resistance machine." Put your palm against your forehead, and push your neck against it. Slowly push the hand forward with your head until the neck is fully bent, then let the head return to the neutral position while continuing resistance. Repeat 10 times. Do the exercise for backward motion (with both hands behind your head), then with side-tilt (with a palm against your scalp just above the ear). Do the exercises twice a day.

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