When It’s O.K. to Run Hurt

 

NY Times – It sounds almost like heresy. The usual advice in treating injuries is to rest until the pain goes away. But Dr. Weinstein and a number of leading sports medicine specialists say that is outdated and counterproductive. In fact, Dr. Weinstein says, when active people consult him, he usually tells them to keep exercising. The idea, these orthopedists and exercise specialists say, is to use common sense. If you’ve got tendinitis or sprained a muscle or tendon by doing too much, don’t go right back to exercising at the same level. The specific advice can differ from specialist to specialist. Some say most people can continue with the sport they love although they may need to cut back a bit, running shorter distances or going more slowly. Others say to cross-train at least some of the time and others say the safest thing to do is to cross-train all the time until the pain is gone.

“We want to keep you moving,” said Dr. William Roberts, a sports medicine specialist at the University of Minnesota and a past president of the American College of Sports Medicine. “Injured tissue heals better if it’s under some sort of stress.” Small repeated stretching of tendons that are already inflamed leads to the production of molecules that heal inflammation. That suggests moderate exercise can actually speed healing. He and others acknowledge that the advice to keep moving may come as a surprise and that some doctors feel uncomfortable giving it, worried that their patients will do too much, make things worse and then blame their doctor. “The easy way out is to say, ‘Don’t exercise,’ ” said Dr. Richard Steadman, an orthopedic surgeon in Vail, CO. That advice, he added, “is safe and you probably will have healing over time.” But, he said, “if the injury is not severe, resting it will probably prolong recovery.”

Dr. Weinstein’s advice for injured patients is among the boldest — he said it’s based on his basic research and his own experience with sports injuries, like knee pain and tendinitis of the Achilles and hamstring. Before exercise, he said, take one anti-inflammatory pill, like an aspirin. Ice the area for 20 minutes. Then start your usual exercise, the one that resulted in your injury, possibly reducing the intensity or time you would have spent. When you finish, ice the injured area again. The anti-inflammatory pill should forestall new inflammation from the exercise that is about to occur. The icing is to constrict blood vessels before and after exercise, thereby preventing some of the inflammatory white blood cells from reaching the injured tissue.