Pub date
2007-01-12

When It? O.K. to Run Hurt

Source:NEW YORK TIMES  Editor:By

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What You Can Do When You Are Injured

?Evaluate yourself. Is there redness or swelling? Does one side look different from the others? If not, continue exercising.

?Cross-train in a way that exercises around the area, like cycling instead of running for an injured Achilles tendon.

?Ice the injured area for about 20 minutes after exercising.

?See a doctor if you have severe pain and are having trouble with your daily activities. Otherwise, you can give it time ?up to a month or two ?to get better before rushing to see a doctor.

?Exercise, and if the pain goes away and is not worse after that exercise, it probably is safe to do it.

?Walk on it; if you can? do that, you should not run on it.

Related

Moving Down the Road to Recovery (January 11, 2007)

Tim Bower

So the surgeon, Dr. James Weinstein of Dartmouth College, decided to go out for a run.

? took an anti-inflammatory, iced up, and off I went,?Dr. Weinstein recalled. When he returned, he said, he felt ?retty good.?/p>

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 Weinstein and a number of leading sports medicine specialists say that is outdated and counterproductive.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?e got tendinitis or sprained a muscle or tendon by doing too much, don? go right back to exercising at the same level.

The specific advice can differ from specialist to specialist. Some, like Dr. Weinstein, 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. You might end up cycling instead of running, or swimming instead of playing tennis. But unless it? something as serious as a broken bone or a ripped ligament or muscle, stopping altogether may be the worst thing to do.

?e 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. ?njured tissue heals better if it? under some sort of stress.?/p>

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.

?? not convinced this is part of every doctor? training or that everyone is ready to make it part of mainstream medicine,?Dr. Roberts said. ?ou have to work with athletes a while to figure out how to do it and how to do it well.?/p>

?he easy way out is to say, ?on? exercise,??said Dr. Richard Steadman, an orthopedic surgeon in Vail, Colo., and founder of the Steadman Hawkins Research Foundation, which studies the origins and treatment of sports injuries. That advice, he added, ?s safe and you probably will have healing over time.?But, he said, ?f the injury is not severe, resting it will probably prolong recovery.?/p>

Medical researchers say that they only gradually realized the importance of exercising when injured. A few decades ago, Dr. Mininder Kocher, a sports medicine specialist and orthopedic surgeon at Children? Hospital Boston, said doctors were so intent on forcing hurt athletes to rest that they would put injured knees or elbows or limbs in a cast for two to three months.

When the cast finally came off, the patient? limb would be stiff, the muscles atrophied. ?t would take six months of therapy to get strength and motion back,?Dr. Kocher said.

At the same time, in a parallel path, researchers were learning that painful conditions that are essentially inflammation ?arthritis and chronic lower back pain ?actually improve when patients keep moving.

Now some researchers, like Dr. Freddie Fu, a sports medicine expert and chairman of the orthopedic surgery department at the University of Pittsburgh Medical Center, and a colleague, James H-C. Wang, are studying minor injuries at the molecular level.

Their focus is on tendinitis ?the inflamed tendons that are the bane of many exercisers and that affect 15 to 20 percent of all Americans at any given time. The symptoms are all too familiar ?pain, swelling and soreness. To study the injury process, Dr. Wang grows human tendons in the laboratory, stretching them repeatedly. In separate experiments, he has mice run on treadmills until their tendons begin to show the tiny microscopic tears that occur in the early stages of tendinitis.

So far, Dr. Wang reports, he and Dr. Fu learned some important lessons: First, forceful stretching of tendons elicits the production of molecules that are involved in inflammation. But 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.