How to stay in shape until you're back in the game
By Colette Bouchez
WebMD Weight Loss Clinic - Feature
Reviewed By Cynthia Haines, MD
You've reduced your calories and increased your activity and finally, the weight loss is starting to show. Then one unsuspecting day you don your workout clothes, tie on your sneakers -- and the next thing you know, you're yelping in pain.
Experts say a workout injury can happen to anyone, regardless of experience or conditioning.
"A pulled muscle, a strained back, a turned ankle, a shoulder sprain -- it can happen in the blink of an eye, usually when you least expect it," says Todd Schlifstein, DO, clinical assistant professor of physical medicine and rehabilitation at New York University Medical Center.
According to sports medicine specialist Robert Gotlin, DO, the most vulnerable areas for pulls and strains are the hamstring and thigh, followed by leg or calf muscles.
If you're a beginner exercising to lose weight, the risk of injury may be even greater, with hot spots that also include knees and ankles.
"If you are overweight, the most common injury is a sprain occurring in either the ankle or the kneecap," says Gotlin, director of orthopaedic and sports rehabilitation at Beth Israel Medical Center in New York. This problem often occurs when surrounding muscles are weak due to a lack of exercise, he says.
"The more out of shape you are when you start to work out, the greater your risk of injury, particularly if your muscles are weak," says Gotlin.
Pain vs. Soreness: Know the Signs
Even if you're already in good shape, experts say problems can occur if you overuse any one set of muscles. To keep this from happening, ease into the activity slowly and never skip warm-ups.
"For example, take five minutes out to stretch your muscles before jumping on that treadmill or bicycle, and don't push yourself to the point of pain -- even if you have done the routine before," says Schlifstein.
Some more advice: Stop immediately if you do feel pain, and rest for a day. If pain begins when you do the same motion again, says Schlifstein, it's a sure bet you've got an injury.
But how do you know you've got an injury and are not just sore from working out?
"Soreness usually shows up one or two days after you work out, and does not usually occur while you are actually doing the activity," says Rich Weil, MEd, CDE, an exercise physiologist at St. Luke's-Roosevelt Hospital in New York and consultant for the WebMD Weight Loss Clinic.
If you try to work out when you're feeling sore, the pain usually subsides after 10-15 minutes of activity, Weil says. Not so when an injury is involved.
"Pain related to an injury gets worse when you are working out," says Schlifstein. "That's when you know it's time to stop and listen to your body."
When Injury Occurs
Of course, while precautions like warming up and starting slowly can reduce your risk of injury, there's always a chance you'll get hurt anyway. The experts say it's important to remember that all but the most severe workout injuries usually heal on their own. Most do so in four weeks or less, says Schlifstein, and you can recover from many muscle strains in less than 10 days.
"Most people can usually heal their injury on their own using the RICE procedure, which is rest, ice, compression and elevation," Schlifstein says. "And the sooner after the injury you begin, the more you reduce the risk of inflammation setting in, and the quicker you can get back on your feet."
Until you're healed, avoid doing whatever activity you were doing when you got the injury, as well as other moves that involve the injured area.
"Don't try to be a hero and 'work through' the pain," says Schlifstein. "You'll only do more damage."
If the injury doesn't feel significantly better within a week -- and certainly if it feels worse -- seek medical care. Any numbness, tingling, or weakness in the leg, or sudden bladder- or bowel-related problems should be reported to a doctor right away.
And what about regaining the weight during the time an injury slows you down?
Because 80% of all injuries usually heal on their own -- often in less than a month -- the threat of weight gain is small during the recovery period, Gatlin says. But for some, Weil cautions, the forced break in activity can be enough of a mental blow to trigger overeating.
"The lack of activity after being injured can cause some people to feel a lack of control in their lives, and together with changes in brain chemistry that also occur when activity stops, can sometimes lead to depression, and that can sometimes lead to overeating," he says.
"Upper-body workouts burn more calories...than a lower-body workout."
This whole process can set in quickly, he says. So if you think you might be at risk -- particularly if you feel a strong sense of powerlessness after an injury occurs -- Weil advises seeking medical care immediately.
"Get to a doctor, get to a physical therapist -- the point is to do something proactive right away so you get back some sense of control," Weil tells WebMD.
Move It Or Lose It
Though you never want to stress an injured area with a workout, neither is it a good idea to take to your bed for more than a day or two after being injured. Instead, doctors say, you should get back to normal movement as soon as possible.
"The more you can encourage normal movement, the quicker the healing process will begin," says Gotlin.
And, doctors say, one of the best things you can do for your body, mind, and weight is to start a brand-new fitness activity -- one that doesn't stress your injured muscle.
"The human being is a unique machine with some 536 muscles in the body, so if you pull a hamstring for example, and you've lost the capacity to work out four or five related muscles, you've still got some 530 other muscles in the body to help you burn calories," says Gotlin.
If your injury is to the lower part of your body, Schlifstein says, concentrate on upper-body workouts like lifting weights or working out on an "arm bicycle."
"Upper-body workouts actually burn more calories and provide more cardiovascular fitness than a lower-body workout, so you're not going to lose anything in terms of conditioning if you just switch your workouts," Schlifstein tells WebMD.
And if you have an upper-body injury (Weil says the most common problems are tendinitis or a shoulder injury), turn to your lower half to keep up your conditioning.
"Riding an exercise bike is good and walking -- but not running -- on a treadmill, since sometimes jarring motions may aggravate a shoulder injury," says Weil. You can also do resistance training on your lower body while your upper body heals.
If you still find yourself gaining weight during your recovery, all three experts tell WebMD that the only answer is to cut back on calories.
"Weight loss is directly related to how much you take in vs. how much you burn up, so if you know you will be burning less because of your injury, you have to adjust your food intake to compensate," says Gotlin.
Returning to the Game
Whether your injury slows you down for several weeks or a much shorter time, the key to returning to your workout safely is to start out at a much slower pace.
One reason, says Schlifstein, is that you can lose muscle much faster than you gain it. Without use, muscle atrophy can begin within two days.
"One week wrapped in an Ace bandage, and it can take three to four weeks to regain strength in the injured area," says Schlifstein.
Also, going back to your activity before you're healed puts you at risk of further damage and a longer healing time.
"If you compound an injury with a second injury in the same area, it can take much longer to heal," says Schlifstein.
How do you know when you're ready to go back? Experts say you should give your body at least one week with no pain before you try again.
"You have to be able to go through the motion -- without actually doing the exercise -- pain-free for one week before you can be sure you're ready to resume your activity," says Gotlin.
When you do return, the experts say, work on rebuilding the power in your injured area one step at a time.
Says Schlifstein: "Within three weeks or less you should be back to your original level of fitness, and then you can feel free to build on your strength from there."
Published Sept. 30, 2005.
SOURCES: Todd Schlifstein, DO, clinical assistant professor of physical medicine and rehabilitation, NYU Medical Center, New York. Robert Gotlin, DO, director, orthopedic and sports rehabilitation; and coordinator, musculoskeletal and sports fellowship training program, department of orthopaedic surgery, Beth Israel Medical Center; assistant professor of physical medicine and rehabilitation, Albert Einstein College of Medicine, Yeshiva University, New York. Richard Weil, MEd, CDE, exercise physiologist, St. Luke's Roosevelt Hospital, New York; consultant, WebMD Weight Loss Clinic.
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