Being injured is no longer a bed-rest sentence

Credit: Nathan Bilow/Allsport

It's the bane of joggers, cyclists and court-sport enthusiasts everywhere. The doctor says: "Stay off it a while" following a bad sprain or tendinitis, consigning the injured to weeks as a couch potato.

Hapless athletes, take heart.

The do-nothing approach to recovering from injuries is passe, say sports medicine professionals, who advocate not only range-of-motion and stretching exercises to speed recovery but also some activities that are aerobic.

"Most athletes go crazy if they aren't able to do something or have to get out of their routine," said Dr. Gregg Fasulo, an orthopedic surgeon and sports medicine specialist. So doctors and other health care practitioners are helping patients find ways to get their cardiovascular workouts even as they heal. Not, Fasulo said, because staying away from a sport for six weeks will cause a precipitous decline in overall conditioning, as some athletes fear.

"It's more a patient satisfaction or patient quality-of-life issue than it is a health concern," Fasulo said. People who practice a sport are simply more satisfied when they are able to remain active, he said.

Also, athletes who maintain their fitness while recovering from an injury are able to return to their sport sooner than those who wait until the injury is healed to get back in shape, according to an article by The American Orthopaedic Society for Sports Medicine.

This does not mean that people can necessarily continue to practice their sport while recovering from an injury, said Andrew Snyder, a physical therapist and athletic trainer at Lancaster General Health Campus in Pennsylvania. But some athletes can continue if they modify their routine. For example, Snyder advises cyclists with some knee injuries to ride shorter distances, pedal in a lower gear and avoid hills.

Depending on the severity of a limb or joint injury, a person may need to give up his or her sport completely as the injury heals, Fasulo said. But that sport can be replaced with aerobic activities that exercise other muscle groups.

Some lower-body injuries are so incapacitating that a person cannot do any weight-bearing activities for some time.

But even people who only have use of their arms and shoulders can work out, said physical therapist Kevin Urbansky of Orthopedic Consultants Ltd. of Lancaster. They can use an upper-body ergometer (UBE), which is like a stationary bicycle for the arms. To derive cardiovascular benefit, all that's necessary is to get the heart rate up to 60 or 70 percent of its maximum for about 20 minutes, Urbansky said, and this can be achieved by pumping the UBE.

If the UBE sounds too tame, there's another option. It involves making slightly different use of weight-lifting equipment at health clubs and gyms.

"Isotonic strengthening exercises can be made aerobic," Urbansky said. Instead of doing repetitions at one station on a weight training circuit and then resting before going on to the next, the key is to minimize the rests between each station, Urbansky said. If an athlete visits about 10 stations with very brief pauses in between, the activity becomes aerobic.

An alternative to exercising on land is to get in the water, which, because of the buoyancy it affords, lessens the pressure on muscles and joints. Swimming can be a viable alternative for people with sports injuries, Snyder said.

Aquatic therapy pools, where people recovering from injuries to their lower extremities often begin, can also be helpful, said Ted Yanchuleff, director of outpatient rehabilitation services.

"(The pool) is the No. 1 way we handle lower extremity injuries and deal with weight bearing," Yanchuleff said. The floor can be raised and lowered according to patients' weight-bearing capacity (water up to the chin reduces a patient's weight by 90 percent; up to chest, by 75 percent; and up to the waist, by 50 percent, Yanchuleff said). The floor of the pool moves like a treadmill, enabling patients to walk or even run up to 8.5 mph.

"Anything that can be done on land, we can reproduce in the water," Yanchuleff said. In addition to helping patients increase their strength and flexibility, he said, working out in the pool two or three times a week enables them to maintain fitness in the early stages of recuperation.

But even people with injuries to feet, ankles and knees can sometimes do weight-bearing exercise as they heal.

"The trend nowadays is ... people are weight-bearing right away," Urbansky said, "unless there's some specific reason why they can't."

So Urbansky has people with sprained ankles doing weight-bearing exercise not (as used to be the protocol) after one or two weeks, but the very next day. Even after surgery, Urbansky said, some patients are able to do weight-bearing activities with the help of a brace.

Local health clubs now provide an array of low-impact workout machines for people nursing lower body injuries.

The stationary bicycle, both upright and recumbent, is an option for patients with limited weight-bearing capacity.

"For ankles, it's a front-line exercise," Urbansky said. But people with knee cap injuries may not be able to use the bicycle, he said, because it requires bending the knee more than 30 degrees.

The flexion of the knee can, however, be partially controlled by adjusting the position of the seat, Yanchuleff said. He added that patients with back problems and those who are overweight or older may prefer the recumbent bicycle.

A low-impact machine that can be used by people with limited leg flexibility is the elliptical trainer. Similar to the old Nordic Track machines, elliptical trainers guide the feet forward and backward in a smooth motion that resembles skiing. According to personal trainer Dawn Hiestand of the Universal Racquet and Fitness Club, the steepness of the movement can be adjusted for greater bending of the knees and a more strenuous workout. Some newer models give the arms a workout as well.

The rowing machine exercises both lower and upper extremities and affords an excellent cardiovascular workout, Snyder said. But because a rower's knees and ankles must be fully flexible, Snyder does not recommend rowing for patients with acute injuries.

The StairMaster and the VersaClimber allow for a rigorous, low-impact aerobic workout. Both machines guide the user's feet straight up and down.

"The more you involve weight and overcoming gravity, the faster you achieve the aerobic effect," Urbansky said. Like some elliptical trainers, these machines can be adjusted for people who must limit the degree of bending at the knee.

All these machines have their limitations, the physical therapists said. And for people who can tolerate them while recovering from an injury, it is wise to use them under the guidance of a doctor or therapist as part of a full program designed to increase strength, balance and range of motion, Fasulo said.

The equipment can also help mend the body and lift the spirits. For sports enthusiasts, the obligatory six weeks of staying off an injured limb may be a thing of the past.

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