2019 October

If you are like most people, getting fit and staying fit is a never-ending cycle with resolutions come and gone, one fitness fad tried and discarded as you start another one. One form of fitness however has been on a rise and consistently so. Running marathons has become the next big thing with more and more people taking it up no matter what age, what fitness background.

Running needs very little investment- its like the saying goes- “Have feet, will run”. Running benefits are myriad including reducing stress, improving overall health, balancing the mind and soul, and is also one of the best ways to lose weight and work the heart. Most runners get addicted to it not just because it gives an adrenalin high but because running becomes a form of meditation, a contemplative silence in touch with your mind and nature. It is indeed cathartic and this sense of well-being percolates into the rest of the day. The fact that all you need is a pair of running shoes to begin is an incentive for many. No wonder so many are taking up marathon running and not looking back.

Running a marathon is a whole other ballgame.Training for a marathon must be done the right way and these tips will get you going.

1. Starting the practice: The right time to begin training for a marathon is at least a year before the D day. This gives the body enough time to allow your body to adapt.
2. Invest in coaching: Training for a marathon with a coach makes a world of difference. A well-structured training program customized for you with the appropriate warm up and cool down stretches go a long way.
3. Invest in proper shoes: Finding the right pair of shoes is critical. Shoes should be picked based on your foot type, terrain and body weight. Getting Gait Analysis done by a sports physiotherapist can help you understand the right way to run and also the right sole-mate for you based on a scientific assessment.
4. Distance: Take care to ramp up your mileages slow and steady.
5. Base mileage: Plan your weekly mileage over time. Running 3-5 times a week with relaxed pacing and increasing the mileage by 10% per week is a great way to train. Practise one long run every 7 to 10 days so that the body gets enough time to recover. Also someone with a smaller body frame can pick up the mileage faster than a person with a heavier body as it puts stresses due to increased weight.
6. Rest and recovery: Recover well with adequate hydration, sleep, nutrition, sports massage and stretching to perform at your best at each run.
7. Strength training: Running involves a lot of muscles working together to create synchronized stride. It is therefore important to maintain muscles at their optimal strength. The calf and quadriceps are especially adapted to act like a spring saving energy to propel the body forwards. Add functional training, Pilates, weight training, swimming, and core workshops on rest days.
8. Energy and hydration: Practise your runs with hydration packs and energy gels or bars in a side pocket so as to get accustomed to it. Long runs lasting for more than two hours cause depletion of energy due to which the body might feel tired and heavy. Replenish your energy at timely intervals; sports drinks are recommended every few miles.
9. Work on your breathing while running. This helps you train your diaphragm and provide enough oxygen to the body to reduce the energy expenditure.
10. New runners should concentrate on building time and not distance. Set realistic goals to keep yourself motivated.
11. Listen to your feet while running. Softer landing will reduce the impact on your knees

Remember that running trains not only your body but also your mind. Sometimes pushing your body just a tad bit to finish your running goal for the day requires a state of mind that is positive, disciplined and goal-oriented. Running with a positive frame of mind can change your world outlook from a glass half-empty to a glass half-full. Run your own race. Don’t compare yourself with other runners. Whether it is a 10 km or a half or full marathon, have a game plan and stick to it. Build a marathon mind and body you can be proud of.

With so many races and marathons across cities and the SCMM around the corner, it is important to understand proper recovery techniques to ensure long and injury free running. There are a number of recovery techniques; let’s look at them and and examine the science behind each.

Sleep and relaxation

Adequate sleep is crucial for recovery and the only way to destroy the nagging symptoms of fatigue. A study of distance runners has shown that one night of sleep deprivation can reduce energy exertion by 8 per cent. Deprivation also upsets sleep cycles and can lead to a reduction in hormone production including melatonin, growth hormone, testosterone and oestrogen – essentials for general health and adaptation to training. It is recommended that runners get at least 7-8 hours of sleep each night. This is especially important for those working fulltime and fitting training around their work schedule.

Nutrition and hydration

After an endurance run, glycogen stores are significantly depleted and runners need to consume carbohydrates to rebuild stores. With adequate carbohydrate intake, glycogen stores can be restored within 24 hours. However, for those training multiple times a day, stores can be rebuilt more efficiently by ensuring carbohydrates are consumed immediately after a running session. It recommended that large amounts of carbohydrates (1.2g/kg/hour) are consumed at regular intervals up to five hours after exercise to optimise glycogen stores. Dehydration leads to impaired performance and therefore rehydrating after training is essential for recovery. It is important to hydrate before each session, during the session and aggressively after exercise. But hydration involves more than replacing lost fluid: electrolytes also need to be replaced. Sports drinks (containing salt and sugar) provide a more complete form of hydration than water. They restore beneficial salts, while the sugar assists the body to maximise water absorption.

Cold water therapy

Cold water therapy is immersion in cold water and reduces muscle inflammation, limiting pain and reversing muscle damage. It has been demonstrated that immediate cold water immersion after intense exercise (14 minutes at 15°C) can help to maintain performance for five days. Another group demonstrated that 5 x 1 minute water immersion at 10°C eased leg pain and reduced fatigue. The most effective water immersion technique is not clearly defined, but research suggests somewhere between 5-15 minutes at a water temperature between 10-15°C. However, note that cold water immersion below recommended temperatures or for excessive periods may be harmful.

Massage, stretching, foam rolling

Massage: Scientific evidence to support massage as a recovery technique is limited, but anecdotal evidence is plenty – with numerous personal accounts of massage playing a vital role in the recovery process. Deep tissue massage may be beneficial to some extent.

Stretching is a useful recovery technique and can be undertaken before, after or in the absence of exercise to improve muscle motion and the functioning of joints. Improved hip flexibility, muscle balance and pelvic symmetry are linked to neuromuscular balance and coordinated muscle contraction – which elicits a lower oxygen cost at sub-maximal workloads. Aside from the injury prevention benefits, a certain amount of flexibility is also required for optimal stride length at high running speeds. Dynamic stretching, running drills and plyometric exercises in addition to static stretching after a proper warm up are recommended.

Foam rolling is a myofascial technique that is gaining popularity for a good reason- it can soften, stretch and re-align muscles in problem areas in order to relieve tension, promote recovery and prepare the body for additional training. This is a useful technique for all runners to have in their tool kit for long and happy running.

This article has summarised some of the popular recovery methods that can be used by runners to reduce fatigue and prevent injury. Runners should follow a well-structured training schedule that includes adequate recovery runs.

Muscle cramps can derail even the most seasoned runners’ races. One of the most common reasons for failure in the marathon is suffering from muscle cramping. There can be several causes for cramps during long races. Hence, it is necessary to deal with several factors to avoid them. The key factors are early race pace, hydration, minerals, electrolytes, weather, being adequate trained and a sufficient taper.

Pace is a major factor, probably the primary one that can lead to cramps. Running just 10-20 seconds per km faster in the first half will extract a big price in the second half in the form of a debilitating cramp. Instead try to pace yourself. Begin slowly and speed up later.

Hydration and loss of electrolytes can be a big factor as well. You may think you are well-hydrated, but if you are drinking mostly water, your cramps may be the result of sodium and potassium depletion. Instead use beverages with electrolytes (like sport drinks) to rehydrate during races. The American Running Association’s Editorial Board suggests carrying a salty snack to eat about every half-hour during a race. Important to remember is to pre-load on the electrolytes instead of waiting till the cramp occurs. Use the sports drinks offered during a marathon at every opportunity to supplement and replenish mineral and electrolyte stores. Don’t wait until midway through the race to use them. Using the drink as early as you can delays depletion of your body’s stores. If you wait until your electrolyte stores are partially diminished before using the drink, it’s too late.

With the growing research on cramps, the current theory on what causes them is muscle fatigue and failures in the neural communication pathways. Basically, you train a muscle to contract and the muscle fatigues. It, then, miscommunicates and stays contracted when it shouldn’t causing a cramp. The mechanism for muscle fatigue and muscle damage causing cramping is best explained through an imbalance that develops in the nervous system control of muscle. Muscles tend to become very twitchy when they become fatigued or are injured. You’re more likely to get cramps, then, when your muscles are working harder and are fatiguing, such when you’re out of shape or racing hard.

Once a cramp strikes, you really only can do one thing: Take a deep breath, stop, and stretch. Static stretching has been shown to stop cramps, because it inhibits muscle contraction. Then, start slow and build your speed up. If you back off early enough, you can usually prevent it. Once a cramp comes on, it can be debilitating and impossible to continue; then the only choice is to back off and do a gentle static calf stretch. Remember to hold the stretch for 20-30 seconds and do not bounce.

One key point to remember is that a calf strain (muscle tear) can mimic a cramp. It is important that you know to distinguish the two because if you have a calf strain and you stretch it and keep running, the muscle will tear further and you will be unable to run for months depending on the severity of the damage done. Here’s how to rrecognize a calf strain: A grade one calf strain will be a sensation of cramping/ tightness/pain in the calf. A grade two strain will be similar to a grade one along with soreness in the calf. A grade three calf strain is very serious and is marked by an immediate burning or stabbing pain that renders the athlete unable to walk without feeling pain. Remember: If the static stretches make the calf feel better and allow you to continue running, it is a cramp. However, if after stretching the tightness and pain does not relent or increases, it could be a strain. In this case it is best to discontinue running to prevent a further muscle tear.

Let’s hope for a cramp free run.

True story! My friend was jogging with me and the sole/bottom of her “branded” shoes came off. I scolded her saying why are you wearing your shoes till they disintegrate? Her response: I picked up these shoes online during a sale just a few months ago!

This is just one reason why buying shoes online is wrong. I know many patients, friends and even family who prefer to buy shoes online either because it is convenient or is cheaper or both! It is too easy to pick up shoes online based on your friend’s recommendation or to pick up the same brand/model as your previous shoes; especially since there are such lucrative discounts available online! Let me elaborate why this might be the most dangerous thing you can do for your health.

Shoes should be picked based on Function, Fit and Feel.

Function means picking your shoes based on your foot/walking/running biomechanics (determined through a gait analysis). Every foot is different. There are several types of feet- you could have a high, medium or a low arch. You could be flat footed. Even flat foot can be classified into several kinds. You could have a rigid, semi-rigid or floppy foot. You could be an over-pronator, neutral type or a supinator. Each of these foot types should be fitted in the right kind of shoe. There is no way that the shoes that are a magical fit for your friend will be right for you too- unless you are twins and don’t know it! Only a well -trained Gait Analyst/Sports Physiotherapist will be able to shed light on this. When you pick up shoes online, you have no idea about how the shoes will fit you functionally and this can lead to injuries.

 Fit depends on the right size, matching the shape of the shoe to the shape of your foot. Is your foot broad or narrow? Is your big toe or your second toe the longest? Buying shoes during the second half of the day is advisable since your feet expand while walking or running and tight shoes are a recipe for disaster. Making sure there is one thumb space in the front of the big toe is crucial. There is no way you can determine these factors online.

Feel depends on how it feels while you walk/run in them. Can you wiggle your toes comfortably, do they feel heavy or light, while walking does your foot lift up from the back or the heel feels secure? These are the questions you ask yourself when you buy shoes. This is absolutely not possible shopping online.

None of these factors are possible to determine when you pick shoes online. Another big red flag is that very few people realize that shoes have a shelf life of two years. This means that even if the shoe has never been used and has been sitting in a store somewhere- it “expires” after two years. This is the reason why online discounts exist- to get rid of old shoes! This is why my friend’s shoe did not last even for a few months.

Needless to say, walking or running in shoes that have not been tested for Function, Fit and Feel and are “old” are a recipe for injuries. It’s like setting yourself up for injuries. So my advice is to spend enough time and effort trying out various shoes till you find your solemate!

Stretching should be the mantra to recovery for a runner, a body builder, a gym enthusiast, a sports player and a recreational walker. I have seen too many discrepancies in stretching which eventually lead to overuse injuries of muscles and joints. Either one doesn’t stretch at all, or not enough or stretches incorrectly. Often people ask me why to stretch and the right way to do them. Here’s why. A static stretch is one where there is little or no movement as the controlled stretch position is maintained for about 30 seconds, then sometimes repeated. Inherent to the practice of yoga, physiologically this type of stretch has been termed ‘a form of visoelastic myofascial release’. Put simply, muscles and their associated fascia begin to lengthen slowly in response to a gentle and continuous load. In therapeutic terms this physiological response is a property of muscle and fascia known as ‘creep’. The fact that the load applied is constant and gentle is key to the effectiveness of active stretching.  Static stretching post workouts can dramatically reduce the chance of overuse and other injuries as well as assist with DOMS- delayed onset muscle soreness. Static stretches also relax your muscles and calm your nervous system.

Below are the static stretches to be done after your workout, during your cool-down period.

Guidelines:

Never bounce when you do static stretching

Once you have initiated a static stretch, hold it until you feel the muscle relax (usually about 20-30 seconds)

Remember to breathe while you are stretching or activating

If you are new to static stretching, make sure you get instruction on how to do it properly

The major mistakes I find people do while stretching is that they tend to bounce and do not hold for the amount of time required for a muscle to relax and lengthen. They are wasting their time. I tell them-do it correctly or not at all.

Side Bends– Stand tall, feet slightly wider than shoulder-width apart, knees slightly bent, hands resting on the hips. Bend slowly to one side, come back to the vertical position and then bend to the other side. Do not lean forwards or backwards

If you take ample time to do stretching post your workouts your workout performance increases many folds. So go ahead and try them.

In this day and age of fitness trends and a wealth of information online, it is important to make sure that you are not being mis-led into issues that can impact your health negatively. One such fitness fact that needs to be understood is the right kind of shoe to wear to train at the gym. Some people who are into various kinds of fitness activities understand that each activity might need a different kind of footwear. However, there are others that think that a shoe is a shoe! This ignorance can mean injuring your knee or your back and having to abandon your fitness goals. Lets make sure this doesn’t happen to you!

There is so much more to look at while buying appropriate shoes for workout apart from the fashion and the labels. And just to break the bubble, workout shoes are not the same as the running shoes. The style of these shoes are very different and the features that they provide are also different.

When going to buy a gym shoe look out for the heel drop, the arch support height, the toe box and the right size. In the gym, we do squats, we lift weights, do cross fit, short runs, high intensity exercises and much more. These need shoe flexibility and a perfect grip. Gym shoes should provide foot movement side to side and flexibility. Also the heel drop of the shoe should be low, making the shoe adaptive to various workouts.

On the other hand, running shoes should provide foot movements forward and backward and a very good cushioning with a higher heel drop as a shock absorption mechanism. Running shoes also come in different types depending upon the arch type. For example, a runner with a rigid high arched foot will need a low heel drop with a wide toe box and good lateral support to avoid lateral wearing out of the shoe and for perfect cushioning.

Currently if you are using running shoes for gym training do realize that the grip may not be that good, cushioning in the shoe may be more than required and shoe flexibility may be less which might lower the gym performance.

Alternatively if you are using your gym shoes for long distance running, understand that since the cushioning is less and flexibility of the shoe is higher, mileage might get hampered and the chances of injury might also increase.

Last but not the least- make sure you check the size of your feet to get the right fit. I have seen foot, toe and heel pain arising from an incorrect shoe size too often. If you still have confusion, head on to the clinic with your shoes and we can guide you.

Invest in the right shoes, Don’t let your shoe ruin your fitness..!

A lot of runners are recreational runners; some may be sedentary runners or even weekend warriors. All these terms vary in the attitude of the runner and also the time and effort put into the running. But the bottom line is that they all have day jobs and the running (whether it is daily or once a month) happens outside of the working hours. What is wonderful is that their bodies are getting the exercise that they need; however attention must be paid to whether sitting all day in a poor posture is affecting your running in some way. If you don’t pay attention to this, you might be allowing yourself to short change your performance or pick up several persisting injuries along the way. So seriously ask yourself- is my sitting killing my running?

The posture you adopt whilst at work can have significant effects on your muscle length and strength and can ultimately affect how you function and move when away from work. Read on to see how your day-to-day posture can affect your body position when running and what you can do to prevent negative impacts on your form.

Good posture can be thought of as when adjacent body parts are aligned in an anatomically ‘optimal’ position and bad posture when they are aligned away from the optimum. In order to understand ‘optimum’ think of a series of wooden blocks stacked one on top of each other. When they are positioned optimally, and each block is perfectly aligned with its neighbour, it is possible to build a tall and stable tower of blocks. The further away from this optimum position the blocks are stacked, the more prone the tower is to becoming unstable and potentially fall over. For example, ankle weakness and over pronation of the foot can lead to compensatory rotations in the tibia that have a knock-on effect to the knee, hip and spine; likewise a forward head posture can lead to rounding of the shoulders, and curving of the spine.

Although all runners are different it is generally accepted that optimal alignment when running will reduce the risk of injury and maximise efficiency. Naturally, there are exceptions to this rule, where runners manage to be extremely efficient despite outrageous body positioning but generally greatest efficiency and reduced injury risk is attained by sticking to the optimal alignment. So how does all of this relate to your posture at work?

Work posture affects your running posture because your body will always try and adapt to the demands placed upon it. To understand this better, think about how your body responds to training. As a runner, every time you train your neural, muscular and skeletal systems adapt to the type of training you do. If you do more long slow running, your body will get better at long slow running; if you do more fast short running you will get better at shorter faster events. Your body will adapt to the loads placed upon it; therefore, when a large percentage of your waking time is spent seated, your body will adapt to being seated. Some of the postural adaptations resulting from daily work habits become permanent adaptations that stay with you when you are running. Unfortunately, some of these acquired postures are not conducive to optimal running alignment. The good news is that being more aware of what these postures are and the negative impact they can have on your running, make it easier to identify and adopt strategies to prevent your desk job killing your running.

Below are the three main examples I believe are most relevant to the runner:

Forward head posture/rounded shoulders:

Workplace Causes: Habitually adopting a slouched position – commonly when using a computer.

Effect on running: A forward head posture and rounded shoulders stays with you away from the desk. When you run with this type of posture your arms tend to swing more across the body, your pectoral muscles become tight reducing expansion of the ribs, and other parts of the spine curve to compensate for the imbalance caused by the head being forward. All of this can lead to inefficiency and injury.

Solution: Set up your workstation so that it is easy to sit well with shoulders back and neck straight- think ears over shoulders! Get up from your seat regularly and stretch your shoulder blades backwards and tuck your chin downwards.

Poor Achilles tendon length:

Workplace Causes: Wearing shoes with a raised heel (not just for the ladies – many men’s shoes will have a 2cm raise).

Effect on running: Habitually working the calf muscle in a short position can lead to calf tightness and a reduction in ankle range of motion. The effects of this can be far reaching, leading to compensatory movements such as excessive pronation of the foot and tibial rotation. Injuries like with achilles tendonopathy, plantar fasciitis and knee pain can crop up.

Solution: Wear shoes with a minimal differential between heel and toe height (drop). Regularly get out of your heeled shoes and stretch your calf muscles.

Poor hamstrings length:

Workplace causes: Prolonged sitting with knees bent. This places your hamstrings in a shortened position which makes them tight. The longer you sit the tighter they get.

Effect on running: For striding while running, decent hamstring length is important else there is a lot of sheer at the knee. This may lead to knee pain or ITB syndrome due to compensatory mechanisms forming.

Solution: Stretch your hamstrings daily even on non- running days and take a quick standing/walking break every hour at work.

Taking care of your body when you are at work can be beneficial to your running and can reduce your likelihood of injury. So follow these tips and don’t let your work posture kill your running.

Barefoot running stated simply is running without shoes. Popularised by the book ‘Born to Run’ by Christopher McDougall, barefoot running has its share of die-hard protagonists and has been a topic of debate in the running community for a long time. Minimalistic running is differentiated from barefoot by the use of running shoes that aim for an experience close to barefoot running. Minimalistic shoes are extremely light and flexible. They have less support and cushioning in comparison with conventional running shoes. Additionally they tend to have a lower drop which is the height differential between the sole under the heel and the sole under the forefoot.

The Theory behind Barefoot:

The plantar foot is considered one of the most proprioceptive* areas of the human body with small and large nerves. The small nerves in the bottom of the foot are responsible for processing information such as texture, skin stretch, vibration, deep pressure and light touch – all the stimuli which allows us to maintain upright stance, manipulate uneven terrain and absorb impact forces. Shoes , socks and orthotics block these highly sensitive small nerves on the bottom of the foot. The blocking of the plantar receptors skews our perception of how hard we are striking the ground, so the tendency is to strike the ground harder. This results in an increase in impact forces as the body is unable to accurately perceive and respond to these impact forces.

Cushioning and extra support in shoes also decreases the strength of the feet.  The feet become de-conditioned due to dependency on shoes and orthotics rather than our own natural neuro-muscular response system.

In her book ‘Barefoot Strong’, Dr. Emily Splichal explains the importance of barefoot activation and strengthening as the key to movement longevity and efficiency and also in avoiding unnecessary injury.

Let’s look at the pro’s and con’s of barefoot running

Benefits:

• A recent Harvard based study has shown that barefoot running has the ability to alter the way the foot strikes the ground and generally produces a forefoot or midfoot strike pattern which generates a lower collision force on impact as compared with a heel strike in shoes. About 75 per cent of shod runners tend to heel strike while the initial contact for most barefoot runners is forefoot or midfoot. Barefoot runners believe this to be a more natural way to run, making the feet stronger and reducing the incidence of injuries.
• Barefoot proponents feel that it enables better proprioception*, balance and coordination as the runner feels more in touch with the ground and the environment.
• Barefoot / minimalistic running can teach you to run more gently, developing a less impactful stride.
• Running barefoot with proper form and technique can strengthen the muscles, tendons and ligaments of the feet.

*proprioception : The term proprioception is used to describe the sensory information that contributes to the sense of position of self and movement. In barefoot running this sensory information is obtained through the small nerve receptors in the feet when in direct contact with the ground. It triggers the body’s instinctive reaction to stimuli enabling barefoot runners to tread lightly and develop natural movement patterns.

Disadvantages:

• Shoes offer a significant amount of protection from surface debris such as glass, nails, rocks and thorns. They also offer insulation in cold weather.
• Heel striking may be the preferred way of many runners and coaches and in this case cushion for the heel while running may be vital.
• The surface for running may be an important consideration when running barefoot or with a minimal shoe. Asphalt and concrete are hard surfaces while grass and dirt trails are softer, more forgiving surfaces.
• Lower extremity injuries may result due to the sudden increase of stress to improperly conditioned muscles and tendons. Transition to barefoot or minimalistic running warrants a careful approach with proper guidance.

If a runner asks me whether they should start running barefoot, I have them answer a few questions first.

1. How long have they been running?
2. What kind of shoes? Neutral or stability or minimal?
3. Number of injuries from the beginning
4. What kind of foot? Neutral or high arched or flat?

Based on the answers I help them determine whether it is safe for them to begin running barefoot. For example if a runner has been running for years without any major injury and has a neutral foot it would be fine to attempt barefoot running. For a new runner with already a few injuries under their belt and possibly an over-pronated or flat foot, I would advise them to work on foot/ankle strength and attempt minimal shoes before they begin barefoot running. Other factors to consider are how heavy you are, what terrain you are running on- beach, treadmill or road; and whether you cross-train along with the running. All these factors can impact the rate of injuries if you decide to go barefoot.

If you are indeed keen to become a barefoot runner it is best to get a running gait analysis performed by a sports physiotherapist- preferably one who specializes in running- who will help you understand your strengths and weaknesses and also help you determine whether you are ready to throw your running shoes away!

Introduction

Imagine this. My friend has had some pain in the low back off and on for weeks now and she ignores it every time. She thinks she has pulled something and goes on about her work and home duties like before not worrying about it. Yesterday she was standing up from her sofa to go to the kitchen and suddenly she gets a sever flash of pain in the same area but with much more severity. Now she is in bed, unable to work, unable to walk, unable to move. Since its a Sunday she cannot get any medical attention easily except for me who of course will assist her whenever she needs me. When I get to her, the first question I ask her is – why she didn’t ask me what to do about the pain when it first started and waited till it got so bad!

This is a true story. And even though it would seem drastic it really is not. The first thing most people do when they experience pain is- no its not what you guessed- they ignore it! And wait for it to go away miraculously. Unfortunately that doesn’t happen. If anything each episode of pain will get worse up until you are forced to act upon it. So my question is simple. Wouldn’t it be better to understand why you have pain and to act upon it on the first instance you experience it rather than wait for it to worsen? I hope you said yes 🙂

Since you have begun reading this e-book I assume you are one of the smarter lots that wants to pro-actively do something about your pain. So lets delve right into it

The what and why of pain

Pain exists for a reason, just like fever does. Everyone knows that when your body is fighting an infection, a cold or anything that has put it under the body temperature rises and this is called fever. What do you do in this case? You give your body the optimal environment to heal so that it can do its job of getting rid of the fever causing agent/virus/infection. You rest, you drink fluids, you take something to soothe your symptoms and if that doesn’t work you see your doc.

Pain is very much like that. Pain is actually a signal that your body sends to let you know that something is not right! If you listened to your body you would understand what it is that may have caused the pain, stay away from the thing that caused it and give it an environment to heal. Lets take my friend for example. When I probed her enough, she jogged her memory and told me that she had done some Diwali cleaning with lots of bending forward that could have caused the pain to start. But she didn’t stop to understand the cause and kept doing the cleaning, causing her pain to get worse with time. So the moral of this story? Listen to your body. Pay attention to pain when it first occurs. Do something about it. If you don’t know what to do, call me! J/k. I mean call your doc.

Pain comes in various different forms, shapes and sizes. Every pain is felt differently- some are dull in nature, some sharp, others blinding or even shifting. It is important to note the type of pain since they all mean different things. The most important thing to note is whether the pain is constant(24/7 and not changing) or intermittent(comes and goes and varying with activity and rest). Constant pain is more serious than intermittent pain. Especially constant pain that worsens at night needs medical intervention asap.

The next important fact to note is the stage of pain you are in. Pain falls in 3 stages- acute, sub-acute and chronic.

Acute pain is when the onset of pain is less than 48 hours. This is the right time to address it so that it never goes into the next phase. Unfortunately, most people are busy ignoring their pain in this phase.

Sub-acute phase is the next phase- where a time span of 48 hours to 2 weeks has gone by from the onset of pain. This phase also responds to treatment quickly provided the right things are done. Once the pain passes from this phase to the next it becomes that much more difficult to reverse quickly.

Chronic pain is the pain that has been around for greater than 2 weeks. This is where the pain is now stubborn and you will have to put in time, effort and/or money to get rid of it. Which is why addressing pain when it is in acute phase is a smart thing to do!

Also important to understand your level of pain by scoring it. This can help you judge the severity and how to make it go away.

The VAS scale is the most popular way to determine intensity of pain. You basically rate your pain from 0(no pain) to 10(requires hospitalization)

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So what should I do now to get rid of it?

Now that you understand pain, its important to pay attention to other symptoms that go hand in hand with pain. Is there swelling along with pain? Some people have a tough time understanding if there is swelling. I believe that’s why God gave us 2 of most body parts- to compare. So compare to the opposite side and figure out if it looks puffier. Also check for redness or any skin changes. If there is swelling and redness along with pain then it is a little more severe than without. But your approach to make it go away will remain the same. Only if the pain is debilitating(VAS of greater than 6) and constant(worse at night) is when you should immediately contact your family physician. Most other pain can be managed with the guidelines I am about to give you.

Your first line of defence against pain should be RICE and then as soon as things start to settle you move to the next phase MICE. How long you do RICE and then move to MICE depends on the severity of the pain. Ideally as soon as pain gets into the 1-2 VAS scale you can move to MICE

Rest: This does not mean full bed-rest but in severe cases (pain scale more than 7) it might mean that. Generally staying away from the activities and movements that make the pain worse and limiting activities in general might be a good idea.

Ice: Ice packs/wraps or even ice cube massage should be done three times a day. Ice cubes put in a plastic bag also works. Any way you ice it, it should be done for a good 10 to 15 minutes each to be effective. Any less and its not enough. Any more and it can cause ice burns. So stick to the 10 to 15 minutes time-frame for best results.

Compression: This is an important element in this process. If ice pack is put on a body part without proper compression, it is not as effective. Your recovery will be so much faster if you do the ice, compression and elevation all at the same time. Once the ice is on the body part, wrap a cloth, handkerchief or crepe bandage to compress it well. Remember to keep it firmly wrapped and not too tight.

Elevation: Once the ice and compression are in place, elevate the body part above heart level. If it isn’t above heart level, it wont work as well. There are exceptions of course, but as much as possible try to keep it raised. For example, it your knee hurts, you should be lying down with the affected leg propped up on several pillows. If it is hip pain then lie on the unaffected side with the ice on the top hip.

Next we move into MICE. This is exactly the same as RICE, only difference is that you can stop the rest and start doing easy movements now. But you continue to do the ice, compression and elevation

Movement: Gentle movements of the body part and moving around more than the RICE phase is recommended. Remember if the pain worsens a lot with gentle movements, you either go back to the RICE phase or see your doctor immediately.

Ice: same

Compression: same

Elevation: same

Do note that with this method of pain relief we are helping our body heal itself by creating a positive, ‘conducive to healing’ environment. There are plenty of times when the body is not able to cope and it might need external help with medications. And that is okay. Doing the right thing at the right time is important so that recovery is not delayed. So if you think that the pain isn’t going away fast enough with these tips, be sure to meet your doctor asap.

In my experience, people underestimate the value of icing the right way, doing it enough and long enough and hence remain in pain much longer than they need to be. Or they might use a hot pack instead and this might feel good but it actually delays healing, potentially even make it worse. My friends and family know by now that if they complain of pain I ask “have you iced it?”. if they haven’t, then I roll my eyes and they know to go home and ice it before calling me again. Only after 2 days of icing if the pain hasn’t gone away do I even assess then thoroughly. That’s how powerful ice is! Of course there are always exceptions when I feel they need my attention right away. But for about 70% of the times they don’t need me again. And that’s exactly why this e-book exists.

Hope this is helpful. If you prefer learning through a video, you can check out the video “how to ice correctly” with the link below.

Sta healthy! Stay pain-free! Stay limitless!