David's Corner

Self-Care for Injury Prevention and Recovery

Dennis James

When you are injured, how you initially deal with the injury is very crucial to how fast recovery will be, and in preventing it from recurring. It is important to understand the 3 stages of healing, recognized by both western and Chinese sports medicine, so that you are aware of what you can do to immediately help the situation; and where to seek professional help or guidance if necessary. The first or ACUTE stage can last anywhere from 1-7 days depending on the severity of the injury. It is characterized by swelling, redness, pain and inflammation. RICE (rest, ice, compression and elevation) is the standard treatment for this stage. Rest means rest; stopping what you were doing that may have contributed to the injury. I cannot over emphasize how important this is. Rest gives your body's immune system a chance to become effective in the healing process. I do understand the reality of how difficult it may be because of the economics involved, or the philosophy of playing through the pain which is a very popular attitude that may work for a very few lucky individuals. Long term damage and career risk are great motivators, however. As a musician who sustained a number of very serious injuries during my career, I found that when it came to practicing I was able to develop a variety of mental approaches so that the physical time at the instrument was reduced dramatically, hence giving my injuries a chance to heal. It also allowed me the time to consider the ergonomics involved in playing the instrument or specific music that may have contributed to the injury.

The use of ice to reduce swelling, inflammation and pain is very common in western sports medicine. From a Chinese medical point of view, its attributes come at the cost of restricting the healing process (some even say ice is for dead people). Cupping, acupuncture, liniments or poultices to eliminate swelling, inflammation and pain are preferred while also encouraging the healing process. This being said, if a Chinese medical approach is not available, I would consider contrast bathing of hot and cold as an alternative. Heat in the form of water or a pack, will bring fresh blood, hence nutrition to the area for healing. Cold water or ice will help draw out the waste from the area through the body's lymphatic system while reducing the swelling, inflammation and pain. Alternating this several times can be very effective. You may want to end with cold if you will be resting the area or may want to end with heat if the area is about to be used. I personally prefer using an ice cube than a pack so that you can avoid leaving a pack on too long and complicating things even more. There are generally 3 sensations one should be aware of when using ice. The first sensation is feeling cold, the second is a burning sensation, and the third is feeling numb. Feeling numbness is when you should stop. Everyone is different and I find that the guidelines for length of hot and cold applications are not very accurate for individual use, so you have to experiment a bit. Generally speaking I would say 3-5 minutes of heat is more than enough time to get fresh blood into an area, and for cold use numbness as a guide for stopping the application. Some people, for example, may be allergic to cold; if you are one of those people, don't even consider cold for your injury.

A Chinese liniment called Dit Da Jui can be a wonderful alternative to contrast bathing. Warming and cooling herbs in an alcohol base give it the quality of a qi regulator. It has been used in martial arts schools for centuries, hence the translation "hit fall wine". It is an excellent remedy for bruises, contusions, sprains, strains, fractures and tendonitis. I have been using it personally and with many of my clients with great success, especially during the ACUTE phase of healing. It is applied liberally by massaging it into the problem area. Many of the commercial brands I have found not to be very effective, but the one prepared personally by Jeffrey Yuen at the Chinatown Wellness Center (52 Walker Street) comes with superior results.

Compression is the immobilization of the injured area through the use of braces, slings or other means (such as walking with a hand in a pocket to eliminate reinjuring a biceps tendon in your shoulder).

Elevation of a limb is used to bring down the swelling through the lymphatic system.

You never really want to massage directly on an injury during the acute stage. Peripheral massage around the area can be helpful in increasing circulation, along with carefully designed movement and exercise to strengthen the area.

The POST ACUTE or 2nd stage is generally a week after the initial injury and can last up to 3 weeks. Usually the swelling and inflammation are less but pain and stiffness may still be present. Now one can be more aggressive in the treatment plan with bodywork. Adhesions (fibers of tissue stuck together) that have been formed from the healing process can now be worked on directly to break up stagnant qi in order to encourage better blood flow to the area.

In the CHRONIC or 3rd stage, approximately 3-4 weeks after the initial injury, the swelling and inflammation should be gone although stiffness and pain may still be present. Now you can start increasing the intensity of your normal activity along with strengthening techniques and the bodywork of your choosing (e.g. acupuncture, massage, etc.).

Once you understand where you are in the healing process, you also have to give thought to the events leading up to the injury. Sometimes it can be the obvious such as not warming up before practicing or lifting an unusually heavy object the day before. Or it could be something more complicated stemming from emotional stress, poor diet, poor ergonomics at the instrument, compounded by practicing too much for that upcoming audition or gig. Whatever the cause it is important to identify the problem or problems and decide on a systematic and commonsense approach to correcting them. This is where the creativity in choosing a therapist or therapy will play a big part in recovery and preventing an injury from recurring. From my experience in the past this can be a hit or miss process, but with a bit of education gained through the internet, asking around, having a good selection of healing books, and personal insights, the decision making on what to do will become less confusing. I again would recommend the books in the bibliography at the end of my first article (November '08 newsletter). If you had to choose just one, I would suggest Tom Bisio's book , 'A Tooth From the Tiger's Mouth', which is one of the most complete books on sports medicine from an eastern and western approach. Recently I found a wonderful article on the internet that is a concise but comprehensive work on dealing with pain from a nutritional to bodywork standpoint ( www.ultraprevention .com/healing/pain.htm).

In conclusion, the most effective way to recover from an injury is one's personal involvement in the healing process as opposed to going to a doctor or professional therapist and asking them to "fix me". It is fine to have a diagnosis of what your injury may actually be, but then one must take into consideration how he or she got to there and what they can do to correct it and prevent it in the future. This can be accomplished through more awareness and good self-care habits encouraged by either a therapist or therapies available. In future articles I hope to include videos of more specific exercises that I think will be beneficial in preventing or recovering from some of the most common injuries musicians may sustain.