Woke Up This Morning…Got Myself a Pain
So this year due to the pandemic I decided to take up a new sport. Well, at least one I haven’t played since I was thirteen. Soccer. Which has been an interesting journey to say the least.
After a partially torn quad, vertigo and now yesterday I can say that my body is definitely not used to the forces involved and has had a hard time adapting. Which is what prompts this article.
I’ve been working with injuries for two decades now, and one thing that people don’t realize is how often I have hurt myself. Usually through sport of some kind, but sometimes just doing stupid things that happen. One example is when I tore a meniscus falling in my driveway on an icy day because my dog pulled me the wrong way. Stuff happens. But sometimes when I go over the laundry list of musculoskeletal things I’ve done to myself it actually boggles the mind. There actually isn’t a part of my body that hasn’t been injured at one point or another except my head and neck and I had three concussions as a kid so maybe that doesn’t count. Active child, go figure.
So what do I do when I actually hurt myself? I realized this could be a good guide for those of you who still happen to get aches or pains and while I love our medical system, waiting for service isn’t exactly an option sometimes – even seeing your GP these days can take months. I decided to put together this quick summary of my thought process and how I approach things. I hope that it might help the next time you do something dumb and aren’t sure what happened. Here’s an easy checklist to follow:
Step One: Find the source.
Usually this is pretty easy. Ow, that hurts. But sometimes it can be a movement or a type of pressure that hurts. For example, this morning when I got out of bed my right leg couldn’t bear much pressure, and definitely couldn’t experience shear in the knee. First thing I always do is check other places. Ankle? Good. Hip? Good. Back? A bit stiff from diving around but still okay.
Press on the area – is it tender? Is there swelling? Is the pain continuous or only during movement or load (ie standing up, lying down or a certain position). Are any of my muscles around it stiff? Make a list and see what you can isolate to investigate further.
I only knew about this when I got out of bed and a bolt of pain shot through my leg. Going downstairs was also quite a challenge. No visible contusions (yet, those can take a day or two). No immense swelling. Pain is isolated to my right side.
Great. So it’s my knee. Now we move on to step two.
Step Two: How bad is it?
Can I put pressure on it? Sort of, just not stable. Can I move it through a partial or full range of motion? Yes, although there is a range that hurts more when I do that. Is there a particular movement or pressure direction that causes pain. Yes, acutely with forward shear and also lateral movement. Like holy crap that hurts.
Problems are stairs, any excessive range while walking or stepping (this is called forward shear) and it is really not happy if I plant my foot and rotate.
What parts of my knee experience that? Now, this may require some knowledge of anatomy, which I am lucky I have. You are all lucky enough to have a phone available with the entirety of Grey’s Anatomy available at the type of a button. So what’s on the outside and base of my knee? And what experiences pain with lateral movement?
With my knowledge I know that it is one of about three things: lateral meniscus bruising or tear (the spongy part between your knee bones), an ACL or LCL sprain (middle and outside support ligaments) or possibly a tibial plateau issue because the pain is in the top of my tibia. However, if it was a fracture I know pain would be acute and immediate so I can rule that out, as I can any sort of tear because that would have me almost immobilized.
So that narrows it down to a ligament sprain or a meniscus bruise. It would take me months to get imaging to confirm that so we treat that and go from there. Thankfully as knee injuries go these are relatively minor, just annoying.
Step Three: What do I do from here?
98% of the time the answer to this is rest it, elevate it and take ibuprofen for pain. Even if you go to the hospital. Avoid movements that cause pain and support it when you need to. Here’s a simple guideline: a strain or sprain will take anywhere from a few days to two weeks to go away. A serious sprain or partial tear more like 2-4 weeks and something really serious (ie a break or fracture) it can be six weeks plus. But if something was that bad hopefully you’d be at the hospital already and getting a cast.
Often over the first 24-48 hours swelling will kick in and things will change. Inflammation, contrary to popular belief, is not a bad thing – it is locking up the area so the body can start to heal it. Using things like ice has been shown to slow that process. After about a day or two, start with heat and massage for blood flow. This can easily be done with heating bags and self-massage. That’s always the first step.
If things don’t resolve in a couple of days or seem to be getting worse, then it’s time to get checked out seriously. But for what I think this is, it isn’t a big deal. It’s only been about sixteen hours so that may change this week.
Step Four: What caused it in the first place?
People forget this step all the time, and then for some reason manage to re-injure themselves. Gee, I wonder why.
I play goalie for my soccer team. It requires a lot of diving, sometimes onto my knees and yesterday I blocked a couple of key shots as well directly with my knees and also got kicked hard in the foot. Any one of these things could cause the issues I’m having today (we still lost, but whatever). So avoiding deep knee compression and forward shear through the joint is a good idea for a little while. In a couple of days, with any luck I’ll be fine. After next game my soccer career is done so with any luck I’ll be okay for next game. But I’m also not stupid, and if something hurts I don’t risk it at the age of 46. Neither should you.
I can’t say that enough – IF SOMETHING HURTS, DON’T USE IT. I put that in caps because athletes are stupid. Give it a day or two to rest and heal and try again later. Your life isn’t going anywhere and if you take a couple of days off, there are lots of other activities you can do. This morning I did an upper body workout because I didn’t want to use my legs. No problem.
Now, just because you read this – please don’t be stupid. If you’re in a lot of pain and can’t move a joint or see massive bruising or discoloration, go to the hospital and get imaging. Something really bad is best treated early on rather than waiting. But in my experience, being proactive and at least trying to figure things out on your own is vital. Or, if you have a practitioner (I happen to know one) who can figure it out or at least suggest some options, contact them. They should be happy to help. Unfortunately most GPs have little knowledge about skeletal injury through no fault of their own and will simply refer you out anyway.
Anyway, please wish me luck with my knee rehab and in the soccer playoffs next week. I hope this helps some of you think about things properly the next time you have an injury and please feel free to reach out to me if you have any questions about anything! Also, feel free to share it with others if you find it useful.