*Muscle and Joint Injuries (Care and Management)
*Should you Use Anti-Inflammatories (Article)
*Wrapping and Ankle Sprain
*Trigger Points
*Shoulder Problems Overview


*Shoulder Injury Rehab


Muscle and Joint Injuries

This article will focus on the soft tissue injuries that a bodybuilder or strength athlete may incur and the important first steps one should take to ensure a speedy recovery. It will not go into specific injuries and is not meant as a comprehensive guide or a replacement for professional medical advice.

Please keep in mind that asking “some dudes I know at the gym” does not constitute medical advice!

Also, it is important to note that injuries to the head, neck, face, or spinal cord; bone fractures, breaks, or injuries with excessive bleeding, are beyond the scope of this article and may require immediate medical attention.

First, some definitions:

Muscle: OK, so you know what a muscle is.

Tendon: Fibrous connective tissue serving for the attachment of muscles to bones and other parts.

Ligament: (Joint Ligament) A band or sheet of strong fibrous connective tissue connecting the articular ends of bones, binding them together and facilitating or limiting motion. It is important to note that ligaments have little if any flexibility. There are other parts of a joint that can be injured, such as the meniscus, but you don’t really want this article to be that long…

The two basic soft tissue injuries are strains and sprains.

Strain: A trauma, tear, or rupture to the muscle or musculotendinous unit from violent contraction or excessive forcible stretch. Can also be caused by a sudden blow. It can be difficult to know when you have strained a muscle or tendon. Bodybuilders and strength athletes are so used to pain and chronic injuries they find it easy to ignore discomfort in a muscle. You may feel something pulling loose or feel a ripping sensation. Or, you may just feel a mild pain in a muscle or tendon. It is best to take any unusual pain or discomfort seriously.

Strains are classified into one of three categories:

Grade I: overstretching of a few muscle fibers with less than 10 percent actual fibers tearing. No palpable defect in the muscle.

Grade II: a partial tear of the muscle fibers usually between 10 and 50 percent of the fibers. A definite palpable defect in the muscle belly.

Grade III: an extensive tear or complete rupture of the muscle fibers. From 50 to 100 percent destruction. Very large palpable depression in the muscle. The muscle may be torn away completely. There is no possibility of normal contraction.

Sprain: A trauma, tear, or rupture to a ligament or joint capsule. Many of us have suffered a sprain at some point and it is usually fairly obvious when you have sustained and Grade II or III. Sometimes even a “pop” is heard. A mild sprain can sometimes be easily overlooked so it is important to take even a mild sudden discomfort in a joint seriously.

They are classified similarly:

Grade I: mild injury caused by an overstretching or slight tear of the ligament with minimal pain, swelling and little or no loss of function. Weight can usually be put of the affected joint.

Grade II: a moderate injury that causes partial tearing of the ligament with bruising, moderate pain and swelling. There is some difficulty putting weight on the affected joint and there is some loss of function.

Grade III: a severe injury with complete tearing or rupture of the ligament. Pain, swelling and bruising are usually severe and the patient is unable to put weight on the joint.

First Aid:

If you experience this type of injury or even suspect you have there are some important first steps you can take to lessen damage and speed recovery. What you do in the period immediately following an injury is the most important part of your recovery. It can make or break you. I cannot stress this enough.

Step 1: Stop! Stop training. Stop moving around as soon as you can and try to asses the inury. Just don’t damage it further. If you hurt yourself somewhere in your upper body that doesn’t mean you should ignore it and switch to legs. The sooner you begin treatment, the better.

Step 2: R.I.C.E. This is still the most common and most effective treatment for strains and sprains. It has been shown to significantly reduce recovery time.

It will help alleviate the bleeding around the injury site and the resultant swelling and pain. It will help prevent further tissue damage and aid in the healing process.

Rest: This goes back to step one. A soon as possible begin keeping the injured area as still. Even moving it around while working other body parts can speed up the blood flow to the area and cause further damage. If it hurts even a little don’t do it. Use some kind of sling or brace to support the injured area if necessary.

ICE: This is the most important of all. Apply ice ASAP using crushed ice in a plastic bag, commercial cold packs or even frozen vegetables such as peas.Chemical ice packs are ok but some can be too cold or not cold enough. Real ice melting in water is best.

Use some kind of buffer between the skin and ice. A damp towel is best. It’s going to be slightly uncomfortable but not painful. You don’t want to get ice burns so only apply it for as long as is tolerable. Go for around 10 minutes but if this is too long then apply it for shorter times more often. Rotate it on and off every 30 minutes, several times a day for the first 24 to 48 hours. Avoid prolonged use of ice on the extremities such as hands and feet/toes and face.

Compression: Wrap snugly, but not to tight, with an elastic bandage. Begin wrapping area farthest from heart. You should be able to slip a finger underneath but even so make sure that it doesn't start to tingle or become numb. I have not been able to find consistent recommendations on whether strained muscles or tendons should always be wrapped. It should help with the bleeding and swelling and in some instances it may help to stabilize the injured area. In general I would say to use a bandage if it helps to reduce the pain. With joint injuries, especially those of the ankle, knee, or wrist it is generally recommended. It is best not to wrap the joint in a circle but to wrap over the joint in a zig-zag or figure eight pattern, anchoring below and above. I would recommend that you have your medical professional tell you whether this step is necessary or warranted based on your injury and have him or her instruct you in the correct method. They may provide you with a special wrap. Included below is specific instructions on wrapping an ankle.


Elevation: Raise the injured area above the level of the heart whenever possible. This will help further reduce the bleeding, swelling, and pain.


For the first 24 to 72 hours avoid any type of heat to the inured area. It would be best to even take lukewarm or cold showers. Avoid any massage or movement. There sould be NO STRETCHING AT ALL during this period.


Lets move on. What happens after the first 48 to 72 hours? Lets take a quick look at how your soft tissue (muscle, tendon, ligament, etc.) repairs itself.

When any sort of damage occurs to the soft tissues, like a strain or sprain, the body immediately goes into a process of repair. Where the individual fibres have been ruptures, or torn, the body begins to bind the damaged fibres together using a fibrous protein called collagen. Or, as it's more commonly known, scar tissue!

You see, when a muscle is torn, you would expect that the body would repair that tear with new muscle. In reality, this doesn't happen. The tear, or rupture, is repaired with scar tissue.

Now this might not sound like a big deal, but if you have ever suffered a soft tissue injury, you'll know how annoying it is to keep re-injuring that same old injury, over and over again. Untreated scar tissue is the major cause to re-injury, usually months after you thought that injury had fully healed.

Scar tissue is made from a very brittle, inflexible fibrous material. This fibrous material binds itself to the damaged soft tissue fibres in an effort to draw the damaged fibres back together. What results is a bulky mass of fibrous scar tissue completely surrounding the injury site. In some cases it's even possible to see and feel this bulky mass under the skin.

When scar tissue forms around an injury site, it is never as strong as the tissue it replaces. It also has a tendency to contract and deform the surrounding tissues, so not only is the strength of the tissue diminished, but flexibility of the tissue is also compromised.

So what does this mean for the athlete? Firstly, it means a shortening of the soft tissues which results in a loss of flexibility. Secondly, it means a weak spot has formed within the soft tissues, which could easily result in further damage.
Lastly, the formation of scar tissue will result in a loss of strength and power. For a muscle to attain full power it must be fully stretched before contraction. Both the shortening effect and weakening of the tissues means that a full stretch and optimum contraction is not possible.

Now, if you've taken the advice from part 1, and used the R.I.C.E.R. regime to treat the initial reaction to a soft tissue injury, you're well on your way to a complete recovery. If however, you didn't use the R.I.C.E.R. regime, you're behind the eight-ball, so to speak. Let me explain.

From last months issue we learnt that when an injury occurs the body responds by sending large amounts of blood to the injury site. If this isn't controlled, with the R.I.C.E.R. regime, it will result in massive bleeding, swelling and pain. More importantly, it will also result in a large formation of bulky, painful scar tissue.

As we know from last month, the R.I.C.E.R. regime will help to control the bleeding, swelling and pain, but more importantly, it will also control the formation of scar tissue. When the R.I.C.E.R. regime is used correctly, there will only be a minimal formation of scar tissue, which allows for optimal return of flexibility and strength.

(The last R here means Referral to a qualified medical specialist.)

The Next 10 to 14 Days
So, how do we put the finishing touches on your recovery? How do we get rid of that annoying formation of scar tissue?

After the first 72 hours most of the initial swelling will have subsided and you can start with some gentle active rehabilitation techniques.

The most effective treatment at this stage is the use of heat and massage, but including light, gentle static and passive stretching exercises after your heat and massage treatment will help to dramatically speed up the recovery process.

Firstly, you must keep active! Don't listen to anyone who tells you to do nothing. Now is the time to start active rehabilitation. Most of the swelling will have subsided after the first 48 to 72 hours and you are now ready to start light activity.

Light activity will not only promotes blood circulation, but it will also activates the lymphatic system. The lymphatic system is vital in clearing the body of toxins and waste products, which can accumulate in the body following a sports injury. Activity is the only way to activate the lymphatic system.

Before we move on, a quick word of warning. Never, Never, Never do any activity that hurts the injured area. Of course you may feel some discomfort, but NEVER, NEVER push yourself to the point where you're feeling pain. Listen to your body. Don't over do it at this stage of the recovery, you've come too far to blow it now.

To complete your recovery and remove most of the unwanted scar tissue, you now need to start two vital treatments. The first is commonly used by physical therapists (or physiotherapists), and it primarily involves increasing the blood supply to the injured area. The aim is to increase the amount of oxygen and nutrients to the damaged tissues.
Physical Therapists accomplish this aim by using a number of activities to stimulate the injured area. The most common methods used are ultrasound and heat.

Ultrasound, or TENS (Transcutaneous Electrical Nerve Stimulation) simply uses a light electrical pulse to stimulate the affected area. While heat, in the form of a ray lamp or hot water bottle, is very effective in stimulating blood flow to the damaged tissues.

Secondly, to remove the unwanted scar tissue it is vital that you start a course of deep tissue sports massage. While ultrasound and heat will help the injured area, they will not remove the scar tissue. Only massage will be able to do that.

Either find someone who can massage the effected area for you, or if the injury is accessible, massage the damaged tissues yourself. Doing this yourself has the advantage of knowing just how hard and deep you need to massage.

To start with, the area will be quite tender. Start with a light stroke and gradually increase the pressure until you're able to use deep, firm strokes. The more you massage the effected area the harder and deeper you will be able to push.

Use deep, firm strokes, moving in the direction of the muscle fibres. Concentrate your effort at the direct point of injury, and use your thumbs to get in as deep as possible to break down the scar tissue.

So what is static and passive stretching?

Static stretching is performed by placing the body into a position whereby the muscle (or group of muscles) to be stretched is under tension. Both the opposing muscle group and the muscles to be stretched are relaxed. Then slowly and cautiously the body is moved to increase the tension of the stretched muscle group. At this point the position is held or maintained to allow the muscles to lengthen.

Passive stretching is very similar to static stretching; however another person or apparatus is used to help further stretch the muscles. Due to the greater force applied to the muscles, this form of stretching is slightly more hazardous. Therefore it is very important that any apparatus used is both solid and stable. When using a partner it is imperative that no jerky or bouncing force is applied to the stretched muscle. So, choose your partner carefully, they must be responsible for your safety while stretching.

The important point to remember during this phase of the rehabilitation process is light, gentle stretching. Never, never, never do any activity that hurts injured area. Of course you may feel some discomfort, but never push yourself to the point where you're feeling pain. Be very careful with any activity you do. Pain is the warning sign; don't ignore it.

The Next 2 to 5 Weeks
The aim of this phase of your rehabilitation will be to regain all the fitness components that were lost as a result of the injury. Regaining your flexibility, strength, power, muscular endurance, balance, and co-ordination will be the primary focus.

Without this phase of the rehabilitation, there is no hope of completely and permanently making a full recovery from your injury. A quote from a great book called "Sporting injuries" by Peter Dornan & Richard Dunn will help to reinforce the value of this phase of the rehabilitation process.

"The injury symptoms will permanently disappear only after the patient has undergone a very specific exercise program, deliberately designed to stretch and strengthen and regain all parameters of fitness of the damaged structure or structures. Further, it is suggested that when a specific stretching program is followed, thus more permanently reorganizing the scar fibers and allowing the circulation to become normal, the painful symptoms will disappear permanently."

So what type of stretching is best to use during this phase? Stick with the static and passive stretching exercises described above, but also include PNF Stretching.

PNF stretching, or Proprioceptive Neuromuscular Facilitation, is a more advanced form of flexibility training that involves both the stretching and contraction of the muscle group being targeted. PNF stretching was originally developed as a form of rehabilitation and to that effect it is very effective. It is also excellent for targeting specific muscle groups, and as well as increasing flexibility, (and range of movement) it also improves muscular strength.


Looking Long Term
Once you're over your injury and have started to regain the fitness components that were lost during the injury process, it's time to focus on making the injured area stronger and more flexible that it was before the injury occurred. To do this, the best types of stretches to use are dynamic and active stretching exercises.

Dynamic stretching uses a controlled, soft bounce or swinging motion to move a particular body part to the limit of its range of movement. The force of the bounce or swing is gradually increased but should never become radical or uncontrolled.

Active stretching is performed without any aid or assistance from an external force. This form of stretching involves using only the strength of your opposing muscles to generate a stretch within the targeted muscle group. The contraction of the opposing muscles helps to relax the stretched muscles. A classic example of an active stretch is one where an individual raises one leg straight out in front as high as possible and then maintains that position with out any assistance from a partner or object.

Just a few final points before we finish up. Be sure to drink plenty of fluid during your injury rehabilitation. The extra fluid will help to flush a lot of the waste products from your body.


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There are some common tip-offs you should recognize as warning signs that you have an injury that needs your attention. While some sports injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop. The following list of six injury tip-offs comes from Anybody's Sports Medicine Book, written by James Garrick, M.D. and Peter Radetsky, Ph.D.

  1. Joint Pain
    Joint pain, particularly in the joints of the knee, ankle, elbow and wrist, should never be ignored. Because these joints are not covered by muscle, there is rarely a muscular origin. Joint pain that lasts more than 48 hours requires a physician diagnosis.

  2. Tenderness At A Specific Point
    If you can elicit pain at a specific point in a bone, muscle or joint, by pressing your finger into it, you may have a significant injury. If the same spot on the other side of the body does not produce the same pain, you should probably see a physician.

  3. Swelling
    Swelling is usually quite obvious, and can be seen, but occasionally you may feel swollen without outward signs. Swelling is always a sign of a sports injury and should never be ignored. Often, swelling within a joint will cause pain, stiffness, or may produce a clicking sound as the tendons snap over one another because they have been pushed into a new position due to swelling.

  4. Reduced Range Of Motion
    If swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion; the limb will only go so far in each direction. Again, compare one side of the body with the other to identify major differences. If there are any, you have an injury that needs attention.

  5. Comparative Weakness
    Comparing one side to the other for weakness is often hard to do, but can be a good clue to identify significant injury. One way to tell is to left the same weight with the right and left side and look at the result. Often therapists will test comparative weakness manually or with special equipment.
  6. Numbness and Tingling
    Never ignore numbness or tingling. Often related to nerve compression, these warning signs may indicate serious injury and should always be seen by a physician.