Should I play through pain?
Douglas Mangan, MD, is an orthopedic surgeon at Banner Estrella Medical Center, specializing in sports medicine.
Question: I have been a regular runner for 12 years. Recently I twisted my ankle helping a friend move but it was very minor. Can I continue my regular routine or should I take time off from exercising?
Answer: When athletes such as you get hurt, either on the field or off, there is the question of should I “play in pain” or do I take time off to recover? The answer may lie somewhere in between.
For years, traditional medical teaching frequently involved prolonged rest and immobilization to treat sports-related injuries. However, with recent advances in the field of sports medicine, the paradigm may be shifting.
Among the greatest challenges to the sports medicine physician is determining the quickest way to return patients to exercise safely.
While previous treatment frequently entailed weeks of casting for a severe ankle sprain, more current thinking focuses treatment on swelling control and early exercise.
Recent research has shown that soft tissues, such as muscles, heal in response to stress. Early exercise after an incident may decrease swelling, decrease stiffness and minimize muscle atrophy and weakness.
Additionally, early rehabilitation may help speed the recovery of proprioception, the body’s ability to know its position in space, which is often disrupted following an injury. The psychological benefits of returning to exercise can be substantial as well.
Of course, all injuries are not amenable to early exercise. Fractures and other severe injuries may require a period of casting or immobilization, with rehabilitation through a physician to follow.
It is mostly minor injuries, which frequently develop as a result of repetitive overuse, that may benefit from early exercise. Recent research has suggested that small, repeated stretching of tendons may produce molecules that heal inflammation.
This suggests moderate exercise may actually expedite healing.
While it is not possible to make universal recommendations, certain treatment strategies can be beneficial in recovering from minor injuries. Ice and anti-inflammatory medications can help decrease swelling and inflammation.
Gentle exercise within a range of comfort can be beneficial. This may entail decreasing the frequency, duration or intensity of exercise to a level that does not aggravate the condition, or cross training with a different sport or exercise entirely until symptoms subside. Overall, activity that causes symptoms to worsen may be a sign of doing too much, too soon.
As long as symptoms are improving, evolving sports medicine recommendations would say “walk it off”, and be as active as your body is willing to let you be.