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Step 3: Become Even More Fit (Part 9)

May 15, 2007

If your patients are going to start any new exercise program then they need to know how to avoid injuring and what to do about the inevitable muscle. Dr. Sheri Colberg has an excerpt from her book The 7 Step Diabetes Fitness Plan: Living Well and Being Fit with Diabetes, No Matter Your Weight. Dealing with Injuries or Muscle Soreness Due to Exercise

Step 3: Become Even More Fit (Part 9)

Dealing with Injuries or Muscle Soreness Due to Exercise


By Sheri Colberg, Ph.D., FACSM

Sheri_ColbergThis discussion would not be complete without covering how to avoid injuring yourself and what to do about the inevitable muscle soreness you will experience after doing new or unaccustomed levels of exercise. You should expect some soreness or stiffness, but intense or lasting pain is not normal. If you do get injured (which you’ll know due to the sharp, localized pain that you’ll feel during or immediately after training), treat it with standard R.I.C.E. techniques–rest, ice, compression, and elevation–and then, as soon as the injury improves, ease slowly back into your exercise routine. Be sure to have the injury checked out by a physician if it doesn’t start to get better within a week.

Types of injuries

Acute injuries may be caused by using improper exercise techniques or by carelessness (e.g., dropping a dumbbell on your foot), or they may be the result of excessive training that results in an overuse syndrome. The latter is the most nagging and persistently uncomfortable type of injury–kind of like having a pebble in your shoe that you can’t get out. By definition, an overuse injury is caused by excessive use of a particular joint. As discussed previously, overuse injuries are more common in people with diabetes due to structural changes in their joints caused by elevations in BG levels over the long term. However, they are treated the same way regardless of how you get them.

Treatment of injuries

Overtraining is a common cause of shin pain, or “shin splints,” which can be any number of conditions, including a stress fracture of the tibia (one of two shin bones) or inflammation occurring within a tissue or structure in that area. Using R.I.C.E. and possibly some anti-inflammatory medications such as ibuprofen (Advil or Nuprin) or naproxen sodium (found in Aleve), you should expect to see a decrease in your symptoms within a week of modifying your activities. If, however, you have tried these measures without experiencing any relief or have a single point of intense pain, you should see a physician (preferably a podiatrist who has expertise in foot, ankle, lower leg problems, and diabetes) who can further pinpoint the cause of your discomfort with an X-ray, bone scan, or MRI, if needed, and steer you to a more effective course of treatment that may include surgery, physical therapy, or rehabilitation of some type.

The important thing in dealing with activity-related injuries is to avoid going back to your normal activities until your symptoms have almost completely gone away. Cross training is one way to deal with injuries without losing all of your conditioning while waiting for the injury to heal. For example, if you have lower leg pain, you can still work out your upper body doing other activities while allowing your legs to rest and recuperate. It is good during this time to alternate weight-bearing activities such as walking with non-weight-bearing ones, such as swimming and stationary cycling, so that you don’t injure another part of your body.
Once you can resume your normal activities, work on strengthening the muscles around the affected area to prevent recurrence of the injury, particularly if it was the result of inflammation (as with tendonitis). For example, following a shoulder joint injury, you should focus on resistance work using all sections of the deltoid muscle, as well as biceps, triceps, pecs, and upper back and neck muscles, to strengthen muscles around the entire area.

General Tips for Safe and Effective Exercise
•     Never bounce during stretches as doing so can cause injuries
•     If you haven’t exercised in a while, start out slowly and progress cautiously
•     Warm up with stretches and easy aerobic work before you begin to exercise more vigorously
•     Choose an exercise that suits your condition; for example, swimming might be better for those who find walking difficult
•     Find an exercise partner to help you stay motivated
•     Set goals to keep your interest up; for instance, if you walk for exercise, get a pedometer and set a goal of adding in 2,000 more steps each day
•     Reward yourself when you reach goals (but preferably not with food)
•     Vary your exercise program occasionally or try out new activities; doing so also emphasizes different muscle groups and increases your overall fitness
•     Cross train to reduce the risk of injury by varying muscle usage
•     Wear appropriate shoes and socks, and check your feet after you exercise
•     When you start a new exercise, check your BG levels before, during (if more than an hour), and afterward
•     Don’t forget to warm up and cool down for best results

Muscle stiffness and soreness

Feeling stiff or tight after training is neither uncommon nor cause for alarm. Simply remember to stretch out all of your tight muscles and joints after workouts. If you are slightly sore the day after exercise, some gentle warm-up and cool-down exercises can also help. However, if you are so sore a day or two afterward that your mobility is limited, then you are likely experiencing delayed-onset muscle soreness (DOMS). Although unpleasant, DOMS is different from an acute injury and requires no special treatment.

DOMS is caused by damage you did to your muscles during training–such as lifting too much weight, running downhill, or overdoing a new activity–and it causes mild to severe muscle stiffness, pain, and cramping. The micro damage to the structure of your affected muscles becomes inflamed, and it may take two to three days to reach its maximum point of pain and a week or more to resolve completely. Mild activity, stretching, gentle massage, hydrotherapy (such as getting into a hot tub), and anti-inflammatory medications can all help alleviate the pain and discomfort you are feeling, but the best healer is simply time. The good news is that your body responds with “stress” proteins that it builds into the repaired muscles, making it very hard to reach that same level of soreness in the same muscles for six to eight weeks afterward, even if you overdo it with them again.

In two weeks, I will share more tips and ideas from my latest book, The 7 Step Diabetes Fitness Plan: Living Well and Being Fit with Diabetes, No Matter Your Weight (2006).  Information about all of my books, my many articles, my research, and more is available on my web site: www.SheriColberg.com


Tip for the day:  
Body “core” exercises are important for preventing injuries and improving your balance.  Some muscle stiffness and soreness following new or unaccustomed exercise is to be expected, but most injuries are preventable.

Read more of Dr. Sheri Colberg’s articles