You need to remember that your back is essentially a stack of aligned vertebrae cushioned by gel-filled discs. It has a natural, concave curvature that should be maintained. It’s not a big deal if you curve your back outward into a convex position if you do not have a load on it. The lower back is naturally in a concave position and should be kept there always when bearing a load, i.e., such as doing squats in the gym.

By letting your back curve outward, i.e., go into a convex position during heavy lifting exercises, the compression on the discs can cause them to loosen and divide, which can cause problems. Given enough pressure, the gel within can squirt out between the fibers and then harden, where it can press on nerves, result in bulging disc(s), and thus, create pain. Thus, you can see why certain exercises are not ideal – a sit up is one of them.

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The back is not a straight line and thus, it is the muscles that stiffen the back so it can bear the load you’re putting on it. It’s usually the lightest and or the heaviest loads that we put on the back that cause the problem with potential injury, not because of just the weight, but because many have poor technique.

You need to fix your technique to lift heavy and prevent lower back injury.

Fix Your Technique
What is the ideal squat form? Many will tell you that you should squat deep, until your butt almost touches the floor. Wrong! Few people can squat this deep successfully without causing potential back injury, which can take up to 10 years to heal.

An ideal form would begin with feet approximately shoulder width apart, toes pointing slightly outward away from the body so that when you squat, the direction of your knee follows your toe; eyes are straight ahead and your squat is deep enough so that your thighs are about parallel to the floor. However, there’s a little more to it because each of us are uniquely different. For some, if you squat until your thighs are parallel to the floor, your back can become convex in shape and now, you are no longer in good form for a squat, which can cause injury.

So, what do you do? You need to find the squat position that is ideal for you, not for anyone else. Using the basic idea above, test yourself on the floor.

Get down on your hands and knees. Place your hands directly beneath your shoulders, but put your knees (your thighs at this point are perpendicular to the floor, i.e., about straight up) about four to six inches apart to begin. Now, slowly push your hips back until you begin to feel movement in your lower back – this indicates your back is beginning to lose its arch. At this point, widen your knees further apart and repeat the motion. You will keep doing this until you find the deepest range of motion without any change to your lower back. Try it with and without your feet being angled. You will likely find that your stance width is much different than you have been using. The next time you go to the gym, use this new stance you have found for yourself. But, a word of caution, use only light weights at first because likely your muscles will not be accustomed to the heavier loads since now you have slightly different angles pushing those loads.

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What are some things that will help you be more persistent in protecting your back? Try the following every day:

1. Perform a core-strength exercise such as side bridge, curl up, etc. If it’s a lift day, do one of these in your warmup routines as they will help stiffen the back prior to squats;
2. Do in-place squats, body weight only, every day; just a couple of sets to keep your hips mobile without the risk of heavy weights; and
3. On workout days, and I cannot stress this enough, wear a weight belt once you near your body weight and or surpass it. Then, when you squat, inhale before you squat, perform the squat and stand back to starting position then, exhale. This will keep your diaphragm expanded and is great at helping to prevent your back going into a convex position under heavy load.

There is a way to treat your back pains, but you need to be persistent. And the 8-12 weeks’ repair time that insurance companies say is ideal it not. It can take years to recover from damage to your back that you have done yourself. Happy, pain-free lifting.

You have been working out at the gym for weeks now and things have been going well. However, you lower back, legs, rhomboid muscles and a few other areas do not seem to be as supple as they should and constantly feel tight and fatigued. You have likely reached a point where your body needs some help in adjusting to the work load you have placed on it.

You’ve also been longing for one for a while now so, it’s time for that massage. Although your fatigue seems to have brought on this necessity, how often one should get a massage is a fairly common question. There is no clear answer, but I’ll attempt to put this in perspective.

There are multiple factors that contribute to the frequency of physical therapy/massage, which primarily include the persons size, training intensity, and training frequency.

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Although massage is mostly used to keep you from injury and over training, it’s great for increasing the flow of nutrients to muscles, reducing tension and stress, increasing flexibility, enhancing nervous system functions, inducing sleep, and increasing appetite.

As a general rule of thumb, the average fitness buff should have a physical therapist check and massage them based on the therapists judgement at least once every 6-8 weeks; more if you’re a competitive athlete of any kind. Depending on your individual uniqueness, scheduled visits will vary. Think of it like a maintenance check for an oil change on your car. Just like that oil change for the car, your body needs to periodically get a massage. I recommend deep tissue types if you are a competitor in fitness and figure, body building, athletics and sports, etc.

Before seeking a massage, you should first try to combat over training. Some common methods to reduce over training include ceasing training for one week and when training always perform a light warm-up and stretching and, cut training time to 30 min/day max. Next, reduce protein intake to 15% of total calories; many fitness buffs use a lot more protein than they really should (pushed in large part by fad diets), pushing it up to 35% or more of daily caloric intake; 25% is generally sufficient as a max, but there are times when you should do more.

Another way to combat over training is to increase complex carbohydrates to 70% of total calories. Your brain actually runs on sugar and this will give you a boost. You can also increase antioxidants to 200% of the recommended dosage. Finally, get a minimum of 9-hours sleep for a few days. These basic techniques can help combat over training. But, the more you have trained, the more in need of a massage you will be. It’s interesting to note that many people will work out for years and never have a massage. If this is you, it’s definitely time to change that habit.

If you still find slow recovery from soreness and other exercise pains, it’s definitely time to visit your therapist.

There are two types of massage; local and full body. For high training loads, a full body massage is advisable (twice per week). These massages should not be deep, but relaxing with rubbing and kneading techniques. If training loads are light or medium, a massage once every two weeks is sufficient.

Local massage is used to treat special areas. An example of a local massage is when you may need extra attention to the hamstrings because of a particular activity that exerts constant work on a specific muscle such as the hamstrings or upper back. When speed-strength training, special attention should be given the lower back, glutes, and hamstrings. A massage should be given only by a qualified sports massage therapist. Times needed for the massage generally range from 5-10 minutes for a light local massage; 10-25 minutes for a medium local massage and 20-25 minutes for a hard local massage.

For most athletes, either a local or full massage should be obtained at least once every 3-4 weeks. The harder you train, the more frequent you will need them and the more you will need to go to a full-body massage. The time requirement for a full body massage usually considers the your body size/weight. Generally for those weighting 135 pounds or less time required is about 40 minutes, 136-150 lb person is 50 minutes; 151-200 lb person is 60 minutes and a person over 200 lb is 60+ minutes. Talk to your therapist or ask one of our experts.

To prevent injury and increase skills requires that proper care be taken with the body. A massage is yet another tool to help you maintain better health and well, they feel great. Go get one and you’ll see.

Question: I’m 55 and want to begin working out with weights. Can you tell me some basics about strength training and what I should know before I get started?

Answer: Strength training involves working muscles against resistance, whether it is rubber tubing, free weights, weights, weight machines or your body weight as when performing sit-ups or in-place squats. Weight training boosts the strength of bones (increases bone density over time), muscles, tendons and ligaments, making everyday chores easier and cutting the risk of osteoporosis, especially among women. By increasing muscle mass, you raise the body’s metabolic rate, which aids in burning calories effectively. Thus, strength training makes a fine partner to aerobic exercise in maintaining a weight-loss program.

You should always seek your doctor’s approval before starting any exercise program. Also consider getting the help of a personal trainer. A trainer can get you started with the proper weight loads and good technique and lifting form. Without proper form, you run a greater risk of injury and won’t progress as quickly as you may desire. Please read our “Online Trainer” section in the Training Nook area for additional information.

For getting started the primary rule is to be patient. With any exercise program, take it slow and easy; also, look at the long term. You will notice improvement in the first several weeks as you become more coordinated and adept at your new exercise regimen. As time passes you will begin to build muscle mass. As you become more fit you will see that improvements come at a slower pace. Be persistent and don’t get discouraged.

Question: Should I use free weights or machines?

Answer: Novices should begin with machines to build a good strength foundation and reduce risks of injury. Machines help you keep focus on one muscle area and require less knowledge of form. While the movements associated with free weights better translate to everyday activities, free weights should be learned slowly and with proper form as your strength foundation improves.

Question: How much weight should I start with?

Answer: Start with a weight you can handle and complete 12 to 15 repetitions while finding it difficult to complete the last one or two repetitions. A repetition is one complete sequence of an exercise, like one complete dumbbell curl. A set is a fixed number of repetitions. For example, this is typically written s 3 sets of 6 so, you would perform 6 repetitions of curls 3 times wish a short rest of maybe one minute between sets.

Question: How fast should I lift and how many sets?

Answer: A general rule of thumb for lifting a weight is to use a count of 2 and then lowering it for a count of 3-4. A smooth rhythmic motion is what you should seek; do not jerk the weights. If you wish to build more muscle mass, lift heavier weights. Speed is not as important as proper technique. As a beginner, 3 sets of an exercise is fine initially. As your fitness level increases, you can increase both the number of sets, the repetitions, and also the weight load used.

Question: What are some of the exercises I can do?

Answer: This would depend on your fitness level, ability to exercise based on you and your doctors decision, and a host of other factors. There are a tremendous number of exercises you can do. Below are some definitions for a variety of exercises.

Aerobics: Walking, running, swimming and cycling are just a few examples of steady aerobic exercise.

High-impact aerobics is a form of aerobics with high-jumping moves.

Low-impact aerobics preserve joints and gives you a low-impact exercise, a stationary bike is an example.

Boxing-based workouts. Traditional boxing-based workouts have been popular for years. They go by names such as Mo-Do Ti, Tai-Bo, kickboxing, and others.

Cross-Fit: is a compilation of varied functional movements performed at high intensity, which is too much for most beginners. This is because a great deal of cross-fit exercises come from component parts of speed-strength training exercises taught to collegiate and professional athletes. Those exercises are geared to produce extreme starting and power from static positions that are functional in nature. Also, many of the weight regimes in cross fit are also derived from speed strength weighted exercises, plyometrics, and ballistics. They are upper-level intermediate to advanced and thus require a great deal of skill – more so than most we have witnessed at a great many cross-fit gyms. Thus, cross-fit movements stem from speed-strength for athletes, general weight lifting, running, some gymnastics, etc.

Cross-train (sometimes now referred to as cross-fit by some – the two are not the same) – This refers to doing two or three complementary workouts. Examples would be walk or jog, pedal a stationary bike, lift weights, or swim on different day, i.e., mix it up.

Cross Country Skiing: This can be done on stationary ski machine such as the Nordic Trac or in the backwoods for those who live in suitable climates.

Cycling: Cycling can be done in or outdoors. Go outside with a lightweight road bike, or tackle the trails on a fat-tire mountain bike. Indoor workouts range from popular spinning-type classes to new classes with bikes that emulate mountain biking.

Dance: There are many styles of dance taught almost everywhere. No matter what you like, youll likely find a class. Options range from basic ballroom steps, to country western line dancing, hip hop cardio, and the ever popular swing-dance to name a few.

Firefighter workout (old school): Similar to popular military-style/fitness workouts like the Navy Seal workout, these simulate moves used by firefighters. Best of all, they use just the body.

In-line Skating: A skating workout set to music.

Jump Rope: An excellent cardio-vascular workout that everyone knows how to do, well almost.

Martial Arts: These can range from basic boxing, adding kicks, and even weapons to increase dexterity and get up the heart rate. It all depends on the instructor and style taught. Many health clubs offer some sort of martial-arts curriculum or class. An excellent full-body workout.

NIA: Neuromuscular Integrative Action: a combination of nonimpact aerobics, dance, and martial arts to improve cardiovascular condition balance and flexibility.

Pilates: This form of exercise uses special equipment (called the Cadillac, chair and reformer) to develop strong core muscles of the abdomen, back and butt in a goal to improve posture, stability and flexibility. These machines use a system of sliding benches, ropes, pulleys and springs to perform a variety of exercises. There are also mat classes using minimal equipment, provide similar benefits in a group setting.

Qi Gong: Is similar to Tai Chi; this Asian martial art focuses on the breath to move the qui (energy) through the body.

Rowing: Use a rowing machine or kayak. Its a great upper body that also includes the legs. Many gyms having rowing machines. Its also a good warm-up exercise.

Running: For some its the end all be all. A good form of exercise that burns calories well, but it doesnt burn the most calories as many runners like to claim. An easy kind of exercise that requires no equipment. However, it is high impact, especially for those who are overweight.

Strength Training: Using free weights, machines, tubing, your own weight and other types of equipment to build lean muscle, the king for reducing body fat. Did you know that there are approximately 250 strength-training exercises with almost 1,000 variations?

Tai Chi: An ancient Chinese martial art that follows a series of gentle moves. It is not a fighting art, but is a great art to practice breathing, stretching, and relaxation. Appropriate for exercisers of all levels. With regular practice it improves functional strength, flexibility, and balance.

Walking: The easiest exercise to begin with. Its a great way to get started and then increase speed of walk as your fitness level increases. Speed or race walking will really burn the calories. Its also low impact.

Water workouts: Aquatic exercise is ideal for strengthening muscles, a great calorie burner, cross-training, injury recovery, and it is non impact. The added resistance of water can help build muscle and cardiovascular strength without joint injury.

Weight bearing exercise: This is really any exercise that includes your body weight while doing it/them. Examples are running, walking, and certain weight lifting exercises such as squats. Others include definitions where any load is placed on the body or body parts. So, there may be some disagreement on definition, but not on the benefits of performing them.

Yoga: An exercise based on mind/body movements that include breathing, stretching, relaxation, flexibility and mental focus. There are many types of yoga ranging from gentle viniyoga to the vigorous ashtanga (power) and more.

Before beginning daily play, golfers can take some preventive measures to protect themselves against injury.

Golfers elbow

Leading the list of injuries is golfers elbow. One of the best ways to avoid elbow problems is to strengthen the forearm muscles and slow the swing so that there will be less shock in the arm when the ball is struck.

To avoid golfers elbow, the American Academy of Orthopedic Surgeons suggests these simple exercises to help build up your forearm muscles.

Squeeze a tennis ball. Squeezing a tennis ball for five minutes at a time is a simple, effective exercise that will strengthen your forearm muscles.

Wrist curls. Use a lightweight dumbbell. Lower the weight to the end of your fingers, then curl the weight back into your palm, followed by curling up your wrist to lift the weight an inch or two higher. Perform 10 repetitions with one arm, then repeat with the other arm. Perform 3-5 sets for 2-3 times per week.

Reverse wrist curls. Use a lightweight dumbbell. Place your hands in front of you, palm side down. Using your wrist, lift the weight up and down. Hold the arm that you are exercising above your elbow with your other hand in order to limit the motion to your forearm. Perform 10 repetitions with one arm, then repeat with the other arm. Perform 3-5 sets for 2-3 times per week.

Lower back pain

Another common complaint among golfers, low back pain, can be caused by a poor swing. The rotational stresses of the golf swing can place considerable pressure on the spine and muscles. This particular motion works, primarily, fast-twitch muscle fibers. Also, poor flexibility and muscle strength can cause minor strains in the back that can easily become severe injuries.

Following are some simple exercises to help strengthen lower back muscles and help reduce or prevent injuries.

Rowing. Firmly tie the ends of rubber tubing. Place it around an object that is shoulder height (like a door hinge). Standing with your arms straight out in front of you, grasp the tubing and slowly pull it toward your chest. Release slowly. Perform three sets of 10 repetitions, at least three times a week.

Pull-downs. With the rubber tubing still around the door hinge, kneel and hold the tubing over your head. Pull down slowly toward your chest, bending your elbows as you lower your arms. Raise the tubing slowly over your head. Perform three sets of 10 repetitions, at least three times a week.

Low-Pulley Rows. Use the machine with this name in the gym. Select a comfortable weight and with legs bent, lower your forehead between your legs until your chest touches your thighs. Then, in a rowing motion, pull your body back to about a 45 degree angle as you pull the weight to your abdomen chest area. Lower the weight and repeat the next repetition. Perform 3-5 sets of 8-10 repetitions for 2-3 times per week.

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One of the best ways for golfers to stretch their muscles and avoid injury could be considered old-fashioned before your round of golf, engage in some simple stretching exercises, and then get a bucket of balls and hit a few golf balls on the driving range. It not only will help your game, but will make you healthier in the long run.

As with other sports, never, never, never play without properly warming the muscles first. An injury can put you days, weeks, or months behind an intended schedule of progress or play.

From the want-to-be athlete to the common fitness buff to the professional athlete, many find it difficult to resist the seductive messages that promise leaner bodies, bigger muscles and better stamina from the contents of a bottle or pill. Look at any fitness magazine and you’ll see what I mean.

Sales of some supplements received a huge boost beginning in 1998 when reporters revealed that baseball player Mark McGwire used the controversial muscle-building substances androstenedione and creatine during his successful bid to break Roger Maris home run record. Despite the outcome, that boost has stayed.

For those craving the miracle cure for large muscles and a lean body, McGwire’s powerful swing and bulging biceps were proof that performance-enhancing substances work. According to the Nutrition Business Journal that provides market research for the dietary supplement industry, U.S. sales of pills, powders, bars and beverages promoted to boost athletic performance reached $1.26 billion in 1997 to $26.4 billion in 2015 in the U.S. and is expected to reach $278 billion globally by 2024.

Was it practice or pills?

McGwire’s swing has more to do with his finely honed eye-hand coordination than to popping a pill or a super-drink, according to Edward R. Laskowski, M.D., co-director of the Sports Medicine Center at Mayo Clinic, Rochester, Minn. As in many sports, finesse counts for more than sheer strength. After all, you don’t see many hard-core bodybuilders in speed sports. The simple reason is that the training for one is not conducive competitive skills in the other. So, strength is not all its cracked up to be in some areas.

However, McGwire claimed andro is a natural substance and says he plans continued use. Major League Baseball officials are taking a hard look at andro and its use. The National Football League, the National Collegiate Athletic Association and the International Olympic Committee already ban andro.

The danger here is that young athletes and others emulated McGwire and began to use substances of questionable value in a bid to gain a competitive edge or to feel better about themselves. However, this has always been a common problem in sports of all kinds. The athlete is always looking for an edge.

Rather than relying on a pill, we would stress the development of strength, skill, and athletic performance. Lets look at two of the most common supplements in use today.

For a little history, Androstenedione was developed by East German researchers who began using it in the 1970s in an attempt to boost the performance of Olympic swimmers and other athletes. Andro was introduced commercially in the United States in the mid-1990s. Marketers widely claim that a 100-milligram dose of androstenedione increases the male hormone testosterone by up to 300 percent. The increase, according to marketers, lasts for about 3 hours. Androstenedione is a precursor hormone in the production of testosterone. Most of the testosterone in men is produced by the testes; it is responsible for facial hair, a lower voice, bigger muscles and other male characteristics.

Testosterone also is produced in both men and women by the glands located atop each kidney called the adrenal glands. The adrenals, like the testicles, are part of the endocrine system, which secrete hormones directly into the bloodstream. Testosterone and other hormones are governed by a feedback system in the body that stimulates the production of a specific hormone when levels fall too low. The same system reduces production when optimal levels are reached. Proponents vehemently argue that the body directly converts andro to testosterone.

An elevated level of the male hormone allows athletes to train harder and recover more quickly. Quite simply, there is very little documented research to back claims made by these people. However, androstenedione is naturally found in meat and some plants. Consequently, the pills and capsules on the market deliver it in a concentrated form that may carry unwanted consequences. As an example, labels of many andro products warn that it should not be used by women, anyone under 18 years old, or people suffering from various medical conditions, including diabetes, heart disease, psychological disorders and prostate hypertrophy.

The Association of Professional Team Physicians, composed of team doctors from professional sports teams, has recommended that androstenedione be banned from all competitive sports. It was banned in 2005 by listing it as a schedule III controlled substance (it was labeled as an anabolic steroid). According to the group, andro has a chemical structure like that of an anabolic steroid a usually synthetic drug that functions like testosterone. The governing bodies of virtually all competitive sports ban anabolic steroids. The ban supported this, but still, some athletes use it, at risk.

The experience of these professional has raised concerns about serious health risks and an “unfair advantage” in competition. They also warn of potential complications such as acne, breast enlargement, liver and heart problems, and personality disorders resulting from andro use.

The question must be asked, “are the potential benefits worth the ensuing health risk?”

Creatine monohydrate is a compound produced by the body that helps release energy in muscles. Creatine is the most studied of all of the nutritional supplements, and the only one to have scientific research support some of its claims. Unlike androstenedione, scientific research indicates that creatine can boost short-term bursts of power.

“Most of the research points to improvements in short term power activities like improving maximum-weight bench press or increasing speed during cycling sprints of very short duration,” says Dr. Laskowski. Other studies have shown an increase in lean muscle mass with creatine. The result of all this is the hype of creatine producing steroid-like effects without the side effects.

Creatine helps muscles make and circulate more adenosine triphosphate (ATP), the fuel the body uses for quick, explosive activity of short duration like weightlifting or sprinting. Creatine also reduces energy waste products. As a result, it’s purported to enhance performance and decrease fatigue.

A normal liver makes about 2 grams of creatine each day. Creatine also is readily available from meat in your diet. Creatine levels are relatively easily maintained, and muscles can store creatine. The kidneys remove excess levels of the substance, which casts some doubt on whether creatine supplements are of any value to someone who already has a high muscle creatine content.

There also are serious questions concerning long-term use of creatine.

A primary concern is that when such supplements are used, the body will sometimes cease production of that product due to artificially high concentrations. Whether the kidneys can process that much creatine for a number of years is a prime worry, especially in young athletes. The amount of creatine that people take also varies significantly with many having the attitude that, “if a little is good more is better.” And, creatine occurs naturally in foods thus, no one knows what a supplemental dose will do over a long period of time, regardless of age.

In addition, creatine tends to draw water away from the body into muscle cells, which can lead to serious dehydration. Those using creatine should make sure they drink plenty of water or other fluids. A few years ago, 3 wrestlers died of dehydration-related kidney complications. While not directly linked with creatine use, all of the wrestlers were taking the product. On a lesser scale, there are many anecdotal reports of increased muscle cramping while taking creatine. Along this same line, Mark McGuire spent part of the 2000 season sidelined with back muscle problems. Whether is was the result of creatine usage is not clear, but there is the coincidence.

One of the main problems with these and other supplements is that they are not FDA regulated and thus, purity is not guaranteed. As a result, harmful binding and other filler agents may be present that can be a long- or short-term health risk, especially for those with medical conditions.

Despite the testimonials to muscle size and strength, there is no evidence that andro, creatine or any other substance enhances athletic performances over what could be attained by practice, training and proper nutrition. This would require considerable research expense and time. The link could be there, but there is no way to say this for certain.

Driving a gold ball for 330 yards certainly requires a lot more than being able to lift 20 extra pounds one more time. There’s speed, agility, reflexes, and technique. In our opinion, no amount of drug or other supplement can substitute for these skills. As an example observe Tiger Woods; he is not the strongest or largest golfer on tour, but he does have one of the longest drives. And, there’s one small other thing he has, a skill and athletic ability that surpasses those who are stronger and larger. Consequently, there’s absolutely no data that any performance-enhancing substances improve hard earned skills.

As a word of caution, if you are using these type supplements, you should at least cycle completely off of them once every 12 weeks for at least 2 weeks of abstinence.

A sprain is an injury that causes a stretch or a tear in a ligament. Ligaments are strong bands of fibrous connective tissue that connect bones at a joint. They are composed of bundles of Type I collagen and elastin. As ligaments insert into bones, the ligament material changes from rigid to more flexible. Sprains may be classified as grade I, II or III. Grade I sprains represent stretching of the ligament without tearing. Grade II represent partial tearing of the ligament. Grade III represent complete disruption of the ligament and often hurt just as much as a broken bone. A sprain of the lateral outer ligaments of the ankle is one of the most common injuries sustained with sporting activities. In fact, 85% of all ankle injures are sprains.

How does it occur? A twisting or severe stretching of a joint is the usual cause of a sprain. In regards to the ankle, a sprain occurs when an individual rolls over their foot onto the lateral ankle. What are the symptoms?

Often, one appreciates a pop or snap at the time of injury. This results in a swollen, painful joint. Following the injury, one may not be able to move the injured joint or have the ability to bear weight. The skin of the joint may be red at first followed by bruising in a few hours or days.

How are sprains diagnosed?

The diagnosis of a sprained joint begins with inspection of the injured joint to identify the location of swelling and bruising. This is followed by palpation of the bony and ligamentous anatomy to identify tenderness. An x-ray may be obtained to make sure you do not have a broken bone.

What is the treatment for sprains?

The goal of initial treatment is to minimize pain, swelling, and stiffness. The general rule for treating sprains is R.I.C.E. Additional treatment modalities include anti-inflammatory medications and physical therapy.

Rest- Depending on the severity of the sprain, the usual treatment consists of immobilization with a splint, brace or sling. In the acute inflammatory phase (1 to 5 days after injury) rest promotes pain control. Upon resolution of the acute inflammation phase, only submaximal activity is recommended, to prevent further injury or re-injury. Prolonged immobilization is discouraged because of detrimental long-term effects such as muscle atrophy and joint stiffness. Protected weight bearing is used until symptoms resolve. Modify your activities and avoid those that cause pain. Occasionally, sprains to the knee and ankle may require crutches for ambulation.

Ice- Cryotherapy, the application of ice, is recommended to ameliorate the effects of the inflammatory reaction by reducing swelling, hematoma formation (localized blood collection in the soft tissue) and diminishing pain. It is hypothesized that ice therapy retards hematoma formation and swelling because it constricts the capillaries and thereby decreases blood flow. Several studies have shown that cryotherapy can either increase or decrease swelling. Therefore, its affects on inflammation and swelling are unclear. Regardless, it is still highly recommended in the acute phase. Conversely, numerous studies have shown cryotherapy to provide an analgesic effect. It is believed to be due to breaking the pain cycle by showering the central nervous system with impulses, which makes the receptors momentarily refactory to pain. This analgesic effect is well substantiated. Although the duration of the effect is not well defined, the temporary analgesia is helpful for early mobilization. In the acute phase, one should apply ice on the sprained area for 20-30 minutes every 3 to 4 hours. Do this for 2 to 3 days or until the pain subsides.

Compression/Elevation- The use of compression and elevation are thought to decrease pain and swelling. Although there are no studies that address the use of these modalities, their employment is generally recommended. A elastic bandage or neoprene sleeve may be utilized to reduce swelling. Also, elevation of the injured joint above the level of your heart will decrease the swelling. Most severe sprains may require compressive bracing for up to 6 months during sports.

Nonsteroidal anti-inflammatory drugs (NSAIDS)- These medications have been used to reduce the acute pain caused by the inflammatory response. The inflammatory response involves the vasodilation of the vessels and collection of blood in the surrounding tissues. Inflammatory cells are recruited and result in swelling, redness, pain and impaired function. Although these effects are detrimental, an inflammatory response is not absolutely undesirable since a certain level of inflammation may be necessary to allow healing to take place. The current recommendation is to use NSAIDS immediately after the injury and a short time thereafter but not to continue for a long period of time to prevent interference with the healing response.

Physical therapy- Physical therapy is recommended after the resolution of the acute pain and swelling. This is beneficial for restoring normal muscle strength and flexibility around the joint. Therapy is important to prevent further injury or re-injury. Active assisted, passive, and resisted range-of-motion with gait, balance and proprioceptive training should be gradually instituted. The majority of patients will be able to return to full activity within six weeks of their injury. Some sprains with complete tearing of ligaments may need surgery.

How long should I wear an elastic bandage or pneumatic splint for an ankle sprain? The length of time depends on the severity of the injury, the activity involved, and the fitness level of the athlete. If the swelling is minimal, several days is usually sufficient. If there is an obvious hematoma or more severe pain owing to the swelling, a 6-week taping protocol or commercially available protective splint is recommended. The splint is discontinued when the person feels comfortable and confident. The exception is those who have chronic or recurrent sprains; in this case, continued protection whenever the person is participating in agility sports is recommended. How are sprains prevented?

Most sprains occur from accidents that are not easily prevented. However, make sure you wear proper shoes for your activities and watch for uneven surfaces when you are walking or exercising.

Food passes down the throat, through a muscular tube called the esophagus, and into the stomach, where it continues to be broken down. From the stomach, the partially digested food passes into a short tube called the duodenum (first part of the small intestine). The jejunum and ileum are also part of the small intestine. The liver, the gallbladder, and the pancreas produce enzymes and substances that help with digestion in the small intestine.

The last section of the digestive tract is the large intestine that includes the cecum, colon, and rectum. The appendix is a branch off the large intestine; it has no known function. Indigestible remains of food are expelled through the anus. These are the basics of the digestive system. A more detailed explanation is below.

The small intestine is about1 1/2 inches to 2 inches around, and is located beneath the stomach. Its also about 22 feet long and has the important task of breaking down the food mixture so your body can absorb all the nutrients it needs from food you eat. So, while that tuna is full of protein, the small intestine is what is responsible for unleashing its power for you.

But the small intestine can’t break down food for its nutrients by itself – it gets help from three other parts of the digestive system. These parts are the pancreas, the liver, and the gallbladder. They are not part of the digestive tract itself, but they help to make up the whole digestive system. How? By secreting different enzymes to the first part of the small intestine. These enzymes help to digest food and allow the body to absorb its nutrients. The pancreas makes juices that help the body digest fats and protein. Bile from the liver helps to absorb fats into the bloodstream. And the gallbladder is like a warehouse for this bile, holding onto extra amounts of it for when the body needs it.

In the upper part of the small intestine, a partially digested mixture of food combines with excretions from the pancreas and the liver. This mixture next moves into the lower part of the small intestine, getting broken down even further. When the mix is almost at the end of its journey through the small intestine, usually requiring up to 4 hours, the nutrients from the food finally pass through the wall of the small intestine and into the blood. Once the nutrients have entered your blood, the blood takes them to a major checkpoint: the liver.

Love Your Liver

The liver is one of your body’s larger organs, sitting on the right side of your body near the digestive tract. In addition to making bile to help with digestion, the liver is the first place that the nutrients from food go. The blood brings them directly to the liver, which processes the nutrients by filtering out any harmful substances or wastes. It turns some of the waste into more bile, which goes to the small intestine to help with digestion or to the gallbladder for storage.

In lay terms, the liver helps figure out how many nutrients will go to the rest of the body, and how many will stay behind in storage! For example, the liver stores certain vitamins and a type of sugar that your body uses for energy.

Once nutrients have passed through the liver they are transported through the blood stream to the rest of the body.

The Large Intestine The large intestine is fatter than the small intestine (3 inches to 4 inches around), and it’s almost the last stop on the digestive tract. Like the small intestine, it is packed into the body, and if it were stretched out would be about 5 feet long. The large intestine has a tiny tube with a closed end coming off it called the appendix. Although the appendix is part of the digestive tract, it doesn’t perform any known functions, although scientists think that the appendix may have been a useful part of the digestive tract millions of years ago.

After almost all of the nutrients have been absorbed from the liquid food mix in the small intestine, there will still be some parts of ingested food that your body can’t use. This leftover waste moves into the large intestine to begin its long journey out of your body. On its way, it goes into the colon, the part of the large intestine where most of the fluid and some minerals that are left in the liquid mix are absorbed into the blood. As the fluid leaves the mix, the waste that’s left gets harder and harder as it keeps moving along, until it becomes a solid.

When this solid waste reaches the end of the large intestine, it may have been in your system for several days. The amount of time that the waste spends in the large intestine depends on the kind of food that was eaten and how a person’s body works. The large intestine pushes the waste into the rectum, the last stop on the digestive tract. From here it is excreted from the body.

Once you understand this basic process, it will shed light on nutrition and why its important to consume a variety of foodstuffs. For example fiber in the form of fruits and vegetables, which has been shown to reduce the risk of colon cancer. These foods help those solids bulk up in the large intestine so you can move them on out. When you take care of your digestive system, it will do you right!