A Process of Alleviating Muscle Soreness:

• Ice.

• Stretch.

• Extended Warm-Up.

• Work-Out.

• Stretch.

• Ice.

A blow to the muscle belly, tendon, or bony prominence may cause swelling and bleeding into the tissue and form a contusion. The blood may coagulate and eventually form scar tissue, impeding normal function. Passive ice therapy needs to be started as soon as possible. After swelling has stabilized, start with active icing and then use cross friction massage. This is a simple technique used to reduce the swelling and congestion. The thumb or index and long fingers are used to apply firm pressure perpendicular to the axis of the tendon or muscle. The injured part is rubbed in this manner for 10 minutes, four times a day.

Ligaments attach bone to adjacent bone, and can be damaged in a fall, an accident, or through overuse. Such injuries are called sprains and include acute back sprains, knee sprains, or ankle sprains. Sprains are graded as mild, moderate, or severe. Mild sprains refer to overstretching and micro-tears of the fibers. A partial tear with or without instability or looseness is considered moderate. A severe sprain implies a complete or near complete tear of tendon fibers that results in looseness or instability at the joint.

• A sprain is a damaged ligament. Ligaments attach bone to bone. An example is the talo-fibular or talo-tibial ligaments.

• A strain is an injury to a muscle or tendon. Tendons connect muscle to bone. Tendonitis is an inflammation of the muscle, tendon, and or bone insertion site.

• Mild to moderate sprains and strains heal without residual problems if treated early. Primary treatment includes ice and NSAIDs, partial weight bearing with crutches as necessary, and early therapy to maintain range of motion at the joint.

Muscle cramps are common and may be precipitated by prolonged physical activity, high heat and humidity (black flag conditions), dehydration, and/or poor conditioning. Cramps are characterized by the sudden onset of moderately severe to incapacitating pain in the muscle belly, and may progress to involve other adjacent muscle groups. The first treatment consists of immediate rehydration with a fluid containing electrolytes. After beginning rehydration, further treatment should consist of grasping and applying pressure to the muscle belly and immediately putting the muscle on stretch until the cramp resolves.

Flexing the foot toward the head for example, would stretch the calf muscle, whereas a thigh cramp would be treated by flexing the knee, bringing the foot to the buttocks. In addition to these procedures, adequate rest should help prevent recurrences.

A true fracture involves a break or chip in the hard outer surface of the bone. With few exceptions, true fractures of the lower extremity require a period of immobilization in a cast, and supervised care by a medical officer.

Stress fractures differ from true fractures and are most commonly seen in the load-bearing bones of the lower extremities, i.e. pelvis, femur, tibia, fibula, and bones of the foot. They are caused by excessive strain on the bone. Bone constantly undergoes remodeling and repairs in response to the stress of weight bearing. The repair process is accelerated by rest, and is slowed in times of heavy exercise as with runs, hikes, marches, and prolonged training. When the breakdown process exceeds the bone's ability to repair itself, a stress fracture may result. As the lower extremity bone becomes weakened, weight-bearing activity, such as running, may cause a vague, aching pain at or near the weakened site.

The first symptoms of stress fractures are initially poorly localized and often ignored. Later, as the process continues, the bone will become tender in a very localized area and will often ache at night or at rest. Ultimately, if left untreated, continued weight bearing may cause a true fracture within the weakened area of bone. Physical training factors that increase the risk for stress fractures include the following activities:

• A change in training surface (grass to asphalt, dirt to concrete).

• A change in shoe wear (worn out or new shoes, boots, or running shoes.

• An increase in physical activity (too much, too fast, too soon).

Important points about stress fractures

All suspected stress fractures should be evaluated and followed by the medical officer. Treatment includes:

• Reduction or avoidance of impact and load bearing activities.

• Partial weight bearing with crutches and advancing to full weight bearing when pain free.

This process typically takes 2 to 4 weeks. Stress fractures are usually not casted when strict non-weight bearing or partial weightbearing instructions can be assured. The reconditioning process should include swimming or water exercises (such as deep water running) to maintain flexibility and aerobic endurance. A program of lower extremity strengthening exercises should be started as soon as tolerated.

True fractures require a period of immobilization that varies depending on the bone involved. However, after the cast has been removed, the extremity should undergo a reconditioning program. After the weight-bearing restriction has been lifted, the individual can begin a reconditioning program for running. A return to running should ideally be initiated on a treadmill. This allows the individual to customize increases in duration and speed, while monitoring pain at the stress fracture site.

• Run on soft and even surfaces, treadmill, or track.

• Run 5 minutes at a slow pace and increase time by 2 minutes every other day.

• When running pain free for 15 minutes, increase pace.

• Advance to figure-of-eight runs, begin at 100 yard intervals and progress to tighter turns.

• Gradually increase distance.

• Resume regular running program.

It is not surprising that injuries occur during training and mission-related scenarios. Clearly, the type of injury will depend on the specific physical tasks and the environments under which the tasks are performed. Other than these platforms, many of the injuries are a result of activities all active duty populations participate in, namely swimming and running.

Swimming is a non-impact activity involving maximum tension on the muscle-tendon unit. Most injuries result from overuse and over training, rather than from one traumatic event. Consequently, once an injury occurs, healing can prove difficult.

• The older, experienced patient, faces the added challenge of tendons and joint capsules that are less resilient, muscles that take longer to warm up, and flexibility which is more difficult to maintain. All of these factors can lead to an increased risk of overuse and acute injury in this age group. The most common injuries arising from endurance swimming are sprains, strains and overuse injuries of the shoulder, knee, and back.

• Freestyle, butterfly, and backstroke place a great amount of stress on the shoulder joint. Use alternate or bilateral breathing on freestyle and be sure to get plenty of roll on backstroke. Before beginning a butterfly set, be sure you are well warmed up. This will allow the shoulder to stay in a more neutral position during the activity of arm recovery and this neutral position helps prevent what is known as "impingement syndrome." Freestyle swimming and kicking with a kickboard places a great amount of stress on the low back because of hyperextension; doing the backstroke relieves the stress. A pullbuoy is also helpful as it raise the hips and allows the spine to assume a more neutral posture.

• Kicking with fins may aggravate the knee (especially the knee cap), and result in a degenerative condition known as patellofemoral syndrome which commonly afflicts athletic individuals. The breaststroke kick helps balance the knee joint by increasing muscular tone on the inside of the quadriceps muscle and serves to balance the effect that running has; increasing muscular tone on the outside portion of the quadric muscle. However, the breaststroke may actually intensify iliotibial band syndrome. Swimmers may need to avoid doing breaststroke if they feel increased pain over the outside of the knee.

Running and hiking work large muscle groups and enhance cardiovascular fitness in a short period of time. Hiking transmits a force to the spine of approximately three times load-bearing weight. Running transmits an impact force to the spine of up to five times load-bearing weight. These forces are minimized with good body mechanics, shock-absorbing shoes and crosstraining for overall fitness.