Types of Injuries

A variety of injuries can be encountered during SEAL and other forms of physical training. In this section we will start with those problems that may be relatively minor and cause mild discomfort, and then proceed to more serious injuries that may limit your activities.

Training-Related Muscle Soreness

Delayed soreness in a deconditioned muscle is normal, and is caused by micro-injury. Pain and tenderness typically appear 12 to 48 hours after beginning a training session. Stiffness and soreness are worse after the cool down and resolve again after warming up. This normal process usually persists for 7-12 days and then disappears.

Table 12-3. A Process of Alleviating Muscle Soreness

Ice Stretch Extended Warm-Up Work-Out Stretch Ice

Contusions

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 long axis of the tendon or muscle (Figure 12-2). The injured part is rubbed in this manner for 10 minutes, four times a day.

Sprains and Strains

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 microtears 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.

Tendons attach muscle to bone. Muscle or tendon injury is referred to as a strain or tendonitis. Tendonitis, including achilles tendonitis, shoulder tendonitis, hamstring or quadriceps muscle strains, fall into this category.

A strain or tendonitis is an injury to a muscle or tendon.

Mild to moderate lower extremity 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

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. The calf muscle, for example, would be stretched by flexing the foot toward the head, whereas a thigh cramp would be treated by flexing the knee, bringing the foot to the buttocks. Pictorial representations of procedures for treating these cramps are presented in Figure 12-3. In addition to these procedures, adequate rest should help prevent recurrences.

Figure 12-3. Examples for Treating Painful Muscle Cramps in the Calf and Quadricep Muscles

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 remodelling and repair in response to the stress of weight bearing. The repair process is accelerated by rest, and is slowed in

Figure 12-3. Examples for Treating Painful Muscle Cramps in the Calf and Quadricep Muscles

Calf

Quadricep

Fractures 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, achy 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 which increase the risk for stress fractures include:

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

♦ A change in shoe wear (worn out shoes or boots or new running shoes or new boots)

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

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

♦ 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 two to four weeks. Stress fractures are usually not casted when strict non-weight bearing or partial weight-bearing 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 which 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. A typical "return-to-running" program is presented in Table 12-4.

Return-to-Running

Run on soft and even surfaces- treadmill/track Run 5 minutes at a slow pace 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 (see Chapter 4)

Resume regular running program

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