Many have a tendency to shrug off minor injuries, sometimes even delaying attention for moderate and severe injuries. This is never prudent. The body has certain built in “warning signals” to tell us that something has gone awry and it’s injured. Ignoring these warning signals rarely makes the injury go away. In fact, it usually leads to a more severe injury or chronic problem. Therefore, it’s important to know how to recognize and examine these “I’m injured” signals:
--PAIN--
To a certain degree, pain may be considered a cultural phenomenon. It has been studied ad nauseam, yet is still often poorly understood. This is mainly attributed to the specific human to pain relationship varying so greatly from person to person and from culture to culture. In other words, what one “feels” is an excruciating pain might be felt as a mere nuisance by another. Another factor is pain perception. Take a child that has a minor scratch on their leg for example. The child may cry hysterically from the scratch, as if in a great deal of pain, but then shortly resume normal play without any serious injury. The point here is that pain alone isn’t always a clear cut indicator of how severe an injury is or isn’t.
That said, pain is often the first signal to alert you that something is amiss. There are four degrees or categories of pain that can be useful in self-examination and describing to others exactly what is being experienced with the injury.
1. Mild Pain
Mild pain will often subside during activity and doesn’t stop normal exercise or sport-related activities; for example, early stage tendonitis pain will usually disappear or minimize with activity. Pain may also be somewhat severe for a few minutes directly following an injury, but then lessen or cease thereafter. Mild pain will not usually prevent sleeping. In most cases, the pain can be prevented from worsening with massage and applying liniment to the area before and after exercise. Mild pain can be chronic. If so, you may want to obtain a specific diagnosis from a medical professional to assist in determining the most effective treatment options.
2. Moderate Pain
Like mild pain, moderate pain usually doesn’t prevent sleeping. The pain could wake you if the injured area is twisted, pressed, or otherwise irritated during sleep. This can often happen in cases of wrist injuries, as it’s easy to get the wrist twisted under the body while you’re sleeping and irritate the injury. Sleeping with the wrist stabilized, such as with a wrist brace or wrist guard, may help. Unlike mild pain, this pain doesn’t subside with activity and may affect performance during a physical activity. Moderate pain may begin as mild pain that gradually increases with time. A slightly sprained wrist or ankle and a chronic pulled hamstring or groin muscle would be some examples of injuries that could produce moderate pain.
3. Severe Pain
This type of pain will most often prevent activity and interfere with sleep. Over-the-counter pain medications will not prevent the pain. The pain may even be severe enough to cause nausea. If severe pain is experienced with an injury, then you should schedule a professional consultation immediately, as severe pain often occurs with torn ligaments, torn tendons, and fractures.
4. Radiating Pain
Radiating pain means that the pain travels outwardly from the area actually injured. A good example would be a lumbar disk rupture that causes pain to radiate into the legs. When pain radiates, it often signals that there’s a nerve impingement. This impingement could be the result of anything from pressure applied to the nerve from a tense muscle or a disk protruding on a spinal nerve. Whatever the causative mechanism, radiating pain is a serious warning signal that shouldn’t be ignored. A medical professional may be able to help determine the causative factor. However, it’s important to note that not all with bulging discs are going to experience radiating pain, or any pain for that matter, and that radiology services, such as an MRI, will not always determine the cause of radiating pain.
--VISUAL INSPECTION--
During the visual inspection you will want to look for certain indicators of injury - bruising, physical deformity, and symmetry:
Bruising
Bruises are caused by blood vessels in the injured area rupturing. The physical sign of bruising presents as a deeply to subtly colored skin discoloration, often called black-and-blue. The skin discoloration may or may not be accompanied by swelling. In Chinese sports medicine, bruises are categorized by the following three colors:
1. Black: A bruise at bone level. Sometimes bone bruises are so deep that they are felt from the skin surface, but not visually seen on the skin surface.
2. Green: A bruise at tendon level.
3. Yellow: A more superficial bruise at muscle level.
It’s important to note that there might be an overlapping of the above colors. A pulled muscle, for example, may present with yellowish green bruising.
Physical Deformity
Since X-rays don’t always show the noticeable differences that can be seen by the naked eye, you should look for a noticeable physical deformity. Here are some helpful tips while doing so:
* find corresponding landmarks (such as two joint creases, two bones, or two muscles) on opposites sides of the body and compare them to each other for swelling and/or shifting of landmarks.
* a marked deformity, such as found in the above observation, combined with pain is a good indicator that a serious problem exists.
* determine if the deformed area hurts and try to pinpoint any especially painful area (refer to palpating and touching section)
* immobilize the area until you’ve sought medical attention to determine injury.
Body Symmetry
Much like looking for a deformity, you will visually compare corresponding body parts, such as both arms or both knees, for symmetry. This will give you an indication if a larger imbalance exists that could be contributing to the injury or causing it. Here are some key points when checking body symmetry:
* compare the height of each hip for symmetry. A raised hip can indicate one side of the back is tighter than the other, which may be contributing to issues involving the knee, ankle, or hip.
* while standing, check to ensure that your knee, shinbone, and ankle are all in vertical alignment. If the knee falls outward, then it might suggest an imbalance in the thigh muscle.
* compare the range of motion for each half of the body, checking to see if there’s any inequality or restriction from one side to the other.
--MOVEMENT--
It should be noted that movement isn’t appropriate for self-inspection in injuries that have mass swelling or a deformity present. These injuries should be immobilized and you should seek immediate medical attention. Otherwise, the following key points may help you assess movement:
* determine if and what movement causes pain to decrease or increase. For example, does a muscle cause pain to increase when contracted or stretched? A muscle that’s torn or pulled will often involve intensified pain upon stretching, as this places tension on the injured muscle fibers.
* check the range of motion for any area thought to be injured and isolate any movement that seems to be irritating the problem. This will help you determine if the bone, muscle, ligament, or so forth is involved.
* listen for any unusual grinding, cracking, popping, or otherwise unusual noises made during movement. Joint injuries can cause a cracking or popping noise on movement.
* you may also feel an unusual slipping or grinding if you touch the area as you move it. This is often assumed to be arthritis. However, muscles and tendons can often slip out of the groves that they’ve threaded their way through in the bones and then slip back into place again. This often occurs due to improper use or injury, and it’s especially common among shoulder muscles and tendons due to the fact that the shoulder joint is primarily held in place by rotator cuff muscles and tendons. Corrective exercise and gentle manipulation will often treat this type of injury.
--SWELLING--
If swelling is present, it most often indicates that blood and other bodily fluids have stagnated in the injured area. There are actually many different specific types of swelling, each an indication of different processes. Here are the four main types of swelling:
1. Pitting Swelling
When pressure is applied to an injured area with swelling, it might slightly pit or indent. If the indentation remains longer than five seconds, it’s called pitting edema or swelling. This is usually an indicator of swelling in deeper tissues, such as that commonly seen in fracture and severe sprain injuries, or an internal imbalance that causes the body to retain water.
2. Outward Pushing Swelling
If the localized area of injury has swelling that pushes outwardly from the body, it’s due to blood and other fluids locally accumulating in the area. This is common in sprains involving blood vessels rupturing.
3. Red And Hot Swelling
Swelling that’s also warm or hot to the touch and has redness is an indicator of inflammation with the accumulation of blood, qi, and other bodily fluids. Liniments, such as the Acute Stage Sinew Liniment and the Sinew Herbal Ice Poultice, can provide a very beneficial anti-inflammatory and cooling effect during this type of swelling.
4. Cottony Swelling
This type of swelling may look and feel mushy. The texture is often compared to that of a piece of cotton. This type of swelling could be a warning sign that there’s a fracture. An X-ray should be taken to confirm or rule out a fracture.
--TOUCHING AND PALPATING--
While palpation is perfectly fine in most injuries, you should be very careful palpating when there’s severe swelling or a noticeable deformity. Begin by superficially, lightly and gently touching the area. If this is tolerated, then gradually progress to deeper tissues. Here are some key points when touching and palpating an injured area:
* there most likely isn’t a fracture if you can’t find an area of significant tenderness when the area around the bone is squeezed and pressed
* there is most likely inflammation if a reddened and swollen area feels warm or hot to the touch
* circulation is most likely reduced if the area feels cold or cool to the touch.
* check the temperature of the area carefully. Just because superficial tissue at the skin level feels warm doesn’t mean that the deeper tissues can’t be cool.
In closing, Chinese sports medicine firmly advocates that any injury, whether the most minor to the most serious, undergo immediate treatment. Through early intervention, minor problems will be significantly less likely to progress into a serious injury or chronic ailment.
