News-Letter

"I think I'm paralyzed!" This was the major thought in my mind the day after I ran my first full marathon, the Baltimore Under Armour marathon on Oct. 14. I had trained appropriately and felt strong throughout the race. I had even qualified for the Boston Marathon on my first attempt. Little did I know my excitement would be followed by muscle aches and soreness the following morning.

The soreness I experienced was due to microscopic tears within the muscle fibers in my legs. After completing an intense workout of any kind these tears in the muscle fibers cause inflammation and soreness. Paradoxically, these tears and the inflammation that follows are part of the process through which the muscles becomes stronger.

Skeletal muscles, the ones found in arms and legs and attached to other bones throughout the body, allow for voluntary movement. On the microscopic level, they are organized in long strands of parallel muscle fibers. Each fiber, in turn, is made of a series of fused muscle cells. Although the fibers are tough, they are susceptible to damage.

While most soreness experienced after a hard workout is minor and disappears after a day or so, some muscle strains and injuries are very serious. When it comes to treating muscle injuries, there is scientific evidence that supports the benefits of a four-part approach to muscle regeneration that includes rest, ice, compression and elevation (known by the acronym "RICE"). The goals of this treatment are to reduce swelling and internal bleeding while allowing muscle fibers to regenerate.

There is a tough balance to keep in mind when your muscles are healing from injuries. Blood flow to the muscles is higher than that to many other parts of the body, due to the high oxygen demand in these tissues. Increased blood flow to the muscle can help carry nutrients and proteins to the wound site, allowing the muscle to repair itself. However, blood flow also causes inflammation, which is often painful and can actually prolong the healing process if unregulated.

The RICE process helps to satisfy both sides of this conundrum. Scientists have found that movement immediately after muscle injury causes more rapid and intense capillary growth and helps speed the regeneration of muscle fibers. Multiple experiments have also shown that immediate mobilization of the injured muscle causes the muscle to return to its previous level of strength faster. As always with muscles, exercise is the key to maintaining their strength and health. The problem with mobilization is that experimental studies have shown that it can cause a larger connective tissue scar, which is susceptible to additional ruptures and may be painful.

Immobilization of a muscle may also have benefits. In mice, this immobilization prevents excessive scar formation and secondary ruptures. Unfortunately, inactivity of the muscle causes atrophy or shrinking of the healthy muscle fibers and slows the recovery of strength in the injured muscle. Therefore, muscle immobilization can be harmful if continued for more than three days, which should be enough time for the initial soreness to decline.

The use of ice on damaged muscles causes a decrease in blood pooling, called a hematoma, between the ruptured muscle fibers. Compression also reduces blood flow to the injured muscle. The combination of ice and compression has been shown to result in a three to seven Celsius degree decrease in the intramuscular temperature and a 50 percent reduction in the intramuscular blood flow.

Elevation of an injured limb above the level of the heart results in a decrease in pressure in the limb and subsequently reduces the accumulation of interstitial fluid, located between cells in muscle.

Stretching is an important component of exercise that many people forget about. It is vital to warm up and stretch before any kind of physical activity, because the stimulated, warm muscles absorb more energy and can handle greater force. Stretching also increases the elasticity of the muscle, making them more likely to resist new tears.

Stretching is not just a warm-up activity. After strains or injuries, stretching is crucial because it gradually elongates the connective tissue scar, which helps prevent sudden re-tearing of the muscle while healing.

After not being able to walk down stairs for two days, I eventually regained the full range of motion in my legs, and my aches and soreness soon disappeared. The treatment principle of rest, ice, compression and elevation proved to be effective after my 26.2 mile adventure, and it left me ready to try again.

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