Guest post by HJJ student AJ Bhardwaj.
3 weeks ago, I hurt my ribs. Quite badly.
A grade 2 cartilage tear.
Yesterday, however, I was back to rolling albeit at sub maximal intensity in the advanced classes fairly pain free. Let me show you how.
We have been lucky to be part of a school that fosters good habits on and off the mats that allows us to have longevity on the mats and in life. That being said, Injuries happen.
3 weeks ago, I was playing with my partner with takedowns and he was able to pull off a beautifully executed Seoi Nage. Well almost. At the last moment, one of his legs lost balance and he landed with his shoulders directly on top of my ribs.
It happens. It’s a contact and combat sport.
I was in pain fairly immediately but I kept training due to the pain modulation that occurs when adrenaline is high. The car ride home however was a different story. It was hurting to sit upright in the car. I was bracing just to breathe. My body had relaxed and with this came the rushing feeling of sadness and anger along with all the terrible thoughts that go with it –
“Why did he do that?”
“Why is it always me?”
“Fuck sake, now I am going to out for another month”.
“I was just starting to get in a groove”.
“I am going to lose all my mojo”.
“How much time off? I will definitely suck afterwards”.
But I knew this was too early to panic.
Wait 48 hours before pain stations
When injuries occur, it’s quite easy to panic. The mix of feelings, emotions and thoughts that come rushing in are just a fraction of the deluge that ends up being labelled “injury”. There’s the pain itself and dealing with not being able to do the things we normally do. There is the information overload. It seems, if you look in the right places, rib injuries cause cancer. Tie that all up with the feelings of guilt, sadness and anger and you suddenly have a perfect recipe for a lower case injury to become an INJURY (cue screaming noise).
I have been working as a physiotherapist and helping people with injuries for a while now. One of the rules (guidelines) that I almost fell in love with straight away was “Wait 48 hours before panic stations”.
A cute saying but those 6 words have a fair bit of science and wisdom behind them.
Firstly, the obvious before someone sues me.
Head injury, uncontrolled bleeding, huge skin damage, obviously broken bones, internal injuries, body parts that are detached, non responsive or otherwise?
Don’t muck around, Emergency Department. 000.
But most of the time it’s not that stuff. Most of the time, like me, you are heading home from training and there is a niggle. A pain, maybe a little bit of swelling in your elbow or knee or rib.
In the first 48 – 72 hours after injury your brain reacts to signals from tissue and floods it with all the chemicals it needs to heal. Once they are there, you want them to disappear quickly.
Swelling and inflammation are necessary for healing, but if it sticks around longer than 48 hours, this is normally a sign of serious trauma.
Hence, “Wait 48 hours before panic stations”.
What I did:
I waited and rested for 48 hours. This meant that I didn’t do much. Being a rib injury, it was hard to sit so I opted to work from home and used my stand up desk. I watched a fair bit of TV. I meditated lying down. I read my book and focused on other parts of my life. I woke up on Friday morning, and the capital INJURY had now become a manageable lowercase injury again. I got diagnosed by a physiotherapist friend that I trusted who advised against getting scans. It was a grade 2 cartilage tear near my false ribs.
“What’s the point? What’s it going to tell you that you don’t already know? Will the information change the way you treat the injury?”
The answer was NO.
So I didn’t get scans. Rib injuries are a bit of a funny one as there really is not much one can do except rest and slow re-introduction of movement. But this method isn’t as insane as it sounds. Volume manipulation and/or complete rest should be the first point of change for everyone. And if you are a runner, lifter or BJJ practitioner, the goal really should be to get back to that as quickly, efficiently and in a pain-free way as possible.
So Friday evening, 3 days after the injury, I went back to class. I didn’t roll. I barely got through some of the warm up. But I moved around. I modified things when needed and completely stepped out of the movements that I knew I couldn’t do.
The following week, I finished most of the class but kept the rolls limited to the people I trusted (Sorry white belts).
And before you know it, I was back. Last night, I rolled at a decent intensity with my friend Danny, turning upside down and the wrong way up, fairly pain free. As I sit here, writing this, there is still a niggle in my ribs. Most minor sprains, strains and injuries take up to 6 – 8 weeks to fully settle but this doesn’t mean that you have to cut yourself away from what you love.
In fact, coming back to the mats actually made it easier to return from the injury.
Hope this helps. See you on the mats.
P.S Some technical takeaways.
Most of you have heard of RICE, but it isn’t great. We need to be POLICED!! No, I’m not saying you are all delinquents that need locking up, it’s another groovy acronym.
Protect – If you have damaged something, it needs protection from excessive and continued use. How much depends on what you have done.
Optimal Loading – Again this depends on what you have done. Sometimes optimal is zero, but a lot of the time complete rest or non-weight bearing is bad for healing.
Ice – all the time and as often as you can. If you’re serious, wake yourself up and ice it overnight. Like the song says – Ice, Ice, Baby! And not at the pub in the bucket of coronas.
Compression – This isn’t a must but has shown to help. Carrying some cohesive bandages is a great idea to limit the swelling. Not wrapped in your jumper, at the pub.
Elevate – Body part higher than your trunk. Again, couch any home, not chaise lounge at the wine bar
DIAGNOSIS!!!!!!!! – The human body is amazing in its capacity to heal. The human person is by its nature a bit silly and can do millions of things to make this go slower. As Physiotherapists, we make sure you know what is wrong, get investigations if you need and are doing the best you can to recover in the shortest possible time for the best possible result.
What not to do – the HARM!!!
No Heat – if you’ve injured yourself keep the hot packs, heat rubs, hot rocks whatever away from it. Remember damage and pain are different. If you’ve got neck, shoulder, back pain but no traumatic incident, then absolutely heat it up. But things that swell and bleed, no Heat
NO ALCOHOL – Hard but true. A man/woman is not a camel, but if you have inflammation and swelling, booze will effectively turn the taps on to full and you will have a balloon where your knee/wrist/ankle used to be. The worst thing is it only takes a drink or 2! So, if you’re serious about getting back onto the mats ASAP – no booze. nil. nada. XXXX gold does not count and should be banned for crimes against taste.
No Running (or exercise – but HAEM looks silly) This doesn’t necessarily mean total bed rest, but if stuff is swollen, painful, bleeding, exertion is going to make it worse. If you can’t afford to not be training – get it looked at!!!! (See D for Diagnosis)
No Massage “Just rub it out, you’ll be fine” said a million old school trainers but no sports medicine practitioner ever. Massage promotes blood flow, increases transportation of inflammatory markers. Plus if you have damaged something serious, pushing it around doesn’t sound like fun.