Have you ever done something and as you are doing it you say to yourself, “this isn’t smart”, but that warning inclination doesn’t stop you and you do it anyway? I have found myself in that situation several times, most recently working out. Don’t be stupid with your workouts. Being stupid can get you hurt as I recently discovered.
The illustration below closely mimics what my chest looked like – not the well developed muscles but the bleeding in my left chest wall. I vary my strength training workouts. Usually I lift moderate weight performing moderate reps and several sets. On rare occasions I will lift light weight doing over 25 or more reps and multiples sets.
But, every now and then I will lift heavier weights, but usually on a machine as I typically workout by myself and using machines are safer.
Don’t Be Stupid
Recently, I was bench pressing using a barbell and had some spotter help. So I decided to see what my one rep max is. I was able to do 300 pounds which is my best. And, I felt I could have done another rep with that weight. And, then my spotter said, “Wow, that seemed relatively easy for you. I bet you can do 315.”
Three hundred wasn’t easy but I was able to do lift it in a nice continuous movement. So I thought, “Yeah, I think I can manage 315.”
Wrong idea …. especially at 57 years old. Why, do it? I pushed my luck with 300. At some point I’m going to fail. Why not end on a “high note” like Jerry Seinfeld recommends? And, what’s the point in trying to lift that much? It’s not like I compete. But, it was one of those stupid male moments.
So after a rest we increased the weight to 315. I got on the bench, positioned my hands on the bar, and counted to three, and lifted the weight off the rack. I lifted it to the highest point. No problem there. But, one third of the way down I felt two quick twinges in my left pectorals – could feel muscle fibers tearing – and said, “no, no.” My spotter quickly grabbed the bar. But, the damage was done.
Boy, Dr. Joe is Stupid
To make this maneuver even more stupid I already have problems with my left shoulder – partial subscapularis tendon tear (part of the rotator cuff) and degenerative tearing of the labrum (cartilage that goes around the socket”. The shoulder specialist I saw wasn’t too keen on scoping and cleaning it up and suggested I live with it for now, which I have done.
The Bright Side of My Stupidity
I like to look at the positive about any setback – and my stupidity. I can see three benefits with this injury. One, it has given me a topic for an article. I was running low on topics so the timing of this injury comes at a good time. Secondly, it has given me an idea for a another article on soft tissue healing and stem cells. And, thirdly has forced me to vary my workouts – and varying workouts is important.
Soft Tissue Healing
As a sports medicine physician I have often questioned the wisdom of icing a soft tissue injury. And, the more I learn about stem cells and how they work I now question the practice of icing more. After a soft tissue jury there is bleeding and inflammation which leads to swelling. That inflammatory response along with the extravasation of blood delivers all the necessary factors the body needs to heal itself – optimally.
Icing reduces bleeding and blunts the inflammatory response. It doesn’t make sense that we would interfere with that inflammatory process, at least not to me. You would be surprised at how many chemical and molecules are involved in tissue regeneration and they are released when there is bleeding. We will go into that in more detail in an upcoming article, but will provide a preview here.
But, we interfere with that natural healing process every day as physicians. Icing of soft tissues injuries is the standard of care. Should it be?
Returning to activities following injury is most dependent on range of motion and pain. Icing does reduce swelling and that facilitates return of normal motion, and thus return to play.
The downside to bleeding and the inflammatory response with its associated swelling is it takes time to resolve, and that limits return to play for an athlete. No doubt icing an injury enables an athlete to return to play sooner, but does it come with some trade-off with the quality of the healing? I suspect in some cases it does.
As physicians we are jaded because we only treat the people that come to our office. But for every person seen in the office with a moderately-severe ankle sprain there is another person with a moderately-severe ankle sprain who does not seek medical attention and does well with no “treatment”. We learn about those “patients” after the fact.
I am increasingly amazed at how well-designed the human body is. It’s miraculous. The body can take a lot punishment and still function well and has great capacity to heal itself if we allow it. The body knows what to do and how to do it when it comes to healing, though that diminishes with age as our number of stem cells decline.
Joseph Purita, MD who is a pioneer in stem cell therapies says this:
No physician in the history of humanity has ever healed a patient. Only the cells of the patient can heal a the patient….The best a physician can do is to move the obstacles out of the way of cells. Harnessing the power of the cells is the fundamental basis of Regenerative Medicine.
It seems to me that icing is an obstacle blocking cells including stem cells from doing what they can do.
If we look at ligament injuries (ligaments connect bone to bone) whether it be the anterior talo-fibular ligament of the ankle, the medial collateral ligament of the knee, or the ulnar collateral ligament of the elbow, the swelling that follows those ligament injuries ingeniously puts the affected joint in position or angle so that the involved ligament can heal at an optimal length. So why do we mess with that by applying ice to reduce the swelling? Mainly to get athletes back to play faster.
Let it Bleed
Following my injury, I did put ice on it immediately and once afterwards later that evening to help with some spasm and discomfort. And, then I thought, heck I’m just going to let it bleed as much as it wants.
The fact that I typically take a baby aspirin most days and fish oil (since I don’t eat fish) helps keep my blood thin and probably allowed my injury to bleed more than it would have otherwise, which is probably a blessing in disguise.
By the way, the photo at top was taken about 60 hours after my injury. As of this posting date it is now day three of my injury. For some reason the photo makes the injury look about 25% worse than it is in reality.
On day three I really had no pain at rest with not quite full range of motion on abduction and external rotation of the shoulder with some pain at the end ranges. I have not babied the shoulder.
Day two I used a rake and pulled some vines in our yard but did so carefully. And, I have been to the gym these past 3 days doing whatever I can do comfortably – mainly legs, aerobics, and some triceps work.
In general I think you should do as much as your body will comfortably allow following an injury with the goal of getting back to usual activities as soon as possible
My muscle is going to heal. If it doesn’t heal to the degree I need it to to do what I want to do then I am going to have a platelet rich plasma injection or PRP. Platelets are not stems cells but have stem cell like properties. They they contain numerous growth and tissue factors needed for soft tissue healing and are easy to obtain.
Platelets circulate in the blood in great numbers. You can obtain them in a blood draw, spin them down in a centrifuge to isolate the platelets and plasma, and then inject them in high concentration back into the body into the injured area to promote further healing. Hopefully, enough platelets have already been released in my body with all the bleeding I have experienced to heal this injury optimally. Time will tell.
As physicians we sometimes induce controlled bleeding to help tissues – mainly tendons and articular cartilage – to heal. When we do tennis elbow injections we stick the tendon several times with a needle as we inject medication to cause some bleeding in attempt to trigger a healing response. Surgeons will drill holes into to the bone to the bone marrow to cause bleeding allowing stem cells to enter the joint to trigger articular cartilage healing.
Yet, we use ice which blunts the healing response. Though most patients do well following the icing of acute soft tissue injuries, I wonder about the wisdom in that practice .
Don’t Be a Dumb Stupid Idiot
Don’t be a dumb, stupid, idiot like me. Here is my advise about your workouts.
I was going to say listen to your body. But, that advise really isn’t applicable to my injury as my body felt fine prior to attempting 315. Three-fifteen was just the straw the broke the camel’s back. But you can’t let “I bet you can do 315” go unchallenged. Who knows maybe I would have pulled off 310 or even 314, but I have no intention of finding out in the future. What makes my injury stupid is there was really nothing to gain by lifting that much at this age, other than a little ego trip.
So be sure to way the risks and benefits with your workouts. It’s okay and even good to push your body, but there is a point where common sense should prevail. Don’t be stupid like me. If a warning light goes off, listen to it.
When my wife asked what happened and I told her she predictably said, “You idiot.” Two days after the injury I was working out I showed my war wounds to a patient of mine who workouts at the same gym. When I told him what happened he asked, “Why would you do something dumb like that?” Whatever your choice of words, “stupid”, “idiot”, or “dumb”, they pretty much all mean the same.
Don’t be like me. Be smart with your workouts!
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