NYC Marathon tips 2018

NYC Marathon Tips: How to Heal an Injury That Makes You Want to Drop Out… and Finish Strong

Here we are again about 6 weeks before the NYC marathon. Our medical massage therapy practice is getting flooded with new clients who are in pain training for the marathon. Each year we get an influx of folks worried they’ll have to drop out and desperate to get back on the road. We can’t guarantee that our NYC marathon tips will get every single one of them through the race. That being said, we have a great track record of helping runners rehabilitate quickly from an injury. And get back up to stride even this close to race day. Having learned a few things over the years, we are happy to share our best NYC marathon tips so that you can have the best day ever on November 4th!

My First Marathon Client That Almost Dropped Out

I’ve been in practice for close to 12 years now. Each year I routinely work with a several dozen NYC marathon runners in all phases of their training. However, my first, was way back in 2009, just a couple years after graduating massage school. A friend of a friend was training for his first ever marathon as a first time runner. (He was not a runner before starting training in spring).

NYC Marathon Tips 1

Start training long before you think you need to: My current advice for folks who aren’t already runners is to start training for a marathon 18 months before race day. (Most people start 6-8 months beforehand). He had started in April, just 7 months before the race. And yes, lots of people start training for their first NYC marathon in the spring of the same year and do fine. However, some folks have older injuries lurking in your history. These will tend to come out and wreak havoc on your training somewhere around September/October.

My client, let’s call him Sven (not his real name), came to me with a golf ball sized knot of seized up muscle tissue in his left calf… 4 weeks before race day. It had been getting progressively worse over the prior 3 weeks. It had gotten to the point where he could no longer run a single mile without debilitating, cramping pain.

He was obviously distraught and unsure what to do. Sven was worried about letting all the people who donated to his race down (a common concern). But he thought that he was beyond help. He had been to a physical therapist 3 times with no relief. Sven was highly skeptical that I could do anything to help him but our mutual friend assured him I was “miracle worker.” (no pressure there or anything!)

Ethically, I’m not allowed to make a guarantee that I can help clients. There are always going to be some cases that are beyond what massage therapy can relieve. Sometimes, surgery and physical therapy are a client’s best recourse. And sometimes all of the best NYC marathon tips you can find won’t matter. So I want to get that out there lest folks think that I actually go around touting myself as a miracle worker (no faith healing here, just straight up science at work). I told him this, and that I’d try my best but I thought I might be able to help.

How we got the client through race day in 3 medical massage therapy sessions:

Session One

I spent most of that first massage on the back of his legs. This included some truly intense deep tissue work directly on the bunched up calf tissue (with his permission of course). We also worked to open up his right hip which was not moving well due to an older injury. I theorized that the hip injury resulted from an even older right ankle sprain. This was confirmed by the client, so I also worked to get the right ankle moving with better alignment.

At the end of the session he said the whole area felt better than it had in weeks and he hoped that this would get him back to race form. At which point I gave him some of the best injury recovery advice I’ve ever come up with…

NYC Marathon Tips 2

Start Over Again – When recovering from an injury DO NOT try to jump back into the same level of training you were at before the injury. That is a sure fire recipe for the injury popping right back again and keeping you down. For Sven, I told him to do the following:

  • Wait two days (agonizing for a runner) before running, spend time stretching
  • Run only 1 mile as long as you aren’t in sharp pain
  • Then stop and call it a day
  • If you are in sharp pain during that 1 mile stop
  • If that went fine with no pain, rest the following day
  • On fifth day, try running only 3 miles as long as there is no sharp pain
  • Rest the following day
  • Book a follow up session for the next week on the 7th day after our first session

I can hear your teeth grinding just reading that list. “But, but, but….it’s only 4 weeks to race day and you are saying I should only put in 4 total miles this week?! What about my big 18 mile long run coming up?!?!?!?!”

Trust me, Sven wasn’t going to make it on that long run in the condition he was in. Thankfully, he did trust me and followed the NYC marathon tips to the letter. He emailed me after each of the 1 mile and 3 mile runs. Sven let me know that there was no sharp pain, just a “bit of tightness that opened up during the run and stopped bothering me by the middle.”

Session Two

Sven came in a week later for session number two. His calf still had a ball of seized tissue but it had shrunk down from golf ball sized to marble sized. We worked on it again, then focused more on quads and hip flexors including the all important psoas muscle. We also worked on opening up his ribcage, and diaphragm. In order to bring his upper carriage into a better alignment with his legs, we worked on his neck.

So many runners come in and request that I work on their legs over and over again. What they don’t realize is that their upper carriage tension in the neck and shoulders is a huge factor for why their legs are always so tight.

After session 2, I gave him the following to do:

  • Wait two days (again, totally agonizing for a runner) before running, spend time stretching
  • Then run 6 miles as long as you aren’t in sharp pain
  • Then stop and call it a day
  • If you are in pain during that run stop
  • If that went fine with no sharp pain, rest the following day
  • On fifth day after session 2, try running 12 miles as long as there is no sharp pain
  • Rest the following day
  • Book a follow up session for the next week on the 7th day after our first session

Sven followed the NYC marathon tips we gave him, emailing me to let me know that his whole running form had opened up. This was likely due to the upper carriage work. He felt not just fine but even better than before on the 6 and 12 mile runs. He wondered whether he even needed the third session. I told him to keep it just in case and that we might be able to shave some time off his run by working on his external hip rotators. He kept it.

Session Three

He came in for session 3 feeling good but a bit worried that he was getting to his long run a bit close to the race. The calf knot was almost non-existent. We spent the session working on his side body, bringing the left and right sides into better symmetry. This session is great for getting the ball and socket joints of the hips and shoulders free again which allows the rest of the body to ease up and relax. The session was on a Thursday.

I gave him the following homework:

  • Wait two days before running, spend time stretching
  • Then run the 20 mile long run as long as you aren’t in sharp pain
  • If you are in sharp pain during that run stop
  • If that went fine with no sharp pain, rest the following day
  • After that take it easy in the lead up to the race doing no more than a few short runs just to keep limber

Sven did fine on his long run and took it easy. Race day went swimmingly and he actually shaved a bit of time off his intended pace! He then followed our NYC marathon tips for race recovery and booked a post race sports massage. He came in for a post race recovery massage a couple days after the race and felt 100% normal by day four.

NYC Marathon Tips 3

Book a post race recovery massage: Some experienced runners book a recovery massage for the evening of race day. Unless you have run several marathons and are sure you’ll react well to that, we don’t recommend it. You could wake up the next day feeling like you had been run over by a tank. However, any time between the day after race and 4 days after the race will be super beneficial. Especially if you have to work at the office and sit in a chair all day. For our studio, we tend to book out the week after the NYC marathon in advance, so book early.

In support of all you runners, we are offering 10% off all sessions from October 1 through November 11th for anyone who is an official participant in the NYC Marathon. Simply bring in your entry approval when you come in for a session and we’ll happily apply the discount 🙂

What we have learned since then:

In a way, Sven was lucky that he was so sidelined. He was willing to go against all instinct and take it easy for a few weeks, even with race day approaching. Had he been in slightly better shape than he was, he might have pushed too hard after the first session. And re-triggered the injury.

Most of these repetitive stress running injuries are due to two main factors. One, an older injury that creates an asymmetrical running form. And two, the slow steady pressure that builds up in the muscles compensating for the older injury. As you start piling on the miles, there comes a tipping point when the system can’t handle what you are asking it to do. It starts complaining loudly. Then boom, you are sidelined.

Correcting the form towards a more symmetrical alignment means less work for muscles to do to get you moving forward. Which in turn means an easier run and faster times.

If all of your muscles are working towards propelling you forward you’ll go faster. If some of them are pushing you sideways or up (or even backwards) instead, you’ll lose efficiency and slow down. Other muscles will have to work harder to fight that movement. You’ll also increase the impact with each stride creating the potential for stress fractures in your feet, shins, hips, or spine.

Ideally, we would work with you when you first start training so that you already have an improved running form. Before you pile on the miles. My NYC marathon tip for Sven after he completed his first successful NYC marathon was to cross train over the winter. Then come in for a few sessions next spring to work on his form. And to go celebrate his first completed NYC marathon  in style 🙂

However, as you can see from above, coming in for medical massage work at any point before race day is likely to improve your day. If you are injured, follow our NYC marathon tips and book a session. Also coming in for a post race recovery massage can get you back to normal quickly!

Good luck to everyone running this year!

physical therapy meets massage therapy

Doing Physical Therapy? Massage Therapy Can Improve Results!

7 Reasons why this powerful combination works

Pain sucks. As a massage therapist, I would know. Almost everyone who comes to see me does so because they're in pain!

Most of the time, my clients have such a powerful response to massage therapy they don't need additional therapies. However, that isn't always the case. I always look for clues that indicate I need to refer a client to another practitioner, such as a physical therapist. 

Physical therapy and massage therapy are both powerful methods for treating pain. By focusing on correcting the underlying muscular imbalances that have caused it in the first place. When used together, they can help clients achieve faster and better results.  

There are several reasons why massage therapy is effective for anyone who is already receiving physical therapy.

Here are the top 7:

  1. Providing pain relief, often times after the first session
  2. Increasing range of motion so that the body can move better
  3. Decreasing local inflammation by working above and below the area
  4. Lessening the pain clients may be feeling during or after physical therapy exercises
  5. Decreasing the pain clients may feel post-surgery
  6. Bringing faster results than just physical therapy alone 
  7. Motivating clients to stick to their physical therapy treatment plan

That's the short version of why massage therapy and physical therapy are a powerful combination. If you're interested in a more detailed explanation, read below! 

The Breakdown: 

1) Massage therapy helps by treating short and overused muscles. 

The goal of many physical therapy exercises is to help strengthen any weak muscles that are causing pain symptoms. The goal is that by strengthening weak muscles, the body will move & feel healthier. But that's only half the picture. 

When it comes to muscles, imbalance happens when one muscle is weak and long while another muscle is overused and short. In order to correct this, BOTH of these problems need to be addressed. This means following the exercises provided by a physical therapist teaching clients how to engage and strengthen muscles that are weak. It also means using massage therapy to address the muscles that are chronically overused.

The right massage therapist will focus on releasing these tight muscles as well as lengthening them when they've gotten short. This can help effectively decrease pain while also improving range of motion and helping the nervous system learn how to move better! 

2) Massage therapy will help with physical therapy. 

Studies show that one major obstacle to physical therapy treatment is that many will stop coming in if the exercises are painful to do, or if their pain doesn't decrease right away. (Source: Read this article) Basically, if the work is too hard and painful, people are a lot less likely to do it. Massage therapy can decrease pain often with immediate results, which will help provide motivation to stick to the physical therapist's treatment plan.  

3) Massage therapy can help post-surgery.

Sometimes people will experience new aches and pains after their recovery from a surgery, even while doing physical therapy. This can happen due to a change in the body alignment and how the body moves after the procedure. If clients are already doing regular physical therapy and still experiencing pain post-surgery, I suggest asking a doctor if it’s medically safe to try massage therapy.

For more detailed information on how massage therapy can help post-surgery, please check out this in-depth article: Click Here!

 

In summary, we see that combining physical therapy and massage therapy help clients move better and feel better by working on correcting any muscular imbalances that can be causing or contributing to pain. 

Want to read more about how we work at Bodyworks DW? 

Click to Learn More about our Massage Therapy
text neck massage therapy neck pain shoulder pain

Save your text neck

The perils of “always on” technology:

Okay, so your "text neck" probably won’t actually kill you (unless you are texting and driving). However, it’s becoming increasingly likely that at some point in the next 5-10 years of tech use, you’ll develop a repetitive stress disorder.

The phrase carpal tunnel syndrome (wrist pain) has been part of the collective conscious for several decades. It's so common as a disrupter of productivity that it has spawned an entire industry of ergonomics solutions. These range from special keyboards to Star Trek styled full desk/monitor set ups. All keep you at your desk longer making trades, typing contracts, writing legal memos.

And then the 2000’s came along. Most of us jumped all in with smartphones and laptops and tablets.

Suddenly we could be productive all the time.

Standing on the subway platform?

Let me check my email.

Taking the train in from CT?

Let me just go over those sales reports.

Date just went to the bathroom?

Let me text my assistant to make sure I’m set up for tomorrow’s board meeting.

Unfortunately, there are costs to constant device use that might change your mind about your phone and tablet.

Looking down at our phone, tablet, or laptop, pulls our head forward and down. This imbalances all the muscles holding up your head (ahem... text neck). These imbalances can cause any and all of the following:

  • neck pain
  • shoulder pain
  • TMJ
  • headaches
  • low back pain
  • carpal tunnel syndrome
  • anxiety
  • low energy
  • bone loss
  • depression
  • memory loss

Sound scary? Don’t believe it?

Check out this New York Times article: Keep Your Head Up: How Smartphone Addiction Kills Manners and Moods

Like many things that aren’t healthy for us, these costs are not going to suddenly show up tomorrow. They build up over time. In ways that make it hard to track what the changes are doing to your body. However, there is hope for us all!

What can I do about this?

I’m not some Luddite preaching that we should all return to farming. I happen to be a business owner with 20+ employees and have tech in so many screen sizes it’s getting ridiculous. I deal with text neck too. 

I’ve got a smartwatch, smartphone, an iPad for home and one for work, an airbook laptop, an iMac at my desk. Not to mention the 15 other devices I have at the office for the staff to be "productive" on. I’m just as tempted as you to go on my phone on the subway and read articles on Facebook or Twitter to pass the time. So I decided to try something out...

Experiments DW

Over the past 2 weeks, I’ve been running an experiment to see just how much I can lighten up my daily commute (see the last blog post on how much we carry around with us and tips to help with that).

I’ve gotten down to just leaving home with the following:

That’s right….NO BAG.

I had to get really clear on what my time is worth to me and what my long term health is worth to me. And I had to spend some extra cash to duplicate certain items at work and at home so that I wouldn’t have to cart them back and forth.

Is it worth it? For me this experiment has been a fascinating eye opener. It’s also reduced my daily stress levels by about 20-30%.

I have less issues with headaches at day end, my back feels better, and my overall mood has noticeably improved.

I’ve got new rules for my text neck, I count em:

#1: I am not allowed to look at my phone during my commute except to choose music.

#2: I am only allowed to work while at the office, or while at my desk at my home office. The couch is only for relaxing and the bed is only for sleeping (and well, you know…).

#3: If I need something both at work and at home, I duplicate that item rather than carry it back and forth. The value in stress reduction and ease of movement on my body is a long-term savings in health and self-care costs down the road.

#4: If I do have to look at a device, I hold it up to horizon level and keep my head up.

#5: When my arm gets tired of holding up the device to eye level rather than looking down, it’s time to take a break and put it away.

You may think I’m crazy for buying a second iPad to keep one at work and one at the office. Really the only reason for me to do that is that it has become my primary note taking device for my life coaching sessions. Sure, I could take notes on paper, but then I’d have to create a filing system for them. The iPad keeps all my notes for each client on the cloud.

Of course, you’ll have to do your own analysis of the following:

- what you can and can’t do without

- how much is your time is worth

- which work can be left until tomorrow or

- what work can be put on hold for the 45 minutes to 2 hours you spend on your commute

You’ll probably come up with different ways to reduce your load and stress than I have. (For instance, maybe it’s spending the extra cash on a monthly gym locker. You can leave your workout gear there most of the time.) Prioritize those ideas and see for yourself how helpful it can be. 

Are you willing to give lightening your load and keeping your head up a try? Yes? Your text neck will thank you.

massage therapy for diastasis recti massage case study

Massage Therapy for Diastasis Recti

Getting to the core of the issue

First off, what is this strange sounding condition?

It’s most common among pregnant or postpartum women. About two thirds of pregnant women have it. So why have you never heard of it?
People don’t talk about.

The facts:

Diastasis Recti is a condition where the rectus abdominis splits down the middle causing a vertical gap in the abdominal muscles. It can cause lower back pain, constipation, and urine leaking. It can even make it harder to breathe and to move normally.

How to treat it if you have it:

Massage therapy for Diastasis Recti can be very helpful to rebuild proper abdominal tone as long as you’re also working with a physical therapist who specializes in this issue. An experienced massage therapist can open stuck tissues that are pulling the abdominal muscles outward. These stuck tissues are generally from previous injuries that have left scar tissue behind. In addition to this kind of bodywork, you’ll need physical therapy exercises to knit the torn muscles back together.

 

Why “ab” exercises don’t work for you now…

 

It’s counter-intuitive, but doing “ab” exercises such as sit ups, or pilates, can often make the problem worse. Without proper firing of the correct support muscles, these exercises often pull outwards on the linea alba (centerline where the gap develops). This can either increase the separation, or keep it from knitting back together.

A combination of massage and physical therapy can speed up the healing process considerably. In most cases it will open up the stuck tissues that would keep physical therapy exercises from working. The synergy between the two modalities is worth way more than the sum of the parts.

Why?

Because massage therapy is an “opening” practice. Our training is in releasing tissues that are either tight (ie over-firing) or stuck (ie glued with scar tissue). We also work to retrain the nervous system to allow muscles that are over-firing to relax and settle into a balanced tone.

Physical Therapy is a “closing” practice. It’s based in strengthening and tightening muscles that are weak (ie under-firing). The repetition of certain exercises draw blood flow to areas that need it, allowing the body to heal and reconstruct itself.


Ready to put in the work?

Diastasis Recti is not a one-time fix situation. It takes a coordinated effort, diligent homework, and focused effort for 8-12 weeks. It is next to impossible to self-heal without a minimum of a few guided sessions. Most clients will need the following:

4-7 sessions with a professional massage therapist

3-5 sessions with a physical therapist who specializes in working with Diastasis Recti

15 minutes a day of homework exercises


If you’d like to know if massage therapy for diastasis recti can help you, don’t hesitate to call us and arrange a phone consultation with David Weintraub. Or book an initial session online!

 

Deep Tissue Massage Therapy for Low Back Pain

Massage Therapy versus surgery for Low Back Pain – an effective alternative?

  • Why medication is just masking the root cause of your pain

  • How a targeted series of massage sessions can significantly reduce pain from herniated lumbar discs and other causes of low back pain

Massage therapy for low back pain is an effective alternative treatment to surgery and medications. Additionally, in most cases the results are noticeably better than either of those traditional approaches according to the newest research (excerpt from Vox article "A comprehensive guide to the new science of treating lower back pain").

How Massage Therapy for Low Back Pain can Help

Bulging discs seem to come out of nowhere, but in reality there are usually other root causes. For instance, an older ankle or knee injury can create an imbalance in the body leading to pain. Compensation from older injuries puts asymmetrical pressure on the low back. Eventually this can cause one or more lumbar discs to bulge. If the bulge presses on nerve pathways, extreme pain can result.

At Bodyworks DW, we evaluate how the rest of the body and posture is affecting your low back pain. Then we will make a plan for a series of session that will unwind any seemingly unrelated issues. As the whole body opens up, pressure on the low back is relieved, allowing the disc to return to it's normal shape. With less and less pressure on the nerves, pain slowly but surely goes away.

How Traditional Approaches Fail

Surgery tries to correct this by shaving down the bulging disc or fusing two vertebrae together. However, the root cause is still affecting the body. The surgery can eliminate symptoms for a short period. Then the bulge pops out in another disc making the problem even worse later on.

Medications mask symptoms, which can feel good and sometimes help you move through the issue. However, the root cause it usually not addressed. Pain will likely come back to plague you in the future. Opioids are especially worrisome as they are highly addictive. This can lead to reliance on them to even function. In an increasing number of cases the addiction spirals out of control.

How Massage Therapy works differently 

With massage therapy for low back pain, we work to discover why the disc is bulging in the first place. Meaning you'll get a more holistic approach. The pathway might be slower, but you'll know that your pain is being reduced in a healthy way. And you'll gain the tools to keep it from coming back in the future.

In addition to massage therapy I want to point out some research from the American College of Physicians advising doctors and patients try “non-drug therapies” such as exercise, acupuncture, tai chi, yoga, and even chiropractics, and avoid prescription drugs or surgical options wherever possible. (If the non-drug therapies fail, they recommended nonsteroidal anti-inflammatory drugs as a first-line therapy, or tramadol or duloxetine only as a second-line therapy.) Centers for Disease Control and Prevention also came out with new guidelines urging health care providers to turn to non-drug options and non-opioid painkillers before considering opioids.

Research is mounting that active therapies (exercise programs, yoga, tai chi) can really help people work through back pain, and alternative approaches (massage, spinal manipulation) can be effective, too.

Are you suffering from low back pain? There are many advantages to working with our team of trained medical massage therapists.

Book online or call today to see if massage therapy for low back pain can help you!

Book Appointment
massage therapy for neck pain

Massage Therapy for Neck Pain: Effective Lasting Treatments

Have you considered massage therapy for neck pain?

Neck pain is a common complaint.

We tend to keep our head in a “head forward” position. This pulls the muscles in the back of your neck into a constant stretch. And makes them work extra hard to fight the weight of your head. Muscles hate being stretched and working hard, so they yell at you. Loudly 🙂

We’ve developed truly effective massage therapy for neck pain that provides long term relief at Bodyworks DW.

Does this sound like you?

a) Sitting at a desk staring at your screen,
b) looking down at your phone much of the day,
c) reading your iPads in bed to unwind and destress after a long day at work

massage therapy for neck pain
The roots of your neck pain aren’t in your neck!

So, my massage therapist should work where the pain is the whole time, right?

Actually, no.

It may feel good to have your therapist spend the session massaging mostly where you feel pain. However, the next day you will feel like you were hit with a bag of hammers. And it won’t do anything to relieve the pain in the long term. Massage therapy for neck pain has to address what’s causing your head to move forward in the first place. And it’s not anywhere near your neck!

The following three areas need to be released move your head into a more balanced position. This allows the muscles in the back of your neck and upper back to relax and stop yelling at you.

3) Is your current massage therapist only working on the back of your neck? Yes, we know that’s where it hurts. However, he or she is not going to make a long term impact. The back of your neck is over stretched. The front side needs to be released in order to give the back some slack.

2) The position of your ribcage in relation to your pelvis is vitally important to relieving neck pain. With a head forward position, the ribcage tilts backwards to compensate. The muscles in the mid back will work extra hard. If I only release the front neck muscles and not the mid back muscles, your neck will feel a lot better, but you’ll be stuck looking up at the ceiling.

1) Your tight hip flexors (from sitting all day) are why the ribcage moves backward and the head moves forward. And if we open up the angle of your neck and your ribcage, but not the hip angle, you’ll be left stooping over!

Effective massage therapy for neck pain addresses all of the forces pulling on your head

Addressing your neck pain effectively requires releasing each of these folds in the same session. You will feel immediate relief at the end of the first session. And you won’t feel sore or beat up the next day.

However, one session won’t “fix” the problem. The first session is a great start to open up the surface musculature. And the first session allows for deeper work in later sessions. Your relief will last a lot longer.

To have a long term impact, we will follow up the first session with 3-5 custom designed sessions. These session will work on more detailed areas in cumulative layers. Each session allows us to go deeper into the stuck front neck muscles and bring your head into better balance. With your head balanced on top of your spine all of the muscles work less. Less work = less pain!

massage therapy for ankle sprain

Massage Therapy for an Ankle Sprain: Advice for Runners

Massage Therapy for an Ankle Sprain: what to do from the moment you get injured…

Massage therapy for an ankle sprain wasn’t my intended topic this week. Then I took a bad fall in a parkour class trying to jump a 12 foot gap. I’ve now got about 6-8 weeks of healing, before exercising again in any weight bearing or high impact capacity. Based on my own professional assessment, anyway.

It’s also timely and useful for those of you currently training for the NYC Marathon or the Ironman Triathlon to know a bit more about treating ankle sprains.

I know that there is a lot of info out there about what to do and what not to do. And much of this info is confusing and conflicting. So I’m going to walk you through what to do based on the most recent science. Using my own injury as an example.

First things first: how bad is it?! (is anything broken)

Before you attempt to do anything at all, you need to figure out if you have a broken bone or an ankle sprain. The very very very last thing you want to do with a bone break is try to move it. So you need to assess visually before assessing whether you can move it.

Questions to answer:

  • assuming you are in excruciating pain, is the ankle hanging off at an extreme angle? (If so do NOT attempt to move it)
  • do you see bone sticking out? (Again do NOT try to move it)

If it does seem like a bone break, you need an ambulance. Call 911 if you are alone, have bystanders do it if there are people around. Do not skimp here and try and get to the hospital by taking a cab. It needs to be looked at by qualified professionals and splinted/immobilized before you are moved. If you try to load yourself in a car, even with help, you are going to smack it around with every bump. This will shred the soft tissue around it even more. More shredded soft tissue = even longer recovery. Not worth it.

Okay, it doesn’t seem broken…now what? (no, not the RICE method)

First, gently test to see whether you can move the ankle at all. Small circles in both directions, flex and point, wiggle the toes. Even just a slight ability to move is a good sign that nothing is completely torn through. If you can make tiny circles, flex and point, and move your toes, then it’s likely an ankle sprain. Of course it’s still possible that you have hairline fractures in one or more of the bones or partially torn ligaments. So don’t jump to conclusions.

In the old days, athletic coaches would tell you to walk off an ankle sprain at this stage. Unfortunately, this has the immediate danger of ripping apart the soft tissue even more. And potentially tearing a muscle, tendon, or ligament all the way through. Trust me, anything torn all the way through is going to take a LONG time to recover. So you definitely want to avoid the possibility of making things worse.

In 1978, Dr. Gabe Mirkin developed the RICE method (rest, ice, compression, elevation). Since the, RICE has been king in sports medicine. The RICE method counteracted the “walk it off” method and prevented further injury to the soft tissue. However, as we are now learning, it also slows down the healing process. And potentially freezes clotted tissue to the ligaments. In the last few years, science has had a nearly 180 degree turn on RICE (in fact, Dr. Mirkin himself has refuted RICE on his own website). Several studies now show that Ice delays healing, as does anything that reduces inflammation.

Second step…flush the tissue with small light movements to a tolerable level of dull pain, but not sharp acute pain. 

In the case of my ankle sprain this meant:

  • lie on my back and raise the ankle up to elevate it
  • make small tiny circles back and forth with the ankle to a tolerable level of dull pain
  • also point and flex the ankle and the toes to a tolerable level of pain
  • use your hands to assist if needed
  • flush for a few minutes, rest,
  • then lightly (and I do mean lightly) stroke the injury area with your fingertips, moving towards the heart
  • repeat several rounds of flushing and resting
  • check in with your pain levels and your body for 15-20 minutes

If the circles get slightly easier to make and/or larger, and your body starts relaxing a bit more, move on to next phase. If the area does not start to move a little better and calm down a bit, go to a sports doctor to get xrays, there may be smaller hairline fractures or a torn through ligament or tendon. 

The point of the flushing phase is three fold: moving fresh blood with nutrients and proteins to rebuild into the area, break down ripped up tissue and old blood, move the broken down wastes out of the area.

The third step…very gently attempt to put weight on the area

In my case with an ankle sprain, it’s best to try to come to hands and knees first, then either with assistance or by grabbing on to something, pull yourself up on the good ankle. Then, while holding on to something or with assistance, try to gently put weight on the bad ankle.

Assess the pain this causes (and it definitely will cause pain)….is it intense but diffuse, or sharply acute on one spot?

  • With intense but diffuse pain, you can attempt to slowly put weight on it and take a step while holding onto a wall or another person
  • With sharply acute pain, take weight back off of it and try flushing it for a few rounds while standing on the good leg, then try to put weight on it again

if putting any weight on it again causes sharp acute pain, such that you can’t take a step at all, get to a doctor or hospital. You’ll want to get xrays and an MRI to see if there are any hairline fractures and/or torn tendons or ligaments. We recommend a few great NYC physical therapists on our collegues page due to their high level of experience and their philosophy of doing full 60 minute sessions with each patient.

However, if you can hobble on it with tolerable pain, call a car and get yourself home, trying to keep the injured ankle elevated on the back seat. If you don’t have a friend with you, call someone and have them meet you at home. You are going to need some help and support.

The fourth step…recovery

ankle sprain massage therapy
My ankle sprain, the day after

Once you are home, elevate the ankle, and make sure that you drink water and eat some food, preferably fruit. This will immediately raise your glucose levels and help keep you from going into shock. Have a blanket handy in case you get cold and start shivering. Absolutely try to get help from a friend, partner or family member to purchase a few needed items. Get a cane and a slip on ankle bandage that provides support and compression. Also an arnica based lotion to apply to help move the bruising through. My personal fav is Topricin.

Why a cane and not a crutch? A crutch will be much easier to move around on at first. However, it will create havoc on your shoulder. In addition, it will be too easy to get moving fast on it, which is a recipe for taking a quick wrong step and re-injuring the ankle. A cane is somewhat humbling, but you can’t really move any faster on it than your bad ankle will let you, which is a good thing.

Recovery is all about getting blood to and from the ankle. Move it or lose it is the name of the game. Keep flushing it several times daily with rounds of circles and movement to a tolerable degree of discomfort. Too much and you’ll probably just want to vomit. None, and the ankle will heal frozen in place and you’ll just have to rip the tissue back open again to get it moving. Slow and steady wins the healing race.

Wear the compression brace whenever you plan to try walking on it. For now you’ll need the stability and it will keep the blood pressure from feeling too awful. However, don’t wear it 24/7. Take it off and elevate it at home when you can (and should) rest.

Recover Faster with less chance of Future Injury

ankle sprain massage therapy
two weeks after injury
ankle sprain massage therapy
four days after injury
ankle sprain massage therapy
My ankle sprain, two days after injury

While it is possible to heal this type of injury on your own, you’ll get far better and quicker results working with experienced wellness professionals. Work with an acupuncturist during the initial stages, and a massage therapist and physical therapist as it starts to heal and take weight better.

DO NOT attempt to exercise on it until you can walk comfortably, without pain or discomfort, without wearing the brace. (At least not without direct guidance from a physical therapist.)

The main reason I’m already walking without a cane and almost no limp at 2 weeks is that I’ve gotten treated 3 times with e-stim by acupuncturist Erika Prinz who hosts community style acupuncture at our studio every thursday. I’ve also had massage therapy sessions from my staff. E-stim (or Electroacupuncture) is especially valuable at the beginning stages to promote healing in the damaged tissue.

Now that I am walking mostly without a limp, and able to take stairs up and down reasonably well, my next move will be getting advanced massage therapy sessions from my staff in order to keep the injury from adversely affecting my knee and hip on the right leg. Often the biggest impediment to healing an injury all the way through is locked up compensating musculature in the rest of the body. In the beginning, this compensation was necessary to keep you from further injuring the ankle. Now, it’s just in your way.

Last but not least…for NYC Marathon Runners

Our tendency is to want to dive right back into our exercise routine once we feel like we have little to no pain. This is just asking for re-injury. Take 4-6 weeks to slowly but surely add back in exercise. Act like you’ve never worked out before. Start small and steady. My first “rehab” exercise was walking to a cafe down the block with my wife for brunch after being stuck at home for 4 days. If you used to run 6 miles a run 5 times a week, start with a walk to the subway. Then walk a quarter mile a few days later. Then walk a half mile in week 2. Maybe by week 3 you try running around the block once. Maybe.

If at any point you step weird and it feels hurt again (and trust me this will happen), take it easy, continue daily flushing. It’s all part of the process of rebuilding a solid working structurally sound ankle.

If you bite off more than you can chew at this stage, you may step wrong, roll the ankle again, this time worse, tearing through already weak ligaments. Do you like the thought of having to take 8-12 MONTHS to recover?! Don’t push too hard!