Everyone's Health

Self-Management: Recovery From Dangerous Crash

Accident convalescence can be as life-threatening as the accident itself. Continuous bed rest can be as detrimental as aging.

The mid-size car hits like a T-bone onto Steve and his bicycle. Steve flies over the car hood onto asphalt. A passerby stops to hold his head, immobilizing it while her friend calls 911. Soon strapped to a gurney and inside the ambulance, Steve is whisked to a medical emergency room. Emergency doctors examine, x-ray, CT scan, and re-package him. Released in the evening, he is now at home with scheduled doctor appointments and the probability of weeks or months to convalesce.

At home in his living room with companion dog Russell for comfort, Steve’s left foot is velcroed to a walking board. It’s too painful to bear weight. Broken bones in the foot will mend, but not today. His left forearm and palm of hand are in a fiberglass cast. The wrist and thumb are immobilized. Steve’s right hand hurts. His neck is painful. He has a throbbing headache.

Bicycle/car accidents can kill or cause permanent damage. Convalescence can be as life-threatening as the accident itself. Three weeks of complete inactivity can be as detrimental as years of aging.

This accident victim is at risk for loss of aerobic capacity, muscular atrophy in the injured foot and leg, left forearm and hand, right hand, and possible long-term complication in his neck and above as well as deep vein thrombosis (DVT), and potentially related heart attack. Primary care physicians say people who don’t exercise are also more likely to suffer from depression.

The purpose of this article is to inform you about practical methods you can use during a period of partial immobilization, to lessen the likelihood of developing more serious problems. It is about maintaining as much fitness as possible during recovery; each situation differs depending upon your injuries. Your health care provider should be consulted in case there are medical contraindications. The information is for individuals who are generally healthy before the accident. Specific disease conditions should be considered individually. Self-management is recommended in addition to physician and physical therapist services.

Good physical condition before the accident provides a desirable base for successful recovery. The advantages of your previous endurance and resistance training will be reversed when you stop or reduce training. The greatest losses are from prolonged bed rest and immobilization by casts. You need a basic maintenance training program to prevent these losses in function. This general information excludes compromising situations such as disability, hot or cold environment, and aging considerations.

If your lower body is not injured, check with your health care provider for permission to continue, or modify, your regular aerobic training routine. Detraining can be modified, perhaps even prevented, by continuing to do some approved amount of intense exercise. In general, you can retain substantial cardio fitness if the duration of each session is reduced by as much as two-thirds, but only if your intensity of exercise during these shorter session is about 70% of your capacity. If you exercise at reduced intensity, for example at 45% of your capacity, in as little as 15 weeks your aerobic capacity will diminish noticeably, and within 2 to 8 months all of your previous cardio gains from training will be dissipated. With your health care providers approval, your fitness trainer can design a suitable maintenance program for you.

While resting, maintain good posture and a slight contraction of your abdominal muscles for much of the time. Wear loose comfortable clothing. Elevate your calves while seated. Be sure they are supported by bedding or a foot stool or a stack of magazines. Elevation and support help to maintain circulation.

During recovery from lower body injuries, after you can move around but not yet jog or use a treadmill, investigate whether your fitness facility has an arm crank machine or other upper body aerobic equipment. Your club may have visit privileges with a nearby rehab or disability organization.

Even during recovery period, your activity goal is to include more physical activity as part of daily life. Include flexibility by moving all joints through a full range of motion at least 3 days per week. Use stretches for thighs and lower back area. Use yoga principles, i.e. holding the stretch for several full breaths or several seconds. You need to do whatever is appropriate in your circumstances to continue the long-term health and fitness benefits of regular activity.

If your legs or feet are injured, as in this bicycle versus automobile example, your circulatory system needs help to overcome gravity bringing blood back to his heart from the lower body. Breathing helps, and muscles in your legs and abdomen assist. Valves in veins prevent backflows. Activity prompts better functioning of the body’s disease fighting cells so that the immune system functions well and keeps the person healthy in numerous ways. You, or someone else, can help maintain circulation by massaging areas that you are temporarily not moving.

Deep vein thrombosis (DVT) is a blood clot in a major vein, usually in the legs or pelvis. DVT is caused by blood clots in veins where blood flow is sluggish or has been disturbed. Blood pools. Bits thicken into a clot. The clot moves slowly through the body to vital organs. It may lodge in a lung or heart. There may be a heart attack. The person may die or have serious heart problems. If the person lives, he may require long-term medical supervision. It is vitally important to maintain circulation by whatever means is possible, depending upon the injuries causing immobilization.

Muscular strength and power is lost at a much slower rate than aerobic capacity diminishes. You may retain full strength and power for the first four to six weeks of inactivity. If you remain moderately active, after 12 months you may still have almost half of the strength you’d gained by resistance training before the accident.

Muscular strength for the average non-athlete can be sustained by as little as a single session per week of resistance training, but only if the usual intensity is continued.

When you are seated or in bed for long periods, try the following every hour or more often. Lift a foot, point your toes, contract your calf muscles, and move your foot in circles. Repeat with other foot. Then contract your calf muscles, holding tightly for 30 seconds or more before releasing. Tighten your thigh muscles, holding tightly for 30 seconds or more before releasing. Do not hold your breath. Continue up your body, tightening, holding, then releasing your abdominal muscles, your buttocks, your chest, your back muscles. Always continue breathing normally. These isometric exercises are a form of resistance training that will help to maintain muscle tone, and assist in circulation.

When your arm or leg is in a plaster cast, muscle mass is lost faster than with mere stopping of resistance exercise training. Your anti-gravity postural muscles in your legs are the most affected by prolonged immobilization. Muscles atrophy faster than bones lose their density. When you resume normal activity, the decreases in cardio and muscle function reverse within days or weeks. However, reversing the decrease in bone mineral density requires weeks to months.

If your upper body is not injured, even though your lower body is immobilized, use free weights to maintain fitness and improve circulation in your arms, and upper torso.

Resume your regular activity and fitness routine as soon as possible. Meanwhile, do stretching, flexibility, range of motion in every joint it’s reasonable to use during recovery. Tense and tighten muscles. Peform isometric exercises. Aerobic will be the most difficult to perform adequately during recovery. Training with light weights can help to compensate during this time. You can do trunk twists and side bends while seated. With your arms at your sides, lean to one side, sliding your arm down your leg.

Caution: Avoid heavy resistance exercises because of the possibility of excessive increase in blood pressure and the additional load on your heart.

Consider adding selected yoga postures to your maintenance routine during recovery. Yoga poses help you maintain flexibility and range of motion and enhance fitness during recovery. Be alert for pain while performing yoga and obey that signal to stop the motion. Go slowly into postures, so as not to reach a difficult pain threshold. Begin by breathing quietly, focusing fully on the air flowing in and out, breathing through your nose. Notice becoming more still and quiet. As your muscles contract and relax, circulation to those muscles, increases. Emphasize practicing a posture for your individual capacity, without concern for an external ideal form. Proceed gently and steadily.

Yoga examples here

• 1 - Hamstring stretch will assist your flexibility and circulation. Begin while lying on your back. Bend one knee, then raise that leg to vertical. Grasp calf or thigh with both hands, press leg gently toward torso, release, repeat twice, then press toward torso holding for three full breaths. Repeat with other leg.
• 2 - Begin in sitting position with legs extended in front, feet separated. Stretching up out of your waist, and bending from the top of your thighs (the natural fold for bending) reach hands toward calf or ankle, holding briefly, releasing, then reaching and holding for three full breaths. Return to beginning position. Repeat on other side.
• 3 - Begin in sitting position with legs extended in front, feet together. Raise straight arms in front to shoulder level. Tightening abdominal muscles, lean backward part way, without touching chair back or bed pillows. Remain in leaning position for 5 full breaths, release, repeat three times.
• 4 - Begin in sitting position with straight arms extended to front, chest high. Move hands separately out to sides at same level, tighten chest muscles and arm muscles and, with fingers separated, tighten all hand muscles. Maintain this isometric position for three full breaths, release, re-tighten twice, return arms to original position, and lower them.

Summary and close.

It’s to your advantage to use all possible means to maintain physical fitness during convalescence. Immobility is detrimental to your future. Loss of tone and strength may be inevitable for some body parts, depending upon your situation. It’s to your benefit to do reinforcement activities that are acceptable for your situation without hindering the mending of broken bones, torn ligaments, contusions, lost toenails, or whatever detriments you have suffered. Follow physician and physical therapy recommendations, and get approval to add the suggestions in this article to your modified fitness routine. You will have a head start on rebuilding your strength, flexibility, and cardiovascular levels when recovery is complete.

Taber's Cyclopedic Medical Dictionary & Taber's Electronic Medical Dictionary CD-ROM

Deep vein thrombosis: Thrombosis of a vein or veins in the deep venous system of the upper or lower extremities. This may occur without obvious cause but is more likely to occur as a result of any condition that involves venous stasis or damage to the endothelial area of a vein, or as a result of conditions associated with certain surgical procedures and the accompanying inactivity of the patient. In many cases the result of this is that the thrombus will form and a portion of it will travel to the lung and create pulmonary embolism.

Thrombosis: The formation, development, or existence of a blood clot or thrombus within the vascular system. This is a life-saving process when it occurs during hemorrhage. It is a life-threatening event when it occurs at any other time because the clot can occlude a vessel and stop the blood supply to an organ or a part. The thrombus, if detached, becomes an embolus and occludes a vessel at a distance from the original site; for example, a clot in the leg may break off and cause a pulmonary embolus.

Bibliography:

Physical Activity and Health: A Report of the Surgeon General
The Health Fitness Handbook
Yoga Journal, June 2003
Yoga for Dummies, 1999

Prior | Tell us what you think | Next

Add to Your Social Bookmarks: Del.icio.us Digg Furl Reddit Simpy Spurl Y! MyWeb - Netscape - StumbleUpon StumbleUpon