Overuse injuries

How many sports enthusiasts do you know who have had an overuse injury? Have you ever done too much one day and paid for it the next?

Overuse injuries result not from trauma or one specific event, but rather, they occur over time because repetitive motions cause tissue damage that requires time to heal. Most people associate overuse injuries with endurance sports such as running, cycling, and swimming. However, they occur in other activities as well. Nearly half of injuries are due to overuse, though it varies by sport.

Common overuse injuries

Overuse injuries affect nerves, tendons, bones, and ligaments. Carpal tunnel syndrome is a common nerve overuse injury.

Tendon overuse injuries include:

• Achilles tendonitis
• Rotator cuff tendonitis
• Lateral and medial epicondylitis at the elbow

Stress fracture is a common bone overuse injury, with others including little league shoulder or elbow in baseball players. Plantar fasciitis in the foot is a common ligament overuse injury.

Training errors and other causes

Overuse injuries occur when repetitive activity fatigues the tissue structure. Without sufficient time for recovery, micro areas of structural damage build, leading to pain and injury. With adequate recovery, the tissue adapts and strengthens.

The major cause of overuse injuries is training errors! With training, the phrase "too much, too fast, too soon, too bad" applies. When one does "too much" or "too fast" training before the body is ready, i.e., “too soon," then "too bad" an injury occurs.

Also, intrinsic and extrinsic factors lead to injury. Intrinsic factors are abnormalities in anatomy or other factors specific to the person.

Intrinsic factors include:

• Flat foot deformity
• Overpronation or supination
• Joint laxity
• Inflexibility
• Muscle weakness
• Anatomic misalignment

Extrinsic factors include:

• Training equipment or surfaces
• Footwear
• Technique
• Training errors
• Peer pressure

The first step in prevention is to correct training errors.

General rules include:

• Don't increase by more than 10 percent per week either distance, time, or intensity
• Only increase distance, intensity, surface, or type of training one at a time
• Have adequate recovery built into the training schedule, such as cross training, days off, slow and light days or weeks mixed with harder days or weeks to give the tissue time to recover
• Keep a training log so that corrections in the training schedule can be made to avoid future injury (most injuries occur from a change in training several weeks before)
• Monitor your heart rate, weight, and sleep. If your heart rate increases by more than 10 percent, weight decreases by more than 10 percent, or sleep decreases by more than 10 percent, then the body is stressed and needs recovery time.
• Correcting training errors includes any abnormalities in biomechanics, muscle imbalance or weakness, flexibility, equipment fit, surface adjustments, etc. With the sport, it's not just running, swimming, or kicking a ball, but also stretching, resistance exercise (such as weight training—even if it's body weight), and form.

Treatment and recovery from injury

Do not just treat pain from an overuse injury with non-steroidal, anti-inflammatory drugs. It isn't enough to mask the pain to play through it. Seek medical advice early, whether it be a team athletic trainer, a physical therapist, or a physician. A medical diagnosis will enable specific treatment to occur. The earlier care is sought, generally the quicker the recovery.

Generally, treatment includes:

• Rest, meaning modifying activity, including cross training or decreasing training time or mileage
• Ice
• Medications
• Physical therapy with stretching, progressing to specific strengthening exercises and then return to play activities
• Avoiding re-injury