A simple guide to overuse injuries
What are overuse injuries?
Overuse injuries are known by many names and can often be confusing. Tendonitis, tendinopathy, RSI (repetitive strain injury), stress fractures, stress reactions have all been used to describe these injuries. Quite simply an overuse injury is an injury that occurs over a period of time as a result of more force or load going through the body’s tissue, than it can recover from. These injuries will usually have a gradual onset. They can occasionally appear suddenly, however there will usually be changes in the tissue well before any symptoms are noticed.
Common examples of overuse injuries include Tennis Elbow, Golfers Elbow, Plantar Fasciitis, Achilles tendon pain, Rotator cuff pain and stress fractures.
How does an overuse injury occur?
All of the tissues in your body are in a constant cycle of breaking down and repairing. This includes your skin, bone, muscle, tendon and hair cells. Usually there is a fine balance between the tissues breaking down and being repaired, and the tissue stays healthy. In an overuse injury the tissue starts to break down faster than it is repaired, and the tissue becomes unhealthy or weakened.
If there is more load being put through a tissue such as a tendon cell, the tissue will break down faster. An increase in load on the tendon may be due to an increase or change in activity, tight muscles pulling on the tendon, an increase in weight, or poor biomechanics such as inappropriate footwear.
There may be other factors that influence a tendon’s ability to repair. As we get older the body does not repair as quickly as it used to. Other factors such as poor nutrition, diabetes, or smoking will also significantly reduce the body’s ability to repair and recover.
Over a period of time with poor loading or recovery, the tissue starts to weaken. This will occur well before any symptoms start to appear. If the tissue becomes weak enough or even inflamed you may start to feel pain.
What are common symptoms?
The most common complaint of overuse injuries is pain that came on gradually after a change or an increase in activity. The pain may come and go and be fine for weeks or even months at a time before recurring. Pain may be worse in the morning or with the beginning of activity, and may ease as the activity continues. In the early stages it usually feels better with rest or a period of time of reduced activity. As symptoms progress the pain can become much more constant, more severe or more frequent. These symptoms may not go away by themselves and it is common for people to complain of months or even years of discomfort.
How are overuse injuries treated?
Because overuse injuries are a result of improper loading, we need to modify the amount of load on the tissue. This may result in a period of time with reduced activity, orthotics or appropriate footwear, release or stretching of tight muscles, taping or bracing, losing weight, or correction of any faulty techniques.
Addressing causes of poor healing may also help recovery. Things like making sure diabetes is well controlled, stopping or reducing smoking, and having a healthy diet with adequate sleep can all help.
Tissue loading is healthy and required to strengthen tissue or maintain adequate strength. Strengthening surrounding muscles and tissue will help allow the tissue to cope with more loads and become healthy again. This is done via a specific progressive exercise program and a gradual return to activity.
Other options of treatment can include Shockwave therapy or dry needling. Your physiotherapist will be able to discuss if this is suitable for you.
What about injections?
Corticosteroid injections or injections such as platelet rich plasma (PRP) or autologous blood injections are often offered as treatment options. These may help with pain and symptoms however will not address the factors originally causing the condition, so should be considered as second line treatments after physiotherapy. There is evidence to suggest that corticosteroid injections may lead to worse long term outcomes and further tissue weakening, so these should not be the first line of treatment or if used should be in conjunction with physiotherapy.
But some weeks it doesn’t hurt?
Overuse injuries are not always symptomatic. We know it takes approximately 3 months for significant improvements in muscular strength, and up to 12 months for significant improvements in tendon strength to occur with specific exercise. Because of this simply having no pain does not mean your tissue has returned to a healthy state, it may mean you have not loaded the tendon enough to become symptomatic and it is likely to become painful again with a slight change in activity.
What should I do?
A good rule of thumb to avoid overuse injuries is slowly increasing any new activity by a maximum of 10 percent each week. This will allow your body’s tissues time to adapt and strengthen to cope with any new demands. Remember it is much easier to treat an overuse injury early, so seek early treatment. If you think you may have an overuse injury speak to one of our physiotherapists today.
Author Kent Jordan, Back In Motion Valley View
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