Overuse Injuries

Overuse Injuries

Article by John Miller

What is an Overuse Injury?

Overuse injuries refer to injuries sustained from a repeated action (such as repetitive strain injury) instead of acute injuries, which occur in an instant (such as a sprained ankle).

Overuse Injuries Can Occur to the Following Structures:

Exercise applies stress to the body. Your body adapts by thickening and strengthening the various tissues involved.  Hence, muscles get stronger, firmer and sometimes larger, tendons get stronger and bone density increases.

However, if exercise is applied so that adaptation cannot occur, the excessive overload can cause microscopic injuries, leading to inflammation, which is the body’s response to injury.

Signs of Overuse or Inflammation include:

  • Swelling (which may be unnoticeable)
  • Warmth to the touch
  • Redness
  • Impaired function of the part.

All of these signs may be present but not noticeable in the beginning stages.  Often the first sign may be stiffness or soreness (especially in the morning), which may disappear with a warm-up. Continued use may cause continued damage, and the pain will last through, and past warm-up and maybe even worse after an activity is finished.

The Four Stages of an Overuse Injury:

  1. The discomfort disappears during warm-up.
  2. The discomfort may disappear during warm-up but reappears at the end of an activity.
  3. Discomfort that gets worse during the activity
  4. Pain or discomfort all the time.

In stage one, injury identification and treatment allow continuing activity as long as the injury does not worsen.

A stage 2, the activity may continue at a modified pain-free level while being treated.  Treatment must continue until completely healed.

If the injury progresses to stage 3, the activity must immediately cease. The supervising physiotherapist will allow a return to action after identifying the cause, and you are completely symptom-free. Competitive athletes, depending on the individual circumstances, may return to activity.

If the injury progresses to stage 3, the activity must immediately cease. The supervising physiotherapist will allow a return to action after identifying the cause, and you are completely symptom-free. Competitive athletes, depending on the individual circumstances, may return to activity with stage 1 symptoms.

What Causes Overuse Injuries?

  • Lack of appropriate muscle strength or endurance
  • Poor core stability
  • Muscle imbalance (strong, tight muscles versus weak stretched muscles)
  • Inflexibility
  • Malalignment or Biomechanical issues (e.g. flat foot, squinting patellae)
  • Training errors
  • Faulty technique
  • Incorrect equipment.

By far, the most common cause of overuse injury is training errors.  Moreover, the most common error is “too much, too soon”.

How to Prevent an Overuse Injury

We can prevent overuse syndromes.  Some of the ways to prevent this injury include:

  • Warm-up (including stretching) and warm-down (including stretching) before and after all exercise.
  • Use proper equipment (e.g. jogging shoes for jogging, a racquet that is the right size with the proper grip size and strings strung to your level of play).
  • Increase at a faster rate than 10% increase per week (distance, speed, weight, etc.).
  • Practice and concentrate on the correct technique.
  • Condition yourself for 2-3 weeks before starting – strength and flexibility.
  • Listen to your body – pain is a warning that something is wrong.  Early identification and treatment will allow you to continue your activity.
  • Identify and correct the cause of pain or discomfort.
  • Ensure full injury rehabilitation, e.g. a sore right leg can cause an overuse injury in the left through compensation.

Common Treatments for Overuse Injuries

The two most important steps in the management of overuse (inflammation) injury are:

  • Remove cause
  • Reduce inflammation
  • Carefully return to activity as the symptoms dictate.

Professional assessment and guidance are highly recommended for overuse injuries. Not only are you repairing acute symptoms you are also aiming to avoid its recurrence once your training resumes.

Article by John Miller

What is a Tendinopathy?

Tendinopathy (tendon injuries) can develop in any tendon of the body. You may have heard of tendinopathies referred to as its aliases: tendonitis, tendinitis, tenosynovitis and tendinosis. In simple terms, they are all tendon injury pathologies, so the medical community now refers to them as tendinopathies.

Typically, tendon injuries occur in three areas:

  • tendon insertion (where the tendon attaches to the bone)
  • mid-tendon (non-insertional tendinopathy)
  • musculotendinous junction (where the tendon attaches to the muscle)

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to occur suddenly, but usually, it is the result of repetitive tendon overloading. As mentioned earlier, health care professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This means "inflammation of the tendon".

Mild inflammation is actually a normal tendon healing response to exercise or activity loading, but it can become excessive, where the rate of injury exceeds your healing capacity.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes the tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent.
  • Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good.
  • The tendon tissue is attempting to heal.
  • You must prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Prognosis: Poor!
  • Tendon cells are dying!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

What is Your Tendinopathy Phase?

It is crucial to have your tendinopathy professionally assessed to identify its current injury phase. Identifying your tendinopathy phase is vital to direct your most effective treatment since certain treatment modalities or exercises should only be applied or undertaken in specific tendon healing phases.

Systemic Risk Factors

The evidence is growing that it is more than just the tendon and overload that causes tendinopathy. People with diabetes, post-menopausal women and men with high central adiposity (body fat) seem to be predisposed to tendinopathies and will need to observe their training loads.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be similar or combined with bursitis.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist or doctor will ask questions about your past health, symptoms, and recent exercise regime. They'll undertake a thorough physical examination to confirm the diagnosis. They will then discuss your condition and devise an individualised treatment plan.

They may refer you for specific diagnostic tests, such as an ultrasound scan or MRI.

Tendinopathy Treatment

Tendinopathies can normally be quickly and effectively rehabilitated. However, there is a percentage of tendinopathies that can take months to treat effectively.

As mentioned earlier in this article, it is important to know what phase your tendinopathy currently is. Your physiotherapist can assist not only in your diagnosis but also guide your treatment to fast-track your recovery.

Before you seek the advice of your physiotherapist or doctor, you can start treating an acute tendon injury at home. To achieve the best results, start these steps right away:

  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.

When to Return to Sport

Every tendinopathy is different, so please be guided by your physiotherapist assessment. Be patient, and stick with the treatment exercises and load doses prescribed by your physiotherapist. If you start using the injured tendon too soon, it can lead to more damage and set you back weeks! It may take weeks or months for some tendon injury to heal and safely cope with a return to sporting loads.

Tendinopathy Prevention

To minimise reinjuring your tendon, you may require some long-term changes to your exercise activities. These should be discussed with your physiotherapist. Some factors that could influence your tendinopathy risk include:

  • Altering your sport/activities or your technique
  • Regular prevention exercises.
  • Closely monitoring and record your exercise loads. Discuss your loading with your physiotherapist and coach. They will have some excellent tips.
  • Always take time to warm up before and cool down / stretch after you exercise.

Tendinopathy Prognosis

While most acute tendinopathies can resolve quickly, persisting tendon injuries may take many months to resolve. Long-term or repeat tendinopathies usually have multifactorial causes that will require a thorough assessment and individualised rehabilitation plan.  Researchers have found that tendon injuries respond differently to muscle injuries and can take months to solve or potentially render you vulnerable to tendon ruptures, which can require surgery.

For specific advice regarding your tendinopathy, please seek the advice of your trusted healthcare professional with a special interest in tendinopathies.