Overuse Injuries

Overuse Injuries

 

Article by J.Miller, Z.Russell, A.Clarke

What is an Overuse Injury?

Overuse injuries refer to injuries sustained from a repeated action (such as repetitive strain injury) as opposed to 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 in such a way 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.

Injury identification and treatment in stage 1, allows 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 rate no faster than 10% increase per week (distance, speed, weight, etc).
  • Practice and concentrate on 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 is highly recommended for overuse injuries. Not only are you repairing acute symptoms you are also aiming to avoid its recurrence once your training resumes.

Sports Injury Management

You probably already know that a sports injury can not only affect your performance, but also your lifestyle. The latest research continues to change sports injury management considerably.  Our challenge is to keep up to date with the latest research and put them to work for you.

How we treated you last year could vary greatly to how we treat you this year. The good news is that you can benefit significantly from our knowledge.

What Should You Do When You Suffer a Sports Injury?

Rest?

Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases.  The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days.  After that, you need to get it moving or other problems will develop.

Ice or Heat?

We normally recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.

Once the "heat" has come out of your injury, heat packs  can be used. We recommend 20 minute applications a few times a day to increase the blood flow and hasten your healing rate. Heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to specifically discuss your situation.

Should You Use a Compressive Bandage?

Yes. A compressive bandage will help to control swelling and bleeding in the first few days.  In most cases, the bandage will also help to support the injury as the new scar tissue is laid down. This should help to reduce your pain. Some injuries will benefit from more rigid support such as a brace or strapping tape. Please ask us if you are uncertain what to do next.

Elevation?

Gravity will encourage swelling to settle at the lowest point.  Elevation of an injury in the first few days is very helpful, especially for ankle or hand injuries.  Think where your injury is and where your heart is. Try to rest your injury above your heart.

What Medication Should You Use?

Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek their professional advice as certain drugs can interfere with other health conditions, especially asthmatics.

When Should You Commence Physio?

In most cases, "the early bird gets the worm".  Researchers have found that intervention of physiotherapy treatment within a few days has many benefits.  These include:

  • Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
  • Improving your scar tissue using techniques to guide the direction it forms
  • Getting you back to sport or work quicker through faster healing rates
  • Loosening or strengthening of your injured region with individually prescribed exercises
  • Improving your performance when you do return to sport - we'll detect and help you to correct any biomechanical faults that may be affecting your technique or predisposing you to injury

What If You Do Nothing?

Research tells us that injuries left untreated take longer to heal and have lingering pain.  They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your symptoms the better your outcome.

What About Arthritis?

Previously injured joints can prematurely become arthritic through neglect. Generally there are four main reasons why you develop arthritis:

  • Previous injury that was inappropriately treated (eg old joint or ligament sprains)
  • Poor joint positioning (biomechanical faults)
  • Stiff joints (lack of movement diminishes joint nutrition)
  • Loose joints (excessive sloppiness causes joint damage through poor control)

What About Your Return to Sport?

Your physiotherapist will guide you safely back to the level of sport at which you wish to participate.  If you need guidance, simply ask us.

What If You Need Surgery or X-rays?

Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, they'll also refer you elsewhere if that's what's best for you. Think about it. you could be suffering needlessly from a sports injury.  Please use our advice to guide you out of pain quicker . and for a lot longer.

If you have any questions regarding your sports injury (or any other condition), please contact your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.

Acute Sports Injury Clinic

PhysioWorks has established an Acute Sports Injury Clinic at our Ashgrove, Clayfield and Sandgate practices to assist with the early assessment and management of acutely injured sports injuries.

The acute sports injury consultation fee is significantly lower than a routine assessment and treatment consultation. In most cases, your private health will cover the full cost of your full acute injury physio assessment fee.

How to Best Care for Your Sports Injury?

There is never an excellent time for an injury. But we do know that most sports injuries occur over the weekend! That's why at PhysioWorks, we have established an Acute Sports Injury Clinic at a selection of our clinics on a Monday and Tuesday.

Why Use an Acute Sports Injury Clinic?

Your Acute Sports Injury Assessment Consultation allows us to provide you with:

  • A quick and accurate diagnosis. One of our Sports Physiotherapist's or an experienced sports injury-focused Physiotherapist will confidently guide your new injury management.
  • Early acute sports injury care, professional advice and education. What to do this week?
  • Fast referral for X-rays, ultrasound or MRI scans to confirm your diagnosis.
  • Prompt referral to Sports Physicians, GPs or Surgeons with whom we work if required.
  • Immediate supply of walking boots, braces and rental crutches if needed.
  • Low-cost professional service.

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sports physiotherapist brisbane

Who is a Sports Physiotherapist?

Sports Physiotherapy is the specialised branch of physiotherapy which deals with injuries and issues related to spokespeople. Practitioners with additional formal training within Australia are Sports & Exercise Physiotherapists.

What is Sports Physiotherapy?

Sports injuries do differ from common everyday injuries. Athletes usually require high-level performance and demand placed upon their body, which stresses their muscles, joints and bones to the limit.  Sports physiotherapists help athletes recover from sporting injuries, and provide education and resources to prevent problems.

Each sports physiotherapist usually has sport-specific knowledge that addresses acute, chronic and overuse injuries. Their services are generally available to sportsmen and women of all ages engaged in sports at any level of competition.

Members of Sports Physiotherapy Australia (SPA) have experience and knowledge of the latest evidence-based practice, skilled assessment and diagnosis of sports injuries, and use effective 'hands-on' management techniques and exercise protocols to assist recovery and prevent future damage. SPA members have access to the most recent advances in sports physiotherapy. You'll be pleased to know that most of PhysioWorks physiotherapists and massage therapists have a particular interest in sports injury management.

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice.  Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

Hands-On Physiotherapy Techniques

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.

Can You Change Knee Running Stress?

It has been shown by simply changing the way we run can have a large bearing on how much stress goes through our knees... and who’s knees wouldn’t mind that?Heiderscheit et al (2011) found that simply by increasing the step frequency during running you can "offload" your knee joint stresses.

Simple things that you can change:

  • Decreasing your step length to avoid overstriding.
  • Less up and down movement of your centre of mass.
  • Less "braking" force on your lower leg.
  • Less knee bend at foot strike.

What is an Efficient Cadence?

Most efficient marathon runners take roughly 180 steps per minutes (90 each leg). If you take fewer steps than this, your knees, shins and heels have more impact stress per stride to disperse plus you tend to overstride.The detrimental implications of overstriding are multifactorial. Primarily as you overstride you require more hip flexion to pull your foot and knee further forward. This effectively inhibits the opposing gluteal muscle group. Your gluteals have a vital hip extension, external rotation and hip abductor control, which leads to hip control. Ineffective gluteals lead to hip “collapsing” issues. Overstriding also increases your heel impact rather than midfoot impact, which can lead to stress fractures in your heels or shins.Edwards et al (2009) research showed that reducing your stride length decreased the probability of stress fracture by 3% to 6%. And, who wouldn’t want to decrease their risk of stress fractures?Overstriding also has an impact on the oscillation of your centre of mass. Essentially you’ll bounce up and down more. The effect is that the ground reaction force absorbed by the ankle, knee and hip at foot strike again increases. You’ve surely seen how some runners simply glide across the air with their feet touching the ground. Compare that to the struggling collapsing runner who I'm sure you also encounter on running paths.This increases the braking force on the stance limb which effectively increases the ground reaction force imparted onto the knee.Finally, overstriding requires additional knee bend during your stance phase. This increases the likelihood of your kneecap compressing into the trochlear groove of your thigh bone. Do that enough and you’ll have painful clicking kneecaps.

How Can You Increase Your Step Cadence to Improve Your Stride Length?

Step cadence can be easily measured and re-trained by running on a treadmill and either watching a step counter (eg Garmin) or listening to a metronome set at 180 to 190 steps per minute. Smartphone apps can be downloaded and played back as you run. Other research, by Wily et al (2105) has shown that this can be effectively done in a two-week block running four times per week.For more advice, please ask your running physiotherapist.Call PhysioWorksBook Online

Common Running Injuries

Running is one of the easiest and most popular ways to stay fit. It is also one of the easiest ways to develop an injury. Running injuries are common and often affect the hips, knees, ankles, and feet of runners. The impact and stress of running is sometimes hard on the muscles and joints; especially if you ignore early injury signs.
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