Sporting Overuse Injuries
The growing trend in all sports is an increased volume or intensity of training. However, the drawback of increased training is that repetitive activity can lead to an overuse injury which is why overuse injuries have become such a common problem in sports medicine.
An overuse injury occurs through repetitive micro trauma to the tendon, bone or ligament which overloads the capacity of the structure to repair itself. This results in an inflammatory response which over time can lead to structural changes to the tissue.
The human body has remarkable capacity to adapt to physical trauma. Adaptations can be positive, for example through being active and participating in regular exercise your bones, muscles, tendons and ligaments get stronger and more functional. This happens through a process of remodelling where tissue is broken down and rebuilt to repair itself. However, if this process is disproportionate and tissue is broken down more rapidly than it is rebuilt injury can occur. This imbalance in the remodelling phase
Overuse injuries are more subtle than acute injuries and usually occur gradually over time and are often associated with your training and technique. These injuries can occur anywhere in the body and with any sport that places constant, high demands on tissue.
Examples in sport:
- Tennis elbow-pain is on the outside of the elbow but caused by overuse of wrist muscles. It is important to reduce inflammation quickly and minimise scar formation.
- Swimmers shoulder (rotator cuff tendonitis) – reducing swimming load may be necessary. Ultrasound, soft tissue massage and exercises are important. Tennis players also get this with serving/overhead smash.
- Runner’s knee – this is due to patellofemoral joint pain (kneecap). Assessment of training methods, running technique is important. Strengthening of the inner quad muscle and taping is very effective. Calf/hamstring/ITB stretching is important too.
- Gluteus medius tendinitis/bursitis-hip pain due to long distance running. Pain is felt on the outside of the hip and made worse by stairs and getting in/out of car. Pelvic tilt may be present which needs correction if so. Sometimes a cortisone injection is required.
- Shin splints- usually soft tissue attachment to the tibia(shin bone) is the cause. Ultrasound and soft tissue release is important. Sometimes cause is stress fracture of the tibia. High foot arches if present need attention.
- Achilles tendonitis. Often slow to recover. Ice/stretching/ultrasound is important. Precursor to Achilles rupture so carrying this injury without attention is risky. Long distance running is often the cause. Assessment of foot arches may be needed.
- Plantar Fascitis -heel pain frequently caused by excessive running or dancing. Pain is often worse first thing in the morning. Responds well to ultrasound, frictions and taping/stretches. Fallen foot arches if present need attention.
- ITB friction syndrome. Pain is felt on the outside of the knee..Running, particularly excessive downhill running ,can cause this. Usually quick to respond to treatment.
This lists common examples-there are many more- a thorough assessment is crucial to positive outcome and speedy recovery.
Treatment:
Relative rest –avoiding aggravating factors-whilst maintaining strength and fitness is important. Addressing the cause is important-is it biomechanics, alignment, sudden increases in training levels, equipment or shoes? With this, treatment can be successful and includes advice, electrotherapy (ultrasound,TENS) soft tissue and joint mobilisation, icing, exercises and if necessary anti-inflammatory drugs. Scans such as x-rays and diagnostic ultrasound may be necessary.
Working together getting you back to your chosen sport or sports as quickly as possible.