Overuse injuries are injuries that occur because of tissue damage caused by repetitive activities associated with occupational, recreational (including physical activity, exercise, and sport), or other types of habitual activities. Overuse injuries are also known as cumulative trauma disorders.
Overuse injuries occur when a person places stress on some particular part of the body that has previously not been exposed to such a stress. For example, a person who is learning to play a new sport or an athlete who is working on a new training technique may place stress on fingers, toes, ankles, knees, shoulders, or other parts of the body unaccustomed to such stresses. The body's normal response to a new stress is to experience minor strains and tears that begin to heal through the repair of damaged tissue. As long as the repair process occurs at a rate at least as fast as damage occurs, no long-term effects are to be expected. But it often happens that such is not the case, and damage occurs more rapidly than the body can repair itself. In such cases, the trauma that has taken place begins to occur, manifesting itself as discomfort, achiness, and pain. These symptoms generally do not show up until some time after the new activity has begun, a matter of weeks or months.
Many specific examples of overuse injury are known by the location of the injury (knee or ankle, for example) and the activity responsible for the damage (typing or throwing, for example). Among the dozens of overuse injuries that have been given special names are:
A number of the most common overuse injuries are also well known by their medical names, including:
Data on the incidence of overuse injury among participants in a variety of occupation and sports and among the general public are widely available. Space limitations here permit a review of only a sample of those data.
Overuse injuries are hardly restricted to sports and other athletic events. Any person who uses the same mechanical motion over and over again is subject to overuse injury. For example, a 1992 study of 59 adult piano players found that over half (53.7%) experienced overuse injuries severe enough to interfere with their regular practice schedule.
In general, overuse injuries are caused by one of two kinds of factors: intrinsic or extrinsic. Intrinsic factors are those that are part of an individual's basic physical makeup, his or her anatomical structure. Sometimes it is just not possible for a person to ask her or his body to perform certain types of functions: to throw a ball in a particular way, to clear a high hurdle properly, or to swing a golf club correctly. Anyone who forces his or her body to perform actions that are physically impossible or unsuitable is likely to develop an overuse injury as the person tries over and over again to get the action “right.” No amount of training or expert advice can prevent overuse injuries in such cases.
Overuse injuries are sometimes difficult to diagnose because they develop over a long period of time. An individual may feel for some time that a knee, ankle, shoulder, or other body part is just “sore” because of exercise and workouts. By the time a person recognizes that the problem may be more serious, the injury may be well developed. The first step in diagnosing any form of overuse injury is a medical history in which patient and doctor try to identify the specific physical actions that may have led to the problem. Often, this history in and of itself may be enough to identify the general type of injury involved. The medical worker may then follow up the patient history with a thorough physical examination that includes a biomechanical evaluation, which may identify the specific location of tissue damage. In some cases, imaging tests, such as x-rays, CAT scans, or MRI scans, may be needed to determine whether or not there has been a bone fracture or tissue tear, and the extent of that damage.
Probably the most common treatment for overuse injuries is R.I.C.E. R.I.C.E is a term that refers to treatment that includes four elements:
R.I.C.E is largely an immediate, short-term approach to the treatment of overuse injuries. On a long-term basis, one may have to use medications that reduce the swelling that causes pain associated with overuse injuries, such as nonsteroidal anti-inflammatory agents (NSAIDs). Physical therapy is often an essential element also in helping damaged tissues to repair themselves and muscle groups to regain their normal strength. Treatments such as hydrotherapy and ultrasound may also help tissues to heal.
Prognosis for full recovery of overuse injuries differs somewhat based on the severity of the injury and the type and location of injury. Generally speaking, however, most overuse injuries heal completely, provided that a person (1) follows completely a recommended treatment regimen and (2) corrects any training errors or errors in technique that led to the problem originally. On average, most overuse injuries improve in a matter of four to six weeks, although more difficult problems may take up to six months to get better.
The most obvious way to prevent overuse injuries is to be aware of and to avoid their main causes, poor training programs and poor technique. Some specific recommendations that trainers make include the following:
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Berliner, M. “An Ounce of Prevention: Physical Activity Plan Can Help Weekend Athletes Allay Overuse Injuries.” Rehab Management 24, no. 3 (April 2011): 18–19.
McLeod, Valovich, et al. “National Athletic Trainers' Association Position Statement: Prevention of Pediatric Overuse Injuries.” Journal of Athletic Training 46 no. 2 (March 3, 2011): 206–20.
Laker, Scott. “Overuse Injury Treatment & Management.” Medscape. August 20, 2015. http://emedicine.medscape.com/article/313121-treatment (accessed (January 20, 2017).
American Orthopaedic Society for Sports Medicine, 9400 W Higgins Rd., Ste. 300, Rosemont, IL, 60018, (847) 292-4900, (877) 321-3500, Fax: (847) 292-4905, firstname.lastname@example.org, http://www.sportsmed.org .
David E. Newton, AB, MA, EdD