Overuse Injuries – an Individualised Approach

Introduction

Overuse injuries are common and difficult to evaluate and manage. These types of injuries are caused by a variety of factors. Understanding the medical diagnosis and the cause of the injury are some of the challenges that clinicians may face in its implementation athletes with overtime injuries.

Definition of Overuse Injuries

An overuse injury is characterized by a lack of visibility or trauma. It starts slowly and the injury results from repeated micro-trauma.[1] The term overuse is used because the onset of these types of injuries is often precipitated by a period of inappropriate muscles loading like:[2]

• Excessive magnitude or volume of load
• Inadequate recovery between prolonged burdens

Why Does Overuse Lead to Injury?

Overuse injuries are usually caused by repetitive activities over a period of time. This repetitive microtrauma overwhelms the tissue’s ability to repair itself.[2] During the exercise the muscles like muscles muscles bones and muscles are becoming loaded and experience overwhelming physical pressure. In addition to the specific exercise activity, muscles adapt in order to become stronger and able to withstand similar stresses in the future. When the adaptive capacity of a particular muscle is exceeded and injury occurs, this is usually an overuse injury. Thus in overzealous athletes who do not allow adequate time for adjustment before the next workout or training session the accumulated muscle damage ultimately exceeds the demand that the muscle can meet deal with and this leads to pain and functional impairment.

Structures Affected by Overuse Injuries

• Bone
  • E.g. Bone stress injury Stress fracture Osteitis Periostitis Osteoarthritis
• Tendons
  • eg. tendinopathy
• Ligaments
  • E.g. Medial ulnar collateral ligament injury in baseball pitchers
• Muscle
  • E.g. Myofascial Pain Chronic Compartment Syndrome Exercise-Induced Muscle Soreness
• Bursa
  • Subacromial Bursa Greater Trochanteric Bursa
• Nerve
  • eg. nerve entrapment syndromes
• Cartilage
• Skin
  • eg. blisters

Risk Factors of Overuse Injuries

Training load, intense competition schedules and inadequate or inadequate recovery are some of the factors that make athletes more prone to overuse injuries. Risk factors can also be divided into intrinsic and extrinsic risk factors:[3][4]

• Intrinsic Risk Factors
  • Malalignment issues such as knee valgus or patella varus, high femoral neck anteversion
  • Leg length discrepancy
  • Muscle imbalance
  • Muscle weakness
  • Mobility issues, such as tight muscles throughout the body that limit the range of motion of the joints
  • Body composition
• Extrinsic Risk Factors
  • Wrong training load, such as too much volumetric intensity for increased recovery and insufficient recovery
  • Surfaces
  • Shoes
  • Equipment
  • Environmental conditions
  • Nutrition
  • Psychological factors

Physiotherapy and Overuse Injuries

Physiotherapists are advocates of physical activity and are closely involved and invested in restoring clients to an appropriate level of function. This level of functionality is different for every client or athlete, and using a customized and personalized approach is critical. way to help The athlete’s return to peak level of function and return to competition is achieved through a thorough understanding of the athlete’s specific sport and an understanding of the physical and psychological demands and demands of the sport. [5]

Imagery Explaining Overuse Injury Management

Patient education is important in the management of overuse injuries. Additionally, there is value in involving multidisciplinary teams and coaches. Treatment or intervention methods are based on managing the loads and/or forces that cause the injury so that the tissues involved have Enough healing time, but also building resistance to these forces. [6] An image of two tugboats pulling at each other can be used to educate patients about their overuse injury. Green tugs (good) will push overuse injuries to heal and restore function or Exercise while red tugs can take overuse injuries away from healing and lead to more serious pathology. The key is to find a balance and fuel the green tugboat with all necessary interventions to promote healing, but not fuel the red tugboat and exacerbate Pathology [5] Educating the client and taking a multidisciplinary and holistic approach is key when developing a treatment plan. Dynamic and flexible timelines should be established, and multi-phase evidence-based and functional progression should be part of the intervention plan.

Assessment of Overuse Injuries

Key factors to consider when assessing an overuse injury include:[7]

• the structure involved
• the nature and severity of the injury
• Duration from onset of symptoms to injury – this will help understand the progression of pathology

Diagnosis of Overuse Injury

Clinical history

• This is an important and valuable tool in diagnosing overuse injuries
• Hear what your clients, coaches, or other medical professionals who work with athletes tell you!
• Identify specific causative factors (intrinsic and extrinsic)
• Also consider the forces on the structure when the athlete is not participating in the sport (e.g. gardening) – understanding the total force on the structure in question is key
• Consider a population at high risk for overtime injury such as:
  • Children – variable training and competitive characteristics in youth sports with a combination of immature musculoskeletal systems[8].
  • Women athletes (Women’s Athletes Trinity)[9]
  • Older athletes – factors such as loss of bone density or existing degenerative issues that can lead to overuse injuries

Diagnostic Imaging

• Plain Radiographs – to detect associated or random bony abnormalities
• Ultrasound – effective imaging modality for tendinopathies although personnel dependent
• MRI
• CT

Diagnosis

Identify the nature and severity of the program(s) involved as well as the duration from the beginning. This will provide insight into the course of the disease. Early diagnosis greatly reduces barriers to optimal treatment.

Management of Overuse Injuries

Phase-appropriate interventions are needed to address overuse injuries. Athletes who come in at different stages of the pathology (i.e. some will present early with an overuse reaction while others may have been struggling with an injury much longer and. pathology of the injury is far more progressed.) Treatment goals may include:[4]

• Identify and address the cause of injury
• Reduce inflammation and pain
• Promote healing
• Prevent complications
• Restore normal use of the injured area
• Symptom-Based Return-to-Play Strategies

Optimize tissue healing through systematic gradual and optimal loading of structures to provide restoration of function and volume.

Treatment modalities may include:

• Relative or graded rest and avoidance of strenuous activity while maintaining fitness [10]
• Recovery protocols
  • Cryotherapy and manual therapy techniques
• Manual therapy
• Strengthening and rehabilitation [10]
  • Phase appropriate loading
  • Progressive loading and conditioning exercises (and the effects of limiting detraining)
• Referral to an appropriate healthcare provider
  • Psychologists – Mental Preparation for Returning to Play
  • Nutritionist – Appropriate Nutritional Advice Considering Exercise Energy Needs
  • Sports physician or specialists