What is an Overuse Injury?

“I haven’t done anything that I don’t usually do…”

As physicians we hear it all the time.
 
A patient comes in and has an injury that has cropped up over the past few weeks. There was no specific accident or inciting incident they can remember. All they know is it slowly started to hurt over the past few weeks, and now it’s getting in the way of work, exercise, or daily activities.
 
This is an overuse injury, and it’s what makes up about 3/4 of the typical sports medicine patients we see.

I like to make the analogy of the straw that broke the camel’s back. The patient has been doing the same thing, the same exercise, the same motion, over and over again, day to day, year to year. Tissue can begin to wear out. Over time, stressed tissues, such as ligaments and tendons, can start to wear down, producing micro-injuries. At the start the micro-injuries are so minute they don’t affect daily use. Eventually they add up, and then one day they add up enough to cause symptoms. That last injury was the straw that broke the camel’s back.

To use another analogy, human tissue is like a rope - thousands and thousands of individual tiny fibers, all oriented in the same direction. Individually they are not very strong at all, but together they have enough strength to pull very heavy loads. If we start to overuse the rope, the individual fibers start to break down. Eventually, if enough of them wear out, the rope begins to fray, and eventually it may fail.

Unluckily, unlike a rope, human tissue hurts when it’s injured.

Luckily, unlike a rope, human tissue has the inherent ability to heal itself. Sometimes we just need to help it along a bit.

How do we do that?

1. Stop doing that!

We all know the old doctor joke…

“It hurts when I do this doc.”

“Well don’t do that!”

Here it holds a bit of weight. If you're causing pain during an activity, back off a bit. Work just below the level of pain. I don’t want you bedridden, but I also don’t want you to cause more damage by working through pain expecting it to heal. This is where some patients can be their own worst enemies.

2. Take an aspirin and call me in the morning

Well, maybe not aspirin (might have to take a lot of it), but another NSAID (Non Steroidal Anti Inflammatory Drug) like Ibuprofen. These can decrease inflammation, decrease pain, and most off all allow some rehab exercises to be done. If you're an exerciser, and we all should be, finding a different exercise that doesn’t hurt while your injury is healing is a great idea.

Ice can also help to reduce inflammation. Ice about 15 minutes, 3 times a day. If you're icing over an area without much tissue between bone and skin (like the elbow or knee) icing through a towel may be a good idea. This helps to avoid injury to superficial structures like nerves from being injured by the cold. Ask your healthcare provider about the best way to ice if you have questions.

3. Protect

Some overuse injuries may be helped out a bit by braces, straps, taping, and other modalities which can reduce loads on the injured tissue and help aid in the healing process. Talk to your healthcare provider to discuss if one of these may be right for you.

4. Stretch and strengthen

Stretching tight tissues will help avoid further pulling and tearing. Strengthening others will help support injured tissues. I tell my patients, “It’s like building a brace under your skin.”

Talk to your provider about the best ones for your specific condition.

5. Don’t go back full force on day #1

Jumping right back into a sport or activity is sometimes a bad idea after a long injury. Remember that overuse injuries generally take weeks to months to develop, so going back to full activity in one day may be a bit counterproductive. We like to reccomend what is called a Graded Return to Play (GRTP).

Think of it as baby steps to recovery, just like in “What About Bob?” (Extra points to those of you who got the reference…great flick).

A graded return refers to slow and progressive steps every few days, starting slow, and progressing over a week or more, until you get back up to pre-injury level again. If you start hurting during one of the steps, stop! The next few days you stick with a step lower, and then try to advance again. Let your body dictate how fast it wants to return.
 
Let's say you're a runner returning to your sport. Day 1-2, maybe you do some light jogging. Day 3-4, a bit faster pace. Day 5-6, a bit more distance. Day 7, maybe you add some hills. And so on, until you get back to full, pre-injruy activity level. Everyone is different, so the GRTP varies from person to person. This leads me to a mantra of mine…“Listen to your body.”

 

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