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Overuse Injury

Overuse injuries refer to injuries that you can develop or get as a result of repeated action (such as repetitive strain injury) instead of acute or traumatic injuries, which usually happen immediate such as

• sports injuries
• sprained ankles
• broken wrist from a fall

Overuse Injuries Can Occur to the Following Structures:

• Tendons: tendinopathies
• Muscle-tendon structures (e.g. tennis elbow)
• Soft tissue compartments (e.g. compartment syndrome)
• Periosteum cartilage, which is the covering of the bone (e.g. shin splints)
• Bursa (e.g. bursitis)
• Nerve tissue (e.g. neural mechanosensitivity)
• Bone (e.g. stress fractures).

Any form of movement, and especially exercise, WILL apply stress to the bones, muscles, joints, tendons etc. What happens is then your body will adapt to the challenge by strengthening the involved tissues or structures.

That's how you get stronger in your bones, muscles, tendons, organs etc.

Signs of Overuse or Inflammation

• Swelling (which can be either very obvious or so small it's not immediately noticeable)
• Warmth to the touch
• Redness
• Impaired function of the part

Most patients experience these early but they aren't very aware of it in the early or beginning stages.

Patients usually may not experience the swelling or the warmth (Singapore's weather is already hot, so it may be hard to tell), but what becomes more clear is when patients start to develop stiffness or soreness in the morning, that disappears after 10 minutes or after a warm up.

Continued use will cause continued damage, and the pain will become increasingly longer. Over time, this stiffness and soreness starts "sticking" around longer and longer, eg more than 30 minutes, then more than 1 hour etc.

The Four Stages of an Overuse Injury

1. The discomfort disappears during warm-up. At this stage, we focus on identifying the injury and starting the treatment. We may allow to continue activity as long as the pain or injury does not get worse with activity.
   
   
2. The discomfort may disappear during warm-up but comes back after the activity. Stage 2, the activity may still be continued at a modified / tolerated pain-free level with treatment. Note: treatment MUST continue until completely healed.
   
   
3. Discomfort that gets worse during the activity. Stage 3 is where things get serious. Activities must stop immediately. Our physiotherapist may allow a return to sports or activities once we've identified the core problem, treating it and getting to no more symptoms. For athletes that are competing, we may play by ear with return to sports (may be a combination of rest, sports and treatment in same day).
   
   
4. Pain or discomfort longer and longer >> all the time. At stage 4, you will have to stop all sports that aggravate the pain or injury and you may even be required to seek treatment from an orthopedic doctor. We will have to treat you until you are symptom free and no return to work until completely healed.

What Causes Overuse Injuries?

1. Muscle imbalance (strong or tight muscles vs weak and overstretched muscles)
2. Poor core activation, strength or stability
3. Stiff joints and inflexibility
4. Weak muscles
5. Insufficient endurance
6. Incorrect training methods or mistakes
7. Biomechanical issues such as flat feet
8. Faulty equipment
9. Poor technique

Most of the time, the common cause of overuse injury is training mistakes...which is too much, too soon ie increasing intensity, game time, duration too rapidly instead of gradual training.

How to Prevent Overuse Injuries

Yes, overuse injuries and syndromes can be prevented. 

Some ways to prevent:

1. Warm-up (including stretching) and warm-down (including stretching) before and after the session.
2. Use the correct equipment (such as jogging shoes for jogging, bicycle that's fitted to your build and play, a racquet that is the right size with the proper grip size and strings strung to your level of play).
3. 10% per week rule: increase distance, speed, load or time (choose 1) at 10% increment per week
4. Practice correct technique.
5. Condition your body 4-12 weeks before training starts, working on flexibility, strength, tolerance.
6. Pay attention to what your body is saying - if there's pain, identify what's causing the pain and work on it. The earlier you identify and treat your pain, the faster you can get back to play.
7. If you get injured, focus on getting back to FULL injury physiotherapy and recovery. If you go back to play with a less-than-fully recovered limb, you may cause reinjury, and overuse injury on the other compensatory limb. 
   
8. If needed, purchase accident insurance that covers physiotherapy and outpatient medical treatment. We have a number of patients who decide to sit or wait-and-see for their sports injury to recover simply because they dont have an accident insurance. This can delay recovery and worse still, it can worsen the injury by degrading it from a simple mild problem to a more complex and chronic one.

Common Treatments for Overuse Injuries

The most important steps in the management of overuse (inflammation) injury are:

1. Remove the primary cause of the overuse injury
2. Reduce inflammation with physiotherapy such as
   
   a. Soft tissue management
   b. Cold therapy / Heat therapy
   c. Stretch therapy
   d. Strengthening
   e. Ultrasound therapy
   f. Shockwave therapy
   g. Mobilization of joints and tissues
   h. Dry needling
   i. Deep tissue release / massage treatment
   
   
3. Carefully and gradual return to activity as the symptoms dictate.