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Overuse Injuries

Overuse injuries, also known as repetitive strain injuries (RSIs) or cumulative trauma disorders (CTDs), occur when a specific body part (muscles, tendons, ligaments, bones, or nerves) is subjected to repeated stress without sufficient time for recovery. Unlike acute injuries that happen suddenly (like a sprain or fracture), overuse injuries develop gradually over time, often due to micro-trauma that accumulates faster than the body can repair it.

Causes of Overuse Injuries

The underlying cause of overuse injuries is repetitive stress, but several factors contribute to their development:-

Repetitive Motion:

  • Performing the same movements repeatedly for extended periods (e.g., typing, using a computer mouse, assembly line work, playing musical instruments, certain sports).
  • Insufficient rest breaks between repetitive tasks.

Poor Technique or Biomechanics:

  • Incorrect form during sports (e.g., improper throwing mechanics, running gait issues).
  • Poor posture while working or performing daily activities.
  • Improper lifting techniques.
  • Muscle imbalances, weakness, or inflexibility that alter normal movement patterns.

Rapid Increase in Activity (Too Much, Too Soon):

  • Suddenly increasing the intensity, duration, or frequency of exercise or work tasks without adequate conditioning.
  • Lack of a progressive training plan (e.g., “weekend warrior” syndrome).

Inadequate Equipment or Ergonomics:

  • Ill-fitting shoes or sports equipment
  • Poorly designed workstations (e.g., incorrect chair height, keyboard position).
  • Lack of shock absorption in running surfaces.

Insufficient Recovery:

  • Not allowing enough time for muscles, tendons, and bones to repair and adapt after activity.
  • Chronic sleep deprivation.
  • Poor nutrition.

Genetic Predisposition: Some individuals may be more prone to certain overuse injuries due to their genetic makeup or anatomical variations.

Age-Related Changes: As people age, tissues can become less elastic and more susceptible to wear and tear.

Previous Injuries: A poorly rehabilitated injury can lead to compensatory movements, predisposing other areas to overuse.

Symptoms of Overuse Injuries

  • Pain: Often a dull ache initially, felt during or after the activity.

    • Progresses to pain during the activity, and eventually, persistent pain even at rest.
    • Can be sharp, burning, or throbbing.
    • Local tenderness to touch over the affected area.
  • Stiffness: Especially in the morning or after periods of inactivity.
  • Swelling: Localized swelling, though often mild.
  • Weakness: In the affected muscles or limb.
  • Numbness or Tingling (if nerve compression is involved): Burning, pins and needles sensation.
  • Reduced Range of Motion: Difficulty moving the affected joint or limb through its full range.
  • Crepitus: A grinding, popping, or crackling sensation when moving the affected joint or tendon.
Examples of Common Overuse Injuries and Their Specific Symptoms:-
  • Tendinopathies (e.g., Tennis Elbow, Golfer’s Elbow, Achilles Tendinopathy, Rotator Cuff Tendinopathy, Patellar Tendinopathy): Localized pain, tenderness, stiffness, pain with specific movements (e.g., gripping for tennis elbow, pushing off for Achilles).
  • Stress Fractures (e.g., shin splints, metatarsal stress fractures): Deep, aching pain that worsens with weight-bearing and activity, specific tenderness over the bone, swelling.
  • Bursitis (e.g., shoulder, hip, knee bursitis): Localized pain, tenderness, swelling, and pain with movement that compresses the bursa.
  • Nerve Entrapment Syndromes (e.g., Carpal Tunnel Syndrome, Sciatica, Thoracic Outlet Syndrome): Numbness, tingling, burning pain, weakness, often radiating along the nerve path.
  • Plantar Fasciitis: Heel pain, especially with the first steps in the morning or after rest.
  • Shin Splints (Medial Tibial Stress Syndrome): Pain along the inner edge of the tibia, usually worse with running.
Advanced Physiotherapy for Overuse Injuries

Phases of Physiotherapy Treatment:-

I. Acute/Pain Management Phase:

  • Relative Rest/Activity Modification: Crucial for allowing tissue healing. This doesn’t necessarily mean complete immobilization, but avoiding or modifying activities that aggravate the injury.
  • Modalities: Ice (for acute inflammation), heat (for muscle relaxation and circulation), TENS, ultrasound, or interferential current (IFC) to reduce pain and inflammation.
  • Manual Therapy: Gentle soft tissue mobilization, massage, or joint mobilizations to reduce muscle spasm, improve circulation, and alleviate stiffness.
  • Taping/Bracing: Kinesiology taping or supportive braces/splints to provide support, reduce pain, and facilitate proper movement patterns.

II. Restoration of Function Phase:

  • Flexibility and Stretching: Addressing muscle tightness and restricted joint range of motion (ROM) through targeted stretching (static, dynamic, PNF).
  • Strengthening: Gradual, progressive strengthening exercises for weakened muscles and muscle imbalances.
  • Isometrics: Initial contractions without movement for pain relief and muscle activation.
  • Isotonics: Concentric (muscle shortens) and eccentric (muscle lengthens under tension) exercises. Eccentric training is particularly vital for tendinopathies, as it promotes collagen remodeling and strengthens the tendon’s load-bearing capacity.
  • Proprioceptive and Balance Training: Exercises to improve body awareness, joint stability, and coordination, especially important for preventing re-injury in weight-bearing joints.
  • Correction of Biomechanics and Movement Patterns:
    • Gait Analysis: For lower limb injuries, video analysis of walking/running patterns to identify abnormalities (e.g., overpronation, altered stride).
    • Ergonomic Assessment: Evaluation of workstation setup, posture during work or daily tasks. Recommendations for adjustments (e.g., chair, keyboard, monitor height).
    • Sport-Specific Movement Analysis: Breaking down movements in sports (e.g., throwing mechanics in baseball, swimming stroke) to identify and correct faulty techniques.
    • Muscle Imbalance Correction: Identifying and addressing strength disparities between muscle groups (ee.g., weak glutes leading to knee pain).
    • Core Stability Training: Strengthening the deep abdominal and back muscles to provide a stable base for limb movements, reducing strain on peripheral joints.

III. Return to Activity/Prevention Phase:

  • Gradual Return to Activity: A carefully planned, progressive reintroduction to sports or work activities, gradually increasing intensity, duration, and frequency. This is crucial to avoid relapse.
  • Plyometrics and Agility Training: For athletes, to restore power, speed, and sport-specific movements.

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