Summary

The different kinds of injury:

There are 2 main kinds of injury:

  • acute injury (e.g. breaking a bone after falling)
  • overuse injury (e.g. a stress fracture caused by overuse and repetitive activity in runners). Acute injuries are easy to spot, overuse injuries tend to be harder to diagnose and treat but they are more common. This website focuses on overuse injuries.

Key features of an overuse injury;

i) Repetitive loading (rather than acute traumatic) which causes microtrauma. Over time the microtraumas accumulate.

ii) Wear ‘n’ Repair. During use bodily tissues are constantly being broken down by stresses and repaired. Overuse exceeds the capacity of the tissues to remodel leading to a damaged structure and microtears.

iii) An imbalance between loads and recovery. Over time this manifests itself with symptoms and loss of function.

nb almost any bodily tissue and part of the body can be affected by overuse injury. Not just the hands, as in the poorly named ‘Repetitive Strain Injury’.

Cause

Normally there are multiple risk factors at play.

  • Risk factors: these are divided into intrinsic and extrinsic risk factors that reduce the individual’s resilience to stress.
  • Intrinsic risk factors are factors within the individual’s body and: include poor preparation (warm up), fitness level, flexibility, previous injuries, diet, age, ability level, sleep, anatomy, psychology.
  • Extrinsic risk factors: are factors outside the individual’s body and include social, environmental and behavioural factors, poor technique, poor posture and poor equipment.
  • Poor technique is caused by:

‘doing too much, too hard, too soon...‘ i.e. a too large an increase in the duration, intensity and frequency of an activity ‘…for your body’  – you may have anatomical and other risk factors that determine how much stress your body can cope with.

poor posture and poor equipment  increases the stress on the body.

If enough of these risk factors come together particularly when the individual increases the intensity of an activity, then an overuse injury will manifest itself.

Almost anybody can experience an overuse injury but some people are more vulnerable because they have more risk factors or poor technique or because they are athletes.

Athletes

  • Everybody is familiar with the concept that if you are a sporting athlete you are putting your body through a great deal of stress. However there are other kinds of athletes;
  • Occupational athletes (occletes). Occletes are people who work in jobs that involve a significant amount of repetitive work e.g. computer users (particularly in jobs that involve data input), factory workers who are undertaking repetitive activities or people working in jobs that put high demands on the voice such as teachers and call centre workers.
  • Artistic athletes (artletes). Artletes include visual artists and musicians who need to also undertake many repetitive movements as part of their work.
  • Weekend warriors. Anybody who takes up a racket, plays a bit of football, does remedial exercises including yoga can get an overuse injury.

Treatment

  • R.I.C.E principles (rest, ice, compression, elevation).
  • identifying the risk factors and seeking to modify or remove them, where this is possible and as long as this does not involve making things worse.
  • identifying problems with technique and addressing these
  • rehabilitation if the above approaches are not sufficient.
  • surgery if rehabilitation is not appropriate or is ineffective.

Chronic overuse injury

Causes of chronic injury

    • inadequate rest. There is a window of opportunity immediately following the onset of the injury when rest is most effective. If you miss this window then you are more susceptible to a downward spiral of re-injury and secondary injury which results in a chronic injury and even osteoarthritis
    • underlying anatomical risk factors. These contribute ongoing stresses that enable the injury to persist
    • reinjury. Injured tissues are more vulnerable to reinjury.
    • poor technique. If you don’t change the poor technique that caused the injury.

Causes of missing the healing window;

  • lack of prompt access to medical expertise and diagnosis. You may consult your GP or physiotherapist but they may not be trained in diagnosing and treating overuse injuries.
  • difficulty in taking sick leave. Sometimes it is not enough to try to rest by simply modifying one’s activities e.g. you may need to move around much more than you realise when you are at work so if you have injured your lower limbs it is essential to take sick leave.
  • lack of pain The human body is not always good at giving us information when we damage ourselves.
  • denial When faced with a new injury it can be tempting to just brush it off because having to rest or seek medical treatment can be stressful and inconvenient.

Superprevention

I present a checklist of injury risk factors that enable you to avoid injury by predicting what your next injury is likely to be rather than responding to it once it has happened.

Restology

Rest is a complex issue, it is not so much about avoiding activity but having recovery time where you are experiencing less or different stress. This can be achieved through measures such as varying your activities and crosstraining, scheduling breaks including microbreaks and minimising high stress movements and compensating by overusing.

Rock ‘n’ Rest – Musician and vocalist injuries

Repetitive Brain Injury

  • The clear parallels between the mechanisms behind physical overuse injuries and some mental health problems suggest that some mental health problems are a kind of mental overuse injury.
  • I therefore present a case for applying the sports science model of injury to some mental health problems. This offers an innovative approach to understanding, preventing and treating these conditions.