Why overuse injuries are a pain

 10+ reasons why overuse injuries are a pain

Getting a diagnosis and the right treatment is hard but the consequences of late diagnosis and poor treatment are potentially catastrophic.

Difficulties with diagnosis:

  • Overuse injuries are not well recognised or taken seriously outside of sport. In my experience most medical professionals do not seem to be aware of them. There are no public health campaigns (e.g. stopping smoking, exercising more and eating less) about how to avoid an overuse injury. There is some awareness of RSI of the hands, but Repetitive Strain Injury is a misleading term because it implies that you can only have an RSI with your hands, whereas they can affect almost any part of the body.
  • The current medical model involves specialists knowing more and more about less and less. This means that GP’s, physiotherapists and orthopaedic doctors tend to look at body parts in isolation thereby not identifying risk factors and connections between apparently unconnected symptoms. Overuse injuries are complex and are the result of a combination risk factors so it is important to identify and address these risk factors.
  • Overuse injuries do not fit into the current medical model which involves prescribing painkillers or other medications, waiting for symptoms to deteriorate and then possibly referring via ‘triage’ to physiotherapy for assessment. There are currently no effective medications for overuse injury and waiting for problems to get worse enables the ‘acute overuse injury’ to develop into a ‘chronic overuse injury’ that is much more resistant to treatment.
  • Physiotherapy diagnosis is not always accurate and scanning is expensive so it can be difficult to have an accurate diagnosis. The current triage system can slow down or obfuscate diagnosis in the case of overuse injuries.

Difficulties with treatment:

  • The current medical model is in general not geared towards early treatment and prevention which is what is required with overuse injuries.
  • You can be harming yourself with an activity without being aware of it for a long time so you can become complacent about e.g. poor posture and technique. There is a time lag between ‘doing too much, too hard, too soon’ and symptoms appearing and when they do initially appear they can be very mild so it’s easy to dismiss an injury in its early stages as just another ‘ache or pain’. However, they could have been building up silently for a long time, maybe years. Once the symptoms have built up they are much harder to treat.
  • Rest can be difficult. It can be difficult to take sick leave because you may not feel ill, or have a specific diagnosis in time and are not incapacitated. Some parts of the body are difficult to rest because they are essential for everyday functioning, e.g. the voice and the lower limbs. Even though inconsistent advice is given about how to rest, rest is essential. Rest needs to be sufficient for the given injury, so carrying on and simply modifying activities may not allow sufficient recovery time for tissues to heal. Not properly resting an injury can lead to a cascade of further injuries.
  • Treatment is poor outside of sport because the main focus of injury treatment is still acute injury. Sports injury medicine is different because it is more scientifically based and it needs to work to enable valuable sports men and women to return to play. Outside of sport, overuse injuries do not respond easily to treatment and the scientific basis for treatments is probably lacking so interventions are initiated on a risky trial and error basis.
  • As mentioned earlier, it is important to identify and address risk factors, however this can be difficult because some risk factors are very difficult to change because they are fixed anatomical features or social factors, such as pressure to work when unwell, which are outside an individual’s control. Inappropriate addressing of risk factors or other interventions can easily make things worse which can enable the ‘overuse syndrome’ to spread to another part of your body.

Consequences of overuse injuries

  • They can cause permanent damage and affect important functions of the body, such as the use of the hands, voice and walking and affect the ability to work which can lead to mental health issues.
  • Given that my experience is probably repeated in many others and given that overuse injuries are more common than acute injuries, it seems reasonable to assume that overuse injuries probably cost the NHS millions, if not billions, each year, due to lack of prevention and poor treatment.

However, the good news is that overuse injuries are almost always completely preventable and these preventative approaches can be used to manage an existing overuse injury.