Overuse injury

Overuse Injury

I prefer the term ‘Misuse Injury’ to ‘Overuse Injury’ but I am sticking with the term ‘Overuse Injury’ because it is more generally used and understood. I think that Misuse Injury is a more accurate term because these injuries are not just caused by overuse but by misuse and the term ‘misuse’ covers the term ‘overuse’ but not vice versa.  This is important because when doctors and the public use the term ‘overuse’ they are then inclined to think that the answer is to simply underuse the affected part, rather than learn correct use and undergo very careful rehabilitation where appropriate.

Definition of overuse injury 

Overuse injury occurs due to ‘repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place’.

Key features 

i) repetitive loading (rather than acute traumatic) which causes microtrauma.

ii) exceeds the capacity of the tissues to remodel leading to a damaged structure and microtears.

iii) there is an imbalance between training loads and recovery. Over time this manifests itself with symptoms and loss of function.

iv) there isn’t necessarily inflammation. Inflammation is something that is more associated with an acute injury, e.g. if you sprain your ankle it will swell because of inflammation whereas if we use tendons as an example the pain and loss of function caused by overuse does not necessarily cause tendonitis i.e. inflammation of the tendons. This is why the term tendonosis or tendonopathy is the preferred term now. This is not a simple case of semantics because tendonitis requires a completely different treatment approach to tendonopathy. Read about research here.

Diagnosis difficulties

One of the main problems with overuse injuries is that they can creep up on you without you noticing, maybe because the microtears are not sufficient to cause pain or because certain tissues such as cartilage are not well innervated. When they do reach the point where you are experiencing symptoms this can happen very suddenly giving you very little chance to respond effectively.  You may feel a twinge and just ignore it and then a few days later suddenly the symptoms become worse. In my case, I have noticed that it has often taken months for the overuse injury to appear. During this time it is easy to become complacent.

The other problem is that overuse injuries can be very difficult to diagnose because of the lack of awareness about the distinction between the overuse injury and the degenerative change. A break to a bone caused by a a traumatic blow is easy to diagnose as an acute injury, the cause(s) of an overuse injury are more separated in time and require more investigation which unfortunately is often lacking in a 5 minute GP consultation.

Overuse injury versus degenerative change:

I have also noticed that therapists, whether doctors or physiotherapists, often do not draw a distinction between degenerative changes in the body and overuse injuries. I’ve tended to find that they tend to confuse overuse injuries with degenerative changes e.g. the tear in my knee cartilage was seen as a degenerative change, rather than an overuse tear – which I know that it is because of the history of the problem.  Obviously there is overlap between degenerative, overuse and acute injuries, for example degenerative change may predispose to an overuse or acute injury but there are differences which will determine the treatment. Treating an overuse injury as purely a degenerative change means that the chance of recovery is lost because it is not treated with appropriate rest and rehabilitation.

Treatment issues

Unfortunately improper treatment of an overuse can lead to further injury, more about this topic on this page.

 Overuse Injury Syndrome?

I am wondering if there is an Overuse Injury syndrome where someone is prone to overuse injuries because I seemed to have picked up so many and it seems unlikely that I am unique.  I think that it may be caused by a combination of physical and psychological vulnerabilities and other factors such as deficiencies in the health care system and not resting properly.  These factors lead to injuries in a cascade effect because one injury leads to further compensatory behaviour within the body and inappropriate interventions, either from health care professionals or oneself. Essentially physical stress is moving from one part of the body to another without being correctly resolved.

Links and references

These are some good links that I’ve found about Overuse Injury:

1)   https://www.youtube.com/watch?v=6avzv3Qo1MI