How to treat an overuse injury

Treatment of overuse injury

  1. Diagnosis

The first step is to check if it is an overuse injury.  This may be clear from the history of the injury, but clearly it needs to be determined by an experienced medical practitioner, or physiotherapist?  Unfortunately in my experience physiotherapists have often misdiagnosed me and the most accurate diagnoses have come from consultants. Overuse injuries can be difficult to diagnose so this first step is not necessarily an easy one. Sometimes getting a diagnosis can only be achieved through having an MRI scan.

– Identify the possible causes. One question you can ask yourself is ‘what have I done differently recently?’ (that may have caused the injury). When I injured my hip, it was only after a week or so that I made the connection with using a shoe raise. The second question is ‘have I been doing anything differently over (however many) years that has increased stress on my body?’

– Location of the injury. Locate exactly where the pain is. The tissues that are present where the pain is are the most probable culprits. Every kind of bodily tissue can have an overuse injury. You can google the tissues that are located at the source of the pain.

– Be prepared for a struggle to get a diagnosis because unless you can afford private medical insurance getting the right diagnosis quickly is very difficult. GP’s often don’t take musculoskeletal injuries seriously, and may just offer you some painkillers.  I think that this is particularly true if you have had any kind of mental health issue (which most people will have had at some point) because you run an even higher risk of your symptoms not being taken seriously and therefore developing a more serious injury.

 

The second step is to avoid a secondary or even a tertiary injury.

The problem of getting an accurate diagnosis quickly is why I think when in doubt it is wise to rest, though this in itself can be difficult because it can be hard to take time off work. Rest is not always a straightforward process. Read about rest by clicking here to read some ideas about how to rest properly.

One injury can easily lead to another so it is important to break the vicious circle of having an injury, not managing it correctly and then getting a further injury.

RICE

RICE stands for rest, ice, compression and elevation and it is put forward as the standard approach to treating injury.  However, apart from rest, the other elements of the protocol may not be of much use in overuse injury. If you are going to use ice then you need to apply it in the first 72 hours after you experience the injury. The RICE protocol may compound the confusion with diagnosis because it implies that visible inflammation such as swelling is a necessary condition of an injury.  This is often not the case with overuse injuries.

Education and modifications to reduce overuse activity

Having identified the causes of the problem you need to learn what to do to reduce the overuse e.g. by adopting the correct posture and following the principles outlined in prevention

Rehab. 

– Take a tailored approach. Different kinds of overuse injury may have different treatments and each injury must be looked at individually. There are general principles with treating these injuries but it is important not to make any assumptions.

– Improve core stability through Pilates.

– Eccentric strengthening for tendon injuries: the evidence seems to be that this is the most effective way to strengthen tendon injuries.  Eccentric strengthening is defined as active contraction of a muscle occurring simultaneously with lengthening of the muscle. For example, in a biceps curl the action of lowering the dumbbell back down from the lift is the eccentric phase of that exercise — as long as the dumbbell is lowered slowly rather than letting it drop (i.e., the biceps are in a state of contraction to control the rate of descent of the dumbbell). For eccentric strengthening to be effective you need to progressively build up your speed with the exercise.

– Stretching.  Structures that are tight put more stress on the body when they are being used.  For example, if you have tight calf muscles this will put more strain on your achilles tendon. However, there is now research that indicates that excessive stretching before exercise may cause injury.  Instead warm up with a mix of low intensity exercises for about five to ten minutes until you begin to perspire.  Stretch after you have exercised and include stretching as part of your fitness regime two to three times a week. Stretching is important in the rehabilitation of tendon injuries where it can improve pain and increase range of movement.

-Adjunct therapies: Ultrasound. Ultrasound uses heat to have a therapeutic effect. The evidence is not that strong for its efficacy, but it may be useful as long as it is combined with other therapies. Massage: This may be useful for breaking down scar tissue. Anti-inflammatory medications: these only work for acute injuries. Steroid injections are also probably ineffective for overuse injuries.

  • Taking care when doing physiotherapy exercises:- Rest. Follow a period of exercise with a period of inactivity e.g. by doing a relaxation exercise after your cool down to give your body some extra time to undertake the remodelling of tissues.

    – Rehabilitative exercises should exercise the part without putting undue stress on it. For example, exercising in water is a way to exercise without putting strain on the joint.  The reformer equipment used in Pilates follows a similar principle. Cross training is similar to this because you are varying the stresses that you are exposing your body to.

    – Don’t combine exercises with other interventions such as podiatric insoles, let your body get used to the insoles first and then start on your exercises to avoid overloading your body with stress.

General points

– Addressing your vulnerabilities to injury.  It follows that addressing an underlying vulnerability should help treat an associated injury. However, you have to be careful that you do not make things worse. It is often difficult to change underlying vulnerabilities because they are anatomical in nature so it is important to focus on the things that you can change, such as your behaviour.

– Give it time. Overuse injuries creep up without any symptoms until a triggering event causes a noticeable symptom.  The body is not always that good at telling us that we are misusing it. On this basis it seems likely to me that the converse to this may be true i.e. that when you are doing things to help with the injury there will be an equal time lag where you do not feel better.  This is difficult because it can be tempting just to give up.  Approaches that may be helpful but may not instantly show results are yoga for stretching and pilates for core stability.

– Be cautious. Be aware that any exposure to medical intervention including physiotherapy and alternative therapies is inherently risky and you need to balance the risks against the benefits and seek to manage the risk.

– Operations. An injury often affects multiple tissues, so even if one part of the injury is addressed through an operation it does not mean that all of the damage caused by the injury will be resolved.