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How to Tell if you Have an Overuse Injury

There are two kinds of sports and exercise injuries. The kind that happens suddenly and dramatically called an acute injury and the type that quietly sneaks up on you little by little known as a chronic injury. An ankle sprain or an ACL tear (a tear in an important knee ligament) is an example of an acute injury. Tendonitis or inflammation of a tendon is an example of a chronic injury. Most exercise injuries are of the chronic type and many of these injuries are caused by overuse of the muscle or joint.

You can have perfect form and technique when performing your sport or exercise but if you do too much without enough time to recover or if you suddenly increase your time or intensity, you can develop an overuse injury.

Repetitive microtrauma.
Dr. Frank Jobe, author of Athletic Forever and head of the Kerlan-Jobe Orthopedic Center, compares an overuse injury to cutting down a tree. The first 99 blows will not make the tree fall down but the 100th blow will. The last strike was not what cut the tree down. It was the 99 strikes that came before it that substantially weakened the tree so the last strike finally fells it.

In the same manner, an Achilles tendon rupture (which can occur in badminton and tennis) appears to happen in a split-second but it is usually only the straw that broke the camel’s back. The tendon was already weakened by “repetitive microtrauma” or micro-tears caused by overuse.

Pain is your body’s way of telling you something is wrong. The pain signal from a sprained ankle or twisted knee is loud and clear. But the signals from an overuse injury can be so subtle that Jobe says you have to go out of your way to notice them. It is always better to catch an injury in its early stages so it doesn’t significantly hamper your game or your exercise program.

Signs of an overuse injury.
One of the first signs of a potential overuse injury, according to Jobe, is morning stiffness. “That’s because at night, your entire body’s blood flow slows down – especially the flow to the muscles and joints. During this time, it’s easy for inflammation to build up. So when you wake up, any trouble spots will feel particularly stiff. While most morning stiffness is transient, it’s a good time to make note of trouble spots that might be susceptible to injury”.

Jobe lists the other warning signals:
· Mild pain after a workout.
· Pain during a workout or while performing a particular movement.
· Point tenderness – pressing down on an area causes a twinge of localized pain.
· Swelling
· Instability
· Snapping, cracking, or crunching feelings or sounds emanating from within a joint.

Exercisers or sports enthusiasts may be deceived about an overuse injury because in the beginning, the pain disappears when they work out or play their sport. This makes them believe that nothing is really wrong since exercise “cures” their pain.

Jobe warns that exercise can actually be making the problem worse. “Quite often, musculoskeletal pain may disappear during exercise, even though the damage is being compounded. Or it won’t become evident for a while after exercise. During exercise, the seven-fold increase in blood flow to the muscles and joints temporarily forces inflammation to subside. However, when you stop exercising and the blood flow slows down, the excess fluid slowly collects once again in the injured area, and eventually the pain returns, becoming quite pronounced.”

Avoid the overuse syndrome.
If you don’t pay attention to the warning signals and inflammation sets it, you can develop the overuse syndrome. Jobe explains, “The buildup of swelling and inflammation leads to pain and decreased blood flow. Pain causes the muscles to tighten, which leads to further reduction in blood flow. That leads to more inflammation. It’s a cycle that can be difficult to overcome”. Now you know why it is called a chronic injury.

Preventing overuse injuries.
Jobe outlines the three best ways to prevent overuse injuries: Increase your exercise load gradually (frequency, time, intensity), warm-up properly, and allow sufficient recovery time between hard workouts.

Many experts also recommend cross training to avoid using the same joints and muscles in the same way. By doing different types of workouts, you not only give your body time to recover but you also spread out the stress so one particular joint or muscle is not taking the brunt of exercise.

Treating overuse injuries.
The PRICE protocol mentioned in last week’s column is a good place to start. PRICE stands for protect, rest, ice, compress and elevate. Anti-inflammatory medications like are also sometimes recommended by doctors to decrease pain and swelling. It is best not to self-medicate so consult a doctor for the appropriate medicine and dosage.

Jobe adds, “In order to heal well, you need fresh blood flow in and out of the injured site. The fresh blood brings in oxygen and nutrients needed to build healthy tissue and carries away waste products and excess fluid that have built up in the area.”

Anything that increases blood flow will reduce inflammation. Jobe suggests trying heat, ice, ultrasound, massage, and moderate exercise that does not cause pain in the injured joint.

Movement after injury.
Jobe writes, “It was once thought that injured joints should be completely immobilized until all swelling and inflammation subsided. That approach is no longer taken in the vast majority of injuries because immobility leads to weakness and atrophy of muscles. Injuries that heal while immobilized are also much more likely to form adhesions and irregular scar patterns that can result in permanently decreased range of motion.”

I can attest to the folly of not moving the joint at all while recovering from an injury. When my shoulder injury was first treated in the early 80’s, my arm was put in a sling for two weeks and I was not given any special rehab exercises. So, my injury kept recurring for the next ten years until I met Dr. George Canlas who made me do rotator cuff exercises. My shoulder has been great ever since. I just have to pay close attention to the early warning signals of pain when I try new exercises that can stress my shoulder.

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