The weather is getting cooler, the days shorter, the leaves are changing colors, and school is back in session but here at LegitMassage we want to prolong summer for just one more week. This summer we examined many overuse injuries such as rotator cuff injuries (June 11), repetitive strain injuries (June 18), bursitis (June 26) and plantar fasciitis (August 20) and now to close our summer series, we will provide an overview for overuse injuries and discuss causes, symptoms, and treatment. I guess I just didn’t want summer to end. Besides, as we are all aware injury can take us out of our game any season whether we are playing outdoors or working indoors.
An overuse injury is any repeated activity, whether occupational or recreational that occurs when a series of micro-traumas to muscle tissue overloads that tissue’s ability to repair itself. In simplest terms, continuing an activity that causes strain and trauma to the muscle fibers perpetuates the same strain in the form of micro-tears, many micro-tears over time creates a cycle of tearing the remodeling scar tissue. This in turn leads to chronic inflammation and a continuous supply of immature collagen being laid down at the injury site. Recall that collagen is a naturally occurring protein found in the flesh and connective tissues and is the main component of connective tissue as well as our most abundant protein. When the collagen is laid down, it is still immature, hence the reason it is recommended to rest before assuming an activity after injury. This is why a break from any activity is recommended; to allow the collagen to mature. Weight lifting for instance is more beneficial 2- 4 times a week instead of 6-7 times a week because the rest or off days give the muscles time to heal. The overuse cycle however, decreases tissue strength and limits range of motion.
Causes of overuse injuries vary and involve a variety of factors. Some factors are extrinsic in nature and some intrinsic. We addressed both in our summer series.
- A rapid increase in the duration and intensity of the activity.
- Inadequate rest
- Inappropriate or worn out shoes and equipment
- Faulty mechanics, biomechanics or posture
- Inadequate nutrition
- Postural dysfunction
- Bony asymmetries (Tune in for greater in-depth review in October LegitMassage.)
- Leg length discrepancy
- Muscle imbalances/weaknesses
Overuse injuries from a symptomatic standpoint are progressive in nature but vary from ailment to ailment. Tendonitis you may recall has an initial acute stage of healing marked by a deep pain over the injured site during and after exertion and by chronic inflammation and decreased range of motion. Plantar fasciitis, on the other hand, has a slow onset with an absence of the acute stage of injury. In the beginning, discomfort and pain is felt after the activity and progresses to pain during the activity to eventually pain even when the activity has ceased. Heat and swelling over the injured site is another tell-tale symptom of an overuse injury. You may have limited range of motion and tightness or stiffness of the muscles as well. These symptoms can give way to muscle weakness which in turn causes tissue break-down or rupture followed by a visit to your doctor instead of your licensed massage therapist. If that is not enough to make you stop the activity and rest, then how about suffering injury to supporting and compensating structures as a consequence? No kidding, rest is never more important.
Paramount to any treatment of an over use injury is to determine the cause of the injury. Sometimes the causes are obvious and sometimes not so obvious and extrinsic and intrinsic factors must be accounted for. A massage therapy treatment session will always depend on the presentation of symptoms and the stage of healing. The goal for massage therapy is to limit and decrease the inflammatory process, decrease pain and reduce the sympathetic nervous system firing. Swedish relaxation techniques and protocol to unaffected parts of the body accomplish the task of cutting pain and raising comfort. At the same time, the goal of the LMT is to decrease adhesions and lengthen any shortened muscles and structures including antagonists. At the same time, the LMT should treat any postural dysfunctions and trigger points with deep tissue techniques and use joint play to increase range of motion. If edema is present, then manual lymphatic drainage should be utilized. Several sessions over a period of weeks may be necessary before longer lasting healthy results are met. In between massage sessions, a healthy dose of self-care is administered. Most important is REST to prevent re-injury. This is also the most challenging aspect and sometimes requires a creative mind to modify the pain-causing activity. Over time, a gradual return to the activity coupled with greater strength and flexibility as well as correcting poor biomechanics and techniques are the best defense in the prevention and return of an overuse injury.
Relative rest from an activity is the number one prescription for an overuse injury. So continue to work easy and play hard and monitor your techniques to make sure that they are biomechanically sound. Take stock of your equipment and replace inadequate gear. Never discount the importance of a proper warm up and cool down for your particular sport or activity. All of these precautions will keep you working and in the game. I’ll see you on the track, the field, the court, the links, the trails wherever the you that makes you unique is doing that thing that you love to do.
Kip Yates, LMT was trained at the Swedish Institute in New York City and is New York State and Texas State licensed. He is owner and operator of Massage Refresh in New York City where he provides Swedish wellness and recuperative Deep Tissue massage that encompasses myofascial release and trigger point therapy. Kip lives in Brooklyn with his wife and three children and also practices at Physiofitness Physical Therapy in Soho.