Overuse injuries occur due to repeated and excessive demands on tissues over time, resulting in tissue damage and pain. All our bodily tissues have tolerances to activities and postures and have a degree of ability to adapt to the stresses placed upon them. The stresses we place on our tissues very enormously in quality and include a large number of different stress types such as compression and impingement, tension and contraction, tension and shearing. Continual stresses on the tissues leads to changes within them which lead to failure and pain as the rate of injury overtakes the ability of the tissues to repair and heal.
Tissues vary in susceptibility to stress and overuse, with neural tissues being very vulnerable especially to the restriction of blood supply or ischaemic damage leading to thickening of the nerve membranes and in severe cases degeneration of the nerves themselves. Muscular pain may result from a low level continuous contraction when muscles are required to perform repeated actions. It is known that psychosocial factors have some relevance, such as satisfaction about work, the self perception of health, the person''s coping mechanisms, depression and anxiety. Many activities, occupations and sporting endeavours involve repetitive actions and can trigger overuse injuries.
The affect of overuse injuries can vary from a minor pain problem which occurs intermittently to a major and disabling problem which interferes with work and normal functioning. The personal, health and employment costs can be extremely high. Physiotherapists assess the symptoms of the patient in terms of the type of pain, the area of pain, what brings it on and eases it and the history of the problem from its onset. Active ranges of motion will be assessed by the physio, checking for tendon crepitus and palpating all the relevant structures in the area. Repeated performance of a physical activity is the typical reason for this problem to start.
Physiotherapy management of overuse injuries starts with resting from the aggravating activities to a degree or by adjusting the way that an activity is performed to reduce the stresses through the affected tissues. Patients need to be taught the reasons for their pain and how to manage it to the best effect. Physios also use ice, splinting, ultrasound, exercises and advice to reduce any inflammation, ease the symptoms and improve function. Modification of the workplace may also be useful to ensure optimal ergonomic relationships with computers and other systems with which sufferers have to interact.
Author: Jonathan Blood-Smyth