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By Dr Ellen Petersen
(WISPA Medical Advisor)
Overuse injuries are the most common injuries occurring in sports as
squash ... where there is not so much direct opponent contact but
where there is a great deal of stretching, turning and jarring
through running and jumping.
The main issue with these injuries are why and when do they occur,
as this knowledge will help to prevent them?
WHY AND WHEN
Overuse injuries mainly occur when using a part of the body more
heavily or in a different way than usual. The main factors causing
overuse injuries are: general strength in the body part and the
amount of stress the body part is put through - in terms of both
repetition and force.
Let me give a more detailed description to give an idea of what it
is that physically happens. This will help to prompt adapting /
altering training regimes a little earlier to help avoid actual
injuries that require periods of reduced training, or even the worse
outcome of a complete break for the healing process.
To start with the basics, it is normal that when training is
increased muscle fibres will adapt within 4-8 weeks. It is not
possible to develop more muscle fibres but the fibres can increase
diameter and so their “effectiveness” can be modified. However,
tendons will probably take up to 6 months before they have fully
adapted to significantly increased workload.
TRAINING TRAUMA
Overuse injuries are mainly problems in the tendon itself, which is
tough, inelastic fibrous tissue, or where the muscle attaches to the
tendon, or at the point where the tendon connects to the bone.
In the beginning when training is increased tiredness in the muscles
is felt, but after a while muscles adapt to the higher workload and
training can be increased even more. After 2 / 3 months of harder
training sore tendons may be evident. In the beginning it will be
mainly after training or the next day during warm up. When the
tendon gets warm the pain usually disappears, only to come back
again after training.
The tendency is to treat with ice and continue the training - but
this is exactly the point where you have to be more careful. Pain in
tendons is nearly always a sign of danger. The tendons do not have a
high level of sensitivity so usually there has been something wrong
with the tendon for a while before pain develops.
Note, there is a clear difference here between muscle pain and
tendon pain. Pain in the muscle is acceptable after training but
pain in the tendons and points of attachment to muscle and bone must
indicate a need to modify or decrease training.
Overuse can come from small changes which alter the stress on a
certain muscle, e.g. changing the size of the grip or the tension of
the strings can give pain in the elbow. Also, the weight and
stiffness of the racket are important factors.
Bear in mind that weight training and plyometrics cause a lot of
stress at the end points of the muscle where they connect to the
bones in the legs. And don’t forget that the stress absorption of
shoes and the surface of training make a difference too. Just think
of the difference in pounding on muscles and joints from running on
concrete as opposed to more forgiving grass.
DECREASE
Since overuse injuries occur mainly because tendons and joints are
not strong enough it is not usually a good idea to stop training
completely as this will only serve to increase weakness when sport
is returned to after a while. The usual recommendation is a decrease
in activity to around 50 % of the previous level, and then do
specific “building” exercises. Elastic band training is usually good
for this.
It is also important to evaluate which changes have been made during
the preceding couple of months to get an idea of why the injury may
have occurred. Discussion with physiotherapists and doctors before
the injury becomes more severe is essential too.
However, reduction is not appropriate for complete tendon ruptures
and stress fractures where exercise must cease completely to
initiate recovery.
So just remember that just as the tendon can be injured long before
pain is felt, in the same way the tendon can stop being painful
before it is healed completely, so looking after and listening to
the body, doctors and physiotherapists all play important roles.
An extra point: If in the recovery training period, there is
more pain than the previous day, then the training has been too hard
and a little step back in the recovery plan is necessary.
An important factor is also that some people are genetically
stronger than others and are less prone to injuries. This is just
fortunate for some and not fortunate for others - who should choose
their parents better next time!
WISPA Medical Advisor |
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Reprinted from
the WISPA Member’s Bulletin
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