Overuse Injuries
In the previous “How To” post we talked about the six different techniques covered so far on this site (foam roller, cross friction, trigger point, active and joint mobilizations, and stretching). We reviewed the techniques and also briefly talked about what kind of injuries each technique was best suited for. In this post, we’re going to talk specifically about overuse injuries. One of the key differences between a new muscle strain or tendinitis and an overuse injury is the how the injury started.
Acute (New) Injury (aka muscle strain, tendon injury, spasm/knot): Symptoms < 7 days old with an identifiable beginning (i.e. speed work at the track = sharp pain in back of thigh). Classic symptoms include pain, swelling, stiffness and possibly bruising. Once the injury is healed, able to return to normal training/racing.
Overuse Injury: Symptoms develop gradually and can be long lasting. Classic symptoms include pain during activity, ache/sore at rest, and swelling. There is no known cause or event (i.e. my foot just started hurting. Felt fine during the run and then poof! Got off the couch and could barely walk on it).
Unlike acute injuries where you are dealing with specific symptoms that began with a specific injury, overuse injuries are much more gradual in their onset. Often times, athletes describe these types of injuries as “starting out of nowhere”. Sometimes there can be warning signs, such as muscle stiffness or a dull ache in the days and weeks leading up to the injury, but more often than not there are no signs at all. It doesn’t help that the early signs and symptoms are things that most athletes (myself included!) chalk up to being the normal aches & pains of training.
Aside from the gradual start and lack of a specific cause, overuse injuries differ from acute muscle injuries in one very specific way – they tend to last longer than 30 days and by that point the muscle itself has started to change in response to the injury. More specifically, the muscle loses it’s elasticity due to prolonged inflammation. Think of inflammation as something that dries the muscle and tendon out. Now when you contract that muscle, instead of a nice fluid movement, you have a muscle that has to work harder to perform it’s usual function.
Managing Overuse Injuries:
Three general rules to remember for managing overuse injuries:
1) Muscles work best when they can move through their full Range of Motion (ROM). If you have a joint that is limited, it will impact how the muscles around it work. This may not be the case with your injury, but without a known cause, it’s best to cover all of your bases.
2) Each muscle group has a beginning and an end (origin and insertion). In overuse injuries, one end is usually symptomatic and the other is not. While working to loosen the symptomatic area it is crucial to remember to work on both ends to alleviate built up tension throughout the entire muscle.
3) Muscle groups work in pairs that work against each other in opposite directions (as one group contracts the other relaxes). If one group of muscles becomes tight or fatigued it will stop contracting fully. This means that the opposing group of muscles will stop being stretched when that happens and stiffen up/restrict motion as a result. This means that you need to work on both muscle groups as both will be affected.
Self Treatment
Step 1) Regardless of the cause of the injury or what’s happened in the surrounding muscles, you still need to heal the injury first. This means R.I.C.E.
Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle/joint will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery.
Ice: while heat may feel better on stiff and sore muscles, ice only during the first 7 days following injury. This will help to decrease swelling, inflammation and pain. 10-15 minutes is sufficient and you can perform every hour as needed. Avoid direct ice to skin contact.
Compression: thanks to the recent explosion of compression sleeves, tights, shorts, etc, you have several options in this department. Ideally you want something that is snug without being uncomfortably tight (think recovery tights if you’ve ever worn them). You can also use a store brought ace wrap to accomplish this. Start the wrap below the injury using good tension on the bandage and move up above the injury. This will help keep swelling from moving down the leg.
Elevation: This is critical in the early days following acute injury where swelling may be present. In the case of an ankle injury for example, elevate the leg so that it is above chest level. This can be accomplished by laying down and propping for your foot up on the arm of the couch with pillows.
Step 2) The next step is going to be to loosen up the injured and opposing muscles. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Overuse injuries are different and in some cases have literally taken years to build up. They will not disappear overnight. Trying to rush the healing process here won’t change that. Don’t overdo it in an attempt to speed up your recovery.
1) R.I.C.E. + gentle stretching. There should be no pain with stretching.
2) Start with the injured muscle group. Begin using the foam roller AROUND the injured area. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or active/joint mobilizations. The order should be foam roll around injury -> stretch -> RICE.
3) Begin using the foam roller over the injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> RICE.
4) Now that there is slack in the injured muscle, we can go back and assess range of motion (ROM). Are there limitations? Do you feel pressure in the joint? This is where you will add in the joint mobilization techniques. The order should be: foam roll around the injury -> foam roll over the injury -> joint mobilization -> stretch -> RICE
4) Begin using the tennis ball for active mobilizations. The order should be foam roll around injury -> over injury -> joint mobilization -> active mobilization with the tennis ball -> stretch -> RICE.
5) Begin using the tennis ball for cross friction + trigger point. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.
6) That was for the injured muscle. Now you must go back through and repeat steps 2-5 for the opposite muscle group. Go easy! You may find some rather sore spots and areas in these muscles as well. Remember- only progress through the levels when you can do so pain free.
Step 3: Range of Motion (ROM) and Muscle Pairs
Now that you know steps for treating overuse injuries, the next step is being able to look at joint ROM and knowing what the muscle pairs are throughout the body. This is an important piece even when dealing with newer injuries such as strains/sprains, spasms/knots and tendon injuries. Due to the volume of material, we are going to break it down into upper and lower body.
Step 4: Training Modification Tips
More often than not, the first question I get is not- what do I do to get this better? It’s what can I do while I get this better? To answer this question, I put together a chart that will help you grade the severity of your injury based on your symptoms, make appropriate training modifications, and determine what course of action is best in terms of medical treatment. Think of it like a giant thermometer. The higher up you move on the chart, the more important action is and the more likely your training and racing will take a hit.
***I can’t stress this enough- use common sense when using this chart. This is not all encompassing and it is not designed to keep you from your healthcare team. If you are experiencing symp- toms like numbness/tingling, swelling, scary dark/purple bruising,inability to stand/weight bear, lift your arm over your head, etc please call your Doctor.***
