Overuse Injuries

Inflammatory Injuries

Bursitis

Bursitis is the condition that occurs in the bursa which surround the joint cavity when the component parts of the joint structure become inflamed from continuous overuse. Treatment of bursitis includes the use of moist heat before activity followed by cold applications at the end of activity. A pressure wrap should be utilized to help inhibit swelling. With bursitis, one should continue in their exercise prescription at pain tolerance levels. Initial treatment usually involves a 3-5 day rest period followed by a gradual return to full participation. A physician may choose to aspirate or inject the affected area as an alternate form of treatment.

Tendinitis

Tendinitis is the result of an inflammatory disorder affecting the musculotendinous unit. Like bursitis, tendinitis occurs from repetitive overuse. The treatment of tendinitis is similar to that of bursitis.

Soft Tissue Injuries

 

Muscle Cramps

Muscle cramps are often quite easy to detect but determining the cause may be very difficult. There are several possible causes and combinations of causes that elicit muscle cramping. These may include fatigue, a direct blow to the muscle, over stretching of the opposing muscle groups, or mineral imbalances in the muscle. Usually during exercise the muscle cramping occurs from fatigue and/or mineral imbalances and dehydration.

Treatment of muscle cramps should include a thorough history of the patterns which have led to muscle cramping in the past. Immediate care should include stretching, gentle massaging (barring other injury), and cold applications. Prevention of muscle cramps should provide for an adequate stretching and flexibility program ,proper fluid intake during exercise events, and adequate time for proper conditioning to the exercise environment.

Muscle Strains

Muscle strains are the most common form of exercise related injuries and are classified by their degree of severity. Symptoms may include complaints of sharp or dull aching pains anywhere along the muscle or tendon.

  • lst degree -(mild) Involves a stretching or tearing of a minimal number of muscle fibers and produces little disability .
  • 2nd degree -(moderate) May include physical trauma to one half of the muscle fibers with significant range of motion (ROM), muscle strength, and functional loss.
  • 3rd degree -(severe) Third degree muscle strains range from three quarters to complete separation of all the muscle fibers. The injury may be compounded with rapid swelling and complete functional disability.

If the muscle is completely torn, the participant may experience a great deal of pain for the first 10-15 seconds followed by complete cessation of pain . Complete muscle tears require surgical repair and may be visually evident by the "bunching up" of the muscle following the injury.

Treatment of muscle strains includes the application of ice, compression, and elevation to the injured area for the first 24-72 hours, depending upon the severity of the injury. After the swelling has subsided from the area, moist heat applications and stretching should be utilized. In order for someone to return to full activity, they should have full range of motion, 90% of pre-injury strength levels returned to the affected area, no swelling, and obtained a physician's release. Again, the amount of pain is not always indicative of the severity of the injury.

Ligament Sprains

Sprains are injuries which occur to the ligaments when undue force has been directed through the joint complex. Ligaments function to prevent any abnormal joint motion. Damage to ligament structures produce joint instability termed laxity. Sprains are classified by the severity of ligament damage resulting in measurable joint laxity and instability.

  • 1st degree -pin point pain is usually indicative of a minor damage to a specific ligament. A first degree sprain does not exhibit laxity and should only require about 10 days for recovery .
  • 2nd degree -involves a great deal of pain and notable disability. A second degree sprain usually requires 2-4 weeks of recovery.
  • 3rd degree -involves a complete tear of the ligament structure possibly requiring surgical intervention. A third degree sprain can involve six weeks to four months for complete recovery.

Ligaments tend to heal slower than other structures due to a poor vascular supply. Treatment of sprains includes ice, compression, elevation, strength, and proprioceptive training (toggle boards used to train the nervous system), with contrast and heat applications in the post-acute stages of rehabilitation. During injury recovery, one should constantly work on regaining a full Range of motion (ROM) even in the acute stages of injury rehabilitation .

Contusions

Contusions (bruises) are caused when capillary beds are ruptured by a direct blow to the body surface area. Treatment of contusions involves the application of ice compresses in the acute phase of injury. Care should be taken to protect the contused area from any future traumatic contact. A major complication which may arise from contusions is the formation of calcium ossification in the injury site. This ossification occurs due to a lack of proper care to the injured area. This ossification is called myositis ossificans, and may require surgical intervention.

Blisters

Blisters are usually formed over a bony prominence where there is an unusual amount of friction over an area of external skin. The prevention of blisters may be assisted by the application of powder or skin lube to decrease the friction, or by wearing extra socks while breaking in new shoes. "Hot Spots" can be prevented by the application of tape, band-aids, or moleskin over the suspected area. One also runs the risk of infection with the formation of blisters. There should be an attempt to keep the skin covered if at all possible, and only puncture the blister if tearing seems to be inevitable. If the blister must be opened, a sterile needle or scalpel should be utilized, and the blister should be incised allowing gravity to drain the area. A pressure pad should be applied over the area along with a doughnut pad to prevent constant friction.

If the blister is open and torn, the flap of the blister should be left open and antiseptic cream should be placed under the flap into the area where the fluid drained out. The area should then be covered with a sterile dressing and doughnut pad (see left).

The remaining flap should not be removed until the underlying skin has hardened.

 

 

One runs the risk of developing a local infection with the formation of a blister. Signs of infection usually surface 2-7 days following the onset of injury. Signs of infection include:

  • Local heat
  • Swelling
  • Redness
  • Pain or tenderness
  • Pus discharge
  • Swollen lymph glands
  • Red streaks

Immediate Care of Injuries

Soft tissue injuries may occur due to collisions, sprains, strains, and/or cumulative over stress on a particular region of the body. Most soft tissue injuries may be treated with R.I.C.E.(S).

  • R - Rest is essential for healing to occur, and rest is essential for prevention or further injury to the affected area.
  • I - Ice in the form of cold treatments would be administered for 20 minutes every one to one and one-half hours. Cold applications help prevent undue swelling and also serves as an anesthetic.
  • C- Compression in the from of a pressure wrap helps prevent and reduce swelling of the injured area.
  • E- Elevation assists in the reduction of swelling. The injured area should be elevated above the level of the heart.
  • (S) - Stabilization or splinting should be utilized for additional protection of the injured limb, especially if there is additional injury such as a fracture or dislocation.