An overuse injury is any repetitive movement whose force requirement exceeds that which a muscle and/or its tendon (a.k.a. muscle-tendon complex) are able to sustain over a given amount of time. The result is tearing of either the muscle or tendons’ fibers. When this occurs there is a small amount of bleeding. In this case, bleeding is advantageous as it will bring in all of the healing constituents necessary to repair the tear. Here, the old adage RICE (Rest, Ice, Compression, Elevation) applies. The underlying problem is most will “chalk” this up as a minor setback. They will not treat it appropriately and will continue to perform the repetitive movement while tolerating the minor pain. Here is where the problem exists: there are 3 stages to injury. The 1st phase is the acute phase. The acute phase is the 1st 24 to 48 hours. It is no coincidence that this is the timeperiod where icing an overuse injury is often recommended. It is in this acute phase where this injury is most easily treated. The 2nd phase is called subacute phase and it is from 48-72 hours. It is generally advocated that during this phase of treatment a person should alternate heat and ice while doing light stretching exercises. If left untreated, during this timeperiod the blood flow to the injured area begins to stagnate and become nonfunctional. An overuse injury is much more difficult to treat during this phase. From 72 hours-on an overuse injury enters its chronic phase. In this phase, the injury must be brought back to the acute phase in order to be treated. This is usually done in physical therapy with the use of physical therapy modalities such as cross-friction massage, ultrasound, electrical stimulation (E-Stim) and/or provoking exercises. Too many times overuse injuries are allowed to enter the chronic phase. Over time and as the overuse injury continues to go untreated, it can increase in size rendering the muscle-tendon complex too painful to use. Continuing, muscle-tendon tearing worsens and can eventually lead to rupture. In summary, overuse injuries are very common in the recreational athlete. If treated immediately using the principles of RICE, these such injuries can be cleared up in a short period of 2 weeks. If left untreated over weeks of repetitive motion, a person might need a minimum 30 days of physical therapy at a frequency of 2 × per week. If longer periods of overuse occur (1+ months), surgical intervention might be the only option.
Dr. Brett Purdom, PT, DPT, ATC, CSCS
Owner of The Foot Mechanic™