What is an Overuse Injury?

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 1^st phase is the acute phase. The acute phase is the 1^st 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 2^nd 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™
www.thefootmechanic.com

Barefoot/Minimalist Running Debunked

Barefoot and minimalist running styles are dangerous for your feet. In fact, they fail to recognize the most primitive biomechanics of running or the deleterious effects of this type of running style on the human foot. Simply stated, longitudinal studies outline the foot must start in a rigid position (closed-packed or supinated) position. It then must transition into a malleable (loose-packed or pronated) position in order to adapt to the ground surface. Finally, its 3rd phase is to re-transition into a rigid (closed-packed or supinated) position in order to gain a rigid lever for push off. The 26 bones in the foot are intimately and precisely positioned to go through these phases (heel strike, mid stance and push-off) in order to prevent injury. By altering the mechanics of walking/running by using toe-running or midfoot striking a person sets themselves up to what we call “retro loading” which puts extreme non-biomechanical forces across the bones of the midfoot (tarsal bones). This can cause, but is not limited to, acute pain, plantar fasciitis, early arthritic changes, stress reactions and even stress fractures. This doesn’t even mention the adverse effects which may occur up what we call the kinetic chain (ankle, shin, knee, hip and low back). The evolution of the human running shoe is not a manifestation of the shoe companies’ attempt to sell more shoes. Rather, the running shoe is a product of evolution based on longitudinal studies of human biomechanics. If they were not we would all still be running barefoot. It seems that this whole “barefoot” running craze/phase is attempting to de-evolve the human foot back centuries. The only reason there are so many advocates for this type of running style is the mere fact that it is so relatively new we do not yet have longer-term longitudinal studies proving the aforementioned osteoarthritic/stress reaction/stress fracture data. However, if you browse around the Internet you will certainly find anecdotal testimonials as to such. I would refer you to the following two articles:

Barefoot Running Problems – Men’s Health www.menshealth.com/fitness/barefoot-running-problems

competitor.com
http://running.competitor.com/2010/05/features/the-barefoot-running-injury-epidemic_10118/4

Dr. Brett Purdom, PT, DPT, ATC, CSCS
Owner of The Foot Mechanic™
http://www.thefootmechanic.com