Have you ever been told you have an “overuse injury”? Did your doctor, chiropractor, physical therapist or friend tell you to stop running, throwing or exercising? Well I am here to tell you that the concept as you know it of overuse injuries is just an old wives’ tale that has been overused for decades in order to explain something that seems inexplicable.
You may be saying in your head, if I play a lot of tennis my elbow hurts, if I don’t play tennis it doesn’t hurt. Then it MUST be an overuse injury, right? Wrong.
On a regular basis I have patients come in with an “overuse” diagnosis yet through specific therapy and careful considerations, they are able to return to their sport the same day or very next day and compete at a high level without pain. They almost never have to decrease or stop their use of a limb, joint, muscle or tendon that seems to be problematic.
In fact, any therapist worth their money should be able to tell you at least one story of someone with a chronic overuse injury that they were able to resolve in only a single visit without any activity restrictions.
What is it then?
So then if the overuse injury can resolve even with an increase in use, was it really ever an overuse injury? I say, NO! This is why all the research papers that are suggesting overuse injuries in kids are a growing epidemic are completely wrong.
Many practitioners get so specific in their niches that they lose sight of the bigger picture. For example, a therapist that treats baseball pitchers often will think that all of the kids are overusing their throwing arms. While this can be true, it is usually not the case. There will always be rare exceptions, but for most people, even endurance and competitive athletes, it’s rarely the case.
You see, your body was made to move all day long without pain. That is a fundamental belief you must have if you are ever going to heal and live a healthy and pain-free life.
The first point I am trying to get at is that if I can treat a pitcher with an “overuse injury” and they don’t decrease their activity level, then it was never really an overuse injury.
What is an Overuse Injury
Okay, let me go back on the overuse injury concept. Can you use a shoulder repetitively and create breakdown of cartilage, ligaments and even bone? Yes, you actually can. So overuse injuries exist in the way that damage can occur and symptoms can appear, but what I hope to cover is why overuse injuries occur, aka the root cause, because it is rarely if ever the fact that someone performs a repetitive task.
First of all, lets note that an overuse injury is a very broad term that encompasses many different injuries that can be very specific or very broad in nature. Tennis elbow, golfer’s elbow, IT Band Syndrome, stress fractures, shin splints, carpal tunnel, any tendonitis, any bursitis, jumper’s knee, patellar tendonitis, plantar fasciitis, Achilles tendonitis and more are all chalked up to overuse and given the typical recommendations of pain killers, decreasing activity, casting, crutches or surgery. If you are lucky you will get a referral to physical therapy, which is a good start.
We have “overuse injuries” because of muscular and nutritional imbalances.
Start with nutrition. Overuse injuries imply inflammation to some extent. All inflammation in the body is chemical in nature. The majority of chemicals we have in our body come our diet. Some people are way more inflamed systemically than others. This occurs because of the standard American diet that includes far too many excessive refined foods, processed sugars, high carbohydrates and low protein and healthy fats.
These high levels of inflammation affect both the repair and the function of the tissues in the body. If your tendon is highly inflamed from a poor diet, then it will be prone to hurt when you add any additional movement or stress to the tendon through exercise and activity.
In a healthy individual with low levels of inflammation and a healthy inflammatory response, inflammation may be created through exercise and activity, but due to the proper functioning of your immune system and other organs, the inflammation is quenched and you don’t experience chronic pain.
Muscular imbalances from previous injuries, surgeries, dental work, auto accidents, etc. all contribute to muscles tightening and decreasing their ability to move fluidly upon demand. When these muscles become imbalanced, then you get a compensation from other muscles, increased stress on tendons and ligaments and sometimes even a grinding of joints and wearing down of bone and cartilage.
When a muscle experience an injury, it essentially “turns off” and no longer can work at the proper speed and strength. The body does this in order to protect the muscle from being hurt even more and causing even more serious damage.
So going back to whether or not you really have an overuse injury, the truth is that most people have muscular imbalances and nutritional imbalances that lead to the symptom of an overuse injury.
Differentiating between a symptom and a root cause makes all the difference in the world when it comes to resolving chronic and acute pain quickly and permanently.
Treating Overuse Injuries
The treatment of overuse injuries by even some of “the best” practitioners is still more often than not being done ineffectively. Many (not all) physical therapists, chiropractors, manual therapists, etc. are still making the big mistake of treating where the pain is.
To understand more fully what I mean, I have created a pie chart :-)
You see most modalities (tools therapists use) were created to address symptoms. If your shoulder hurts for example your therapist will likely manipulate the shoulder, use ice or heat on the shoulder, stretch the shoulder, scrape the shoulder, cold laser the shoulder, kinesio tape the shoulder, etc. You should get the point that the focus is on the shoulder.
The localized approach to treating pain is outdated and leads to longer treatment times and slower recovery. The faster way to recover and to discover root level issues is to look more globally at the body as a whole.
Continuing with the shoulder example, an extremely common dysfunction I find is that of gait. In this example, it may mean that each time you take a step with your right foot forward, it creates a problem with your left shoulder. Correcting the gait in the low back/hip region is what must be corrected prior to recovery and in order to keep the shoulder pain from returning. The opposite hip dysfunction in this example is often caused by a diaphragm, digestive or hormonal problems.
So bringing this shoulder example full circle, you may have chronic shoulder pain (overuse injury) due to muscular imbalances in the low back and hip region with a true root cause of hormonal imbalances.
Understanding your health in a comprehensive manner is what will provide the most rapid and lasting relief.
In the above example, even if your shoulder got better but you never addressed hormonal imbalances it would likely return. Then people say things like, “I have had this off and on for 20 years” or they have to take a medication or supplement every day to decrease the pain.
At home treatments for “overuse injuries”
- Don’t treat where it hurts, that is not the problem! Look for muscles that attach to the region that you are trying to address. If your elbow hurts, look for trigger points in the biceps, forearm and shoulder regions. If your foot hurts, work on trigger points in the muscles in the calf region. Trigger points will often be tender and once located at home should be worked on 2-3 times a day. Simply find an area of tenderness (away from the site of the pain) and put some deep pressure into it.
- Fix your nutrition. If you aren’t eating a healthy whole foods diet yet, now is the time to start. Remove all refined sugars and processed foods. Avoid artificial anything as well as high carb foods such as breads and pastas. Increase your protein to at least 90 grams of protein per day with a focus on eating whole meat sources.