OVERUSE INJURIES
by: Dr. Darrell M. Schreyer, D.C.

Overuse injuries make up the majority of injuries sustained during walking, jogging, and running activities. They are the most common athletic complaint treated by Doctors of Chiropractic and other health care providers. Unchecked and untreated, these injuries can lead to severe or even permanent disability.

The anatomical location of most overuse injuries is in the lower limb, especially the knee and tibial area or shin. A cycle of overload, abuse, and fatigue leads to tissue failure which cannot be repaired while the offending activity continues. Strength and flexibility are reduced, until, in frustration if not pain alone, the injured party seeks professional care. Treatment is further complicated by the patient's desire to resume the offending activity as soon as pain is relieved. This contributes to the recurrent nature of overuse injuries, and demands good communication and cooperation between patient and doctor.

When forces are imposed which exceeds the body's present level of structural strength and ability to repair, something must fail. The major sources of these structural breakdowns and mechanical errors, structural asymmetries, tissue weaknesses, and excessive external loads. All of the proceeding factors result in repetitive micro trauma, which is the underlying cause of overuse injuries. The source of micro trauma must be recognized and treated in order to prevent further tissue breakdown and chronicity.

Bio mechanical errors are created by work or sports habits which place undue or unbalanced stress on normal body parts. One example would be the tendency of many long distance runners to consistently run on the same side of the road or the same way around a track.

Structural asymmetries or imbalances result in increased bio mechanical forces which cannot be corrected by changing work or training procedures. Anatomical leg length discrepancy, or short-leg syndrome has been shown to lead to increased frequency of several overuse syndromes.

Tissue weaknesses such as muscle imbalance, poor cartilage or disc nutrition, and ligament laxity can also be a significant factor in the development of overuse injuries. If the tissue is weakened to start with, it will e able to tolerate only low levels of stress.

Excessive external loads or forces such as a sudden increase in training schedule, mileage, or weights can overwhelm the body's capacity to maintain and repair the muskuloskeletal system. Running on unyielding surfaces, or even standing and working for hours every day on concrete and linoleum may eventually result in micro trauma breakdown and overuse syndrome.

Overuse injuries are generally treated through a combination of inflammation control (RICE: Rest, Ice, Compression, and Elevation), specific adjustments, therapeutic exercise, postural support and stabilization, and attempting to prevent further abuse. This is done by correcting training errors, improving environmental factors, and modifying equipment and workstations.

By prescribing strengthening exercises for the extremities and postural muscles, the doctor can satisfy the patient's desire for activity and encourage better muscle balance when athletic participation or work attendance resumes.