May 18, 2011 • Sports Medicine

SportsMed: Dealing with overuse injuries

When the summer approaches, many student-athletes ask teammates the question: “What are you doing to get better this summer?” A desire to improve performance initiates the process of planning for a strength-and-conditioning program that will meet the needs of the student-athlete.

Photo: Kevin Hoffman

Unfortunately, few of these programs will be supervised and most athletes have a tendency to push beyond appropriate physical limits in an effort to excel in his or her respective sport. Consequently, excessive loading and overuse injuries often occur.

Such injuries can include pectoral strain, low-back strain and disc herniation from improper weight lifting. Conditioning injuries typically involve the lower extremity, such as hamstring or quadriceps strains, hip flexor or groin strain. Injuries are often due to poor technique, an overload of the structure, a strength deficiency or lack of muscle endurance. Olympic lifts such as the power clean, snatch or dead lift have been shown to present elevated risk for injuries. Proper technique is imperative for realization of optimal results, and most importantly, the prevention of injuries. A solid strength foundation should be in place before attempting such exercises.

Avoiding overuse injuries

For strengthening exercises (e.g., bench press, squat, shoulder press), load level should be based on 1-RM (Rep Max) testing or a Rep-Max test that estimates 1-RM. A systematic approach to determination of an appropriate load level, exercise selection and adequate recovery reduce injury risk. For example, performing squatting exercises more than twice per week can result in an overuse injury. Most strength-and-conditioning programs balance intensity (load level) and volume (reps and sets) with workout frequency (sessions per week).

Injuries sustained during conditioning drills typically occur from poor execution of a rapid movement (which typically involves rapid acceleration, deceleration and change of direction) without proper body positioning. A contributing factor may be fatigue of the muscle, which overloads mechanical tolerance. Hamstring, quad, groin and hip flexor strains occur abruptly when an athlete is moving at peak velocity. Proper warm-up and stretching prior to the performance of drills are essential to prevent such injuries.

Overuse injuries result from concentration of stress on specific tissues and inadequate recovery time, which leads to pain and inflammation. Patellar tendinitis, Achilles tendinitis and rotator-cuff tendinitis are common overuse injuries that can result from improper training programs. General soreness following exercise is typically the first indication that an overuse condition has developed. Sharper pain develops subsequently, which makes proper technique difficult to maintain.

Overuse injury management

Overuse injury management involves a three-phase approach.

Phase I of the overuse injury recovery process should focus on decreasing pain and inflammation through the use of ice and anti-inflammatory medication (e.g., ibuprofen) during the early stage (three to five days), while trying to increase range of motion. Exercises that do not involve the injured body area can generally be performed, if they do not cause pain. For example, an athlete may still do a leg press exercise if he or she has a shoulder injury.

Phase II of the recovery process involves strength restoration through a full range of motion. Exercises should be pain-free with emphasis on proper technique to prevent injury recurrence. For example, low volume and proper technique should be emphasized for an athlete with a low-back injury that resulted from squatting. If poor technique was the cause of the injury, the athlete’s technique must be corrected. The amount of weight should always start at a low level and gradually be increased as tolerated. Return to the pre-injury strength level may require weeks to months, depending on injury severity.

Phase III of the recovery process involves a gradual re-introduction of complex movements (Olympic-style lifting, moderate-intensity running drills) after motion and strength have been restored. As the athlete feels more comfortable with the movements, and proper technique is maintained, volume and intensity generally can be increased and sport-specific exercises can be introduced. Progression from walking, to jogging, to running, to sprinting, to slow-velocity cutting, and to high-velocity cutting should be carefully monitored.

Strength-and-conditioning injuries are common among competitive athletes. Injury management should not involve complete restriction of all activity, but should facilitate healing, restoration of motion, function, and maintenance of cardiovascular fitness.


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