female runner holding her knee

Fitness at All Costs? PTs Treating Overuse Injuries

Chances are, some young adults have winced their way into your office or clinic. They may be diehard marathon runners, hardcore CrossFit addicts, or just regular people who are determined to get into better shape—whatever the cost may be to their bodies.

More and more millennials, especially, have become devoted to strenuous and frequent workout sessions. But now they’re injured and they’re hurting, and the cause seems to be excessive exercise.

“Overuse injuries are caused by doing too much, too often, without enough recovery time between bouts of activity,” explained Michael Bergeron, PhD, FACSM, senior vice president of development and applications for the Center for Advanced Analytics in Sport and Health for GameChanger Analytics. “These injuries are the result of repeated submaximal overload that causes a breakdown in body tissue—e.g. muscle fibers, tendons, ligament, bones or all of the above.”

It’s important for physical therapists and other medical professionals to identify the root cause of the injury or identify the potential risk, Bergeron said. He recommends a full evaluation, including assessment of the patient’s overall fitness, range of motion, muscle balance and strength. 

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David Hanawalt, PT, DPT, CMPT, said he sees a lot of overuse injuries in his Chicago practice. “It can vary a lot, depending on the person and the region of the body, but a lot of it stems from some type of central or proximal core weakness,” he said.

 As a result, he likes to add some type of core strengthening element to regimens he creates for people with overuse injuries. “It’s your base for all your extremities to work off,” he tells patients. 

What PTs Should Tell Their PT Patients

A carefully planned and executed physical therapy program is necessary to help a patient, of any age, recover from an overuse injury. But the hardest part of your job may be convincing your patients of the importance of taking better care of themselves in the future. 

One of the most important things to stress is that overuse injuries are usually preventable. Consider these strategies when advising your physical therapy patients how to avoid future injuries:

1. Encourage patients to build up slowly. It’s all too easy for someone to get gung ho about a new exercise, throw themselves into it, and then get hurt. Instead, it’s better to work progressively toward a goal, said Bergeron. “This needs to be a long-term process where the loaded tendons, muscles, ligaments and bones have the opportunity to recover and positively adapt,” he said. 

2. Promote cross-training. Urge patients to vary their workouts. Many overuse injuries develop when a person does the same activity over and over again. Encourage patients to try incorporating a different type of activity into their routine so they challenge their muscles in different ways. If they love to run, suggest they consider adding a weight-lifting session or a yoga class to their schedule. 

3. Remind patients to pay attention to form. Good form and posture while exercising are very important, noted Hanawalt. A good coach or instructor should be cueing them to monitor their form. 

4. Emphasize the importance of rest. “Rest is a critical component to any good workout routine and time spent allowing the body to recover is a great way to recover injuries,” wrote Mary Nadelen, MA, ATC, in “Basic Injury Prevention Concepts” for the American College of Sports Medicine (ACSM). 

5. Recommend stretching—every time. Most athletes know about this basic concept, but may skip this step or cut it short from time to time. “A good warm-up before activity is important,” said Hanawalt. “You want your muscles to be warm and loose and limber. You don’t want to exercise cold muscles—they have a much higher chance of tearing and breaking.

6. Spell out the warning signs of excessive exercise. Their body will tell them when something is wrong, but they have to listen to it. “People need to recognize the warning signs indicating when ‘training’ becomes ‘straining,’” said Bergeron. Pain, undue soreness, unusual amounts of fatigue and other signs can be very reliable indicators of overload or overuse—and it’s important to take the time to stop, examine the situation and take corrective action.

Whether you provide these recommendations all at once, or weave them into your conversations during physical therapy sessions, your guidance on how to avoid overuse injuries in the future can be an important part of your patients’ recovery plan. It is up to them to follow through.

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