eMedicine Specialties > Physical Medicine and Rehabilitation > Muscle Pain Syndromes

Overuse Injury: Follow-up

Author: Scott R Laker, MD, Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center
Coauthor(s): William J Sullivan, MD, Assistant Professor, Pain Medicine Fellowship Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center; Scott Strum, MD, Director of Traumatic Brain Injury Service, Assistant Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center
Contributor Information and Disclosures

Updated: Mar 12, 2008

Follow-up

Deterrence/Prevention

  • Minimizing repetition when possible, optimizing techniques within the offending activity, minimizing vibration and force, and avoiding awkward positioning are the first steps in prevention.
  • Improving job satisfaction, as well as teaching stress management techniques and coping skills, has led to some decrease in repetitive stress injuries.
  • Athletes may require an expert evaluation of their techniques in order to determine any modifications that can be used. Proper-fitting equipment is also crucial in preventing overuse injury.

Prognosis

  • Most overuse injuries resolve after 3-6 months. However, unless the offending causes are addressed, recurrences are quite common. Patient motivation and commitment to prevention are key to rehabilitating these injuries.
  • Home exercise programs tailored to the individual's biomechanics are another important facet of treatment.
  • Recovery after surgery varies depending on the procedure.

Patient Education

  • Education is an indispensable part of the treatment program for patients with overuse injuries. For several reasons, the interested patient should receive as detailed an explanation of the diagnosis and the treatment program as possible.
    • Conveying this information establishes patient confidence that the physician is knowledgeable and trustworthy. Without this confidence, the patient is likely to seek help elsewhere or may not adhere to the recommended treatment program.
    • Patients also should agree with the physician's explanation of the problem so that they will participate appropriately in the intervention program. If a patient does not believe in an allopathic explanation of his/her disorder, the patient is unlikely to participate effectively in an allopathic treatment program
    • Education also gives patients reasonable expectations of the interventions planned and of their own responsibility to follow recommendations at home (eg, activity modification, exercise).
  • The causes and prevention of overuse injuries must be explicated, and it is appropriate to state that this is an area of some controversy within the medical community. For athletes and performing artists, who generally are people who are highly motivated to resume the offending activity as soon as possible, emphasis must be placed on the long-term consequences of returning to their activities too early. For those with probable secondary-gain issues, the physical and psychological complications of lack of activity must be emphasized.
  • For excellent patient education resources, visit eMedicine's Sports Injury Center and Muscle Disorders Center. Also, see eMedicine's patient education articles Repetitive Motion Injuries and Sprains and Strains.

Miscellaneous

Medicolegal Pitfalls

  • In what can be called a litigious era in medicine, all interactions with patients should be undertaken with an awareness of possible future legal involvement. This awareness further compels clinicians to be accurate, thorough, and reasonable in the presence of the patient and with any documentation. Assuming the physician is knowledgeable and reasonable, an amiable doctor-patient relationship is the best way to prevent being sued. The clinician's notes may be part of a workers' compensation chart, which frequently is subject to legal review. A physician may be deposed as the treating physician or as an expert witness. In any of these situations, appropriate documentation is very desirable.
  • Legal concerns are quite rare when only conservative interventions are prescribed. Poor outcomes from invasive procedures are far more likely to prompt a lawsuit. Be sure to perform injections and other procedures in a manner consistent with community standards and for clear reasons. The patient's fully informed consent is crucial.

See also the following related Medscape topic:
Resource Center Medical Malpractice and Legal Issues

Special Concerns

  • The experience of Australia in the 1980s regarding repetition strain injury raises awareness of the potential for abuse in this field.18,19 Repetition strain injury was briefly noted to be a rapidly increasing problem in the late 1970s and early 1980s among telephone operators and bank employees; in some settings, there was a 1-year increase in incidence of as much as 275%.
    • Reviews of this public health phenomenon have concluded that no pathologic findings, no examination findings, and no consistently abnormal laboratory findings were apparent.
    • Although the patients who reported upper extremity symptoms worked in a range of different jobs, young to middle-aged female employees in low-paying, monotonous jobs with low prestige complained most commonly.20,21 Avoidance of work did not result in improvement in many cases; instead, steady deterioration of subjective symptoms was often observed.
    • Although controversial, repetition strain injury has been called a psychosomatic symptom complex and an iatrogenic epidemic of simulated injury.
    • The frequency of complaints of repetition strain injury dropped dramatically, although less rapidly than the complaints had arisen, when the Supreme Court of Australia made a landmark decision against a plaintiff alleging repetition strain injury; educational efforts were undertaken by those who recognized the pattern of abuse. Similar historic precedents have been recorded in which the removal of the secondary gain has resulted in a decline in reported complaints of these injuries.
  • Repetition strain injury is distinguished from commonly accepted overuse and degenerative conditions by the presence of the following:
    • Clearly defined and distinguishable subjective symptoms
    • Recognizable gross and microscopic pathologic features
    • Reproducible, objective clinical findings
    • Appropriate responses to effective forms for physical therapy or treatment
 


More on Overuse Injury

Overview: Overuse Injury
Differential Diagnoses & Workup: Overuse Injury
Treatment & Medication: Overuse Injury
Follow-up: Overuse Injury
References
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Further Reading

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Keywords

repetitive stress disorder, repetition strain injury, cumulative trauma disorder, secondary gain, malingering, worker's compensation fraud, workers compensation fraud, worker's compensation abuse, workers compensation abuse, worker's compensation, workman's comp, overuse injuries, cumulative trauma disorder, repetitive demand injuries, occupational injury

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Contributor Information and Disclosures

Author

Scott R Laker, MD, Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center
Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

William J Sullivan, MD, Assistant Professor, Pain Medicine Fellowship Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center
William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, International Spine Intervention Society, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Scott Strum, MD, Director of Traumatic Brain Injury Service, Assistant Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center
Scott Strum, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Medical Editor

Teresa L Massagli, MD, Residency Director, Professor, Department of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine
Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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