Overuse Injury Treatment & Management
- Author: Scott R Laker, MD; Chief Editor: Consuelo T Lorenzo, MD more...
Relative rest, particularly avoidance of the inciting activity, is a hallmark component of treatment. Using the involved area in nonpainful ways often helps maintain ROM. Total bed rest is virtually never advisable for these patients. Participation in a carefully planned physical therapy program is important for the following reasons:
Supervised use of the injured part 
Appropriate use of modalities (eg, transcutaneous electrical nerve stimulation units, similar electrical treatments, ultrasound/phonophoresis, iontophoresis, heat/cold)
Development of a home exercise program
Psychosocial benefits related to frequent interaction with an active partner in the treatment regimen
In a randomized clinical trial, the short- and long-term effect of an exercise training program used for treating adductor-related groin pain in athletes was evaluated. The program had 47 participants who agreed to be interviewed and examined in an 8- to 12-year follow-up. The results found that the exercise program had a long-lasting effect on the participants and is the first time an exercise treatment program for overuse injuries to the musculoskeletal system has had this significant outcome.
The physical therapy program also offers the patient the chance to see that movement will not lead to ongoing tissue damage, thus preventing significant "sick behaviors" or kinesophobia.
Overuse injury in athletes is commonly caused by ill-fitting equipment (eg, in cycling), overtraining/over-reaching (eg, with regard to triathlons, marathons, etc.), or technique flaws.[25, 26] Specialized bike-fitting is available, sports psychology is worthwhile in combating overtraining, and sport-specific coaching is often invaluable. Coaches, athletes, and physicians must work together to correct these problems and maintain a healthy musculoskeletal system.
See also the following related Medscape topic:
Occupational therapists with experience in this field can help to identify workplace modifications. In cases of individuals with disabilities who develop overuse injuries as a result of the interface with adaptive equipment, occupational therapy may be of great benefit. Often, simple modifications in the manner in which the patient performs activities of daily living or modifications in the equipment itself confer relief.
Vocational rehabilitation and work-hardening programs are often effective for bringing motivated patients back into the workforce. Integration of this type of program has proven to be effective in the corporate world and has decreased the overall financial impact of overuse injuries in the workplace.
Significant medical complications are quite rare with conservative treatment of these disorders. Adverse drug reactions and side effects occur, but they usually resolve with cessation of the medication. Comorbidities, such as diabetes, may be exacerbated by medications, particularly injections of steroids, which may yield elevations in blood glucose levels. Injections and surgical procedures may be accompanied by bleeding or infection. Insufficient treatment may result in chronic pain and disability, depression, and insomnia. These complications may require additional, more complex treatment.
Surgical intervention is undertaken if conservative approaches fail and if the injury is amenable to surgery. In overuse injury, decompression of nerves and repair of lax or failed ligaments are the most common problems that lead to surgery. Surgeries that are performed solely to relieve pain in the absence of objective findings are notorious for suboptimal outcomes.
Overuse injuries in athletes are often most effectively treated by a physician with experience in sports medicine and a thorough knowledge of the kinetic chain. Patients with injuries stemming from the performing arts are also often best served by a physician who deals extensively with that population. Consultation with an orthopedist or neurosurgeon is appropriate if conservative measures are unsuccessful.
Flick J, Devkota A, Tsuzaki M, et al. Cyclic loading alters biomechanical properties and secretion of PGE2 and NO from tendon explants. Clin Biomech (Bristol, Avon). 2006 Jan. 21(1):99-106. [Medline].
Arnoczky SP, Lavagnino M, Egerbacher M. The mechanobiological aetiopathogenesis of tendinopathy: is it the over-stimulation or the under-stimulation of tendon cells?. Int J Exp Pathol. 2007 Aug. 88(4):217-26. [Medline].
Archambault JM, Jelinsky SA, Lake SP, et al. Rat supraspinatus tendon expresses cartilage markers with overuse. J Orthop Res. 2007 May. 25(5):617-24. [Medline].
Devkota AC, Tsuzaki M, Almekinders LC, et al. Distributing a fixed amount of cyclic loading to tendon explants over longer periods induces greater cellular and mechanical responses. J Orthop Res. 2007 Aug. 25(8):1078-86. [Medline].
Le P, Solomonow M, Zhou BH, et al. Cyclic load magnitude is a risk factor for a cumulative lower back disorder. J Occup Environ Med. 2007 Apr. 49(4):375-87. [Medline].
Moore A, Wells R. Effect of cycle time and duty cycle on psychophysically determined acceptable levels in a highly repetitive task. Ergonomics. 2005 Jun 10. 48(7):859-73.
Nakama LH, King KB, Abrahamsson S, et al. Effect of repetition rate on the formation of microtears in tendon in an in vivo cyclical loading model. J Orthop Res. 2007 Sep. 25(9):1176-84. [Medline].
Bongers PM, Kremer AM, ter Laak J. Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature. Am J Ind Med. 2002 May. 41(5):315-42. [Medline].
Melhorn JM. Cumulative trauma disorders and repetitive strain injuries. The future. Clin Orthop. 1998 Jun. (351):107-26. [Medline].
Roos KG, Marshall SW, Kerr ZY, et al. Epidemiology of Overuse Injuries in Collegiate and High School Athletics in the United States. Am J Sports Med. 2015 Jul. 43 (7):1790-7. [Medline].
Schroeder AN, Comstock RD, Collins CL, Everhart J, Flanigan D, Best TM. Epidemiology of overuse injuries among high-school athletes in the United States. J Pediatr. 2015 Mar. 166 (3):600-6. [Medline].
Hart DA, Archambault JM, Kydd A, et al. Gender and neurogenic variables in tendon biology and repetitive motion disorders. Clin Orthop. 1998 Jun. (351):44-56. [Medline].
Pritchard MH, Pugh N, Wright I, et al. A vascular basis for repetitive strain injury. Rheumatology (Oxford). 1999 Jul. 38(7):636-9. [Medline].
Battery L, Maffulli N. Inflammation in overuse tendon injuries. Sports Med Arthrosc. 2011 Sep. 19(3):213-7. [Medline].
Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. Br J Sports Med. 2013 May. 47(8):495-502. [Medline].
Siewe J, Rudat J, Röllinghoff M, Schlegel UJ, Eysel P, Michael JW. Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011 Sep. 32(9):703-11. [Medline].
IJmker S, Huysmans MA, Blatter BM, et al. Should office workers spend fewer hours at their computer? A systematic review of the literature. Occup Environ Med. 2007 Apr. 64(4):211-22. [Medline].
Andersen JH, Harhoff M, Grimstrup S, et al. Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder. Occup Environ Med. 2008 Feb. 65(2):126-31. [Medline].
Banks KP, Ly JQ, Beall DP, et al. Overuse injuries of the upper extremity in the competitive athlete: magnetic resonance imaging findings associated with repetitive trauma. Curr Probl Diagn Radiol. 2005 Jul-Aug. 34(4):127-42.
Cartwright MS, White DL, Demar S, Wiesler ER, Sarlikiotis T, Chloros GD, et al. Median nerve changes following steroid injection for carpal tunnel syndrome. Muscle Nerve. 2011 Jul. 44(1):25-9. [Medline].
Meltzer KR, Standley PR. Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fibroblast proliferation and interleukin secretion. J Am Osteopath Assoc. 2007 Dec. 107(12):527-36. [Medline]. [Full Text].
Hölmich P, Nyvold P, Larsen K. Continued significant effect of physical training as treatment for overuse injury: 8- to 12-year outcome of a randomized clinical trial. Am J Sports Med. 2011 Nov. 39(11):2447-51. [Medline].
Brenner JS,. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. 2007 Jun. 119(6):1242-5. [Medline].
Hreljac A. Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective. Phys Med Rehabil Clin N Am. 2005 Aug. 16(3):651-67, vi.
Landorf KB. Foot orthoses can reduce lower limb overuse injury rate. J Physiother. 2011. 57(3):193. [Medline].
Ireland DC. Australian repetition strain injury phenomenon. Clin Orthop. 1998 Jun. (351):63-73. [Medline].
MacEachen E. The demise of repetitive strain injury in sceptical governing rationalities of workplace managers. Sociol Health Illn. 2005 May. 27(4):490-514.
Szeto GP, Straker LM, O'Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work--2: neck and shoulder kinematics. Man Ther. 2005 Nov. 10(4):281-91.
Szeto GP, Straker LM, O'Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work--1: neck and shoulder muscle recruitment patterns. Man Ther. 2005 Nov. 10(4):270-80.
Armstrong AJ, McMahon BT, West SL, et al. Workplace discrimination and cumulative trauma disorders: the national EEOC ADA research project. Work. 2005. 25(1):49-56.
Barr AE, Barbe MF, Clark BD. Work-related musculoskeletal disorders of the hand and wrist: epidemiology, pathophysiology, and sensorimotor changes. J Orthop Sports Phys Ther. 2004 Oct. 34(10):610-27. [Medline].
Bonde JP, Mikkelsen S, Andersen JH, et al. Understanding work related musculoskeletal pain: does repetitive work cause stress symptoms?. Occup Environ Med. 2005 Jan. 62(1):41-8. [Medline].
Geraci MC, Brown W. Evidence-based treatment of hip and pelvic injuries in runners. Phys Med Rehabil Clin N Am. 2005 Aug. 16(3):711-47.
Lassen CF, Mikkelsen S, Kryger AI, et al. Elbow and wrist/hand symptoms among 6,943 computer operators: a 1-year follow-up study (the NUDATA study). Am J Ind Med. 2004 Nov. 46(5):521-33.
Lassen CF, Mikkelsen S, Kryger AI, et al. Risk factors for persistent elbow, forearm and hand pain among computer workers. Scand J Work Environ Health. 2005 Apr. 31(2):122-31. [Medline].
Maganaris CN, Narici MV, Reeves ND. In vivo human tendon mechanical properties: effect of resistance training in old age. J Musculoskelet Neuronal Interact. 2004 Jun. 4(2):204-8. [Medline].
Morton JP, Atkinson G, MacLaren DP, et al. Reliability of maximal muscle force and voluntary activation as markers of exercise-induced muscle damage. Eur J Appl Physiol. 2005 Aug. 94(5-6):541-8.
Novak CB. Upper extremity work-related musculoskeletal disorders: a treatment perspective. J Orthop Sports Phys Ther. 2004 Oct. 34(10):628-37. [Medline].
Plastaras CT, Rittenberg JD, Rittenberg KE, et al. Comprehensive functional evaluation of the injured runner. Phys Med Rehabil Clin N Am. 2005 Aug. 16(3):623-49.
Shah SN, Miller BS, Kuhn JE. Chronic exertional compartment syndrome. Am J Orthop. 2004 Jul. 33(7):335-41. [Medline].
Toledo SD, Nadler SF, Norris RN, et al. Sports and performing arts medicine. 5. Issues relating to musicians. Arch Phys Med Rehabil. 2004 Mar. 85(3 Suppl 1):S72-4.
Werner RA, Franzblau A, Gell N, et al. A longitudinal study of industrial and clerical workers: predictors of upper extremity tendonitis. J Occup Rehabil. 2005 Mar. 15(1):37-46. [Medline].
Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. 2005 Sep 1. 72(5):811-8. [Medline].