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Overuse Injury Treatment & Management

  • Author: Scott R Laker, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Aug 20, 2015
 

Rehabilitation Program

Physical Therapy

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:

  • Patient education
  • Supervised use of the injured part [23]
  • 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.[24]

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:

Medical Interventions Effectively Treat Overuse Injuries in Adult Endurance Athletes

Occupational Therapy

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.

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Medical Issues/Complications

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.

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Surgical Intervention

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.

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Consultations

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.

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Contributor Information and Disclosures
Author

Scott R Laker, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Medical Director, Lone Tree Health Center

Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Scott Strum, MD 

Scott Strum, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

William J Sullivan, MD Associate Professor, Pain Medicine Fellowship Site 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, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Teresa L Massagli, MD Professor of Rehabilitation Medicine, Adjunct Professor of Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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