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 to 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:
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Patient education
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Supervised use of the injured part [32]
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Appropriate use of modalities (eg, transcutaneous electrical nerve stimulation units, similar electrical treatments, ultrasound/phonophoresis, iontophoresis, heat/cold)
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Development of a home exercise program
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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 of an outcome. [33]
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/overreaching (eg, with regard to triathlons, marathons, etc), or technique flaws. [34, 35] 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.
Medical Care
Steroid injections are the most commonly used procedure in the treatment of overuse injuries, although controversy surrounding this treatment is still readily apparent. Tendons and ligaments can become structurally weakened by the use of steroids, predisposing them to rupture. The use of local anesthetics and steroids should be reserved for patients with significant pain who have the ability to change the underlying cause behind their injury. Repeatedly injecting patients who will inevitably return to the same routine that initially caused the injury is not advisable [4]
Many steroid injections can be performed under ultrasonographic guidance to increase accuracy and decrease the possibility of intratendon or intraligament injection.
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 can result in chronic pain and disability, depression, and/or insomnia. These complications may require additional, more complex treatment.
Surgical Intervention
Surgical intervention is undertaken if conservative approaches fail and if the injury is amenable to surgery. Decompression of nerves and repair of lax or failed ligaments are the most common overuse injuries that lead to surgery. Surgeries that are performed solely to relieve pain in the absence of objective findings are notorious for suboptimal outcomes.
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. [36] 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.
Prevention
According to the aforementioned study by Arnold et al, overuse physeal injuries in young athletes can be prevented by limitations in participation and via sport-specific training programs. Once an overuse physeal injury has occurred, the best treatment was found to be an extended interval of active rest and, when necessary, immobilization of the joint. [14]
A meta-analysis looking at prevention strategies for lower extremity overuse injuries in runners showed that there is poor evidence at this point for a generalized approach to prevention that is suited to the majority of athletes. Currently, prevention strategies should be tailored to the individual and his/her specific risk factors (ie, work type, anatomy, biomechanics). [37]
