Overuse injuries occur to muscles, tendons, ligaments, fascia, and bone, and they are caused by any repeated activity, whether occupational or recreational. Essentially, this type of injury occurs when repetitive micro-trauma overloads a tissue’s ability to repair itself. The inflammatory response that occurs when tissues are damaged initially results in acute inflammation and tissue repair. Continuing activity perpetuates the micro-trauma, tearing the remodeling scar tissue. Over time, chronic inflammation occurs. Immature collagen is continuously laid down at the injury site, reducing the overall tissue strength. This scar tissue reduces the range of motion and can cause pain.
The cause of overuse injuries may be grouped according to extrinsic and intrinsic factors.
Extrinsic factors include: Repetitive stretch or strain of a tissue, Intensity or sudden change in activity, Inadequate rest, Faulty technique or posture, Inadequate nutrition.
Intrinsic factors include: Postural dysfunctions, Bony asymmetries, Muscle imbalance, Muscle weakness, Tight fascia, Lack of flexibility
The Treatment: Healing time varies from client to client, so treat the tissue as it currently presents. Positioning should be comfortable and it should not stress the injury site. Perform a relaxation massage on the unaffected parts of the body. Any postural dysfunction or tight fascia is treated as well. Hypertonicity, trigger points, and adhesions are reduced. Any hypomobile joints can be addressed with joint play techniques. Lymphatic drainage can also be beneficial to reduce chronic edema. Specific overuse injuries and their specific treatments are outlined in further chapters.
Hydrotherapy and Spa Techniques: Hydrotherapy varies with the presentation of the injury. A cold application is applied to reduce pain and inflammation and follows friction techniques. A heat application is applied to tight, short fascia that is proximal to the overuse injury, and sometimes to short antagonist structures or to adhesions at the injury site. Contrast applications may be used to increase local circulation following treatment or to flush out chronic edema. Hot stone, herbal compress, or any hot spa technique can be utilized as a heat application. Cold stone is also useful as a cold application technique.
Self-Care: An initial rest period from the aggravating activity is necessary to avoid stress on the affected tissue and to allow healing to take place. Hydrotherapy applications are appropriate to the injury site. The client should apply ice after an activity that causes inflammation. Once pain is reduced, pain-free stretching can be introduced on both the antagonist muscles as well as the affected ones. Strengthening activities of affected muscles are gradually progressed from isometric to isotonic exercises.