By William Callahan, MD
Contributing Writer

Summer in Seattle means more people – of all ages and fitness levels – are taking part in sports and other outdoor pursuits. Although just about any aerobic activity is good, too much of a good thing done too quickly may cause more harm, often in the form of overuse injuries.

As a primary care sports medicine specialist, I see people for overuse injuries on a regular basis. Whether you’re a weekend warrior or a seasoned athlete, there are a few important things to keep in mind.

Overuse injuries
There are basically two types of injuries: acute and overuse. Acute injuries are usually the result of a single, traumatic event. Common examples include wrist fractures, ankle sprains, shoulder dislocations and pulled hamstrings.

Overuse injuries, which are the most common and challenging to diagnose and treat, are more subtle and usually occur over time. They are the result of small, repetitive injuries to the tendons, bones and joints. Common examples include tennis elbow, runner’s knee, Achilles tendinitis and shin splints.

Why do overuse injuries occur?
The human body has an amazing ability to adapt to physical stress. In fact, many positive changes occur as a result. With exercise and activity, bones, muscles, tendons and ligaments get stronger and more functional. This happens due to a process called ‘remodeling,’ which involves the break down and build-up of tissue. However, there’s a delicate balance between the two. If break down occurs more rapidly than build up, injury occurs.

This can happen when people begin an activity and try to do too much too soon. If you start playing tennis and do so for several hours in an effort to quickly improve, you’re setting yourself up for an overuse injury. This is because you’re trying to do too much and don’t allow your body enough time to adapt and recover. As a beginner, you may also have poor technique, which might put you at higher risk for tennis elbow, etc.

Factors usually responsible for overuse injuries
Training errors are the most common cause of overuse injuries. They involve a quick acceleration of the intensity, duration or frequency of an activity. An example is someone who runs several miles three days a week without any problem. That person then starts training for a marathon by running longer distances every day at a faster pace, which can make injury or break down inevitable.

Overuse injuries also happen when people are returning to an activity after injury and try to make up for lost time.

There are also technical, biomechanical and individual factors. Proper technique is critical in avoiding overuse injuries. Slight changes in form may be the cause. For this reason, coaches and athletic trainers can help prevent recurrent overuse injuries.

Some people are more prone to overuse injuries. Imbalances between strength and flexibility around certain joints, as well as body alignment, put people at higher risk for injury. Many people also have vulnerabilities due to old injuries, incompletely rehabilitated injuries or other anatomic factors.

Other factors include equipment, like the type of ballet shoe, and terrain – hard versus soft surfaces when running.

Diagnosing overuse injuries
An overuse injury can usually be diagnosed after a thorough health history and physical exam. This is best done by a sports medicine specialist, orthopedist or other provider familiar with the problem. In some cases X-rays are needed and occasionally other tests, like a bone scan or MRI, are ordered.

Treatment for overuse injuries

Treatment for overuse injuries depends on the diagnosis. In general, the most common approaches include:
• Lessen the intensity, duration or frequency of the activity

• Adopt a hard/easy workout schedule and cross train with other activities that allow you to maintain overall fitness levels while your injury heals

• Work with a coach or take lessons to help ensure proper training and technique

• Focus on proper warm up and use ice after the activity

• If symptoms persist, a sports medicine specialist can create a more detailed treatment plan for your specific condition. This may include a thorough review of your training program and an evaluation for any predisposing anatomic or biomechanical factors

• Physical therapy and athletic training services may also be helpful
Preventing overuse injuries
The good news is that most overuse injuries can be prevented with proper training and common sense. Learn to listen to your body. Remember that “no pain, no gain” doesn’t apply here.

One thing I tell patients is that the “10-percent rule” is very helpful. By that I mean you shouldn’t increase your activity more than 10 percent per week. This allows your body enough time to recover. The 10-percent rule also applies to increasing pace or mileage for walkers and runners, as well as to the amount of weight added during strength-training workouts.
Workouts can also be changed to maintain overall fitness levels in a safe manner while you recover from your injury.

In addition, to prevent chronic problems people should seek the advice of a sports medicine specialist when starting an exercise program or sport.

Services available at Virginia Mason
Virginia Mason offers a comprehensive array of sports medicine, physical medicine and rehabilitation services. For more information, visit virginiamason.org/sports and virginiamason.org/physical.
William Callahan, MD, is a primary care sports medicine specialist. He practices at Virginia Mason University Village Medical Center (2671 NE 46th St, Seattle, WA 98105; 206-525-8000; virginiamason.org/universityvillage) and at Virginia Mason Hospital & Seattle Medical Center (1100 Ninth Ave., Seattle, WA 98101; 206-223-6600; virginiamason.org/seattle).

Online resources
For more information on overuse injuries, visit:
• American Academy of Family Physicians (aafp.org)
• American Academy of Pediatrics (healthychildren.org)
• American Orthopaedic Society for Sports Medicine (sportsmed.org)
• American Medical Society for Sports Medicine (amssm.org)
• National Athletic Trainers’ Association (nata.org)