By: Richard DeFalco DPT, OCS, CSCS, CWcHP, Cert. DN
October was National Physical Therapy month and this years' topic was sports injury prevention across the lifespan. As a practicing physical therapist, member of the American Physical Therapy Association, the South Carolina Physical Therapy Association, and as someone who actively engages in and preaches regular exercise I felt it to be appropriate to offer some information regarding sports injury prevention, more specifically as it relates to injuries sustained during repeated movements and/or postures. On a similar note we will also include repetitive strain injuries (RSI), which is a term generally associated with repeated maneuvers/postures that occur in the workplace that result in injury. I include RSI because there are those in the workforce whose jobs place a repetitive strain on an area of the body day in and day out, quite similar to the repetitive nature of many sports related injuries (e.g., throwing a baseball, swinging a golf club, hitting a tennis ball, running). Of note, there are many traumatic sports and non-sports related injuries that are not necessarily caused by repetitive forces. The purpose of this article is to focus on the potential adverse effects of repetitive movements not traumatic injuries.
You do not need to be a professional, collegiate, or high school athlete to sustain a sports related injury. In fact there are a myriad of injuries that occur both in a sporting event as well as in activities of daily living/recreational activities/employment; the difference is that they occur at a higher rate on the field of play. Also being involved in sports or athletic activities is not limited to our youth, hence the topic of prevention across the lifespan.
What we need to do many times as individuals who are moving in one way or another is to listen to our body. There is a fine line between the phrase "no pain, no gain" and a potential career/work ending injury. Our body has this great internal system that serves as a warning sign prior to potential injury, sort of a yellow light, just prior to the red light cautioning you to stop. It is called fatigue! We tend to take it for granted. Fatigue is defined as the inability to contract muscle repeatedly over time. The real danger of continuing to exercise (move, throw, run, swing, lift, push, pull, etc.) well beyond fatigue is the chance of injury. Notice that this again includes not just typical sports related movements, though common every day movements as well. Anything performed in a repetitive nature beyond the point of fatigue has the potential to cause an injury.
Now I know what many of you are thinking, that you need to push yourself to the limit to experience some type of positive physiological effect (e.g., increased muscle size, weight loss, increased work productivity, decreased mileage time, etc); which I am all for and routinely engage in myself! However, in a typical fitness or rehabilitation setting it is fairly easy to recognize the signs of fatigue and most of us will cease the activity at that time. Though, in a sports related setting / work setting, we tend to push through the signs of fatigue whether it is due to the competitive drive to succeed or the need to achieve a certain level of productivity while on the job. This topic of repetitive strain has been highlighted in youth and high school athletics, with athletes choosing to play and train for one sport year round rather than engaging in different seasonal based sports and what is known as active rest, allowing the body to recover from one sport/activity while engaging in another sport that targets the body in a different fashion. Regardless of the causative factor, repetitious movements that are performed beyond the body's ability to withstand them can be destructive in nature.
Pushing well beyond the point of fatigue on a repetitive nature can cause a relatively easy-to- treat inflammatory condition towards the more difficult-to-treat chronic degenerative condition. The point is you need to know how to monitor yourself and be aware of the signs and symptoms of potential overtraining/overworking. These include but are not limited to pain during activity, pain upon cessation of activity, excessive soreness lasting beyond 24-48 hours, pain upon palpation of the affected area, swelling/warmth in the affected area, and weakness/lack of endurance.
Some examples of sports/work related injuries as a result of repetitive strain are golfer's elbow, tennis elbow, DeQuervains syndrome, rotator cuff pathology, intersection syndrome, and carpal tunnel syndrome just to name a few. Over the past decade there have been more RSI as a result of technology, though less common they include the newly coined "Blackberry thumb", "gamer's thumb", and "Wii-itis." Regardless of the name, they are all caused by a movement performed repeatedly beyond fatigue.
If you are experiencing some of the aforementioned symptoms, you should initially stop the activity that you think may be causing the problem. If this is a recent development you can initially treat the area conservatively with rest and ice (15-20 minutes, twice daily). If the problem still persists then an over-the-counter anti-inflammatory may be indicated, though check with your physician and pharmacist for any possible contraindications given your medical history. If your symptoms continue to persist, worsen, or are of a chronic nature, seek out your physician or physical therapist for treatment. Ideally you will want to have the issue addressed before it becomes unmanageable.
Physical therapists are trusted health care professionals with extensive clinical experience who examine, diagnose, and then prevent or treat conditions that limit the body's ability to move and function in daily life. As such, they are experienced in treating repetitive strain injuries amongst other musculoskeletal injuries. One of the most effective strategies for dealing with injuries that are secondary to a repetitive movement is prescriptive exercise in the form of eccentric loading. An eccentric contraction is a lengthening contraction of the muscle and when emphasized in cases of RSI, it has been shown to be more effective than traditional exercise. The eccentric loading of a muscle has been shown to increase collagen production at the tendon junction and subsequently allows increased loading without ill effects. In other words you are preparing your body to withstand the demands you are placing upon it. In addition to prescriptive exercise, physical therapists may also use various types of manual techniques and modalities (electrical stimulation/iontophoresis, ultrasound) to treat the area.
At Professional Rehabilitation Services, we treat a wide variety of musculoskeletal conditions including sports and work related injuries using the latest in evidence based therapies provided by highly credentialed physical therapists. Professional Rehabilitation Services now has three locations, with the newest office located at 1301 48th Ave North, Myrtle Beach, SC. For further information on this or other related topics you can contact Brian P. Kinmartin PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, (Pawleys Island) (843) 235-0200, Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Surfside) (843) 831-0163 at Professional Rehabilitation Services, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Myrtle Beach) (843) 839-1300, or visit our website at www.prsrehabservices.com.