Overuse injuries

We all know that exercise is good for us. Unfortunately, even a beneficial activity taken to an extreme or performed incorrectly can lead to trauma and injuries. That's why it is important to know what is overuse syndrome, how it develops, and how to avoid it. 

Overview
 
Occupational overuse syndrome (OOS), also called Repetitive Strain Injury (RSI), is an umbrella term for conditions caused by repetitive movements, constricted posture, forceful movements or constant muscle straining. It is classified as a gradual process injury (GPI) developing over time and can cause pain, discomfort or stiffness in joints, tendons, muscles, nerves or other soft tissues. The term encompasses various diagnoses including habitual, occupational or recreational activities. Localised injuries such as tennis and golfer’s elbow, trigger finger, carpal tunnel syndrome as well as various diffuse pain patterns may be classified as OOS.
 
Early signs and symptoms
 
The very early signs of OOS may include tingling, soreness, or discomfort in the shoulders, neck, arms, wrists or fingers. These may progress if the body doesn’t have sufficient opportunity to recover and the stressor persists. The following may appear:

• Aches and pains in the body
• Discomfort, tightness, and spasms in the muscles
• Numbness and tingling, usually in the extremities
• Feeling hot or cold sensations

 
Tiredness, headaches, loss of concentration and anxiety may also start to appear at this stage. As the stress cycle continues the following symptoms may develop:

• Constant pain and discomfort
• Shooting, burning or aching pain
• Loss of muscle strength and/or function
• Disturbed sleep (insomnia is possible)
• Difficulties in performing normal everyday activities like turning a tap or opening a door
• Chronic heat or coldness in the affected areas of the body

 
Classification
 
The various conditions falling under the umbrella terms OOS and RSI can be classified as follows:

• Pain syndromes are complex conditions that develop over time. Emotional symptoms like depression and anxiety may be present as well as the pain is usually widespread and persistent. It may be very difficult to identify the culprits precisely, so treatment is more difficult and recovery may take months or even years. A holistic approach to improving one’s physical, emotional, and spiritual wellbeing may be most appropriate. Such an approach would include as a minimum: a form of bodywork, improvements in the diet, a form of exercise, a form of mental exercise such as mindfulness or meditation. The development of trigger points in around the soft tissues of the body, sometimes called fibromyalgia, is an example of a pain syndrome.

 

• Compression syndromes occur when a nerve is pressed by inflamed muscles or other soft tissues. The pain is not as systemic as with some pain syndromes but is still relatively widespread. Recovery may take weeks to months and the treatment can be more targeted as the culprits are usually easier to spot. Injections, massage, pain medication, and surgery are some of the possible treatment options. Having the patience to eradicate the condition through changes in habits, exercise and bodywork are safer and more beneficial than more invasive options. The compression of the median nerve in the forearm as it travels through the wrist and causes ‘pins and needles’ in the fingers, known as carpal tunnel syndrome, is one example.

 

• Local inflammations are restricted to a specific part of the body. They tend to be treated more easily and precisely and recovery can happen in days or weeks. Usually, massage and stretching and or strengthening are sufficient to recover completely from such inflammations. Heat or cold applied to the area can also bring some relief. Examples include rotator cuff syndrome (the tendons around the shoulder are inflamed) and tennis elbow (the tendons on the lateral side of the elbow are inflamed).

 
Causes and development
 
There can be multiple causes for OOS but at their heart, they are about repetitively holding a muscle tight or tense for a long time. When the muscles are tight and tense their supply of nutrients and their capacity for detoxification is compromised due to constricted circulation. This leads to inefficient use of nutrients, fatigue, and build-up of pro-inflammatory acidic waste products. This causes further stiffness and perpetuates the development of debilitating conditions.
 
The muscles and tendons need regular rest and a variety of movements in order to be able to recover effectively and withstand fatigue. Problems start developing when they are strained and overused through some of the following:

• Working in uncomfortable temperatures particularly, in cold
• Prolonged tension in the muscles
• Forceful movements or forceful holds
• Poor body mechanics while working, exercising or in everyday life
• Repetitive movements
• Working quicker than the body can cope
• Unnatural or constricted postures
• Emotional and psychological stressors

 
Affected tissues

• Muscles & Tendons

 
Muscles and tendons sustain tiny tears whenever they are used. The body is in a continual process of repairing the micro damage in response to the localised inflammation. When the damage accumulates more quickly than healing, there may be formation of scar tissue and thickening over the torn soft tissues.
 
In the absence of enough rest, the cycle continues and the conditions worsen progressively. Collagen bundles may start looking chaotic and discontinuous under a microscope as opposed to their tight, parallel structure. Muscle fibres may loosen and decrease in diameter.
 
This increases the chances and can directly lead to more complex injuries. A tennis elbow, for example, can degenerate into a form of arthritis as the bone starts taking some of the damage from the repeated stressor.

• Nerves

 
Tingling, numbness or ‘pins and needles’ may be experienced when nerves are compressed in RSIs. The health of the muscles and the nerves is closely related so damage to one of the structures will affect the other as well. Furthermore, healing of damaged nerves takes very long.
 
The most common sites of OOS caused nerve damage are the neck, shoulders, and the wrists and hands. These nerves also go through the discs and facet joints of the neck. These nerves will then be unable to move freely in the arm if their surrounding soft tissues are tight or damaged.
 
Repetitive use and straining of these already compromised nerves will make them sore and inflamed. Continual insult without sufficient recovery will only worsen the condition. The progressive degeneration can make occupational and everyday activities like typing or lifting a cup very difficult or even painful to perform.

• Joints

 
Pain, stiffness, and degenerative changes may start happening in the joints due to prolonged abnormal posture or movements. Over time the worsening of the muscles, nerves and other soft tissues can lead to detrimental effects for the bones as well.
 
Prevention
 
The progressive nature of OOS means that the best form of care is prevention. The following habits and practices would greatly diminish the likelihood of such a condition when applied consistently:

• Handling a manageable workload – not too much, not too sedentary
• Optimising the work environment – comfortable temperature and lighting
• Training, education and risk policies to protect people
• Safe work and handling procedures and practices
• Intelligent human-centered design – ergonomic work stations

 
Common sense would also dictate the following in order to reduce the likelihood of OOS:

• Discontinue activities causing unexpected discomfort
• Take brakes regularly
• Maintain a good overall fitness and health
• Eliminate risk factors like smoking, being overweight or taking drugs
• Reduce and manage stress
• Avoid prolonged movements which are repetitive
• Identify and maintain a correct posture

 
Identification and treatment
 
It may sometimes be difficult to diagnose because of their complex and progressive nature. A full review of medical history and comprehensive lifestyle analysis may be required. Once the diagnosis is ascertained, the treatment plan may include rest, change in work habits, postural correction, soft tissue therapy, medication, relaxation, stretching and exercise, mediation and many other modalities. Individualisation and a consideration of the whole body and mind are essential for a truly effective approach.