And he’s got the icepack on his groin there, so possibly not the old shoulder injury.
Ray French, British TV sports commentator
Overuse injuries present three distinct challenges to the clinician—diagnosis, understanding of why the injury occurred, and treatment. Diagnosis requires taking a comprehensive history of the onset, nature, and site of the pain along with a thorough assessment of potential risk factors; for example, training and technique. Careful examination may reveal which anatomical structure is affected. It is often helpful to ask patients to perform the maneuver that produces their pain.
The skilled clinician must seek a cause for every overuse injury. The cause may be quite evident, such as a sudden doubling of training quantity, poor footwear, or an obvious biomechanical abnormality, or may be more subtle, such as running on a cambered surface, muscle imbalance, or leg length discrepancy. The causes of overuse injuries are usually divided into extrinsic factors such as training, surfaces, shoes, equipment, and environmental conditions, or intrinsic factors such as age, gender, malalignment, leg length discrepancy, muscle imbalance, muscle weakness, lack of flexibility, and body composition. Possible factors in the development of overuse injuries are shown in Table 5.1.
Overuse injuries: predisposing factors
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Overuse injuries: predisposing factors
|Extrinsic factors||Intrinsic factors |
• excessive volume
• excessive intensity
• rapid increase
• sudden change in type
• excessive fatigue
• inadequate recovery
• faulty technique
• worn out
• pes planus
• pes cavus
• rearfoot varus
• tibia vara
• genu valgum
• genu varum
• patella alta
• femoral neck anteversion
• tibial torsion
Leg length discrepancy
Lack of flexibility
• generalized muscle tightness
• focal areas of muscle thickening
• restricted joint range of motion
Sex, size, body composition
• genetic factors
• endocrine factors
• metabolic conditions
Treatment of overuse injuries will usually require addressing of the cause as well as specific additional elements such as activity modification, specific exercises to promote tissue repair, soft tissue massage, and pharmacologic agents where appropriate (Chapter 13).
Bone stress reactions, which can develop into stress fractures, are fatigue failure injuries of the bone. Stress fractures account for 0.7% to 20% of all sports medicine clinic injuries.1 Track-and-field athletes have the highest incidence of stress fractures compared with other athletes.1–3 There is a continuum of bone response to stress that ranges from mild (bone strain) to severe (stress fracture) (Fig. 5.1). The clinical features of bone strain, stress reaction, and stress fractures are summarized in Table 5.2. Different sites of stress fractures are associated with particular sporting activities (Fig. 5.2).
The continuum of bone stress: from silent stress reaction ...
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