Friday, February 21, 2014

Overuse Injuries—What the Experts Are Saying

The statistics on overuse injuries are astounding.
  • Thirty percent of college athletes suffer the same, with 62 percent of the injuries going to women. Low contact sports, such as rowing, softball, volleyball, cross country, and track and field, have the highest rates of overuse injury.
  • Orthopedic surgeons report seeing four times as many patients with overuse injuries than five years ago.

What is an overuse injury? In any physical activity, there is breakdown and buildup of tissue. When breakdown exceeds buildup, injury in the form of inflammation—the “-itis” in tendonitis—and mild pain result. The mild pain that athletes become aware of initially is not usually sufficient to make them cut back. With continued activity, the inflammation and pain increase gradually, though both may take days, weeks, or even months to become significant.

The cause of overuse is too much, too soon. Too much running, throwing, jumping, etc., before the body has had time to rebuild the tissue that was broken down by the excessive activity.

Treatment of overuse injury requires rest and physical therapy to build up strength surrounding the injury and manipulation to stimulate blood circulation.

Failure to treat overuse injury can lead to physical deformity and arthritis (1, 2).

The cause of these alarming statistics is generally agreed to be the rise of year-round specialization in a single sport. This in turn has meant a dramatic increase in the number of games and practices required of young, unprepared bodies.

Recommendations to prevent overuse injuries are more rest, meaning time off from the sport, and more multi-sport participation, to use different parts of the body and give rest to those parts stressed in the first sport. Time off does not mean a couple off days here and there. Depending who one reads on the subject, recommendations range from ten consecutive weeks a year to two to three non-consecutive months. The doctor-run website Stop Sports Injuries Now recommends pitch counts for softball pitchers.*

Change comes slowly in almost every endeavor, but especially in sports. I recently attended a meeting sponsored by a regional softball governing body. I asked the head of the organization if anything was being done to deal with overuse injuries and if perhaps pitch counts for softball pitchers would be recommended. His reply was a testy “We leave that to the coaches.” Yet, another speaker at the meeting pointed out that “concussion training is coming,” meaning training will soon be required for all coaches. My conclusion? Such organizations are not going to do anything until they are forced into it by public opinion and the media!

Leaving control over an athlete’s health to coaches is unfortunate. Coaches do not read the research and at the high school and college levels, they do not listen to their athletic trainers. At the college level, coaches have the power to hire and fire their trainers, so if the trainer says an athlete is not fit to play, the coach tells the trainer to take a hike. As a result, a few colleges—too few—are moving their trainers out of the athletics departments and into health services where they will no longer be beholden to the coaches, but perhaps now will be able to influence them (1, 2, 3).

I am tempted to say to some of these win-at-all-cost coaches who ignore both research and medical advice, “Sooner or later, coach, it is not just a doctor or athletic trainer who is going to be knocking on your door. The next knock just might come from a lawyer!”

* It is a myth, heard too frequently and as gospel in the softball world, that softball pitchers do not need the rest of their baseball counterparts. Shoulder and elbow pain are commonly felt by all softball players, but especially by the pitchers, plus back and neck pain. Rupture of the bicep tendon has occurred in college softball pitchers due to overuse.

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