The evaluation and management of chronic overuse sports/athletic injuries is one of the most pervasive concerns in sports medicine today. Overuse sports injuries outnumber acute, instantaneous injuries in almost every athletic activity. Because overuse sports injuries are not instantly disabling they attract less medical attention than those that cause an acute and obvious loss of function. Therefore, their frequency of occurrence is almost always underestimated in surveys of athletic injuries. The treatment of overuse sports injuries is made difficult by various factors, including an insidious onset which means that the problem is usually ignored at the start. When athletes actually present for treatment, the injuries are well established and more difficult to manage successfully. Additionally, these injuries seem less serious to the athletes and makes it difficult to convince them of the importance of intensive treatment for correction.
Overuse injuries are almost always a result of change in
three general areas: the athlete, the environment, or the activities.
Identifying these changes requires patience, precision in history-taking, and a
great understanding of the demands of the specific sporting activity. The most
common cause of overuse athletic injuries is continued athletic participation
despite the presence of symptoms associated with another injury (eg. pitcher
who continues to throw despite persistent elbow tendonitis). Continued
participation with an existing injury also occurs as the result of inadequate
rehabilitation.
Some overuse dysfunctions are the result of normal
physiological changes such as rapid growth spurts in which musculotendinous
flexibility often decreases and indirectly causes tendonitis (eg.
Osgood-Schlatter knee syndrome). Environmental alterations occur in the
athlete’s personal environment (eg. equipment and clothing) or the more global
sports environment (eg. running hills in a training regimen previously limited
to running flat surfaces). Advancing to a higher level of athletic proficiency
involves both quality and quantity of workouts. Even increasing workout time in
an abrupt manner can result in overuse athletic injuries, especially when an
athlete attempts to perfect a single, isolated skill.
The prevention of recurrences of overuse injuries is the
most important aspect of managing overuse injuries thus, the physician’s role
becomes one of reinforcing and reminding the athlete to identify the
appropriate changes to be made in their regimen…
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