Overuse Injuries

Overuse Pathophysiology - Strain Game Begins

Overuse injury: Tissue damage from repetitive submaximal loading, where microtrauma accumulation outpaces repair.

• Risk Factors:
  • Intrinsic (Host): 📌 "MALES" - Muscle imbalance, Alignment (e.g., genu varum/valgum), Limb length discrepancy, Endurance poor, Strength deficits.
  • Extrinsic (Environment): 📌 "TOES" - Training errors (sudden ↑ intensity/duration), Old/improper equipment, Environment (hard surface), Sport technique poor.
• Pathophysiological Stages:
  • Microtrauma accumulation.
  • Inflammation (acute response).

    ⭐ Tendinopathy is primarily a degenerative condition ('tendinosis'), not inflammatory, despite common suffix '-itis'.

  • Failed healing (repair capacity overwhelmed).
  • Degeneration (structural tissue changes).
• Commonly Affected Tissues: Tendons (tendinopathy), bone (stress fractures), bursa (bursitis), fascia (fasciitis).

Upper Limb Overuse - Arm Agonies

• Rotator Cuff Tendinopathy/Impingement:
  • Anatomy: 📌 SITS (Supraspinatus, Infraspinatus, Teres minor, Subscapularis) muscles; subacromial space.
  • Mechanism: Repetitive overhead activity, compression.
  • Tests: Jobe's (supraspinatus), Neer's, Hawkins-Kennedy, Painful arc (60-120° abduction).

    ⭐ Painful arc syndrome (pain between 60-120° of shoulder abduction) is characteristic of subacromial impingement.

• Lateral Epicondylitis (Tennis Elbow):
  • Anatomy: Common extensor origin (esp. ECRB - Extensor Carpi Radialis Brevis).
  • Mechanism: Repetitive wrist extension/supination.
  • Tests: Cozen's test (resisted wrist extension), Mill's test.
• Medial Epicondylitis (Golfer's Elbow):
  • Anatomy: Common flexor origin.
  • Mechanism: Repetitive wrist flexion/pronation.
  • Tests: Golfer's elbow test (resisted wrist flexion & pronation).

Comparison: Upper Limb Tendinopathies

Lower Limb Overuse - Leg Loads

• Patellofemoral Pain Syndrome (PFPS)
  • Mechanism: Malalignment, overuse (running, jumping).
  • Symptoms: Anterior knee pain, worse with stairs, squatting; "movie-goer's sign".
  • $Q-angle$: ↑ angle linked to PFPS. Normal: Male $14°$, Female $17°$.
• Achilles Tendinopathy
  • Mechanism: Repetitive microtrauma, overuse.
  • Symptoms: Pain/stiffness at posterior heel/calf, worse with activity.
  • Test: Pain on palpation, Thompson test (for rupture, not tendinopathy typically).
• Plantar Fasciitis
  • Mechanism: Inflammation of plantar aponeurosis due to overuse, poor footwear.
  • Symptoms: Inferior heel pain, esp. first steps in morning or after rest.
  • Test: Windlass test, tenderness at medial calcaneal tuberosity.
• Stress Fractures
  • Mechanism: Repetitive submaximal loading (e.g., tibia, metatarsals).
  • Symptoms: Insidious onset, localized bone tenderness, pain with activity.
  • 📌 Mnemonic (Common sites): "Tired Muscles Take Frequent Falls" (Tarsals, Metatarsals, Tibia, Fibula, Femur).

Overuse Dx & Rx - Fix & Prevent

• Dx Approach:
  • History: Training errors (sudden ↑ load, ↓ rest), insidious onset pain.
  • Exam: LOOK (swelling), FEEL (point tenderness), MOVE (painful arc), Special Tests.
  • Imaging: X-ray (late stress #); USG (tendons, dynamic); MRI (gold standard soft tissue/early stress #).
• Rx - Fix:
  • 📌 POLICE principle. Activity modification (relative rest).
  • NSAIDs: Short-term; ⚠️ cautious in tendinopathy.
  • Rehab: Pain control → ROM → Strength (esp. eccentric) → Proprioception → Gradual RTS.
• Prevention:
  • Training: 10% rule (gradual ↑ load).
  • Proper technique, equipment, biomechanics.
  • Adequate warm-up, cool-down, rest.

⭐ Eccentric exercises are the cornerstone of tendinopathy rehabilitation.

High‑Yield Points - ⚡ Biggest Takeaways

• Overuse injuries: Repetitive microtrauma exceeding tissue repair.
• Hallmark: Pain with activity, relieved by rest; night pain indicates severity.
• Tennis elbow (lateral epicondylitis): ECRB origin; Golfer's elbow (medial): flexor-pronator mass.
• Jumper’s knee: Patellar tendinopathy at inferior patellar pole.
• Stress fractures: Insidious onset point tenderness; initial X-rays often normal.
• Key management: Activity modification, physiotherapy, gradual return to sport.
• Chronic cases are tendinopathy (degenerative) more than tendinitis_._