How do I know if I'm injured? The stages of an overuse injury.
Overuse injuries are extremely common. They are also easily addressed with PT, especially if they're addressed early.
Overuse injuries happen often in active populations, especially with sports/activities that have some degree of repetition (think runners, cyclists, weightlifters, climbers, etc).
They can also happen with daily activity too though, usually with a sudden increase in repetition (think painting your house and only using your dominant arm, using a screwdriver over and over on a home project or digging in the garden).
Your body can only heal so fast and some tissues are more susceptible to overuse injuries because they have slower healing times.
Muscles heal relatively fast when overloaded. You've probably seen that in the form of getting muscle soreness after exercising. Usually within a few days the soreness is completely gone and you can go do the same exercise again without any issue.
Other tissues, such as tendons, have a much slower rate of turnover (healing) when they're overloaded. This balance of breakdown and healing can get out of whack pretty easily, leading to an overuse injury.
The simple way to explain an overuse injury is that you're breaking down your tissues faster than your body can heal them.
In this series, we'll cover the different stages of an overuse injury and what you can do about it in each phase. Sometimes you only need a little self management while other stages will require intervention from a PT.
STAGE 1 OF AN OVERUSE INJURY
DISCOMFORT THAT DISAPPEARS DURING YOUR WARM UP
Let's get an example going here...
You decide to head out for a run. You take off down your street or maybe the greenway and your Achilles feels a little sore, not necessarily really painful, but it doesn't feel like the other side. You continue to run and after half a mile or so the discomfort goes away and you can finish your run.
All you felt was that little bit of discomfort at the beginning and you never felt anything again so you think you're fine and continue to go about your usual running over the next few weeks...
This is your body's way of trying to tell you something isn't right. You're not "injured" yet but your Achilles is giving you the "check engine light" to get your attention.
You see, your body can give you early warning about a potential overuse injury, something most people ignore and just continue on with their training or exercise.
At this stage, you don't need to quit doing what you want to do, but you might give yourself a couple "rest" days and cross train those days instead to let that tissue get a little more time to heal. Instead of going for runs the next couple days, do some yoga or go lift weights. You still want to move and stay active but give that tissue (in this scenario, the Achilles) a bit of rest from it's usual form of loading so it can heal.
STAGE 2 OF AN OVERUSE INJURY
DISCOMFORT THAT MAY DISAPPEAR DURING WARM UP BUT RETURNS AT THE END OF ACTIVITY
So you had a little discomfort with your warm up on your runs and ignored it for a few weeks. That's what most people do. "It'll go away. It's nothing."
You've still been running your usual volume. You notice the Achilles discomfort during your warm up and then it goes away, only now you're starting to notice some discomfort after you stop running. Maybe that discomfort is back when you walk to your car after running through the park.
You're moving into the next stage of injury now. This is inching closer to an overuse injury. You're right on the verge of sending it over the edge, unless you act now.
At this stage, you'll want to take some days off of your heavier activity that you're feeling the discomfort with. That might mean at least a few days and up to a week of no running and only cross training. Again, you want to do activities that load the tissue differently than the one you've been doing.
This means, if you're a runner, you don't want to cross train by jump roping as it's a similar movement. Do an activity that moves your body in a totally different way.
If you do this and the pain persists when you resume your normal activity again, seek help from a PT. The quicker you get help, the quicker it will clear up - and that means more time exercising and training.
If it feels ok when you get back to it, you might want to slightly decrease your volume or frequency of activity and work it back up over a couple weeks to ensure it doesn't just come right back.
STAGE 3 OF AN OVERUSE INJURY
PAIN THAT GETS WORSE DURING ACTIVITY OR THAT MAKES YOU STOP OR SKIP EXERCISING
Let's go back to our runner scenario...
You've continued to run despite that fact that you're in stage 2 of an overuse injury, pain with warm up and right after activity, but still think it's nothing because you can still run and train like you want to and it's not affecting your daily function either.
The problem is, you're teetering on the edge of pushing that discomfort into a full blown injury.
If you keep running, what you'll see next is the pain will persist throughout your activity now, maybe even worsening. It's causing you to cut your run short now, or maybe you even decide to start skipping runs because it just hurts too much.
At this stage, you are "injured." The tissue has gone past just giving your warning signs that you need to change something.
At this stage, you're going to need rest from the activity that hurts. You're going to need some help with this stage too as rest alone won't fully heal the tissue. This is where you'd want to seek help from a PT. The injured tissue can heal with the appropriate rest and treatment such as manual therapy (hands on PT), maybe some dry needling, and specific exercises because in order to fully heal and get stronger, the injured tissues need to be exercised and loaded. They just need the right kind and amount of exercise. That's where your PT can help you!
In this stage, the sooner you address the injury, the better. That means you can get back to doing what you love sooner!
STAGE 4 OF AN OVERUSE INJURY
PAIN THAT IS PRESENT WITH NORMAL DAILY ACTIVITY, PAIN THAT IS CONSTANT, AND COMPLETE INABILITY TO EXERCISE
This stage is a significant overuse injury. You can't do your normal exercise (in our scenario, running) at all and the pain may even impact your ability to cross train too. You might have pain even at rest and you definitely have pain with normal daily activity such as walking, stairs, or hobbling when standing up from a seated position, etc.
Unfortunately, at this stage, you will require significant time off from your regular activity in order for the tissue to heal. You will need physical therapy to fully heal and prevent it from returning when you resume your activity. Again, as in stage 3, rest alone will NOT fully heal the tissue.
Injuries at this stage not addressed with PT may eventually progress into full tissue tears and/or require surgical intervention.
You do not want to get to this stage. If you're in the middle of training for a race, you very likely won't be able to compete. If you're hitting the gym hard, there's a chance you'll have to pause or cancel your membership or just not use it. We don't want to see anyone get to this stage, especially since it can be prevented with earlier intervention.
If you're in this phase, don't wait. Set something up with one of our PT's immediately so you can start to heal.
SO WHAT DO I DO I'M INJURED?
SET UP AN EVALUATION SO YOU CAN START MOVING AND START HEALING
Physical therapists are musculoskeletal experts and are trained to evaluate and treat injuries as well as identify when something more serious is going on. You don't need a referral to see a PT.
Overuse injuries rarely require any imaging or medication if they're addressed quickly. The sooner you see a PT, the faster you can start to heal. This means less time away from your favorite activities and less overall cost for treatment.
Our PT's are the best around at dealing with overuse injuries. All of us are regular exercisers and understand the importance of being able to do what you love, as well as the overall impact on your health by being able to stay active. We don't want to see anyone get to stage 3 or 4 of an overuse injury but we're here to help if you find yourself there.
At Nashville PT, you always get your entire appointment 1-on-1 with your PT, meaning you get their undivided attention to make sure you're getting what you need to heal and get back out there.
Our PTs have a wide variety of specialties as well including running, cycling, swimming, rock climbing, hiking, golf, weightlifting, dance, figure skating, pilates and yoga - and that means you can find a PT who understands your sport or activity so you can get the most out of your visits and get back out there ASAP.
It's our mission to keep active people active, without medication, without surgery, and without pain.