ABSTRACT

The popularity of sport and recreational exercises has led to the proliferation of associated injuries and illnesses. The literature describing exercise-related disorders is quite robust, as elite and recreational athletes (heretofore grouped as athletes) can be victim to anything from ankle sprains, Achilles tendinitis, and exercise-associated collapse to verbal abuse and dog bites.15,37,72 The overwhelming majority of injuries that affect athletes, however, are secondary to overuse, with a history of prior injury and inadequate rehabilitation representing important risk factors for future harm.12,25,47,71 These injuries can be challenging and frustrating for both providers

and athletes as the pathophysiology of overuse injuries has yet to be fully elucidated (Table 28.1).2,3,17

Athletes by the time they venture to seek medical attention have in all probability sought counsel from exercise colleagues and exhausted multiple interventions and therapies. In addition, while most athletes are willing to adjust and modify training regimens, few are willing to accept prolonged periods of refraining from land sport and recreational exercises. This chapter briey reviews the epidemiology and etiology of injuries in athletes, with particular attention to overuse injuries, and then details an effective strategy for diagnosing, managing, and rehabilitating injuries in this population. In addition, we discuss the concept of prehabilitation and its role in preventing injuries, as well as introduce new orthobiologic interventional therapies.57,67

Overuse injuries are thought to be the most commonly encountered sports injuries by primary care providers.30 Overuse sports injuries have been reported to be twice as frequent as acute injuries with the most common presentation being anterior knee pain.9 Studies involving sport and recreational exercise clinics have consistently demonstrated that the majority of presenting clinical problems are the result of overuse with patellofemoral disorders being most common.12,49 Matheson evaluated age as a determinant for presenting injuries in runners and found that patellofemoral dysfunction and stress fractures were more prevalent in young athletes, while metatarsal pain syndromes and plantar fasciitis were more prevalent among older athletes.53 Additionally, patellofemoral pain and stress fractures are reported more commonly in women than in men; however, this may be more sports specic than gender specic.7,8 In one study evaluating referrals to a primary care sports medicine clinic, the most common overuse injuries diagnosed included rotator cuff tendonitis (11.7%) and patellofemoral tracking disorders (10.6%), with the latter predominating in running athletes.14,57

28.1 Introduction ..................................................................................................................................................................... 277 28.2 Epidemiology of Overuse Injuries ................................................................................................................................... 277 28.3 What Causes Overuse Injuries? ....................................................................................................................................... 278 28.4 Five Steps to Management ............................................................................................................................................... 279 28.5 Prehabilitation and the Preparticipation Examination .................................................................................................... 283 28.6 Conclusion ....................................................................................................................................................................... 284 References ................................................................................................................................................................................. 284

TABLE 28.1 Key Clinical Considerations

Overuse injuries result from repetitive microtrauma that leads to local tissue damage in the form of cellular and extracellular degeneration; the exact pathophysiology of these disorders remains to be fully elucidated.2,5,32,57,75 This tissue damage can culminate clinically in tendinitis or tendinosis, stress fracture, joint synovitis, entrapment neuropathies, ligament strains, or myositis.34,75

These injuries are most likely to occur when an athlete changes the mode, intensity, or duration of training; a phenomenon that Leadbetter describes as the “principle of transition.”39 Physical training uses prescribed periods of intense activity or overreaching to induce the desired goal of supercompensation or performance improvement. However, a mismatch between overload and recovery can lead to breakdown on a cellular or systemic level. At the cellular level, repetitive overload on tissues that fail to adapt to new or increased demands can lead to tissue degeneration and overuse injury. It is important to realize that, in theory, this subclinical tissue damage can accumulate for some time before the person experiences pain and becomes symptomatic39 (shown in Figure 28.1).