Overuse and Chronic Injury Care
What is an overuse injury?
Training and performance intentionally load your muscles, ligaments, joints, tendons, and bones. If the tissues are loaded gradually and given sufficient time to recover, they can adapt by increasing their ability to cope with the load. If the length, frequency, or intensity of the load is too great or increases too rapidly for the tissues to adapt, overuse injuries, previously known as repetitive strain injuries, may occur. Injury often occurs following a break from training or performance because the rest period allows the muscles to lose strength and the tendons and bones to lose their load tolerance. Faulty technique can also be a contributing factor, as it can alter the way the load is distributed through the body.
Muscle injuries are called strains, whereas ligament injuries are called sprains. Injured joints can become swollen. Tendons, in particular, hate sudden changes in load and can swell and become painful. In bone, sudden changes in load can result in injuries such as stress reactions and stress fractures. Unfortunately, injured tissues are more easily fatigued, less responsive, and less efficient, further reducing performance and increasing the risk of developing a more serious injury if training or performance continues. With any injury, the first step is to obtain a diagnosis and advice from a Health Professional (HP), such as a General Practitioner, Physiotherapist, or another accredited practitioner who understands the specific needs of performing artists. Search for someone in your area in the Members Directory tab on the ASPAH home page.
What is a chronic injury?
While an acute injury occurs suddenly, a chronic injury develops gradually over time. It may persist considerably longer than usual, or it may intensify or recur frequently. Sometimes chronic injuries are ignored because the symptoms are mild and the pain is low-grade, but they can have an increasing harmful impact on your technique, your performance, and your confidence. Injuries that do not receive appropriate rest and adequate rehabilitation sometimes become chronic.
How can overuse and chronic injuries be managed?
These conditions often require a multifaceted approach, so it is important to start by asking your HP for guidance (for questions to ask, see next section). Your management may include:
- Relative rest – unloading the injured tissues to some extent is the essential first step towards recovery. Guidance from your HP is key to optimal recovery because careful load management is essential to resolving chronic injuries. Although some injuries need complete rest, most will recover with relative rest.
- Risk factor analysis – recognising the risk factors that may have contributed towards the development and continuance of overuse and other chronic injuries is fundamental to full recovery.
- Physical condition – a high level of general fitness, strength and overall health are important contributors towards optimal performance and recovery. Your rehabilitation will be improved by increasing your general fitness and practising movements that do not involve the injured body part. Remember that adequate sleep will assist your healing.
- Technique analysis – ask your teacher whether technical habits are contributing factors.
- Practice habits – examine the way you use your time, the balance between movement and recovery, your focus, your mental and physical response to challenges, etc.
- Posture analysis – use a video or mirror to examine your postural habits during training and performance.
- Treatment – your HP may recommend further treatment such as manual therapy, acupuncture or electrotherapy, and may suggest you make use of ergonomic and supportive aids.
- Exercise – you may be prescribed a rehabilitation program of strengthening, cardiovascular exercise, proprioception and stretching
- Movement and somatic therapies – practices such as yoga, Feldenkrais®, Alexander Technique, Ideokinesis, etc. can restore your coordination and movement patterns
- Medication – ask your GP or Pharmacist (chemist) before taking anti-inflammatory or analgesic drugs.
What should you ask your HP?
Before you visit your Health Professional, make a list of what you want to know. This may include:
- Can you explain simply what the injury is, and what treatment I may need?
- How long before I can expect to return to practising, and to performing?
- How much practice, rehearsal or performance can I do now?
- Can I still do other activities (e.g. a hobby or playing sport)?
- How can I help my own recovery (e.g. walking, swimming, modified training, fitness training)?
- What should I avoid to make sure I recover as well as possible?
Managing pain associated with these injuries
To manage pain, it helps to understand what pain is and why it may become chronic. See the ASPAH Guide to Understanding Pain to familiarise yourself with the relationship between pain and tissue damage, and how pain can be managed. Your emotional state will directly affect the severity of your pain. Unfortunately, the existence of pain can also change the way you move the rest of your body. Many people with chronic pain become scared to move, and this can ultimately prolong or prevent recovery. Understanding pain processes gives you the weapons to manage or even avoid this potentially debilitating situation.
Prevention is better than cure – be alert to early warning signs
Even better than good injury management is injury prevention. If you have any of the following warning signs while practising, rehearsing or performing you could be risking an overuse injury:
- Physical, mental or emotional fatigue
- Reduced coordination or clumsiness
- Stiffness and difficulty with normal daily activities
Early advice from your HP, careful attention to your loading, and an exercise program may prevent the development of an overuse injury, while a change in practice routine may alleviate stress on vulnerable areas.
Where to find more information
Explain Pain, 2nd Ed. David Butler and Lorimer Moseley. 2013
Explain Pain Supercharged. David Butler and Lorimer Moseley. 2017
Playing (less) Hurt: An Injury prevention guide for musicians. Janet Horvath. 2010
The Musician’s Body. Jaum Rosset-i-Llobet and George Odam. 2009
Dancer Wellness. Eds Virginia Wilmerding and Donna Krasnow. 2016
NB: This ASPAH Guide is intended as an educational resource only and does not replace professional advice. ASPAH recommends that diagnosis and initial advice is always obtained from an accredited healthcare professional.
Version April 2018. Contributors: Janet Karin, Danica Hendry, Susan Mayes, Cliffton Chan.