Repetitive stress injuries (RSIs) occur when too much stress is repeatedly placed on a part of the body, resulting in inflammation, muscle strain, or tissue damage. RSIs are also referred to as overuse injuries, and can include over one hundred different kinds of injuries and illnesses that can vary in severity.
Orthopedic physicians recognize that musculoskeletal injuries occur frequently among fitness program participants, runners, athletes, military recruits and others who engage in routine vigorous exercise. The same parameters of exercise (intensity, duration and frequency), that determine the positive fitness and health effects of physical training, also appear to influence the risk of injuries. Studies of runners and other physically active groups have consistently demonstrated that greater duration and frequency of exercise are associated with higher risks of injury. These studies also indicate that the strongest and most consistent association exists between greater total amounts of exercise and higher risks of injury.
Overuse injuries typically occur over time and usually don’t present themselves until the damage is already done. Sports and other athletic activities often are the cause of overuse injuries, but they are also seen in the workplace, with repetitive tasks like using a mouse or swinging a hammer. According to the European Journal of Public Health, studies have shown that a small fraction of patients with repetitive injuries account for a large portion of medical costs.
Estimates suggest that repetitive motion injuries cost United States businesses over $20 billion just in workers’ compensation alone. Factor in the costs of employee replacement, productivity loss, and other related expenses, and we’re talking upwards of another $100 billion.
RMIs are painful, costly to treat, and are often times permanent. Permanent injuries put a damper on an individual’s ability to perform the jobs in which they have been trained, meaning there may be the additional stressor of finding work in a new field.
Previously thought to only be an adult injury, repetitive stress injuries are on the rise for youth athletes. But, unlike adult repetitive stress injuries, youth RSIs are usually associated with sports-related activity. According to The Journal of Athletic Training, overuse injuries in youth are a significant healthcare concern, with fifty percent of pediatric patients admitted to sports medicine clinics for chronic injuries.
RSIs occur gradually, when a repetitive motion is repeated so often that the body does not have enough time to heal between playing. Overuse injuries can affect muscles, ligaments, tendons, bones, and growth plates. For adolescent athletes, overuse injuries most often occur at the growth plates, which are the areas of developing cartilage where bone growth occurs.
The growth plates are weaker than nearby ligaments and tendons, so repetitive stress can lead to injury of the growth plate. The areas most affected by RSIs are the elbows, shoulders, knees, and heels, all of which contain growth plates. While overuse injuries can occur in any sport, some RSIs are more common in certain sports. One of the more common known overuse injuries for baseball players is Little League elbow, which is caused by a repetitive throwing motion.
The Journal of Athletic Training states that an estimated fifty percent of overuse injuries in physically active children and adolescents are preventable, if people were only aware of the causes. There are several commonly recognized causes of RSIs, and it is essential that coaches, trainers, parents, and athletes are aware of these.
One of easiest preventable causes of RSIs is using the wrong equipment for the sport or using equipment that does not fit properly. As discussed earlier, adolescent athletes seem to be the most susceptible to RSIs, largely due to adolescent growth spurts. Therefore, equipment needs to be checked regularly, to determine if it is in good condition and if the equipment still fits properly.
Poor nutrition can also lead to RSIs, and conversely, good nutrition plays a pivotal role in preventing RSIs. Proper nutrition is essential for developing strong bones and muscles, for the repair and recovery of muscles, and for providing fuel for athletic performance.
In addition, coaches and trainers need to be aware of RSIs due to training errors (quick jumps in intensity or increases in weights) and/or excessive training. Coaches need to be exceedingly aware of poor mechanics – these are the leading cause of RSIs. Improper mechanics and techniques can put pressure on tendons, bones, and joints, and when done repeatedly, can lead to a variety of overuse injuries.
Types of Youth Repetitive Training Injuries
- Little League Elbow is a painful overuse injury to one of the elbow’s growth plates. It generally occurs from throwing and occurs in patients aged 7-15.
- Little League Shoulder is a common overuse injury for throwers and can result in a significant amount of pain during the throwing motion.
- Osteochondritis dessicans (OCD) is a condition that gymnasts, throwers, and athletes of all ages can get in the cartilage and bone of the knee or elbow. Usually caused by overuse and repetitive training, some younger patients can develop OCD without a predisposing cause.
- Sever’s disease is one of most common causes of heel pain in youth athletes and often occurs during adolescent growth spurts.
- Bursitis is inflammation of the bursa, which is a fluid-filled sac that acts as a cushion for a joint.
- Carpal tunnel syndrome is swelling that occurs inside a narrow “tunnel” formed by the bone and ligament in the wrist.
- Epicondylitis is a condition characterized by pain and swelling where the bones join at the elbow.
- Osgood-Schlatter disease is a common cause of knee pain in teens undergoing a growth spurt, causing inflammation where the tendon from the kneecap attaches to the shinbone.
- Patellofemoral syndrome is a softening or breaking down of kneecap cartilage.
- Shin splints are pains along the shin or front of the lower leg.
- Stress fractures are tiny cracks in the bone’s surface caused by rhythmic, repetitive overloading. These usually occur in runners.
- Tendonitis is the tearing and inflammation that occurs in the tendons.
Prevention of Youth Repetitive Training Injuries
Yes, RSIs can be prevented. While the coach or trainer is responsible for the conduct of practices and games, the parent and the athlete also have a responsibility to help prevent overuse injuries. Dr. Gavin offered these suggestions to young athletes:
- Before any sports season, have a physical examination and address any issues or concerns with your doctor.
- Always warm up and cool down with appropriate stretching exercises.
- Wear the proper clothing and equipment for your sport, including safety gear.
- Make sure equipment fits properly and is used correctly.
- Drink water before, during, and after your workouts.
- Vary your day-to-day activities, rather than doing the same activity every day.
- If you are experiencing symptoms such as pain, swelling, numbness, or stiffness, stop and seek medical attention.
Chronic injuries usually result from overusing one area of the body while playing a sport or exercising over a long period. The following are signs of a chronic injury:
- pain when performing an activity
- a dull ache when at rest
Common Repetitive Motion Injuries in Adults
- Tendinitis: The most common symptom associated with tendinitis is pain at the site involved. Tendinitis is made worse by active motion of the inflamed tendon. The skin overlying the inflamed tendon may be red and warm to the touch.
- Biceps: The painful spot is usually in the groove where the arm meets the shoulder. You can reproduce the pain by flexing your elbow at 90 degrees and trying to turn your hand palm up (supination) against resistance.
- Tennis elbow: This pain is in the elbow and is reproduced by cocking your wrist back (extending the wrist) as if you are bringing a tennis racket back to hit the ball.
- Golfer’s elbow: This pain also occurs in the elbow but is made worse by flexing the wrist forward as if you are hitting a golf ball.
- Rotator cuff: Raising your arm out to the side reproduces this pain. The painful area is usually over the affected shoulder.
- Bursitis: Common symptoms include pain, tenderness, and decreased range of motion over affected area. Redness, swelling, and a crunchy feeling (crepitus) when the joint is moved may also be found.
- Knee: This condition involves swelling over the bottom part of the kneecap that is red and warm to the touch. Usually, the range of motion of the knee will be less because of the pain that bending and straightening the knee causes.
- Elbow: Pain, swelling, and redness are found over the elbow. The pain gets worse when you flex and extend your arm at the elbow.
- Hip: Pain is increased by walking or by lying on the affected side. Bringing your leg away from and toward the midline of the body can also reproduce the pain.
- Stress Fractures: Common symptoms include pain directly on the bone, especially when running. Localized swelling and inflammation may occur during the late stages of the process.