Overuse injuries, Finding the right balance

Pain that keeps you from making progress in your training? Overuse problems such as tennis elbow, achilles pain, jumpers knee and plantar fasciitis all fall into this category and can really hinder our training progress.

Too often people get stuck in the “all or nothing” or “boom bust” cycle. You do a session, the pain gets worse, you take some time off, the pain gets better. But the next time you attempt another training session, the pain comes back and it feels like you are back to square one.

While resting may seem like the natural response and can be helpful as a short term option, staying in the cycle of resting and re-aggravating the injury will keep you stuck in the same place. 

The solution to improving overuse problems involves 2 basic principles

Reducing the aggravating activity to a tolerable level, then gradually increasing the activity again, within your tolerance to help reduce pain sensitivity over time

Targeting the affected area with strength training exercises to build up your tissue capacity    to handle more stress over time

By decreasing the aggravating activity while also building tissue capacity, we can gradually build back up to a level where you can start making progress with your training again

I usually tell my patients that pain is to be expected while we are managing and working on these issues, because we are trying to target the tissues that are involved. However we want to keep the pain in an acceptable range so that progress is possible.

I use the traffic light analogy to help guide this progress

Green light - minimal or no pain during the activity, no pain flare up after

Yellow light - Tolerable pain (4/10) during the activity, and tolerable pain up to 24 hours afterwards

Red light - Sharp/intolerable pain (5-6/10) during the activity, or intense flare ups that last more that 24 hours. Pain should not be increasing from subsequent training sessions or on a week to week basis. If pain is in the red light zone, overall loading should be decreased to a tolerable level

This is the “bread and butter” of managing most overuse problems. Identifying what the best course of action for you and a plan tailored to your goals and lifestyle is where a physiotherapy assessment can help.