Managing and preventing overuse injuries in sport

Unless a young athlete plans to substantially and permanently reduce loading (time in sport)*, healthy soft tissues (muscles and tendons that are not irritable or sore) depends on striking the correct balance between work and restorative influences.  The tipping point is unique to the individual and takes time to find, especially when tissues are grumpy to begin with (image at bottom).

Restorative factors (deposits in the image below) include rest, massage and stretching, and improved tissue strength and joint range of motion.  There are other positive influences, such as adequate nutrition and hot/ cold therapies, but it's helpful to first understand and gain control over the major influences.  The stressors can be thought of as influences that further diminish tissue resilience.  Resilience is lowered anytime we impose additional stress on to already irritable joints and soft tissues.  Tight joints and poor management of posture are especially strong impairments to tissue health. 

The basic idea is that of a bank account, with deposits and withdrawals.  Healthy tissues are in the black while symptoms of injury and irritability represent an account in the red.  The critical fact about highly active bodies is that 'health' is a fragile condition - a bank account fractionally in the black.  This leads us to three important facts about managing and preventing sport overuse injuries:

1. small net improvements in restorative factors and stressors, e.g. marginally better posture and posture management, might be all that is needed to restore tissue health
2. 'transformation' is not necessary, only improvement.  The key is to understand the trajectory of tissue condition: are things getting better or worse.  Provided condition is improving it will eventually 'tip' back into health.  When we assess risk factors we aren't seeking to impose an ideal on a body but rather to determine the health trajectory and find obvious places to intervene
3. overuse injuries are like icebergs: 80% asymptomatic (below the symptom line) before 'the straw breaks the camels back'.  This explains the apparently innocuous causes of injuries that people experience.  The point is to be aware of the health of your body before a manifest problem occurs.  Massage is particularly useful in this regard - compression of irritable soft tissues hurts and a reduction in tissue sensitivity to compression is a good sign of restoration

How much time will be needed to regain soft tissue health is not fixed.  It depends on what tissue is affected (muscle versus tendon), how high frequency factors impact the tissue (e.g. sporting skills), and the emotional or psychological resilience of the individual.  Sometimes, more than a little bit of trial and error is needed.  Be patient and use common sense.

*athletes must push the margins and that means a lot of stress as well as an inherent risk of a 'speed bump' (e.g. an injury).  Risk and reward in sport are bed fellows.