What are repetitive strain injuries? With summer well under way and warm weather encouraging us to get out and enjoy our favourite activities, repetitive strain injuries can occur from repeated movements that stress a particular muscle or tendon. These types of injuries can occur in many parts of the body and symptoms can include inflammation, pain, numbness, or a restricted range of movement around the affected area.
Symptoms can often persist for longer than other sudden injuries, especially if they are not treated. Below we review some common repetitive strain injuries associated with soccer, tennis and golf, and tips for preventing them.
While heat illness from hot summer practices and concussions from player-on-player contact remain the most common soccer injuries to watch for, repetitive strain injuries are also a concern.
- Twisted or sprained ankle – Ankle sprains are very common soccer injuries and often occur when turning, twisting, or moving suddenly results in rolling of the ankle. This can cause ankle ligaments to stretch or, possibly tear. Proper conditioning to increase leg strength can help prevent injury through exercise like leg presses and curls, as well as calf raises. However, if injury occurs it’s important to rest, elevate, and ice the area of concern and seek treatment if symptoms do not improve.
- Knee displacement – Quick and forceful twisting motions, while the feet remain on the ground, can strain the ligaments in the knee. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) provide stability to the knee when flexing and extending. Medial and Lateral collateral ligaments (MCL and LCL) prevent bending of the joints to the side. These ligaments can all be injured with twisting. Proper warm-up and cool-down stretches (e.g. iliotibial band stretch, quad stretch, hamstring stretch, etc.) before any physical activity can help reduce stress on and prevent injury to these ligaments. Mild injuries may heal on their own if the injured knee is rested and you refrain from using it to support your weight, but further treatment may be required if symptoms persist.
- Hamstring pull or tear – The hamstring is made up of three muscles that contribute to the knee’s ability to flex properly. It’s commonly injured in sports that mix continuous running with quick stops and starts, and sudden turns. To prevent injury it’s important to not overload your hamstring with frequent, strenuous exercise sessions and to properly warm up and cool down after exercising. Again, rest and ice can help treat mild injuries and if symptoms continue, seek treatment.
In the summer, outdoor tennis courts can be very busy. To prevent injury it’s important to always warm up, stretch, and cool down, as well as train for the specific physical demands of tennis – although you should avoid over-repetition of any one type of shot. Some injuries to watch for include:
- Tennis elbow – Tennis elbow is an overuse injury of the extensor muscles of the forearm. Pain and tenderness are felt at the origin of these muscles at the outer side of the elbow, but may radiate into the arm, wrist, and fingers. The injury usually develops gradually, as a result of microtrauma and scar tissue at the muscle attachment. It is not always possible to prevent tennis elbow, but gradually increasing the level of your training, warm-up and stretching exercises, suitable equipment, and the correct technique (hit the ball in front of the body with a straight, firm wrist) can help.
- Low back pain – Low back pain is very common among tennis players. The repeated rotating, flexing, and extending of the back during the serve may cause problems. Building up core strength with abdominal and back exercises can help prevent injury, as well as a complete warm up and cool down.
- Achilles tendon – The Achilles tendon is one of the longest in the body; it stretches from the calf muscles down to the heel. Chronic repetitive movements during running and jumping can cause injury to the Achilles tendon. The symptoms can include a gradual increase of pain, initially only in the morning and at the start of the training, but later the pain may be continually present during exercise and even at rest. A complete warm up before and cool down after exercise, proper footwear, and massage can help prevent injury. If injury occurs, rest the affected area and seek treatment if symptoms don’t improve.
Golf is another favourite summer activity than can cause repetitive strain injuries, such as:
- Golfer’s elbow (medial epicondylitis) – Tendinosis (irritation of the tendon) can occur due to an injury to one of the tendons in the elbow from repetitive movements that increase stress on susceptible tendons, such as hitting golf balls. This type of injury can be aggravated by an improper swing motion, so it’s important to increase muscle strength in the arms and core and correct an improper swing. Resting the injured tendon is also key, if injury occurs.
- Shoulder (rotator cuff) injury – Golfers can develop tendinosis, bursitis, and tears in the rotator cuff due to the repetitive motion of the golf swing. Pain may be felt in the shoulder or upper arm. Often modifications to the golf swing combined with strength conditioning can help prevent or alleviate symptoms. If symptoms don’t improve, further treatment may be required.
- Hand and finger injuries – The repetitive motion and high speed of the typical golf swing can injure the hands and fingers. Repetitive blunt trauma to the fingers can lead to numerous conditions such as tendinosis, broken, or deformed bones.
The most important preventive measure is a thorough warm up prior to, and a cool down after, physical activity; this allows the muscles time to adjust. Regular exercise will keep the muscles working effectively and the joints loose, and will reduce the chance of a repetitive strain injury.
WHAT HAPPENS IF I AM INJURED?
If you do experience pain as a result of your favourite activity, treatment can take many forms. Sometimes simply stopping the activity, elevating the injured area, and icing it are enough, while other injuries may respond to dedicated physiotherapy or different treatments. If your symptoms do not resolve, however, it’s important to speak to your health care practitioner about your symptoms. Diagnostic imaging, which could include X-ray, ultrasound, or MRI exams, may be ordered to help diagnose an issue.
Agel, Julie, et al. (2007) “Descriptive Epidemiology of Collegiate Men’s Soccer Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 Through 2002–2003.” Journal of Athletic Training. 2007 Apr-Jun; 42(2): 270–277.
Newman, Tim (2018) “Repetitive strain injury (RSI) explained.” Medical News Today. www.medicalnewstoday.com. Accessed July 16, 2018.
International Tennis Federation (2018) “Tennis Injuries.” www.ITFTennis.com. Accessed July 16, 2018.
Palacois-Jansen, Karen (2009) “10 common golf injuries.” Golf Fitness Magazine. www.golfchannel.com. Accessed July 16, 2018.
American Society for Surgery of the Hand (2014) “Golf Injuries to the Hand, Wrist or Elbow.” www.assh.org. Accessed July 16, 2018.