A Sports Medicine Approach to Overuse Injuries: General Principles for the Industrial Athlete


Reprinted from The RSI Network - Issue 26 - Feb'98

Jeffrey Pearson, DO
North County Urgent Care Medical Center 
1595 Grand Avenue, Suite 102, San Marcos, CA 92069 
(760) 471-2273, Fax : (760) 471-0513

Sports medicine physicians grade overuse injuries based on the symptoms and impact on the athlete's performance. This grading helps guide the treatment and rehabilitation process.

  • Grade 1: No pain with activity, but some discomfort afterward (either immediately or during the evening or the following days)
  • Grade 2: Some discomfort with activity but does not interfere with performance
  • Grade 3: Discomfort with activity; interferes with performance
  • Grade 4: Discomfort so intense that activity cannot be performed at all

Treatment Guidelines

Grade 1: Usually, reducing the intensity or duration of the activity by 25% is all that's required. Activity can be gradually increased as symptoms allow. A runner, for example, should never increase weekly mileage by more than 10%. Similarly, an assembly-line worker should gradually increase production to avoid reinjury. Sudden, excessive overtime is a sure-fire recipe for overuse complaints because workers don't have an opportunity to build up their endurance prior to the extra work.

Grade 2 : Reduce intensity or duration of the activity by 50%. In addition to ice and stretches, consider using nonsteroidal anti-inflammatory agents. Physical therapy can be considered but is not absolutely necessary at this point. When pain is gone, the therapist should teach an endurance program, in addition to concentrating on strengthening exercises.

Grade 3 : "Active" rest; the worker should stop performing the offending tasks but is allowed to move the affected part for daily activities. Physical therapy is used to speed resolution of the discomfort, as well as rehabilitate—that is, strengthen, increase endurance, and restore coordination. In addition to the oral nonsteroidal anti-inflammatory agents, a corticosteroid injection may be considered at this time.

Grade 4 : Complete rest of the affected part, usually involving the use of a sling or splint (even casting is considered in severe cases). All of the above options are applicable here. If there is no improvement, or the condition recurs despite adequate treatment, then surgical intervention may be required—for example, removal of a subacromial spur affecting a rotator cuff tendinitis.

Unlike in sports, there is no "off-season" for workers to recover from a season of overuse, nor is there a "pre-season" to warm up before beginning employment. Industrial athletes perform all year round. Therefore, it's extremely important to emphasize a continued flexibility program; otherwise, the tissues will be "tight" with reduced flexibility, which will make it easier for microscopic tears to occur, leading to injury. Only after the tissues have achieved a certain degree of flexibility should a strength training and endurance program be initiated. Starting strength exercises too soon will often result in worsening of the condition. Ice should be used to decrease or prevent inflammatory response in affected regions after work.

Industrial physicians should try to become familiar with the job specifics of their patients and become acquainted with the tools and equipment that their patients use. Identifying poor ergonomically designed workstations can help to prevent certain injuries. For example, placing a shock mat under the feet where a worker stands all day long on a cement warehouse floor can help reduce back and lower extremity discomforts. Changing the types of tools, much like an athlete's changing tennis racquet types, can also reduce stresses placed on muscles.

About the Author

Jeffrey Pearson, DO, is a board-certified family physician with added qualifications in sports medicine. Dr. Pearson graduated from Gettysburg College in Pennsylvania, received his medical degree from the Kirksville College of Osteopathic Medicine in Missouri in 1983, and completed a rotating internship and residency program in the New York metropolitan area.

Jeffrey Pearson, DO (jpearso1@san.rr.com) of the Industrial & Sports Medical Center, 740 Nordahl Rd., Suite 117, San Marcos, CA 92069, (760) 432-9000.

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Last Updated: 06/16/01