Overuse symptoms in athletes: Is surgery necessary? And is surgery a long-term solution?

What is an overuse symptom?

Probably you are aware that an overuse of tissues causes pain and that an inflammation is a result from microtraumata, acute or chronic. In sports we see them most frequently near the tendons and muscle attachments, such as Achilles tendon inflammation, knee tendon inflammation, abdominal muscle inflammation (pubalgia), adductors, … and in players using overhead movements such as volleyball and tennis: shoulder inpigments (restraints), elbow and wrist problems, back pain, …
What initially started as pain and often disappears after a good warming-up progresses to a chronic inflammation that will no longer disappear after a warming-up and even in its worst stage shows discomfort at rest.

Clearly there is ‘something’ wrong with our body…

What’s wrong?

An inflammation caused by overuse while performing sports can occur in two particular ways; after an acute trauma (like healing after a fracture, accident, …) or rather in a slow, lingering way. In acute trauma, the cause is clear and evident; the chronic version however requires the right knowledge to produce an appropriate and lasting solution.
Since we collide with chronic inflammation regularly in the sports world for which often a surgery is appropriate, we will continue focusing on this topic because the impact of a surgery is larger than we think and in many cases isn’t a solution in the long run. We will come back on that.
We might want to look at the formation of a local overuse injury in this way: You lift a heavy table with three people, then one quits so you have to lift the table with two, then the other quits so you need to lift the burden on your own. The chance that you become overused as the only remaining one is large and as long as you don’t get help from ‘your mates’ again the chances of recovery are small.

This is a very simple way of explaining the emergence of a chronic injury and it also explains why we often have no other solution than to surgically remove the inflamed tissue. Perhaps we focus too much on the inflamed tissue and not enough on ‘the mates’ who don’t do their job?
You can imagine that the ‘surgery’ is often only a temporary solution and that we should focus on the ‘mates’ of the inflamed body part in case we want to have our athletes performing sports again.
(In this article we won’t discuss nutrition which also has an effect on inflammation.)

‘Removing’ the overuse injury/ inflammation: surgery

We have top surgeons in our region and it’s reassuring to be able to count on them when we are faced with an acute trauma or severe injury while performing sports. In the surgical treatment of an overuse injury however; we can ask the following questions, at least when we assume that the cause lies somewhere else than in the inflamed tissue:
1. If the cause lies elsewhere and the inflammation / overuse injury is the result of a ‘mate’ who doesn’t work properly, how can this surgery be a long term solution?
2. Can we avoid surgery given we find the root cause? Or are we looking at the wrong spot?
3. The surgery was successful, the inflammation and pain are removed : how can you avoid relapse if the cause is still there? And don’t we end up having the same question as prior to the surgery: What is the cause of the overuse injury?
4. What are the disadvantages of surgery on our connective tissue and on the balance in our body and do these weigh against the benefits of symptomatic treatment?
5. Assuming that a surgery of an overuse injury is only a symptomatic approach, in other words the cause is still present (with the risk of relapse), + the disadvantages of a surgery = don’t we create chronic illness rather than a permanent solution?
Obviously each situation is different; however you won’t regret taking your time to perform a thorough screening of the overuse injury in order to analyze the root cause before you opt for surgery.

A multi-disciplinary approach to overuse injuries?

In hospital TV series you sometimes see a number of doctors standing around the patient’s bed and every doctor shares his/her opinion. This gives the other doctors the chance to confirm the opinions expressed, to question them, to add something, …

By assembling a number of specialists you immediately get more insight, knowledge and talent ‘around the table’ and this will only benefit the patient. The ego of the doctor, whose opinion on a particular case might not be the best, could temporarily be bruised; however eventually one can only conclude that the patient and the doctors (as a group and as individuals) benefit from this approach.
Wouldn’t it be a significant progress if the recreational or elite athlete, who is suffering from an overuse injury, is surrounded by a team of surgeons, trainer, physiotherapist, movement analyst, podiatrist, osteopath, orthopedist, … and that they -all together- screen every patient?
This is currently a utopia; however we could start with having 2 or 3 disciplines around the table and invoke a 4th or 5th discipline depending on the situation.

We already notice some good initiatives and it would be beneficial to all parties involved to make this a standard practice instead of an exception…

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Over act2prevent

Kinesitherapeut & personal trainer van opleiding, gek op persoonlijke ontwikkeling en sporten. Mijn passie is voetbal en andere balsporten. Hou van duiken en genieten van het leven. Sinds eind 2014 gestart met een eigen voetbalschool voor talentvolle spelertjes geboren in 2008 en later. Wij bieden met de voetbalschool extra trainingen aan tijdens 'vrije' momenten net als een complete 'interne' opleiding.
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