The Overtraining Sport Injury “Epidemic”: An Overuse Treatment Protocol
SPORTS
FEATURE
Hirad NajafBagy
DC
Athletes are known for their competitiveness and drive. That’s why it’s no surprise to learn that research published in the Journal of Sports Medicine found that a large majority of athletes—as many as 60 percent—regularly “overreach” or “overtrain” by either working their bodies too often or too hard.
With over 20 years of experience as team sports chiropractor for the Washington Redskins, Washington Nationals, and D.C. United, I know all too well the role poor biomechanics and overtraining play in regard to injury and performance. In fact, one case that I had just recently is an excellent example of an overtraining injury.
A Positive Case Example
A baseball player presented with biceps tendonitis, one of the most common injuries I see. After following evaluation protocol, it was evident that the patient’s scapula and clavicle did not have full range of motion. Both were restricted and the major muscle groups of the rotator cuff had lost elasticity, imbalances, and hypertonicity.
Upon further evaluation, I found that there was an imbalance between the athlete’s right and left shoulders. This right-handed pitcher also had decreased motion in the left ankle and had lost elasticity and mobility in the left calf and hamstring. I often see this discrepancy in athletes where the lower body biomechanics can cause shoulder and arm injury.
However, after engaging in a six-week treatment plan that consisted of three visits per week for four weeks, two visits per week for two weeks, and the addition of custom orthotics, with support for all three arches of the foot, the patient is now on a maintenance treatment plan and pitching pain free. This type of recovery is possible with proper evaluation and my overuse treatment protocol.
Overtraining injuries like these make up the bulk of my practice. Patients come in either because they’re experiencing symptoms that are disrupting their ability to engage in the sport they love or they notice that their performance is decreasing or has otherwise changed.
Most Common Overtraining Injuries
What types of overtraining issues are of most concern? It depends on the sport.
For instance, when it comes to baseball, the overtraining injuries I treat most often are those related to the shoulder and elbow. The American Orthopaedic Society for Sports Medicine agrees, adding that these two issues are becoming so problematic that they’re actually “on the verge of becoming an epidemic.”
Samford University adds that basketball players specifically experience a higher number of overuse injuries to their knees, lower back or pelvis, and shins and calves. Perhaps the worst part? Injuries such as these are appearing in much younger athletes because they are specializing in one specific sport at a very young age.
Overtraining and the Younger Athlete
The average age of athletes coming into my office is getting younger. They used to be 15 or 16, now they are 10,11, or 12. So, what is putting these kids at even greater risk when playing their favorite sport?
I speculate that the main reason I am seeing younger athletes with these types of repetitive injuries is because of a rather recent trend that involves minimal, if any, diversification in sports. This means that players are now using the same muscles and movements yearround. Even during the off season, they are still using the same agility, strength, and weight-lifting exercises. With incentives such as college scholarships hanging in the balance, it’s not hard to see why these young athletes are working harder than ever to perfect their sport. According to a 2016 survey of NCAA schools, the average men’s baseball team awards $13,220 in financial aid and the average women’s basketball team hands out $36,758. To qualify, players often need to be the elite of the elite, causing overtraining issues to now develop in the early to late teens. Although this sounds rather daunting, the good news is that, with the right approach, Doctors of Chiropractic (DCs) can often help their athlete’s avoid overtraining injuries with very positive results.
Overuse Injuries Are Often Secondary to the Root Cause
Sports chiropractic has great success in treating conditions like biceps tendonitis, but to recognize the root cause of an overuse injury it is also critical to evaluate the overall biomechanics of the body through comprehensive examination starting with an assessment of the foot and ankle. We need to ask ourselves: what is happening in the athlete’s biomechanics to cause this overuse injury?
The answer often lies in the young athlete’s schedule. On the day of the game, for instance, they typically have some type of unhealthy grab-and-go breakfast, then jump in the car for a 1to 2-hour ride, only to arrive maybe a half-hour before the first game begins. At this point, they’ve had minimal nutrition and limited time to warm up. Then, after playing 3 to 4 games total, they do the same things in reverse. This means that there is no time for the player to rehab after the game and, because it’s easier, fast food is usually on the menu at that point as parents are intent on satisfying their player’s appetite, but not necessarily their body’s nutritional needs.
Another factor behind overtraining injuries in youth athletes is imbalances within their body. Adolescents in the 12to 16-year-old age range have tremendous development in bone growth, soft tissue development, and strength. Due to these physical developments and the increased demand of their sports, imbalances are created that lead to chronic injury. The best way chiropractors can help their athletes is through thorough biomechanical assessment and treatment, biomechanical reeducation to include custom orthotics with 3-arch support as needed, and education of both parent and athlete.
That’s why I implemented an overuse treatment protocol that addresses the evaluation and treatment of soft tissue injuries related to overtraining in sports.
Overuse Treatment Protocol
"If you want to understand the biomechanics of an athlete, be an expert in evaluating and treating the foot and ankle"
Overall assessment of biomechanics. The first step is to understand foot and ankle mobility and instability. Foot and ankle biomechanics of all my patients—both in office as well as the professional athletes are continuously assessed throughout treatment. I always assess their gait and how it translates to their motion. I help them understand how changes in foot and ankle mobility can affect every movement. Regardless of whether they are a baseball pitcher or a lineman, foot and ankle mobility and balance are big keys to performance and injury prevention. Custom orthotics are an integral part of creating a foundation for stability and balance for the entire body.
"If you want to get the athlete better you need to be an expert in soft tissue manipulation and extremity adjustment"
All sports chiropractors need to be experts in adjusting extremities and soft-tissue mobilization. Evaluating and understanding the biomechanics of the extremities and how it effects the rest of the body is a key component to recovery and performance. Being able to use proper soft-tissue mobilization to improve elasticity is a game changer for athletes and teams. Proper range of motion is established only when the soft tissue and joints are working harmoniously through manipulation.
"Proper dynamic biomechanics is the key to reducing chronic injury"
Restoring proper biomechanics. An athlete in motion needs proper dynamic biomechanics. Orthotics are an integral part of establishing a proper foundation. With new advancements in custom orthotics, I am able to fit orthotics for all of my athletes regardless of age or sport. But it’s imperative the orthotics support each of the three arches in the foot. If you have ever looked closely at a pair of baseball or football cleats you will see that they do not have much support or stability for performance. Athletes need to have proper support through each phase of their gait which is the main goal of custom orthotics. Athletes also need to be trained in proper biomechanics, stability and strength through all phases of gait. The majority of my professional and amateur athletes are seeing the benefit of custom orthotics and stability training.
"Athletes need continued prehab and rehab care to avoid overuse injury"
Educating Patients (And Everyone Else Involved)
How can DCs help prevent overtraining issues when the rest of the world seems to want athletes to specialize in one sport and one sport only? It all begins with education.
Every visit is an opportunity to educate my patients and their parents about what to look for, what to do, and how to do prehab and rehab. The more they are informed about what overtraining is, how it affects them, and how to avoid it, the easier it is to maintain the athlete’s musculoskeletal health and improve their performance.
It also involves teaching athletes how to communicate with their coaches if they have a symptom of overtraining. It is critical to educate players, parents, and coaches about how to have the right dialogue so they are all on the same page and can address symptoms proactively. An overuse injury that is ignored can lead to substantial rehabilitation time for an athlete leaving his/her team in jeopardy. An overuse treatment protocol can make a big difference for athletes, potentially gaining control over this growing epidemic.
Dr. Bagy is the Founder and president of United Wellness Center, Dr. Hirad NajafBagy (Dr. H) is sought after for his ability to keep competitors in the game and get people to enjoy optimal health and physical well being. His therapeutic and soft tissue techniques have benefited thousands, from top professional athletes to those recovering from traumatic injury to many who simply want to decrease physical discomfort and improve their quality of life.
