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The 5 Most Common Overuse Injuries

Overuse injuries are common among athletes and individuals who engage in repetitive activities or have altered biomechanics. Custom Orthotics can help manage and prevent further injuries by providing support, shock absorption, cushioning, and corrective measures regarding biomechanical issues. 

Plantar Fasciitis

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One of the most common overuse injuries prevalent within clinical practice is plantar fasciitis. Plantar fasciitis is described as the inflammation and micro-tearing of the plantar fascia, a thick band of connective tissue that runs along the bottom of the foot. It is a very common cause of inner heel pain, especially in runners and those who spend hours on their feet within their occupation. Custom orthotics can provide essential cushioning and shock absorption properties to aid in alleviating pain and modifications can be made to provide arch support. Shock absorption and cushioning properties typically consist of memory foam, poron, and comfort EVA materials built into the orthotic, and excess cushioning materials can be built into the arch and heel to accommodate the pain. Medial posting and internal arch adjustments can be added to the custom orthotic device to maintain the foot in a more neutral position while supporting the arch where the plantar fascia runs. Lastly, modifications can be used to alleviate pressure on the plantar fascia and prevent further micro-tearing to promote healing. Plantar fasciitis can be treated by a physiotherapist through assessment, manual therapy, stretching and strengthening, and activity modification and education. They may suggest manual therapy sessions to reduce pain and inflammation on the plantar fascia using shockwave treatments, stretching, and strengthening of the surrounding musculature such as calf stretches and toe curls. They may provide guidance regarding the modification of activities and sports that may aggravate the condition. Chiropractors may incorporate very similar techniques of treatment such as soft tissue therapy, myofascial release, or shockwave treatment on the plantar fascia and with the surrounding musculature. It may also be useful to incorporate chiropractic adjustments into the treatment plan as misalignments within the back and lower body can influence gait mechanics and mobility, possibly placing stress on the plantar fascia.

Achilles Tendonitis 

Another common overuse injury is Achilles tendinitis, meaning the inflammation of the Achilles tendon which connects the calf muscles to the calcaneus. It is a common occurrence in runners and those who participate in sporting activities that involve running and jumping. It commonly causes pain at the insertion point of the Achilles tendon or can take place about halfway up the Achilles known as mid-insertional Achilles tendinitis. Custom-made orthotics can be of great use to those suffering from this condition as they can provide essential shock absorption and cushioning properties that help to offload tension and strain on the Achilles tendon. Modifications such as medial and lateral postings, poron heel additions, and heel lifts can be very useful. Postings can be used to help control excessive pronation or supination of the foot that may be contributing to Achilles tendinitis while excess heel cushioning assists with pain management and shock absorption. A heel lift is the most common modification, and this is placed extrinsically on the orthotic to help shorten the Achilles during weightbearing therefore reducing the tensile load placed on it. Additional treatment from a physiotherapist can be warranted and manual therapy and soft tissue mobilization can be used to reduce pain and inflammation. Ultrasound, electrical stimulation, and shockwave therapy can be used to promote healing and reduce scar tissue buildup. Chiropractors may take a similar approach but could perform adjustments to the joints of the foot, ankle, and lower extremities to improve mobility, restore normal biomechanics and reduce stress on the Achilles tendon.

Medial Tibial Stress Syndrome

A third common overuse injury are shin splints (medial tibial stress syndrome) which refers to pain along the medial aspect of the tibia commonly due to inflammation of the muscles, tendons, and bone tissue sheath surrounding it. This condition is commonly seen in long distance runners and those engaged in repetitive impact movement such as running and jumping on harder surfaces. Custom made orthotics can be useful to those with shin splints because there is most likely a biomechanical concern that is causing overuse and stress on muscles, tendons, and ligaments. Shock absorption is going to be the best feature to incorporate in this orthotic to help absorb shock upon impact and reduce impact forces up the kinetic chain during activities. Other modifications such as posting, medial or lateral, can help to correct excessive pronation or supination that may be contributing to added tensile and muscle stress. A metatarsal pad may be used to assist in offloading pressure from the forefoot to redistribute weight more evenly across the foot, in hopes to reduce strain on the tibia and lower leg. Physiotherapy treatment may begin with an exercise focused approach to treatment to address any muscle imbalances, improve strength, flexibility, and endurance in the lower extremities. This may include stretching exercises for tight muscles such as the calf, muscles of the medial compartment, tibialis anterior, and tibialis posterior. Likewise with all other conditions mentioned, exercise and proper footwear education would also be highly beneficial. Chiropractors may take on a similar approach while also utilizing soft tissue treatment such as instrument-assisted soft tissue mobilization, or active release techniques to address muscle tightness and any scar tissue buildup within the calf and lower leg. They may also recommend exercise and rehabilitation techniques to improve flexibility, strength, and mobility within the lower limbs.

Patellofemoral Pain Syndrome

Another common overuse injury is patellofemoral pain syndrome involving pain around or behind the patella, often associated with years of activities that involve repetitive bending or loading of the knee such as sporting activities, running, cycling, or weightlifting. Normally when the lower limb flexes and extends the patella glides back and forth within the femoral groove but in cases of PFPS the patella mal-tracks and can grind against the femoral condyles causing crepitus and pain. Although PFPS can be a biproduct of repetitive sporting activities over the years, abnormal biomechanics can also be a contributing factor. Those with genu valgus can possess abnormal patellar tracking placing increased stress on the patellofemoral joint and overpronation during gait causes increases internal rotation of the tibia and femur contributing to abnormal alignment of the patella and increased pressure on the patellofemoral joint. Lastly, excessive lateral patellar tilt during gait can contribute to maltracking and lateral shifting of the lower limbs. Adding shock absorption and cushioning properties into any custom orthotic for this condition will be useful to reduce impact forces and loading of the patellofemoral joint by attenuating the forces transmitted through the lower extremities and up the kinetic chain to the patella during activity. Providing medial posting and internal arch adjustments strive to decrease excessive internal rotation of the foot and lower limb in aims to get the lower limb to a neutral position. Physiotherapy treatments such as soft tissue mobilization, joint mobilization, and strengthening exercises of the quads, hamstrings, and hip abductors can be useful for weak and tight surrounding musculature. Hands on treatment in and around and patella consisting of ultrasound and shockwave therapy can be provided to decrease scar tissue and promote blood supply to the area. Chiropractors may take a similar approach focusing on soft tissue therapy and strengthening exercises while performing chiropractic adjustments to restore proper joint alignment and reduce muscle tension that may be contributing to PFPS. OTS knee bracing is also a great option for this condition and may be recommended by the treating pedorthist, physiotherapist, or chiropractor.

Peroneal Tendinitis

Finally, the last common overuse injury this article will be discussing is peroneal tendinitis, an inflammatory condition of the peroneal tendons that run along the outer aspect of the ankle and foot causing swelling and pain. This can be caused by overuse or repetitive stress on these tendons during activities such as running, jumping, walking on uneven surfaces, or altered gait mechanics placing excess stress on the lateral compartment. An orthotic modification useful for this condition may be lateral posting as this can help to counteract any ankle instability, excessive lateral strike, or prolonged supination of the foot that may be contributing to the tendinitis. Additionally, adding components of shock absorption, cushioning, and arch support can be designed to help distribute pressure more evenly along the foot and support the MLA to help alleviate strain on the peroneal tendons and promote proper alignment of the foot and ankle. Treatment can be done by a physiotherapist or chiropractor to help combat further progression and alleviate pain and discomfort. Chiropractors and physiotherapists may take a similar approach and practice manual therapy and soft tissue mobilization to trigger point muscle tightness and stiffness in and around the ankle and foot. Ultrasound and TENS therapy can be used to reduce pain and any inflammation in the affected area in hopes to stimulate tissue healing. The suggestion of activity modification is also beneficial to limit activities that may aggravate the peroneal tendons and the surrounding tissues!

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