Overuse Injury or Repetitive Strain (Stress) Injury? Is there a difference?

Before I get started here, I feel obliged to let you know that this isn’t my usual blog post. I generally try to give you either practical step-by-step instructions on how to address common injuries, updates on current clinical research findings, or ways of looking at how you train. This isn’t any of those.

In fact, I’m not totally sure why I’m writing this, but it’s been stirring in my mind since reading a blog post (I’ll share it with you in a bit) two weeks ago and I’d like to get it out. So please humor me and read on until I’ve figured things out.

I believe that for you, I am trying to demonstrate 2 similar but different paths to injury. For me, I am trying to solidify a separation of definitions for two terms that are often used interchangeably. This is more of an intellectual conversation I’d like to have with those of you who are interested in the language of physiology, and its serpentine path, as users try to find firm definitions for two different causes of injury.

That last sentence should give you an indication of where I’m going here, so consider yourself warned.

Up until very recently, I used the terms overuse injury and repetitive strain injury (sometimes called repetitive stress injury) interchangeably and without much thought. They both can be used to describe the tendon, muscle and nerve injuries I discussed in previous posts about tricep tendonitis or ulnar nerve entrapment. But I’d like them to do more.

Specifically, I’d like a simple way to distinguish whether the cause of the injury was acute or chronic. Did you mess yourself up quickly in an afternoon or slowly over several months, or even years?

Acute

Here’s an example of an acute cause of injury…overdoing it in a condensed period of time, such as a day or two. Example: doing yard work and you try ripping out several large bushes, moving boulders, pruning trees…performing movements and using tools you’re not used to. You spend two full days pushing your body to do things that it wasn’t prepared to handle. The tendons in your forearms have sharp pain from grabbing large rocks with an open claw grip and tossing them into a pile. Your back muscles ache from bending over and yanking roots out. And for some reason, you like to cock your head to the side when pruning trees. Combine this with using pruning shears and a pole saw for several hours causes the scalene muscle on one side of your neck to tighten up and compress your ulnar nerve, leaving a weak, burning feeling running through your arm and into the forearm and hand.

Chronic

On the other-hand, you can have chronic causes for all the same injuries by spending years sitting at a desk and working on a computer 30-40 hours a week. The forearm tendons get sore from the non-stop use of a mouse. All of that time sitting, leaves you with a stiff back and tight hip flexors. When you finally stand and take a walk, your hips are so tight that you never truly stand up straight and those last few degrees of anterior tilt in your hips means that your lower back muscles are constantly engaged and leaves you with a constant ache. Once again, you have this little sideways cock to your head when staring at the computer monitor and it leaves you with very tight scalene muscles and a nerve entrapment.

Note: Just for further clarification, if you were a landscaper and did all the same work as the acute example, but the injuries developed over the course of months instead one or two days, that would make it a chronic condition.

Overuse Injury Now that you see the difference between the two, you may be wondering why I think it’s important that they each have their own term. After all, the exercises you do to heal them are the same. It doesn’t matter if the cause was acute or chronic, and that is a very good point.

But now that I’m really thinking about this, there is one key difference: ongoing self-care after the injury has healed.

If you had an acute cause of injury from a random day of over doing it, then once you’re healed, that’s it. Move on with your life.

But if you have a chronic cause of injury that remains an ongoing part of your life, your responsibility for remaining injury-free never ends. If there are repetitive movements causing strain on tissues, you need to be mindful of the imbalances they cause.

A regular maintenance program is required to counter those movements and correct the imbalances. And those specific exercises should always be backed up by a well rounded training program that develops all of the fundamental movement patterns.

This brings me to the original blog post that lead me to this train of thought. It was written by Jarlo over at Gold Medal Bodies and can be found here. It contains some great advice on different injury causes and what you can do about them. But what really grabbed my attention was how he defined the following:

Overuse injury…

[Formed by]  a relatively fast breakdown in tissue, because of the introduction of a stress that the structure is not equipped to tolerate.

Repetitive Strain Injury…

Formed by a slow buildup of irritation to a tissue. Unlike overuse injuries, repetitive stress problems occur over the course of weeks, months, and perhaps even years, before symptoms are noticed.

The way Jarlo classified the two injuries made great sense to me and I wondered why I hadn’t come across this idea before. To the internet I went…and found nothing. Wikipedia, WebMD, Webster’s Dictionary, blog after blog, none of them made a clear distinction between overuse injury and repetitive strain injury. Perhaps I didn’t search deep enough but then again, I shouldn’t have to if it’s a common definition. Why was no one else making this distinction?

Maybe there isn’t really a difference between the two terms. Maybe no one else cares at all about this entire conversation besides Jarlo and myself. Or maybe there just hasn’t been enough people insisting on a distinction of terms and if it matters enough to me I should help sway popular use of terms until it becomes the definition. I mean, doesn’t the evolution of  language simply boil down to a good ol’ popularity contest?

There it is. I just realized that the whole reason why I wrote this post is to convince you to help me popularize an easier way of distinguishing between the pace at which we can inflict injury upon ourselves. Sunday morning well-spent. We may now carry on with our lives.

9 comments

  • Chinese medicine makes the distinction between acute and chronic conditions and treats them differently. In acute situations we often focus on removing stagnation and inflammation. In chronic situations we focus on addressing a patient’s lifestyle and strengthening the bodies ability to repair itself.

  • Thanks for this interesting and educational Email. Definitely worth saving and sharing!

  • Makes sense. I’ve had both. I did a couple of days (a day off between) on upper body machines at a health club after many months off. A couple of days later my forearms blew up – woke up with serious burning and deep throbbing in both forearms and shooting pains that were also in the wrists and across the palms and fingers. It felt like I had done years of RSI all in one week. When I finally got a prescription for PT two months later (delay requested by doctor who I guess hoped time would heal me and gave me a nerve test to rule that out), the deep burning symptom remained, it was awful. 2 months of PT arm stretching and strengthening resolved that.

  • This makes a lot of sense. Thanks for sharing. 😄

  • Hi Jamie. I have repetitive strain injury from using a mouse at work all day. It’s in my right wrist. The doctor has been less than helpful. Do you have any tips for this?

  • Hi Katie. I would find a good acupuncturist or massage therapist to release trigger points in the arm and shoulder. That should help.

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