There are quite of number of common causes of repetitive stress injuries but even when the individual’s problem is understood it can be difficult to correct.

I recommend that those with multiple strains, sprains and tendinopathies determine whether they have the necessary tissue strength and if not, whether the cause is hyperflexibility or insufficient training base. The problem may be repetitive stress activities that they have not conditioned carefully for.

Muscle tissue can develop strength and endurance faster than tendon and ligament. This is particularly important to someone who develops weaker tendon. We see this with stress fractures in young beginning women runners and tendinopathies in many young athletes of both sexes. In men this may be due to the participation of youths with high testosterone and growth hormone levels permitting rapid muscle growth which could be a competitive power advantage but also predispose to injury or degradation of tendons that were unable to keep up with their muscle development.

The solution is a planned program that matches the individual and is periodized to provide sufficient rest and variety of conditioning with specificity to their sport. For starters, select the right sports and activities for yourself. Then read the page on periodization and get help planning if you need it. Put your plan together and follow it. Include enough sleep and proper nutrition. Include some cross training and core strengthening to avoid repetitive stress problems and imbalances.

Muscle imbalance is one of the major causes of chronic and repetitive stress injuries in runners. An important cause of imbalance is when an athlete trains too frequently to the end of endurance at which point they are using alternative muscles substituting for the proper movers. Their form deteriorates toward the end of the run and damage is done.  This also occurs when an athlete is beginning a new sport or going from speed to endurance competitions or training up too rapidly without consolidating their technique.  

Once a muscle becomes chronically shortened the opposing muscles become inhibited and weakened. This type of muscle imbalance can also occur when an injury causes reflexive chronic protective tension. It can also occur when a muscle is not stretched back to its normal operating length after being heavily exercised.  It can become shortened as your hamstrings and hip flexors will if you run and then work a sedentary job without stretching.

You can create a muscle imbalance from the opposite mechanism by overstretching a joint. The deep stabilizing muscles may actually be strong in the long, stretched position but not in the shortened position where they are needed to coordinate and stabilize the joint. Many of the muscles around the joint may then become shortened to compensate, particularly the ones opposite the overstretched weakened one.

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Hypermobility, Tissue Strength and Injury:

There are known genetic factors predisposing individuals to weaker collagen formation. Although we can test for some of these, testing is expensive and incomplete. It is my opinion that the most accurate test for the interaction of these multiple factors on the musculoskeletal system is stress testing for hyperflexibility and the existence of multiple tendinopathies in the patient.

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For example:
Do your knees and elbows hyperextend and can your thumbs touch your forearm, do you have tennis elbow in addition to your Achilles tendinopathy?

If so, what do we do for you?
I recommend avoiding contact sports for obviously hyperflexible people and caution with endurance activities.  Find activities that maintain condition without injury, often in the gym setting where the forces are more controlled.

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(My following recommendations may seem general but this is necessarily due to the variables that make each athlete an individual.)

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Aside from the sport and equipment you need to consider your age and general condition, experience, sex, size and weight, who you are genetically and developmentally with your specific musculoskeletal configuration and overall potentials as well as your injury history.

Injured or not, I generally check the basic ranges of motion, strength and movement patterns because even well trained athletes will generally have deficits that impair their performance or predispose them to injury.  This is particularly true for stability of individual joints as well as core to floor stabilization, coordination, balance and agility.

One of the initial approaches I used is simply to observe athlete while standing, walking and running to see if there's anything obviously amiss and if there is, search for the cause.

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(If they come to me at a race with a specific complaint; I may, in the interest of time and at the risk of missing something, jump ahead and investigate some of the more common potential causes.)

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Putting athlete through fundamental activities or movement patterns can be very revealing. Functional testing is critical before preseason training or once an injured athlete is out of pain to deteremine what needs to be conditioned.

For example:
Have them stand on one foot balancing with their eyes open, with their eyes closed and then with their eyes closed and head tilted back places increasing challenge on their position sense and stability from the ankle to their hip. Observing single leg toe ups barefoot on stairs can demonstrate loss of arch and ankle control as well as any hip rotation weakness that may be contributing to it.

I might also have them perform an overhead squat or lunges in various directions while observing balance, control and stability as well as range of motion from the ankle to the hip.  Observing their knee orientation and hip control during the act of stepping or jumping down particularly when fatigued can show up weakness and lack of control.

Frequently the corrective exercise for any deficits I observe is simply to have them use the test exercise that was improperly performed, keeping within a range that they can control until they become stronger and can perform it full range then with increased speed and possibly progressing to added resistance or sport specific training.

In order to train a specific skill, strength or philosophy you have to perform exercises/training that is as close in angle, coordination and speed as possible to the sport.

Eccentric Training:
You may have read about eccentric training or have eccentric exercises prescribed for the prevention or correction of chronic tendon problems. 

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