Overuse Syndrome

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The amazing human body
Symmetry by design
What exactly is overuse syndrome? 
Why does overuse syndrome affect people with upper limb differences?
What kinds of movements cause overuse syndrome? 
At what age does overuse syndrome begin?
How does overuse syndrome develop?
The four stages of overuse syndrome
Things you can do to stop overuse syndrome

The amazing human body

Even when asymmetrical because of a limb difference, the human body is highly adaptable and capable of performing both everyday tasks and incredible feats of agility and strength. If you follow social media or the news, you can’t help but be astonished by the athletic feats that children and adults with upper limb differences (ULD) are accomplishing every day such as bodybuilding, dancing, rock climbing, playing all kinds of sports, weightlifting, repairing sports cars, magician, rocket, actor, the list goes on. 

Symmetry by design

But the human body also is designed to be symmetrical: two eyes and ears, two arms and hands, two legs and feet, etc. It is especially helpful when adults understand that the compensations that these children develop to accomplish tasks take a cumulative toll on the body. Children with limb differences should be encouraged to choose and decide which activities they want to pursue and given support to do them in as safe and healthy a manner as possible.

Teaching children from a young age to use their affected side(s) in everyday activities to balance their bodies during functional activity is essential to reducing strain on the “dominant” side and to preserving the strength and endurance of the body parts that are overused. Since this strain is cumulative, activities that were easy in one’s childhood can become straining as one ages. Sometimes strain can turn into a prolonged overuse syndrome that can last for months or even years, which can pose a significant challenge and affect many aspects of life.

What exactly is overuse syndrome? 

Overuse syndrome is a short or long term condition involving pain, strain, and/or decreased function. It is also known as occupational overuse syndrome (OOS), cumulative trauma disorder (CTD), repetitive strain injury (RSI), repetitive motion disorder, repetitive stress disorder, or overuse injury.

“Repeating one movement or motion constantly over a long period of time can lead to overuse syndrome in your hands and arms. Though many are able to recover from this condition, it can be very inconvenient, and can prevent you from completing everyday tasks and activities.” (Definition from the Cleveland Clinic)

Factors that can cause overuse syndrome are: repetition of one movement or motion, frequently, over a span of time, in hands and arms, that can prevent completion of everyday tasks and activities (Adapted from the Cleveland Clinic).

Why does overuse syndrome affect people with upper limb differences?

People with ULD face increased risk for overuse syndrome because of strain on the dominant side and compensations on the limb different side(s). Overuse syndrome typically develops in hands and/or arms before spreading to other parts. Compensations in hands/arms can cause strain or fatigue in other muscles, and overuse syndrome can affect upper arms, back, shoulders, and neck. Catching OS early is important to prevent long term problems.

Unfortunately, there‘s very limited research on overuse syndrome for upper limb difference. There are several studies on adults with acquired limb loss and no studies on congenital limb difference. So we can apply research on overuse injuries in young athletes. (Source: Dr. Brenner & Dr. Watson, “Preventing Overuse Injuries in Young Athletes: American Academy of Pediatrics Policy Explained;” 1/2024)

What kinds of movements cause overuse syndrome? 

… repetition, high force, awkward joint posture, direct pressure, vibration, and prolonged constrained posture. The unilateral upper limb amputee patient may have a problem avoiding many of these risk factors because of the natural heavy reliance on the sound limb…

Overuse Syndrome and the Unilateral Upper Limb Amputee: Consequences and Prevention; 2008

Overuse syndrome can also be caused by not enough rest and recovery, poor body positioning and/or posture, repeating specific straining motions, stress or untreated mental health issues, or weak muscles or deconditioning.

At what age does overuse syndrome begin?

We thought overuse syndrome started in middle age for folks with ULD, but we may have been wrong. In a recent unpublished study, adults with congenital one-sided ULD reported: 82%: experienced pain/overuse and 70%: pain/strain developed by age 26.

How does overuse syndrome develop?

Overuse syndrome develops in stages over time. Catching overuse syndrome early in either arm or hand can prevent symptoms from worsening. Because it‘s easy to ignore pain, learning to recognize the stages for oneself or a loved one (child, spouse, friend) and noticing patterns of ignoring or pushing through pain can help reduce the risk of overuse syndrome.

The four stages of overuse syndrome

  • Stage 1: pain occurs after activity:
    • Hands and/or arms feel fatigued after activity or work shift
    • Subsides with overnight rest
    • Example: pain and/or fatigue after cooking, playing sports, or typing one-handed

  • Stage 2: pain occurs during activity – but doesn’t affect performance
    • Fatigue or pain starts earlier
    • Discomfort may last into the next day
    • Increasing aching and tiredness
    • Rest and over the counter anti-inflammatory medication bring relief
    • Example: pain and/or fatigue during cooking, playing sports, or typing one-handed

  • Stage 3: serious aching, fatigue, pain – and limits performance
    • Pain limits full participation in activity
    • Discomfort lasts into the next day
    • Rest and over the counter anti-inflammatory medication bring limited relief
    • Muscles may weaken
    • Example: pain and/or fatigue limit ability to cook, play sports, or type one-handed

  • Stage 4: chronic pain even at rest
    • Constant aching, fatigue, pain
    • Pain is unrelated to activity
    • Daily life and sleep are affected
    • Only extended rest brings relief
    • Muscles likely have weakened
    • Example: constant pain and/or fatigue in either hand/arm, back, neck, shoulder

Mindsets that can cause harm

Many widely held mindsets promote overdoing and overachieving. These mindets also encourage “proving” capability to others. Many adults say they wish they’d made better-informed decisions about how much to push their bodies.

Things you can do to stop overuse syndrome

Making lifestyle changes during stages 1 & 2 can stop overuse syndrome from worsening. But ignoring the pain in these stages is easy. Because there may be no bruising, people may not realize that overuse syndrome is happening. It’s important to recognize pain and not push through!

Here are some things you can do as parents to understand more about overuse and reduce the likelihood that your child will be affected by overuse syndrome:

  • Learn about/educate yourself about good posture and biomechanics
  • Encourage symmetry by involving the affected (limb difference) side(s) in activities of daily living
  • Seek professional help from an OT who works with children with upper limb differences
  • Always listen/respond if your child complains about pain in either the dominant or affected side(s)
  • When your child begins to use technology, adapt the technology to your child rather than adapting the child to the technology!

Complete the form below to download a free printable copy of the Upper Limb Difference (ULD) Overuse Syndrome: preven, reduce, treat infographic

© 2024. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy