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Injuries Related to Being Active with Diabetes: Part 2 (Prevention of Overuse Injuries)

Sep 7, 2009

Sheri_ColbergBy Sheri Colberg, Ph.D., FACSM



Prevention of Overuse Injuries


If your nagging aches and pains are only minor, simply cutting back on how hard, how often, and how long you do the activities that irritate your joints may bring relief from your symptoms. In other words, give your joints a rest! One way to prevent problems in the first place is to adopt a hard-easy workout schedule in which you alternate and vary your workouts by the day to avoid stressing your joints in the same way with every workout.

If your problems are being caused by anatomical concerns, fix what you can (such as getting orthotics to correct leg-length discrepancies) and then consider doing other activities that don’t cause as much risk of injury, such as working out on an elliptical trainer a few days a week instead of always running outdoors on asphalt. In addition, working with a coach or teacher or taking lessons can help you improve your training and technique. Make sure to do a proper warm-up and cool-down, ice down inflamed joints after workouts, and use NSAIDs to control inflammation and pain.

You may also benefit from cross-training. To use this approach, you do other activities to maintain overall fitness levels while your injured area recovers. For example, if you have lower-leg pain, you can still work out your upper body by doing activities that allow your legs to rest and recuperate. Try alternating weight-bearing activities like walking or running with non-weight-bearing ones, such as swimming, upper-body work, and stationary cycling so that you don’t injure another part of your body. 

After you resume your normal activities, work to strengthen the muscles around the previously injured joint to prevent recurrence, especially following tendinitis. Strengthening the muscles around an affected joint, after the pain is gone, is critical to preventing the return of the problem. For example, following a shoulder joint injury like rotator cuff tendinitis and impingement, focus on doing resistance work using all sections of the deltoid muscle in particular, along with exercises for the biceps, triceps, pectoral muscles, upper-back muscles, and neck muscles.


Choosing the Proper Footwear 

Wearing proper shoes is critical to preventing many lower-extremity and foot problems. The best type of shoes to wear varies by activity. Walkers and runners generally need some cushioning, whereas tennis players require footwear with greater stability for side-to-side movements. For most activities, though, you will benefit by picking your shoes based on whether you rotate on your feet toward the arch of your foot or toward the outside edge. 

To determine how you step, look at the wear pattern on your shoes. For example, exercisers who overpronate (rotate their feet too far to the inside), have flat feet, or carry a lot of extra body weight wear out the insides of their soles first. If you have this problem, motion-control shoes may help. Generally heavy but durable, they are rigid, control-orientated running shoes that have firm midsoles designed to limit overpronation; they also come in varieties with more cushioning. If your shoes do not compensate for overpronation, you may place extra stress on your knees, hips, and ankles that can result in injuries. Conversely, supinators usually have high arches and more rigid feet and thus wear out the soles of their shoes on the outside edge. If you’re a supinator, you will generally do better in highly cushioned shoes with plenty of flexibility to encourage foot motion. If you have normal arches, you’ll want to aim for shoes with moderate control, such as those with a two-density midsole. If you’re unsure which type of arches your feet have, wet your feet and make a footprint to see how much of the arch region of your foot shows.


Recognizing and Treating Overtraining Syndrome 

Overtraining syndrome frequently occurs in athletes who are training for competition or a specific event without allowing adequate time for rest and recuperation. Becoming more fit and improving your performance is a balancing act between training and recovering from it. You’re not stronger or faster right after your workout, but rather after your body has repaired the damage that you did to it with the exercise. Overloading your body excessively without enough recovery time can result in both physical and psychological symptoms. 

The symptoms of overtraining are not hard to recognize when you know what to look for. They include chronic tiredness, lethargy, soreness and aches, chronic pain in your muscles and joints, an unexpected drop in your performance, insomnia, an increased number of colds and upper-respiratory tract infections, mild depression, and general malaise. To determine whether you have overtraining syndrome, measure your resting heart rate first thing in the morning. If it is increasing over time, you’re likely overtraining. 

Getting sick more frequently means that excessive training is compromising your immune function, and because overtraining results in elevated levels of cortisol, you may have more problems controlling your blood sugars as well. If you start feeling chronically tired, drained, and lacking in energy, cut back on your training schedule a bit and see whether that helps; if you’re overtraining, it will. Cross-training (or doing different activities) can also help if you’re overworking certain muscles or joints, and it may help you maintain or improve your psychological outlook. Total recovery can take several weeks. Proper nutrition and stress reduction are important to the recovery process. 

In my next column, you’ll learn more about specific arm and shoulder injuries.


This column is excerpted from Diabetic Athlete’s Handbook (2009), which contains essential exercise-related information and examples for Type 1, Type 1.5, and Type 2 diabetic exercisers of all ages. More information is available at www.shericolberg.com.