Overtraining Injuries: Muscle Strain and Recovery

Overtraining injuries can develop when training demands outpace rest and recovery. Muscle strains vary in severity; grading and actual function matter when interpreting recovery advice.

How did the pandemic change exercise habits?

According to a 2021 review, in the pre-pandemic era, the global health club industry finished the decade with revenue totaling $96.7 billion US dollars in 2019. In 2019, about one in five Americans belonged to a health club or studio. The figures of more than 184 million members and nearly 210,000 facilities describe the global industry, as reported by IHRSA in 2020.

What was a good year for the fitness industry with a seemingly bright future ahead was suddenly crushed in early 2020 when the world shut down for COVID-19. In 2020, “the fitness industry revenue declined by 58% compared to the previous year. By the fourth quarter of 2020 visits to gyms shrunk down to 38% even after gyms were allowed to reopen” according to a 2021 review.

During the pandemic, when people were in lockdown, consumer habits began to change. People were exploring how to stay healthy and in shape while staying indoors. There was now a greater emphasis on basic health and wellbeing. Whether exercising at home or in a gym, it is possible to exercise too much which may lead to musculoskeletal injuries.

Does lactate explain delayed muscle soreness?

Most people correctly believe that exercise helps prevent and aids the treatment of coronary heart disease, heart failure, diabetes mellitus, hypertension, obesity, and depression. A 2021 review suggested that some people fail to see that there is “evidence that suggests that the relationship between exercise and mortality may be curvilinear, with modest additional benefit at higher levels. Intensive exercise has also been associated with increased atrial fibrillation risk”. Lactate is formed and used even when oxygen is available. It is not simply a waste product produced by oxygen shortage, and its accumulation does not explain delayed-onset muscle soreness. Lactic acid build-up has historically been blamed for producing muscle soreness. That historical explanation is not supported as the cause of delayed-onset soreness. But the more strain put on a specific body part, the more likely an injury may arise in that area.

“Many exercise-related injuries can be avoided with proper training,” said Dr. Marci Goolsby, a primary care sports medicine physician at the Hospital for Special Surgery in New York City. “The most common reason people get stress fractures is usually a common error,” Goolsby said. “This could mean either forgoing strength training or increasing the intensity of a workout too quickly”. Muscle “burn” is to be expected when you attempt a challenging workout. Muscle pain, however, is a signal that something is wrong.

How do recovery and compulsive exercise differ?

Most everything in life, whether taking vitamin C, eating bananas, or exercising, has upper dose limits. Overtraining can occur when you train without allowing enough recovery time between workout sessions. Rest is an important part of exercising and training. It’s what allows your body to make it through, successfully and safely, to the next workout. Pushing too hard for too long can backfire.

In some rare cases exercising can even become a compulsion. This may occur when exercise becomes something you do not choose to do. Instead, it becomes something you feel like you must do. Compulsive exercise may often be accompanied by an eating disorder, such as anorexia and bulimia. A 2020 paper suggested that it can cause problems with your heart, bones, muscles, and nervous system, and professional medical help should be sought. Compulsive running can lead to overuse injuries such as shin splints, stress fractures, and plantar fasciitis. Other types of overuse injuries include joint strains, broken bones, and soft tissue injuries. “A high impact exercise such as running puts stress and wear and tear on your body. If you have an injury, take a break from all types of training to allow it to heal” was the advice of a 2020 review. HSS guidance focuses on avoiding activities that cause pain or further injury, with return depending on the injury and function.

Symptoms of overtraining may include, not eating enough, soreness accompanied with strain and pain, fatigue, irritability, decline in performance, disturbed sleep, and even loss of motivation. You could avoid such symptoms by listening to your body and getting enough rest. You could also eat sufficient calories for your level of exercise and make sure to drink enough water when you exercise. Do not exercise in extreme heat or cold.

MedlinePlus guidance includes at least 6 hours between periods of exercise and a full day off each week. These are general overtraining-avoidance suggestions rather than a recovery plan for a diagnosed injury.

What can cause a muscle strain?

Those unfamiliar with researching workouts or “best practices” may continue to overtrain and experience muscle strains. A muscle strain, also known as a pulled muscle, occurs when the muscle tissue is overstretched or torn. Reasons for these injuries may include fatigue, overuse, or even improper use of a muscle. Although they may occur in any muscle in the body, strains are most common in the hamstring, lower back, shoulders, and the neck.

Muscle strains occur when the force placed on a particular muscle is so great that the tissue begins to tear. Such tears may occur suddenly and unexpectedly. A 2019 study stated that this could be due to “not warming up properly before physical activity, poor flexibility, poor conditioning, and overexertion. There’s a misconception that only rigorous exercises and workouts of high intensity cause muscle strains. According to Johns Hopkins Medicine, muscle strains can even occur from walking”.

What do the three strain grades mean?

There are different levels of muscle strain. The severity of the strain may be determined when evaluated to see how much strength and range of motion has been lost. Muscle strains can be categorized into three grades based on severity:

Grade 1: The subject will have mild damage to their individual muscle fibers that causes a minimal loss of strength and motion.

Grade 2: The subject will have more extensive damage present involving more muscle fibers. The muscle itself, however, is not completely ruptured.

Grade 3: The subject will have complete rupture of their muscle or tendon. This can be presented with a palpable defect in the muscle or tendon. These injuries, in severe cases, may require surgery to have the damaged muscle and tendon reattached.

What does RICE describe?

Most muscle strains do not require surgery, but care depends on the injury and its severity. HSS describes RICE for many acute partial tears; anti-inflammatory medicines may reduce pain, but they are not proven to speed healing. The following RICE outline is general information rather than an individualized treatment plan:

R- Rest and avoid using the injured muscle or tendon for a few days especially if movement causes pain. Don’t wait too long, as too much rest may cause muscle to become weak and prolong the healing process. After a few days slowly begin to use the affected muscle or tendon, taking care not to overdo it.

I- Ice should be applied immediately to help minimize swelling. Ice should not be placed directly on skin. Instead use an ice pack or wrap the ice in a towel. Keep ice on the affected area for about 20 minutes repeating every hour on the first day.

C- Compression is key to help reducing swelling in the affected area. Wrap the area with an elastic bandage until the swelling reduces. Be careful not to cut off blood circulation by wrapping too tightly.

E- Elevate the injured area to a position above the level of your heart.

Can an activity alone predict recovery?

There is little difference between someone who injures their back while gardening and someone who performed deadlifts incorrectly. Neither case alone establishes carelessness, the severity of an injury or a reliable recovery timeline. Recovery depends on the actual injury and function, not simply whether the activity was gardening or deadlifting. Exercising, though beneficial, is not without its risks.

References

Rizzo, N. (2021, October 12). 77 gym membership statistics, facts, and trends [2020/2021]. Athletic shoe reviews. Retrieved December 2, 2021, from https://runrepeat.com/gym-membership-statistics#gym-attendance-statistics.

Connor, L. (2021, April 13). The gym membership statistics you need to know – boutique fitness and gym management software. Glofox. Retrieved December 3, 2021, from https://www.glofox.com/blog/10-gym-membership-statistics-you-need-to-know/.

Goh, F. Q. (2021, June 1). Can too much exercise be dangerous: What can we learn from the athlete’s heart? The British Journal of Cardiology. Retrieved December 3, 2021, from https://bjcardio.co.uk/2021/06/can-too-much-exercise-be-dangerous-what-can-we-learn-from-the-athletes-heart/.

Cronkleton, E. (2020, April 17). Signs of overtraining: 13 tip-offs and what to do. Healthline. Retrieved December 3, 2021, from https://www.healthline.com/health/signs-of-overtraining#signs-and-symptoms.

U.S. National Library of Medicine. (2020). Are you getting too much exercise?: Medlineplus medical encyclopedia. MedlinePlus. Retrieved December 3, 2021, from https://medlineplus.gov/ency/patientinstructions/000807.htm.

Pietrangelo, A. (2019, March 8). Muscle strains: Symptoms, causes, and prevention. Healthline. Retrieved December 3, 2021, from https://www.healthline.com/health/strains#prevention.

Muscle strain: What you need to know about pulled muscles. Hospital for Special Surgery. (2019, November 19). Retrieved December 3, 2021, from https://www.hss.edu/conditions_muscle-strain.asp.

Brooks, G. A. (2020). Lactate as a fulcrum of metabolism. Redox Biology, 35, 101454. https://doi.org/10.1016/j.redox.2020.101454

Schwane, J. A., Watrous, B. G., Johnson, S. R., & Armstrong, R. B. (1983). Is Lactic Acid Related to Delayed-Onset Muscle Soreness? The Physician and Sportsmedicine, 11(3), 124–131. https://doi.org/10.1080/00913847.1983.11708485

IHRSA. (2020, June 26). The 2020 IHRSA Global Report: Clubs Post Record Numbers in 2019. https://www.healthandfitness.org/the-2020-ihrsa-global-report-clubs-post-record-numbers-in-2019/

Recovery reminders

“Lactic acid build-up has historically been blamed for producing muscle soreness.”

“Muscle strains occur when the force placed on a particular muscle is so great that the tissue begins to tear.”

“Rest and avoid using the injured muscle or tendon for a few days especially if movement causes pain.”