Wednesday, January 1, 2003

Repetitive Motion Injuries in Sports and Industry Prevention and Management Program

© 2003 by Dr. Tim Maggs

Repetitive activity is the breeding ground for many injuries in both the sports world as well as the workplace. Much research has been conducted in an effort to find better postures, ergonomic strategies, exercises and more effective supports. Despite the benefits to date, much more can be done.

Understanding basic muscular physiology will suggest that more attention needs to be paid to the warm-up, recovery and conditioning of repetitively used muscles. Most muscular injuries are a result of under-recovery of muscles, and these injuries consist of many of the low-back, neck, hip, carpal tunnel and other injuries we see everyday in our offices. By applying a consistent muscle management program, prevention and recovery of these over-used muscles can be improved greatly.

Basic Physiology

Regardless of the muscles that are repetitively used, the physiological process is the same. Increased muscular use increases the production of harmful toxins that will accumulate in the fibers of involved muscles. With this accumulation, a domino-like effect takes over. The blood flow is decreased, the fibers shorten, and the muscle now becomes as effective as the shortest fibers, thus increasing the potential for injury and reducing the performance potential of the muscle. If accumulation of these harmful toxins could be addressed and managed earlier and on a more frequent basis, a reduction in the time frame and incidence of these injuries will occur.

The Maggs Muscle Management™ Program (MMMP)

The application of deep pressure over a muscle multiple times per day will produce two results; the first is and influx of nutrient and oxygen-rich blood to the treated muscle. Secondly, harmful toxins will be broken up and flushed out of the muscle and back into the system. This is the first step in aiding a muscle to recovery. The use of the Intracell Stick® (Fig. 1) is one means to address these muscles. The rolling pin-like device is rolled over an entire muscle, in both directions, 20-30 times. The pressure is to tolerance, and this exercise can be performed by individuals on themselves.

Fig. 1

Preparing a Muscle for Activity-Warming Up

Once rolled, a muscle is now better prepared for stretching (Fig. 2) as the muscle is passively warmed. Flexibility exercises become more beneficial once a muscle is warmed, and this passive warming of a muscle reduces the risk of injury while maximizing the benefits to the muscle. The muscle should then be put into a mild, static stretch for 5-7 seconds. If time allows, each muscle should be rolled and stretched 2 times. There is a technique for all major muscle groups, and should be encouraged both before and after activity. If used in the workplace, this exercise could and should be performed at respective workstations.
Fig. 2

Enhanced Recovery

Under-recovery is the usual cause of most muscle pulls, tendonitis' and other related syndromes. Under-recovery is usually the result of increased muscle activity with minimum muscle management. Accumulated toxins produce shortened fibers predisposing an individual to injuries. Rest will allow injuries to symptomatically heal, however, the muscle will become injured again once activity resumes. Until full and complete recovery can occur in a muscle, there will always be a limited potential of that muscle. These are the injuries that keep individuals on full disability, keep surgeons busy and keep costs soaring in both sports and industry.

Once a muscle has been exercised, either in a practice, a game or in the workplace, the muscle now resembles a clenched fist, making it difficult for blood to enter for recovery purposes. Using Mother Nature's time frame for recovery, the time frame is longer and far less complete. The greater the activity and accumulation of harmful toxins, the longer a muscle will take to recover. Unfortunately, game schedules and work schedules are more demanding than what many muscles can handle. This lack of recovery ultimately leads to injury.

With the application of the MMMP, blood is encouraged back into a muscle, increasing the recovery nutrients needed, as well as eliminating harmful toxins before they can accumulate, increasing the rate of recovery in the muscle. The application is the same as the warm-up recommendation---roll the muscle 20-30 times, to tolerance, and then gently stretch the muscle for 5-7 seconds.

Research has shown that a muscle has a "recovery window" that ranges from 15-30 minutes after a muscle is exercised. It is during this window of time that a muscle is most hungry for recovery nutrients (that are carried to it by the blood) and will produce best results when attempting to get a muscle to recover, whether it be from exercise or injury.

Muscle Injuries

The same recipe for muscle care applies to all muscles, but the actual exercise and tool used may vary depending upon where the injury is. For example, plantar fascitis occurs on the base of the foot. These tendons and muscles are highly vulnerable to injury and inflammation for a variety of reasons. The first and most obvious reason is the amount of stress they endure during a typical day. For athletes and employees alike, the amount of force that goes through the feet is the very reason so many end up with injury. Secondly, the footwear may not be adequate from a support point of view. Thirdly, most athletes and employees have never had a thorough foot evaluation to determine foot type, proper shoes and if custom-fitted orthotics are indicated. Without these supports for those who need them, injuries are typically just a matter of time before they become evident. Finally, the muscles and tendons of the feet are not managed correctly, and when this can be implemented into an individual's schedule, proper blood flow and improved recoverability will take place. As seen in (Fig. 3) the Foot Wheel? is an ideal tool to address trigger point accumulation in the feet.
Fig. 3

Carpal tunnel syndrome costs industry millions and millions of dollars per year. As stated earlier, the same physiological changes cause the many symptoms experienced by a huge percentage of our workforce. Repetitive activity leads to shortening of fibers, and these changes produce pain and fatigue in the forearm, tingling and numbness in their hands and weakness in their grip. The Trigger Wheel? (Fig. 4) is highly effective in addressing the primary sites of trigger point accumulation. The proximal posterior forearm (Fig. 5) is a well-established site for trigger point accumulation that has a direct relationship with the incidence of carpal tunnel symptoms.
Fig. 4

Injuries such as low back, calf and hamstring pulls, as well as many other common injuries, respond well with the use of the Intracell Stick®. The advantage with using a tool such as the Intracell Stick® is merely that a larger area of the body can be addressed in a reasonably short period of time, and people have the ability to perform these exercises multiple times on a daily basis. Much of the research that has been done with regard to trigger points never considered the ability for multiple applications per day. But, with this new, self-applied program, results are superior to any prior recommendations. The combination of rolling and stretching the muscle produces a far greater effect than just doing trigger point work on a patient.


The entire neuro-musculo-skeletal industry under-serves the public. The very fact that treatment is only considered once an injury occurs should awaken all of us to the need for management and prevention. In industry, key boards are split in half and work-stations are rearranged, but no one ever talks about physiologically altering the very muscles that are repetitively used and under-recovered. Until we begin to address these muscles, limited benefits will be the best we can hope for.

Secondly, the public needs to learn that treatment for injuries is the most elementary approach to keeping costs down and employees and athletes well. Prevention through pro-active involvement is the only way we can really begin to make improvements in the current state of affairs. Keeping muscles clean, well-circulated and flexible would make a magnanimous difference in the amount of money saved vs. the cost of providing for the injury, disability, worker replacement costs, etc.

In a recent Newsweek article, new general manager Theo Epstein of the Boston Red Sox states, "If we can make our pitchers 25% healthier, that's worth tens of millions of dollars and is a huge competitive advantage". These are words of a visionary, and this muscle management program provides the very difference that Epstein is talking about. How do you make a muscle work longer with less likelihood of injury? It's simple, keep it clean on a daily basis and encourage a continual flow of food and oxygen to keep it at it's healthiest state.

What industries will benefit the most from this program? Sports and industry. Immediately, they will recognize improvements. But, it's up to the chiropractic profession to grasp onto a program such as this, and then begin the laborious process of educating our communities to a new and better way. With a growth of chiropractors subscribing to this approach, momentum will eventually turn in our favor. For, it's been far too long since a revolutionary approach has been handed to our communities, and chiropractic has the opportunity to become this messenger.

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