Mastering Musculoskeletal Injuries: Acute versus Chronic

In today's blog post, we will explore each type of injury and discuss how they can be prevented.

Whether it’s a twisted ankle or ongoing joint pain, musculoskeletal injuries can greatly affect your quality of life1. Understanding the cause and treatment of these conditions is key to staying healthy and active. Injuries are divided into two categories: acute and chronic. 

 Types of Injuries

 Acute injuries can happen in the blink of an eye - a sudden fall leading to a broken bone, a hit to a joint, or a quick twist - the sudden impact overwhelms the body’s defence mechanisms resulting in an injury¹. 

Sprain¹- partial or complete tear of ligaments, which connect the end of one bone to another. Ankle sprains are one of the most common musculoskeletal injuries. When you turn, twist or roll your ankle, the ligaments in the joint are stretched and can even be torn. People who play sports in which there is a lot of pivoting, like basketball and volleyball, are particularly at risk.

 Strain¹- a twist, pull or tear of a muscle or a tendon, the connection between muscles and bones. Tendon tears are more common among middle-aged people who play sports that involve running and jumping. It can be a result of a hard landing or an awkward jump. Some examples of muscle strain include a groin pull or a hamstring strain. 

Dislocation¹- the bones forming a joint get knocked out of place and separated. It happens when the arm bone’s round end is pushed out of its shallow socket. 

 Fracture¹- a broken bone from a one-time injury. 

 Chronic injuries, on the other hand, like painful shin splints that gradually develop from overusing an area of the body, result in ongoing pain1.

 Shin splints - pain along the shin bone (tibia)¹. Usually felt after the intensification of a training routine. The extra activity overworks the muscles, tendons and bones, leading to pain2.  

 Tendinitis¹- inflammation of a tendon, usually caused by repeating the same motion over and over again. An example is Golfer’s elbow, it results in pain in the inner part of the elbow that can spread all the way to the wrist. Golfers and people who repeatedly use their wrists or grip can develop it. 

 Bursitis¹- inflammation of the bursae, cushions between the bone and other parts of the body like muscles and tendons. It can be caused by a blow, a fall, repeated motions like throwing a ball or long periods of pressure like kneeling on a hard surface. 

  Osteoarthritis - referred to as wear and tear arthritis, caused by damage or breaking down of the cartilage, the layer at the end of bones that prevents them from rubbing together when you use your joints¹,³,⁴.  

Stress fractures¹- as the name suggests, it’s caused by too much stress on the bone. It is common in sports with repetitive impact, like running and jumping. 

 Chronic musculoskeletal pain makes everyday activities more difficult, increases the consumption of medication, and results in more sick leaves and disability pensions, lowering the quality of life5. Additionally, overuse injuries can weaken tissues and joints, setting the stage for an acute injury¹. On the other hand, acute injuries can become chronic. Chronic ankle instability is described as recurrent pain, swelling, and sprains in the year following the original sprain6. This happens to over 40% of people who experience sprains⁶. 

The Road to Recovery  

Treatment options for acute and chronic injuries range from conservative to more invasive approaches such as surgery, but all have the common goal of restoring function and quality of life⁶. Minor injuries can typically be treated at home by RICEing: Resting, Icing, Compressing and Elevating the affected area1. Ice is generally used in the first 48-72h after the injury to help control the pain and swelling⁷. For older injuries or chronic pain, the opposite, heat, can be more beneficial⁷. It improves blood flow and helps relax muscles, making them easier to move during rehab⁷.

 In some cases, you may need a cast, sling or brace to immobilize the area to allow it to heal6. Treatment can also include physical or occupational therapy to help you regain your range of motion, which can occur at a specific site or from the comfort of your home with prescribed exercise plans⁶-⁷. 

 In case of an extensive fracture, surgery may be needed to stabilize the bone. It can also be used to replace a joint like a total knee replacement is used to treat the joint if it has been degraded by osteoarthritis8. 

 In chronic cases, conservative approaches like home exercises and OTC medication may not be enough, and treatment will progress to physiotherapy and prescribed medication5. 

Preventing Injury 

 Factors like training patterns, medical history and footwear all play a role10. Longer, more intense and frequent workouts can increase the stress on bones, muscles, tendons and ligaments¹⁰. So, next time you’re out running on a trail, make sure you’re not adding too many kilometres too fast! 

 Individuals that have had an injury before are at the greatest risk10. Before returning to your typical routine or starting a new running program, it’s always a good idea to make sure your body has enough muscle support and joint mobility to handle the physical stress of running11.  Most acute and chronic trail running musculoskeletal injuries happen in the knee and ankle11. More than 70% are because of overuse. Noticing symptoms early and getting treatment is essential to prevent injury¹¹.

 Strengthening your muscles is crucial to provide plenty of support, even for your cognitive functions! When you're running on trails, your brain needs to quickly respond to shifts in the ground, avoid obstacles, and adapt to uneven ground11. Strong muscles contribute to better control the movements of legs and feet, promoting stability and reducing the risk of injuries11.

From twists to repetitive movements and falls, our body’s ability to adapt and recover is remarkable. But as you play your favourite sports, remember that although the body can feel like a resilient machine, it still needs care and rest.

1. NIH. Sports Injuries. https://www.niams.nih.gov/health-topics/sports-injuries (2021).

2. Mayo Clinic. Shin Splints. https://www.mayoclinic.org/diseases-conditions/shin-splints/symptoms-causes/syc-20354105 (2021).

3. CDC. Osteoarthritis (OA). https://www.cdc.gov/arthritis/basics/osteoarthritis.htm#:~:text=Osteoarthritis%20(OA)%20is%20the%20most,underlying%20bone%20begins%20to%20change (2020).

4. Cleveland Clinic. Cartilage. https://my.clevelandclinic.org/health/body/23173-cartilage#:~:text=What%20is%20cartilage%3F,when%20you%20use%20your%20joints. (2022).

5. El-Tallawy, S. N. et al. Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain. Pain Ther 10, 181–209 (2021).

6. Luke, A. & Ma, B. Current Medical Diagnosis & Treatment 2022. (McGraw Hill, 2022).

7. Jaworski. At-home exercises for 4 common musculoskeletal complaints. J Fam Pract 69, (2020).

8. Australian Institute of Health and Welfare. Chronic musculoskeletal conditions. https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions/contents/summary#tx-and-mx (2023).

9. MedLine Plus. Acetaminophen. https://medlineplus.gov/druginfo/meds/a681004.html (2022).

10. Roche, M., Fredericson, M. & Kraus, E. Bone Stress Injuries. in Clinical Care of the Runner 141–151 (Elsevier, 2020). doi:10.1016/B978-0-323-67949-7.00014-8.

11. Vincent, H. K., Brownstein, M. & Vincent, K. R. Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners. Arthrosc Sports Med Rehabil 4, e151–e162 (2022).