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Move it or lose it, underuse as a cause of injuries to muscles and bones

At a glance:

Musculoskeletal injuries are often believed to be caused by overuse, but in fact they can be caused by under-use followed by an unfamiliar movement.

Lifetime physical activity protects people from musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 injury, and the health of most people would be improved by increasing their physical activity.

Exercise is an effective prevention, but what about after an injury has occurred? Treatment guidelines also recommend exercise, not rest, after an injury. Patients should be encouraged to keep active and reassured that exercise will not hurt them.
In the last century doctors prescribed rest for many conditions. People were rested after a heart attack, following hip surgery, when they had a painful back and for many other health problems.

Overtime a number of studies have revealed the problems that occur with rest. Muscles get weak, joints get stiff, fitness is lost, and it takes the body quite a lot of activity to reverse the problems caused by rest.

Inactivity causes similar problems. An increasing number of studies are recommending against rest for problems like back pain, shoulder and arm problems and neck conditions. Instead, it has been recognised that people need to exercise to maintain their health. For example, exercise is now known to be the best way to treat back problems and prevent future episodes of back pain.

Exercise strengthens muscles and bones and significantly reduces the risk of an injury. Scientific treatment guidelines also state that staying active produces the best recovery after an injury.

The minimum recommendations for exercise are 30 minutes of moderate exercise, 3 days a week. This may sound daunting, but two brisk 15-minute walks to the train station or supermarket would be enough to meet the guidelines. Exercise doesn't have to be exhausting or painful and you don't even have to do it all in one go. The benefits to physical and mental health
mental health
Emotional wellbeing. Ability to cope with difficulty and enjoy life. THe absence of a mental health problem.
 are extensive, it reduces the risk of many diseases, general ill-health and death. Exercise is a more important factor than weight in preventing disease and improving health.
Physical exercise can protect people from musculoskeletal injuries that are caused by sudden awkward or unfamiliar movements. Consider implementing a workplace exercise program, providing access to fitness equipment, or exercise breaks at work. Encouraging employees to exercise regularly can reduce the incidence of workplace injury, along with sick leave from all causes.

Remaining active has been found to be the best treatment after an injury, while rest has no advantage and may be harmful. Offering alternative duties while a person recovers from an injury helps them to get back to their old activities at work. This speeds their recovery, lowers the risk of a reoccurrence and reduces medical and indemnity costs.
This article reviews 'overuse' injuries. It argues that they are inappropriately named and that under-use followed by an unaccustomed use contributes to musculoskeletal injuries. This is consistent with the epidemiological finding that musculoskeletal complaints are more common after people return to work after a period of annual leave.

Evidence-based treatment guidelines for musculoskeletal injuries recommend movement rather than rest or immobilisation. Patients are likely to be anxious about activity after an injury, or after non-specific pain. There are fears of exacerbating the problem or causing a re-injury. Other studies have shown a number of treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 are hesitant about telling people to return to activity, and are so called "fear avoidant.'

It is important that patients understand that most activities are safe and beneficial, and that rest is detrimental to recovery.
This article reviews the evidence on 'overuse' injuries and argues that musculoskeletal injuries are not due to excessive physical activity, but rather inactivity followed by an unfamiliar movement. Regular exercise can protect workers from musculoskeletal injuries and reduce pain for injured workers. Workplace fitness programs may help reduce injury rates.

Activity and exercise after an injury speed recovery and improve return-to-work outcomes.

Encourage employees to discuss their exercise program with their treating practitioners. Some treaters give an ‘activity prescription.'
Original Article, Authors & Publication Details:
S. D. Stovitz1 and R. J. Johnson1 (2006).

"Underuse" As a cause for musculoskeletal injuries: Is it time that we started reframing our message? Br J Sports Med; 40(9):738-739.

1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA

Background, Study Objectives, How It Was Done:

This article reviews causes of musculoskeletal injuries. Articles about musculoskeletal injuries often suggest that activity, or “overuse', is the cause of the pain.

As we learn more about these injuries it is becoming clear that the real cause is often inactivity followed by an unfamiliar movement. “Underuse injuries' may be a more appropriate term in most cases.

Study Findings:

There have been thousands of articles on musculoskeletal injuries in the past few decades, and most of them described “overuse' as the cause of the injury.

However a 14-year study of people aged over 50 found that those who exercised had a significant reduction in musculoskeletal pain – even when differences in gender, body mass and strength were taken into account.

Several recent studies have found that adults who are more physically active have less pain and disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 and better health.

Lifetime physical activity seems to protect people from musculoskeletal pain and injury.

Current treatment guidelines for musculoskeletal injuries encourage movement, not rest. A recent review has shown that resting for back pain produces no advantage and may cause harm. Another review found that movement is also more effective than rest or immobilisation for limb injuries.

Athletes who over-train get injured more often and overuse may be the cause of sports medicine injuries. However recent research into the prevention of hamstring and ankle injuries suggests that a lack of strength is a risk factor for injury. In this case athletes increase strength to prevent injury, rather than resting.


In many countries inactivity is a major issue. It is recommended that adults do at least 30 minutes of moderate exercise on most days of the week. This does not have to be strenuous, or completed all in one session; three 10-minute sessions of brisk walking is enough to meet the recommendations. Nonetheless, many people do not meet these minimum requirements. Only 12% of young people who do regular exercise remain active as young adults, while the total time spent consuming media (television, internet etc) is estimated to be five hours a day.

There are some extremely active people who push their bodies more than is healthy. For the vast majority of people, however, it would be beneficial to increase physical activity. Too much exercise is not a major public health problem, while inactivity is.

The research suggests that too little activity over time may in fact be the cause of most musculoskeletal injuries. Health professionals, including those in sports medicine, should promote physical activity and assure patients that exercise will not hurt them.

PubMed Abstract
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