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Understanding Cumulative Trauma Disorders

Tennis elbow? Carpal tunnel syndrome? Tendinitis?

These conditions are excellent examples of cumulative trauma disorders (CTD), injuries to the muscles, tendons, blood vessels, nerves or even bone which result from an overload of tissue strain with inadequate healing time. More often than not, CTD is referred to as repetitive strain injuries however this term is misleading. CTD can occur from repetitive motions such as twisting, gripping, hammering, etc. But the injury cycle can also begin through acute trauma such as a fall, impact or abrupt strain such as a pulled muscle.

In the acute injury scenario, your body begins a cascade of inflammation which attempts to heal and repair the injured tissue. To picture this best, think about an injury to the skin. If you scrap your knee your body responds by building a scab. The scab goes through several visible changes during the course of a week as your body repairs the tissue underneath. First, the body is focussed on removing debris and cleaning up the site of damaged cells. Then it tries to stabilize and protect the area by creating a hard scab. The final step of healing leaves behind tissue that looks similar to the original, but is slight different. A scar. Most of us have lots and can appreciate how the tissue looks, feels and even moves differently than the tissue which surrounds it.

This same process happens underneath the surface to muscle, tendon, bone and fascia. The immobility of scar tissue can affect neighbouring muscle, blood vessels and even nerves. As regional mobility becomes less efficient, recurrent strain can be experienced by these tissues which may lead to more inflammation and/or pain.

Enter repetitive motion injuries. These injuries are related to the physical factors of tissue health, repeated tasks/motions/strains and the manner in which the body can recover between strain cycles. To put this into more clear language, think about the average person who begins a running program. When they start, they typically run for one minute and walk for two minutes. The act of walking gives them a chance to recover in between run cycles. Without this, their 20 minute work out would be over in 1.5 minutes when they run out of steam. The act of recover allows you to recover, repair and do more. Repetitive motion injuries are the same. A tissue can perform X number of repetitions at Y force and need Z recovery time.

X times Y = Z

If repetitions increase, either force per repetition has to decrease or the recovery time has to increase. This simple and formulaic reasoning can be applied to a keyboard operators keystrokes per day, to a metal stamper working on a factory line or to a grocery store employee lifting inventory and stacking shelves. As the work demand increases, adequate rest must be applied to avoid injury.

Whether from acute injury or repetitive motion injury, different muscle groups can become tight and/or weak. This can lead to altered body mechanics, increased friction and tension. This leads to decreased circulation and promotes inflammation and the build of scar tissue……which affects motion and leads to muscle groups becoming tight and/or weak and so on. The cycle continues.

This is the process of CTD.

But the more important question you will likely have is how to manage the problem once identified.

Speaking from the perspective of a chiropractor, the first objective is to identify this is in fact the problem at hand and then to identify all the tissues involved and how they are functional versus dysfunctional. A very effective treatment method used to treat CTD is Active Release Techniques (ART).

Active Release is a hands on technique that utilizes anatomical specificity, functional range of motion and tissue tension to reduce friction, pressure and scar tissue formation (referred to as adhesions) within and between muscles. This helps to free up movement and restore normal mechanics. This interrupts the CTD cycle, reduces inflammation and therefore pain.

For more information regarding Active Release Techniques please review the Active Release Techniques section on our website, visit or contact our office.

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