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The causes of microtraumatic overuse injuries are often less obvious compared to the macrotrauma of an acute injury. During the early stages of a CTD, there is little or no pain and the person might unknowingly continue to place pressure on the injured area. As a result, the involved tissue doesn't have the necessary time to heal. Repetitively applied stresses that are below the tensile limit of the injured tissue typically result in positive remodeling, but not without adequate rest, retraining, and skilled bodywork. WHAT ROLE DOES THE BRAIN PLAY IN CTDS? The SAID principle—an acronym for Specifi c Adaptation to Imposed Demands— is a classic sports medicine term describing how physical adaptations develop when the body is placed under stress, thereby allowing it to better handle future stressors. Stated simply, the body gets better at doing whatever it does regularly. Unfortunately, as our bodies get better at seemingly "looking after us," peripheral nerves can become hyperexcited and begin conveying danger-signaling messages. As the area becomes more sensitized, brain cells that are triggering the pain are on high alert. Image 5 shows how increased cognitive, emotional, and sensory input can accumulate in the brain. Any additional input from a chronic or acute injury can cause these protective coping systems to overfl ow into things such as reactive muscle guarding, stress, and pain. Our job as therapists is to help lower the threat level in the stress bucket through good bodywork and by coaching the client on new ways to move, think, and behave. Immediate treatment should include training modifi cations, graded exposure stretching of injured connective tissues, and stabilization of weakened areas. For long-term improvement, biomechanical alignment problems also need to be addressed. A comprehensive approach to rehabilitation of CTDs provides the best hope for many years of pain-free recreational enjoyment. Notes 1. Julius Wolff, The Law of Bone Remodeling, P. Maquet and R. Furlong trans. (Springer- Verlag, 1986) (Original work published 1892). 2. M. I. Boyer and H. Hastings, "Lateral Tennis Elbow: Is There Any Science Out There?," Journal of Shoulder and Elbow Surgery 8, no. 5 (1999): 481–91. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfi ng, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit erikdalton.com. L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 29 Microscopic tissue derangement from tendon strain (tennis elbow). Nerve compression may lead to nerve damage. Damage to nerve layers may lead to axonal degeneration. Acute and chronic tissue damage may lead to reactive muscle guarding, stress, and pain. 2 3 4 5 VIDEO: "MEDIAN NERVE SOFT TISSUE PREP" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch!