Avoiding Overuse Injuries with Activity and Diabetes

Helpful tips to lower your risk of complications of diabetes

sheri complications of diabetesBy Sheri Colberg-Ochs, PhD

March 2014 — Overuse injuries that can limit how well your joints move are some of the many potential complications of diabetes. People with diabetes commonly get conditions like "frozen shoulder," carpal tunnel syndrome (wrist pain), fractures in their foot bones, and even neuropathy-related joint disorders (Charcot foot).

In fact, the longer you've have diabetes, the more likely you are to develop these complications of diabetes, including nerve compression syndromes at the elbow and wrist that may become aggravated by usual daily activities. For example, tennis elbow is a type of tendinitis (joint inflammation) on the outside of the elbow common in tennis players as well as rowers, carpenters, gardeners, golfers, and other exercisers who repeatedly bend their arms forcefully. Swimmers often develop tendinitis and other impingement syndromes in the rotator cuff (shoulder) because of the overhead movement required by the sport. In sports that involve running and jumping, tendinitis often occurs in the knee, foot, and Achilles' (heel) tendons.

What can you do to prevent overuse injuries and complications of diabetes? In most cases, keeping your blood glucose levels under control reduces your risk for developing all of these injuries that are largely the result of glycation of joints, which happens when elevated blood levels cause glucose to "stick" to joint structures and make them more rigid. If you're having nagging aches and pains that are only minor, you should simply cut back on how long, hard, and frequently you're doing the activities that aggravate the condition. Some problems can be improved with use of orthotics (e.g., to correct leg-length differences).

You can also help prevent these kind of complications of diabetes  by varying your daily activities to avoid overstressing joints in the same way with every workout. Engaging in cross-training can help prevent and treat overuse injuries. Individuals should do other activities to maintain their overall fitness levels while the injured area recovers. For example, with lower leg pain, an individual can still work the upper body by doing activities that allow the legs to rest and recover. They also can alternate weight-bearing activities like walking or running with non-weight-bearing ones, such as swimming, upper-body work, and stationary cycling.

Another helpful strategy is to focus on strengthening the muscles around joints where you've previously had problems to prevent them from recurring. For example, following a shoulder joint injury like rotator cuff tendinitis and impingement, you should start doing some resistance work (with resistance bands, free weights, or weight machines) that include all sections of the upper shoulder (deltoid) muscle, along with exercises for the biceps, triceps, pectoral muscles, upper-back muscles, and neck muscles. Doing daily stretching and other flexibility exercises (including tai chi and yoga), along with your resistance work, can help maintain your full range of movement around all your joints.

Here are some tips you can follow to lower your chances of getting overuse injuries related to being physically active:

•    Include stretching and other flexibility activities (e.g., tai chi and yoga) as part of your daily activity routine.
•    Never bounce during stretches because doing so can cause injuries, although dynamic stretching is fine (movement stretches).
•    If you're currently sedentary, start slowly and progress cautiously to avoid acute or overtraining injuries.
•    For best results, include a warm-up and cool-down period with each exercise session.
•    Warm up with stretches and easy aerobic work before undertaking vigorous exercise.
•    Choose appropriate exercises, such as swimming, if recovering from an ankle or knee injury.
•    Vary the exercise program occasionally or try out new activities to emphasize different muscle groups and increase overall fitness.
•    Cross-train (by doing different activities from day to day) to reduce the risk of injury by varying muscle and joint usage.
•    Avoid going back to normal activities until your overuse symptoms have almost completely gone away.

In summary, despite the fact that having diabetes increases your risk of developing complications of diabetes such as overuse injuries, remaining physically inactive raises your risk even more. If you develop nagging aches and pains that are only minor, simply cut back on the irritating activities to bring relief of symptoms. Try to engage in a variety of activities to avoid injuries, and make sure to include stretching as a part of your regular routine to keep your joints more nimble. Don't forget to talk to your doctor about an exercise plan that is right for you!

Read Sheri's bio here.

Read more of Sheri Colberg-Och's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: May 20, 2014

All content on dLife.com is created and reviewed in compliance with our editorial policy.
  1. Am Fam Physician. "Evaluation of overuse elbow injuries." (Accessed 3/14.)
  2. BMC Musculoskeletal Disorders. "Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study. " (Accessed 3/14.)
  3. International Journal of Immunopathology and Pharmacology. "Limited joint mobility in diabetes and ageing: recent advances in pathogenesis and therapy. " (Accessed 3/14.)
  4. Circulation. "Advanced glycation end products activate endothelium through signal-transduction receptor RAGE: a mechanism for amplification of inflammatory responses." (Accessed 3/14.)
  5. Diabetes Care. "Effects of 8 weeks of flexibility and resistance training in older adults with type 2 diabetes." (Accessed 3/14.)
  6. Gait Posture. "Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study." (Accessed 3/14.)

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