by Dr. Matt Fontaine


A human takes an average of 2000 steps to walk one mile.  That is a significant number of repetitive movements.  What happens if poor joint movement and muscle imbalance are causing you to bare weight unevenly?  These faults can cause overload and injury overtime as reps accumulate load into the tissues.

It is a process, NOT AN EVENT

Every Human has some basic needs to move correctly and live a pain free life.

Many times when I see a patient in the office for an injury, they are expecting to be able to attribute it to a specific event, such as strenuous lifting, or a sports setting injury, or some trauma.  Acute and sudden events do occur, but typically involve an acute sports setting injury or accident like a slip and fall or some other trauma.  Most injuries, aches, pains and syndromes we see in clinic are the result of repetitive motion injury and accumulation of training load over time.

All tissues fatigue and wear down over time. 

How soon and how much depends on how we train and more importantly, how we recover.


The Most Common Way Muscles and Fascia become damaged is due to Repetitive Motion Injury.

What is a repetitive motion injury and what are the telltale signs you have one?

The stress and wear and tear from activity compound over time.  Even the effects of inactivity compound overtime, in the form of deconditioning, muscle imbalance, weakness often resulting in chronic pain.

To better understand the body’s repair mechanisms, let’s compare blood vessels to muscle and fascia.  When blood vessels become damaged due to high blood pressure and inflammation, the body repairs that damage with cholesterol plague, patching nicks and cracks in the blood vessel wall.  This is known as atherosclerosis and results in Peripheral Arterial Disease.

Let’s compare that physiology with that of muscle and fascia. The muscles, fascia and other soft tissues respond to repetitive motion damage over time by forming adhesion, a sort of glue that binds damaged muscle tissue together.  When muscles get tight, they rub, and that friction causes inflammation.  The tightness restricts blood flow, causing hypoxia (decreased oxygen).  This decreased level of oxygen and inflammation trigger a cell in the body called the myofibroblast to lay down fibrous glue, resulting in adhesion within and between muscles.

What is Fascia and Why is it so important?

For the active individual, your hard-working muscles get tighter and tighter over time continued effort and output during exercise and sport.  The result of this is a buildup of friction between muscles and between muscle and fascial layers.  Fascia is a thin sheath of fibrous tissue enclosing all our muscles and organs.  It is the “shrink wrap” that interweaves in between and around all our muscles, ligaments and tendons.  When healthy, it provides a frictionless “sliding” between muscles, tendons, ligaments and nerves.  The fascia of the human body is a continuous meshwork that gives our human body tensegrity.

A quick Google search of the term will produce the following:  Tensional integrity, the structural principle characteristic property of a stable three-dimensional structure consisting of members in compression under continuous tension.  In the human frame, the bones are under compression via the continuous tension provided by the myofascial system.



Fascia is not just a structural component.  The Fascia houses and intricate neural circuit network.  A bed of nerve receptors called mechanoreceptors and proprioceptors that monitor changes in tension and position and signal our brain’s sensory cortex about these changes.  Our brain then responds with motor output to the muscles and fascia via the brain’s motor cortex.  When the fascia gets injured, this neural circuit highway can become gridlocked, resulting in poor and slow communication between the body’s soft tissues and joints and the main frame.


But I don’t have pain when I exercise. How can I tell if and which exercises or activities are causing my pain?


PAIN is a lagging indicator.  It can take as long as 48-72 hours for inflammation to set in after overdoing it or injury.  Contrast to an acute sports setting injury where the inflammation can be immediate (think severe sprain, dislocation or fracture).  With repetitive motion, the friction results in tightening, poor blood flow and eventually inflammation and pain.  So, after exercise, it is important to track symptoms for up to 72 hours to see if there is any blowback from the activity.

For instance, say you do a squat workout on Monday, no immediate pain. Great, but you are not out of the woods for the next 24-72 hours. If you experience more pain and tightness, then it is likely the body tissues do not yet have the capacity for that amount of squatting. This is important and valuable information about training through injury. It is critical that you know and listen to your body so that you will be tactical in your approach of Do and Don’t exercises with the goal of keeping active while you recover from injury.


What to do if I suspect I have an injury?

Armed with this knowledge, you and your doctor can do a deep dive into the exercises that you are doing, and scaling or modifying those exercises and activities that would otherwise prolong or impede recovery.

Except for acute sports setting injury or trauma, most muscle and joint pain syndromes can be effectively treated while simultaneously continuing to exercise.  The key is to be strategic and tactical about your approach to exercises> actively reloading can allow tissues to heal but keep you moving and exercising.

How do we deal with these compounding repetitive motion injuries?  We…

  • overhaul bad movement patterns
  • fix poor mechanics that rob power, bleed force, and dump torque
  • increase your capacity
  • Develop strategies that restore function to your joints and tissues
  • Accelerate recovery after training
  • Run faster, jump higher, throw farther through increased work capacity


Myofascial adhesion is the most common, most widely undiagnosed, and most easily resolved problem in the musculoskeletal system.

Not just an exercise video.  Not just therapy or exercises.  Your treatment plan should be an Integrated Physical Medicine Approach.