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Overuse Injuries

What is an overuse injury?

There are basically two types of injuries: Acute injuries and overuse injuries. Acute injuries are usually the result of a single, traumatic event (macro-trauma).

Acute injury examples:

  • wrist fractures
  • ankle sprains
  • shoulder dislocations
  • hamstring muscle strain

Overuse injuries are more subtle and usually occur over time. They are the result of repetitive micro-trauma to the tendons, bones, and joints. Overuse injuries are a very common sports injury.

Common examples of overuse injuries:

  • tennis elbow
  • swimmers shoulder
  • Little league
  • elbow
  • runner’s knee
  • jumpers knee
  • Achilles tendinosis
  • low back pain
  • shin splints

Why do overuse injuries occur?

In most sports and activities, overuse injuries are the most common and the most preventable type of injury. The human body is very good at adapting to physical stress.

With exercise and activity, bones, muscles, tendons, and ligaments get stronger and more functional. This happens because of an internal process called remodeling.

The remodeling process involves both the breakdown and build-up of tissue. If break down occurs more rapidly than build-up, injury occurs. The zone of remodeling we encourage is called optimal load; a sweet spot between supra- physiological load (too much load) and under-training (not enough load).

Female body builder lifting a barbell that could potentially end in an overuse injuryWhat causes overuse injuries?

Training errors are the most common cause of overuse injuries. These errors involve a too rapid acceleration of the intensity, duration, or frequency of your activity.

Some people are more prone to overuse injuries and this is usually related to anatomic or biomechanical factors. Imbalances between strength and flexibility around certain joints predispose to injury. Body alignment, weak hips, bow legs or knock-knees, unequal leg lengths, and flat or high arched feet can be bio-mechanical features that contribute to higher injury risk. Many people also have weak links in their bodies due to previous injuries or incompletely rehabilitated injuries.

How to prevent and treat an overuse injury?

Diagnosis can usually be made after a physical examination. This is best done by an orthopedic or sports medicine specialist with specific interests and knowledge of your sport or activity.

Prevention of overuse injuries

The NATA says there are five ways parents, coaches, and athletes can help to reduce the number of repetitive stress injuries in children and adolescents.

1. Proper education and supervision

  •  Athletes, parents, and coaches should know the warning signs or symptoms of overuse
  • Athletes need to notify an adult if they experience signs of an overuse injury.

2. Pre-participation physical exams (PPEs)

Student-athletes should undergo a PPE before beginning a new sport to screen for potential risk factors, including:

  • Previous injury
  • Muscle imbalances
  • Inflexibility
  • Muscle weakness
  • Instability
  • Conditioning

3. Rule changes and participation limits

The most consistent predictor of overuse injury is the sheer volume of sports activity, whether measured as the number of throws/pitches or the quantity of time participating. The NATA recommends:

  • As a general rule, athletes should limit sports to no more than 16 to 20 hours a week.
  • Athletes should take at least 1 to 2 days off per week from competitive practices,
    competitions, and sport-specific training. Coaches and administrators should consider
    these required days off when organizing schedules for the season.
  • Athletes should participate on only 1 team of the same sport per season when
    participating in 2 or more teams in the same sport (e.g. high school and club) would involve practices or games (or both) more than 5 days per week.

4. Training and conditioning programs

Proper training and conditioning, both before and during the season, may prevent overuse injuries:

  • Athletes should begin a general-fitness routine encompassing strengthening, endurance, and flexibility training as well as lifestyle physical fitness (e.g. taking the stairs instead of the elevator) at least 2 months before the sports season starts.
  • Once a general foundation of fitness has been established, athletes should begin to gradually increase training loads following the 10% rule, which allows for no more than a 10% increase in the amount of training time, distance, repetitions, or load per week.
  • Coaches might choose to use a structured warm-up program which includes technique training, neuromuscular control, and balance and strengthening exercises. Programs such as the PEP Program have shown in studies to reduce the risk of non-contact anterior cruciate ligament (ACL) injuries. WPT can help develop this as well.
  • Coaches should develop an overall-prevention mentality, including improved warm-up, cool-down, taping unstable ankles, rehabilitation, promoting fair play, and exercises to improve joint stability, flexibility, strength, coordination, reaction time, and endurance.

5. Delayed sports specialization

  • Youth athletes should be encouraged to participate in multiple sports and recreational activities throughout the year to enhance general fitness and aid in motor development.
  • Athletes should take time off between sports seasons and take two to three non-consecutive months away from a specific sport if they participate in a single sport year-round.

Best treatments for an overuse injury

Treatment depends on the specific diagnosis. In general, for minor symptoms with acute onset, cutting back the intensity, duration, or frequency of the offending activity brings relief.

Adopt a hard/easy workout schedule and cross-train with other activities that allow you to maintain overall fitness levels while the injured part recovers. This is very important for treating the early symptoms of overuse injuries. If they are truly minor issues, they should resolve rapidly within 1-2 weeks.

Working with a coach or trainer can assure proper training and technique. Paying particular attention to proper warm-up before activity and using ice after activity may also help. Check with a doctor to see if over-the-counter anti-inflammatory medications can also be taken to relieve symptoms.

If symptoms persist, sports medicine specialists such as our Doctor of physical therapy will be able to create a more detailed treatment plan for your specific condition. This may include a thorough review of your training program and an evaluation for any predisposing anatomic or biomechanical factors. Physical therapy services are a great solution for keeping optimal load and conditioning of the athlete while healing the condition more rapidly.

For more information on overuse injuries and treatment give us a call or visit our locations so we can help you get to the root of your pain.