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Prevention of Overuse Injuries – Athlete Version


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). Common examples include wrist fractures, ankle sprains, shoulder dislocations and 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. Common examples include tennis elbow (lateral epicondylosis), swimmers shoulder (rotator cuff tendonitis and impingement), Little league elbow, runner’s knee, jumpers knee (infrapatellar tendinosis), Achilles tendinosis, low back pain and shin splints.


In most sports and activities, overuse injuries are the most common and the most preventable type of injury. The human body has a tremendous capacity to adapt to physical stress. In fact, many positive changes occur as a result of this. 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 break down and build up of tissue. There is a fine balance between the two. 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).

Supra-physiologic load can happen when you first begin sports or activity for the season and try to do too much, too soon or too often. We refer to this as the Rule of Too. If you begin playing tennis and train for several hours in an attempt to improve rapidly without adequate recovery, you are setting yourself up for an overuse injury. This is because you do not allow the body adequate time to recover. As a beginner, you may also have poor technique or form which may predispose you to an overuse injury called tennis elbow.


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. A typical example is a runner who has run several miles three times a week without a problem. That runner then begins advanced training for a running a marathon, running a longer distance every day at a faster pace. Injury or breakdown is inevitable. Overuse injuries also happen in people who are returning to a sport or activity after an injury and try to make up for lost time.

There are also technical, bio-mechanical and individual factors that lead to injury. Proper technique is critical in avoiding overuse injuries. Slight changes in form may be the culprit as well. For this reason, coaches, athletic trainers and physical therapists can play a role in preventing recurrent overuse injuries.

Some people are more prone to overuse injuries and this is usually related to anatomic or bio- mechanical 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 body due to previous injuries or incompletely rehabilitated injuries.


Diagnosis can usually be made after a history and physical examination. This is best done by an orthopedic or sports medicine specialist with specific interest and knowledge of your sport or activity. Our clinics stand prepared to offer insight from our orthopedic and sports medicine specialists. Our Doctor’s of Physical Therapy are available in each of our six clinics in the Magic Valley. We assist in preventing injuries by offering complimentary screens and Movement Assessment Risk Stratification for individual athletes and teams.


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
    injuries; WPT can offer advice and training at no cost to your schools
  • 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 (or prior to the start of a new sports season) to screen for potential risk factors, including:

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

Wright Physical Therapy schedules Dynamic Movement Assessment Screens for teams at no cost. We have seen astounding success with our college teams that utilize this service. Email bryan@wrightpt.com for more info or to schedule your athlete or team for Risk Assessment testing.

3. Rule changes and participation limits. Studies suggest that the most consistent predictor of overuse injury is the sheer volume of sports activity, whether measured as number of throws/pitches or quantity of time participating. The NATA recommends:

  • As 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 on 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 sport 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 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.

  • Although there is little evidence-based research to demonstrate that early specialization of athletes participating in the same sport year-round from a young age has negative consequences on physical growth or psychological outcomes, many clinicians, health care organizations, and youth sports experts, have advocated for diversity in sport participation or delayed 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.


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 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 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’s of physical therapy will be able to create 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 bio-mechanical factors. Physical therapy services are a great solution for keeping optimal load and conditioning of the athlete while healing the condition more rapidly. Wright Physical Therapy offers complimentary screens from our DPTs to help you know what is needed. Call 208-736-2574 to schedule your screen or treatment.

Most overuse injuries can be prevented with proper training and movement assessment screens. Learn to listen to your body. Remember that “no pain, no gain” does not apply here. The 10% rule is helpful. In general you should not increase your training program or activity more than 10% per week. This allows your body adequate time for recovery and response. The 10% rule also applies to increasing pace or mileage for walkers and runners, as well as to the amount of weight added in strength training programs. Call us today if you are a leader of school teams that would like to schedule movement assessment screens that we provide at no cost to your teams.