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Overuse Injuries:
How to Spot Them, How to STOP Them

Orthopedic Surgeon

In my last article, we defined overuse injuries. Now, let's talk about why they occur.

Overuse injuries result from intrinsic or extrinsic factors. Intrinsic factors are those related to the athlete themselves such as: anatomic alignment (leg length differences, hip rotation, foot deformities); growth; muscle-tendon imbalance; underlying diseases (chronic disease, previous fractures or injuries inadequately treated or rehabilitated, previously unrecognized conditions) and cultural reconditioning (too much TV or computer games and too little physical exercise).

Extrinsic factors include training errors, environmental and equipment factors. Training errors are the most common factors predisposing an athlete to overuse injuries. These injuries develop when the athlete performs too much too soon, increasing the volume, duration and/or intensity of the activity too quickly. These training errors result in inadequate recovery time, preventing the proper tissue adaptations from taking place. Overuse injury can also develop in people returning to a sport or activity after injury. Typically, they try to make up for lost time.

Training errors most commonly occur early in the training program when a relatively unused tissue is subjected to stress it may not be accustomed to. The potential for the development of overuse injuries occurs when new skills are introduced that stress different tissues, or when the training intensity is increased too rapidly. Overuse injuries also are known to occur during the later phases of the training programs when the athlete is pushing towards peak performance. It is during this time in the training program that the tissues are close to their ultimate breakdown point and vulnerable to injury.

Inadequate or poor technique in the performance of a particular sport or activity (e.g. improper throwing mechanics) can place abnormal stress on musculoskeletal tissue leading to overuse injury.

Improperly fitting equipment or inadequate equipment also have been shown to predispose an athlete to overuse injures. A common example is seen in athletes wearing poorly fitting or worn-down shoes during heavy running.

How Are Overuse Injuries Diagnosed?
The diagnosis of overuse injuries can only be made after a thorough history and physical examination are conducted by a sports medicine specialist. Some cases will require additional diagnostic testing such as X-rays, bone scans or MRI studies.

How Are Overuse Injuries Treated?
The treatment of overuse injuries depends on the specific injury diagnosed. Treatment might include oral medications and physical therapy. Decreasing the intensity, duration, or frequency of the offending activity may also be recommended. Also beneficial are: careful attention to technique, working with a coach, warming up properly prior to activity, proper cool-down after activity, in addition to the application of ice after exercise.

Prevention of Overuse Injuries
The majority of overuse injuries can be prevented with proper training and common sense during training. There is no truth to the saying "no pain, no gain." Athletes must listen to their own bodies and recognize the early signs of over-training.

Generally, if increases in volume and intensity of training are kept below 10% per week, allowing the body adequate time for recovery and response, the majority of overuse injuries can be prevented.

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