What is an Overuse Injury?

Overuse injuries refer to injuries sustained from a repeated action (such as repetitive strain injury) instead of acute injuries, which occur in an instant (such as a sprained ankle).

Overuse Injuries Can Occur to the Following Structures:

• Tendons: tendinopathies
• Muscle-tendon structures (e.g. tennis elbow)
• Soft tissue compartments (e.g. compartment syndrome)
• Periosteum cartilage, which is the covering of the bone (e.g. shin splints)
• Bursa (e.g. bursitis)
• Nerve tissue (e.g. neural mechanosensitivity)
• Bone (e.g. stress fractures).

Exercise applies stress to the body. Your body adapts by thickening and strengthening the various tissues involved. Hence, muscles get stronger, firmer and sometimes larger, tendons get stronger and bone density increases.

However, if exercise is applied so that adaptation cannot occur, the excessive overload can cause microscopic injuries, leading to inflammation, which is the body’s response to injury.

Signs of Overuse or Inflammation include:

• Swelling (which may be unnoticeable)
• Warmth to the touch
• Redness
• Impaired function of the part.

All of these signs may be present but not noticeable in the beginning stages. Often the first sign may be stiffness or soreness (especially in the morning), which may disappear with a warm-up. Continued use may cause continued damage, and the pain will last through, and past warm-up and maybe even worse after an activity is finished.

The Four Stages of an Overuse Injury:

1. The discomfort disappears during warm-up.
2. The discomfort may disappear during warm-up but reappears at the end of an activity.
3. Discomfort that gets worse during the activity
4. Pain or discomfort all the time.

In stage one, injury identification and treatment allow continuing activity as long as the injury does not worsen.

A stage 2, the activity may continue at a modified pain-free level while being treated. Treatment must continue until completely healed.

If the injury progresses to stage 3, the activity must immediately cease. The supervising physiotherapist will allow a return to action after identifying the cause, and you are completely symptom-free. Competitive athletes, depending on the individual circumstances, may return to activity.

If the injury progresses to stage 3, the activity must immediately cease. The supervising physiotherapist will allow a return to action after identifying the cause, and you are completely symptom-free. Competitive athletes, depending on the individual circumstances, may return to activity with stage 1 symptoms.

What Causes Overuse Injuries?

• Lack of appropriate muscle strength or endurance
• Poor core stability
• Muscle imbalance (strong, tight muscles versus weak stretched muscles)
• Inflexibility
• Malalignment or Biomechanical issues (e.g. flat foot, squinting patellae)
• Training errors
• Faulty technique
• Incorrect equipment.

By far, the most common cause of overuse injury is training errors. Moreover, the most common error is “too much, too soon”.

How to Prevent an Overuse Injury

We can prevent overuse syndromes. Some of the ways to prevent this injury include:

• Warm-up (including stretching) and warm-down (including stretching) before and after all exercise.
• Use proper equipment (e.g. jogging shoes for jogging, a racquet that is the right size with the proper grip size and strings strung to your level of play).
• Increase at a faster rate than 10% increase per week (distance, speed, weight, etc.).
• Practice and concentrate on the correct technique.
• Condition yourself for 2-3 weeks before starting – strength and flexibility.
• Listen to your body – pain is a warning that something is wrong. Early identification and treatment will allow you to continue your activity.
• Identify and correct the cause of pain or discomfort.
• Ensure full injury rehabilitation, e.g. a sore right leg can cause an overuse injury in the left through compensation.

Common Treatments for Overuse Injuries

The two most important steps in the management of overuse (inflammation) injury are:

• Remove cause
• Reduce inflammation
• Carefully return to activity as the symptoms dictate.

Professional assessment and guidance are highly recommended for overuse injuries. Not only are you repairing acute symptoms you are also aiming to avoid its recurrence once your training resumes.