Overuse injuries are impairments caused by repeated trauma to the tissues over time. The human body is very resilient and it can adapt to most repeated stress over time; however, if that stress occurs more frequently than the body can handle, or if it increases more rapidly than the body is able to adjust, then an injury occurs. These injuries are called overuse injuries.

In other words, an overuse injury is damage to a bone, muscle, ligament or tendon caused by repetitive stress without allowing time for the body to heal.

For example, normal daily activity actually causes microscopic cracks in the bones every day. But, if a runner begins to train for a race and increases their mileage too quickly, those cracks will continue to increase every day until the bone cracks through and a “stress fracture” occurs.

Basically, there are two types of injuries: acute injuries and overuse injuries. Acute injuries are usually the result of a one-time, traumatic event. The most usual examples in athletes include wrist and ankle fractures, ligament sprains, shoulder dislocations and muscle strains.

Overuse injuries are actually more common in sports than acute injuries, but they are subtle and usually occur over time, making them challenging to diagnose and treat. They are the result of repetitive micro-trauma to the tendons, bones and joints. Common examples include tennis elbow, swimmer’s shoulder, little league elbow, runner’s knee, jumper’s knee, Achilles tendinitis, stress fractures and shin splints. Because they are subtle, occur insidiously and get worse with time, many athletes do not recognize them when they occur, ignore them or try to train through them. This allows the injury to get worse and, ultimately, increases the treatment that is needed and the down time that results.

In terms of sports, exercise applies stress to the body. Your body adapts by thickening and strengthening the various tissues involved.  In other words, muscles and tendons get stronger while bone density increases. However, if exercise is applied in such a way that adaptation cannot occur, the excessive overload can cause microscopic injuries, leading to inflammation and pain, which is the body’s response to injury. If allowed to progress, tendons and muscles tear and bones break.

The key is understanding and prevention. If overuse injuries occur, recognizing them and treating them quickly is ideal. The sooner they are addressed, the faster they get better.

Essentially, overuse injuries are caused by repeated actions that apply pressure to any muscle, joint or area of soft tissue. Over time, conditions worsen as the affected area becomes increasingly worn or stretched. An overuse injury typically stems from:

  • Training errors. Training errors can occur when you take on too much physical activity too quickly. Going too fast, exercising for too long, adding too much weight to quickly or simply doing too much of one type of activity can strain your muscles and lead to an overuse injury.
  • Technique errors. Improper technique also can take its toll on your body. If you use poor form as you do a set of strength training exercises, swing a golf club or throw a baseball, for example, you may overload certain muscles and cause an overuse injury.
  • Worn or poor fitting equipment.  If your pads, helmets, shoes or other equipment are worn down or don’t fit correctly, they cannot offer the support or protection that is needed to prevent injury.
  • Training on poor surfaces. Continued high impact on surfaces that are too hard or uneven will eventually lead to an overuse injury.

Most over use injuries can be prevented.  The best ways to avoid them are:

  • Use proper form and gear. Whether you’re starting a new activity or you’ve been playing a sport for a long time, consider taking lessons. Using the correct technique is crucial to preventing overuse injuries. Also make sure you wear proper shoes for the activity. Consider replacing your shoes for every 250-500 miles you walk or run, or at least twice a year if you regularly exercise. A poorly sized grip on your tennis racquet or worn strings will lead to tennis elbow. Every sport has specific equipment. Running shoes are not basketball shoes are not baseball cleats.
  • Pace yourself. If you’re starting a new fitness program, avoid becoming a weekend warrior. Squeezing your physical activity for the week into two days can lead to an overuse injury. It’s also a good idea to take time to warm up before physical activity and cool down afterward.
  • Gradually increase your activity level. When changing the intensity or duration of a physical activity, do so gradually. A good rule of thumb is if you want to increase the amount of weight you’re using while strength training or the distance you’ve been running, increase it by no more than 10 percent each week until you reach your new goal.
  • Mix up your routine with cross training. Instead of focusing on one type of exercise, build variety into your fitness program. Doing a variety of low-impact activities – such as walking, biking, swimming and water jogging – can help prevent overuse injuries by allowing your body to use different muscle groups and not overload any one particular group. And be sure to include strength training for the major muscle groups in your arms, legs and core at least twice a week.
  • Get checked before you start. Evaluation by a sports medicine professional or personal trainer can identify pre-existing injuries or deficits that can be corrected or compensated for to prevent injuries.

Even when all the precautions are taken, injuries can still occur. The most important thing to do is to recognize and accept that an injury has occurred and to begin taking steps to fix it. Initially, most overuse injuries can be treated along the same principals when they are caught early. Simply put: remove the source of injury and eliminate the inflammation. This can usually be accomplished with rest (take some time off), ice and over-the-counter anti-inflammatories. Sometimes rest can include immobilization with a brace or splint.

If you suspect that you have an overuse injury, and it does not recover with simple measures in a short time, consult your doctor. He or she will likely recommend you continue to take a break from the activity that caused the injury, but they also may recommend alternative training as long as it does not stress the involved body part. Prescription non-steroidal anti-inflammatories and injected cortisone may be used to eliminate inflammation when it is severe. Physical therapy can be prescribed to help heal the injury and to prevent further injury when you return to sports. In addition, further tests such as X-ray and MRI can be ordered to evaluate the injury and insure the correct diagnosis.

When you think the overuse injury has healed, ask your doctor to check that you’ve completely regained strength, motion, flexibility and balance before beginning the activity again. When you return to your activity, pay special attention to proper technique to avoid future injuries.

Remember, most overuse injuries are caused by repetitive stress that is applied too frequently or increased too quickly. Following a few simple basic rules will prevent most overuse injuries. When injuries do occur, they key to recovery is early recognition, diagnosis and treatment. If the symptoms do not resolve quickly, consultation with a sports medicine professional is recommended. Early intervention can prevent more serious injury and allow a quicker and safe return to the activities you enjoy.

Dr. Michael Gross, the founder and director of Active Orthopedic and Sports Medicine, is the section chief of sports medicine and the orthopedic director of the Center for Sports Medicine at Hackensack University Medical Center, as well as medical director of Active Center for Health and Wellness.

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