Traditionally, an overuse injury refers to an injury or pain cycle present in the absence of a clearly defined and identifiable traumatic cause. Furthermore, the term “overuse” is somewhat of a misnomer as this classification of injury is not solely caused by a long, continued, and chronic workload. While it is possible that repetitive maladaptive movement patterns can cause tissue breakdown and ultimately injury, other causes leading to pain might include excessive loading, inefficient biomechanics, insufficient recovery, and unpreparedness for a given workload. In fact, it is generally thought that most injuries caused in activity are due to a variety of factors that include: intrinsic factors (such as body shape, muscle type distribution, leg length, and others), extrinsic factors (surfaces, shoe type and dimensions, equipment, and nutrition), training load and methods, and recovery. Some have suggested that the term “overuse” be replaced with “errors in training load”, while others propose this detracts from the multifaceted origins of these types of injuries.
WHAT CAN CAUSE OVERUSE INJURY?
The overarching principle of overuse injury is that the stresses placed on a specific tissue over time overshadow the tissue’s ability to repair itself effectively, leading to further breakdown. Typically, during training or physical activity, tissues are loaded and stressed, causing breakdown. An inflammatory response is triggered in order to clear and rebuild the tissue in order to equip the body for another bout of activity. Gradually, over time, the inflammatory response will adapt to build more, or stronger, tissue in an area continuously loaded. Overuse injury is caused by a maladaptive process in which tissues are loaded past their capacity to generate a sufficient inflammatory response to heal and rebuild tissue that was broken down. Over time this leads to further breakdown and prevention of adaptation, and ultimately pain and potentially chronic inflammation.
COMMON OVERUSE INJURIES
Tissues that are at risk for overuse injury include: bones, muscles, tendons, fascia, bursae, and nerves.
Runners and nordic skiers tend to be at particular risk for conditions such as achilles tendonitis, medial tibial stress syndrome (shin splints), stress fracture, chondromalacia patella, patellofemoral pain syndrome, and plantar fasciitis.
Another common distance and endurance sport, biking, may also suffer from these, however other overuse injuries more commonly related to cycling may include: patellofemoral pain syndrome, patellar tendonitis, pes anserine bursitis, IT band syndrome, trochanteric bursitis, iliopsoas tendonitis, low back pain, neck pain, and nerve compression in the hand and foot.
PREVENTING OVERUSE INJURY
Utilizing a proper training protocol and allowing for adequate recovery is essential for preventing overuse injuries. Periodization, which includes following a predictable and systematic pattern of change in training variables, is effective with resistance training. Additionally, utilizing a system of graded, progressive overload in training variables will ensure adequate tissue loading and adaptation.
BEGIN WITH THE FOUNDATION – EXAMPLE TREATMENT AND PREVENTATIVE PROTOCOL
Core bracing in hooklying
2 sets x 2 min
Bird dogs
2 sets x 2 min, bilaterally
Palloff Press
2 sets x 2 min, bilaterally
References
- Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. J Orthop Surg Res. 2018;13(1):309. Published 2018 Dec 5. doi:10.1186/s13018-018-1017-5
- Drew MK, Purdam C. Time to bin the term ‘overuse’ injury: is ‘training load error’ a more accurate term?. Br J Sports Med. 2016;50(22):1423-1424. doi:10.1136/bjsports-2015-095543
- Hreljac A. Impact and overuse injuries in runners. Med Sci Sports Exerc. 2004;36(5):845-849. doi:10.1249/01.mss.0000126803.66636.dd
- Lorenz DS, Reiman MP, Walker JC. Periodization: current review and suggested implementation for athletic rehabilitation. Sports Health. 2010;2(6):509-518. doi:10.1177/1941738110375910
- Physiopedia. 2021. Overuse Injuries in Sport. [online] Available at: <https://www.physio-pedia.com/Overuse_Injuries_in_Sport> [Accessed 3 November 2021].