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What are Overuse Injuries?

Overuse injuries are defined as damage to muscles, ligaments, tendons, or bones as a result of repetitive stress over time. Overuse injuries are often sports-related, and seen in tennis, swimming, soccer, and other activities that involve repetitive motions.

The areas most commonly affected by overuse injuries are the knees, shoulders, elbows, and heels. The majority of overuse and sports injuries are due to micro-traumas involving soft tissues. These injuries can involve neurovascular structures, muscle-tendon units, bursae, bones, and the physis (growth plate) in pediatric athletes. Typical examples of overuse injuries include stress fractures, lateral epicondylitis (tennis elbow), and shoulder impingement.

Causes of Overuse Injuries

Overuse injuries may result from training errors such as ramping up an activity too soon or exercising too long without sufficient rest and recovery. They can also result from doing a particular exercise in which only certain bones or muscles are utilized, such as repeated pull-ups, or with sport specialization where only one sport is played throughout the year. Bad technique can also play a role in overuse injuries, whereby tissue can be repetitively overloaded in an improper manner. This can occur with strength-training exercises such as squats or bench presses, and can also happen during an actual sporting activity, such as swinging a club in golf or throwing in baseball.

Signs and Symptoms of Overuse Injuries

Some signs and symptoms of overuse injuries include:

  • Pain and inflammation in the affected area
  • Numbness, tingling, or tenderness
  • Soreness or stiffness
  • Feelings of fatigue or weakness in the arms, hands, or legs
  • Clicking or popping sensation

Where Do Overuse Injuries Occur Most Frequently?

Overuse injuries can develop anywhere in the body, but they most commonly develop in the joints that are used the most. These include:

  • Elbows (tennis elbow)
  • Hips (stress fractures, IT band syndrome)
  • Knees (jumper's knee, runner's knee, IT band syndrome)
  • Feet/heels (stress fractures, Achilles tendonitis)
  • Shoulders (shoulder impingement syndrome, rotator cuff tendonitis)
  • Legs (stress fractures, shin splints)
  • Back (herniated disc, musculature strain)

What are the Common Types of Overuse Injuries?

Some of the common types of overuse injuries include:

  • Achilles Tendinitis: Inflammation of the Achilles tendon is known as Achilles tendinitis. The Achilles tendon is a tough band of fibrous tissue that runs down the back of your lower leg and connects your calf muscle to your heel bone. The tendon is used when you walk, climb, jump, run, and stand on your tip toes. Achilles tendinitis occurs as a result of repetitive stress to the tendon and is common among runners.
  • Plantar Fasciitis: Plantar fasciitis is an inflammation of the plantar fascia, a thick band of tissue on the bottom of the foot. It runs from the heel bone to the toes and forms the foot arch. The plantar fascia functions as a shock absorber and supports the arch of your foot. Excessive pressure over the fascia may strain and tear the tissue, causing heel pain. Repeated overstretching or overuse causes irritation or inflammation of the fascia. This usually occurs with excessive training, intense running, or poor shoe support.
  • Shin Splints: This is a term used to describe pain and inflammation of the tendons, muscles, and bone tissue around the tibia (shin bone). It occurs as a result of vigorous physical activity such as exercise or sports. The condition is also referred to as medial tibial stress syndrome (MTSS). The common cause of shin splints is overuse of the muscles and bone tissue of the tibia due to repetitive activity and/or a sudden change in physical activity level.
  • Iliotibial Band Syndrome (ITBS): This is an overuse injury resulting from the inflammation of the iliotibial band. This is a tough group of fibers that begins at the iliac crest of the hip and runs along the outside of the thigh, attaching at the top of the shin bone. Its function is to coordinate with the thigh muscles and provide stability to the knee joint. Iliotibial band syndrome occurs when the iliotibial band and the lower outside portion of the thigh bone at the knee joint rub against each other. It commonly occurs in athletes, cyclists, and runners.
  • Runner's Knee: Runner's knee, also called patellofemoral pain syndrome, refers to pain under and around the kneecap. Runner’s knee involves a number of medical conditions such as anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella that all cause pain around the front of the knee. As the name suggests, runner’s knee is a common complaint among runners, jumpers, skiers, cyclists, and soccer players.
  • Stress Fractures: Stress fractures are defined as tiny cracks in the bone's surface caused by rhythmic, repetitive overloading forces. These injuries can occur when a bone comes under repeated stress from walking, running, jumping, or marching, or from stress caused by wearing worn-out sneakers or sudden changes in running surfaces.
  • Little League Elbow and Little League Shoulder: Little league elbow, also called medial apophysitis, is an overuse condition that occurs when there is overstress or injury to the inside portion of the elbow. It is commonly seen in children involved in sports activities that require repetitive throwing such as in baseball. Little league shoulder is an injury to the growth plate of the upper arm bone at the shoulder joint of children. It is an overuse injury caused by repeated pitching or throwing, especially in children between the ages of 10 to 15. This condition is mostly seen in baseball pitchers, but children in other sports who use an improper throwing action are also at risk.
  • Tennis Elbow: Tennis elbow is the common name used for an elbow condition called lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow (lateral epicondyle). It is a painful condition occurring from repeated muscle contractions at the forearm and leads to inflammation and micro-tears in the tendons that attach to the lateral epicondyle.
  • Golfer’s Elbow: Golfer’s elbow, also called medial epicondylitis, is a painful condition occurring from repeated muscle contractions in the forearm, leading to inflammation and micro-tears in the tendons that attach to the medial epicondyle. The medial epicondyle is the bony prominence on the inside of the elbow. Golfer’s elbow and tennis elbow are similar, except that golfer’s elbow occurs on the inside of the elbow and tennis elbow on the outside.

Diagnosis of Overuse Injuries

To diagnose overuse injuries, your physician will review your medical history, conduct a thorough physical examination, and order diagnostic tests for additional details, such as:

  • X-rays, which provide a clear image of the bones

As growth plate damage and stress fractures are often not visible on x-rays, your physician may order an MRI or CT scan to confirm a diagnosis.

  • Computed tomography (CT) scans: This provides a cross-sectional image of the bones and offers a much higher level of detail than X-rays
  • Magnetic resonance imaging (MRI): This provides high-resolution images of both bones and soft tissues that are not visible in an X-ray or CT scan

Treatment of Overuse Injuries

The treatment objectives of overuse injuries include:

  • Identifying and addressing the cause of injury
  • Reducing pain and inflammation
  • Promoting healing
  • Preventing complications
  • Restoring normal use of the injured region
  • Developing strategies with the intention of early return to sports

Treatment of overuse injuries may include:

  • Activity modification and rest
  • Use of crutches, splints, or cast to facilitate healing and recovery
  • Application of ice and electrotherapeutic modalities
  • Soft-tissue techniques such as massage therapy
  • Strengthening and rehabilitation to stretch and strengthen the injured muscles, ligaments, and tendons
  • Medication, such as NSAIDs to mitigate pain and inflammation
  • Shockwave therapy to stimulate the release of growth factors into injured tissues
  • Regenerative medicines, such as platelet-rich plasma (PRP) injections to stimulate tissue regrowth and healing
  • Surgery is a last resort if the injury is recurring, you are in constant pain despite conservative treatment such as medications, or if a muscle, ligament, or tendon is badly torn

Other General Orthopedics Topics

Useful Links

  • Picture of American Academy of Orthopaedic Surgeons
  • Picture of American Orthopaedic Society for Sports Medicine
  • Picture of The Arthroscopy Association of North America
  • Picture of Mayo Clinic
  • Picture of OrthoCarolina

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