Many people in the course of their lives will suffer an overuse injury. They may not know that they have one; if they do know, it may not be severe enough to seek medical treatment or alternatively, it may be virtually crippling and completely life changing. The injuries can happen at any age for anyone taking regular physical exercise of any type.
This article will –
- Answer the question, ‘What is an overuse injury?’
- Explain the difference between an acute injury and an overuse injury
- Explore the causes of overuse injury in children
- Explore the causes of overuse injury in adults, in both sport and the workplace
- Describe the symptoms of overuse injuries and in what parts of the body they occur
- Give some examples of common overuse injuries
- Detail some common treatments
- Give information on how to prevent overuse injury
The information given here has been gathered from many sources, including some of the world’s most respected medical facilities and many in-depth academic research papers. These are either represented as links within the text or are cited and referenced at the end of the article.
Overuse Injury Definition
Overuse injury or Overuse Syndrome is a fairly wide ranging term applied to a type of injury which is common in both sport and the workplace. Anyone can suffer from an overuse injury, from athletes to musicians and typists to factory workers. This type of injury is caused by repeatedly making the same movement, prolonged stress on one or more parts of the body or consistently having to maintain an awkward posture. Overuse Syndrome is also commonly known as Repetitive Stress Injury, Repetitive Strain Injury or RSI and a more technical term is Cumulative Trauma Disorder.
Acute Versus Overuse
There is a very marked difference between acute and overuse injuries.(1)
Acute injuries often result from accidents or incidents involving direct impact, abnormal bending or twisting and falls. An acute injury can be classed as anything from a simple bruise to a broken bone, including torn ligaments, pulled muscles,sprains, and dislocations. As a broad generalization, you can say that with an acute injury, one minute you don’t have it and the next minute you do.
Overuse injuries fall much more into the chronic category. These are injuries which take time to happen, sometimes a great deal of time, and which involve inflicting the same trauma to the same part of the body over and over again until the damage becomes established.
Causes of Overuse Injury
Probably, you will have been doing some sort of activity over a long period of time and gradually noticed an ache or a pain creeping on, always in the same place. It usually starts out as a minor discomfort and, at first, may well go away as soon as you stop the activity. However, as you continue to do that activity the ache or pain starts more quickly each time, takes longer to go away each time, and eventually may not go away at all, even when you rest. The condition may accelerate very quickly if you don’t allow enough time between bouts of the activity for the affected part to heal sufficiently.
Overuse injuries are most usually associated with sports, and indeed, are relatively common in adult athletes who engage in their sporting activity very regularly. Overuse injury problems can begin much earlier in life, however.
Overuse injuries in children are usually sport-related. There has been a great upsurge in awareness of fitness issues for children and the importance of exercise for young people over the past two decades or so. Statistics say that over 35 million young people between the ages of five and 18 played organized sports in the U.S. last year. Generally speaking, this is a good thing, as the level of obesity in children has also risen significantly and has been a subject of concern for many years.(2) Nevertheless, care has to be taken that children do not overdo any one form of exercise.
There is often a goal for a child to excel at one particular sport for which he or she may show a strong aptitude at an early age. However, intensive training in one branch of sport can cause huge problems for growing bones, ligaments,tendons, and muscles, to the extent of causing serious overuse injuries.(3)(4)It is the uneven growth in children’sbody structures that can cause overuse injuries to be more serious than they might be in an adult.
The American Academy of Orthopaedic Surgeons explains that children’s bones are the first structures to grow and can put strain on tight ligaments and muscle, making them more liable to injury. The areas of growth (growth plates) at the ends of the bones are not as strong as the attached tendons and ligaments and repeated injury to the plates can cause the bones not to grow as they should. Continuous repetition of this damage through persisting with a one-sport training regime leads to overuse injuries. Long-term consequences can include growth-impairing injury and life-long health problems. Reports suggest that at least 50 percent of all sports injuries in children and teenagers are from overuse.
Neeru Jayanthi, a sports medicine physician atLoyola University Medical Center in Chicago, and his colleagues reported in 2015 that young people who concentrated on one sport for more hours each week than their age - for example, a nine-year-old who played 10 hours or more of baseball - would be 70 percent more prone to overuse injuries at a serious level.(3)
Although the term ‘overuse injury’ is usually associated in everyone’s minds with sports, the mention of one of the alternative names Repetitive Strain Injury tends to make people think of work-related injuries. Adults can be prone to either type of injury.
There are several reasons why overuse injuries may occur in sports -
It was thought at one time that working through any pain felt while training or playing sport was a good thing which built up stamina and enabled the athlete to reach higher achievements. The once widely-followed ethos of ‘pushing through the pain barrier’ and ‘no pain, no gain’ is now seen as highly dangerous and has probably been responsible for a lot of long-term overuse injuries.(5) Not listening to what your body is telling you can be very unwise. It is recommended not to increase the activity more than 10 percent at a time – advancing no more than 2 extra push-ups if you’re currently doing 20, for instance, or increasing to running 11 miles instead of 10, until you are doing that easily.
Bad technique is one of the main causes of overuse injuries. If you consistently use a bad posture or inadequate form when for instance, throwing a ball, lifting weights, or swinging a bat, you may well over-strain part of your body and cause an overuse injury. Training errors are the largest cause of overuse injuries.
Taking on too much exercise too quickly can also be a culprit and is the most common error people make in exercising. If you aren’t used to exercise and you enthusiastically embark on a fitness routine or a new sport, it’s easy to do too much at the beginning. It can also be a problem if you have very limited time in the week and you cram in all of your weekly exercise on one day, perhaps at the weekend. Such a vigorous assault on untrained muscles and ligaments is almost certain to result in an injury of some sort. Repeating this too often can lead to long-term damage.
Another likely reason to incur an overuse injury is again down to enthusiasm. Getting keen on a sport or a sporting activity can lead to spending too much time doing that activity. Constantly performing the same movements, maybe with some stress involved as when weightlifting or running, can easily result in repeated trauma to the same part or parts of the body, leading to overuse injuries.
Not giving yourself sufficient time for your body to recover and heal between exercise sessions can also result in anoveruse injury. Even experienced exercisers and sportspeople can get these injuries through overtraining.
A further cause of overuse injuries in sport is using the wrong equipment in the activity you’ve chosen. Usually, this will take the form of something like wearing the wrong shoes for running or dancing, putting great strain on your feet, knees, and hips.
Other factors which can lead to overuse injuries are related to specific pre-existing body issues in an individual. Flexibility and strength imbalances in certain joints can increase the likelihood of injury. Certain alignments of the body like feet with flat or very high arches, knock-knees, having one leg slightly longer than the other, or bow legs, for instance, can also be risk factors. Having old injuries which are perhaps not completely healed or which have left a weakness of some kind also give a vulnerability to overuse injury.
In the Workplace
Perhaps surprisingly, occupational overuse syndromewasrecognized over three hundred years ago in 1700, when Italian doctor Bernardino Ramazzini researched and published his treatise on writing overuse injuries in the workplace.(6)
Since then, many historical theories as to the cause of these injuries - some relatively minor, but others resulting in complete temporary paralysis of a limb or even permanent crippling of the patient – have been put forward.(7) These range from existing abnormalities in the patient’s body through to disorders of the brain, but today we know that workplace overuse injury can be attributable to faulty work practices, lack of ergonomic equipment, poor handling or bad posture.
The issues were brought to wider attention after the medical journal The Lancet published worrying statistics in 2007 regarding the numbers of workers across the world displaying RSI symptoms.(8) The report stated that some countries returned figures showing that between 5 and 10 percent of their populations suffered from the condition, but for some particular occupations such as secretaries and dressmakers, this went up as high as 40 percent.
At that point in time, the U.K.Chartered Society of Physiotherapy reported that almost 450,000 workers in the U.K. were suffering from some sort of RSI injury. This resulted in over 4.5 million lost work days. Multiplied across the world, the figures would be staggering and highlight a serious problem. In 2010, the American Industrial Hygiene Association reported in their journal that injuries ‘caused by overexertion and repetitive motion are the leading causes of compensable lost-time cases in the United States’ No more recent studies seem to have been conducted, however.
As with sports overuse injuries, the issues are caused by constantly repeating the same damaging action throughout the course of the working day. As these activities will continue day after day and week after week, there is no time for the affected part of the body to heal.
Some typical risk activities could include:
- any work involving a lot of writing
- continuous computer work with a keyboard and mouse
- production line work involving the same body movements over and over again
- playing a musical instrument and practicing for many hours a day
- constantly lifting and moving heavy objects
- dancing for many hours per day
- kneeling for many hours per day
There are of course many other possibilities and once you think about it, you may be able to attribute that little nagging ache to something you’re doing at work. There is more useful information on workplace overuse injuries here.
Symptoms of Overuse Injury
Although everyone is different, overuse injuries can tend to follow a recognizable pattern. There are four broad stages in the onset of an overuse injury:
- Mild discomfort which goes away during warming-up and may be more noticeable in the morning. This is often missed as a symptom because people tend to expect to be slightly stiff the day after doing physical activity.
- Soreness which disappears during warmup but comes back again after the activity is over. At this point, providing the condition has been diagnosed and is being treated, the activity can safely continue but at a level which does not bring on the pain.
- Pain that gets worse throughout the length of the activity. Once the injury reaches this level, the causal activity must stop if permanent damage is not to follow. Ideally, the progress of the injury should be monitored and treated and the supervising healthcare professional will advise when it’s safe to resume the activity.
- Pain that continues all the time. By this point, serious and long-term damage may already have been done.
Outward signs of an overuse injury can include:
- Swelling, which may not actually be noticeable
- The affected part may feel warmer than the surrounding area
- There may be visible redness
- The affected limb may have impaired function
Although these stages and signs refer mostly to sports injuries, they can be used as indicators in workplace overuse injury as well.
Where Can Overuse Injuries Occur?
Overuse injuries or RSI can occur in almost any part of the body which is subject to continual abnormal posture, repetitions of the same movement, or unusual stresses over time. Anywhere where repeated trauma to the bones, tendons, ligaments, and joints may happen.The following section details some of the common injuries and where they occur in the body.
Some Examples of Common Overuse Injury
As previously mentioned, overuse injuries can be so mild as to be a minor irritation for a short space of time, also so serious as to cause life-changing consequences.
Here is a list of some of the most common overuse injuries and their symptoms:
- Corns, calluses, and blisters on the feet. Yes, these do qualify as overuse injuries. Generally, they occur due to unsuitable footwear for the activity being undertaken. Of course, these fall at the milder end of the list, but serious damage to the feet can be caused by continuing to wear the wrong footwear or the wrong size footwear.
Blackened and bruised toenails and toes can also be caused by the wrong footwear or the wrong size footwear. Depending on the activity being undertaken, suitable protection may also need to be applied inside the shoe.
- Achilles tendonitis is an overuse injury inflicted on the Achilles' tendon. This is the largest tendon in the body and runs up the back of the heel. Tendinitis is inflammation which is thought to be caused by repeated tiny damage to the tendon when running or jumping. The condition can also be inflicted by excessive walking, general over-exercise involving the lower leg or habitually wearing high heeled shoes. Symptoms include pain or swelling in the back of the heel and the pain can be extremely intense, to the point of not being able to put the foot flat on the floor.
- Jumpers Knee or patellar tendonitis affects the front of the knee. This is one of the most common overuse knee injuries and generally occurs from too much jumping or running which causes damage to the kneecap tendon. Pain is usually felt quite specifically at the bottom of the kneecap. The bottom of the kneecap will feel very tender when pressed and may be obviously swollen when compared to the other knee. This is an injury which tends to be ignored in its early stages, however, if neglected and allowed to become a chronic injury, it can be hard to treat and may need surgery.
- Little League Elbow and Little League Shoulder are overuse injuries associated with children in the U.S., but which can present in anyone who consistently plays a sport which involves power-throwing a ball, for instance, fast bowling in cricket. During the motion of throwing, a lot of stress is placed on the elbow and shoulder tendons, bone growth plates and ligaments and can cause considerable injury at a young age.
- Runners Knee which is medically known as patellofemoral pain syndrome (PF PS) is, not surprisingly, common amongst runners. The stress created by running can cause inflammation between the top of the kneecap and the bottom of the thigh bone, producing pain and possibly some swelling.
- Shin Splints is a general term for the condition called Medial Tibial Stress Syndrome (MTSS) which affects the front part of the lower leg. This is one of the overuse injuries which tends to happen in the ‘too much, too soon’ category of injuries. It is most common in people who take up dancing or running and it is also seen in new military recruits who are doing a lot of training. Basically, the muscles ligaments and tendons in the lower leg are overworked and not given chance to rest. Symptoms will probably be pain down the inner edge of the shinbone and possibly a small amount of swelling.
- Stress fracture. Stress fractures happen when muscles become tired and can no longer absorb extra shocks. Over time, the tired muscle transfers stress load to the attached bone which can cause a tiny crack. If this is not discovered and allowed to heal, the crack can become worse. Stress fractures can happen in a variety of sports ranging from gymnastics and basketball to tennis and track and field events. Although anyone can get astress fracture, studies have shown that women are slightly more prone to them than men. The main symptom associated with astress fracture is pain on activity, which goes away when at rest.
- Tennis elbow or lateral epicondylitis occurs when the muscles of the forearm are overused and put strain on the surrounding ligaments. The most common symptom is tenderness on the outside of the elbow and in the forearm muscles. It can be very mild or so severe that you can’t hold anything in that hand. The symptoms may appear gradually and possibly not until between one and three days later, so that you might not associate them with the activity that is actually causing them.
- Carpal Tunnel Syndrome (CTS) is one workplace overuse injury that most people seem to have heard of. It can occur in anyone who uses their hands in a strenuous and repetitive motion, typically people who write with a pen a great deal, typists, and craftspeople who make things with their hands. Also, about 50 percent of pregnant women get temporary CTS which tends to go away about three months after the birth. CTS is more common in women than men and gets more likely to occur the older you get. Pain is caused by compression of the median nerve which controls movement and sensation in the hand and symptoms can include numbness, tingling, weakness in the thumb or pins and needles. The thumb, index, and middle fingers are usually most affected.
- Bursitis, also known by the somewhat outdated name of Housemaid’s Knee is an overuse injury generally found in the workplace. It can afflict anyone who spends a lot of time kneeling down, for instance - carpet layers, gardeners, mechanics, roofers, nuns and priests, and miners. There can be a marked swelling around the knee and it can be painful to the touch, but the range of movement in the knee is not restricted.
Overuse injury treatments are generally fairly straightforward if the injury is caught early enough.
The first and easiest treatment is to stop the activity that is causing the injury until it has had time to heal and the pain has gone. After that, the activity can usually be taken up again but should be reduced in duration, frequency, and intensity to avoid the injury happening again.
If the injury is pinpointed soon enough, then simple home remedies will be enough to prevent it getting worse and to treat thecurrent symptoms. One of the most common treatments is an ice pack over the affected area (cryotherapy). A couple of notes, though - never put ice directly onto your skin as it can burn you; put a wet cloth between the skin and the ice pack. Also, only apply the ice for 10 every two hours as, after 10 minutes, the body will react to the cold by increasing the blood flow to warm up the area and this will make any swelling worse. You can also elevate the affected part to reduce blood flow to it and to help stop the muscles being used. Plenty of rest should complete the cure.
In more severe cases, painkillers and anti-inflammatory treatments may be necessary. If the symptoms persist for more than a few days, it would be advisable to seek medical advice.
If the injury has gone past the simple stage, it may need some sort of surgical support, treatment from a physiotherapist or even, in extreme situations, surgery.
Preventing overuse injuries is, in general, down to common sense and an understanding of what causes them. As already mentioned, adopting a sensible approach to exercise, using the right equipment, and making sure that techniques used are correct will go a long way to preventing sporting injuries. Simple things like making sure you warm up and warm down thoroughly before and after exercise will be very helpful.
Particularly for children, it is important to avoid concentration on one sport, certainly until the child reaches puberty. A mixture of different activities will ensure that no one area of the body is overly stressed. Also, restricting the amount of time spent in sporting activity will help to avoid overuse injuries. These measures also make sense for adults.
In the workplace, it can be a little more difficult to easily adapt processes to counter overuse injury problems. Using correct equipment i.e. chairs at the right height for the desk or table, wrist rests for those using computer keyboards or typing, perhaps voice recognition software which can take some of the load instead of typing, and possibly adapting necessary movements to avoid overstrain on a production line. Employers have a legal duty to try and reduce the likelihood of RSI injuries in their workplaces as part of their everyday health and safety measures. There is a helpful check-sheet of basic preventative measures here.
In general, it can be seen that the majority of overuse and RSI conditions can be avoided with a minimum of disruption to the enjoyment of a sport, exercise or employment. Knowing that there may be a risk to consider is one of the best preventative measures.
Coaches, trainers, employers and the individuals themselves should all be aware of the possible problems that may arise from the activity involved and should take steps to ensure that the stresses and strains on the body of the participant don’t reach the level likely to cause an overuse injury.
The individual sports person needs to be honest about theirown limits and not go beyond them in anything but a carefully-planned program, designed for their size, weight, and abilities. Employees should make a record of those activities which cause them discomfort and discuss remedial measures with their employer.
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