Why do overuse injuries occur?

Overuse injuries only occur for one reason: the cumulative loads in the tissue are higher than what the tissue can tolerate. Its that simple. This means that prevention and treatment of on overuse injury is going to be based on reducing that cumulative load in the tissue and increasing the ability of the tissue to take that load¹. Its that simple.

So how do you decrease the load in the tissues?

  • reduce activity levels (eg have more rest days; do an alternative activity², don’t run as far each day; mostly use commonsense)
  • strapping or tape (for example, low dye strapping for plantar fasciitis; great for the very short term if the problem is painful enough to interfere with activity levels)
  • foot orthotics (provided they have the right design features that actually do reduce the load in the problematic tissue; in some injuries they can not reduce the load; good in the short and medium term; long term use will probably depend on the magnitude of the forces causing the problem and if tissues can adapt)
  • gait retraining/change running form (different injuries are more or less common in different foot strike patterns; its a matter of picking the one that reduces the load in the problematic tissues, keeping in mind that any change will increase the load in another tissue; good in the medium to longer term if done properly)

So how do you increase the ability of the tissues to take the load?

  • progressive loading (this is the slow progressive adaptation that the tissues go through in response to added load; the increase in loading has to be below a level that causes damage, but above a level that nothing happens; the old trusted mythical 10% rule is applicable here: ie never increase total weekly distances run by more than 10% or the length of the longest run by more than 10%; slow progressive transitions to new running techniques or new running shoes important here; this is at least a medium to long term measure once an injury has healed or is close to healed)
  • eccentric loading program (eg Alfredsons approach to Achilles tendonopathy; medium to long term intervention)
  • nutrition and tissue health (eg nutrition plays a role in tissue healing and health; eg issues surrounding things like osteoporosis and the female athlete triad and tissue health)

To advocate a blanket one approach over another is nonsensical. Good clinicians are going to make good clinical decisions and recommendations and not fall into the trap of  ‘one size fits all’.

¹Additionally, injuries are also going to be treated with modalities to help heal the actual tissue damage of injury such as ice, NSAIDs, heat, cortisone, shockwave, platelet rich plasma, deep tissue mobilization etc. However, all these are aimed at the healing of the tissues, and not at reducing the load or increasing the ability to take the load.

²Personanlly I am a huge fan of deep water running with a float, once I learned how to do it properly!

Last updated by .

2 Responses to Why do overuse injuries occur?

  1. Wondering March 28, 2013 at 6:29 am #

    What role does genetics play in these sorts of injuries?

    • Craig March 28, 2013 at 6:36 am #

      Good question Wondering! It probably plays a big role and does underpin a lot of what I said above. There has been a lot of work, for example correlating tendon injury to particular genes (eg see these studies on Achilles tendenopathy). The role that genetics plays here is probably one of the tissue not being able to adapt as well as you would like to the loads (making the load reducing strategies even more important in these people).

      Also our bone and joint structure is inherited,so this means that positions of joints and joint axes relative to tendons (ie the lever arms) is going to have a significant impact on kinetics; ie the load in the tissue.

Leave a Reply