Access to the PPM Journal and newsletters is FREE for clinicians.

Sports Overuse Injuries on the Rise

July 24, 2015
Lack of "cross-training" and intense training routines place certain high school athletes at higher risk for overuse injury than other athletes.

For a high school athlete in the midst of strenuous, competitive season, the physical stress of a tenacious schedule of games or an intense daily practice regimen can take a toll on the body. As the repetitive microtrauma caused by athletic performance bares down on specific joints and muscles,1 overuse injuries become a common problem, something that athletic trainers have a hard time trying to prevent.

Overuse injuries have become far more frequent in recent years because of excessive focus placed on year-round performance in one specific sport," according to Elmer G. Pinzon, MD, medical director of University Spine & Sports Specialists in Knoxville, Tennessee.2-4

“There were much less overuse sports-related injuries in the past, since there was so much more ‘cross-training’ with multiple sports, as opposed to the year-round sports concept, which does not allow the growing muscle-tendon-bony structure to heal adequately from season to season,” said Dr. Pinzon.

Cross-training is a very important tool for athletes to stay healthy. Sports staff, trainers, therapists, and physicians can prescribe alternative movements to athletes to keep their motions varied. Whether it be aqua-jogging, elliptical, stationary spinning bike, Thera-band resistance training, strength-training—exercises that incorporate other accessory muscles are key to taking some of that constant stress off of the affected body site, regardless if it has healed or hasn’t even undergone overuse injury yet, he noted.

“Repetitive motion and of any kind, over and over again without some sort of counter balance, is not good for the musculoskeletal system," agreed Dr. Joseph J. Ruane, DO, medical director for the McConnell Spine, Sport & Joint Center in Columbus, Ohio. "Joints needs a good balance of muscle strength around them to function properly. Tendons need push and pull to be as healthy as they can be. Doing only one thing places undue stress on limited parts of the system and ignores other parts. This is the principle of biologic tensegrity.”

“The real problem now is with tendon overuse," Dr. Ruane said. "We have gone from the term tendinitis to understanding tendinopathy. Tendinopathy is an actual physical change in the structure of the tendon, and once you have got it you are often stuck with it.” This is often the case with runners, who try to keep running while suffering from Achilles heel or patellar tendon pain and end up doing serious damage down the line.

New Study Results

Unfortunately, there is very little epidemiological data about this common injury, though. And as experts call for more action into preventing these injuries from occurring, new research suggests some athletes may be more in danger than others, like runners and swimmers.

A new study published in The Journal of Pediatrics  showed girls’ track and field and field hockey had the highest rates of overuse injuries, at 3.82 and 2.93, respectively.5 Overuse injuries were also the most typical type of injury reported in certain sports, particularly boys’ swimming and diving, where they accounted for 55.7% of all injuries.

The study used retrospective data compiled from 100 high schools around the country that had certified athletic trainers (ATs) on staff. The trainers recorded incidences when athletes suffered a “chronic” or “overuse” injury that had occurred during some type of athletic exposure (AEs), such as a practice session or competition.

From 2006 to 2012, ATs reported 2,834 overuse injuries out of 18,889,141 practice sessions or competitions, which came out to a rate of 1.50 overuse injuries per 10,000 AEs. A strong majority (79.9%) of these overuse injuries were newly occurring, not the result of a past incident.

Out of the 20 different sports recorded in the study, the types of overuse injuries obviously varied. However, overuse injuries oftentimes were sport specific, especially for sports where long practice sessions and repetitive movements were commonplace.

For instance, the lower leg area (between the knee and ankle) and the knee were common sites of overuse injuries. Consequently, this was the most frequently injured site in girls’ track and field, a sport where the greatest percentage of injuries were from overuse.

Overuse injuries were also typical for boys’ and girls’ swimming and diving, sports that put repeated stress on the shoulder area. Indeed, for those sports, the shoulder was the common site of injury.

Gender’s Role in Overuse Injury

Overuse injuries were more common in adolescent girls than boys, accounting for 13.3% of all injuries for women, compared to just 5.5% of all injuries for men. Interestingly, the rate of overuse injuries by school year (freshman [FR], sophomore [SO], junior [JR], and senior [SR]) was fairly even, but when gender was factored in, the numbers showed noticeable differences.

Overuse injuries were far more common for women in the early years of high school (FR 30.7%, SO 26.1%, JR 23.4%, and SR 19.8%), while men were the opposite, suffering from more overuse injuries later in their high school careers (FR 20.7%, SO 24.4%, JR 26.4%, and SR 28.5%).

Other studies have found these kinds of sex variations in overuse injuries, and a popular explanation is how puberty affects girls and boys at differing times in their adolescence.2,6 As girls and boys mature, their growing bones and cartilage can become more susceptible to injury and growth spirts can cause muscle and tendon tightness.7 But there could be another explanation besides puberty, the authors noted.

How elite athletes handle the physical stress of a four-year athletic career could account for the difference in numbers, as well. For instance, as teenagers progress through their high school careers, female athletes’ bodies could become more accustomed to the repetitious strain of their sport. However, for men, the opposite could happen, where the repeated stress of athletics could take a toll in the later years of high school – a time when boys typically experience growth spurts, too. 

Resting is Good for the Body

There is currently a debate over the clinical significance of overuse injuries that do not restrict athletic activity. Indeed, only one half of the reported overuse injuries in the current study resulted in the athlete missing play for more than a week, the authors noted.

However, pinpointing the patterns behind overuse injuries—the sport-specific body sites of injury or the age and gender makeup of the athletes suffering—could help keep future high school athletes robust throughout their athletic seasons. And as high school sports continue to grow more competitive and physically demanding every year, there is a need for smart preventive measures to protect the health of young athletes.

With athletes in danger of pushing their bodies too far, Drs. Pinzon and Ruane both recommended that physicians, trainers, coaches, and especially parents should take overuse injuries more seriously—pushing through tendon pain could lead to long-term consequences.

The best strategy to prevent these types of injuries is to raise awareness and keep players safe, even if that means missing the two-a-day practices, or even the big game. "My message to those parents and athletes is how good is the training time if you are not performing at your best and possibly even developing poor habits because you are training around an injured body part?” Dr. Pinzon said.

This study was funded by the Centers for Disease Control and Prevention, the National Federation of State High School Associations, the National Operating Committee on Standards for Athletic Equipment, DonJoy Orthotics, and EyeBlack. Study author Allison N. Schroeder, BS, received funding from the OSU College of Medicine (Roessler) Research Scholarship. The content of this study and the opinions expressed are solely the responsibility of the authors involved and do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors declare no conflicts of interest.

Last updated on: July 24, 2015
Continue Reading:
Chronic Overuse Sports Injuries in the Adolescent/Pediatric Population

Join The Conversation

Register or Log-in to Join the Conversation
close X