Overuse Injuries and the Myth of Too Much Too Soon

About 1/3 of all injuries suffered by athletes are deemed "overuse" injuries. The definition of an overuse injury is: damage to a bone, muscle, ligament, or tendon caused by repetitive submaximal stress without allowing adequate time to allow for structural adaptation to take place. Examples of overuse injuries are:

• tennis elbow (lateral epicondylitis)
• golfer's elbow (medial epicondylitis)
• swimmer’s shoulder (rotator cuff tendinitis and impingement)
• Little League elbow syndrome
• runner’s knee (patellofemoral pain syndrome)
• jumper’s knee (infrapatellar tendinitis)
• Achilles tendinitis
• shin splints (periostitis)
• rotator cuff tendonitis and tears
• bursitis (prepatellar, olecranon, trochanteric, and retrocalcaneal)
• iliotibial band syndrome
• spondylolisthesis
• spondylolysis
• Osgood-Schlatter disease

​Most overuse injuries are blamed on doing "too much too soon". While this makes sense at first, with further examination it becomes clear this isn't the whole picture. 

Let's examine "overuse" injuries common to runners like runner's knee, Achilles tendonitis, shin splints, stress fractures, and iliotibial band syndrome. These injuries often occur on only one side of the body. How can "too much too soon" be the cause of a unilateral injury when both legs were running the same miles? If running too many miles too soon was the cause of a runners Achilles tendonitis, then both legs would be affected the same and often they are not. This means that something else is contributing to the Achilles tendonitis on the injured side. 

I believe that the often unidentified factor that is contributing to the overuse injury showing up on one side of the body is posture imbalance. A common posture imbalance that can cause one sided running injuries is having a slightly stronger and more stable hip compared to the other. This will cause very slight changes in stride length, stance time, and subsequent imbalanced forces on muscles and connective tissues. For instance if your right leg is slightly stronger than your left leg you will spend more time loading your right leg which could lead to patellofemoral pain syndrome on your right knee from the extra load. This extra loading of the dominate hip/leg can also lead to stress fractures of the foot. In this instance you will also try to unload your weaker left hip quicker which could mean you are pushing off with your left foot harder leading to Achilles tendonitis on your left side. ​

But what about overuse injuries that occur in more one sided sports like golf, tennis, and baseball? Let's use common sense again to examine if "too much too soon" is really the whole picture. In tennis some common "overuse injuries" are tennis elbow, carpal tunnel, rotator cuff tendonitis, ankle sprains, knee tendonitis, stress fractures, and low back injuries. If hitting "too much too soon" causes overuse injuries, why do some players get tennis elbow while others get carpal tunnel and others end up with rotator cuff injuries? What determines where the "overuse" shows up?

​I believe posture imbalances are responsible for where overuse injuries show up. If a tennis player has a strong but tight shoulder, that strength might make their shoulder injury resistant but the limited range of motion of the shoulder will mean they have to create excessive range of motion somewhere else. They might try to create the excessive range of motion from the wrist which could cause carpal tunnel or lateral elbow epicondylitis. A different player might have strong wrists and arms but weak shoulders comparatively which means their rotator cuff will be under excessive stress and stain and they might end up with a rotator cuff tear or tendonitis of the rotator cuff tendon(s). ​

What about injuries gymnasts get like spondylolysis and spondylolisthesis? They are just caused by the excessive spinal extension and rotation gymnasts put their bodies through right? Maybe not...why don't all gymnasts get these injuries? Why does a spondylolisthesis show up at L5 in some athletes and L4 or L3 in others and T12 in still others? I believe that posture and muscle imbalances are responsible for intensifying extension and rotational forces at a certain vertebral level leading to the back injury. Restoring postural alignment and muscle length/tension balance will decrease chances of injury. 

While blaming too much too soon as the cause of overuse injuries is easy, it is not the whole picture. Posture imbalances play a part in most if not all overuse injuries. Correcting your posture and muscle imbalances will help you prevent overuse injuries. If you are already injured, correcting your posture will help you heal faster and get back to your sport sooner. 

If you would like a free posture evaluation and injury consultation, contact me today and I'd be happy to help you understand what is the underlying cause of your injury and how to decrease your chance of future injuries. 

Related articles/videos:
Patellofemoral pain syndrome and your posture
Spondylolisthesis and Egoscue
Tennis elbow
Why runners don't get knee arthritis
Sports and the blame game