Tips to Avoid Overuse Injuries

Written by Michael W. Gish, M.D.

Overuse injuries generally occur due to repetitive submaximal loading of the musculoskeletal system – when rest is not adequate to allow for structural adaptation to occur. Such injury may involve muscles, tendons, bones, joint cartilage or growth plates. When recovery between loading exposures is sufficient, tissue adaptation occurs to accommodate the imposed stress. However, excessive stress and/or an inadequate recovery period can overwhelm the ability of tissue to remodel, resulting in a weakened, damaged structure. Most overuse injuries will resolve with a period of rest and cause no long-term sequelae, but some may lead to lasting issues, causing difficulty with return to play. 

 Some risk factors for overuse injuries include: 

• History of prior injury – prior injury is a strong predictor of future overuse injury
• Adolescent growth spurt – overuse injuries appear to be more common during periods of rapid growth
• Workload – while it is very difficult to define specific workload thresholds, one study showed that training more than 16 hours per week was associated with a significantly increased risk of injury
• Scheduling – such as multiple competitive events in a short period of time

Although specific risk factors exist, in reality most overuse injuries result from a complex interaction of multiple risk factors in specific settings coupled with an inciting event.

Recommendations to minimize the risk of overuse injury/burnout include: 

First of all, be aware of the risk of overtraining and the potential for burnout in today’s competitive sports environment. Be especially mindful during the adolescent growth spurt. 

• Do not play on more than one team at the same time
• Limit training time to less than 16 hours per week. 
• Vary training regimen and cross-train so as to provide varying stresses to your body. 
• Get adequate sleep and hydration (ages 6-13 should get 9-11 hrs./night; ages 14-17 should get 8-10 hrs./night) 
• Look for enjoyable activities other than sports for a mental diversion from the stresses of sports. 
• Practice stress reduction techniques such as meditation, visualization and breathing techniques.  

Many apps are currently available to assist with this. While the level of competition in today’s sport, especially at the elite club level is high, it is key to balance the inherent training demands with time for rest and recovery. It is important to maintain a lifelong love for the “beautiful game” and stay healthy to be able to continue to play it as long as you would like. More is better continues to be emphasized in the world of sport, but the reality is that sometimes, less is more.