Overuse Injury or Training Load Error

Bones, muscles, tendons and ligaments get stronger and more functional with exercise and activity. This happens because of an internal process called remodeling, which involves both the breakdown and the build-up of tissue. If breakdown occurs more rapidly than build-up, an injury can result. For example, when a player first begins a sport or activity and tries to do too much too soon, more breakdown than build-up of tissue can result.

Poor technique may also be involved.

In fact, training errors are the most common cause of overuse injuries. They involve a too rapid acceleration of the intensity, duration or frequency of the activity.

Overuse injuries also occur among individuals who return to a sport or activity after an injury and try to make up for lost time. Technical, biomechanical and individual factors may also be involved. For example, imbalances between strength and flexibility around certain joints can predispose an individual to an overuse injury. Body alignment, such as knock-knees, bowed legs, unequal leg lengths and either flat or high arched feet are also factors.

Overuse Injury

In 2007 Researchers at the Harvard School of Medicine published their research in which they identified overuse injuries in female athletes: Here is their list

Shoulder |Medial Elbow | Ulnar collateral ligament reconstruction | Tommy John – Throwing overuse injuries in the developing male athletes

Doctors at the University of Alabama at Birmingham School of Medicine say in the hypercompetitive environment of year round youth baseball, arm pain is commonplace.

With a focus on “little leaguers, the researchers evaluated five of the most common elbow and shoulder injuries:

  • Little Leaguer’s elbow, Little Leaguer’s shoulder
  • ulnar collateral ligament sprain or tear,
  • osteochondritis dissecans/Panner’s disease, Osteochondritis dissecans (OD) is a localized injury or condition affecting an articular surface of a joint, that involves separation of a segment of cartilage and subchondral bone. It is found most commonly in the knee although other joints can be affected, notably the elbow, ankle and hip.

The researchers strongly suggested that “offering early diagnosis and treatment appropriate to a child’s level of development will enable youth to not only continue to play sports but to also maintain full functionality as active adults.”2

Emory University School of Medicine researchers write that: Medial elbow injuries in the throwing athlete are common and increasing in frequency. They occur due to repetitive forces acting on the elbow during the overhead throw. Overuse and inadequate rest are the main risk factors for injury. 3

Please see my article on counter-research on Tommy John Surgery outcomes.

Gymnast’s wrist

University of Connecticut of University of Chicago researchers identified overuse injury in “Gymnast Wrist.” They include:

  • wrist capsulitis (ligament inflammation),
  • ligament tears
  • triangular fibrocartilage complex tears,
  • chondromalacia of the carpus, breakdown of wrist and hand bone cartilage.4

Please see our article on wrist instability

Overuse injury to the lower limb – Distance Running Injuries

Researchers in England say overuse in their footballers or soccer players age 7 – 18 years occur with overtraining distance running in combination with the running that needs to occur during a match.5



The usual recommendation in the traditional sports medicine community is to stop whatever activity is resulting in the chronic pain and to start the RICE protocol, as well as taking non-steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin or Ibuprofen. Although RICE treatment, which stands for stands for Rest, Ice, Compression and Elevation, does reduce pain for a while, it usually returns, which leads to chronic nagging injuries. In fact, RICE treatment can actually hinder the healing process rather than aid it.

Prolotherapy for Overuse Injuries

The natural medicine approach to overuse injuries is Prolotherapy, which stimulates tissues to make more collagen and proteoglycans, which in turn will rebuild the injured tissue, resulting in a stronger, thicker ligament or tendon. Prolotherapy is administered directly to the injured areas in order to stimulate the fibroblasts that make the new connective tissue. Once an individual’s ligaments and tendons are stronger and thicker, activity can actually be increased rather restricted, as is usually the case with the traditional modern medicine approach.



1 Ivković A, Franić M, Bojanić I, Pećina M. Overuse Injuries in Female Athletes. Croatian medical journal. 2007;48(6):767-778. doi:10.3325/cmj.2007.6.767

2 Daruwalla JH, Daly CA, Seiler JG 3rd. Medial Elbow Injuries in the Throwing Athlete. Hand Clin. 2017 Feb;33(1):47-62. doi: 10.1016/j.hcl.2016.08.013.

3 Tisano BK, Estes AR. Overuse Injuries of the Pediatric and Adolescent Throwing Athlete. Med Sci Sports Exerc. 2016 Oct;48(10):1898-905.

4 Wolf MR, Avery D, Wolf JM. Upper Extremity Injuries in Gymnasts. Hand Clin. 2017 Feb;33(1):187-197. doi: 10.1016/j.hcl.2016.08.010.

5 Bacon CS, Mauger AR.Prediction of overuse injuries in professional U18-U21 footballers using metrics of training distance and intensity.  J Strength Cond Res. 2016 Nov 19. [Epub ahead of print]

Get Help Now!

You deserve the best possible results from your treatment. Let’s make this happen! Talk to our team about your case to find out if you are a good candidate.