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Overuse, micro-traumas and injuries

Is it just me and my advancing age, or are more words being overused these days? Like, literally? It’s hard for me to even see those words on a page and not hear a Ross O’Carroll-Kelly-type voice in my head. Lately I spend much less time on social media, and even less time reading the hashtags, partly because the overused adjectives used to trigger Tourette’s style outbursts.

In physio terms, there are issues around overuse as well, although they are more likely to cause my patients to swear than me. Overuse injuries don’t have a single, identifiable, traumatic cause. Instead there is typically a gradual onset with a series of repetitive ‘micro-traumas’. Individually, the action associated with an overuse injury rarely causes a problem.

During exercise the body’s various tissues – muscles, bones, tendons and ligaments – are loaded, sometimes even damaged slightly. Once the session is finished, those tissues undergo an adaptive process so that they can tolerate the exercise once again, preferably at a higher level. This is the basic premise of any training programme, whether it be strength, skill or endurance based. We follow a cycle of train, adapt and recover, then train again until we reach our goal. Sometimes when we get the balance wrong, overuse injuries appear.

Intrinsic/extrinsic Overuse injuries can be attributed to a combination of intrinsic and extrinsic risk factors. Intrinsic risk factors are those related to the athlete themselves and include such things as muscle weakness or imbalances, joint mobility and body composition. Remember that when you run, the impact force each time you hit the ground is equivalent to two-and-a-half times your body weight. If you aren’t strong enough, mobile enough or moving well, your risk of injury is higher.

Extrinsic risk factors include things like training load errors, surfaces, equipment, environmental conditions, nutrition and certain psychosocial factors. There isn’t enough space here to discuss all of these, so let’s concentrate on the low-hanging fruit of training load errors. Training load errors The first of these errors is where the volume or intensity of training is just too high, essentially the athlete does too much. The second scenario is where the recovery and adaptation time is insufficient, in this instance the athlete trains too soon. Many people combine the two and do too much too soon.

The obvious case is the person who takes up running and finds they enjoy it so much that they simply must do a marathon by the end of the year. They go from not running for years to running longer distances five days a week, while still juggling work, home and social responsibilities. A rapid increase in load plus insufficient recovery time equals some quality time with your physio!

All exercise programmes, regardless of intensity, carry some risk of overuse injury and everyone from beginner to elite is at risk to a certain extent. The simplest way to reduce the risk is to follow the old fashioned rule of only increasing your training load by 10 percent each week.

For runners this rule usually refers to mileage, but this can be misleading and doesn’t take training intensity into account. A hard interval training session might take more out of you and necessitate a longer recovery period than an easier longer run, but not add much in terms of mileage.

When to get help How do you know if you have an overuse-type injury? Let’s go back to the definition above- an injury without an identifiable, traumatic cause, usually related to a change in training load. More often than not they start as a niggle and get gradually worse to the point of causing problems away from exercise. By taking a break from training, you will usually get some relief, but the issue often comes back as the training load increases again, especially if you haven’t addressed the weaknesses and imbalances that fed the problem in the first place.

That’s where your friendly local physio comes in; our job is to identify any intrinsic weaknesses and extrinsic training load issues and guide you in how to improve both.

Of course, you literally don’t want to spend too much time with your physio, so just, like, be #mindful of how you train and adjust your loads gradually. Then you can feel #blessed and mean it.

This post first appeared in The Mayo News

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