Avoiding Overuse Injuries

Avoiding Overuse Injuries

By: Heather Hirsch, MD • Posted on May 27, 2015 • Updated April 22, 2020

Preventing Exercise Injuries

Are you a “weekend warrior?” Or are you a regular exerciser?

Either way, the summer is upon us, and most persons tend to step up their activity level in the summer. I love driving home and seeing all my neighbors out on their bikes, running with their dogs or walking as a family. Going outside and being active is a great way to burn calories and connect with family and nature. Unfortunately, it is also a time when people are prone to overuse injuries, as many of us are trying to quickly burn off what we put on during the winter months. This can lead to an increase in overuse injuries as we ramp up our physical activity level too fast.

The following 5 tips can help prevent overuse injuries:

  1. Turn up the dial on your physical activity level in a controlled manner
  2. Remember to stretch before and after every workout or game!
  3. Keep yourself well hydrated
  4. Maintain adequate Vitamin D with supplements
  5. Always use sunscreen for skin protection when exercising outdoors

Common Overuse Injuries That Tend To Occur


Plantar Fasciitis

The most common symptom of plantar fasciitis is pain beneath the heel and sole of the foot. Traditionally, pain occurs on the bottom of the foot and is often noticed when you first get out of bed in the morning. It is typically caused by repetitive motions, such as running long distances in improper or old shoes, or excessive training with a steep increase in activity level. Having flat feet or high arches can also exacerbate the situation. Plantar fasciitis can be treated by:

  • Decreasing your activity level
  • Icing
  • Investing in new and supportive shoes (reverse clogs)
  • Stretching out your calf muscle

Do not go barefoot and contact your physician if these measures do not help.

Stress Fracture

Another typical overuse injury is a stress fracture, in which a bone breaks after repetitive compressive stresses, each acting in an additive measure to cause enough trauma to cause a break in the bone, even if it is a very small fracture. Risk factors include:

  • Female gender
  • Advancing age
  • Low bone density
  • Low vitamin D levels
  • Low body weight

Typically, a plain X-ray will show the degree of the fracture. The road to healing is with decreasing your activity level, icing, and utilization of a special boot, which can help stabilize the bone while it is healing. You can ask your doctor if you should wear a supportive boot, as it will depend on the extent of the fracture.


Tennis and Golf Elbow

The medical term for this is 'Epicondylitis'. It is the result of an overuse injury of either the lateral (outside) “tennis elbow” or medial (inside) portion of the lateral epicondyle “golf elbow", or where the tendon in the elbow connects muscle to bone. Tennis or gold elbow is typically caused by repetitive movements of the elbow, as in a golf or tennis swing, but can also occur in carpenters, butchers, plumbers and painters in which there is repetitive motion of the arm. If the tendon is very inflamed, this condition can also lead to pain in the forearm or hand. Rest, ice and the use of anti-inflammatories can help ease the symptoms. If not you should contact your doctor, and physical therapy may be indicated.


Tendonitis is more common when women are low in estrogen like postpartum after have a baby and/or postmenopausally, if women are not on hormone therapy.


There are a few types of knee pain that are commonly seen with overuse injuries.

Patellofemoral Syndrome

This condition is typical of a pain in the front of the knee cap that often occurs in runners or weightlifters. Pain is often worsened with:

  • Squatting
  • Prolonged sitting
  • Climbing stairs
  • Running downhill

Unlike other conditions, swelling of the knee is not common. Resting, ice and strengthening the muscles around the knee are particularly helpful. If you are unaware of how to strengthen the quadriceps and hamstrings, a few visits to a physical therapist can be helpful. Sometimes a brace can also provide stability and help with recovery, along with icing and rest.

Meniscal Tear

Meniscal tears most often occur with twisting injuries, such as when doing a quick pivot, a quick change in direction or a quick deceleration movement. It often occurs when playing contact sports like soccer or softball, but can happen in other scenarios as well such as skinning or even with running.

Tears can also be classified as “full” or “partial” and are determined by how significant the tear is on imaging. Acutely, there is swelling in the joint, and the onset of the tear may be accompanied by a “popping, locking or clicking” sound, or the knee “giving out.” Talk to your doctor if you are having any of these symptoms. An MRI is the imaging of choice to determine the extent of the tear. If you are concerned about a tear, rest and ice the knee, and if you have crutches available, use them to avoid putting pressure on the knee. Depending on the size of the tear, this will determine the need for surgery.


More specifically, the medical term is ‘anserine bursitis’, and this is typically a pain noted on the inside portion of the knee, and a bit below the main bone in the knee. This is another common overuse injury seen in runners or walkers, especially when ambulating on an incline. Pain often occurs at night, and it is easy to point one finger to the site of the pain. Swelling is often seen in this condition, and x rays are usually normal. You want to avoid crossing your legs, squatting and doing repetitive motions. You can aid in recovery with:

  • Icing
  • Bracing
  • Gentle use of over the counter anti-inflammatories

Contact your doctor if these are not easing the pain.

Iliotibial Band

Iliotibal band syndrome, or “IT band” syndrome, is suggested by a history of lateral (outside) knee pain that worsens with activity. It is seen often in runners and cyclers. It can cause referred hip pain, meaning there is pain also at the hip, but the pathology actually lies in the knee joint. Pain is most often aggravated when running downhill. It is often described as a burning pain, and as it worsens it can become more constant, instead of just causing irritation with activity. Stretching with a foam roller can help decrease inflammation of the tendon, and is recommended. Decrease activity levels and consider gentle activities like yoga to improve the strength of the surrounding muscles.

Women who undergo joint replacement postmenopausally and are on hormone therapy, have better long-term success with their joint replacement.


Rotator Cuff Pain

Pain from a troubled rotator cuff can be from:

  1. Inflammation of the tendon, called tendinitis
  2. Muscle impingement
  3. Partial or full thickness tear of the muscles of the shoulder

Injuries can stem from activates that require repetitive motion of the shoulder, and thus is seen often in baseball pitchers, but also in hockey players, painters and others. Diffuse pain and arm weakness are the typical signs. Your physician should do a series of physical exam tests to try and narrow down what kind of rotator cuff injury you are suffering from. An X-ray and possibly an MRI are needed to determine the best treatment options, which include:

  • Icing
  • Resting
  • Physical therapy
  • Steroid injections
  • Even surgery depending on the depth and thickness of the tear

With concern for any overuse injury you cannot go wrong by scaling back on your activity, icing, elevating and using anti-inflammatories if you have no contraindications to taking these medications. Scale up your activity in an appropriate manner. Contact your physician if these conservative measures do not help.

Enjoy the summer and especially enjoy life-enhancing physical activity.

Be Strong. Be Healthy. Be in Charge!

-Heather Hirsch MD, MS, NCMP
Physician, Menopause & Midlife Clinic
Brigham and Women's Hospital
Harvard Medical School

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