ABC of Sports Medicine: Overuse Injury In Sport

doi:10.1136/bmj.308.6941.1430

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P N Sperryn

New Victoria Hospital, Kingston, Surrey and the Hillingdon Hospital, Uxbridge, Middlesex.

The demands of training make overuse injury endemic in modern sport. High volumes of hard work underpin strength and stamina, while skills are honed through endless repetitious practice of event techniques.

Causes of overuse injury

Load too great for conditions
Technique or posture poor
Equipment faulty or of poor quality
Posture or anatomy inappropriate

Sports training and competition have intensified with the the trend towards professionalism. For instance, many club level runners now cover some 50-110 kilometres a week, mostly on hard surfaces, instead of the previous generation's 30-40 kilometres. Field event athletes may train with weights of over 130 kg, and the scope for injury is obvious. Swimmers, often young adolescents, can train for several hours a day, and the physical, mechanical, and mental stresses are important factors in many youngsters' decisions to drop out of sports prematurely.

Overuse factors

Load

An appropriate training load is one that the athlete is ready to manage on a given day but no ready definition exists of ideal or safe training loads. The concept of gradual and continuous training increments is central to the serious athlete's career development as well as safety. In today's sport, the winner is no longer the best athlete, but the one who succeeds in reaching the start - a statement well illustrated by the familiar pattern of outstanding athletes overtraining at the peak of their careers and breaking down in the run up to major competitions.

Progressive resisted exercise - for training and rehabilitation

Intensity of exercise increases gradually
Loads increase slowly (rather than starting exercise too intensively and increasing loads too fast)

A training history is essential for the diagnosis and management of injury in athletes. Overuse injuries result from unaccustomed overload, such as going to training camps, working on new techniques, or being pushed by over ambitious coaches. More unexpectedly, simply returning to normal training after a rest long enough …