Overuse injuries are becoming more common.  They are prevalent in the workplace, sports (including youth sports), hobbies, and even daily activities.  They can also put a halt to the benefits of living a more active and healthy lifestyle.

Overuse syndrome, known by several other names (repetitive strain injury, cumulative trauma disorder, repetitive stress syndrome), is truly a common source of pain. According to the U.S. Bureau of Labor Statistics, approximately 60% of workplace pain and injury complaints are from overuse (O’Neil et. al 2001). Likewise, in a study of youth sports across the United States, overuse was also found to be the main cause of injury and pain (Patel et. al 2017).

Overuse injury occurs from repetitive motions which create submaximal exertion of our body’s soft-tissues (muscles, tendons, and nerves).  The interrelated factors that increase or decrease the chances of incurring an overuse injury are:

  • Frequency
  • Force
  • Amplitude
  • Relaxation/pause/rest

The joints and soft-tissues of your body need to have nutrients pumped in and waste pumped out, continually.  The greater the frequency, force, amplitude, and the less the relaxation/pause/rest of an activity, the more the nutrient/waste pathway is compromised. The risk of injury will be increased in the regions of overuse and pathway disruption.   

For example, an office worker might be exposed to a high frequency of computer keystrokes (avg. 25,000) per day, with little to no relaxation between strokes.  Even though this activity has low force and low amplitude, the lack of relaxation and the high frequency can still disturb the nutrient/waste pathway, making the person susceptible to overuse of the upper extremities (shoulders, arms, forearms, wrists, and hands).  Some common overuse conditions seen in this scenario are:

  • Carpal tunnel syndrome
  • Medial or lateral epicondylitis (golfers/tennis elbow respectively)
  • DeQuervain’s tenosynovitis
  • Cubital tunnel syndrome
  • Tunnel of Guyon syndrome

Looking at a different example, consider an avid cyclist.  Cyclists can be in a continuous protracted state for long periods of time, creating overuse of the lower extremity at the hips, thighs, knees, ankles and feet.  In the case of the cyclist, there’s increased frequency, force, amplitude, and decreased relaxation, as they’re perpetually pedaling.  Considering the nutrient/waste pathway, it is no wonder that 42% – 65% of recreational road cyclists show a history of lower extremity overuse injuries (Gervasi et. al 2017).  Common overuse injuries in competitive cyclists include:

  • Quadriceps Strain
  • Hamstring Strain
  • Patellofemoral pain syndrome
  • Patellar tendinitis (osis)
  • Achilles tendinitis (osis)

As an interesting side note, additional factors affecting the likelihood of overuse syndrome are:

  • Increased Stress
  • Higher mental demand activities
  • Self perceived exertion of the activity
  • Existing neck or back pain and tension

The evidence for this appears in a study demonstrating that those experiencing any, or all of the above, were recorded to have higher computer keystroke forces when typing, in comparison to those not experiencing the above factors (Levanon et. al 2016).  It is assumed that using higher forces than necessary under these circumstances will translate to not only keystrokes, but all activities performed.    

Strategies for preventing overuse in the workplace focus on ergonomic set-up for reducing activities of repetitive stress, and avoiding prolonged awkward postures.  In addition, taking microbreaks to perform stretching and strengthening exercises are essential.  

In the example of competitive cycling, prevention programs consist of soft tissue manual treatments, nutrition, and corrective exercises.  

The whole spectrum of overuse injuries are primarily treated conservatively through manual treatments, corrective exercises, short-term monitored immobilization/bracing when necessary, non-steroidal anti-inflammatory medications, and cold or hot therapy.  In the minority of cases that don’t respond to comprehensive conservative care, surgical consult is recommended.  


Daniel Yinh

Daniel Yinh


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