What is overuse syndrome?
Overuse syndrome is a term used to describe a group of diseases that
occur due to excessive stress on a anatomic area of the body. Typically,
microtrauma occurs as a repeated injury usually not noticed initially
because the injury is microscopic in magnitude. Over time, the cumulative
trauma leads to pain and in some cases, significant disability. Overuse
syndromes can occur at any age, although it is very common in children
because of peculiarities of growth.
Examples of overuse syndromes in children include the following.
- Sever's disease - inflammation of the growth
cartilage at the heel (the calcaneal apophysis) and the insertion of
the Achilles tendon at the heel.
- Ankle sprain - especially the lateral
- Shin splints - often used to describe
pain along the shin of the leg, which could include stress fracture
of the tibia, chronic exertional compartment syndrome, and periostitis
of the tibia.
- Patello-femoral syndrome - also called
anterior knee pain or chondromalacia patella.
- Little League elbow - or pitcher's
- Shoulder impingement syndrome
- common in pitchers in baseball and swimmers
- Spondylolysis and Spondylolisthesis - common
in gymnastics, football and weightlifting.
What causes overuse syndrome?
Factors that come into play include the following.
- Too much too soon. Overuse syndromes occur most commonly during the
beginning of a season when athletes overtrain to get ready for the sport.
Organized sports has also contributed to an epidemic of overuse syndromes
by putting pressure on kids to excel. How much is too much? There is
no easy answer. Some studies on certain sports have come out with data.
For example, young female gymnasts who train more than 16 hours a week
are known to have a significantly increased rate of injury. Young baseball
pitchers who do more than 350 overhand throws a week are liable to significantly
increased risk for injury. For most sports, however, there is no hard
data. And it behooves the enlightened coach (and parent) to be sensitive
to the needs and limitations of their young charges. The common sense
approach is to stop and rest when it hurts, but when "winning is everything",
common sense can be uncommon.
- Growth. Growth is a dynamic affair that during growth spurts, will
cause tightness of certain muscles and tendons, especially the hamstrings,
Achilles tendons and hip flexors. This creates extra tension on the
muscle-tendon junction as well as the attachments of the tendons and
muscles on the bone, which become more prone to injury. Also, the epiphyseal
plates or growth zones at the ends of long bones are prone to injury.
- Anatomic malalignment. Genu valgum or knock
knees can predispose a teenager to patello-femoral syndrome. Pes
valgus or flatfeet can predispose a runner
to posterior tibial tendinitis.
- Improper equipment. The child who uses a tennis racket that is meant
for an adult is predisposed to elbow tendinitis. The runner who uses
shoes that are not supportive or have enough cushion is predisposed
to shin splints. The basketball player who trains on concrete or asphalt
is more prone to plantar fasciitis.
- Nutritional and hormonal factors. Proper nutrition is essential for
growth as well as for energy necessary for participation in sports.
The young gymnasts who not only trains diligently, but also cuts down
of food to keep her "ideal body form" is prone to amenorrhea and injuries.
Physiological and bone age can be quite different from a child's chronological
age, and this has to be taken into consideration.
What can be done to prevent or minimize overuse injuries?
The following should be considered.
- Avoid overuse. As discussed above, use common sense, and tailor a
training program suitable for that child, taking into consideration
his maturity and athletic ability.
- Proper nutrition. Make sure child has enough nutrition for growth
- Pre-sports physical. Any anatomic malignment
should be corrected. For example, shoe inserts for pes valgus and genu
valgum. Any tight muscles or tendons, or muscle imbalance should be
corrected by stretching and strengthening exercises. For example, hamstring
and heel cord tightness should be corrected by stretching. Muscle imbalance
between the vastus lateralis and medialis (VMO) should be corrected
to prevent patello-femoral pain. Any systemic or other general health
problems should be addressed before the child participates in competitive
- Proper warmup and stretching exercises specific
to the sports before playing. Proper warmup could consist of 5 minutes
of jogging till one gets a slight sweat. Then 5 minutes of stretching
exercises would prepare the child for competition.
- Proper equipment. The runner should have shoes that have a firm and
padded heel cushion, flexible sole for bending at the forefoot when
running, and adequate cushioning. He should also train on soft running
surfaces rather than concrete or asphalt. The young tennis player should
be fitted for a racket that allows him to get a good grip on the handle.
for warmup and