Overuse injuries in sport: when training exceeds capacity
Not every sports injury happens with a tackle, fall or awkward landing.
Some build gradually.
An athlete may notice a tendon becoming sore after training, a joint starting to ache during longer sessions, or a muscle that never quite settles between games. There may be no single moment when the injury occurred.
In these situations, one of the questions we often need to ask is simple:
Has the amount of load placed on the tissue started to exceed what it can currently tolerate?
That is the basic idea behind many overuse injuries.
The problem is not always that someone has done something “wrong”. Sometimes training has increased too quickly. Sometimes recovery has not kept pace. In other cases, technique, equipment, surfaces or the demands of several sports at once all contribute to the load being placed on the body.
What is an overuse injury?
An overuse injury develops when repeated physical stress builds faster than the body can adapt to it.
Muscles, tendons and joints are designed to respond to load. Training is one of the ways we make tissues stronger.
The difficulty comes when the intensity, duration or total volume increases more quickly than the tissue can condition itself for.
That can happen suddenly.
A runner may add substantially more kilometres in one week. A footballer may move from pre-season into several intense sessions and matches. A swimmer may rapidly increase training volume before an event.
But it can also happen more quietly.
Someone may build each part of their training sensibly, yet the combined weekly workload is still greater than their recovery capacity.
This is why overuse injuries are not always obvious at first.
The hidden problem of training load
One of the most common contributors we see is an abrupt increase in training.
The body needs time to adapt to higher intensity, longer duration and greater overall volume.
When that increase happens too quickly, the tissue may not yet have the capacity to manage it.
That does not necessarily mean the training itself is inappropriate.
The issue may simply be timing.
A good example is an athlete who has trained two or three times a week for months, then suddenly adds extra sessions, games, running or gym work within a short period.
Each session might be reasonable in isolation.
Together, they may represent a significant increase in total load.
Multi-sport teenagers can be particularly vulnerable
This is something I often see with teenagers who are involved in several sports at the same time.
A young athlete may have school sport, club training, representative commitments and perhaps another sport altogether. Each coach may be managing their own program sensibly, but those programs do not necessarily communicate with each other.
The football coach may see two training sessions and a game. The school sees another training session and match. A representative program may add further sessions or tournaments.
For the athlete, all of that becomes one total workload.
I particularly notice problems when seasons overlap, finals approach or representative commitments increase. The individual programs may still look reasonable, but the combined training load can rise very quickly and leave less time for recovery.
That is why managing an overuse injury in a young athlete often means looking at their entire week, not just the sport in which the symptoms first appeared
Overtraining and overuse are related, but not identical
The terms are sometimes used interchangeably, but there is a useful distinction between them.
An overuse injury usually refers to a particular tissue becoming irritated or overloaded through repeated stress.
Overtraining is broader.
Even when training volume has been increased gradually, problems can still develop if the overall amount of training is too high and recovery is insufficient.
For an athlete, the important question is often not simply “Am I training too much?” but:
Am I recovering sufficiently for the amount of training I am doing?
That balance can change during the season.
Finals, tournaments, extra representative sessions or a sudden increase in competition can shift what was previously a manageable schedule into one that is much harder to recover from.
Excessive training combined with inadequate recovery can be one contributor to sports injury.
Technique can change where the load goes
Training volume is not the only factor.
How an athlete performs a movement can also affect where stress is concentrated.
This can show up in many different sports:
- running with a suboptimal gait
- swimming with poor form
- fielding high catches in football
- poor tackling technique in rugby
- serving technique in tennis
- batting or bowling mechanics
The important point is not that there is one perfect technique for every athlete, but that repeated movement performed with insufficient strength, range of motion or control may place excessive load on a particular tissue.
For some athletes, technique becomes one of the modifiable factors worth addressing as part of rehabilitation.
Preparation matters before training even begins
The way an athlete prepares for sport can influence how well the body handles the session.
Warm-up, mobility and muscle activation all form part of getting the body ready for higher-speed or higher-load movement.
Hydration and nutrition can also be relevant factors.
If an athlete is poorly fuelled or inadequately hydrated, fatigue can develop earlier.
As fatigue increases, movement quality and the ability to tolerate repeated loading may change.
This does not mean every overuse injury can be explained by warm-up or nutrition.
It means these factors are part of the broader picture when we are trying to understand why the injury developed.
Equipment and surfaces can add to the problem
Footwear and equipment also affect how load is distributed.
This may include running shoes, tennis footwear, football studs and even whether sporting equipment such as a cricket bat fits the athlete appropriately.
The surface matters too.
Repeated training on very hard ground may expose the body to different loads from softer surfaces.
Slippery or uneven ground can create different problems again.
For footballers, the studs that work well on dry ground may not be ideal in wet conditions.
For runners, a change in surface combined with increased training volume may add another layer of stress.
Again, these factors rarely sit in isolation.
An overuse problem is often the result of several smaller influences adding together.
Overuse injuries are often more complicated than finding one thing that went wrong.
In practice, I often find that several smaller factors have combined.
A runner may have increased training slightly, changed footwear and added more hills. A teenager may have started representative sport just as club finals begin. A tennis player may be training more frequently while also working through a serving technique issue.
None of those factors necessarily explains the injury on its own.
Together, however, they can increase the amount of stress placed on a tissue until the load becomes greater than it is currently conditioned to tolerate.
This is why assessment involves identifying the possible contributors and then working out how much influence each one is actually having. Training volume may be the main issue in one athlete, while movement mechanics or recovery may matter more in another.
Not every possible factor needs to be changed. The focus is on the controllable issues most likely to make a meaningful difference.
The injured tissue still matters
Even when training load is clearly part of the story, we still need to know what has actually become injured.
I place emphasis on accurate diagnosis of the “victim tissue.”
That may be a muscle, tendon, ligament, joint, bone or neural tissue.
This matters because different tissues respond differently to load and have different rehabilitation requirements.
A tendon overload problem is not managed exactly the same way as a joint injury.
A muscle problem is not automatically progressed in the same way as a neural presentation.
Understanding the tissue helps guide how quickly load can be reintroduced and what type of rehabilitation is appropriate.
That same principle underpins our broader physio for sports injuries service.
How physiotherapy approaches an overuse injury
When I assess an overuse injury, one of the first things I want to understand is what changed before the symptoms started.
That could be a sudden increase in training volume, more competition, overlapping sporting commitments, reduced recovery, a technique change, different footwear or a change in the surface being used.
We then look at the tissue involved, movement, strength, range of motion and the demands of the athlete’s sport.
The aim is to distinguish between the tissue that has become painful and the factors that may have contributed to overloading it.
Treatment may initially help settle pain and irritation, but rehabilitation then needs to rebuild capacity. This can include progressive strengthening, movement retraining, load management and gradual exposure to the movements that previously aggravated the problem.
Depending on the presentation, manual therapy, dry needling, Mulligan Mobilisation with Movement or neurodynamic techniques may also be used.
The important part is that treatment does not stop at settling symptoms. The contributing factors and the demands the athlete needs to return to remain part of the rehabilitation plan.
Why simply resting is not always the full answer
Reducing load can sometimes help an irritated tissue settle.
But if the athlete simply rests until the pain disappears and then immediately returns to the same training volume, the original problem may still be there.
The tissue may also have lost some conditioning while training was reduced.
That is why rehabilitation generally needs to include a progressive return to load.
The athlete has to rebuild enough capacity for the demands of the sport.
This might involve modified training first, followed by increasing volume, intensity and sport-specific movement over time.
The goal is not simply to become pain-free at rest.
It is to prepare the athlete for training and competition again.
Return to sport starts before full return to play
Sports rehabilitation is rarely a simple jump from being injured to being fully back.
Modified training can often form an important bridge between the two.
As the injured tissue becomes more capable, sport-specific movement can gradually return. That might include running patterns, swimming technique, jumping and landing, tackling, serving, throwing or drills specific to the athlete’s position.
Training volume, intensity and contact can then be increased progressively rather than all at once.
Where appropriate, communication with coaches and trainers can also help make sure the athlete’s current limits and progression are understood.
I particularly enjoy this later stage of rehabilitation because it is where the athlete starts moving beyond exercises and back towards the things that make their sport feel familiar again.
The goal is not simply to be comfortable in the clinic. It is to build enough capacity and confidence for successful return to training and, ultimately, competition
Young athletes need the whole workload considered
For growing athletes, this becomes particularly important.
Young people are often trying to manage rapidly changing bodies while also deciding which sports they want to pursue.
They may compete across different age groups or representative levels and be pulled in several directions at once.
Looking only at one team’s training plan can miss the bigger picture.
Rehabilitation may therefore involve helping the athlete and family understand the combined physical load across school, club, representative sport and other activity.
The aim is not necessarily to remove sport.
It is to manage the demands more effectively while the athlete builds the capacity to tolerate them.
Overuse injuries can follow the local sporting seasons
Around Aldinga and the southern region, I see a noticeable seasonal pattern in the sporting injuries that come through the clinic.
Summer brings more activity along the coast, including swimming, stand-up paddleboarding, surfing and Surf Life Saving. These sports place very different repetitive demands on the shoulders, spine and lower limbs.
Winter shifts the picture towards football and netball through the Southern and Great Southern leagues, where training volume, running, jumping, change of direction and contact all contribute to the overall load on athletes.
Running continues throughout the year. We see people preparing for and recovering from events such as the Great Southern Half Marathon, Great Southern Bolt, McLaren Vale Running Festival, Victor Harbor Half Marathon, Heysen Trail Ultra and trail events around Kuitpo Forest and Mount Bold.
These local patterns are another reminder that an overuse injury needs to be understood in the context of the athlete’s actual sport, training cycle and time of year, rather than treated simply as an isolated painful tissue.
What can help reduce the chance of another overuse injury?
There is no way to remove every sports injury risk.
But some contributing factors are modifiable.
Depending on the athlete, that may involve:
- building training volume more gradually
- allowing sufficient recovery
- considering total workload across several sports
- improving strength or range of motion
- addressing sport-specific technique
- reviewing footwear or equipment
- considering the surfaces used for training
- progressing back to competition rather than jumping straight from rest to full load
The most useful changes are usually the ones that relate directly to why that particular injury developed.
Overuse injury physiotherapy in Aldinga
If a sports injury has developed gradually or keeps returning as training increases, Aldinga Bay Physio can assess the injured tissue and look at the factors that may be contributing to the problem.
We work with school-aged athletes, club players, recreational competitors and people who simply want to keep participating in the sport they enjoy.
You can learn more about physio for sports injuries in Aldinga, or book an appointment to have your injury assessed.
For knee-related symptoms, you can also read about physio for knee pain and our guide to the causes of knee pain.