Overuse Injuries: Situational Cause and Effect

Just the title of this article will have people calling it out of date and linguistically incorrect. As evidence begins to pile up with a conclusive directive toward tissue load tolerance and a particular time lapse between the period of initial pain onset and preliminary medical health consultation. There is a growing trend toward naming the once touted overuse injuries as “Training Error” injuries, and in those performing athletic or artistic feats this may just be appropriate when contact and “moment in time” incidents have been ruled out.
But what about your average punter?
What about your client who removes themselves from physical activity altogether and presents with the same conditions as those who are involved in sport at an elite level? How do you explain them that this has clearly been brought on by a “Training Error”?  Aside from saying you have this issue because you don’t train at all, and there lies your training error.

For those who are interested in the athletic side of load management a recent article which has been quite popular can be found here: https://footnotesblogging.com/2017/02/28/prevention-vs-performance-managing-demands-of-elite-athletes/

So, Jackson, if not an overuse injury and not a training error injury, and patient biomechanic abnormalities are only risk factors but not enough to predict an injury then how on earth do we explain to a patient how their issue came about and why our management is aimed at addressing areas not directly at the spot of where their pain coming from.

Quite simply with another label…. Tissue Load Intolerance. Quite simply dear patient, the load you have placed through the tissues associated with the affected area have been too much for those tissues to tolerate, and as a result you now have an injury.
The load you have placed through those tissues may have been for a number of reasons;


Biomechanics Training Technique Tissue Tolerance


Range of Motion Frequency Foot Strike Strength Weight
Kinematics Intensity Foot Placement Power Diet
Kinetics Duration Stride Length Endurance Activity Level
Distal Type Stride Rate Movement Specific Excessive Alcohol
Proximal Chronic Period Triple Extension Task Specific Drug Use
Chain Influence Acute Period Proximal Movement Medications/ Medical Condition Previous Injury History

What should be taken away from this article, or rant however you look to interpret it is that labels should be taken with a grain of salt and not used to broadly cover a group of injuries or simplify a process you as practitioner to beyond the comprehension of your client. Education of patients is important! If patients have only been shown to remember a small percentage of that verbally communicated during a consult, then make sure you have printed or electronic copies of the information available for the patient to review at their own leisure.
Otherwise, how “informed” is your informed consent?

Until Next Time

Jackson McCosker
Director/ Chief Editor



Clarsen, B., Bahr, R., Heymans, M., Engedahl, M., Rosenland, L., Thorsen, G., & Myklebust, G. (2014). The Prevalence and Impact of Overuse Injuries in Five Norweigian Sports: Application of a New Surveillance Method. Scandinavian Journal of Medicine & Science In Sports, 1 – 8.

Goossens, L., Verrelst, R., & Cardon, G. (2013). Sports Injuries in Physical Education Teacher Education Students. Scandinavian Journal of Medicine and Science in Sports.

Hawke, F., Burns, J., Radford, J., & du Toit, V. (2008). Custom- Made Foot Orthoses For The Treatment of Foot Pain (Review). Cochrane Library.

Rome, K., Handoll, H., & Ashford, R. (2005). Interventions For Preventing and Treating Stress Fractures and Stress Reactions of Bone of the Lower Limbs in Young Adults (review). Cochrane Library.

Seay, J. (2015). Biomechanics of Load Carriage – Historical Perspectives and Recent Insights. Journal of Strength and COnditioning is Research, 129 – 133.

Yeung, S., Yeung, E., & Gillespie, L. (2011). Interventions For Preventing Lower Limb Soft-Tissue Running Injuries (Review). Cochrane Library.


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