Overuse sports injuries: PREDISPOSING FACTORS

'During training, I suffered a stress fracture. It was madness that I carried on and ran the 800 metres and 1500 metres, but because it's the Olympics, you run through the pain. You never know if you'll have another chance at the Olympics, so unless you can't actually walk you carry on, because you don't want to be asking yourself, 'What if?'

Dame Kelly Holmes, MBE, DBE, 800 and 1500 m gold medallist, Athens 2004 Olympic Games

Overuse injuries present 3 distinct challenges to the clinician - diagnosis, understanding of why the injury occurred and treatment. Diagnosis requires taking a comprehensive history of the onset, nature and site of the pain along with a thorough assessment of potential risk factors e.g. training and technique. Careful examination may reveal which anatomical structure is affected. Often it is helpful to ask patients to perform the movement that produces their pain.

The cause may be quite evident, such as a sudden doubling of training quantity, poor footwear or an obvious biomechanical abnormality, or it may be more subtle, such as running on a cambered surface, muscle imbalance or leg length discrepancy. The causes of overuse injuries are usually divided into extrinsic (e.g. training, surfaces, shoes, equipment and environmental conditions) and intrinsic (e.g. age, gender, malalignment, leg length discrepancy and muscle imbalance) factors. A more comprehensive list of predisposing factors is shown in the diagram below.

Treatment of overuse injuries will usually require addressing of the cause as well as specific additional elements such as activity modification, specific exercises to promote tissue repair, soft tissue therapy and pharmacologic agents where appropriate.

REFERENCES Brukner, P., 2012. Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill.