Overuse Injuries: The Four Stages

The Four Stages of Overuse Injuries

Overuse injuries can occur in any part of the musculo-skeletal system. It doesn’t matter where the injury is, if it’s an overuse injury, the progression of the injury can be broken down into four stages. 

  • Discomfort that you feel during the warm up only
  • Discomfort that disappears as you warm up. It might come back again at the end of your training session
  • Discomfort that gets worse during the training session, and may become real pain
  • Pain or discomfort which you feel all the time, or nearly all the time, to varying degrees

When you exercise, you apply stress to your body. The body gets fitter, by adapting to this stress, by thickening and strengthening the tissues worked in training. So, muscles get firmer and stronger, tendons get stronger, bone gets denser. All good things, for the most part.

If you don’t allow your body enough time to recover, then adaptation cannot occur. Too much overload can lead to injuries and inflammation, the body’s response to injury. How much overload is too much? That’s a very individual thing, and will depend on your current fitness level, past history of injuries and how they have been treated, and how well your body recovers from individual exercise bouts.

Guidelines for running with and managing an overuse injury

If you’ve been experiencing pain or discomfort for more than a week, I’d strongly advise you to see a physiotherapist. Depending on the type of pain, or where it is, you should seek advice sooner.

  • Any pain in your calf which is associated with a buildup of fluid in your lower leg, and/or the lower leg feeling warm to the touch, should be taken to a doctor to rule out deep vein thrombosis.
  • Any pain associated with jaw, neck, shoulders and arms, particularly down the left side should also have you on your way to the doctor, to rule out heart problems!

Before we get back to your ordinary everyday garden variety overuse injury, if you’re wondering if you should run when you have a cold or other illness, you should see this article.

Having said you should consult a physio for treatment for an overuse injury, here are a few basic guidelines you can follow to determine whether or not you should quit training for a while.

Stage One

You can continue activity, as long as the condition doesn’t get worse. Keep in mind that without professional help, it may not get any better either. A physio can guide you as to what you should be doing to prevent the injury from worsening, or coming back once it’s better.

Stage Two

You can keep training if you have a stage two soft tissue injury, but your training will need to modified to a pain free level whilst the injury is being treated. For example, when I was training for my first half marathon, I developed bursitis in my hip. The pain only came on at about the 14km mark in my long runs, so for a while, I didn’t run any further than 14km. When the pain hit, I stopped.

Stage Three

If you let your overuse injury progress to stage three, you need to stop training for a while, and definitely seek treatment. You’ll probably be able to continue with some kind of cross training that does not aggravate the injury

Stage Four

You’ll need to stop training, and quite likely stop some of your daily activities which aggravate the injury. You need treatment, no ifs, no buts – and that doesn’t mean you wait till after the race to seek treatment  because you’re scared of being told not to race!

Remember that overuse injuries can occur through doing too much of ANYTHING. It’s not always the result of massive amounts of training. Many repetitive strain injuries are the result of working for too long in one position, not having breaks, and doing the same task over and over again, day in day out – think mouse use and typing, driving. I gave myself an ITB problem by sitting at my desk with my legs crossed for too long. I was doing very little running at the time, so it definitely wasn’t a running injury. The morning I woke up with it I was off to the physio immediately, and a few agonising massages later, I was back on track .

So, be on the lookout for overuse injuries which might result from your every day tasks, as well as your specific training and exercise program.


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