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Overuse Syndromes

Overuse syndromes are difficult to diagnose and treat. These injuries are becoming increasingly common as both participation in sport in general and the intensity and duration of training increase. Although overuse injuries (stress fractures) were first documented as early as 1855, little research has
been done since, and today’s knowledge is based mainly on practical, clinical experience. Overuse injuries are generally caused by repetitive overloading, resulting in microscopic injuries to the musculoskeletal system. Tissues can withstand great loads but there is a critical limit to this capacity, which varies greatly between individuals and according to the frequency of load. Tissues may be made more susceptible to injury by intrinsic factors such as malalignment of the leg, muscle imbalance, and other anatomical problems, and extrinsic factors such as training errors, faulty technique, incorrect equipment and surfaces and poor conditions. The actual frequency of injury due to overuse is unknown, but it is estimated that 25–50% of athletes visiting sports medicine clinics have sustained an overuse injury. The age of occurrence of overuse injuries also varies: they are most common in  top-level athletes aged 20–29 years, but are also seen in noncompetitive athletes aged 30–49 years. In adults, overuse injuries are more prevalent after 2 years of regular daily training. Some sports carry a greater risk: 80% of overuse injuries are reported to occur in endurance sports such as long-distance running, or in individual sports requiring skilled technique and
repetitive movements, such as tennis, gymnastics, and weightlifting; of these injuries, 80% occurred in the lower extremities of the body, most frequently at the knee (28%) and at the ankle, foot, and heel (21%). For most overuse injuries, the underlying problem is an inflammatory response. Overuse injuries in tendons are often secondary to degeneration.

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