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  • Dori Nissenson

No Pain No Gain Doesn't Always Work!


Does your body hurt during exercise or sport? Do you have aches and pains in your muscles and/or joints before, during or after exercise or sport? If your answer to either of these questions is yes, then you may have an overuse injury.

In this day and age when we are all focused on physical well being and physical fitness, I am seeing a lot of overuse injuries in my practice... as many of us are just simply overdoing it... AND... I hate to say it, but we are all getting older and many of us have not modified our exercise or sport regime accordingly.

I had previously written a letter regarding overuse injuries in children playing team sports. In this letter, I will focus on adult overuse injuries, their symptoms, how to best manage them and how to best prevent them from occurring and recurring.


An overuse injury is any type of muscle or joint injury such as tendinitis or a stress fracture that is caused by repetitive stress.

Overuse injuries from sports are actually more common than acute sports injuries. Overuse injuries are subtle and usually occur over time which makes them challenging to diagnose and treat.

Common examples of overuse injuries are tech neck, tennis elbow, swimmer’s shoulder, runner’s knee, jumper’s knee, Achilles tendinitis, shin splints, and stress fractures. In subsequent newsletters I will discuss specific overuse syndromes in more detail regarding symptoms and management… stay tuned!!!


The human body has a great capacity to adapt to physical stress. Physical stress is simply exercise and activity and as we know both exercise and activity is beneficial for our bones, muscles, tendons, and ligaments.

Exercise and activity drives an internal process called remodeling. Remodeling is what makes our bones and soft tissue stronger and more functional. The remodeling process involves both the breakdown and build-up of tissue.

There is a fine balance between the two and if the breakdown occurs more rapidly than the buildup, an overuse injury occurs.


  1. The most common cause of overuse injuries are training errors. These errors involve rapid acceleration of the intensity, duration, or frequency of activity.

  2. Technique errors can also cause overuse injuries. Poor technique can take its toll on your body. If you are playing a sport or exercising with improper technique, every time you swing a golf club with poor technique or do a lunge with poor form, for example, you may overload your bones and soft tissue causing an overuse injury.

  3. Imbalances between strength and flexibility around certain joints may predispose some people to overuse injuries.

  4. Poor alignment can also impact overuse injuries. What I mean by this is the way you are naturally built. Often alignment issues like knock knees, bow legs, flat or high arched feet can contribute to overuse injuries.

  5. Weak links such as old injuries, incompletely rehabilitated injuries, or habitual poor postures can also impact overuse injuries.

  6. Overuse injuries are more likely to occur as we get older, especially if you don't modify your routine accordingly.

  7. Exercise equipment such as poor shoes can contribute to overuse injuries.

  8. Exercise environment such as hard versus soft surfaces, hilly and uneven surfaces can facilitate the development of overuse injuries.


If you think that you may have an overuse injury, the most important first step is to seek the help of a medical professional such as a Physical Therapist immediately.

Overuse injuries take a bit of time to treat and the sooner you get started on a program of PT, the faster you will be able to return to your exercise routine or sport.

Your physical therapist will perform a detailed assessment of your muscles, joints and your body alignment and will then create a treatment plan that may include the following:

  1. instruction to rest and/or cut back on the intensity, duration or frequency of the activity that is causing the pain

  2. gentle soft tissue and joint mobilization (unless contraindicated) for pain relief and to facilitate blood flow to the injured area for faster healing

  3. modalities such as ice and electrical stimulation to relieve pain and facilitate the healing of the overused structures

  4. stretching tight musculature that may be either causing the overuse injury or placing undue stress on the bones and joints and perpetuating the overuse injury

  5. bracing, taping and/or fabrication of orthotics to provide external support to the painful joints or muscles during healing

  6. strengthening weak muscles (once your pain is gone) in order to prevent re-injury and allow the muscles to be able to withstand your level of activity

  7. education on proper shoewear, gear, cross-training and warming up and cooling down before and after exercise and sport

  8. education in modification of your exercise or sport regime to allow maintenance of your fitness level while you recover from your injury

Your physical therapist will advise you when it is safe to return to your exercise regime or sport.


Overuse injuries can be prevented with proper training AND common sense. Listen to your body and if something doesn't feel good, DO NOT keep doing it.


Here are some helpful tips for avoiding the development of overuse injuries:

  1. When beginning a new training regime, use the 10% rule which states that you should not increase your training or activity more than 10% each week. This allows your body adequate time for recovery and response. This applies to mileage with runners and walkers and weights in strength training programs.

  2. Warm-up and cool down appropriately.

  3. With sport training, incorporate strength, flexibility training and core work to minimize overuse injuries.

  4. Use proper form and gear. With a new sport, take a lesson to learn correct technique as this is essential in avoiding the development of an overuse injury. Try to avoid old and worn out equipment such as running shoes.

  5. Try mixing it up. Instead of focusing on one type of exercise, build variety into your fitness program. Incorporating a variety of low-impact activities such as walking, biking and swimming can help prevent overuse injuries by allowing you body to use different muscle groups and not overload any one particular group.

Don't allow an overuse injury to prevent you from being physically active. By working with your physical therapist and listening to your body and pacing yourself, you can avoid setbacks due to overuse and safely do what you love!

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