Chiswick-Physio BLOG


What Is An Overuse Injury?
Plantar Fasciitis Stretch

A brief explanation of overuse injury

An overuse injury occurs when a particular body part is subjected to repeated stress or strain without sufficient recovery time. This can occur in tissues like muscles, tendons, bones, and ligaments. After exercise, tissues adapt to become stronger. An overuse injury occurs when tissues don’t have enough time to adapt before the next workout, resulting in cumulative tissue damage that exceeds the tissue’s threshold, causing pain and dysfunction.

Overuse injuries are caused by repetitive stress on tissues and can result in acute or chronic conditions. They can be caused by both intrinsic (individual-related) and extrinsic (external) factors. Understanding the interplay between these factors is important to effectively prevent and manage these injuries.

Types of overuse injuries

Overuse injuries are categorised as acute or chronic.

Acute overuse injuries occur suddenly due to a specific event or activity. Such injuries can happen when an activity’s intensity, duration, or frequency is abruptly increased, leading to tissue damage.

Chronic overuse injuries result from repeated movements or actions that cause stress or strain on a particular body part. They usually occur due to overtraining or poor biomechanics. Chronic overuse injuries are harder to treat compared to acute injuries and may require a longer recovery period.

Risk factors in Overuse Injuries

The cause of overuse injury is often MULTIFACTORIAL and can involve extrinsic and intrinsic factors; these include:

Intrinsic risk factors: These risk factors result from an individual’s genetics, age, flexibility, body alignment, muscle imbalances, and past injuries. These factors affect how the body reacts to stress and can impact injury susceptibility. They guide injury prevention and management.

Extrinsic risk factors: External factors include training intensity, footwear, the training surface and environmental conditions. Identifying and modifying these factors can reduce injury risks and promote safe and effective training for athletes and active individuals.

The most common types of overuse injuries

The 7 Most Common Overuse Injuries that we see at Chiswick-Physio are:

  1. Achilles Tendinopathy
  2. Runner’s Knee (PFPS)
  3. Tennis Elbow
  4. Shoulder Impingement (Subacromial pain)
  5. Peroneal tendinopathy
  6. Plantar Fasciitis
  7. Iliotibial band syndrome (ITBS)

Achilles Tendinopathy

Achilles tendinopathy, also known as Achilles tendinitis, is an overuse injury affecting the Achilles tendon, which connects the calf muscles to the heel bone.

Achilles tendinopathy presents with the following signs and symptoms

  • Mild ache or pain in the mid portion of the Achilles tendon or where it inserts into the heel bone.
  • Morning stiffness, can improve with mild activity such as walking.
  • Swelling or thickening of the tendon.

To prevent Achilles tendinopathy, consider the following prevention strategies:

  • Gradually increase exercise intensity and duration to avoid sudden overloading of the tendon.
  • Incorporate regular stretching and strengthening exercises for the calf muscles and Achilles tendon.
  • Ensure proper footwear with support and cushioning, especially during physical activities involving running or jumping.

Treatment for Achilles tendinopathy may include:

  • Temporarily reduce or modify activities that exacerbate symptoms.
  • Following a structured 4-step tendon rehab programme.
  • Exercises to strengthen the calf muscles and improve flexibility.
  • Modalities, such as Shockwave Therapy.
  • Taping or orthotic inserts can help alleviate stress on the Achilles tendon.

An accurate diagnosis and tailored treatment plan for Achilles tendinopathy can significantly improve outcomes and reduce the risk of recurrence.

Runners Knee (PFPS)

Runner’s knee, also known as patellofemoral pain syndrome (PFPS), is a common injury that affects both male and female runners. This condition is often associated with an imbalance in the muscles supporting the knee and mechanical errors that result in poor knee mechanics.

Common signs and symptoms include:

  • Pain behind or around the kneecap, especially when running, going up or down stairs, or sitting with knees bent for a prolonged period.
  • Swelling or a sensation of grinding or popping in the knee joint during movement.
  • Increased pain or stiffness standing from sitting or during activities that load the knee joint, such as squatting or lunging.

To prevent runners’ knee, consider the following prevention strategies:

  • Avoid sudden increases in training intensity or duration and gradually build up mileage, intensity, or frequency of workouts to allow your body time to adapt and strengthen.
  • Losing weight if needed.
  • 3D gait analysis to help you improve your running form and reduce the risk of injury.
  • Cross-training and strengthening exercises that promote overall strength and flexibility, particularly targeting the muscles around the hips, thighs, and knees.

Treatment for Runner’s knee may include:

  • Temporarily reduce or modify activities that aggravate symptoms, such as running, kneeling, or prolonged sitting, to allow the knee time for recovery.
  • Exercises to strengthen the muscles around the hip, knee and ankle to correct biomechanical issues contributing to the condition.
  • Orthotic devices and supportive footwear can help redistribute pressure, reducing stress on the patellofemoral joint.

Runner’s knee can impact performance and well-being. Early recognition, treatment, and addressing underlying biomechanical causes are crucial for recovery.

Tennis Elbow

Tennis elbow, or lateral epicondylitis, is a painful condition of the tendons that attach to the bony prominence on the outer side of the elbow. It typically results from repetitive overuse or strain of the forearm muscles and tendons.

Common Signs and symptoms include:

  • Pain and tenderness felt on the outer side of the elbow, specifically around the bony bump identified as the lateral epicondyle.
  • Pain that worsens when gripping, lifting, shaking hands, or rotating the forearm, such as turning a doorknob.
  • Weakness in the affected arm, especially during activities requiring a fist or wrist movement.

To prevent tennis elbow, consider the following prevention strategies:

  • Use proper technique and equipment well-suited to your skill level and body mechanics when participating in sports or activities involving repetitive arm movements.
  • Gradually increase activity intensity and duration to prevent sudden tendon strain.
  • Stretching and strengthening exercises can improve muscle balance, flexibility, and resilience in the forearm, wrist, and shoulder muscles.

Treatment for Tennis Elbow may include:

  • Reduce or modify activities that worsen your elbow symptoms. This will give your affected tendons time to heal.
  • Exercise to correct biomechanical issues, strengthen forearm and shoulder girdle and improve flexibility.
  • Use braces or straps to reduce strain on your tendons during activities.
  • Make ergonomic adjustments to your equipment or workspace to help alleviate stress on the affected area.

With appropriate treatment and preventive measures, individuals can achieve full relief and prevent the recurrence of Tennis Elbow.

Shoulder Impingement (Subacromial pain)

Subacromial pain syndrome, previously known as shoulder impingement, is a common overuse injury affecting the shoulder.

Key signs and symptoms include:

  • Pain originating in the shoulder and spreading down the upper arm towards the elbow. It is commonly triggered by certain movements or activities, such as lifting the arm above shoulder height or reaching behind the back.
  • Difficulty lying on the affected shoulder, causing sleep disturbance.
  • The pain may vary from a dull ache to a sharp shooting sensation.

To prevent subacromial pain, consider the following strategies:

  • Incorporate exercises to strengthen the shoulder muscles and improve upper back flexibility. These include lateral rotation, isometric loading and rowing exercises.
  • Gradually increase the intensity and duration of activities involving the shoulder, allowing adequate time for rest and recovery between sessions to prevent overuse.
  • Incorporate various exercises and activities into your routine to avoid repetitive stress on the shoulder. Cross-training can help strengthen different muscle groups while giving the shoulder a break from constant strain.

Treatment for subacromial pain may include:

  • Muscle-strengthening exercises focusing on the rotator cuff and mid-back muscles can help prevent shoulder joint injuries.
  • Proper technique and ensuring correct form during activities and sports that involve the upper limb can minimise unnecessary stress on the shoulder.
  • Activity modification and adjustment of certain activities to avoid movements exacerbating shoulder pain.

Subacromial pain syndrome is a manageable condition with early intervention and adherence to recommended therapies shown to improve outcomes and reduce the impact on individuals’ lives.

Peroneal Tendinopathy

Peroneal tendinopathy, or peroneal tendonitis, is an overuse injury that affects the tendons on the outer side of the ankle.

Peroneal tendinopathy presents with the following signs and symptoms:

  • Pain along the outer edge of the foot and ankle, particularly behind the lateral malleolus (the bony prominence on the outer side of the ankle).
  • Swelling or tenderness over the peroneal tendons, which run behind the lateral malleolus and along the foot’s outer side.
  • Weakness or instability in the ankle, especially during activities that involve eversion (outward rolling) of the foot or pushing off the ground.

To prevent peroneal tendinopathy, consider the following prevention strategies.

  • Wear shoes that provide adequate support and stability for your foot type and activity level.
  • Avoid sudden increases in training, and gradually build strength and flexibility in the ankle and lower leg muscles.
  • Engage in exercises to strengthen the muscles around the ankle and improve balance and proprioception to reduce the risk of injury. These include calf raises, ankle dorsiflexion, plantarflexion, and single-leg balance drills.

Treatment for peroneal tendinopathy may include:

  • Temporarily reduce or modify activities that aggravate lateral ankle symptoms.
  • Engage in exercises to strengthen the peroneal muscles and improve flexibility.
  • Correct biomechanical issues and assess gait form with a 3D Running Gait analysis.
  • Utilise orthotic inserts, ankle braces, or supportive footwear to help support the lateral ankle.

Excessive loads can cause peroneal tendinopathy. A multifaceted strategy that includes education, strengthening, and support is needed to treat it optimally.

Plantar fasciopathy

Plantar fasciopathy, previously known as plantar fasciitis, is a condition characterised by pain in the plantar fascia, a band of tissue on the sole of the foot that connects the heel bone to the toes.

Common Signs and symptoms include:

  • The primary symptom is a deep aching pain at the base of the heel, which can spread into the foot.
  • The pain may be particularly severe in the mornings, especially on the first steps out of bed, which usually improves within several minutes.
  • Symptoms may also occur during and after long periods of walking or getting up after being seated.

Preventative strategies for plantar fascia pain may include:

  • Wear supportive shoes with good arch support and cushioning, especially during prolonged standing, walking, or running activities.
  • Incorporate stretching exercises for the calf muscles to improve flexibility and reduce plantar tension.
  • Strengthen the muscles of the foot and lower leg to support the arch and absorb shock during movement.
  • Avoid sudden increases in activity intensity or duration, and gradually build up mileage or intensity to allow the foot and plantar fascia to adapt.

Treatment may include:

  • Stretching the plantar fascia and calf muscle helps relieve tension, reduce strain on the fascia, and promote healing in plantar fasciitis.
  • Strengthening exercises to improve foot, calf and lower limb muscle support, reducing stress on the plantar fascia and aiding in the rehabilitation of plantar fasciitis.
  • Other modalities and treatment options for plantar fascial irritation include Shockwave, taping of the foot and off-the-shelf orthotics.

Following the 4-stage continuum of tendon loading can achieve a full recovery from Plantar fasciotomy.

For more information, look at our blog: What is Plantar Fasciitis?


Iliotibial band syndrome (ITBS)

Iliotibial band syndrome (ITBS) affects the iliotibial band, a thickened band of deep fascia that runs down the lateral (outside) aspect of the leg, from the hip to the knee.

ITBS presents with the following signs and symptoms:

  • Sharp pain, burning, or ache on the outside of the knee may spread down the leg and occasionally up towards the hip.
  • Tenderness to touch on the bone on the outside of the knee
  • Pain worsens with repetitive activities, such as running downhill, walking downstairs, or repeatedly bending the knee.
  • Pain may initially go away after warming up, but over time, it may worsen as exercise continues.

To prevent ITBS, consider the following prevention strategies:

  • Engage in regular stretching and strengthening exercises for the hip, gluteal, inner quadricep (thigh), and core muscles to improve flexibility and stability.
  • Increase mileage or intensity of activity gradually to avoid sudden strain on the iliotibial band and allow for adequate rest and recovery between workouts.
  • Ensure proper running or cycling technique and consider 3D Gait analysis.

Treatment for ITBS may include:

  • Treatment should aim to first calm symptoms, rest from the aggravating activity and engage in alternative exercises that reduce the load on the iliotibial band.
  • The ITB cannot be stretched; therefore, treatment should not focus on stretching.
  • Strengthen: Loss of strength and control around the hip are considered key in developing ITBS, especially weakness in hip abduction and external rotation.

Successful treatment of ITBS requires a multipronged approach with complete recovery if a progressive strengthening programme is followed.

For more information, look at our blog: What is Iliotibial Band Syndrome?

Importance of seeking treatment for overuse injuries

It is crucial to seek treatment for overuse injuries to prevent long-term complications and chronic conditions. An accurate diagnosis is essential to target interventions and reduce the risk of exacerbation. Early treatment can address underlying issues and promote faster recovery, preventing injury recurrence. Ignoring overuse injuries can lead to worsened conditions, chronic pain, decreased mobility, and functional limitations. Timely intervention can minimise the need for invasive procedures and long-term disability, ultimately enhancing overall quality of life.


In conclusion, overuse injuries are common among athletes and individuals who engage in repetitive activities. These injuries can have a significant impact on daily life and athletic performance, ranging from subacromial pain to plantar fasciitis. However, many overuse injuries can be effectively managed through proper understanding, prevention, and treatment.

Emphasising the importance of gradual training progression, adequate rest, and a consistent strengthening program can help prevent overuse injuries from occurring. Moreover, early intervention, including proper diagnosis and targeted rehabilitation exercises, minimises the risk of long-term complications and chronic conditions. By prioritising proactive measures and seeking early treatment, individuals can safeguard their health, optimise athletic performance, and enjoy an active lifestyle for years.

Overuse Injury FAQs 

What is the most common overuse injury?

The most common type of overuse injuries is tendon-related. These injuries occur when tendons, the tissues connecting muscles to bones, undergo repetitive stress, leading to the breakdown of the tendon tissue and discomfort. Common examples include Achilles tendinitis, which affects the tendon at the back of the ankle, and tennis elbow, which impacts the tendons in the elbow region.

What does an overuse injury feel like?

An overuse injury typically manifests as persistent pain, tenderness, and stiffness in the affected area. It may also involve swelling, weakness, and fatigue during or after activity. These symptoms can vary in intensity and onset and often worsen with continued stress on the injured tissue.

How long does it take for an overuse injury to heal?

The healing time required for an overuse injury can vary significantly based on several factors, such as the severity of the injury, individual recovery rate, and treatment adherence. Typically, the average recovery time can range anywhere from six weeks to as long as twelve months. Therefore, seeking professional advice and being proactive in your rehabilitation programme as early as possible is imperative. Ignoring your symptoms will only worsen the situation. The key message is to remain patient and invest in the process. Although it may take a long time, following the correct advice will get you there.

What is the difference between a traumatic and an overuse injury?

Traumatic injuries are those that occur suddenly and are caused by external forces, while overuse injuries develop gradually over time due to repetitive stress. Traumatic injuries tend to cause immediate pain and dysfunction, while overuse injuries manifest as persistent discomfort over a period of time. Both types of injuries require appropriate management for optimal recovery and to prevent long-term complications.

How many stages of an overuse injury are there?

There are four progressive stages of an overuse injury that worsen if left untreated:
Stage 1: Discomfort that disappears during warm-up.
Stage 2: Discomfort that may disappear during warm-up but resurfaces at the end of the activity.
Stage 3: Pain that worsens during the activity or makes you stop or skip exercising.
Stage 4: Pain present with normal daily activity is constant, leading to a complete inability to exercise.

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