Overuse Running Injuries: Causes, Physiology & Recovery

Overuse injuries are a common but preventable issue in both amateur and elite sport. Despite being well documented in the literature, there remains a lack of consensus on exactly how and why they occur.

By Colm O'Rourke

Last updated: July 30th, 2025

Contents of Article

• Summary

• What are overuse injuries?

• How do overuse injuries occur?

• Risk factors for overuse injuries

• How can overuse injuries be prevented?

• Are overuse injuries different from acute injuries?

• Common overuse injuries in sport

• Benefits of Sport Massage

• What future research is needed?

• References

• About the Author

Summary

Overuse injuries account for a large portion of injuries seen in sport – particularly in endurance and youth athletes. These injuries develop gradually over time, typically due to repetitive stress without adequate recovery. While the mechanisms are multifactorial, poor load management, inadequate technique, lack of strength or mobility, and insufficient recovery strategies are often key contributors.

Overuse injuries are challenging to detect in their early stages and, if ignored, can lead to long-term absence from sport. Prevention through proper education, load monitoring, and individualised programming is essential.

What are overuse injuries?

Overuse injuries are injuries that develop gradually due to repetitive microtrauma to tissues such as muscles, tendons, bones, or joints. Unlike acute injuries, which occur from a single traumatic event (like a sprained ankle or broken bone), overuse injuries build up slowly over time, often without a specific incident (1).

Examples include:

• Patellofemoral pain syndrome (knee)

• Achilles tendinopathy (ankle)

• Medial tibial stress syndrome (shin splints)

• Rotator cuff tendinopathy (shoulder)

• Stress fractures (bone)

How do overuse running injuries occur?

The human body has a remarkable ability to adapt to physical stress through a process called remodelling. However, when the stress applied exceeds the body’s ability to recover,

injury risk increases. Overuse running injuries occur when this balance is disrupted – usually due to:

• Excessive training load without adequate rest

• Repetitive movements that stress the same tissue group

• Poor biomechanics or technique that create abnormal load

• Lack of variation in movement or training surfaces

  
  

Essentially, tissues become overloaded and fail to recover, leading to microdamage that accumulates over time (2).

Risk factors for overuse running injuries

The causes of overuse injuries are complex and involve a combination of intrinsic (internal) and extrinsic (external) factors (3).

Intrinsic risk factors:

• Previous injury history

• Poor flexibility or mobility

• Muscular imbalances or weakness

• Biomechanical issues (e.g., flat feet, leg length discrepancy)

• Age, sex, and growth stage (especially in youth athletes)

  
  

Extrinsic risk factors:

• Sudden changes in training load (too much, too soon)

• Inadequate footwear or equipment

• Hard or uneven training surfaces

• Environmental factors (e.g., cold weather)

• Coaching or technique-related issues

Importantly, load management – how much, how often, and how intensely an athlete trains – is widely regarded as the most modifiable risk factor (4).

How can overuse running injuries be prevented?

Prevention is always better than cure. Many overuse injuries can be avoided through careful planning, education, and regular monitoring.

Key prevention strategies include:

• Gradual progression of training load (no more than 10% increase per week)

• Monitoring athlete fatigue and wellness (using tools like RPE and wellness questionnaires)

• Periodised strength and conditioning programs

• Technique correction and motor control training

• Adequate sleep and nutrition

• Recovery strategies such as rest days, mobility work, and cold or heat therapy

In youth athletes, special care should be taken to avoid early specialisation and ensure appropriate recovery during periods of rapid growth (5).

Are overuse injuries different from acute injuries?

Yes – both in onset and management.

Overuse Injury	Acute Injury
Gradual onset	Sudden onset
No single identifiable event	Specific trauma or impact
Often harder to diagnose early	Easier to detect immediately
May worsen over time	Usually immediate pain/swelling
Often needs activity modification	Often needs immediate treatment

Management of overuse injuries tends to involve load reduction, addressing contributing factors, and gradual return to play, whereas acute injuries may require rest, ice, compression, elevation (RICE), immobilisation, or even surgery (6).

Common overuse injuries in sport

Different sports pose different risks based on their movement pattern

Sport	Common Overuse Injuries
Running	Shin splints, stress fractures, Achilles tendinopathy
Swimming	Swimmer’s shoulder, lower back pain
Cycling	Patellar tendinopathy, lower back pain
Basketball	Jumper’s knee, plantar fasciitis
Rowing	Low back pain, rib stress fractures

Benefits of Sports Massage for Overuse Injuries

Sports massage can be a valuable tool in both the prevention and management of overuse running injuries. It works by addressing muscular imbalances, improving tissue quality, and supporting recovery — all of which are important in reducing the load placed on overused structures.

Key benefits include:

• Improved blood flow and nutrient delivery: Massage increases circulation to tight or overworked areas, helping speed up recovery and reduce inflammation.

• Breakdown of adhesions and scar tissue: Regular massage can help keep soft tissues healthy by reducing buildup of knots or adhesions, which often develop with repetitive strain.

• Reduced muscle tension and tightness: By helping to relax muscles, massage can prevent compensatory movement patterns that lead to joint stress or tendon overload.

• Early identification of problem areas: Therapists often pick up on tightness or sensitivity before it becomes a full-blown injury, allowing earlier intervention.

• Mental relaxation and recovery: Overuse isn’t just physical — massage also provides psychological benefits by reducing stress and improving body awareness.

  
  

While sports massage won’t fix overuse injuries on its own, it can play a valuable role when combined with proper load management, strength training, mobility work, and rest.

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What future research is needed?

Despite advances in injury monitoring and prevention, several questions remain:

• What is the most effective method of early detection for overuse injuries?

• How can we individualise training loads more accurately?

• What role do psychological factors (stress, motivation) play in overuse injury risk?

• How can wearable tech and AI be used to predict injury risk in real-time?

• What are the long-term effects of overuse injuries in youth athletes?

Answering these questions will help optimise athlete care and performance across all levels of sport.

References

1. Gabbett TJ. (2016). The training-injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine, 50(5), 273–280.

2. Reinking MF. (2017). Tendinopathy in athletes. Physical Therapy in Sport, 25, 5–10.

3. DiFiori JP, et al. (2014). Overuse injuries and burnout in youth sports. Pediatrics, 133(6), e1420–e1431.

4. Soligard T, et al. (2016). How much is too much? (Part 1). British Journal of Sports Medicine, 50(17), 1030–1041.

5. Myer GD, et al. (2011). The risks of early sport specialization. Journal of Athletic Training, 46(3), 293–302.

6. Orchard J. (2001). Intrinsic and extrinsic risk factors for muscle strains in Australian football. American Journal of Sports Medicine, 29(3), 300–303.