Contributor:
Cheri A. Blauwet, MD, Mass General Brigham Sports Medicine specialist

Runner's knee, Achilles tendinitis, shin splints and stress fractures are among the most common overuse injuries among female athletes. They’re often caused when training focuses too much on a particular activity, putting undue stress on one part of the body.

Mass General Brigham Women’s Sports Medicine specialists like Cheri Blauwet, MD, treat overuse injuries in women. These injuries most often affect endurance athletes—for example, long-distance runners and triathletes—although they’re also common across other sports such as soccer, lacrosse, field hockey, tennis, gymnastics and dance. Bone and tendon—the strong, flexible tissues that attach muscle to bone—are particularly vulnerable to this type of damage.

Much of what researchers have learned about how to treat overuse injuries has come from studying elite athletes, but the insights apply to weekend warriors engaging in recreational sports as well. And because many people are serious athletes well into middle-age and beyond, overuse injuries occur across the lifespan.

Injury Prevention Exercises: Cross-training and Strengthening

Lack of strengthening, overtraining without time for recovery and poor nutrition all put athletes at risk for overuse injuries, according to Dr. Blauwet.

“Engaging in a variety of activities is key when it comes to preventing overuse injuries,” says Dr. Blauwet. “Female athletes often focus on just one type of training to hone their skill in their sport— for example the repetitive maneuvers of a gymnast, or a soccer player working almost exclusively on ball handling skills, or a runner who’s just focusing on getting in their mileage.”

Instead, female athletes need to pay more attention to strengthening. Research shows that core and lower extremity weakness is one of the main risk factors for overuse injuries. Take running as an example: Building a strong core and strong hips helps avoid overuse injuries, even when clocking high mileage. A strong core and hips can absorb the impact of pounding the pavement, sparing more vulnerable body parts—like the shin, foot and Achilles tendon—from injury.

“If you’re a marathon runner, one of the most important things you can do to prevent an overuse injury is to maintain a strengthening program as you’re increasing your mileage to build endurance,” Dr. Blauwet says.

Time Needed for Recovery and Rebuilding

Another common mistake among athletes that leads to overuse injuries is intensifying their workouts too quickly, says Dr. Blauwet. Stress fractures, also known as bone stress injuries, are one result. These microscopic injuries occur because the athlete has overloaded the bone and not allowed adequate time for the body to heal and produce new, healthy bone.

Other tissues, like tendons, are similarly vulnerable, according to Dr. Blauwet. “Tendons are built to sustain load over a prolonged period of time. If you overload a tendon, it can lead to a condition called tendinopathy, wherein the tendon tissue becomes thickened and irregular, which can lead to pain.”

Tendinopathy’s symptoms include pain, stiffness and weakness in the affected area. “All of our tissues are meant to sustain a certain load,” she says. “If we go beyond that threshold, then you start to develop pathology in those tissues.”

Eating Well to Prevent RED-S and Promote Injury Healing

If an athlete doesn’t consume enough calories, it may hinder her from healing from overuse injuries. Scientists call this condition relative energy deficiency in sport or RED-S.

“All athletes, including female athletes, are at risk for developing what we call ‘low energy availability.’ Nutrition is one of the underpinnings of your body's ability to heal. Athletes with low energy availability are at higher risk of developing chronic, non-healing overuse injuries and these injuries start to accumulate,” says Dr. Blauwet. These athletes also may experience loss of menstrual periods or irregular cycles.

RED-S is most common in sports where a lean body is the dominant aesthetic and in some cases figures into how experts judge performance. Sports where low energy availability is often a problem include gymnastics, dance, synchronized swimming, figure skating and even long- distance running.

“In many sports there is a dominant culture that thinness is better,” says Dr. Blauwet. “Whether thinness actually helps these athletes’ performance is debatable.”

Treating Overuse Injuries

If you’ve developed an overuse injury, Dr. Blauwet recommends that you consult a sports medicine specialist as soon as possible. The earlier a health care provider diagnoses and treats your injury, the better. Once you’re in good hands, it’s likely your provider will recommend:

  • Taking a break from the activity that caused the problem. For example, you may need crutches for a period of time to recover from a hip or lower extremity stress fracture
  • Maintaining your conditioning by cross training to exercise other muscles. For example, a runner may want to cycle or swim for a while
  • Adding a strengthening program into your workouts, ideally under the guidance of a physical therapist
  • Seeing a sports nutritionist if your dietary plan is impeding recovery. If the athlete is not menstruating or has irregular cycles, a consultation with an endocrinologist may be necessary

Athletes can avoid most overuse injuries by adding variety of activities to their training, building rest into their schedules and fueling appropriately. But if they do find themselves sidelined by an injury, with the right treatment, they will be back to their sport in good time.

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