Overuse Injuries in Women Are Common and Treatable

Runner's knee, Achilles tendinitis, jumper’s knee, 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 or repeat movement, putting too much stress on one part of the body.

“Strength training, conditioning, and proper recovery are key to preventing overuse injuries,” says Elizabeth Matzkin, MD, co-leader of Mass General Brigham Women’s Sports Medicine and women’s sports medicine surgeon.

Dr. Matzkin treats elite athletes across multiple sports and brings her experience as an athlete and mother of female athletes to her work. In this article, she explains overuse injury risks, prevention, and treatment.

What is an overuse injury?

Unlike an acute injury—one that happens suddenly—an overuse injury builds up over time. Lack of strength and conditioning, poor form, improper fueling, and pushing your body too far can all contribute to overuse injuries. Overuse injuries can also set the stage for an acute injury due to weakening of the joints, tendons, or bones.

Overuse injuries 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, swimming, 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 athletes participating in recreational sports as well. And because many athletes start at a young age and continue well into middle age and beyond, overuse injuries occur across the lifespan.

Common overuse injuries

Anyone can develop an overuse injury, but some injuries are so common in specific sports that they’re named after it. Some common sport-specific overuse injuries are:

• Tennis elbow
• Golfer’s elbow
• Little League elbow
• Runner’s knee
• Jumper’s knee

Other common overuse injuries include:

• Rotator cuff tendonitis
• Shin splints
• Achilles tendinitis
• Shoulder impingement

Any repetitive movement can cause overuse injuries—in combination with athletic activities or in place of them—including gardening, computer use, or poor posture.

Injury prevention exercises: Cross-training and strengthening

Risk factors for overuse injuries can include:

• Using improper form or wearing the wrong equipment
• Training too frequently or for too long
• Playing one sport without cross-training activities

“Athletes can over-focus on one aspect of training,” says Dr. Matzkin. “A runner only focused on mileage or a tennis player over-practicing her serve is at risk for an overuse injury.”

Cross-training helps athletes avoid overuse injuries while still being active. “The more an athlete can vary her activities, the less likely it is she’ll experience an overuse injury and miss time in her sport of choice,” notes Dr. Matzkin. Pick cross-training activities that allow your primary sport muscles to rest—consider yoga, biking, swimming, or other low-impact sports to balance out your sport-specific training.

Female athletes need to pay more attention to strength and conditioning. 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 muscles around the hip helps avoid overuse injuries, even when clocking high mileage. A strong core and hip muscles can absorb the impact of pounding the pavement, sparing more vulnerable body parts—like the shin, foot, and Achilles tendon—from injury.

“Some women used to avoid strengthening exercises, afraid they might get too bulky or look less feminine,” says Dr. Matzkin. “Research and the increase in popularity of women’s professional sports has helped change this concern and young athletes now aspire to be healthy and strong with a better understanding of the long-term benefits of strength training.”

Strength training is one of the most valuable things a woman can do, both to prevent injury in her sport and to increase her overall health. Research has shown that strength training can benefit teen athletes in particular, helping them prevent injury throughout their career. According to Dr Matzkin, strength training and other weight-bearing exercises can also help women avoid osteoporosis later in life.

Time needed for recovery and rebuilding

Another common mistake among athletes that leads to overuse injuries is intensifying their workouts too quickly, says Dr. Matzkin. 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. Stress fractures more commonly happen in the lower extremities—feet and legs—and in sports with repetitive impacts from jumping or running.

Other tissues, like tendons, are similarly vulnerable, according to Dr. Matzkin. “Tendinopathy develops over time as an athlete overloads or overworks the tendon,” says Dr. Matzkin. “Not allowing proper time for rest between training sessions or training too hard, too soon can lead to pain and even require surgery to repair.”

Eating well to prevent RED-S and promote injury healing

If an athlete doesn’t consume enough calories, it can directly affect their bone health and lead to an increased risk of bone stress injuries. This is called RED-S or relative energy deficiency in sport. The more activity you perform, the more you need to consider fueling your body with adequate nutrition and energy.

“All athletes need proper nutrition in order to participate in their chosen sport,” notes Dr. Matzkin. “Fueling your body is critical to perform your best, avoid injury, and support recovery.”

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, body building, figure skating and long-distance running.

Dr. Matzkin notes that regardless of aesthetics, athletes need to eat well and hydrate. “A sports nutritionist can help you determine the right amount of protein, carbs, and other critical nutrients needed to perform your best,” she says.

Learn more about proper nutrition in sports.

Treating overuse injuries

If you’ve developed an overuse injury, Dr. Matzkin 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 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 you are not menstruating or have irregular cycles, a consultation with an endocrinologist may be necessary.

You can avoid most overuse injuries by adding a variety of activities to your training, building rest into your schedule, and fueling appropriately. But if you do find yourself sidelined by an injury, with the right treatment, you can return to your sport stronger and less prone to re-injury.