Q&A About Overuse Injuries

What is overuse syndrome in overhead athletes?

DSC_3843Overuse syndrome is a condition in young athletes caused by repetitive motion and over practice. Sports medicine physicians at Midwest Orthopaedics at Rush (MOR) and members of the Illinois Athletic Trainers Association are increasingly concerned that overuse syndrome is causing injuries to the developing musculoskeletal structure of young athletes.

In most cases, overuse causes short-term symptoms and pain. However, orthopedic surgeons have noted that overuse syndrome can lead to permanent changes to the body, resulting in lifelong problems. Studies show that kids who participate in a single sport for 12 months per year are four to five times more likely to have a serious injury that may require surgery.

According to the Centers for Disease Control and Prevention, more than 2.6 million children under the age of 18 suffer a sports-related injury each year, with approximately half of these due to overuse. For example, The American Journal of Sports Medicine released an important study showing that the stress from excessive throwing motions may significantly harm the developing muscles and bones in the shoulders of young ball players. And another study in this publication showed that approximately 75 percent of all baseball players, ages 8 to 18, complain of some form of arm pain.

A new survey released recently by Safe Kids indicates that in the U.S., one in three children who plays team sports suffers injuries severe enough to require medical treatment. The same survey showed that nine out of ten parents underestimate how long children should refrain from playing any one sport in order to protect them from overuse, overtraining and burnout. Ninety-two percent of parents said they rely on coaches to keep their children safe while playing sports, but nearly half of all coaches said they have felt pressure to play an injured child in a game. Moreover, three out of ten children think a good player should keep playing even when he or she is hurt, unless a coach or other adult makes them stop.

What are common overuse injuries in the shoulder?

Prevention of Shoulder InjuriesSome of the conditions that can result from advanced overuse of the shoulder in young athletes include: tendinitis, shoulder instability, shoulder impingement syndrome and SLAP tears.

The shoulder joint is formed at the intersection of three bones: the humerus (upper arm bone), scapula (shoulder blade) and the clavicle (collarbone). The humerus is held in the shoulder socket by the rotator cuff, with muscles and tendons supporting the joint. A bursa, or lubricating sac, is located between the rotator cuff and the acromion (top of the shoulder) and allows for smooth movement of the arm.

Shoulder Instability/Dislocation:

As the most versatile joint in the body, the shoulder may dislocate or become unstable due to overuse. Instability of the shoulder joint involves the humeral head (ball), which is located at the top of the humerus, moving out of the glenoid (socket). If it is a partial dislocation (subluxation), the ball moves partially out of the socket, whereas a complete shoulder dislocation means the ball comes completely out of the socket. Shoulder instability can also vary based on the direction of the dislocation. The four directions include: anterior, posterior, inferior, or multi-directional. When a shoulder becomes unstable, it involves damage to the labrum and capsule.

Impingement syndrome:

Shoulder Impingement syndrome is the inflammation of the rotator cuff tendons and bursa. It is caused by the acromion rubbing against the tendons and bursa when the arm is raised.

SLAP tears:

A SLAP (Superior Labrum from Anterior to Posterior) tear or SLAP lesion is a type of labral tear most commonly seen in overhead throwing athletes such as tennis players and baseball players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder.

Rotator Cuff Tendinitis:

This can occur when the rotator cuff tendons become irritated and inflamed.

What are common overuse injuries in the shoulder?

UCL Injuries:  The ulnar collateral ligament (UCL) is a structure in the elbow that holds bones together and helps to control the movement of joints. The UCL can be injured in several different ways. Most commonly, there is a gradual onset of medial elbow pain due to repetitive stresses on the ligament. For athletes participating in overhead or throwing sports, poor mechanics, inflexibility, or fatigue can eventually lead to muscle strain, which puts more stress on the UCL. These stresses create tiny tears in the ligament. The gradual stress causes the ligament to stretch until it no longer holds the bones tightly enough and impacts the ability to throw. This condition is often treated with Tommy John surgery.

What causes overuse syndrome?

P6220620Experts believe that year-round specialized training for young athletes is contributing to the overuse epidemic. Without periods of rest or cross-training, young players continue to strain the same muscles over and over again. Other contributing factors include: starting the sport at a very early age, poor mechanics, poor practice or conditioning and genetics. Those factors, coupled with a developing skeleton that isn’t strong enough and underdeveloped growth plates, can lead to injuries. An example would be pitchers and catchers who practice year-round by participating on school teams, club sports, off-season training and private coaching sessions. These athletes continue to strain the same muscles over and over again. The question now becomes: How will this affect the daily life of players years later when they reach adulthood?

What are the symptoms of overuse syndrome?

Depending on the location and severity of the injury, symptoms of overuse syndrome vary from person to person. Symptoms that often coincide with overuse syndrome:

  • Pain during and after activity
  • Swelling and stiffness
  • Weakness/Instability
  • Inability to fully straighten the arm or put arm above head

More severe injuries can lead to a clicking feeling or noise when movement occurs.

Athletes in what sports are more prone to overuse syndrome?

Overuse syndrome can be experienced in almost any sport. All athletes who train too much are more prone to overuse syndrome. Athletes who compete in overhead sports, such as baseball, softball, tennis, lacrosse, volleyball, gymnastics and swimming are more at risk of wear and tear of the shoulder.