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Prevention

Overuse injuries are a growing component of both a general medical and pediatric practice. Recognizing that a particular sport may adversely affect a given area should make prevention easier. A careful evaluation can often identify root causes and provide the opportunity to offer the athlete tips on injury prevention and rehabilitation. Focusing on more common conditions characterized by overuse (Table 1) can help guide the initial evaluation and treatment while reducing morbidity in an active population.

TABLE 1
Common conditions characterized by overuse
Condition
Likely Cause
Evaluation
Treatment
Shoulder
Rotator cuff tendinosis Too much overhead activity, weak rotator cuff muscles, poor form
 Assess rotator cuff strength and sport technique Strengthen rotator cuff and scapular muscles
Glenohumeral laxity Same as above Perform shoulder apprehension test

 Same as above
Elbow
Medial elbow pain Excessive throwing, weak arm flexors, poor technique Assess valgus laxity of elbow, obtain radiographs Rest, strengthen arm flexors assess and correct technique
Lumbar spine
Spondylolysis, spondylolisthesis Repeated hyperextension, poor hamstring flexibility Perform stork test, obtain radiologic imaging Increase hamstring flexibility +/- bracing (referral)
Knee
Sinding-Larsen-Johansson disease, Osgood-Schlatter disease Immature apophyseal regions, tight hamstrings Palpate regions of tenderness, measure popliteal angle Begin ice massage, increase hamstring flexibility
Patellofemoral pain syndrome Weak quadriceps (especially, VMO), tight hamstrings Measure popliteal angle, perform patellar compression, assess lateral movement

 Hamstring stretches VMO strengthening, possibly apply patellar bracing or taping
Tibial region
Medial tibial stress syndrome (aka shin splints) Dorsiflexor weakness, too much impact, hyperpronation Assess for diffuse tenderness on medial tibial border and midfoot hyperpronation

 Reduce impact activities begin ice massage, correct hyperpronation
Tibial stress fracture Too much impact, hyperpronation, possibly eating or menstrual disorder Assess for focal pain on examination, order radiographic exams, obtain nutrition and menstrual history

 Possibly, put patient on non-weight-bearing status limit impact activities
Ankle
Achilles tendinosis Tight dorsiflexors, too much running or jumping Assess for focal pain at Achilles tendon on examination, limited dorsiflexion, and hyperpronation Limit impact activities increase dorsiflexion use heel cup/wedge begin ice massage
Sever disease Same as above, plus the patient is age 8-12 Assess for pain at Achilles insertion into posterior calcaneus limited dorsiflexion, and hyperpronation

 Same as above
January 2002