Overuse Injuries: Why More Isn’t Always Better

By Dr. Carmen Jansante, PT, DPT, CSCS

If I had to estimate, I’d say nearly 80% of the injuries we see in the clinic are related to overuse. While acute injuries like a twisted ankle, broken bone, or collision on the field certainly happen, overuse is often the underlying factor behind many of the injuries athletes experience.

As a physical therapist working with athletes every day, especially baseball and softball players, I see the effects of repetitive movement firsthand. Our bodies are incredibly adaptable, but they also have limits. When we constantly ask the same muscles, tendons, ligaments, and joints to perform the same movement over and over without enough recovery or variation, something eventually has to give.

At Undefeated Physical Therapy and Performance, we believe that training smarter—not just harder—is one of the best ways to improve performance while reducing injury risk.

What Is an Overuse Injury?

An overuse injury develops when repetitive stress is placed on the body faster than it can recover. Unlike a traumatic injury that happens in a single moment, overuse injuries build gradually over days, weeks, or months.

Common examples include:

• Tendinitis

• Stress reactions and stress fractures

• Little League Shoulder

• Little League Elbow

• Rotator cuff irritation

• Patellar tendinopathy (jumper’s knee)

• Shin splints

• Low back pain from repetitive loading

The common denominator isn’t one bad movement—it’s too much of the same movement for too long without adequate recovery.

Why More Isn’t Always Better

Many athletes believe that if some training is good, more training must be even better.

Unfortunately, the body doesn’t work that way.

Performance improves through a balance of stress and recovery. Training creates stress on the body. Recovery is when the body repairs itself, becomes stronger, and adapts. Without enough recovery, performance begins to decline instead of improve.

This is especially true in youth athletes who are practicing year-round, playing on multiple teams, attending showcases, lifting several days per week, and rarely taking an actual offseason.

The goal isn’t to avoid hard work.

The goal is to recover well enough that your hard work actually pays off.

Why I Encourage an Offseason

One thing I strongly believe is that every sport should have some type of offseason.

That doesn’t necessarily mean sitting on the couch for three months. Instead, it means intentionally reducing the amount of sport-specific volume to give the body time to recover while continuing to build athletic qualities.

This is one reason I’m a big fan of younger athletes playing multiple sports.

Playing basketball after baseball. Soccer after football. Volleyball after softball.

Not only does this naturally create an offseason for the primary sport, but it also exposes athletes to completely different movement patterns.

Your body learns to move in different directions instead of repeating the exact same motion thousands of times.

Variety Builds Better Athletes

One of the biggest mistakes athletes make is thinking they only need to practice their sport.

The truth is, becoming a better athlete means becoming a better mover.

Different sports and different styles of training challenge:

• Balance

• Coordination

• Agility

• Rotational power

• Speed

• Strength

• Mobility

• Body control

These qualities transfer back to sport while reducing repetitive stress on the same tissues.

Even inside the weight room, variety matters.

While foundational lifts should remain consistent, accessory exercises, movement planes, tempos, carries, jumps, medicine ball work, mobility, and conditioning can all be rotated throughout the year to continue making progress while avoiding excessive repetitive loading.

Baseball Is a Great Example

Since we work with so many baseball players, baseball is one of the easiest sports to use as an example.

It’s usually not one throw that causes an injury.

It’s the total volume of throws accumulated throughout a season.

Bullpens.

Games.

Warm-up throws.

Long toss.

Practice.

Travel ball.

Showcases.

Throw after throw, day after day.

As fatigue builds, the body naturally starts to compensate.

Muscles begin producing less force.

Movement quality decreases.

Mechanical changes occur.

The body starts asking other muscles and joints to absorb forces they weren’t designed to handle.

Eventually those tissues become overloaded.

That’s when shoulder pain, elbow pain, back pain, and other overuse injuries begin to appear.

Often, the athlete doesn’t remember one specific throw that caused the injury because there wasn’t one.

The injury was developing long before the pain ever showed up.

Recovery Is Part of Training

One of the hardest concepts for competitive athletes to accept is that recovery isn’t time away from training.

Recovery is training.

Sleep.

Nutrition.

Hydration.

Mobility.

Soft tissue work.

Strength training.

Proper workload management.

Scheduled lighter weeks.

These aren’t signs that you’re doing less.

They’re what allow you to continue improving over months and years instead of constantly dealing with setbacks.

Train for Longevity

The best athletes aren’t simply the ones who train the hardest.

They’re the ones who stay healthy enough to consistently train over time.

Building strength, improving movement quality, managing workload, and allowing adequate recovery will almost always outperform trying to do more every single day.

Remember, more isn’t always better.

Better is better.

If you’re an athlete, parent, or coach looking to reduce injury risk while improving performance, the goal shouldn’t be to eliminate hard work—it should be to make sure every training session has a purpose and every athlete has a chance to recover from it.

At Undefeated Physical Therapy and Performance, we specialize in helping athletes move better, recover faster, and perform at their highest level through individualized physical therapy, strength training, performance programming, return-to-sport rehabilitation, and injury prevention.

Whether you’re dealing with nagging pain or simply want to stay ahead of injuries before they happen, we’d love to help.

References

DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. British Journal of Sports Medicine. 2014;48(4):287-288.

Bell DR, Post EG, Biese K, Bay RC, Valovich McLeod TC. Sport Specialization and Risk of Overuse Injuries: A Systematic Review. Sports Health. 2018.

American Academy of Pediatrics Council on Sports Medicine and Fitness. Sports Specialization and Intensive Training in Young Athletes. Pediatrics. 2016.

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 11th Edition.