Overuse Injuries (RSI)

Medically Reviewed By William C. Lloyd III, MD, FACS

What are overuse injuries?

Overuse injuries occur over time from a repetitive activity that causes wear and tear. They are common in people who frequently play sports and participate in other recreational activities. They can also affect people who perform repetitive activities for work. These injuries affect the musculoskeletal system, including the muscles, nerves, tendons, ligaments, bones, and other joint structures and connective tissues. There are other names for this type of injury, such as repetitive strain injury (RSI), repetitive stress injury, repetitive motion injury, and overuse syndrome.

Common overuse injuries include:

  • Bursitis is inflammation and irritation of a bursa. Bursae are fluid-filled sacs that cushion joint structures and allow tendons, ligaments and muscles to slide easily over bones in the joint.

  • Growth plate problems in children and teens. Growth plates are active when children and teens are growing. These areas at the ends of bones have rapidly multiplying bone cells. This makes them vulnerable to stress from repetitive motions and forces. Common areas for these problems include the shoulders, elbows, knees and heels.

  • Nerve compression is pressure on a nerve due to swelling of surrounding connective tissues. Carpal tunnel syndrome and cubital tunnel syndrome are examples.

  • Sprains are injuries to ligaments from overstretching. Ligaments are strong bands of connective tissue that hold bones together at a joint. They are able to stretch to allow joint movements. However, they can stretch too far and start fraying and tearing with repeated stress.

  • Strains are injuries to a muscle, tendon, or group of muscles and tendons. Tendons are also bands of connective tissue. However, they attach muscles to bones. Contracting the muscle pulls on the tendon, which moves the bone.

  • Stress fractures are small cracks in a bone. These fractures often occur in the lower leg and foot. The bones in these areas bear your body weight and constantly absorb forces from walking, running, and other activities. It’s important to get medical care for a stress fracture because it can eventually result in a complete break in the bone.

  • Tendinitis is inflammation and irritation of a tendon. This common injury often affects the shoulders, elbows, forearms, knees, shins, and back of the ankles.

Pain and other symptoms tend to develop gradually with these chronic injuries. Seek prompt medical care for symptoms of an overuse injury that persist to prevent further damage. Treating the problem early will help you avoid complications.

What are the symptoms of a repetitive strain injury (RSI)?

Common symptoms of overuse injuries include pain, swelling, and limited range of motion. Specific motions and activities will aggravate these symptoms, while rest usually improves them. You may also notice creaking, grinding, clicking or popping when you move the area causing problems.

Other possible RSI symptoms include:

It can be difficult to tell if a child is suffering from an overuse injury. They may not be able or know how to tell you what they are experiencing. Signs that a child may have an RSI include:

  • Changing their form or technique to compensate for symptoms. Children may or may not be aware they are doing this.

  • Losing interest in the sport or activity

It’s important to see your doctor early if you suspect an RSI. You may need X-rays or other exams to properly diagnose the cause of the problem. Starting treatment promptly can help prevent further damage and usually results in a better outcome.

What types of overuse can cause an RSI?

Overuse injuries are the result of continually using a set of muscles or joints without enough time for rest. Periods of rest allow the body to heal and recover from repeated stresses. Without adequate breaks, muscles and tissues become irritated. These injuries often occur after an increase in the frequency, duration or intensity of an activity.

Any repetitive activity can cause an RSI. Here are some examples:

  • Playing a musical instrument

  • Playing sports

  • Texting

  • Using a keyboard or mouse

  • Operating a video game controller

  • Working at jobs that require recurrent tasks, such as cashiering, stocking shelves, or waiting tables

What are the risk factors for overuse injuries?

A number of factors increase the likelihood of developing an overuse injury. Children, teens, and older adults tend to have a higher risk of these injuries. Children and teens are especially vulnerable during growth spurts. Older adults are more susceptible because tendons and other tissues often weaken with age. However, not everyone in these groups will have problems.

Other risk factors for an RSI include:

  • Improperly fitting shoes and equipment

  • Overtraining

  • Poor training, conditioning or form

  • Sports specialization, which means participating in one sport with the exclusion of all others. This constantly puts stress on the same body parts in the same positions, which can lead to muscle imbalances.

Reducing your risk of overuse injuries

You may be able to lower your risk of overuse injuries by:

  • Balancing cardiovascular, strength and flexibility exercises

  • Cross-training with a variety of sports and activities

  • Scheduling periods of rest and time off from physical activities

  • Staying hydrated

  • Taking time to warm up and cool down after physical activity

  • Using the right equipment with the proper fit

If you regularly participate in activities that could put you at risk, talk with your doctor. Ask about strategies to prevent an RSI and learn how to identify symptoms early.

How are overuse injuries treated?

The first step in RSI treatment is rest. Your body needs time away from the repetitive activity to begin the healing process. In addition, your doctor may recommend ice, compression and elevation. Together with rest, this treatment goes by the name RICE. Anti-inflammatory medicines, splints, corticosteroid injections, or physical therapy may also be necessary to heal the injury. The longer an RSI goes untreated, the more likely these other measures may be necessary. Sometimes, surgery is the solution in order to repair the injury.

What are the potential complications of overuse injuries?

With adequate rest and treatment, overuse injuries usually heal. However, complications can occur if the damage continues or if you do not allow enough time to heal. Long-term problems can include chronic pain and disability. Working with a physical therapist can help prevent these complications. The therapist will teach you how to protect the area from further injury and prevent future problems. Recovery from an overuse injury takes longer than you might think. It often takes longer to see positive results and symptom relief the longer you have the injury and symptoms before seeking treatment.

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  1. Carpal Tunnel Syndrome. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/
  2. Hip Bursitis. American Academy of Orthopedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/hip-bursitis/
  3. Overuse Injuries in Children. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/overuse-injuries-in-children
  4. Overuse Injury. Medscape. https://emedicine.medscape.com/article/313121-treatment#d10
  5. Overuse Injury: How to Prevent Training Injuries. Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/overuse-injury/art-20045875?pg=1
  6. Repetitive Stress Injuries. Nemours Foundation. http://kidshealth.org/en/teens/rsi.html#
  7. Sprains and Strains. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/sprains-and-strains
  8. Sprains, Strains, and Other Soft Tissue Injuries. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/sprains-strains-and-other-soft-tissue-injuries/
  9. Stress Fracture. American Orthopaedic Foot and Ankle Society. https://www.aofas.org/footcaremd/conditions/ailments-of-the-midfoot/Pages/Stress-Fractures.aspx
  10. Stress Fractures. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/stress-fractures/
  11. Tendinitis. Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/tendinitis/basics/definition/con-20020309
  12. Tendonitis. Medscape. http://emedicine.medscape.com/article/809692-overview
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 26
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