Overuse injuries are deceptive. They do not arrive suddenly with a sharp moment of pain and a clear incident to point to. They develop slowly, with a dull ache that initially appears only during activity, then persists afterwards, then becomes present at rest. By the time most people seek help, the problem has been building for weeks or months.
The name suggests a simple solution: do less. The reality is more complicated.
What Is an Overuse Injury?
An overuse injury occurs when a tissue, most commonly a tendon, a bursa or a stress-reactive area of bone, is subjected to repeated load that exceeds its capacity to adapt. The tissue begins to break down faster than it can repair itself, producing localised inflammation, structural change and eventually pain.
Common overuse injuries include patellar tendinopathy (anterior knee pain in runners and cyclists), Achilles tendinopathy, plantar fasciitis, rotator cuff tendinopathy, lateral epicondylalgia (tennis elbow), and tibial stress reactions.
The Underlying Causes Are Rarely Simply “Too Much”
Training load is one factor, but overuse injuries almost always involve a contributing mechanical issue. The most common include:
Biomechanical dysfunction. Altered movement patterns mean that load is distributed unevenly across the involved structures. A runner with reduced hip abductor control, for example, places excessive load on the ITB and the lateral knee. A swimmer with restricted thoracic rotation overloads the shoulder. Treating the painful tendon without addressing the movement fault means the injury returns when training resumes.
Inadequate recovery. Adaptation occurs during recovery, not during training. Insufficient sleep, poor nutrition and inadequate rest between sessions means the tissue never fully adapts to the load being applied.
Rapid load increases. Tendons adapt slowly to training load, more slowly than cardiovascular fitness or muscle strength. Increasing volume or intensity too quickly leaves the tendon unable to keep pace with the demands placed on it.
Previous injury. Incompletely healed tissue or unresolved movement dysfunction from a previous injury changes how load is distributed in the affected region.
Why Rest Alone Is Not the Answer
Tendons in particular do not respond well to unloaded rest. A tendon that has developed pathological change needs progressive, controlled loading to stimulate the structural remodelling that produces genuine recovery. Removing load entirely produces short-term symptom relief but does not reverse the underlying pathology.
The gold standard treatment for tendinopathy is progressive tendon loading, delivered according to the tissue’s current tolerance and capacity. This requires accurate assessment to identify where in the pathology spectrum the tendon sits, and a carefully graduated programme to take it from its current state back to full function.
This is the foundation of sports therapy at Hever Health. Connor’s assessment identifies both the injured tissue and the contributing mechanical factors, and builds a programme that addresses both. Where osteopathy is needed to correct a structural or postural contributor, both can be delivered within the same clinical relationship.
If a nagging injury has not responded to rest, book an assessment and find out what it actually needs.