High school athletes: Early detection, appropriate rest key to treating overuse injuries

High school athletes: Early detection, appropriate rest key to treating overuse injuries


High school athletes: Early detection, appropriate rest key to treating overuse injuries


At the beginning of every school year, Colts Neck athletic trainer Eric Nussbaum sees an influx of freshman athletes whose bodies get shocked by the amount of conditioning and training they’ve endured while preparing for the fall sports season.

“It happens without fail,” said Nussbaum, past president of the Athletic Trainers’ Society of New Jersey. “For some kids, it’s a big transition to go from middle school to high school sports, especially if they haven’t done anything for most of the summer. They’re the ones ripe for overuse injuries.”

Dr. Stephen Rice, a pediatric sports medicine specialist and director of the Sports Medicine Center at Jersey Shore University Medical Center in Neptune, knows the situation well.

“It’s the classic scenario for overuse,” Rice said. “It happens with cross country runners a lot. You get a kid who may be used to running a mile a day, if that, and by the end of the first week of practice he’s running two or three. That’s how a lot of kids get hurt.”

According to the U.S. Centers for Disease Control and Prevention (CDCP), high school athletes account for an estimated two million injuries, a half-million doctor visits and 30,000 hospitalizations per year, with nearly half of all injuries to middle or high school athletes comprised of the overuse type — that is, an injury which develops slowly over time due to repetitive stress on tendons, muscles, bones or joints.


Medical community is exploring emerging treatment techniques for overuse injuries

But just in the same way developing a training method for the individual athlete is essential, so is treating an athlete with an overuse injury. There is no one-size-fits-all method to helping an athlete recover from such injuries, but some things are extremely important if an athlete is to fully recover and continue playing without further injury.

What’s up, doc?

The first step on the road to recovery is to identify the problem, get a proper diagnosis and treatment plan in place. Nussbaum believes an important aspect to getting started in the right direction is for an athlete with pain to see a qualified sports medicine specialist.


How to detect the early signs of overuse injuries in student-athletes

“There might be signs and symptoms that get me concerned about a potential injury,” he said. “I can get a kid started with rest, stretching and ice, but treatment really begins with a good diagnosis by a quality physician. But there are all sorts of little variables that can go into why an athlete has an overuse injury. Sometimes what you’re seeing is the tip of the iceberg.”

Early recognition is a key factor in how quickly an athlete can recover and return to action, Rice said.

“If you’re doing a really great job as an athletic trainer, you’re going to recognize most of these problems early,” he said. “Sometimes that’s not as easy as it sounds, but obviously it’s better for the athlete if the problem is taken care of early on.”

Dr. Charlie Weingroff, a physical therapist, athletic trainer and certified strength and conditioning specialist in Marlboro, said the next step is figuring out what happened.

“When the tire goes flat, you first have to figure out how badly the tire is flat — essentially, how bad is the tendinitis?” he said. “Then you have to determine how it got that way, or, in this example, how the tendinitis occurred.”

Understanding the nature of an overuse injury can involve many things. While X-ray and MRI technology can help pin down the exact location of the injury, other factors that may have caused the injury have to be determined in order to come up with a viable treatment plan.

In order to go forward, a medical professional has to go back, Nussbaum said.

“Typically with overuse injuries, a change of some kind took place to help cause the injury, so you have to go back and look at what those changes were,” he said. “Was it a change in intensity, duration, frequency, quantity, equipment or technique? Was there an alteration to the specific activity. Essentially, you’re trying to find out which straw broke the camel’s back. Once you get there, then you can figure out what the biomechanical causes were that led to the injury.

“But you have to go back to where it all started.”

Turn the dial down

Once there, a treatment and recovery plan can be put into place. Most often, the plan starts with what is referred to as “appropriate rest.”

“Some kids think running their miles three minutes slower per minute is rest,” said Dr. Laurie Glasser, a sports medicine physician with the Orthopaedic Institute of Central Jersey. “That doesn’t constitute rest. But rest doesn’t mean doing nothing. You still need to move the muscles, and you’re not going to do that by lying on a couch.”

In most instances, an overuse injury doesn’t require complete stoppage of activity. Instead, it’s important for the athlete to have an alternative activity plan — something that will help an athlete maintain a good cardiovascular flow while strengthening the areas in an around the point of injury and allowing the injured area to heal.

“Treatment is injury-specific,” said Dr. Tim Hosea, an orthopedic surgeon who specializes in sports medicine with University Orthopaedic Associates in Somerset. “You have to remove the offending activity but replace it with things that will allow you to heal from your injury and keep you on pace to achieve your goal, which is to get back to regular competition.”

Nussbaum used the example of a runner who might have an injury and has to stop running on a track for several weeks.

“Whether it’s sprint work, middle-distance or distance, you can get a very similar workout, in which your heart rate is at maximum peak, on a bike,” he said. “Or if you can somehow use an underwater treadmill, they’re tremendous. The bottom line is you can’t speed the healing of the body, but you can do things to maintain fitness or strengthen other areas that will help you be just as good an athlete as when you first got the injury.”

Often adding to the quandary is the desire of the athlete to get back to the real action. But Rice said there’s no real “fast track” to getting a player back onto the field.

“Once there’s an injury, the athlete has to back off and rest,” he said. “And what the athlete must realize is, the deeper you sink into the hole the longer it takes to get out. You just have to scale back, do what you can to maintain a certain level of fitness and let the injured area heal.”

So what happens if an athlete doesn’t heal completely from an overuse injury and gets back to competition before his or her body can handle that regular load again? In short, such a scenario is a recipe for long-term issues, such as more complicated injuries or injuries to other areas, as well as prolonged ineffective performance, and perhaps, at some point, never competing again.

“The No. 1 predictor of injury is previous injury,” Weingroff said. “The body is a scientific machine and it can’t be messed with. Is there anybody who doesn’t get injured? No, but we all have to be careful. Whether it’s mental or physical stress, if you’re doing the same thing over and over again, you’ll probably make yourself worse than before the initial injury occurred.”

And at that point, treating an injury caused by overuse becomes a much bigger burden to the athlete, said Dr. Aman Dhawan, an orthopaedic surgeon who also specializes in sports medicine with University Orthopaedic Associates in Wall.

“That’s when it’s very problematic on a number of levels,” he said. “Not only does it require much longer rehabilitation and rest times than had it been addressed early, but it often requires more involved treatments like surgery, injections or orthotics that then can take an athlete out of sports for an entire season or year. In addition, these injuries may continue to plague an athlete over years and even decades because they weren’t addressed appropriately early on.”


More USA TODAY High School Sports