Sports Medicine

, Volume 44, Issue 3, pp 405–421 | Cite as

Definition and Usage of the Term “Overuse Injury” in the US High School and Collegiate Sport Epidemiology Literature: A Systematic Review

Systematic Review

Abstract

Background

A number of epidemiologic and surveillance-based studies of sports injury provide statistics on, and sometimes discussion of, overuse injuries. However, there is no consensus on the definition of “overuse.” Some studies consider “overuse” as a mechanism of injury while others use a diagnosis-based definition.

Objective

The objective of this study was to describe variation between studies in the definition and use of the term “overuse.”

Methods

PubMed and SPORTDiscus databases were searched between May and November 2012 to find articles published or online ahead of printing pertaining to US high school or collegiate athletics, which were epidemiologic in nature. Inclusion criteria required that the article present data collected on athlete exposure and provided statistics pertaining to overuse injuries. PRISMA guidelines were adhered to, to the best ability of the authors.

Results

The initial search resulted in 5,182 articles with potential for inclusion. After review of titles or abstracts where appropriate, 232 studies were read in entirety to determine if they were appropriate for inclusion. Of the 35 articles included, 13 used data from the National Collegiate Athletics Association’s Injury Surveillance System, 12 used data from the High School Reporting Information Online (RIO) injury surveillance system, and one used data from both of these systems. The remaining nine articles used data from distinct surveillance systems or prospectively collected data. All of these articles included data on overuse injuries, although not all provided definitions for overuse. A major finding from the literature is that the term “overuse” has been used both as a mechanism of injury and as an injury diagnosis (or a category of diagnoses). Specifically, of 35 articles, 14 used “overuse” as a mechanism of injury, seven used it as a category of injury diagnoses, eight used it as both a category of injury diagnoses and a mechanism of injury, and it was unclear in one how the term is used. Only one of the 35 articles provided a biomechanical definition for overuse injuries. Twelve of 35 articles combined “overuse” with other terms such as “chronic,” “gradual onset,” and “repetitive stress.” Use of the term “no contact” was investigated in relation to “overuse.” Four of 35 articles define overuse in the context of no contact injuries. Only one of 35 articles define “no contact” as a specific acute mechanism of injury, while all other mentions of “no contact” do not specifically distinguish whether “no contact” was limited to acute injuries only, or has potential to include “overuse” injuries.

Conclusion

There is a great deal of inconsistency in the use of the term “overuse” both within and between data sources. This is further complicated by the multiple uses of the term “no contact.” We recommend that the term “overuse” only be used in regard to the mechanism of injury in order to enhance interpretation and understanding of the literature regarding overuse injuries and enhance the ability to compare results between studies. We also recommend the adoption of a common working definition of overuse injuries within injury surveillance. This definition should emphasize that overuse injuries are characterized by (1) a mechanism of gradual onset, and (2) an underlying pathogenesis of repetitive microtrauma.

References

  1. 1.
    Arnheim DD, Prentice WE. Principles of athletic training. 8th ed. St Louis: Mosby-Year Book; 1993.Google Scholar
  2. 2.
    Cuff S, Loud K, O’Riordan MA. Overuse injuries in high school athletes. Clin Pediatr. 2010;49(8):731–6.CrossRefGoogle Scholar
  3. 3.
    Current comment from the American College of Sports Medicine. August 1993–“The prevention of sport injuries of children and adolescents”. Med Sci Sports Exerc. 1993;25(8 suppl):1–7.Google Scholar
  4. 4.
    DiFiori JP. Evaluation of overuse injuries in children and adolescents. Curr Sports Med Rep. 2010;9(6):372–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Harrelson GL. Physiological factors in rehabilitation. In: Andrews JR, Harrelson GL, Wilk KE, editors. Physical rehabilitation of the injured athlete. 8th ed. Philadelphia: W. B. Saunders Co.; 1998.Google Scholar
  6. 6.
    Hogan KA, Gross RH. Overuse injuries in pediatric athletes. Orthop Clin North Am. 2003;34(3):405–15.PubMedCrossRefGoogle Scholar
  7. 7.
    Malina RM. Early sport specialization: roots, effectiveness, risks. Curr Sports Med Rep. 2010;9(6):364–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Prentice WE. Rehabilitation techniques in sports medicine. 2nd ed. St Louis: Mosby-Year Book, Inc.; 1994.Google Scholar
  9. 9.
    Difiori JP. Overuse injury of the physis: a “growing” problem. Clin J Sport Med. 2010;20(5):336–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Hreljac A. Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective. Phys Med Rehabil Clin N Am. 2005;16(3):651–67, vi.Google Scholar
  11. 11.
    Hreljac A, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc. 2000;32(9):1635–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Lord J, Winell JJ. Overuse injuries in pediatric athletes. Curr Opin Pediatr. 2004;16(1):47–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Valovich McLeod TC, Decoster LC, Loud KJ, Michelli LJ, Parker JT, Sandrey MA, White C. National Athletic Trainers’ Association position statement: prevention of pediatric overuse injuries. J Athl Train. 2011;46(2):206–20.Google Scholar
  14. 14.
    van Wilgen CP, Verhagen EA. A qualitative study on overuse injuries: the beliefs of athletes and coaches. J Sci Med Sport. 2012;15(2):116–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Wang Q. Baseball and softball injuries. Curr Sports Med Rep. 2006;5(3):115–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Yang J, Tibbetts AS, Covassin T, Cheng G, Nayar S, Heiden E. Epidemiology of overuse and acute injuries among competitive collegiate athletes. J Athl Train. 2012;47(2):198–204.PubMedCentralPubMedGoogle Scholar
  17. 17.
    Fuller CW, Molloy MG, Bagate C, Bahr R, Brooks JH, Donson H, et al. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Clin J Sport Med. 2007;17(3):177–81.PubMedCrossRefGoogle Scholar
  18. 18.
    Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med. 2006;16(2):97–106.PubMedCrossRefGoogle Scholar
  19. 19.
    Fuller CW, Bahr R, Dick RW, Meeuwisse WH. A framework for recording recurrences, reinjuries, and exacerbations in injury surveillance. Clin J Sport Med. 2007;17(3):197–200.PubMedCrossRefGoogle Scholar
  20. 20.
    Meeuwisse WH, Love EJ. Development, implementation, and validation of the Canadian Intercollegiate Sport Injury Registry. Clin J Sport Med. 1998;8(3):164–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Knobloch K, Yoon U, Vogt PM. Acute and overuse injuries correlated to hours of training in master running athletes. Foot Ankle Int. 2008;29(7):671–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Meeuwisse WH, Tyreman H, Hagel B, Emery C. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med. 2007;17(3):215–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Shrier I, Feldman D, Akakpo H, Mazer B, Goulet C, Khelia I, et al. Discordance in injury reporting between youth-athletes, their parents and coaches. J Sci Med Sport. 2009;12(6):633–6.PubMedCrossRefGoogle Scholar
  24. 24.
    American Academy of Pediatrics. Committee on Sports Medicine and Fitness. Intensive training and sports specialization in young athletes. Pediatrics. 2000;106(1):154–7.Google Scholar
  25. 25.
    Jenkins WL, Raedeke SG. Lower-extremity overuse injury and use of foot orthotic devices in women’s basketball. J Am Podiatr Med Assoc. 2006;96(5):408–12.PubMedGoogle Scholar
  26. 26.
    Brooks JH, Fuller CW. The influence of methodological issues on the results and conclusions from epidemiological studies of sports injuries: illustrative examples. Sports Med. 2006;36(6):459–72.PubMedCrossRefGoogle Scholar
  27. 27.
    Valuri G, Stevenson M, Finch C, Hamer P, Elliot B. The validity of a four week self-recall of sports injuries. Inj Prev. 2005;11(3):135–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Mena HR. The pain of acute bursitis/tendinitis of the shoulder. Am J Med. 1986;80(3a):140.PubMedCrossRefGoogle Scholar
  29. 29.
    van Dijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19(5):835–41.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Caine DJ, Nassar L. Gymnastics injuries. Med Sport Sci. 2005;48:18–58.PubMedCrossRefGoogle Scholar
  31. 31.
    Kennedy JG, Knowles B, Dolan M, Bohne W. Foot and ankle injuries in the adolescent runner. Curr Opin Pediatr. 2005;17(1):34–42.PubMedCrossRefGoogle Scholar
  32. 32.
    Collins CL, Comstock RD. Epidemiological features of high school baseball injuries in the United States, 2005-2007. Pediatrics. 2008;121(6):1181–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Fernandez WG, Yard EE, Comstock RD. Epidemiology of lower extremity injuries among U.S. high school athletes. Acad Emerg Med. 2007;14(7):641–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Ingram JG, Fields SK, Yard EE, Comstock RD. Epidemiology of knee injuries among boys and girls in US high school athletics. Am J Sports Med. 2008;36(6):1116–22.PubMedCrossRefGoogle Scholar
  35. 35.
    Shankar PR, Fields SK, Collins CL, Dick RW, Comstock RD. Epidemiology of high school and collegiate football injuries in the United States, 2005-2006. Am J Sports Med. 2007;35(8):1295–303.PubMedCrossRefGoogle Scholar
  36. 36.
    Ditsios K, Agathangelidis F, Boutsiadis A, Karataglis D, Papadopoulos P. Long head of the biceps pathology combined with rotator cuff tears. Adv Orthop. 2012;2012(6):405472.PubMedCentralPubMedGoogle Scholar
  37. 37.
    Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011;84(6):676–82.PubMedGoogle Scholar
  38. 38.
    Kibler WB, Safran M. Tennis injuries. Med Sport Sci. 2005;48:120–37.PubMedCrossRefGoogle Scholar
  39. 39.
    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.Google Scholar
  40. 40.
    PRISMA. Transparent reporting of systematic reviews and meta-analyses. http://www.prisma-statement.org/index.htm. Accessed 1 Jun 2012.
  41. 41.
    McFarland EG, Wasik M. Epidemiology of collegiate baseball injuries. Clin J Sport Med. 1998;8(1):10–3.PubMedCrossRefGoogle Scholar
  42. 42.
    Flik K, Lyman S, Marx RG. American collegiate men’s ice hockey: an analysis of injuries. Am J Sports Med. 2005;33(2):183–7. doi:10.1177/0363546504267349.PubMedCrossRefGoogle Scholar
  43. 43.
    Ferrara MS, Schurr KT. Intercollegiate ice hockey injuries: a causal analysis. Clin J Sport Med. 1999;9(1):30–3.PubMedCrossRefGoogle Scholar
  44. 44.
    Pasque CB, Hewett TE. A prospective study of high school wrestling injuries. Am J Sports Med. 2000;28(4):509–15.PubMedGoogle Scholar
  45. 45.
    Hinton RY, Lincoln AE, Almquist JL, Douoguih WA, Sharma KM. Epidemiology of lacrosse injuries in high school-aged girls and boys: a 3-year prospective study. Am J Sports Med. 2005;33(9):1305–14.PubMedCrossRefGoogle Scholar
  46. 46.
    Ramirez M, Schaffer KB, Shen H, Kashani S, Kraus JF. Injuries to high school football athletes in California. Am J Sports Med. 2006;34(7):1147–58.PubMedCrossRefGoogle Scholar
  47. 47.
    Rauh MJ, Macera CA, Ji M, Wilksten DL. Subsequent injury patterns in girls’ high school sports. J Athl Train. 2007;42(4):486–94.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Rebella GS, Edwards JO, Greene JJ, Husen MT, Brousseau DC. A prospective study of injury patterns in high school pole vaulters. Am J Sports Med. 2008;36(5):913–20.PubMedCrossRefGoogle Scholar
  49. 49.
    Dick R, Agel J, Marshall SW. National Collegiate Athletic Association Injury Surveillance System commentaries: introduction and methods. J Athl Train. 2007;42(2):173–82.PubMedCentralPubMedGoogle Scholar
  50. 50.
    Dick R, Hootman JM, Agel J, Vela L, Marshall SW, Messina R. Descriptive epidemiology of collegiate women’s field hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003. J Athl Train. 2007;42(2):211–20.PubMedCentralPubMedGoogle Scholar
  51. 51.
    Dick R, Ferrara MS, Agel J, Courson R, Marshall SW, Hanley MJ, Reifsteck F. Descriptive epidemiology of collegiate men’s football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):221–33.PubMedCentralPubMedGoogle Scholar
  52. 52.
    Dick R, Hertel J, Agel J, Grossman J, Marshall SW. Descriptive epidemiology of collegiate men’s basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):194–201.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Dragoo JL, Braun HJ, Durham JL, Chen MR, Harris AH. Incidence and risk factors for injuries to the anterior cruciate ligament in National Collegiate Athletic Association football: data from the 2004-2005 through 2008-2009 National Collegiate Athletic Association Injury Surveillance System. Am J Sports Med. 2012;40(5):990–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Marshall SW, Covassin T, Dick R, Nassar LG, Agel J. Descriptive epidemiology of collegiate women’s gymnastics injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):234–40.PubMedCentralPubMedGoogle Scholar
  55. 55.
    Dick R, Putukian M, Evans TA, Marshall SW. Descriptive epidemiology of collegiate women’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003. J Athl Train. 2007;42(2):278–85.PubMedCentralPubMedGoogle Scholar
  56. 56.
    Dick R, Sauers EL, Agel J, Keuter G, Marshall SW, McCarty K, McFarland E. Descriptive epidemiology of collegiate men’s baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):183–93.PubMedCentralPubMedGoogle Scholar
  57. 57.
    Marshall SW, Hamstra-Wright KL, Dick R, Grove KA, Agel J. Descriptive epidemiology of collegiate women’s softball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):286–94.PubMedCentralPubMedGoogle Scholar
  58. 58.
    Agel J, Palmieri-Smith RM, Dick R, Wojtys EM, Marshall SW. Descriptive epidemiology of collegiate women’s volleyball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):295–302.PubMedCentralPubMedGoogle Scholar
  59. 59.
    Agel J, Olson DE, Dick R, Arendt EA, Marshall SW, Sikka RS. Descriptive epidemiology of collegiate women’s basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):202–10.PubMedCentralPubMedGoogle Scholar
  60. 60.
    Dick R, Romani WA, Agel J, Case JG, Marshall SW. Descriptive epidemiology of collegiate men’s lacrosse injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):255–61.PubMedCentralPubMedGoogle Scholar
  61. 61.
    Dick R, Lincoln AE, Agel J, Carter EA, Marshall SW, Hinton RY. Descriptive epidemiology of collegiate women’s lacrosse injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):262–9.PubMedCentralPubMedGoogle Scholar
  62. 62.
    Agel J, Evans TA, Dick R, Putukian M, Marshall SW. Descriptive epidemiology of collegiate men’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003. J Athl Train. 2007;42(2):270–7.PubMedCentralPubMedGoogle Scholar
  63. 63.
    Bonza JE, Fields SK, Yard EE, Comstock RD. Shoulder injuries among United States high school athletes during the 2005-2006 and 2006-2007 school years. J Athl Train. 2009;44(1):76–83.PubMedCentralPubMedCrossRefGoogle Scholar
  64. 64.
    Nelson AJ, Collins CL, Yard EE, Fields SK, Comstock RD. Ankle injuries among United States high school sports athletes, 2005-2006. J Athl Train. 2007;42(3):381–7.PubMedCentralPubMedGoogle Scholar
  65. 65.
    Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, Comstock RD. Epidemiology of knee injuries among U.S. high school athletes, 2005/2006-2010/2011. Med Sci Sports Exerc. 2013;45(3):462–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Swenson DM, Henke NM, Collins CL, Fields SK, Comstock RD. Epidemiology of United States high school sports-related fractures, 2008-09 to 2010-11. Am J Sports Med. 2012;40(9):2078–84.PubMedCrossRefGoogle Scholar
  67. 67.
    Swenson DM, Yard EE, Fields SK, Comstock RD. Patterns of recurrent injuries among US high school athletes, 2005-2008. Am J Sports Med. 2009;37(8):1586–93.PubMedCrossRefGoogle Scholar
  68. 68.
    Borowski LA, Yard EE, Fields SK, Comstock RD. The epidemiology of US high school basketball injuries, 2005-2007. Am J Sports Med. 2008;36(12):2328–35.PubMedCrossRefGoogle Scholar
  69. 69.
    Yard EE, Schroeder MJ, Fields SK, Collins CL, Comstock RD. The epidemiology of United States high school soccer injuries, 2005-2007. Am J Sports Med. 2008;36(10):1930–7.PubMedCrossRefGoogle Scholar
  70. 70.
    Krajnik S, Fogarty KJ, Yard EE, Comstock RD. Shoulder injuries in US high school baseball and softball athletes, 2005-2008. Pediatrics. 2010;125(3):497–501.PubMedCrossRefGoogle Scholar
  71. 71.
    Yard E, Comstock RD. Injury patterns by body mass index in US high school athletes. J Phys Act Health. 2011;8(2):182–91.PubMedGoogle Scholar
  72. 72.
    Bylak J, Hutchinson MR. Common sports injuries in young tennis players. Sports Med. 1998;26(2):119–32.PubMedCrossRefGoogle Scholar
  73. 73.
    Hreljac A. Impact and overuse injuries in runners. Med Sci Sports Exerc. 2004;36(5):845–9.PubMedCrossRefGoogle Scholar
  74. 74.
    McLauchlan GJ, Handoll HH. Interventions for treating acute and chronic Achilles tendinitis. Cochrane Database Syst Rev. 2001;(2):CD000232.Google Scholar
  75. 75.
    Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384–93.PubMedCentralPubMedCrossRefGoogle Scholar
  76. 76.
    La Porta GA, La Fata PC. Pathologic conditions of the plantar fascia. Clin Podiatr Med Surg. 2005;22(1):1–9.PubMedCrossRefGoogle Scholar
  77. 77.
    Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis. J Ultrasound Med. 2005;24(8):1041–8.PubMedGoogle Scholar
  78. 78.
    Williams SK, Brage M. Heel pain-plantar fasciitis and Achilles enthesopathy. Clin Sports Med. 2004;23(1):123–44.PubMedCrossRefGoogle Scholar
  79. 79.
    Price N. Prepatellar bursitis. Emerg Nurse. 2008;16(3):20–4.PubMedCrossRefGoogle Scholar
  80. 80.
    Orchard J, Hoskins W. For debate: consensus injury definitions in team sports should focus on missed playing time. Clin J Sport Med. 2007;17(3):192–6.PubMedCrossRefGoogle Scholar
  81. 81.
    Cassas KJ, Cassettari-Wayhs A. Childhood and adolescent sports-related overuse injuries. Am Fam Physician. 2006;73(6):1014–22.PubMedGoogle Scholar
  82. 82.
    Tenforde AS, Sayres LC, McCurdy ML, Collado H, Sainani KL, Fredericson M. Overuse injuries in high school runners: lifetime prevalence and prevention strategies. PM R. 2011;3(2):125–31.PubMedCrossRefGoogle Scholar
  83. 83.
    Zifchock RA, Davis I, Higginson J, McCaw S, Royer T. Side-to-side differences in overuse running injury susceptibility: a retrospective study. Hum Mov Sci. 2008;27(6):888–902.PubMedCrossRefGoogle Scholar
  84. 84.
    Clarsen B, Mykleburst G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. Br J Sports Med. 2013;47(8):495–502.PubMedCrossRefGoogle Scholar
  85. 85.
    Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Br J Sports Med. 2009;43(13):966–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  1. 1.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Injury Prevention Research CenterUniversity of North Carolina at Chapel HillChapel HillUSA

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