What’s an overuse injury, and how can you treat or prevent it?

It's no secret that triathletes are prone to overuse injuries. Physiotherapist Lauren Priest explains all you need to know about overuse injuries, including how to prevent them from occurring

Close up of a male runner's hands over his knee

What is an overuse injury and what causes them?

Physiotherapists will often talk and warn about overloading. In essence an overuse injury is one that causes the tissue to fail through repetitive loading/stress.

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This can occur at multiple structures including tendons, joints, bones and bursas.

Due to the intense nature of triathlons and the different stresses of three disciplines, triathletes are often subject to overuse injuries. A multitude of studies have found over 80% of triathlon injuries being due to overuse.

What are the symptoms of an overuse injury?

Often these symptoms can present:

  • Ache
  • No specific event or injury
  • Pinpoint tenderness
  • Pain or tension last more than 48hrs post activity
  • Swelling
  • Fatigue

What are the different stages of an overuse injury?

Initially these symptoms may only be present post-activity such as a 10km run. However if the injury continues to be loaded the symptoms can become more constant and also disrupt daily function. With worsening symptoms there can be increased signs of pain and inflammation.

What are the most common overuse injuries for triathletes?

Stress fractures

Iliotibial band syndrome (ITBS) 


Chrondromalacia patella (runner’s knee)

Back pain

There are multiple factors that can predispose a structure to become overload. The most common cause is too much too soon. This is why it is key to have a clear training plan for each event.

As well as training for the events individually, transitional training needs to also be incorporated to ensure the tissues can withstand a change of stresses while fatigued.

Identifying areas of weakness pre training can be key to developing a programme and this is where a physiotherapist can help.

There some extrinsic factors too which need to be considered; faulty equipment (old trainers or cleats)

How to treat an overuse injury

  • In your training plan establish a baseline and needs for the events, time frame, goals etc.
  • Modify your activity to allow your training to continue yet not cause further overloading. For example, this could include a period of not running, yet completing a programme of drills and strengthening, before slowly reintroducing running while following a rehabilitation plan.
  • Follow a strengthening programme to strengthen areas of weakness, and improve overall stability.
  • Use the time to do sport specific drills, for example mounting and dismounting a bike.

How can you prevent overuse injuries?

  • Ensure your training plan has at least 1 rest day per week.
  • Ensure tapering before races, and key dates.
  • Do a strength and balance workout at least twice a week.
  • Ensure bike setup is optimum for you.
  • Remember to foam roll and stretch.

The National Institute for Health and Care Excellence updated their guidelines in 2019 to advise everyone to include two strength-based exercise sessions per week.

However physiotherapists often see athletes who are keen to up their mileage either reduce their strength training or remove it altogether for further distance sessions.

Strengthening tissues and tendons will improve their capacity to handle increasing demands. Without this specific training there is a high risk of the tissue failing thus leading to injury or further injury.

If you have any concerns at all, like with any health issue, seek medical advice from a qualified medical practitioner, whether that’s a doctor or physiotherapist.

Keen cyclist Lauren Priest is a physiotherapist at Six Physio Moorgate.

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Top image credit: Getty Images