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A Guide to Overuse Injuries & Burnout

Track Athlete in Pain

Team USA athletes have been training for countless hours in preparation for the Rio 2016 Olympic and Paralympic Games. But is it possible for athletes to train too much?

Unfortunately, this is a case when there can be too much of a good thing. When athletes train too much, they can develop overuse injuries or even burnout. Whenever an individual is active, they are micro-injuring their body; they are micro-fracturing their bones, muscles, and tendons. When the body is given time to rest, it heals these micro-injuries and adapts to become stronger. If the body is not allowed enough time to heal, the micro-injuries can continue to progress and eventually become an overuse injury. Overuse injuries can involve the muscles and tendons in the form of tendinopathy, bone in the form of stress fractures, or bursa in the form of bursitis as just a few examples.

Unlike an acute traumatic injury, overuse injuries develop gradually over time. Although they are not associated with a specific injury, they can still result in a significant amount of time lost from sport or even end a career. While the term “no pain, no gain” is often heard in sports, it is often a dangerous mantra to live by. Pain is a way for your body to warn you that something is wrong. Overuse injuries typically begin with a slight pain or discomfort during activity, but if left untreated, can progress to pain that lasts after activity, or even occurs outside of activity. Risk factors for overuse injuries include too heavy of a training workload (whether it be the total amount, the intensity, or the rate of progression), poor equipment or technique, prior injury, poor level of conditioning, and age (with adolescents at a higher risk given the effects of growth on the body).

In general, treatment for overuse injuries involves relative rest to allow the affected area the necessary time to heal, which can be a period of weeks to months. This is followed by a course of rehabilitation to strengthen the injured area and correct any imbalances that may have predisposed to the injury, before finally a gradual return to activity. The best treatment for overuse injuries is to prevent the injury from occurring in the first place. As the overuse name implies, it is important to monitor the amount of activity being performed.  Whether it is by taking a day off during the week, incorporating cross training or activities that utilize different areas of the body to limit repetitive stress, or gradually increasing the amount of activity when starting to train, it is important to ensure the body has enough time to recover and heal to prevent overuse injuries.

Too much training can also have effects outside of the musculoskeletal system. If an athlete trains too hard and is placed under intense demand and stress, it can cause psychological effects and lead to changes in the nervous and endocrine systems that can ultimately lead to decreased performance. If this intense demand and stress continues, eventually the athlete can experience burnout and choose to stop participating in their sport.

There is not a specific test for overtraining and burnout, but a gradual decline in performance over time can be a sign that it is developing. Overtraining and burnout is often treated with a course of relative rest to allow the body and mind time to recover.


Dr. David A. Wang is a primary sports medicine physician at Hospital for Special Surgery specializing in the treatment of acute and overuse injuries. His main clinical and research interests are overuse injuries, concussions, viscosupplementation injections, and the pre-participation physical exam. As a former collegiate baseball player, he also has a special interest in the care of baseball players.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.