Kevin M. Biese

Context : The definition of an “overuse injury” had some ambiguity until recent publications. It is unknown whether the improved definition of “overuse injury” has been applied to epidemiology studies that examine high school-aged athletes. This population may be predisposed to overuse injuries due to several factors. Clinical Question : Is there more consistency in how the term “overuse injury” is being used, and has the rate of overuse injuries in high school-aged athletes’ epidemiology studies changed since Roos and Marshall’s 2014 systematic review on overuse injury definitions? Clinical Bottom Line : Since Roos and Marshall’s systematic review, more studies are recognizing “overuse injuries” as needing a specific mechanism of injury; however, several studies failed to differentiate “overuse injuries” from “noncontact injuries.” The rate of overuse injuries does not appear to have changed significantly.

Context: Studies have illustrated that overuse injuries occur in adolescent athletes more often than previously reported. The general purpose of this study was to provide a thorough report of secondary school athletic trainers encounters, practices, and perceptions of overuse injury in adolescent athletes. Design : Cross-sectional. Methods : An anonymous online questionnaire was distributed via email to athletic trainers in the secondary school setting. The questionnaire was sent to participants during the summer of 2021 and 430 participants (highest educational degree earned: master’s degree = 66%) completed the survey. Various survey methods were used to evaluate athletic trainers (1) demographics, (2) estimations about what percentage of injuries evaluated and treated were classified as overuse, (3) methods for treating overuse injuries, (4) confidence in treating overuse injuries and the complete implementation of their treatment plan, (5) perceptions of various barriers to treating overuse injuries, and (6) perception as to why patients did not want to reduce activity to treat their overuse injuries. Results : Participants reported that about half of all evaluations and treatments in a year were overuse injuries and they were “fairly” or “completely” confident (90%) in their ability to treat these injuries. The most common treatments cited were stretching (91%) and reducing activity (90%). Only 61% of participants were “fairly” or “completely” confident in the complete implementation of their treatment plan. Participants believed that patients’ reluctance to reduce sport activities (82% “moderate” or “extreme” barrier) was the most significant barrier to treatment. Participants cited athletes’ avoidance of missing games as the most common reason athletes were reluctant to reduce sporting activity. Conclusions : Participants felt confident in treating overuse injuries yet faced significant barriers in treating these injuries. Clinicians should be prepared to have conversations about the importance of reducing sporting activity to allow proper healing for overuse injuries in adolescent athletes.