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Causes


Overhead athletes suffer overuse, encompassing microtrauma resulting from repetitive use of the limb at extreme ranges of motions without increasing force.  Factors causing overuse can be extrinsic or intrinsic [13,14]:

Extrinsic

  1. Training errors    
  2. Conditions
  3. Bad environment (terrain)   
  4. Inadequate nutrition   
  5. Poor equipment inc. footwear   

Intrinsic

  1. Malalignments (valgus/ varus)
  2. Muscle imbalance/ weakness 
  3. sex, size, body composition
  4. Psychological factors

  It is of insidious onset [13] and the changes seen are degenerative as well as inflammatory.  Structures involved in overuse injuries are most commonly muscles and fascia [15] but bone and tendon/ muscle insertions may also be affected.  Diagnosis of these injuries is based largely on clinical experience.  Attention should be paid in the history to the duration and nature of the onset of the injury and analysing the pain causing situation [16].  Swelling, locking and popping should be noted as well as the patient’s training program; changes in distance and intensity, the number of work out sessions and the type of strengthening and stretching being used.  The extrinsic factors listed above ought also to be considered [13].

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