• Inflammation
• Tumor [Latin]- Swelling is the most common sign of an overuse injury. redness,
• Calor [L] – Warmth
• Dolor [L] – Pain with movement, pain to deep touch,
1. In the beginning, after practice or game
2. During practice or game
3. Persistent Pain, all the time
• Rubor [L] – Redness
• Rubbing. Grating sensation over the muscle. tendon, ligament or joint when it is moved.

One or more of these signs and symptoms might be present. At first, the signs and symptoms occur after practice. With progression of the overuse injury, the pain will occur during practice or games. Eventually, without proper treatment the signs and symptoms will persist at all times and the Athlete’s performance will be compromised.

Children and Youth are not little adults and cannot be treated as such. Child and Youth Athletes are most risk for overuse injuries because their bones, joints, ligaments and tendons are in the process of growing and have not fully developed. Human growth and development continues into the early 20’s. Growth Plate development is at Risk.

The best treatment is Prevention, but in the alternative .R.I.C.E. and proper medical consultation and treatment are necessary.

• Prevention is Key and the most important treatment. Coaches musst be able to recognize the Physical Limits of Athletes and not cross the line and cause overuse and over training injuries.

However, in the event overuse Injury Results the treatment follows:

• Rest involves giving the injured tissue adequate time to repair itself. During periods of acute pain, athletes should consider a stop in play and allow time for the injury to heal.
• Ice is used to decrease inflammation and should be applied before and after practice or games over the injured body part.
• Compression involves applying an elastic wrap over the injured part to help reduce swelling.
• Elevation helps to decrease swelling by using gravity to assist in the process.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen after consultation with the Trainer and Doctor are beneficial for healing.

The Coach can yell and scream, push and punish until the cows come home, but more is not better. More exercise, repetition and conditioning will not help overcome the laws of nature for both male and female athletes: particularly where the female Athlete body is concerned i.e. anatomy (ectomorph, mesomorph, endomorph), female hormones and neuromuscular control.

Prolonged Anaerobic Metabolism (Exercise to Exhaustion) is self-defeating and damages tissue and cells beginning microscopically but ultimately it results in major neuromuscular and joint injuries. Controlling the intensity and duration of the sport participation activity is the secret to injury prevention.

“A literature review reveals that 30% to 50% of all sports injuries result from overuse. Overuse injuries occur when a tissue is injured due to repetitive submaximal loading. The process starts when repetitive activity fatigues a specific structure such as tendon or bone. With sufficient recovery, the tissue adapts to the demand and is able to undergo further loading without injury.

“Without adequate recovery, micro-trauma develops and stimulates the body’s inflammatory response, causing the release of vasoactive substances, inflammatory cells, and enzymes that damage local tissue. Cumulative micro-trauma from further repetitive activity ultimately causes clinical injury. In chronic or recurrent cases, continued loading produces degenerative changes leading to weakness, loss of flexibility, and chronic pain.

“Thus, in overuse injuries the problem is often not acute tissue inflammation, but chronic degeneration (ie, tendinosis instead of tendinitis).”
[Overuse Injuries in Children and Adolescents John P. DiFiori, MD THE PHYSICIAN AND SPORTSMEDICINE – VOL 27 – NO. 1 – JANUARY 1999]

Baquie and Bruckner recently reported that overuse injuries at their center during a 1-year period were twice as frequent as acute injuries, with the most common presentation being anterior knee pain. “An overuse injury occurs when repetitive microtrauma overloads the capacity of a tissue to repair itself. This may result in an inflammatory response leading to acute, and then possibly chronic, inflammation, ultimately resulting in structural changes in tissue. Overuse injuries have become an increasing problem in sports medicine in the past two decades as a result of a trend towards increased volume of training in all sports.” [Baquie and Bruckner BrJ Sports Med 1997;31:2-4 Overuse injuries: where to now?]

[BrJ Sports Med 1997;31:2-4 1 Baquie P, Brukner PD. Injuries presenting to an Australian sports medicine clinic. CGin J Sport Med (in press).

Bennell KL, Crossley K. Musculoskeletal injuries in track and field: incidence, distribution and risk factors. AustrJSci Med Sport 1996;28:69-75.

Bennell KL, Malcolm SA, Thomas SA, et al. The incidence and distribution of stress fracture in competition track and field athletes. A twelve month study. Am J Sports Med 1996;24:21 1-18.
Brukner P, Khan K. Clinical sports medicine. Sydney: McGraw Hill, 1993: 17.

Bennell KL, Malcolm SA, Thomas SA, et al. Risk factors for stress factors in track and field athletes. A twelve month prospective study. Am JT Sports Med (in press).

Dalton SE: Overuse injuries in adolescent athletes. Sports Med 1992;13(1):58-70

Herring SA, Nilson KL: Introduction to overuse injuries. Clin Sports Med 1987;6(2):225-239

Micheli LJ: Overuse injuries in children’s sports: the growth factor. Orthop Clin North Am 1983;14(2):337-360

Gross ML, Flynn M, Sonzogni JJ: Overworked shoulders: managing injury of the proximal humeral physis. Phys Sportsmed 1994;22(3):81-86

Drinkwater BL, Nilson K, Chesnut CH III, et al: Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 1984;311(5):277-281

Myburgh KH, Hutchins J, Fataar AB, et al: Low bone density is an etiologic factor for stress fractures in athletes. Ann Intern Med 1990;113(10):754-759

Ilahi OA, Kohl HW III: Lower extremity morphology and alignment and risk of overuse injury. Clin J Sport Med 1998;8(1):38-42

Gieck JH, Saliba EN: Application of modalities in overuse syndromes. Clin Sports Med 1987;6(2):427-466

Current comment from the American College of Sports Medicine: The prevention of sport injuries of children and adolescents. Med Sci Sports Exerc 1993;25(suppl 8):1-7


Measuring Exercise Intensity Gin Miller.com

“There are several ways to measure your exercise intensity: target heart-rate checks, perceived exertion and talk test, and heart rate monitors, now increasing in popularity due to ease of use and relative accuracy.

For many years, measuring exercise intensity using the target heart-rate method and pulse check was the standard in group fitness and exercise videos. In more recent years, the easily-applied perceived exertion check and talk test has become more prevalent in both.

Today, heart rate monitors are becoming the new standard for goal-oriented and serious-minded exercise enthusiasts. Not only do they provide immediate and fairly accurate feedback but they can also track your progress and improvements in fitness over time.

The Target Heart Rate Method

The “Target Heart-Rate” is the level at which it is recommended to be working in order to challenge the cardio-respiratory system and to be working in the “training” or “aerobic” zone. Within this zone, your body burns a higher percentage of fat calories, therefore it is commonly referred to as the “fat burning zone”. (However, research has shown that higher intensity training results in an increased overall caloric burn – see intensity training.)

If you are just getting started with cardiovascular exercise, it’s a good to know your “normal” or beginning heart rate, which will help you monitor your overall gains in your cardiovascular fitness.

Prior to your exercise session, first check your normal activity heart-rate. After you have gradually increased the level of intensity in your work effort, you should check to see where you are working within your training zone. At the peak of your intensity effort, measure your heart rate, then as you decrease intensity back to normal, check your heart rate again. The amount of time from peak activity back to normal heart rate is your recovery time. By measuring how long it takes for you to recover will give you an idea of your improvement in cardiovascular fitness. The fitter you are, the faster your heart-rate will recover back to normal.

Calculating Target Heart Rate

The most prominent and accurate means of determining target heart-rate is the Karvonen formula. This formula calculates a percentage of the heart-rate reserve, which is the difference between the resting heart-rate and the maximal heart-rate.
Heart-rate reserve = maximal heart-rate – resting heart-rate

Maximal Heart-rate is the highest rate a person can attain during exercise. While an electrocardiogram test would provide the most accurate MHR, for practical application an age-predicted heart-rate formula was developed.

Maximal heart-rate = 220 – age

This formula is based on the assumption that one’s heart rate at birth is 220 and decreases by one every year. The accuracy of determining maximal heart-rate based on this formula can vary at any given age by + 10 beats per minute.

Resting Heart-rate is the rate at which your heart beats at full rest. It is recommended that this rate be taken before getting out of bed, counting the pulse for a full 60 seconds, 3 mornings in a row and averaging the counts.
Determining the target heart-rate ranges:

Karvonen Formula

Using the Karvonen formula, the generally accepted heart-rate ranges are between 60% to 80% of maximal heart-rate reserve.
Target heart-rate = % intensity X heart-rate reserve + resting heart-rate
Here’s how it would be calculated for a 45 year old with a resting heart-rate of 80 and an age-predicted maximal heart-rate of 175 at an 80% intensity level of maximum heart-rate reserve:

175 (age predicted MHR)
– 80 (resting heart-rate)
95 (heart rate reserve)
X.80 (intensity level)
+80.00 (resting heart-rate)
156.00 (target heart rate)

It is recommended that the formula be applied to both ends of the range, 60% and 80%, to determine the target heart-rate training zone.
The Karvonen formula is considered more accurate than the Maximal heart-rate formula, because the resting heart-rate is used in the calculation. From a practical standpoint, few people actually figure out an average for their true resting heart-rate.

Maximal Heart-Rate Formula

Therefore the simplified Maximal heart-rate formula is the standard that was used in most group exercise settings:

target heart-rate = maximal heart-rate (mhr) X % intensity
For the same 45 year old, here’s how the range would be figured:
At 60 % Intensity –
175 (mhr: 220 – age)
X.60 (percent intensity)
105 (target Heart-rate)
At 80% Intensity –
175 (mhr: 220 – age)
X.80 (percent intensity)
140 (target heart-rate)

In group fitness settings, easy reference for intensity levels may be provided with a Target Heart Rate Chart. To view a sample of a heart-rate/age/intensity chart, click here.


July 6, 2008 7/6/08:

Beijing Air Pollution Will Kill Several Olympic Athletes; US Trainer Takes Precautions; Olympians Wearing Masks? by Stephen Fox



“The state of exhaustion is one that is a common occurrence in all forms of athletic performance. It is a description that is intended to reflect a final, often dramatic, result of one or more bodily processes on the brink of failure. Where there is exhaustion, there must be an extreme level of fatigue, to the point where relief must be sought by the athlete or a catastrophe will invariably follow.

Exhaustion is a term employed in three distinct contexts in sports science. Physical exhaustion is the expression used to describe either musculoskeletal fatigue or a general inability to physically continue to perform at the desired level due to all energy stores having been consumed. Physical exhaustion is most common in those sports where the activity occurs over a longer period of time, as in distance events of all types; it may also arise through prolonged training for shorter duration events.

Mental exhaustion is the loss of mental keenness. Mental fatigue can occur during an event, such as an endurance race, but more commonly this state occurs in a cumulative fashion, due to factors such as the pressure of high level competition or the stress imposed upon the athlete through daily training sessions. Terms such as “burnout,” “staleness,” and “brain-fog” are expressions of mental exhaustion. Heat exhaustion is a subset of physical exhaustion, but as it arises in specific environmental circumstances, it has a separate and well-developed set of physical indicators.

Physical exhaustion is a condition that is most commonly revealed by extreme fatigue on the part of athletes, where they are no longer physically capable of performing at their accustomed level. As physical exhaustion typically occurs in endurance sports, it is the aerobic energy system that is central to an examination of the mechanics of this condition. When the body requires energy for activities lasting longer than approximately 90 seconds, it will fuel itself through the production of the energy source adenosine triphosphate (ATP), using available stores of glucose.

ATP is produced as the culmination of a process whereby the bodily carbohydrate stores, glycogen, are converted to glucose and transported through the red blood cells of the bloodstream to the muscles where the ATP conversion occurs. The red blood cells also transport the oxygen required to metabolize, or burn, this fuel; the blood also removes the waste products and carbon dioxide produced in this process.

The simplest and most common form of physical fatigue is when the body simply runs out of the primary sources of carbohydrate required to manufacture energy in the form of ATP. When the body determines that it has no more glycogen available to it (the liver regulates the level of these sugars present in the bloodstream), it will revert to the consumption of stored fats to convert into energy sources.

Fats are a comparatively lesser, more inefficient fuel for energy production. As with any machine, when the fuel sources are spent, the body cannot continue to perform.
An inability to produce energy does not only affect the muscles and other working components of the body, but also the functioning of the brain and the central nervous system; a depletion of physical energy stores will cause significant reductions in concentration and mental function.

Absent any other physical factors contributing to the physical exhaustion, such as extreme cold or altitude, this circumstance will be corrected through rest and the ingestion of appropriate carbohydrate-rich foods to redress the bodily balance.

The other most common potential causes of physical exhaustion in an athlete, occurring either singly or in combination with other factors, include: illness (such as cancer); poor long-term nutritional habits (such as lacking vitamins or minerals necessary to the function of the energy systems); mental stress; environmental condition (e.g., air pollution); and dehydration (when the fluid level of the body is reduced, the volume of fluid in the bloodstream is correspondingly less).

Physical exhaustion is also an expression used to describe the testing processes used to calculate performance measures such as VO2max, the maximum amount of oxygen that an athlete can process, which is a powerful indicator of endurance sport fitness.

Physical exhaustion is also the stated limit to carbohydrate depletion tests and interval training of all types. The immediate, short-term athletic goal in each of these mechanisms is to train to physical exhaustion; the long-term objective is to extend the prior physical limits.

Mental exhaustion can arise in a number of circumstances in relation to both training and competitive circumstances. Professional team sport athletes who are required to play a number of games over a period of weeks will often complain of a lethargy and lack of motivation. Hard training, especially when the individual components are repetitive, can occasionally result in a similar mental fatigue.

Heat exhaustion a progression in the overheating of the body known as hyperthermia. When the body is working, especially in warm or humid conditions, it cools itself by forcing warm blood to the surface of the skin, which results in the production of perspiration, which in turn both dehydrates the system and depletes the body of the mineral sodium.

The symptoms of heat exhaustion are severe thirst, generalized weakness, and a loss of coordination (due to reduced mineral levels, which aid in the transmission of nerve impulses to the muscles). The next stage in this progressive heat illness is a heat stroke, which may result in cardiac arrest and death. A notable fatality due to heat stroke was that of Korey Stringer, National Football League (NFL) lineman, in 2001 during a hot weather training camp session.”


Vo2 Max

“An athlete’s exercise effort is best clinically measured by Vo2 Max. This measure will tell you the given physiological effort exerted during exercise. However, in a practical setting exercise effort is harder to define. Many coaches and athletic trainers will use heart rate as the measure of exertion in such a setting. This however will only measure effort for a specified time of exertion and not over the course of time or training.”

“Over exercise/training is not at all easy to measure objective. Research in this area has tried to define several characteristics that can explain when a person has passed threshold of exercise. This is typically referred to as overtraining syndrome. It is best diagnosed through a variety of factors most of which are relatively subjective rather than objective. The measure used to define it in high level athletes are usually; fatigue outside of exercise, decreased performance, fatigue during simple exercise, decreased interest in the activity, decreased ferritin lab values, decreased Vo2 Max and increased rates of injuries and/or muscle soreness. As you can see overtraining syndrome is not easy to diagnose. Most commonly athletic trainers and physicians will go by injury rates, ferritin lab values and performance indicators.”
[Amy Waugh, certified athletic trainer, University of Kentucky Department of Orthopaedics and Sports Medicine]


If deaths continue a futuristic football helmet might have an RFID-enabled football helmet that prevents heatstroke by measuring body temperature and a monitor that measures the target heart-rate and pulse check to prevent over exercise/training. Both would be wirelessly transmitted to the sideline traineer who moniters the measurements. Measuring exercise intensity attempts to define the threshold of exercise tolerance and over training syndrome. Increased rates of injuries and/or muscle soreness are indicators of course. Objective laboratory findings are decreased ferritin lab values and decreased Vo2 Max. These are performance indicators, but not as practical as target heart-rate and pulse check in the helmet.