What Are Overuse Injuries?
Overuse injuries are conditions that develop gradually as a result of repeated stress being placed on a tissue without sufficient recovery time between periods of loading. There is no single, clearly identifiable traumatic event. Instead, tissue damage accumulates silently until it eventually presents with pain and impaired function.
They are among the most common conditions in endurance sports, throwing disciplines and any activity involving frequent repetitive movements.
Typical examples include Achilles tendinitis, patellar tendinopathy, tennis elbow and stress fractures.
Overuse injuries commonly affect people who have suddenly increased the volume or intensity of their training, changed their training surface or started a new sport without allowing sufficient time for gradual adaptation.
Characteristics of Overuse Injuries
Overuse injuries tend to follow a characteristic pattern. Initially, pain is mild and appears only after exercise. It then begins to occur during exercise without affecting performance, later starts to impair performance and, eventually, may also be present at rest or during everyday activities.
This gradual progression means that many athletes ignore the early warning signs and continue training, causing the condition to worsen.
At a histological level, overuse injuries are characterised by degenerative changes, including collagen disorganisation, microtears, vascular ingrowth and the deposition of irregular connective tissue.
The affected tissue remains in a state of incomplete repair: each new period of loading causes more damage than the body is able to repair before the next one begins.
Management requires a reduction or temporary cessation of the activity causing excessive strain. However, rest alone is not sufficient in advanced cases, in which active biological support for tissue repair may also be required.
Scientific and Clinical Research
Research into overuse injuries has highlighted the central role of inadequate vascularization and oxygenation in their persistence. Studies have shown that the activation of growth factors, particularly VEGF and TGF-β, is essential for breaking the cycle of incomplete tissue repair, and that hyperbaric oxygen therapy may stimulate their activity.
Clinical studies involving athletes with chronic overuse injuries affecting tendons and the periosteum have reported significant improvements in pain scores and functional recovery following a course of hyperbaric oxygen therapy, particularly when it was combined with a physiotherapy programme.
Hyperbaric Oxygen Therapy for Overuse Injuries
In overuse injuries, hyperbaric oxygen therapy may act as a biological stimulus that helps break the cycle of incomplete repair by providing the affected tissue with the biochemical conditions required for more complete recovery, rather than merely allowing it to continue functioning despite ongoing tissue damage.
Increased oxygenation activates fibroblasts and tenocytes, promoting the synthesis of functional type I collagen, which replaces the disorganized type III collagen associated with degenerative tissue.
At the same time, the stimulation of neovascularisation may improve the long-term blood supply to the affected tissue and reduce the risk of recurrence.
Hyperbaric oxygen therapy is always planned as an adjunct to physiotherapy, eccentric loading exercises and modification of the patient’s training load.
A typical treatment course consists of 20 to 30 sessions, with the patient’s response assessed after every 10 sessions. The decision to incorporate the treatment into the rehabilitation programme is made in collaboration with a sports medicine physician or physical and rehabilitation medicine specialist.