I like to give an answer written by much smarter people as overall look at his injuries.
Overuse injuries: tendinitis,
stress fractures, compartment syndrome,
and shin splints
Robert P. Wilder, MD, FACSM*, Shikha Sethi, MD
Department of Physical Medicine and Rehabilitation, The University of Virginia,
545 Ray C. Hunt Drive, Suite 240, P.O. Box 801004, Charlottesville, VA 22908-1004, USA
Approximately 50% of all sports injuries are secondary to overuse [1]. The
frequency of overuse injuries evaluated in primary care sports medicine clinics is
even greater, reportedly up to twice the frequency of acute injuries [2]. The majority
of injuries evaluated in running injury clinics are related to overuse [3,4], and
approximately half of these involve the lower leg (20%), ankle (15%), and foot
(15%) [5,6].
Overuse injuries result from repetitive microtrauma that leads to local tissue
damage in the form of cellular and extracellular degeneration, and are most likely to
occur when an athlete changes the mode, intensity, or duration of training—
a phenomenon described as the ‘‘principle of transition’’ [7,8]. Physical training
uses prescribed periods of intense activity to induce the desired goal of ‘‘supercompensation’’
or performance improvement. A mismatch between overload and
recovery can lead to breakdown on a cellular, extracellular, or systemic level,
however.At the cellular level, repetitive overload on tissues that fail to adapt to new
or increased demands can lead to tissue breakdown and overuse injury. It is
important to realize that, in theory, this subclinical tissue damage can accumulate
for some time before the person experiences pain and becomes symptomatic. On
the systemic level, rapid increases in training load without adequate recovery may
cause a global ‘‘overtraining syndrome.’’ Strong predictors of overuse musculoskeletal
injury include a previous history of injury as well as walking or running
more than 20 miles per week [9].
Both intrinsic and extrinsic factors contribute to overuse injuries. Intrinsic
factors are biomechanical abnormalities unique to a particular athlete and include
such features as malalignments, muscle imbalance, inflexibility, weakness, and
instability. High arches, for example, have been demonstrated to predispose to a
greater risk of musculoskeletal overuse injury than low arches (‘‘flat feet’’) in
military recruits [10]. Extrinsic (avoidable) factors that commonly contribute to
overload include poor technique, improper equipment, and improper changes in the
duration or frequency of activity. These improper changes in activity duration/
frequency or ‘‘training errors’’ are the most common causes of overuse injuries in
recreational athletes. Vulnerability to extrinsic overload varies with the intrinsic
risk factors of an individual athlete [7].
Sports-acquired deficiencies, categorized as an extrinsic risk factor, actually
represent the product of biomechanical abnormalities and training errors. Because
sports activity can overload an athlete’s musculoskeletal system in predictable
ways, athletic repetition without proper conditioning can propagate muscular
imbalance and flexibility deficits.
Injuries are often related to biomechanical abnormalities removed from the
specific site of injury, underscoring the importance of evaluation of the entire
kinetic chain [11].
Common overuse injuries of the lower leg, ankle, and foot include tendinopathies,
stress fractures, chronic exertional compartment syndrome, and shin
splints.