Overuse Knee Injuries

Part 1, Overuse Knee Injuries

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Knee pain, like other injuries, can be categorized into different injury types. In this Post we’ll discuss overuse injuries, why they occur, and how you can stop them in their tracks!

Here’s how we categorize knee pain:

  • Overuse Injuries
  • Ligament Injuries
  • Fractures

Some of the knee injuries that occur in your gymnast are common and some are not. Some you’ve probably never heard of! Here’s a great picture that describes the different types of overuse knee pain:

Overuse Knee Injuries

OVERUSE KNEE INJURIES ARE A RED FLAG. They are a warning sign for us letting us know that are athletes are not on the right track when it comes to training and their ability to function. This also means that their movement mechanics are faulty, putting them at high risk for further injuries like ligament damage and fractures.

Another aspect of overuse knee injuries is that we see them most in the pre-pubescent and pubescent athletes. In females, these injuries are occurring most between the ages of 10-13 and in boys, these can last until they are done growing.

Why Are Overuse Knee Injuries Occurring?

Overuse knee injuries occur because of three reasons and we’ll be breaking down each one of these reasons:

  1. Dysfunction of muscles
  2. Faulty mechanics
  3. Overtraining

Dysfunctional Muscles

Muscles are designed to work in tandem with each other. Many issues in the body occur because one muscle group overtakes another group and the body has imbalance and dysfunction ensues.

In the case of knee pain, the muscles most at fault of dysfunction are quadriceps, hamstrings, glutes, and gastrocnemius muscles.

Most overuse injuries in the knee are because the quadriceps muscles are overpowering knee mechanics, and gluteus maximus muscles are not controlling the mechanics of the knee.

Osgood-Schlatters, Sinding-Larsen-Johansen Syndrome, patellar tendonitis, jumpers knee are all the result of the quadriceps muscle overpowering the growth plates and tendons of the knee, creating inflammation and pain.

Faulty Mechanics

Faulty mechanics occur because our athletes do not control their bodies.

THEY LACK CORE CONTROL, or they’ve never been taught the proper mechanics of landing the right way. So their current landing patterns lead to overdevelopment of the quadriceps muscles, which in turn create a cycle of injury.

Here what faulty landing mechanics looks like:

  • Valgus stress, or knees come together on landing
  • Knees are in front of the toes and knees are sliding forward
  • Torso is extremely erect and hip angle is very low
  • Hyperlordosis, or in other words, sway back on landing

What landings should look like:

  • Strong knees: feet shoulder width apart, and there should be a straight line from the 1st/2nd toe, to the knee, to the hip, to the shoulder
  • Knees should hinge and toes should stay behind the toes
  • 30 degree angle in the hips
  • Tight and strong core on landing


Our bodies have a limit. What effects this limit? Age, training time, ability, strength, ability to rest, NUTRITION.

When we exceed this limit are bodies cannot cope with the training and function decreases. This functional decrease occurs over time and refer to this phenomena as overtraining syndrome.

One of the reasons athletes have overuse injuries is because their bodies were never able to recover from their injuries, and they continued to a point where they are now in immense amounts of pain.

Overtraining creates dysfunction and faulty mechanics. Here’s a list of resources on the Gymnast Care site to help you with overtraining:

Plan of Action

We need a plan of action to protect our athletes from injury and get them out of pain. Here’s what we use for overuse knee injuries:

  • Immediate relief of pain
  • Teach proper body/core control
  • Teach proper landing mechanics
  • Stress proper core and landing mechanics

Immediate Relief of Pain

Our main goal needs to be to reduce pain as soon as possible in our athletes that are experiencing this pain. Like any injury, we want to implement PRICE as soon as possible. PRICE stands for

  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation

Here’s how to compress and protect the knee:

Protect the knee because many of these overuse injuries can be very tender to the touch or if our athlete hits their knee on the coffee table it can be incredibly painful.

What does rest for an athlete mean? Rest is the removal of any action that creates pain or dysfunction. If an athlete can go to workouts and has no pain with running, but jumping causes pain, then we want to eliminate the jumping aspect of the practice until they can do this action with no pain.


Pain is a warning sign that your body is doing things incorrectly. Do not train through pain.

Get Control of Your Body

Body control is the number one measure your athlete can implement to make sure they stay injury free.

We’re trying to encourage the athletes brain communicating with the body better and this means they have to start with incredibly simple exercises that encourage control, and not strength.

Here’s the first step in controlling the core. Their three incredible simple exercises that create enormous core when done correctly:


Proper Landing Mechanics

Landing properly is actually just a function of body control. We want our athletes to be able to tell their bodies where to go, and they go there! We don’t want the forces produced to take advantage of their bodies…we want them to control the forces. So as with the video above, core control is the first step to proper landing mechanics.

We add the squat to core control because it get’s the body in the habit of keeping the feet, knees, hips, back, and core in the right positions.

The landing position is a function of the squat.

Stress The Core and Landing Position

Once our athletes understand core control and how the body needs to land, these positions should be stressed so our athletes can increase their control and perfect their landing abilities.

Further Training

In the Gymnast Care Book on Injuries, we get in depth to core protection and landing mechanics. The knee chapter is packed full of these protocols and will walk you through each exercise.

The Gymnast Care Book on injuries is a resource for you and your family. It’s a critical part of injury prevention and injury care.

Get Your Book on Injuries Now!

We have 2 versions of the Book on Injuries and you can find them here:

Book on Injuries, Print Edition

Book on Injuries + Videos, Digital Edition


Dr. Joshua Eldridge

About Dr. Joshua Eldridge

Dr. Joshua Eldridge has specialized in protecting gymnasts from injury. He is the inventor of The X Brace, and has developed a treatment protocol for Sever's disease and heel pain that has helped thousands of gymnasts throughout the world. Dr. Eldridge brings practical, easy injury care and prevention that can be done at home.