Defining the Term "Overuse": An Evidence-Based Review of Sports Epidemiology Literature.

Reference/Citation:  Roos KG, Marshall SW. Definition and usage of the term "overuse injury" in the US high school and collegiate sport epidemiology literature: a systematic review. Sports Med. 2014;44(3):405-421.

CLINICAL QUESTION:   What is the current context of the term overuse in the epidemiologic sports injury literature?

DATA SOURCES:   The authors performed a database search of PubMed and SPORTDiscus. The Boolean phrases athletics AND injury and overuse OR epidemiology were searched.

STUDY SELECTION:   Studies were included in the review based on the following criteria: (1) epidemiologic in nature, (2) involved US high school or collegiate athletes, and (3) published in English between 1996 and 2012. In addition, a study was classified as epidemiologic in nature if appropriate exposure data were collected in order to calculate injury incidence rates. One reviewer initially read the titles or abstracts of the studies to determine their relevance for the systematic review. Studies were excluded if they (1) were biomechanical or anatomical in nature, (2) were clinical in nature, or (3) assessed the effectiveness of an intervention.

DATA EXTRACTION:   The reviewer extracted statistics and definitions of the word and phrase overuse and no contact. The reviewer adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as much as possible.

MAIN RESULTS:   A total of 5182 titles of articles were initially identified in the databases searched. Then 232 studies were read to determine if they included overuse statistics. A total of 35 articles were included in the final review. Two main surveillance programs were used in these studies, with the authors of 12 articles (n = 12/35, 34.3%) using data from the High School Reporting Information Online (RIO) and the authors of 13 articles (n = 13/35, 37.1%) using data from the National Collegiate Athletic Association's Injury Surveillance System (ISS). One group (n = 1/35, 2.9%) used both surveillance systems, whereas 9 groups (n = 9/35, 25.7%) used other surveillance systems. Articles were categorized as (1) high school or collegiate studies using neither ISS nor RIO data, (2) high school studies using RIO data, or (3) collegiate studies using ISS data. The authors of only 1 article of the 35 (2.9%) provided a comprehensive definition of the word overuse. Collectively, 14 groups classified overuse as a mechanism of injury, 7 classified it as a category of diagnosis, and 8 classified it as both a mechanism of injury and a category of diagnosis. Specifically, 12 of the 35 articles combined overuse with other terms such as chronic, gradual onset, and repetitive stress, whereas 4 of the 35 articles defined overuse in the context of no-contact injuries.

CONCLUSIONS:   A great deal of inconsistency exists within the sports injury epidemiological literature regarding the term overuse. The authors of the systematic review recommended using the term overuse when referencing the mechanism of injury. A working definition of the term overuse should be used in injury surveillance such that injuries due to overuse are characterized by a mechanism of gradual onset and an underlying pathogenesis of repetitive microtrauma.