Tendonitis Data

Overuse injuries may be defined as a mechanism of injury as well as a specific injury. For the purpose of this discussion overuse injuries will be defined as a category of injury with specific injury etiology due to repetitive microtrauma with a gradual onset of pain. Overuse injuries are generally chronic in nature without a single onset episode.

Tendinitis Injuries account for 19.69% of all injuries reported by Punahou athletes in grades 7 through 12, for the 25-year period from 1988 to 2013. This includes time-loss and no-time-loss injuries. As noted in Table 1, there is a decrease in tendinitis injuries, as the student/athlete gets older. Seventh grade athletes, male and female, recorded 792 tendinitis injuries, 28.96% of the 2735 injuries reported. Tendinitis injuries accounted for only 12.36% of injuries for 12th grade athletes.

Table 1: Percent Tendinitis - Gender/Grade: 88-13.

Points of Interest Table 1:

  1. The 7th grade athletes reported the highest percentage of tendinitis injuries although actual overuse injuries were the lowest reported by any grade.
  2. The percentage of tendinitis injuries decreased annually for both genders.
  3. Females reported a higher percentage of tendinitis injuries at all grade levels than males.
  4. The number of female tendinitis injuries decreased after grade 9 as did the total injuries.
  5. Males reported more tendinitis injuries during the 11th and 12th grades, but the percentage of all injuries is lower.

Observations from Table 1:

  1. Overuse tendinitis injury percentages decrease with age regardless of sport/activity for each sex.
  2. Females report a higher percentage of overuse/tendinitis injuries than do males for each grade.
  3. The total number of injuries decreases in 11th and 12th grades as do total gender specific injuries and gender specific tendinitis injuries
  4. Males report more total injuries than females with a lower percentage of tendinitis injuries.

Table 2: Varsity Female Overuse Tendinitis Exposure Rate (Injuries per 1000 Athlete Exposures - /1000AE)

Points of Interest Table 2:

  1. Of the 6002 female varsity sport injuries reported, 2974 (49.5%) were time loss injuries.
  2. If No-time-loss injuries are ignored, 51% of all female injuries would go unreported.
  3. Overuse injuries (1620) accounted for 27% of all varsity female injuries.
  4. The overuse exposure rate is 1.81/1000 AE.
  5. There were 584 time–loss overuse injuries (9.7% of all injuries), which is 36% of all overuse injuries.
  6. A total of 1036 no-time-loss were reported (17.2% of all injuries) which is 64% of all overuse injuries.

Specific Sports – Females
Track and Field

  1. Track and Field (TF) had the highest annual participation rate with an average of 124 athletes competing at the Varsity/JV level per year.
  2. Female athletes reported 1674 injuries of which 731 (43.7%) were classified as overuse injuries.
  3. The overuse Exposure Rate was the highest at 3.19/1000 AE.
  4. Time-loss overuse injuries (232) accounted for 39.9% of all TF injuries with an exposure rate of 1.274/1000 AE.
  5. No-time-loss overuse injuries (439) accounted for 60.1% of all varsity TF injuries.

Cross Country

  1. Cross Country (CC) had the second highest participation level for female athletes with an average of 68.5 athletes per year.
  2. Overuse injuries accounted for 377 (49.9%) of all reported injuries with 136 time-loss injuries (17.9% of all injuries).
  3. The Exposure Rate for all overuse injuries was 2.65/1000 AE with a time-loss exposure rate of .959/1000 AE.
  4. The No-Time-Loss exposure rate s 1.694/1000 AE.


  1. Varsity volleyball reported only 55 overuse injuries which is only 19.5% of all injuries.
  2. The Overuse Exposure Rate is 1.79/1000 AE. (Low participation rate)
  3. Only 8 of the overuse injuries were time-loss injuries for an exposure rate of 0.260/1000 AE.
  4. The No-Time-Loss injuries (47) accounted for 85.5% of all overuse injuries.
  5. Fourty-one of the 55 volleyball overuse injuries (74.5%) occurred to the lower extremities with only 10 shoulder injuries reported.


  1. Data for female wrestling is for 15 years, rather than the 25 years for male wrestlers.
  2. Female wrestling had the lowest participation rate with 10.9 participants per year.
  3. Wrestling reported on average 1 overuse injury per year (16) which is 4.4% of all injuries.
  4. Four time-loss injuries were reported during the 15-year cycle.
  5. The variety of cardiovascular and physical conditioning exercises did not result in repetitive microtrauma.


  1. Only 8.5% of all injuries (74) were classified as overuse injuries for varsity girl's soccer
  2. The no-time-loss injury (55) exposure rate was 1.202/1000 AE as athletes continued to participate with minor irritations.

Canoe Paddling/Kayaking

  1. These sports reported 49% and 42% of all injuries as overuse.
  2. As the exposure rates are similar, it should be noted that 71% (63) of the overuse injuries involved lower extremities. These were the result of dry-land conditioning programs.

Table 3: Varsity Male Overuse Tendinitis Exposure Rate (Injuries per 1000 Athlete Exposures - /1000AE)

Points of Interest Table 3:

  1. There were 1510 overuse injuries reported by varsity male athletes. This is 13.4% of all injuries reported, which is half of those reported by varsity females.
  2. The 541 time-loss injuries were 9.5% of all time-loss injuries reported.

Track and Field

  1. Track and Field had the highest number of participants (average of 115/year) and the highest number of overuse injuries (495) which is 35.5% of all injuries.
  2. The Overuse Exposure rate was 2.43/1000 AE, second highest.
  3. The time-loss overuse injuries accounted for 25.7% of all time-loss injuries and 39% of all overuse injuries.
  4. No-time-loss injuries accounted for 61% of overuse injuries and had the second highest no-time-loss exposure rate of 1.483/1000 AE.

Comparisons between Table 2 and Table 3.

  1. Males reported 5240 more injuries than did females. While the majority of this difference was due to football injuries, with football injuries removed males still reported >600 injuries more than females.
  2. Females reported more overuse injuries (1620 to 1510) than males and without football the number is 1620 to 1400.
  3. Males have more contact/collision type injuries than due females.
  4. Females report that 27% of all injuries are overuse, compared to male reported injuries at 13.4%.
  5. The exposure rate is 1.81/1000 AE for females and 1.39/1000 AE for males. The rate ratio is 1.30 reconfirming that females have a higher overuse injury rate.

Contributing Factors for Possible overuse injuries.

  1. High School Physical Education (PE) credit is available for all students while participating in athletics. This credit is generally attained while in grades 9 and 10, but can stretch to grade 11.
  2. Students trying to earn this PE credit generally choose the non-cut sports.
  3. Lack of pre-participation conditioning, both muscular and cardiovascular, is the primary cause of overuse injuries in middle school and secondary school sports.
  4. Proper footwear is essential for all sports. Cleated shoes may place excessive stress on the calcaneus as the foot lands on the ground. A shoe with bars on the sole disperses the stress over the foot reducing the force on the contact points from the cleats.
  5. Establishing standards for cardiovascular conditioning as well as technical and athletic skills should be the basis for athletic participation.
  6. Athletic participation should be a goal for students, not just a means for easy PE credit.