Ep. 113 Overuse Injuries: Causes, Diagnosis, and Management with Dr. Grant Ralston

Why do overuse injuries keep coming back even after the pain settles down? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Grant Ralston to define overuse injury as a load-related disorder, and to work through its causes, diagnosis, and management in both pediatric and adult athletes. They review common conditions like bone stress injuries, chronic tendinopathy, plantar fasciitis, and apophysitis, and discuss why year-round play, early sport specialization, social media, and name, image, and likeness (NIL) pressures are making these cases more frequent in clinic.

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Timestamps

00:00 - Introduction
06:22 - Defining Overuse Injuries
08:31 - Why Overuse Injuries Are Increasing
15:33 - Corticosteroid Injections in Chronic Tendinopathy
22:05 - Relative Rest and Cross-Training
26:28 - Lower Extremity Overuse Injuries
34:40 - Gluteal Tendinopathy and Greater Trochanteric Pain
39:17 - Hydrodissection and Prolotherapy
51:37 - Upper Extremity Overuse Injuries
56:05 - Early Sport Specialization and Time Off
01:00:39 - Training Load, Sleep, and Nutrition
01:08:20 - Imaging, Physical Therapy, and Treatment Options
01:15:40 - Final Takeaways and Wrap Up

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More about this episode

The conversation moves through the lower and upper extremities, addressing Achilles tendinopathy, medial tibial stress syndrome, gluteal tendinopathy, patellofemoral pain, and rotator cuff tendinopathy, all with a focus on underlying biomechanical deficits. Drs. Ralston and Balle dissect the pros and cons of repeated corticosteroid injections, explore alternatives like ketorolac, prolotherapy, PRP, hydrodissection, and shockwave, and clarify when imaging should and shouldn’t drive decisions. They close with tips on relative rest, scheduling breaks from sport, optimizing sleep and nutrition, and building strong referral networks to support patient recovery.

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Resources

Fredericson M, et al. Tibial Stress Reaction in Runners: Correlation of Clinical Symptoms and Scintigraphy with a New Magnetic Resonance Imaging Grading System. Am J Sports Med. 1995
https://journals.sagepub.com/doi/10.1177/036354659502300418

Taheri P, et al. Comparison of Subacromial Ketorolac Injection versus Corticosteroid Injection in the Treatment of Shoulder Impingement Syndrome. J Res Pharm Pract. 2017
https://pubmed.ncbi.nlm.nih.gov/29417082/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

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