Overuse Syndrome

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The amazing human body
Symmetry by design
What exactly is “overuse syndrome”? 
Why does overuse syndrome affect people with upper limb differences?
What kinds of movements cause overuse syndrome? 
At what age does overuse syndrome begin?
How does overuse syndrome develop?
The four stages of overuse syndrome

Exploring prevalent mindsets
What are the prevalent mindsets?
Things you can do to stop overuse syndrome
Recap on Overuse Syndrome
Quick Links

The amazing human body

Even when asymmetrical because of a limb difference, the human body is highly adaptable and capable of performing both everyday tasks and incredible feats of agility and strength. If you follow social media or the news, you can’t help but be astonished by the athletic feats that children and adults with upper limb differences (ULD) are accomplishing every day such as bodybuilding, dancing, rock climbing, playing all kinds of sports, weightlifting, repairing sports cars, magician, rocket, actor, the list goes on. 

Symmetry by design

But the human body also is designed to be symmetrical: two eyes and ears, two arms and hands, two legs and feet, etc. It is especially helpful when adults understand that the compensations that our children develop to accomplish tasks take a cumulative toll on their bodies. Children with limb differences should be encouraged to choose and decide which activities they want to pursue and given support to do them in as safe and healthy a manner as possible.

Teaching children from a young age to use their affected side(s) in everyday activities to “balance” their bodies during functional activities is essential. So is reducing wear and tear on the “dominant” side, as it rarely gets a break. Building core and upper body muscular strength and endurance also can help to protect overused muscles and joints.

Since the strain on the upper body is cumulative, activities that may have been easy in childhood can become straining as one ages. Sometimes strain can turn into a prolonged overuse syndrome that can last for months or even years, which can pose significant challenges to functioning and affect many aspects of life.

What exactly is “overuse syndrome”? 

Overuse syndrome is a short or long term condition involving pain, strain, and/or decreased function. It is also known as occupational overuse syndrome (OOS), overtraining syndrome (OTS), cumulative trauma disorder (CTD), repetitive strain injury (RSI), repetitive motion disorder, repetitive stress disorder, or overuse injury.

Repeating one movement or motion constantly over a long period of time can lead to overuse syndrome in your hands and arms. Though many are able to recover from this condition, it can be very inconvenient, and can prevent you from completing everyday tasks and activities.

The Cleveland Clinic

Factors that can cause overuse syndrome are:

  • repetition of one movement or motion
  • frequently
  • over a span of time
  • in hands and arms
  • that can prevent completion of everyday tasks and activities (Adapted from the Cleveland Clinic).

Why does overuse syndrome affect people with upper limb differences?

People with ULD face increased risk for overuse syndrome because of strain on the dominant side and compensations on the limb different side(s). Overuse syndrome typically develops in hands and/or arms before spreading to other parts. Compensations in hands/arms can cause strain or fatigue in other muscles, and overuse syndrome can affect upper arms, back, shoulders, and neck. Catching overuse syndrome early is important to prevent long term problems.

Unfortunately, there‘s very limited research on overuse syndrome for upper limb difference. There are several studies on adults with acquired limb loss and no studies on congenital limb difference. So we can apply research on overuse injuries in young athletes. (Source: Dr. Brenner & Dr. Watson, “Preventing Overuse Injuries in Young Athletes: American Academy of Pediatrics Policy Explained;” 1/2024)

What kinds of movements cause overuse syndrome? 

… repetition, high force, awkward joint posture, direct pressure, vibration, and prolonged constrained posture. The unilateral upper limb amputee patient may have a problem avoiding many of these risk factors because of the natural heavy reliance on the sound limb…

Overuse Syndrome and the Unilateral Upper Limb Amputee: Consequences and Prevention; 2008

Overuse syndrome can also be caused by not enough rest and recovery, poor body positioning and/or posture, repeating specific straining motions, stress or untreated mental health issues, or weak muscles or deconditioning.

At what age does overuse syndrome begin?

We thought overuse syndrome started in middle age for folks with ULD, but we may have been wrong. In a recent not yet published study, adults with congenital one-sided ULD reported: 82%: experienced pain/overuse and 70%: pain/strain developed by age 26.

These statistics are considerably higher than in the general population. According to the CDC’s article “Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019,” data from the National Health Interview Survey showed that “The percentage of adults with upper limb pain increased with age, from 16.2% for those aged 18–29 and 24.1% for those aged 30–44 to 37.9% for those aged 45–64 and 42.0% for those aged 65 and over”- all of these are considerably lower than the 70% of ULD people reporting pain by 26.

How does overuse syndrome develop?

Overuse syndrome develops in stages over time. Catching overuse syndrome early in either arm or hand can prevent symptoms from worsening. Because it‘s easy to ignore pain, learning to recognize the stages for oneself or a loved one (child, spouse, friend) and noticing patterns of ignoring or pushing through pain can help reduce the risk of overuse syndrome.

The four stages of overuse syndrome

  • Stage 1: pain occurs after activity:
    • Hands and/or arms feel fatigued after activity or work shift
    • Subsides with overnight rest
    • Example: pain and/or fatigue after cooking, playing sports, or typing one-handed

  • Stage 2: pain occurs during activity – but doesn’t affect performance
    • Fatigue or pain starts earlier
    • Discomfort may last into the next day
    • Increasing aching and tiredness
    • Rest and over the counter anti-inflammatory medication bring relief
    • Example: pain and/or fatigue during cooking, playing sports, or typing one-handed

  • Stage 3: serious aching, fatigue, pain – and limits performance
    • Pain limits full participation in activity
    • Discomfort lasts into the next day
    • Rest and over the counter anti-inflammatory medication bring limited relief
    • Muscles may weaken
    • Example: pain and/or fatigue limit ability to cook, play sports, or type one-handed

  • Stage 4: chronic pain even at rest
    • Constant aching, fatigue, pain
    • Pain is unrelated to activity
    • Daily life and sleep are affected
    • Only extended rest brings relief
    • Muscles likely have weakened
    • Example: constant pain and/or fatigue in either hand/arm, back, neck, shoulder

Exploring prevalent mindsets

On the one hand/nub, in western culture, people often share particular mindsets to offer comfort and validation to those experiencing challenging situations. On the other hand/nub, these mindsets also can promote overdoing and overachieving by people with physical differences and disabilities.

Children and adults with upper limb differences may find some of the mindsets helpful in general and/or in certain situations. At the same time, we want our children to be able to do the things they want to do not just as a kid – but also later when they’re grown up – at 30, 40, 50 and beyond. These mindsets can also promote overdoing and overachieving by people with physical differences and disabilities. Given the high incidence of overuse syndrome among adults with upper limb differences (70% by age 26), let’s consider which mindsets may be contributing factors. Many adults say they wish they’d made better-informed decisions about how much to push their bodies.

What are the prevalent mindsets?

Given the high incidence of overuse syndrome among adults with upper limb differences, let’s continue exploring possible contributing factors. Let’s delve into these mindsets, examining (who and) how they may help and also how they may harm our children:

  • “they can do everything just like kids with 10 fingers” 
  • “no pain, no gain”
  • “treat them exactly the same”

“They can do everything just like kids with 10 fingers” 

It makes sense that we may fear that our children won‘t be able to do typical kid things because of hteir limb differences. Of course we want our children with upper limb differences to be able do everything as their limb typical peers, like:

  • have the same opportunities to develop confidence, competence, and resilience
  • feel empowered to do what they want without internalizing they can’t do certain things
  • perform age-appropriate activities
  • be included by peers
  • feel good about things they do

Why RETHINK ‘they can do everything just like kids with 10 fingers’?” 

This mindset can contribute to overuse syndrome because children with upper limb differences:

  • are eager to please adults
  • may feel they constantly need to prove they are capable
  • may pick up on parents’ fears they won’t be able to do things independently
  • may push themselves beyond their bodies’ limits to do even unimportant tasks

‘No pain, no gain’ 

Of course we may think that the best way to instill resilience is by encouraging children with upper limb differences to “overcome their difference”, work harder than peers to be treated as equals, and be strong enough to handle life’s challenges.

Why RECONSIDER ‘no pain, no gain’?” 

This mindset can contribute to overuse syndrome because children with upper limb differences:

  • may not realize they’re pushing their bodies beyond their natural limits
  • already work harder than most of their limb typical peers
  • don’t get to rest the side they use most

‘Treat them exactly the same'” 

Many well-intentioned health care providers advise treating “limb different” children exactly like “limb typical” children. But health care providers who work exclusively with children may not may not know about the risk of overuse syndrome later in life. The perspective of even highly distinguished and experienced health care providers may be limited from lack of exposure to adults experiencing overuse syndrome. Finally, there is unfortunately very limited research on what causes overuse syndrome in people with upper limb differences.

Why REEXAMINE ‘treat them exactly the same’?”

Following this advice can contribute to overuse syndrome because children with upper limb differences may avoid requesting needed help. They also have unique needs and challenges because of their asymmetries. Young children and even teens often haven’t developed enough body awareness to recognize how compensations they invent may strain them. While they may resist accommodations and adaptations because they want to look like everyone else, accommodations and adaptations may help lessen the risk of developing overuse issues.

Things you can do to stop overuse syndrome

Let’s encourage our children with upper limb differences to do the things they want to do. At the same time, let’s recognize that overdoing puts them at greater risk of developing overuse syndrome.

Most parents begin teaching their children from a young age various aspects of taking care of their bodies, such as brushing teeth to avoid cavities and avoiding dangers like touching a hot stove. Similarly, we can teach our children with upper limb differences about taking care of their special bodies, such as using tools to use their limb difference side(s) more and reducing strain on their typical side.

For those experiencing the beginning stages of overuse syndrome, making lifestyle changes during stages 1 & 2 can stop it from worsening. But ignoring the pain in these stages is easy. Because there may be no bruising, people may not realize that overuse syndrome is happening. It’s important to recognize pain and not push through!

Here are some things you can do as parents to understand more about overuse and reduce the likelihood that your child will be affected by overuse syndrome:

  • Learn about/educate yourself about good posture and biomechanics
  • Explain that it is our job as parents to help our children grow strong bodies, which includes:
    • developing symmetry by involving the affected (limb difference) side(s) in activities of daily living using tools that increase the ability to grasp
    • strengthening and stretching the core and upper body to reduce strain on the dominant side
  • Seek professional help from an OT who works with children with upper limb differences
  • Always listen/respond if your child complains about pain in either the dominant or affected side(s)
  • When your child begins to use technology, adapt the technology to your child rather than adapting the child to the technology!

Recap on Overuse Syndrome

  • Individuals with upper limb differences face increased risk of developing overuse syndrome over their lives
  • This is due to their upper body assymetries and atypical use patterns
  • Using the affected side(s) in everyday activities to create balance in the upper body during functional activities is essential
  • So is reducing wear and tear on the “dominant” side
  • Building core and upper body strength and endurance protect joints and muscles
  • Overuse syndrome can start very young and develop over many years
  • There are many names for overuse syndrome
  • Overuse syndrome develops in stages over a span of month or years
  • We used to think that overuse syndrome began in middle age, but we may have been wrong; in a recent not yet published study, adults with congenital one-sided ULD reported: 82%: experienced pain/overuse and 70%: pain/strain developed by age 26
  • There are some prevalent mindsets that people may share in an effort to offer comfort and validation; however, these mindsets may contribute to the problem
  • Teaching our children with upper limb differences about taking care of their special bodies, such as using tools to use their limb difference side(s) more and reducing strain on their typical side, can instill this knowledge and understanding at a young age
  • Making lifestyle changes during stages 1 & 2 can stop overuse syndrome from worsening – but ignoring the pain in these stages is easy
  • There are many things parents can do to reduce the risk of overuse syndrome from developing

Complete the form below to download a free printable copy of the Upper Limb Difference (ULD) Overuse Syndrome: preven, reduce, treat infographic

© 2025. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy