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Watch Out Athletes – Here’s What Happens to the Pros.

Blog written by Kylie Marler


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It happens to most athletes at some point in their career, whether it’s in high school, college, or even professional sports. But here’s the thing: once you “go pro”, your injury chances sky rocket due to the demands of becoming a full-time professional athlete.

NFOR/OTR: Defined

Did you know that – according to an article published in the American College of Sports Medicine reports – 60% of elite athletes reported significant performance decrements that lasted weeks (or even months) caused by NFOR/OTR? And that 30% of non-elite athletes reported the same thing?

Author Chris Beardsley defines NFOR/OTR in this article he published in 2018. He defines NFOR (non-functional overreaching) as, “a short-term reduction in performance that recovers fully (but does not lead to improved performance), and only after a sustained period of rest.” He also defines OTR (overtraining syndrome) as, “a longer-term reduction in performance that recovers fully, but only after a sustained period of rest lasting longer than 2 months.”

Muscle Damage and Muscle Fibers

This Swedish study examined competitive powerlifters and discovered that the athletes showed unusually severe muscle damage; some muscle fibers were even at the point of necrosis (death). These findings were so strange that it strongly suggests that muscle damage can accumulate over time and increase in severity, if multiple workouts are done before the muscle fully repairs itself.

The study continues with its main objective (assessing the presence of muscle fiber splitting in powerlifters) and concluded that muscle fiber splitting is an indication of partial or incomplete repair of muscle damage caused by strength training.

(Muscle fiber splitting is when one muscle fiber splits/divides into two or more smaller fibers.)

Here’s How It Works

According to this article on, “powerlifting is a strength sport in which maximal strength determines competitive success. Powerlifting is based on 3 barbell lifts (the “powerlifts”): the squat, bench press, and dead lift.” Basically, each athlete gets three (3) one-repetition attempts to lift the heaviest weight they can for each of the powerlifts – squat, bench press, and dead lift – with the goal of getting the highest possible total (the sum of their highest successful lifts).

But here’s the thing: the powerlifts (bench press, squat, and dead lift) are also common training exercises for athletes outside of powerlifting. For example, athletes of non-strength related sports or even recreational lifters. And since the powerlifts are multi-joint exercises that utilize multiple major muscle groups, they’re considered to be an efficient way to train.

And… the Consequences

All of this extreme lifting can’t be good, right? Well, as it turns out, that’s absolutely correct. Another Swedish study examined the effects of powerlifting on sub-elite classic powerlifters. The study found that 70% of participants admitted they were currently injured, with a whopping 87% admitting they’d experienced an injury within the past year. A staggering number of injuries seemed to occur during training, and the study concluded that injuries are very common in powerlifters and were found to change the content of training sessions. The researchers added that management of training loads and optimization of training are crucial in powerlifting.

Picture This

Staples Center, Tuesday October 28, 2014. It’s the Lakers’ regular-season opener and NBA debut for 19-year-old Julius Randle. The sold-out stadium is silent, with every pair of eyes watching as the rookie lying underneath the basket is surrounded by medical personnel. His right leg is stabilized in an air cast, teammates load him onto a stretcher, and he disappears into the tunnel, his leg broken, and his rookie season ending just minutes after it began.

While the injured rookie (and Lakers’ top draft choice) is wheeled into medical care, Lakers head strength and conditioning coach Tim DiFrancesco analyzes the replay, trying to figure out what went wrong. As DiFrancesco watches the playback, he sees a normal run to the rim, jump, and landing, with no mid-air collision. Not a single clue as to what caused Randle’s leg to break – it just broke.

The Diagnosis

According to this article on, “Randle suffered a clean break of the tibia and was having surgery Wednesday morning.” While the rookie was being prepped for his emergency surgery, sources from the Lakers said, “the Lakers’ initial fear was that he’d miss 4-6 months”. Another ESPN article wrote, “An X-ray would later find that Randle had suffered a “stress reaction,” a precursor to a stress fracture but without the break. Repetitive impacts to that bone had led its structure to break down”.

So What Does This Mean?

In 2017, NBA commissioner Adam Silver said, “What our orthopedics are telling us is they’re seeing wear-and-tear issues in young players that they didn’t used to see until players were much older.” The shocking statistics back this up in this article from ESPN, “in 2017-18, the number of NBA games lost to injury or illness surpassed the 5,000 mark for the first time since the league stopped using the injured reserve list,” and, unfortunately, the numbers just keep climbing. But why?

The article also quotes Dr. Marcus Elliott, “what they [basketball players] put their bodies through is so rigorous. It’s so extreme. And a lot of them don’t make it out to the other side.” According to the article, “overuse can lead to chronic ankle injuries, development of joint and cartilage problems, even spine problems.”

In 2015 the NBA hired Dr. John DiFiori as Director of Sports Medicine. In response to the growing numbers of players affected by overuse/overtraining, DiFiori says, “that sort of accumulation of the injuries, or the development of asymmetries, muscle tendon dysfunction, etc. That certainly can shorten a career span.”

Numbers Don’t Lie

Steve Adams writes in an article that early in the 2021 season, injury list placements were “up 15 percent overall compared to the first month of the 2019 season…with a 22 percent uptick among pitchers. Specifically, soft-tissue injuries such as hamstring, quadriceps and oblique injuries have nearly doubled in frequency, while arm and elbow injuries are up by a much slighter margin of 19 percent.”

Here’s Just One Example

Kole Calhoun (currently with the Texas Rangers) was an outfielder for the Arizona Diamondbacks during his 2021 season. In a game against the San Diego Padres, Calhoun attempted to steal third base in the sixth inning, resulting in a strained hamstring. The pro-baller’s injury was so severe that he, “had surgery to remove a split hamstring tendon in his left leg” and was predicted to “be out for six to eight weeks, depending on how the healing process goes,” according to this article on The article also says, “Calhoun missed the first seven games of the season after having surgery on his right knee earlier in Spring Training.”

A Dramatic Increase

This article on addresses the spikes in MLB injury rates, “through May [2021], there were 104 soft tissue injuries that resulted in stints on the IL [injured list], a 160% increase over the 48 after two months in 2019.” The article also states, “oblique strains and tears are up 83%”.

The article quotes Stan Conte, the former trainer for the Los Angeles Dodgers and New York Giants, as he talks about the first two months of the 2021 MLB season, “The increase is real. Whether it will smooth out after these two months? We’ve never seen an increase like we’ve seen these past two months.”

And lastly, the article writes, “professional sports are now a 12-month endeavor, with athletes investing in their own bodies to maintain peak performance”. James Gladstone, head of sports medicine at New York’s Mount Sinai Health System, says, “certainly, if you’re fatigued, you’re prone to injury”.

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Adams, S. (n.d.). MLB’s Mounting Injury Problem – MLB Trade Rumors. MLB Trade Rumors. Retrieved April 11, 2022, from

Athlete Overtraining. (n.d.). Home. Retrieved April 6, 2022, from

Beardsley, C. (2018, April 2). When is overreaching useful?. If you enjoy this article, you will… | by Chris Beardsley | Medium. Medium; Medium.

Cardoos, N. M. D. (n.d.). Overtraining syndrome : Current sports medicine reports. Current Sports Medicine Reports – American College of Sports Medicine. Retrieved from

Eriksson, A., Lindström, M., Carlsson, L., & Thornell, L.-E. (2006, November 1). (PDF) Hypertrophic muscle fibers with fissures in power-lifters; fiber splitting or defect regeneration? ResearchGate; Springer Verlag.

Frontiers | The Minimum Effective Training Dose Required for 1RM Strength in Powerlifters | Sports and Active Living. (n.d.). Frontiers. Retrieved April 7, 2022, from

Gilbert, S. (2021, May 1). Kole Calhoun has surgery on left hamstring. MLB.Com; MLB.

Holmes, B. (2014, October 29). Julius Randle of Los Angeles Lakers suffers serious right leg injury in opener. ESPN.Com; ESPN.

Holmes, B. (2019, July 11). “These kids are ticking time bombs” — The threat of youth basketball. ESPN.Com; ESPN.

Lacques, G. (2021, June 3). MLB’s injury plague: There has been a big increase this season. USA TODAY; USA TODAY.

Prevalence and Consequences of Injuries in Powerlifting: A Cross-sectional Study – PMC. (n.d.). PubMed Central (PMC). Retrieved April 7, 2022, from

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