Before coming to Stanford, freshman swimmer Caitlin Reynolds trained about 24 hours a week, sometimes practicing five hours with her club team in the morning before competing in a high-school meet later that afternoon. In her first months on the Farm, Reynolds felt healthy and prepared for the 20-hours-a-week training schedule.

Then the pain hit. After years of overtraining, the tissue in her shoulder had loosened enough that every stroke triggered throbbing pain.

But even after seeing a trainer and modifying her work-outs, Reynolds’ shoulder pain did not subside. In examining her MRI, Stanford doctor Tim McAdams recommended surgery to remove the scar tissue and tighten up the joint. Reynolds, however, decided to tough-out the season. One week after it ended, she underwent surgery, and now she will spend the offseason in recovery.

“Like most Stanford athletes,” she said, “I wanted to push myself to the limits.”

Stanford Athletics is the best in the country year after year. And the recruits have already trained long and hard for years by the time they arrive. Most competed on club teams. Many had private coaches. Some even had their own entourage of nutritionists, psychologists and personal trainers. But despite all of the support — or maybe even because of it — many athletes say they come to Stanford with an increased risk for overuse injuries.

“While some bodies are able to take more of a beating,” Reynolds said, “some people’s bodies who did a lot in high school just break down.”

The push to succeed does not begin the moment many first put on their Cardinal uniform or attend their first team training session. It begins when they decide to get serious about their sport, whether at age six or 16.

Stanford physicians do not release statistics of athletic injuries, citing the need to respect patient privacy, but many athletes have already had multiple surgeries to tweak common problems, and their injuries are the price to pay for competing at the college level.

Athletes in individual sports, like swimming and gymnastics, usually train even longer and harder to boost their rankings. Freshman gymnast Carly Janiga recalled that as early as seventh grade she was leaving school to train. In high school, she practiced 40 hours per week, three hours each morning and four hours each afternoon. Because of their more intense schedules, individual athletes say they suffer more overuse injuries in college.

Freshman tennis player Lindsay Burdette was the nation’s top recruit last year. However, before Lindsay there was her older sister Erin, who graduated from Stanford in 2005. During Erin’s freshman and sophomore years, she garnered All-American accolades and was primed to win even more individual honors in her junior year.

Then she hit a backhand and heard a pop. Wrist surgery kept Erin from competing at the ITA Indoor Championships and Northwest Regional Championships.

She sat out most of her senior year with shoulder problems. Eyeing her last shot at the NCAA Championships, Erin opted for a quick fix — a cortisone shot. Stanford went on to win the NCAA team title, and Erin and her teammate took home the doubles’ title. Though the cortisone shot temporarily eased Erin’s pain, her shoulder injury became worse as she continued to play. Only after her senior year did she finally undergo needed surgery.

“Erin deals with pain every day because she actually needs another surgery,” Lindsay Burdette said. “Her injury will affect her later. It’s not really the surgery. In some ways there isn’t much difference, but it’s the abuse in the first place that I would blame more than the surgery.”

Having practiced three to four hours each day in high school, Lindsay, too, has suffered her share of overuse injuries. Like Erin, she has experienced shoulder problems and undergone wrist surgery.

“There definitely is a certain expectation to practice and work out,” Lindsay said.

Though the coaches try to accommodate injured players with modified drills, Lindsay said the trainers are usually more sympathetic because they know more about the physiological problems that can result from tough conditioning.

“The coaches just don’t understand how much a workout can [affect you, injure you or help you] if it’s done right,” she said. “For instance, we were super sore and broken down from a really intense series of workouts, and my coach didn’t seem to understand that we were completely shot by the time that we played USC.

“She was frustrated and kept telling us to stretch,” Burdette continued. “I wanted to politely explain that millions of micro tears in our bodies weren’t going to heal or stop emitting lactic acid just by stretching them. It doesn’t work that way.”

The most skilled doctors plus the most experienced coaches plus the most qualified trainers should equal the strongest, healthiest college athlete. But there’s one piece missing from this equation that keeps it from being true: the constant grind that athletes here force their bodies to endure, week in and week out, year in and year out.

Stanford’s strict recruiting and selection process ensures that its athletes are driven to succeed and will push their bodies to the limit. This ethic often causes athletes to ignore or belittle signs of pain.

According to physical therapist Marc Guillet of Agile Physical Therapy in Palo Alto, each athlete should have to pass strict functional testing criteria before training, “especially when they are having pain.” But Stanford has no strict functional testing criteria, and athletes are usually left to determine for themselves whether they can compete, or if they need help. Many are reluctant to complain because they do not want to sit out.

“It’s definitely up to the individual,” Reynolds said. “If you can catch yourself at the onset, you really need to be persistent in getting help.”

While Burdette and Reynolds knew how to handle injuries, some incoming athletes are less aware of the process. Some managed to go injury-free throughout high school only to develop painful conditions in college.

Freshman lacrosse player Charity Fluharty played four years of high-school varsity basketball, soccer and lacrosse before incurring severe knee problems. It was only during the spring of her senior year that she began to develop pain in her left knee, which an MRI later showed was due to inflammation.

Last August, Fluharty underwent surgery to remove scar tissue and spent the fall offseason in physical therapy. But right as she was ready to gear up for the regular season, her groin began troubling her. An MRI showed inflammation of the pelvic muscles. Stanford sports physician Gordon Matheson referred the freshman to Arrillaga’s physical therapy unit. However, between physical therapy sessions, she continued her modified workouts.

As she continued to train, the injury grew worse. While resting temporarily eased the pain, it would flare up the moment she began training again. She recalls that at one point it hurt just to sit. Nevertheless, Fluharty pushed herself through workouts because of the “pressure to tough it out with the team.”

When the injury failed to improve with time, her physical therapist required her to take a break from all physical activity. After spring break, Fluharty received a cortisone shot, and she finally began exercising again just one week ago.

“The coaches had said, ‘Had we known about how serious it was earlier, we would have had you healthy by now,’ but they didn’t take me seriously when I was telling them I was in pain,” Fluharty said. “It’s really frustrating.”

Stanford trainer Perry Archibald suggested that the pressure to ignore injuries comes on many fronts. Other than the clear pressure from coaches, he cited peer and self pressure as other common sources. Archibald also echoed that returning too soon from an injury like Fluharty’s will often exacerbate the problem.

“Many times, when an athlete returns too early, he or she will only injure themselves worse,” Archibald said. “Usually, it will take many more days to get the athlete better because of returning too quickly.”

Given Stanford athletes’ strained bodies and driven nature, trainers and physical therapists are limited in their treatment and prevention options. Their role is usually reactive rather than pro-active.

They can perform the protective taping. They can recommend a medical specialist. They can modify work-outs. However, they cannot help an athlete who does not indicate in any way that he or she is in pain. Doctors cannot remove all the damaged muscle tissue.

Doing anything to stop any fiurther overexertion would require drastically truncated training schedules, which coaches are both unlikely and unwilling to do. While benefiting from Stanford’s first-rate coaching, training and medical treatment, athletes pay a price. Some will continue to pay it later in life.

“It’s sad what we’re doing to our bodies, but at the same time, it’s amazing what we can push ourselves to do,” Reynolds said. “It’s a weird trade-off.”