Introduction[edit | edit source]Musculoskeletal injuries are common in athletes of all levels. The nature of these injuries varies between sports, but the majority of injuries are caused by a combination of factors, and it can be difficult to establish the specific mechanism that leads to injury.[1] Epidemiological studies in sports show that the rate of injury in athletes varies from 10%-65%.[2][3] Because of this, one of the main goals of sports physiotherapists and other professionals in sports is to prevent injury.[4] A key step in evidence-based injury prevention is to identify possible risk factors for injury.[5] Risk factors such as strength, balance, joint mobility and biomechanics are often of interest as these are modifiable, whereas risk factors such as age and previous injury are non-modifiable.[6] Understanding modifiable risk factors is necessary for the design of effective, targeted risk mitigation strategies.[5] This may lead to the development of accurate and reliable tests to investigate risk factors, which are necessary for athlete screening, monitoring over time and to determine the efficacy of injury prevention programmes.[7] Show
Risk Factors[edit | edit source]In 2005, Bahr and Krosshaug[8] described risk factors for injury and mechanisms of injury. Internal risk factors that may predispose an athlete can include:
When an athlete is exposed to external risk factors, they become susceptible to injury. External risk factors include:
When an inciting event (ie injury mechanism) occurs, the athlete is injured. Examples of inciting events are:
Comprehensive model for injury causation designed by Bahr and Krosshaug[8] Meeuwisse et al.[1] focused on the intrinsic and extrinsic risk factors for injury and developed a dynamic, recursive model of aetiology in sports injury. This injury prevention model highlights the fact that “adaptations occur within the context of sport (both in the presence and absence of injury) that alter risk and affect aetiology in a dynamic, recursive fashion.”[1] It is suggested that one should look further than the initial risk factors preceding an injury and consider how these risk factors may have changed during various cycles of training or participation. Dynamic model of aetiology in sport injury[1] It is evident that there are multiple factors involved in the risk of injury occurrence and the interaction between these factors may increase the risk. Herrington et al.[9] provides a detailed list of these factors[9]:
Bolling et al.[10] illustrates the complexity and multiple levels of the factors associated with injury occurrence. A multilevel system map with factors, strategies and stakeholders in relation to injury and its prevention. Starting at the centre of the map (ie, the athlete) and moving outwards; (A) entails artist-related intrinsic injury factors; (B) presents external injury factors; (C) describes the main preventive strategies (eg, load management, safety and preparation) which are driven by the factors from the inner two circles; (D) represents the stakeholders in the system as well as how they connect to the strategies and factors across the multiple levels.[10] Injury Mechanisms[edit | edit source]Injury mechanism can also be referred to as the “inciting event.” From a biomechanical perspective, considering tissue properties and load characteristics, an injury occurs when the transfer of energy to the tissue and the mechanical load is in excess of the tissue's load tolerance. The International Olympic Committee Injury and Illness Epidemiology Consensus group[11] define injury as:
This is different for each type of tissue and is dependent on the type of load, the rate of load, the frequency of load and the magnitude of the load. Key points to remember when considering the biomechanical perspective: biomechanics must explain how the injury is caused by mechanical load in excess of the tissue's loadbearing tolerance; or how the mechanical load has reduced the tissue's tolerance level to a point where normal mechanical loads cannot be tolerated.[8] When considering an epidemiological model, load and load tolerance are influenced by the main elements of the model - the intrinsic risk factors, the extrinsic risk factors and the inciting event. It is important to have a precise description of the injury mechanism or "inciting event". This information may be used to develop injury prevention measures for specific types of injuries and even for specific sports. According to Bahr and Krosshaug,[8] the description of the injury mechanism should include information on different levels. These levels can be separated into four categories[8]:
The following table, adapted from Bahr and Krosshaug,[8] shows how these categories can be implemented: Categories of injury mechanism descriptions with the example of boxing[8]
There are more examples in Table 1 of this article: Understanding injury mechanisms: a key component of preventing injuries in sport[8] Sports physiotherapists and sports professionals should know that each injury type has its typical patterns and the same is true of sports. Staying informed by keeping up with evidence-based literature is important for professionals working with athletes in all sports. Read more on Injury Type and Classification in Sport Sports Injury Prevention Models[edit | edit source]Van Mechelen Injury Prevention Model[12] Van Mechelen Injury Prevention Model Van Mechelen et al.[12] developed the fundamental, conceptual model for the prevention of sports injuries. This model has since been developed and further adapted for many sports and specific types of injuries. The four steps of action in this model are:
Dynamic Model of Aetiology in Sports Injury[1] Meeuwisse et al.[1] focused on the intrinsic and extrinsic risk factors for injury and developed a dynamic, recursive model of aetiology in sports injury. With this model, the authors suggest it is necessary to look further than just a snapshot of the initial predisposing factors to an injury and consider how these factors change and adapt within the context of the sport. Translating Research Into Injury Prevention Practice (TRIPP) Model[13] The TRIPP model by Finch[13] considered the context of interventions and the behavioural features of athletes and sports professionals. The TRIPP framework is an extension of the Van Mechelen model and includes two additional steps that are necessary to translate injury prevention strategies into real-life practice. These are: understanding the real world for which the specific intervention is being developed; and the evaluation of this intervention in a real-world setting.[13] Translating research into injury prevention practice (TRIPP) Framework Team-Sport Injury Prevention Cycle Recently a new model has been proposed for injury prevention in team sports: the Team-sport Injury Prevention (TIP) cycle.[14] The three key phases in this model are[14]:
This model incorporates key aspects of previous models, but also adds insight into implementation aspects. Read more about this here: A new model for injury prevention in team sports: the Team-sport Injury Prevention (TIP) cycle.[14] See also: Injury Prevention in Sport Screening and the Element of Causality[edit | edit source]Musculoskeletal screening is commonly practised in several sports. For many years, the aim of screening was to identify the athletes at risk of injury and to implement injury prevention programmes for these athletes. Screening cannot predict if an athlete will get injured,[15] but screening can help find predisposed athletes. Having a predisposition to a certain injury does not mean that the athlete will get injured. Furthermore, if an athlete does not have a predisposition to an injury, this is not a guarantee that the athlete will not be injured. Athletes become vulnerable to injury when they are exposed to load and inciting events. Read more about Musculoskeletal Injury Risk Screening Examples where a specific condition/finding is seen as a causality that then creates an effect:[16]
So, GIRD in isolation may not be an issue, but just something that is present when an athlete comes for treatment of their injury. What came first? The injury and then the loss of internal rotation or the loss of internal rotation and then the injury?[16]
Complex System and Risk Identification[edit | edit source]Sport injuries are multifactorial. Bittencourt et al.[21] proposed the complex systems approach for sports injuries, where the focus is on injury pattern recognition rather than on risk factor identification.[21] The authors argue that a reductionist view is taken in sports injury aetiology investigations where “a phenomenon is simplified into units and analysed as the sum of its basic parts.”[21] With this approach, correlation and regression analyses are undertaken. However, despite the effort, it is still difficult to identify or isolate predictive factors to injury.[21] Bittencourt et al.,[21] therefore, argue that a complex systems approach should instead be considered. In this approach, athletes are seen as complex (much like the majority of human health conditions) and the injury occurs as a result of complex interactions between a web of determinants (biomechanical, behavioural, physiological, psychological).[21] To prevent sports injuries, risk profiles need to be identified. This requires sports professionals to move away from simply identifying risk factors, and instead adopt a more complex approach of risk pattern recognition. Clinicians should be well informed about the interaction between risk factors, so that they can plan an effective preventative intervention.[21] Read the full article here: Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept[21] [22] Screening and Preventative Measures[edit | edit source]There are different views on screening and its use in athletes. Screening cannot predict which athlete will sustain an injury, but there are many benefits of athlete screening. Read more on:
An editorial by Verhagen et al.[7] summarises how screening can be important for an athlete:
Watch this video where Nicol van Dyk, the second author of this paper discusses their rationale. [23] Workload: Mediators and Moderators[edit | edit source]Spikes in training and competition workload are also an injury risk.[24] According to Windt et al.,[24] this workload-injury relationship can be further analysed through mediators and moderators. Mediators can be seen as the steps that explain the association between a variable and an outcome. ("Why changes in workloads might cause injuries?") For example: Rugby league players with spikes in running workload (as determined by the acute:chronic workload ratio) are at an increased risk for a non-contact injury. The mediator in this scenario can be neuromuscular fatigue as increased workloads cause higher levels of fatigue and this may predispose the athlete to an injury.[24] The moderators are seen to modify the effect of a variable on an outcome. ("What characteristics make certain athletes more robust or susceptible to injury at given workloads?")[24] For example, high aerobic fitness protects against spikes in workload. Thus, aerobic fitness moderates the workload effect by reducing the risk of rapid workload increases.[24] See Figure 1 in this article: Why do workload spikes cause injuries, and which athletes are at higher risk? Mediators and moderators in workload–injury investigations. Again, this may seem a simplified approach, but the complexity of injuries needs to be considered as well as the temporality of risk factors. General Guidelines on Risk Factors and Injury Mechanisms[edit | edit source]
References[edit | edit source]
What is the difference between adults who are considered athletes vs nonathletes in terms of physical aging?What is the difference between adults who are considered athletes versus nonathletes in terms of physical aging? a. Athletes experience more subtle and gradual declines in physical abilities from the late-30s to the 60s.
Why are nontraditional students better at making meaning of theoretical concepts?42. Why are nontraditional students better at making meaning of theoretical concepts? c. Because they have life experience and knowledge of multiple roles that help.
What is the pattern of gradual age related declines in physical functioning called?Senescence. A pattern of gradual age-related declines in physical functioning begins in early adulthood.
What is the earliest at which some men's reproductive ability can begin declining?Another study that evaluated the relationship between age and semen parameters also concluded that male fertility decline begins at 35, and suggested that male fertility peaks between 30 and 35. Bottom line: Men generally see a decrease in fertility beginning at 35, and the decline progresses from there.
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