Causes of Injury
Both extrinsic and intrinsic factors
can increase the risk of injury. Intrinsic factors include
biomechanical deficiencies, including malignancy of limbs, muscular
imbalances, degenerative processes, and other anatomical factors.
Extrinsic factors include training errors, faulty technique,
poor environmental conditions, incorrect equipment and surfaces.
Extrinsic Factors of injury can be further classified into
overuse, misuse, abuse, or disuse (Wanivenhaus 2012).
- Overuse is performing a task with a frequency that
does not allow the tissues to recover and symptoms may be due
to lack of muscle strength or endurance
- Misuse using improper form or equipment which may
put abnormal stress on tissue structures.
- Abuse is having excessive force going though normal
- Disuse occurs after taking a period of time off without
training resulting in deconditioning or altered neuromuscular
Excessive fatigue can negatively affect proper form and/or
decreases the ability of stabilizers to maintain sound biomechanics.
Careful monitoring of training volume, intensity, and duration
will minimize overuse injuries. (Wanivenhaus 2012)
Intrinsic factors such as stability and mobility defiencies
have been attributed to athletic and fitness related injuries.
Compensatory movement patterns develop to overcome stability
and mobility deficiencies. These poor movement patterns are used
subconsciously whenever executing future tasks leading to greater
mobility and stability imbalances and deficiencies which increase
risk of injury. (Cook 2010)
Prior injury is one of the the most significant risk factors
predisposing individuals to injuries. A decrease in proprioceptive
input occures if an injury is left untreated or inappropriately
treated. A disruption in proprioception will negatively effect
movement-pattern behaviors. The altered mobility, stability,
and asymmetric influences eventually lead to compensatory movement
patterns, increasing risk of injury. (Cook 2010)
Risk of injury is increased under following conditions:
- Insufficient warm up
- Insufficient recovery
- Training stimulus is not progressive and regular
- Mechanical impairments
Also see first 4 of 5 Adaptation
Common Biomechanical Impairments
Biomechanical impairments (as those referenced
below) may contribute to orthopedic injury when combined
with other factors than may negatively affect joint integrity
(e.g. hyper-mobility, biostructural weakness, insufficient adaptation
of joint or muscular structures, fatigue, acute or chronic overtraining, etc.). For example,
hypermobility does not produce joint instability unless the secondary
stabilizers do not function adequately and symptoms occur (Tovin
The biomechanical impairments are listed for precautionary
measures only, so they may be identified and possibly corrected
in attempt to decrease risk of athletic injuries during exercise
or physical activity. These impairments are possible risk factors
for injury and may only increase injury when combined with other
risk factors. A physician may need to establish if a biomechanical
deficiency is structural, muscular, neuromuscular, or due to
some other pathology.
The corrective exercises assume impairments are due to a muscular
imbalance (flexibility, strength, or posture). Only a qualified
physician or health care provider should diagnose and give prescription
for an existing injury. In some circumstances, an attempt to
correct a biomechanical impairment may irritate the injury and
prolong recovery, particularly if certain therapy exercises are
used inappropriately or initiated too soon or aggressively after
an injury has occurred. The exercise selection should be based
on positions that do not overstress the healing tissues. Even
after an underlying biomechanical impairments have been improved,
a preexisting injury may require the attention of a physical
therapist under the advice of a physician to restore total functionality.
See Injury Prevention Tidbits
and Sports Injury First Aid.
In athletic conditioning,
improper planning and inadequate conditioning (both general and
sports specific) prior to the competitive season are major causes
of injury. In elite athletes, high volume and intensity of the
training load is one of the major causes of injury (Slobounov
SM 2008). Also see Causes of Injury (above).
An improperly planned conditioning program can be attributed
to failure to understand and implement fundamental training
principles and adaptation
criteria through a periodized
programming. A program that does not adequately prepare the
athlete for the specific types of forces and stresses experienced
on the field or court place athletes at risk. See Training
Specificity and Resistance
Training for the Reduction of Sports Injury. Programs that
fail to incorporate movements that condition stabilizing muscles
(joint stabilizers such as hamstrings, rotator cuff muscles,
etc), maintain ideal muscular
balance, and correct biomechanical
deficiencies unique to each athlete, increase the risk of
injury on and off the playing field.
Contrary to popular belief, conventional stretching
per se does not appear to decrease the occurrence of injury (see
Stretching and Flexibility). However,
movement specific warmups before drills,
tests, and the event performance can decrease risk of injury.
Ideally, movement specific warm-ups should proceed the event
by several minutes, mimic the sports activity in the exact mechanics
in which it will be performed, yet, not be so taxing as to compromise
sports performance. Some sports are obviously more unpredictable
than others and will not allow for rehearsal of every possible
movement several minutes before they occur. Power or speed sports
should consist a short series of movement specific warmups at
progressive intensities. For example, several minutes before
the start of 100m dash, a sprinter could perform a short progressive
submax series of block starts immediately, followed by a short
run, or simulated movement, thereby warming up in the same mechanics
in which they will be engaging.
In the weight room, performing a movement specific warm-up
set (eg: 50% 10RM) before workout sets, allow for performance
benefits in addition to decreasing the risk of injury (see Weight Training Warm-up). Injuries
can also be circumvented by well thought-out programs that adhere
to evidence based research and sound training protocols (see
Periodizaiton) that allow for adequate recovery (see Overtraining). Also, using too much
resistance or performing too many sets, particularly when athletes
are first introduced to new movements or exercise variations
are common training errors which can greatly increase the risk
The coach can introduce methods in which athletes can customized
a 'group program' to each athlete's unique abilities, results,
and needs. Coaches must allow for proper rehearsal and adaptation
to 'new' exercises or movements, understand the benefits periodization
techniques, adhere to adaptation criteria, implement program
customization, use of movement specific -ups, and schedule adequate
recovery periods for optimal progress.
Cook G (2010) Movement: Functional Movement Systems, pg
65-67. See in Store.
Crown LA, Hizon JW, Rodney WM, (1997) Musculoskeletal Injuries
in Sports, The Team Physician's Handbook, Mosby, 2: 361-370.
Slobounov SM (2008). Injuries in Athletics, Causes and
Consequences, Springer, 25-43.
Tovin BJ (2006). Prevention and Treatment of Swimmer's
Shoulder. North American Journal of Sports Physical Therapy,
Wanivenhaus F, Fox AJS, Chaudhury S, Rodeo SA (2012). Epidemiology
of Injuries and Prevention Strategies in Competitive Swimmers.
Sports Health. May 2012; 4(3): 246251.