A conceptual model and detailed framework for stress-related, strain-related, and overuse athletic injury.

A multitude of athletic injuries occur when the various tissues that make up the human body experience stresses and strains that exceed their material strength. The precise amount of stress and strain that any given tissue can withstand is determined by the mechanical properties and resultant strength of that particular tissue. These mechanical properties are directly determined by an individual's physiology and acute regulation of these properties. A number of theoretical frameworks for athletic injury occurrence have been proposed, however, a detailed conceptual framework for injury aetiology that considers the interplay between the physiological and mechanical factors and outlines the causal pathways to tissue damage and injury is needed. This will guide injury research towards a more thorough investigation of causal mechanisms and understanding of risk factors. Further, it is important to take into account the considerable differences in loading patterns which can result in varying injury outcomes such as acute stress-related, strain-related, or overuse injury. Within this article a simplified conceptual model of athletic injury is proposed along with a detailed, evidence-informed, conceptual framework for athletic injury aetiology that focuses on stress-related, strain-related, and overuse injury.

[1]  W. Brent Edwards,et al.  Modeling Overuse Injuries in Sport as a Mechanical Fatigue Phenomenon , 2018, Exercise and sport sciences reviews.

[2]  C. Finch,et al.  A framework for the etiology of running‐related injuries , 2017, Scandinavian journal of medicine & science in sports.

[3]  Sean Gallagher,et al.  Musculoskeletal disorders as a fatigue failure process: evidence, implications and research needs , 2017, Ergonomics.

[4]  T. Gabbett,et al.  How do training and competition workloads relate to injury? The workload—injury aetiology model , 2016, British Journal of Sports Medicine.

[5]  A. Shield,et al.  Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study , 2015, British Journal of Sports Medicine.

[6]  Hugh H. K. Fullagar,et al.  Sleep and Recovery in Team Sport: Current Sleep-Related Issues Facing Professional Team-Sport Athletes. , 2015, International journal of sports physiology and performance.

[7]  A. Arampatzis,et al.  Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults , 2015, Sports Medicine - Open.

[8]  Hugh H. K. Fullagar,et al.  Sleep and Athletic Performance: The Effects of Sleep Loss on Exercise Performance, and Physiological and Cognitive Responses to Exercise , 2015, Sports Medicine.

[9]  David A Opar,et al.  Eccentric hamstring strength and hamstring injury risk in Australian footballers. , 2014, Medicine and science in sports and exercise.

[10]  M. Lind,et al.  Running more than three kilometers during the first week of a running regimen may be associated with increased risk of injury in obese novice runners. , 2014, International journal of sports physical therapy.

[11]  Rasmus Oestergaard Nielsen,et al.  Weekly running volume and risk of running-related injuries among marathon runners. , 2013, International journal of sports physical therapy.

[12]  Sean Gallagher,et al.  Examining the Interaction of Force and Repetition on Musculoskeletal Disorder Risk , 2013, Hum. Factors.

[13]  B. Schoenfeld,et al.  Does exercise-induced muscle damage play a role in skeletal muscle hypertrophy? , 2012, Journal of strength and conditioning research.

[14]  R. Verlengia,et al.  Mechanotransduction pathways in skeletal muscle hypertrophy , 2012, Journal of receptor and signal transduction research.

[15]  K. Jepsen,et al.  Activation of bone remodeling after fatigue: differential response to linear microcracks and diffuse damage. , 2010, Bone.

[16]  D. Laudier,et al.  Subrupture tendon fatigue damage , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[17]  S. Yeung,et al.  A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor , 2009, British Journal of Sports Medicine.

[18]  Marc Genty,et al.  Strength Imbalances and Prevention of Hamstring Injury in Professional Soccer Players , 2008, The American journal of sports medicine.

[19]  I. Hunter,et al.  Preferred and optimal stride frequency, stiffness and economy: changes with fatigue during a 1-h high-intensity run , 2007, European Journal of Applied Physiology.

[20]  Colin W Fuller,et al.  Contact events in rugby union and their propensity to cause injury , 2007, British Journal of Sports Medicine.

[21]  Willem H Meeuwisse,et al.  A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation , 2007, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[22]  C. Turner,et al.  Bone Strength: Current Concepts , 2006, Annals of the New York Academy of Sciences.

[23]  W. Stanish,et al.  Musculoskeletal Injury in the Masters Runners , 2006, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[24]  T. Krosshaug,et al.  Understanding injury mechanisms: a key component of preventing injuries in sport , 2005, British Journal of Sports Medicine.

[25]  T. Hewett,et al.  Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study , 2005, The American journal of sports medicine.

[26]  B. Mason,et al.  Cricket , 2004 .

[27]  K. Esser,et al.  Mechanotransduction and the regulation of protein synthesis in skeletal muscle , 2004, The Proceedings of the Nutrition Society.

[28]  Uwe Proske,et al.  Predicting hamstring strain injury in elite athletes. , 2004, Medicine and science in sports and exercise.

[29]  Nicole J Chimera,et al.  Effects of Plyometric Training on Muscle-Activation Strategies and Performance in Female Athletes. , 2004, Journal of athletic training.

[30]  M. Hulse,et al.  The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries , 2004, British Journal of Sports Medicine.

[31]  G. Beaupré,et al.  Effects of Creep and Cyclic Loading on the Mechanical Properties and Failure of Human Achilles Tendons , 2003, Annals of Biomedical Engineering.

[32]  L. Avois,et al.  Ankle injuries in basketball: injury rate and risk factors , 2001, British journal of sports medicine.

[33]  E Baumgart,et al.  Stiffness--an unknown world of mechanical science? , 2000, Injury.

[34]  K. Bennell,et al.  Ground reaction forces, bone characteristics, and tibial stress fracture in male runners. , 1999, Medicine and science in sports and exercise.

[35]  N. Kerr HARKing: Hypothesizing After the Results are Known , 1998, Personality and social psychology review : an official journal of the Society for Personality and Social Psychology, Inc.

[36]  A. Natri,et al.  Etiology and pathophysiology of tendon ruptures in sports , 1997, Scandinavian journal of medicine & science in sports.

[37]  John Orchard,et al.  Preseason Hamstring Muscle Weakness Associated with Hamstring Muscle Injury in Australian Footballers , 1997, The American journal of sports medicine.

[38]  W. Garrett Muscle Strain Injuries , 1996, The American journal of sports medicine.

[39]  M. Latash,et al.  Joint stiffness: Myth or reality? , 1993 .

[40]  J W Melvin,et al.  Fracture mechanics of bone. , 1993, Journal of biomechanical engineering.

[41]  T. Souryal,et al.  Intercondylar notch size and anterior cruciate ligament injuries in athletes , 1993, The American journal of sports medicine.

[42]  R L Lieber,et al.  Muscle damage is not a function of muscle force but active muscle strain. , 1993, Journal of applied physiology.

[43]  B. Martin,et al.  A theory of fatigue damage accumulation and repair in cortical bone , 1992, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[44]  M Schootman,et al.  A multivariate risk analysis of selected playing surfaces in the National Football League: 1980 to 1989 , 1992, The American journal of sports medicine.

[45]  R L Lieber,et al.  Structural and mechanical basis of exercise-induced muscle injury. , 1992, Medicine and science in sports and exercise.

[46]  R L Lieber,et al.  Muscle damage induced by eccentric contractions of 25% strain. , 1991, Journal of applied physiology.

[47]  T. Noakes,et al.  Low bone density is an etiologic factor for stress fractures in athletes. , 1990, Annals of internal medicine.

[48]  K. Edman,et al.  Changes in force and stiffness induced by fatigue and intracellular acidification in frog muscle fibres. , 1990, The Journal of physiology.

[49]  S. Walter,et al.  The Ontario cohort study of running-related injuries. , 1989, Archives of internal medicine.

[50]  B. Marti,et al.  On the epidemiology of running injuries , 1988, The American journal of sports medicine.

[51]  Marc R. Safran,et al.  Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure , 1987, The American journal of sports medicine.

[52]  J. Whiteside,et al.  Women athletes with menstrual irregularity have increased musculoskeletal injuries. , 1986, Medicine and science in sports and exercise.

[53]  P V Komi,et al.  Training of Muscle Strength and Power: Interaction of Neuromotoric, Hypertrophic, and Mechanical Factors , 1986, International journal of sports medicine.

[54]  M M Rodgers,et al.  Glossary of biomechanical terms, concepts, and units. , 1984, Physical therapy.

[55]  W. Garrett,et al.  Histochemical correlates of hamstring injuries , 1984, The American journal of sports medicine.

[56]  V. Dietz,et al.  Regulation of Muscle Stiffness in Human Locomotion , 1984, International journal of sports medicine.

[57]  V. Frankel,et al.  Fatigue behavior of adult cortical bone: the influence of mean strain and strain range. , 1981, Acta orthopaedica Scandinavica.

[58]  A Chamay,et al.  Mechanical influences in bone remodeling. Experimental research on Wolff's law. , 1972, Journal of biomechanics.

[59]  David G. Behm,et al.  Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. , 2016, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[60]  M. de Hoyo,et al.  Effects of a 10-week in-season eccentric-overload training program on muscle-injury prevention and performance in junior elite soccer players. , 2015, International journal of sports physiology and performance.

[61]  C. Hrysomallis Relationship Between Balance Ability, Training and Sports Injury Risk , 2007, Sports medicine.

[62]  E. Radin,et al.  Bone remodeling in response to in vivo fatigue microdamage. , 1985, Journal of biomechanics.

[63]  D R Carter,et al.  A cumulative damage model for bone fracture , 1985, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[64]  E. W. C. Wilkins,et al.  Cumulative damage in fatigue , 1956 .

[65]  A. Palmgren Die Lebensdauer von Kugellargern , 1924 .