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Extrinsic injury risk factors

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Gary Boswell Extrinsic injury risk factors Typical extrinsic injury risk factors include the following: * Excessive load on the body (such as the nature and speed of movement, the number of repetitions, impact, footwear or training surface) * Training errors (such as rapid increase in training distance, high intensity training, hill training, fatigue, poor programme structure and design, poor exercise or sport technique) * Poor or inappropriate equipment (such as footwear, headgear or protective clothing) * Ineffective rules (including rules or safety guidelines that are not enforced) Typically, when any overuse injury is being evaluated, the specialist will ask questions to determine whether any of the above factors has contributed to the injury. Excessive load on the body The tissues of the body are potentially capable of withstanding considerable stress. For example, it is not uncommon for upwards of three times the body weight to go through the body even when jogging slowly. However, tissues that have not been accustomed to such forces will not have adapted to withstand them and are therefore likely to be injured when they are applied. Certain types of movement demand that the body either develops force rapidly or must control force very quickly. Sprinting and jumping for example, require the muscles to develop big forces very quickly to 'power' the action and also to control the limbs and body with each foot contact or landing. Consequently, this type of training or activity must be gradually introduced as part of a training programme, preferably following a period of several weeks of general training. This is where the help of a coach can be invaluable in planning a training programme. ...read more.


As with the warm up phase, the time course is similar according to what has been done. The Intrinsic injury Risk Factor The intrinsic injury risk factors are those that the individual brings with them to the sport, exercise or activity. These include factors such as the shape and structure of the major joints. For example, feet which pronate ('roll inwards') or have a poor arch often contribute to lower leg, shin and knee conditions in runners, as do 'knock knees' (genu valgus) or 'bow legs' (genu varus). Other injury risk factors include: * Leg length discrepancy * Muscle weakness or imbalance * Decreased flexibility * Joint laxity (that is, not being able to control and stabilise joints throughout their full range of motion) * Gender (there are potential gender differences that make women more susceptible to certain knee injuries) * Age (tendons degenerate with age, so an acute rupture is more likely in the older athlete. Similarly, certain injuries only occur in children) * Being overweight (since this increases the load on muscles, tendons, ligaments and joint structures during weight bearing activities) As a consequence, these potential injury risk factors may well be evaluated during a biomechanical assessment, postural or gait analysis by the appropriately qualified professional. Leg length discrepancy It is not unusual for most people to have one leg longer than the other. As with joint malalignments, the effect of a leg length discrepancy from an injury perspective is the potential for a change in the forces going through muscles and joints. With a structural difference in leg length of at least 1.5 cm, it is not uncommon for the pelvis and spine to compensate for this difference. ...read more.


may also occur. Similarly, certain knee joint configurations commonly referred to as 'knock knees' (genu valgus) or 'bow legs' (genu varus) plus specific hip and pelvis angles can increase the risk of overuse injury. A hip joint that naturally rotates inwards (femoral anteversion) for example, or a pelvis that tilts forwards excessively (anterior tilt) can also contribute to overuse injuries of the knee and/or contribute to injuries to any of the many muscles attached to the pelvis, hip and thigh. A pelvis with excessive anterior tilt usually leads to an increase in the curve in the lower back (lordosis) and occasionally a compensatory curve in the opposite direction in the mid-spine known as a kyphosis. However, there are many sportsmen and women with less than perfect joint mechanics who do not suffer from overuse injuries. The important point is that if you suffer an overuse injury, particularly one that re-occurs, you should seek appropriate treatment. Abnormal lower limb biomechanics can often be improved through specific conditioning and rehabilitation approaches and/or custom made inserts (orthotics) once an athlete's gait and movement mechanics have been evaluated. Gender The generally wider pelvis of the female compared with the male means that the angle of the thigh relative to the knee is different. In turn, this means that the relationship between the line of pull of the front thigh muscles (the quadriceps) and the angle of the quadriceps tendon (patellar tendon) also differs. The greater the angle between the line of pull of the quadriceps and the patellar tendon (known as the Q angle), the greater the risk of injury at the knee during running and jumping activities. ...read more.

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