Rethinking acute sports injuries: evidence for an overuse mechanism in hamstring and ACL injuries

Review written by Dr Travis Pollen info

Key Points

  1. Contrary to traditional belief, this brief review contends that hamstring strain injuries and anterior cruciate ligament injuries can be characterized by sudden onset overuse mechanisms, rather than purely acute mechanisms.
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BACKGROUND AND OBJECTIVE

Injury mechanisms are typically classified in two ways:

  1. Acute/traumatic: based on a clear inciting event in which excessive stress or strain leads to immediate failure, or

  2. Overuse: based on the absence of an inciting event and the result of mechanical fatigue from repetitive stress and strain with insufficient time for repair (1).

Recent efforts have sought to further differentiate overuse injuries based on gradual versus sudden onset (2). A gradual onset overuse injury is one that worsens over time, starting as discomfort and developing into pain. Conversely, a sudden onset overuse injury is one that appears abruptly but without an inciting event.

This brief review contends that two injuries that have traditionally been classified as acute - hamstring strain injuries (HSIs) and anterior cruciate ligament (ACL) injuries - may more accurately be considered sudden onset overuse injuries.

Injuries are generally classified as either acute from a single excessive event or overuse from repetitive stress without adequate recovery.
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Reframing Hamstring strain injuries and ACL injuries as overuse issues highlights the importance of consistent training to build tissue capacity and careful monitoring of load and recovery to reduce injury risk.

METHODS

This review of injury mechanisms for HSIs and ACL injuries cites a wide range of data, from human to cadaveric and animal research. The author also acknowledges the limitations of the existing evidence and addresses the implications of reclassifying the

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