Internal and external risk factors

Internal risk factors

Internal risk factors are those relating to the person exercising or participating in physical activity. These are athlete or participant-dependent. Some of the factors include:

• Age

• Effects of training

• Previous injury

• Sex differences

• Pregnancy (prenatal/postpartum)

• Congenital factors

• Psychological factors

Age

Adolescents’ increase in growth of bone tissue can cause issues until the soft tissue surrounding it catches up. ‘Age’ group categories can be an issue, too.

• There are higher injury risk factors with increasing age

• Skeletal growth can rapidly create a size difference between bone and soft tissue. This is temporary; however, during this period an individual may experience reduced balance. This can increase the risk of injury, for example, ankle sprains.

• Sometimes, this isn’t the case as children, for example, might have more flexible bones, and these exhibit elasticity, which results in a lower risk of fracture injuries

• An increase in height and weight of players is often not linear

Effects of training

Large increase in volume of training and the intensity of training influcnes the risk of injury

• The psychological and adaptive responses the body experiences due to the training process

• If an athlete were to overtrain, when the load (FIT) exceeds the body limit, this impairs their ability to recover and adapt, leading to chronic fatigue, decreased performance and increased susceptibility to injury and illness

• Insufficient rest between sessions leading to an immediate reduction in performance, impaired coordination, and increased risk of accidents or poor form.

• The body may not adapt positively if the training stimulus is inappropriate (e.g., too high, too low, or incorrect exercises), leading to persistent weaknesses or imbalances.

Previous injury

A previous injury increases the risk of a recurrent injury due to reduced strength and proprioception. This is why it is important not to return to sport before full rehabilitation can occur

• A history of prior injury can impact the severity of any current injury may occur, especially if the initial injury was not fully rehabilitated

• Re-injury can be due to the injured tissue (ligament, muscle, tendon, bone) may remain weaker, less flexible, or have altered proprioception (sense of body position), making it vulnerable to recurring damage in the same spot.

• It is common to have reduced ROM in an injured joint, meaning there is an increased in injury risk with a decrease in ROM

Sex differences

Recent studies show that male athletes tend to experience more injuries overall, especially in the thigh, while females are more prone to stress fractures and concussion, with longer recovery times and greater neurocognitive impacts

Research on sex-based causes of injuries is still developing, and more studies

Pregnancy (prenatal/postpartum)

Exercise when pregnant is beneficial, apart from sports that pose a risk of a fall. Sports such as swimming that reduce the weight of a pregnant female may be more comfortable in the later stages.

Postpartum athletes should have a gradual return to exercise with a focus on pelvic floor strength

Congenital factors

Factors that were present at birth that may have implications further in life, e.g. structural abnormalities or neurological conditions such as cerebral palsy

Psychological factors

Death of close family members, end of relationships, sleep quality and quantity as well as overall stress, may increase the risk of injury. This may be due to fatigue relating to reduced or lack of sleep affecting performance, biomechanics, and recovery from training or previous injury

External risk factors

External risk factors relate to factors outside the exercising person, such as the environmental conditions or the playing surface. Some factors include:

• Position

• Personal protective equipment

• Playing surface

• Equipment

Position

Different positions on a playing court pose different risks

Personal protective equipment

PPE is widely used in sports to reduce the risk of injuries such as concussions and fractures. Devices like angle braces or wrist guards reduce re-injury rates, especially in previously injured athletes.

Playing surface

Higher risk when playing on an artificial surface astro or 3G pitches

Equipment

Sporting equipment needs to be set up correctly within the right parameters to reduce the risk of injuries, e.g. a bike, when put together, needs to correct height for the saddle/bars, etc