Does Acute Fatigue Negatively Affect Intrinsic Risk Factors of the Lower Extremity Injury Risk Profile? A Systematic and Critical Review
Acute fatigue is hypothesized to alter lower extremity injury risk profiles by affecting intrinsic risk factors (i.e. single leg postural control, hamstring strength). However, no systematic overview exists that merges the insights into prospective lower extremity injury risk profiling with the effect of acute fatigue on functional test performance.
The objective of this review is to identify the influence of acute fatigue on prospectively determined modifiable intrinsic risk factors for lower extremity injuries.
PubMed (MEDLINE), Web of Science, PEDro, and Cochrane Library were searched until 29 May 2019. Studies were eligible when the study outcomes encompassed intrinsic modifiable risk factors for lower extremity injury, an acute fatigue intervention, and included healthy athletes or physically active people. Intrinsic modifiable risk factors were identified through recent systematic reviews and meta-analyses, and the referenced original research papers were used to determine outcome measures associated with increased injury risk.
Forty-three studies reported acute fatigue effects on modifiable risk factors, with eight studies matching all criteria for data-extraction. Acute fatigue can decrease single leg postural control, decrease ankle joint position sense, decrease isokinetic strength of hamstring and quadriceps muscles and can affect isokinetic hamstring:quadriceps ratios.
Acute fatigue affects prospective intrinsic modifiable risk factors for lower extremity injury, indicating an altered injury risk profile for lateral ankle sprain, patellofemoral pain syndrome and hamstring injuries. Future research should allow for individual fatiguability as a relevant outcome, and merge insights from athlete-centred injury risk profiling and fatigue.
The authors would like to thank the entire Human Physiology and Sports Physiotherapy Research Group team for its assistance and repeated valuable discussions on the topic of fatigue. The authors would like to thank the physiotherapy students of Vrije Universiteit Brussel, as some insights were able to be further developed while preparing and teaching theoretical and practical courses on injury prevention and rehabilitation, with interesting discussions on the relevance of fatigue and possible clinical implications within these domains. The authors wish to thank the editorial team and anonymous reviewers for their constructive feedback and added perspectives that helped improve this manuscript.
Compliance with Ethical Standards
No sources of funding were used to assist in the preparation of this article.
Conflicts of interest
Jo Verschueren, Bruno Tassignon, Kevin De Pauw, Matthias Proost, Amber Teugels, Jeroen Van Cutsem, Bart Roelands, Evert Verhagen and Romain Meeusen declare that they have no conflicts of interest relevant to the content of this review.
Data availability statement
The authors declare that all data supporting the findings of this study are available within the article [and its supplementary information files].
- 2.Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):705–29.PubMedCrossRefGoogle Scholar
- 21.Bittencourt NFN, Meeuwisse WH, Mendonca LD, Nettel-Aguirre A, Ocarino JM, Fonseca ST. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med. 2016;50(21):1309–14.PubMedCrossRefGoogle Scholar
- 33.Gibson AS, Swart J, Tucker R. The interaction of psychological and physiological homeostatic drives and role of general control principles in the regulation of physiological systems, exercise and the fatigue process—the integrative governor theory. Eur J Sport Sci. 2018;18(1):25–36.CrossRefGoogle Scholar
- 40.Xia R, Zhang XN, Wang X, Sun XL, Fu WJ. Effects of two fatigue protocols on impact forces and lower extremity kinematics during drop landings: implications for noncontact anterior cruciate ligament injury. J Healthc Eng. 2017;2017:5690519. https://doi.org/10.1155/2017/5690519(Epub 2017 Jul 12).CrossRefPubMedPubMedCentralGoogle Scholar
- 57.Koumantakis GA, Lountzis D, Papatsimpas G, Kentritas O, Katsiki X, Michaleas P. Effects of a functional lower extremity fatigue protocol and a 5-minute recovery period on the performance of a single leg hop test for distance in healthy participants. J Sports Med Phys Fitness. 2018;59:916–24.PubMedGoogle Scholar
- 100.Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DT, et al. Evidence review for the 2016 international ankle consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496–505.PubMedCrossRefGoogle Scholar
- 114.Walden M, Krosshaug T, Bjorneboe J, Andersen TE, Faul O, Hagglund M. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. Br J Sports Med. 2015;49(22):1452–60.PubMedPubMedCentralCrossRefGoogle Scholar