Does Acute Fatigue Negatively Affect Intrinsic Risk Factors of the Lower Extremity Injury Risk Profile? A Systematic and Critical Review

  • Jo Verschueren
  • Bruno Tassignon
  • Kevin De Pauw
  • Matthias Proost
  • Amber Teugels
  • Jeroen Van Cutsem
  • Bart Roelands
  • Evert Verhagen
  • Romain MeeusenEmail author
Systematic 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.


Systematic review.


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].

Supplementary material

40279_2019_1235_MOESM1_ESM.docx (39 kb)
Supplementary material 1 (DOCX 38 kb)
40279_2019_1235_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 13 kb)
40279_2019_1235_MOESM3_ESM.docx (36 kb)
Supplementary material 3 (DOCX 36 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and PhysiotherapyVrije Universiteit BrusselBrusselsBelgium
  2. 2.Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational HealthAmsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
  3. 3.Strategic Research Program ‘Exercise and the Brain in Health and Disease: the Added Value of Human-Centered Robotics’Vrije Universiteit BrusselBrusselsBelgium

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