Overview

In sport and physical activity, injuries rarely happen by chance. They are often the result of a complex interaction between internal and external risk factors that, when combined, can predispose an individual to injury. Understanding how these factors interact is crucial for preventing injuries, promoting safe participation, and informing return-to-play decisions.

Internal risk factors are those that originate within the individual. These include:

Previous injury – scar tissue or reduced joint stability can increase the likelihood of reinjury.

Muscle imbalance or weakness – uneven strength around a joint can increase stress and reduce control.

Poor flexibility or limited range of motion can affect technique and increase strain on tissues.

Fatigue – tired muscles respond more slowly, compromising coordination and protection mechanisms.

Growth and maturation – In youth athletes, rapid growth can lead to temporary imbalances and increased vulnerability.

Psychological readiness – anxiety, lack of focus, or overconfidence can affect decision-making and movement control.

While these internal factors can make an individual more vulnerable, external risk factors often act as the trigger for injury. These include:

Training load – sudden increases in volume or intensity can overload tissues.

Poor technique or coaching – inefficient movement patterns lead to increased mechanical stress.

Environmental conditions – wet surfaces, uneven ground, or poor lighting can lead to slips and falls.

Equipment – ill-fitting shoes or faulty protective gear can fail to provide adequate support or protection.

Opposition and contact – in team or combat sports, collisions and tackles present external dangers.

In reality, injuries often result not from a single factor but from multiple risk factors aligning simultaneously. For example, an athlete returning from injury (internal factor) who trains on a slippery surface (external factor) while fatigued (internal factor) is at increased risk.

This interplay is significant in injury prevention programmes, which aim to reduce internal vulnerabilities (e.g., through strength and conditioning) and manage external risks (e.g., through appropriate surfaces, rules, and load monitoring). Recognising and managing the complex interplay of risk factors empowers athletes and coaches to make more informed training decisions and promote long-term health and performance.