You’ve probably wondered, what is it about injury-prone people that make their tendons and ligaments so much more likely to tear or strain? Is it just bad luck? Is it poor mechanics of movement and insufficient rest? Or does it all come down to genetics?
Let’s explore what various studies have shown and see what you can do to reduce the risk of sports injuries and ease injury concerns.
But first, let’s take a look at what exactly it means to be injury-prone.
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What exactly does it mean to be injury-prone?
Dictionaries tell us that injury-prone means “frequently injured or often sustaining injuries”.
When people say "injury-prone," they usually have someone's injury history in mind. The phrase itself is not concerned about types of injuries or the reason behind them. It can describe constant minor injuries or a few major injuries that take a while to recover from.
Being seen as injury-prone is definitely damaging for a pro athletes’ image, but the phrase also relates to recreational athletes. You know, that one friend who seems to get hurt every time they do anything even resembling a sport.
However, one could argue there are different types of injury proneness and injury-prone athletes as well as two types of injuries - acute injuries and overuse injuries. Symptoms of acute injuries develop rapidly, while overuse injuries occur as a result of repetitive friction, pulling, twisting, or compression that develops over time.
According to a study that interviewed 30 relevant professionals (coaches, trainers, physical therapists, and doctors), there are three main factors responsible for injuries:
- Incorrect sports techniques
- Physiological or anatomical factors
According to a functional neurologist, Garrett Salpeter, being injury-prone really means being inefficient. He says that when your muscles don't elongate properly, they can't absorb as much force during deceleration. Therefore a bigger part of that force transfers to the connective tissue and bones and can cause problems there.
As you can see, being injury-prone is not a simple “black or white” matter. So, we’ll take a closer look at movement mechanics, genetics, and we’ll also touch overtraining. These are the risk factors you can mitigate if you understand them and if you know your body well enough.
Suboptimal movement mechanics
Athletes, professional or recreational, rely on a combination of movements that they can’t easily change. This is not an issue if they are using proper movement technique. However, people usually move in the easiest way possible. Research has shown that regular runners change their technique in order to improve the efficiency of their movement, but they don’t focus on reducing injury risk.
The problem is that many injuries begin as micro-tears or fractures as a result of an awkward movement. If you don’t correct this movement, and sometimes you don’t even know you have to, this micro problem can quickly turn into a knee injury or another major injury.
Let’s look at an example of football players (soccer players for our American readers) and their problematic non-contact injuries. They are actively developing various footballing skills such as passing, shooting, set pieces, etc. They are also working on their conditioning. What they are usually not working on is their running technique and direction changing mechanics. Although these are fundamental movements that are used all the time, most clubs don’t really see them as important skills.
That puts players with improper or quirky running technique at higher injury risk. Poor, long-ingrained movement patterns throw off delicate balances that can accumulate until a final straw that causes a major injury. That’s why you can often see a player fall down and grab their Achilles tendon for no apparent reason. You can also see that with basketball players where stress accumulates until there’s a “sudden” ACL tear (tear of the anterior cruciate ligament) leading to knee surgery and at least an entire season off the court.
Returning after such an injury is a period where both overtraining and bad mechanics come into play. Pre-existing injuries usually alter how we move and that’s why returning players have a higher risk of getting hurt a second time. Quite often the player wants to help their team as soon as possible and therefore doesn’t take enough time to evaluate the cause of the first injury and correct their movement technique.
These players weren’t inevitably injury-prone.
Once your muscles' structural integrity is damaged, it is more likely you'll suffer a recurring injury in the same area.
Still, we can avoid most injuries caused by poor movement mechanics by correcting the technique of the movement. For those of you who've even been to rehab - it often employs exactly this principle. Obviously, you need enough time, which can be a problem when it comes to pro athletes.
But what about genetics? Are there people who are simply born injury-prone?
Genetic factors that influence injury proneness
Studies have confirmed that certain genetic predispositions have a significant impact on injury risk. While this information might have been just an interesting fact for most athletes just a couple of decades ago, it’s different today. Nowadays you can get tested and see if you are indeed more prone to injuries.
Researchers from Stanford University believe that this sort of genetic testing gives athletes valuable information that can be used to prevent injuries and increase their competitive edge.
Genetic information is also valuable for amateur athletes. It’s good to know if you’re at a higher risk of suffering ankle injuries or a shoulder injury before joining a recreational basketball or tennis league.
We’ll focus on genetic factors that influence soft tissue injury risk as most common injuries affect soft tissues - muscles, tendons, ligaments, and nerves. We’ll also take a look at muscle fatigue and post-exercise recovery. In case you were wondering, we won’t talk about bone fractures as that would open a whole new chapter discussing mineral structure, illnesses, stress fractures, etc.
Soft tissue injury risk
The role of soft tissue is to connect, support or surround other structures of our body; therefore, it is quite exposed to injury.
Your genetic makeup can importantly contribute to being more susceptible to soft tissue injury and if this is the case, appropriate training, especially warming up, is even more important.
An important factor of soft tissue injuries are variations in the genes that control the production of collagen. It is the main component of tendons and ligaments.
Researchers have found that specific variations of a collagen gene named COL1A1 were under-represented in a group of recreational athletes who had suffered ACL injuries. Those who had torn their ACL were four times more likely to have a blood relative who had suffered the same injury compared to the uninjured study participants. This suggests that genetics are at least partially responsible for the strength of the ligament.
The COL1A1 gene has also been linked to other soft-tissue injuries - like Achilles tendon ruptures and shoulder dislocations. TT genotype is especially interesting. It’s one of three potential variants of the COL1A1 gene and it’s found only in 5% of the population. People who have it are extremely unlikely to suffer a traumatic ligament or tendon injury.
Although it seems like the COL1A1 gene does impact soft tissue injury risk, it’s highly improbable that a single gene can determine a person’s genetic risk for such an injury. Our genome is just too complex and there are other genes that also play a role - COL5A1 that affects our natural (in)flexibility or MMP3 which is involved in wound repair.
Genes also play a significant role in areas closely related to injury risk; take, for example, muscle fatigue.
Muscle fatigue is also a factor when it comes to injury risk and it is correlated with the rate at which lactate is cleared out of our muscle cells.
A variation in a gene called MCT1 influences the amount of MCT1 transporters produced. Since they are responsible for exporting lactate across the muscle cell membrane, they impact how quickly you get fatigued.
During exercise, contracting muscles produce lactate and hydrogen ions as a result of a process called glycolysis. Contrary to its bad reputation, lactate acts as an energy source, acid buffer, and signaling molecule.
However, the accumulation of H+lactate during high-intensity exercise can lower muscle pH, which creates a burning sensation in muscles and limits muscle contractility. This results in muscle fatigue and a higher risk of injury if muscles can’t relax properly.
Lower-intensity exercise only increases blood lactate levels slightly, because there is limited reliance on the anaerobic metabolism of lactate. When the intensity of exercise increases, more anaerobic processes are necessary for our body to meet the demand for energy. At this point, we reach the lactate threshold which we can only sustain for a short period of time.
A specific mutation within the MCT1 gene influences the amount of MCT1 transporters produced and, in this way, affects the rate at which lactate is cleared out of our muscle cells.
As a result, our genes influence how long our muscles stay fatigued and, with it, another aspect of injury proneness.
Post-exercise recovery is another area influenced by genes that can affect injury risk by impacting the likelihood of overtraining.
Physical activity leads to increased production of reactive oxygen species (ROS), which can cause oxidative stress in our bodies. Besides the production of ROS, exercise can affect the body’s complex immune system and produce a cascading effect of inflammatory responses, leading to chronic inflammation which can increase our injury risk.
How? During high-intensity training, the uptake of oxygen into active muscles increases up to 20-fold, while the flow of oxygen in the activated muscles can increase even up to 100-fold. This significantly boosts the production of ROS, and the same happens with skeletal muscle injuries.
If our body produces ROS in amounts exceeding the capacity of our antioxidant defence system, this results in oxidative stress in our body. This does not mean that ROS are always bad; a short and limited increase in the production of ROS after exercise is responsible for positive adaptations.
But when a body becomes chronically inflamed, we have perfect conditions for a host of negative and potentially injurious conditions.
How your body deals with this process and how long it takes to recover is largely based on your genes.
Hopefully, that makes it clearer how genes can determine if someone is more or less injury-prone. Now let’s see what you can do to avoid the dreaded “injury bug” even if you are one of the unlucky ones, potentially prone to injuries.
What can you do to mitigate injury risk factors
Let’s take a look Van Mechelen’s injury prevention model from 1992, which has been widely used to implement preventive measures in response to sports injuries, says there are four steps you need to go through when trying to prevent an injury:
- Identify the magnitude of the problem (prevalence and incidence of injuries)
- Identify the cause and mechanism of injury
- Develop and implement an injury prevention strategy
- Evaluate the effectiveness of the intervention
It’s not perfect, but focusing on these steps is not too complicated and can still help you a ton.
If you identified the cause of your injuries as a bad movement technique or mechanism, you should analyse it with a professional and see what you need to change.
However, if you’re at a higher injury risk due to your genes, we have some more specific tips.
Tips for mitigating soft tissue injury risk
- Massage your leg muscles (especially calf muscles) and Achilles tendon after intensive training.
- The day after a game or high-intensity training or training on a hard surface, reduce the load on your tendons. You can go swimming or cycling.
- If you feel pain, use ice pads for about 10–20 minutes.
- Maintain normal body weight or BMI < 25, since higher BMI poses a higher risk of injury.
- Have a sports biomechanics professional, rather than a "brand" shoe distributor fit you with the most appropriate training shoes. The shoes must feel comfortable; rotating between a few pairs of shoes is beneficial for better load distribution over time. Slightly worn-in shoes are better than brand new ones.
- Increase your warm-up duration & intensity, especially in cold environmental conditions.
- Include additional stretching and strengthening exercises in your weekly training programme.
- During warm-up, increase speed or jump height gradually.
- Don’t neglect rest days, preferably utilise active recovery with different, less-strenuous activities.
Tips for sufficient and quicker post-exercise recovery
- Heavy legs and laboured breathing are sure signs you still need some time to recover.
- Another sign is a higher-than-normal resting heart rate (RHR). Measuring your resting heart rate the next morning can give you some clues about how your body is doing.
- If you are a sedentary person, active only once in a while, your physical activity should not be too intensive, as this is high stress for your body, since your body is not adapted to high-intensity activity
- The amount and quality of sleep also affect your recovery; therefore, get enough rest, especially after high-intensity activity.
- We recommend higher amounts of omega-3 fatty acids and lower amounts of omega-6 fatty acids, which positively affect inflammatory processes in your body.
- Abolish trans fats and limit saturated fatty acids for lower inflammation.
- Training diary management is highly recommended for finding an optimal recovery time and for monitoring signs of overtraining.
- Performing an active cool-down after a workout will help clear metabolite by-products than just resting.
- Do not forget about a sufficient intake of magnesium. It is required for the production of high-energy molecules (ATP) and it is crucial in decreasing the accumulation of lactic acid. Magnesium is also one of the electrolytes which will help you to maintain fluid balance in your body during and after the workout.
- Stay properly hydrated and consider adding electrolytes to improve your focus, recovery, and performance.
Find out if you are more likely to get injured, and more
Knowledge of genetics alone won't keep athletes from getting hurt. But it may, at the very least, reveal those at higher risk and help minimise future problems.
If you want to know more about your genetic potential regarding soft tissue injury risk, post-exercise recovery and muscle fatigue, you can take GenePlanet’s MyLifestyle test.
Check out the Sport and recreation chapter and see all the secrets it can unlock!
It’s a great tool for making your workout as efficient as possible and to truly know what is best for your body. It also reveals your muscle structure, aerobic potential, heart capacity, and more.
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