Why are some people more prone to muscle and joint sprains?

Why Some People Are More Prone to Muscle and Joint Sprains

Previous injury is the single strongest predictor of future sprains, with individuals who have sustained a prior ankle sprain being at 1.8-2.7 times higher risk of recurrent injury. 1

Non-Modifiable Risk Factors

Sex

• Women face higher baseline injury risk than men when exposed to fixed levels of physical activity, though this difference largely reflects inability to modulate training intensity rather than inherent biological vulnerability 1
• In competitive sports, males actually demonstrate higher in-competition sprain risk (RR 3.42) compared to females (RR 2.71) 1

Previous Injury History

• A history of prior musculoskeletal injury doubles the risk of future overuse injuries and represents the most consistently identified risk factor across both civilian and military populations 1
• Previous ankle sprains specifically increase risk of recurrent ankle sprains through mechanisms including residual ligament laxity, impaired postural control, and peroneal muscle weakness 1, 2
• Up to 40% of individuals develop chronic ankle instability (CAI) following initial lateral ankle sprain despite appropriate initial treatment 1

Age

• Age alone is not a strong predictor of injury risk in adults under 45 years 1
• Some military studies show trainees over 23 years have elevated risk, though civilian studies show inconsistent results, likely due to ability to self-modulate training intensity 1

Modifiable Intrinsic Risk Factors

Physical Fitness and Conditioning

• Lower baseline physical fitness dramatically increases injury susceptibility when individuals are exposed to standardized training loads 1
• Decreased muscle strength, impaired coordination, and limited ankle range of motion all independently increase sprain risk 3
• Peroneal muscle weakness specifically predisposes to functional ankle instability and recurrent sprains 2
• Deficiencies in dynamic postural control and inability to complete jumping/landing within 2 weeks after initial sprain predict progression to chronic instability 1

Biomechanical Factors

• Limited dorsiflexion range of motion increases heel spur and lower extremity injury risk 3
• Altered hip joint kinematics following initial ankle sprain contributes to CAI development 1
• Muscles crossing two joints, acting eccentrically, and containing high percentages of fast-twitch fibers are most susceptible to strain injury 4

Body Composition

• Increased BMI and greater body height elevate injury risk, particularly in high-level sports participation 1
• Excessive height and weight predispose to stress injuries during physical training 5

Health Behaviors

• Smoking increases training-related injury risk by 25-130% across multiple populations 1
  • Female smokers: 77% injury rate vs 62% for nonsmokers
  • Male smokers: 1.9-2.3 times higher injury risk than nonsmokers
• Previous regular physical activity appears protective in men, though evidence is inconsistent for women 1

Modifiable Extrinsic Risk Factors

Activity-Related Factors

• High physical workload and competitive-level sports participation significantly increase sprain risk 1, 3
• Sports involving jumping and landing (volleyball, basketball) carry elevated risk, with landing after jumps being the most important mechanism 1
• Playing soccer on natural grass increases lateral ankle sprain incidence compared to artificial turf (RR 0.53 for artificial turf) 1
• Defensive positions in soccer account for 42.3% of all sprains 1

Footwear

• High heels (9.5 cm vs 1.3 cm) substantially heighten lateral ankle sprain risk 1
• Inappropriate or ill-fitting footwear contributes to heel spurs and general lower extremity injury 3

Training Factors

• Inadequate warm-up before intense exercise increases muscle strain susceptibility 4
• Excessive fatigue during training sessions elevates injury risk 4
• Insufficient rest between repeated strain exposures leads to cumulative injury and potential fibrosis 6

Clinical Implications for Risk Assessment

Healthcare providers should specifically assess:

• Complete injury history, particularly previous ankle sprains 1
• Current pain levels and physical workload, as these negatively influence recovery and increase recurrence risk 1
• Smoking status and counsel cessation 1
• Baseline fitness level relative to planned activity intensity 1
• Postural control and peroneal muscle strength in those with prior ankle injuries 1, 2
• Sport-specific risk factors (type of sport, playing surface, position, footwear) 1

Common pitfall: Failing to recognize that 5-46% of patients report persistent pain and 33-55% experience ongoing instability 1-4 years after initial ankle sprain, indicating need for aggressive early intervention to prevent chronic sequelae 1