Malalignment and Improper Biomechanics as Risk Factors for Overuse Injuries
1. Poor Technique and Abnormal Mechanical Loading
Improper technique can cause uneven distribution of mechanical forces, placing abnormal stress on joints, tendons, ligaments, and surrounding musculoskeletal tissues. Over time, repetitive stress that exceeds tissue capacity limits recovery and increases susceptibility to overuse injuries, including tendinopathies, enthesitis, stress fractures, and progressive joint degeneration. These chronic microtraumas can compromise tissue integrity and predispose individuals to long-term musculoskeletal dysfunction [Buckwalter et al., 2013; Vila Pouca et al., 2021].
2. Malalignment, Anatomical Variations, and Load Intolerance
Malalignment and anatomical or functional variations—such as abnormal bone morphology, joint hypermobility, congenital deformities, genetic predisposition, obesity, reduced mobility, or degenerative changes—can exceed the load tolerance of musculoskeletal tissues over time. This cumulative overload elevates the risk of overuse injuries and degenerative changes [Wilder & Sethi, 2004; Hayashi et al., 2012; Guilak, 2011].
These alterations compromise joint congruency and alignment, impairing the mechanical efficiency of surrounding tissues. Individuals often adopt compensatory movement strategies across the kinetic chain, which can further increase mechanical stress in adjacent or distal regions, amplifying the likelihood of injury [Hayashi et al., 2012; Xu et al., 2022].
References:
Buckwalter, J.A., Anderson, D.D., Brown, T.D., Tochigi, Y. & Martin, J.A., 2013. The roles of mechanical stresses in the pathogenesis of osteoarthritis: implications for treatment of joint injuries. Cartilage, 4(4), pp.286–294. https://doi.org/10.1177/1947603513495889
Guilak, F., 2011. Biomechanical factors in osteoarthritis. Best Practice & Research: Clinical Rheumatology, 25(6), pp.815–823. https://doi.org/10.1016/j.berh.2011.11.013
Hayashi, D., Englund, M., Roemer, F.W. et al., 2012. Knee malalignment is associated with an increased risk for incident and enlarging bone marrow lesions in the more loaded compartments: the MOST study. Osteoarthritis and Cartilage, 20(11), pp.1227–1233. https://doi.org/10.1016/j.joca.2012.07.020
Vila Pouca, M.C.P., Parente, M.P.L., Jorge, R.M.N. & Ashton-Miller, J.A., 2021. Injuries in muscle-tendon-bone units: a systematic review considering the role of passive tissue fatigue. Orthopaedic Journal of Sports Medicine, 9(8), p.23259671211020731. https://doi.org/10.1177/23259671211020731
Wilder, R.P. & Sethi, S., 2004. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clinics in Sports Medicine, 23(1), pp.55–81. https://doi.org/10.1016/S0278-5919(03)00085-1
Xu, Y., Song, B., Ming, A., Zhang, C. & Ni, G., 2022. Chronic ankle instability modifies proximal lower extremity biomechanics during sports maneuvers that may increase the risk of ACL injury: a systematic review. Frontiers in Physiology, 13, p.1036267. https://doi.org/10.3389/fphys.2022.1036267