How An Initial Injury Leads to Reinjury
1. Persistent Biomechanical Deficits
After an initial injury, abnormal movement patterns, altered gait, joint instability, and reduced range of motion can increase mechanical stress on the injured site and surrounding tissues. These deficits may lead to compensatory movements, elevating the risk of reinjury [Hewett et al., 2013; Kim et al., 2019].
2. Maladaptive Neuromuscular Changes
Injury can cause long-lasting alterations in both the central and peripheral nervous systems, leading to neuromuscular inhibition and maladaptive neuroplasticity [Coderre et al., 1993].
Neuromuscular inhibition: Persistent inhibition of motor units contributes to muscle weakness and is commonly observed in ACL and hamstring injuries [Hewett et al., 2013; Fyfe et al., 2013].
Maladaptive neuroplasticity: Altered proprioception, delayed reflexes, and peripheral sensory deficits (e.g., joint instability) disrupt normal communication between the joint and the CNS [Shitara et al., 2022; Neto et al., 2019].
Persistence after healing: These changes can remain even after tissue repair, reducing strength, coordination, and protective reflexes. Standard functional tests may not detect these deficits, which can result in premature return to activity and increased reinjury risk [Needle et al., 2024; Grooms et al., 2023].
3. Inadequate Rehabilitation
Incomplete, overly aggressive, or delayed rehabilitation can result in scar tissue formation, fibrosis, chronic inflammation, and incomplete tissue remodeling. These changes compromise joint stability, proprioception, muscle strength, and range of motion, leaving tissues vulnerable to reinjury [Tran et al., 2023; Rockey et al., 2015; Kohlhauser et al., 2024; Moretti et al., 2022; Kaneguchi et al., 2022; Sharma & Pai, 1997; Proske & Gandevia, 2012].
References:
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