Reviewing the Variability-Overuse Injury Hypothesis: Does Movement Variability Relate to Landing Injuries?

Overuse injuries are common in sport, but complete understanding of injury risk factors remains incomplete. Although biomechanical studies frequently examine musculoskeletal injury mechanisms, human movement variability studies aim to better understand neuromotor functioning, with proposed connections between overuse injury mechanisms and changes in motor variability.

In a narrative review, we discuss the variability-overuse injury hypothesis, which suggests repeated load application leads to mechanical tissue breakdown and subsequent injury when exceeding the rate of physiological adaptation. Due to the multidisciplinary nature of this hypothesis, we incorporate concepts from motor control, neurophysiology, biomechanics, as well as research design and data analysis. We therefore summarize multiple perspectives while proposing theoretical relationships between movement variability and lower extremity overuse injuries.

Experimental data are presented and summarized from published experiments examining interactions between experimental task demands and movement variability in the context of drop landing movements, along with comparisons to previous movement variability studies.

We provide a conceptual framework for sports medicine researchers interested in predicting and preventing sports injuries. Under performance conditions with greater task demands, we predict reduced trial-to-trial movement variability that could increase the likelihood of overuse injuries.