TABLE 4-10 Risk Factors for Developing Overuse and Traumatic Injuries in Military Populations

Risk Category

Risk Factor

Supporting Literature

Physical factors

Greater physical demand levels (including exercise)

Berkowitz et al., 1999; DiBenedetto et al., 2002; Dybel and Seymour, 1997; Feuerstein, Berkowitz, and Peck, 1997; Huang and Feuerstein, 2004; Jones, Cowan, and Knapik, 1994; Lincoln et al., 2002; Potter et al., 2002; Shaffer et al., 1999b; Smith and Cashman, 2002; Tomlinson, Lednar, and Jackson, 1987

Individual factors

Low levels of past physical activity

Almeida et al., 1999; Gardner et al., 1988; Jones et al., 1993a, 1993b; Kowal, 1980; Shaffer et al., 1999a; Winfield et al., 1997


Low levels of physical fitness

Almeida et al., 1999; Bell et al., 2000; Jones et al., 1993a, 1993b; Knapik et al., 1993; Kowal, 1980; Reynolds et al., 1994; Schneider et al., 2000; Shaffer et al., 1999a; Pope, 2002



Jones et al., 1993a; Lincoln et al., 2002; Reynolds et al., 1994


Age (older)

Brudvig et al., 1983; Jones et al., 1993a; Lincoln et al., 2002; Pope, 2002


Age (younger)

Feuerstein, Berkowitz, and Peck, 1997; Knapik et al., 1993; Tomlinson, Lednar, and Jackson, 1987; Winfield et al., 1997

load without structural damage, current research is beginning to expand the concept of tolerance to include not only mechanical tolerance of the tissue but also the point at which the tissue exhibits an inflammatory reaction.

Many activities associated with exercise as well as work tasks involve lighter tissue loads yet have become increasingly repetitive. The conceptual load-tolerance model can also be adjusted to account for this type of risk exposure. Figure 4-6 shows that biomechanics logic can account for this trend by decreasing the tissue tolerance over time. As suggested in this figure, during repetitive activities the load imposed on a tissue remains relatively constant; however, the ability of the tissue to tolerate the load decreases over time. This is believed to be the mechanism of risk during highly repetitive activities or activities that are performed for extended periods of time.

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