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029 Does acute fatigue negatively affect the lower extremity injury risk profile? A systematic and critical review
  1. Jo Verschueren1,
  2. Bruno Tassignon1,
  3. Kevin De Pauw1,3,
  4. Matthias Proost1,
  5. Amber Teugels1,
  6. Jeroen Van Cutsem1,
  7. Bart Roelands1,
  8. Evert Verhagen2,
  9. Romain Meeusen1,3
  1. 1Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy , Vrije Universiteit Brussel, Brussels, Belgium
  2. 2Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  3. 3Strategic Research Program Exercise and the Brain in Health and Disease: the added value of Human-Centered Robotics, Vrije Universiteit Brussel, Brussels, Belgium


Background Acute fatigue is hypothesized to alter injury risk profiles by affecting intrinsic risk factors (i.e. postural control, hamstring strength). However, no systematic overview exists that merges the insights of prospective lower extremity injury risk profiling with the effect of acute fatigue on functional test performance.

Objective The objective of this review was to identify the influence of acute fatigue on prospectively determined modifiable intrinsic risk factors for lower extremity injuries and to determine if individual fatigue outcomes should be integrated within an athlete centred injury risk profile and prevention strategies.

Design Systematic review

Methods PubMed (MEDLINE), Web of Science, PEDro, and Cochrane Library were searched until 29 May 2019. Studies were eligible when the study outcomes encompassed intrinsic modifiable risk factors, an acute fatigue intervention, and included healthy athletes or physically active people. Intrinsic modifiable risk factors were identified through recent systematic reviews and meta-analyses. Referenced original research papers were used to determine outcome measures associated with increased injury risk.

Main Outcome Measurements Acute fatigue effect on the intrinsic modifiable risk factors for lower extremity injuries.

Results Forty studies reported acute fatigue effects on modifiable risk factors, with eight studies matching all criteria for data-extraction. Acute fatigue can decrease single leg postural control, decrease ankle joint position sense, decrease isokinetic strength of hamstring and quadriceps muscles and can affect isokinetic H:Q ratios.

Conclusions Acute fatigue affects prospective intrinsic modifiable risk factors, indicating an altered injury risk profile for lateral ankle sprain, patellofemoral pain syndrome and hamstring injuries when fatigued. Current data does not allow conclusions for non-contact ACL injury risk. Clinicians should consider acute fatigue responses as part of injury risk profiling strategies. Future research should allow for individual fatigability as a relevant injury risk outcome and merge insights from athlete centred injury risk profiling and fatigue research.

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