Background Considering the high incidence and consequences of athletic injuries, it can be beneficial to investigate possible causes and prevention strategies. No previous studies have reviewed the use of biomarkers for prevention and recovery of athletic injuries.

Objective To study the effect of exercise on immunological biomarkers in athletes and which prevention or rehabilitation interventions can help manage these biomarker concentrations and thus athletic injuries.

Design Systematic review.

Methods A search was carried out on databases using the keywords: ‘Sports’, ‘Recovery’, ‘Injury prevention’, ‘Athletic injuries’, ‘Overtraining’, ‘Exercise immunology’, ‘Rehabilitation’, ‘Metabolism’ and ‘Training load’. These articles were screened and submitted to a quality assessment.

Results Rather than just high load, a high acute:chronic load ratio is a risk factor for injury. Competition should be seen as a rapid increase in load, and thus be identified as an injury risk factor. But when high loads are achieved gradually (weekly increments <10%) and in a controlled manner, a protective effect against injuries is observed. Adequate recovery time is an important factor, as insufficient rest leads to a higher injury risk. Recovery strategies such as active cool-down, foam rolling and whole-body cryotherapy may facilitate recovery and thus prevent injuries. An earlier training of exercise is effective for preventing muscle damage, if timed properly. To identify when an athlete has entered a maladaptive state, the load can be monitored as a combination of external and internal load measures that are relevant and specific to each sport.

Conclusion Immunological biomarkers indicating muscle damage increase after exercise. To keep these within a normal range, strategies such as load management, a prior session of exercise and/or gradually increasing the load (<10% per week) can be used. Other strategies such as active cool-down, foam rolling or whole-body cryotherapy can be considered, but sufficient evidence is lacking.