• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of brjsmedBritish Journal of Sports MedicineVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Br J Sports Med. Feb 2003; 37(1): 13–29.
PMCID: PMC1724594

Risk factors for lower extremity injury: a review of the literature


Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine addtional risk factors for lower extremity injury.

Full Text

The Full Text of this article is available as a PDF (174K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kraus JF, Conroy C. Mortality and morbidity from injuries in sports and recreation. Annu Rev Public Health. 1984;5:163–192. [PubMed]
  • Taimela S, Kujala UM, Osterman K. Intrinsic risk factors and athletic injuries. Sports Med. 1990 Apr;9(4):205–215. [PubMed]
  • Seil R, Rupp S, Tempelhof S, Kohn D. Sports injuries in team handball. A one-year prospective study of sixteen men's senior teams of a superior nonprofessional level. Am J Sports Med. 1998 Sep-Oct;26(5):681–687. [PubMed]
  • Prager BI, Fitton WL, Cahill BR, Olson GH. High school football injuries: a prospective study and pitfalls of data collection. Am J Sports Med. 1989 Sep-Oct;17(5):681–685. [PubMed]
  • Messina DF, Farney WC, DeLee JC. The incidence of injury in Texas high school basketball. A prospective study among male and female athletes. Am J Sports Med. 1999 May-Jun;27(3):294–299. [PubMed]
  • Nielsen AB, Yde J. Epidemiology and traumatology of injuries in soccer. Am J Sports Med. 1989 Nov-Dec;17(6):803–807. [PubMed]
  • Ekstrand J, Gillquist J, Möller M, Oberg B, Liljedahl SO. Incidence of soccer injuries and their relation to training and team success. Am J Sports Med. 1983 Mar-Apr;11(2):63–67. [PubMed]
  • Söderman K, Alfredson H, Pietilä T, Werner S. Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season. Knee Surg Sports Traumatol Arthrosc. 2001 Sep;9(5):313–321. [PubMed]
  • Stuart MJ, Smith A. Injuries in Junior A ice hockey. A three-year prospective study. Am J Sports Med. 1995 Jul-Aug;23(4):458–461. [PubMed]
  • Bahr R, Bahr IA. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors. Scand J Med Sci Sports. 1997 Jun;7(3):166–171. [PubMed]
  • Myklebust G, Maehlum S, Holm I, Bahr R. A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball. Scand J Med Sci Sports. 1998 Jun;8(3):149–153. [PubMed]
  • Stevenson MR, Hamer P, Finch CF, Elliot B, Kresnow M. Sport, age, and sex specific incidence of sports injuries in Western Australia. Br J Sports Med. 2000 Jun;34(3):188–194. [PMC free article] [PubMed]
  • Peterson L, Junge A, Chomiak J, Graf-Baumann T, Dvorak J. Incidence of football injuries and complaints in different age groups and skill-level groups. Am J Sports Med. 2000;28(5 Suppl):S51–S57. [PubMed]
  • Chomiak J, Junge A, Peterson L, Dvorak J. Severe injuries in football players. Influencing factors. Am J Sports Med. 2000;28(5 Suppl):S58–S68. [PubMed]
  • Hopper DM, Hopper JL, Elliott BC. Do selected kinanthropometric and performance variables predict injuries in female netball players? J Sports Sci. 1995 Jun;13(3):213–222. [PubMed]
  • Hosea TM, Carey CC, Harrer MF. The gender issue: epidemiology of ankle injuries in athletes who participate in basketball. Clin Orthop Relat Res. 2000 Mar;(372):45–49. [PubMed]
  • Milgrom C, Shlamkovitch N, Finestone A, Eldad A, Laor A, Danon YL, Lavie O, Wosk J, Simkin A. Risk factors for lateral ankle sprain: a prospective study among military recruits. Foot Ankle. 1991 Aug;12(1):26–30. [PubMed]
  • Barrett JR, Tanji JL, Drake C, Fuller D, Kawasaki RI, Fenton RM. High- versus low-top shoes for the prevention of ankle sprains in basketball players. A prospective randomized study. Am J Sports Med. 1993 Jul-Aug;21(4):582–585. [PubMed]
  • McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001 Apr;35(2):103–108. [PMC free article] [PubMed]
  • Lambson RB, Barnhill BS, Higgins RW. Football cleat design and its effect on anterior cruciate ligament injuries. A three-year prospective study. Am J Sports Med. 1996 Mar-Apr;24(2):155–159. [PubMed]
  • Barrett J, Bilisko T. The role of shoes in the prevention of ankle sprains. Sports Med. 1995 Oct;20(4):277–280. [PubMed]
  • Sitler M, Ryan J, Wheeler B, McBride J, Arciero R, Anderson J, Horodyski M. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. A randomized clinical study at West Point. Am J Sports Med. 1994 Jul-Aug;22(4):454–461. [PubMed]
  • Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. Am J Sports Med. 1994 Sep-Oct;22(5):601–606. [PubMed]
  • Tropp H, Askling C, Gillquist J. Prevention of ankle sprains. Am J Sports Med. 1985 Jul-Aug;13(4):259–262. [PubMed]
  • Engström BK, Renström PA. How can injuries be prevented in the World Cup soccer athlete? Clin Sports Med. 1998 Oct;17(4):755–vii. [PubMed]
  • Arnason A, Gudmundsson A, Dahl HA, Jóhannsson E. Soccer injuries in Iceland. Scand J Med Sci Sports. 1996 Feb;6(1):40–45. [PubMed]
  • Inklaar H. Soccer injuries. II: Aetiology and prevention. Sports Med. 1994 Aug;18(2):81–93. [PubMed]
  • Danielsson L, Lindberg H, Nilsson B. Prevalence of coxarthrosis. Clin Orthop Relat Res. 1984 Dec;(191):110–115. [PubMed]
  • Jørring K. Osteoarthritis of the hip. Epidemiology and clinical role. Acta Orthop Scand. 1980 Jun;51(3):523–530. [PubMed]
  • Backous DD, Friedl KE, Smith NJ, Parr TJ, Carpine WD., Jr Soccer injuries and their relation to physical maturity. Am J Dis Child. 1988 Aug;142(8):839–842. [PubMed]
  • Ostenberg A, Roos H. Injury risk factors in female European football. A prospective study of 123 players during one season. Scand J Med Sci Sports. 2000 Oct;10(5):279–285. [PubMed]
  • Lindenfeld TN, Schmitt DJ, Hendy MP, Mangine RE, Noyes FR. Incidence of injury in indoor soccer. Am J Sports Med. 1994 May-Jun;22(3):364–371. [PubMed]
  • Orchard JW. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med. 2001 May-Jun;29(3):300–303. [PubMed]
  • Knapik JJ, Sharp MA, Canham-Chervak M, Hauret K, Patton JF, Jones BH. Risk factors for training-related injuries among men and women in basic combat training. Med Sci Sports Exerc. 2001 Jun;33(6):946–954. [PubMed]
  • Wiesler ER, Hunter DM, Martin DF, Curl WW, Hoen H. Ankle flexibility and injury patterns in dancers. Am J Sports Med. 1996 Nov-Dec;24(6):754–757. [PubMed]
  • Bennell KL, Malcolm SA, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark JD. Risk factors for stress fractures in track and field athletes. A twelve-month prospective study. Am J Sports Med. 1996 Nov-Dec;24(6):810–818. [PubMed]
  • Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med. 1995 Nov-Dec;23(6):694–701. [PubMed]
  • Gwinn DE, Wilckens JH, McDevitt ER, Ross G, Kao TC. The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med. 2000 Jan-Feb;28(1):98–102. [PubMed]
  • Powell JW, Barber-Foss KD. Sex-related injury patterns among selected high school sports. Am J Sports Med. 2000 May-Jun;28(3):385–391. [PubMed]
  • Gray J, Taunton JE, McKenzie DC, Clement DB, McConkey JP, Davidson RG. A survey of injuries to the anterior cruciate ligament of the knee in female basketball players. Int J Sports Med. 1985 Dec;6(6):314–316. [PubMed]
  • Hewett TE. Neuromuscular and hormonal factors associated with knee injuries in female athletes. Strategies for intervention. Sports Med. 2000 May;29(5):313–327. [PubMed]
  • Hickey GJ, Fricker PA, McDonald WA. Injuries of young elite female basketball players over a six-year period. Clin J Sport Med. 1997 Oct;7(4):252–256. [PubMed]
  • Zelisko JA, Noble HB, Porter M. A comparison of men's and women's professional basketball injuries. Am J Sports Med. 1982 Sep-Oct;10(5):297–299. [PubMed]
  • Bell NS, Mangione TW, Hemenway D, Amoroso PJ, Jones BH. High injury rates among female army trainees: a function of gender? Am J Prev Med. 2000 Apr;18(3 Suppl):141–146. [PubMed]
  • Baumhauer JF, Alosa DM, Renström AF, Trevino S, Beynnon B. A prospective study of ankle injury risk factors. Am J Sports Med. 1995 Sep-Oct;23(5):564–570. [PubMed]
  • Beynnon BD, Renström PA, Alosa DM, Baumhauer JF, Vacek PM. Ankle ligament injury risk factors: a prospective study of college athletes. J Orthop Res. 2001 Mar;19(2):213–220. [PubMed]
  • Beachy G, Akau CK, Martinson M, Olderr TF. High school sports injuries. A longitudinal study at Punahou School: 1988 to 1996. Am J Sports Med. 1997 Sep-Oct;25(5):675–681. [PubMed]
  • Slauterbeck James R, Fuzie Stephen F, Smith Michael P, Clark Russell J, Xu K, Starch David W, Hardy Daniel M. The Menstrual Cycle, Sex Hormones, and Anterior Cruciate Ligament Injury. J Athl Train. 2002 Sep;37(3):275–278. [PMC free article] [PubMed]
  • Wojtys Edward M, Huston Laura J, Boynton Melbourne D, Spindler Kurt P, Lindenfeld Thomas N. The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sports Med. 2002 Mar-Apr;30(2):182–188. [PubMed]
  • Slauterbeck J, Clevenger C, Lundberg W, Burchfield DM. Estrogen level alters the failure load of the rabbit anterior cruciate ligament. J Orthop Res. 1999 May;17(3):405–408. [PubMed]
  • Liu SH, Al-Shaikh RA, Panossian V, Finerman GA, Lane JM. Estrogen affects the cellular metabolism of the anterior cruciate ligament. A potential explanation for female athletic injury. Am J Sports Med. 1997 Sep-Oct;25(5):704–709. [PubMed]
  • Beynnon BD, Ryder SH, Konradsen L, Johnson RJ, Johnson K, Renström PA. The effect of anterior cruciate ligament trauma and bracing on knee proprioception. Am J Sports Med. 1999 Mar-Apr;27(2):150–155. [PubMed]
  • Bahr R, Lian O, Bahr IA. A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study. Scand J Med Sci Sports. 1997 Jun;7(3):172–177. [PubMed]
  • Tropp H, Ekstrand J, Gillquist J. Stabilometry in functional instability of the ankle and its value in predicting injury. Med Sci Sports Exerc. 1984;16(1):64–66. [PubMed]
  • Ekstrand J, Gillquist J. The avoidability of soccer injuries. Int J Sports Med. 1983 May;4(2):124–128. [PubMed]
  • Orchard J, Seward H, McGivern J, Hood S. Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med. 2001 Mar-Apr;29(2):196–200. [PubMed]
  • Dvorak J, Junge A, Chomiak J, Graf-Baumann T, Peterson L, Rösch D, Hodgson R. Risk factor analysis for injuries in football players. Possibilities for a prevention program. Am J Sports Med. 2000;28(5 Suppl):S69–S74. [PubMed]
  • Jones BH, Bovee MW, Harris JM, 3rd, Cowan DN. Intrinsic risk factors for exercise-related injuries among male and female army trainees. Am J Sports Med. 1993 Sep-Oct;21(5):705–710. [PubMed]
  • Twellaar M, Verstappen FT, Huson A, van Mechelen W. Physical characteristics as risk factors for sports injuries: a four year prospective study. Int J Sports Med. 1997 Jan;18(1):66–71. [PubMed]
  • Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study. Med Sci Sports Exerc. 1983;15(3):267–270. [PubMed]
  • Krivickas LS, Feinberg JH. Lower extremity injuries in college athletes: relation between ligamentous laxity and lower extremity muscle tightness. Arch Phys Med Rehabil. 1996 Nov;77(11):1139–1143. [PubMed]
  • Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973 Sep;32(5):413–418. [PMC free article] [PubMed]
  • Godshall RW. The predictability of athletic injuries: an eight-year study. J Sports Med. 1975 Jan-Feb;3(1):50–54. [PubMed]
  • Glick JM, Gordon RB, Nishimoto D. The prevention and treatment of ankle injuries. Am J Sports Med. 1976 Jul-Aug;4(4):136–141. [PubMed]
  • Baumhauer JF, Alosa DM, Renström AF, Trevino S, Beynnon B. Test-retest reliability of ankle injury risk factors. Am J Sports Med. 1995 Sep-Oct;23(5):571–574. [PubMed]
  • Kaufman KR, Brodine SK, Shaffer RA, Johnson CW, Cullison TR. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 1999 Sep-Oct;27(5):585–593. [PubMed]
  • Elveru RA, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting. Subtalar and ankle joint measurements. Phys Ther. 1988 May;68(5):672–677. [PubMed]
  • Shambaugh JP, Klein A, Herbert JH. Structural measures as predictors of injury basketball players. Med Sci Sports Exerc. 1991 May;23(5):522–527. [PubMed]
  • McGuine TA, Greene JJ, Best T, Leverson G. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sport Med. 2000 Oct;10(4):239–244. [PubMed]
  • Tropp H, Ekstrand J, Gillquist J. Factors affecting stabilometry recordings of single limb stance. Am J Sports Med. 1984 May-Jun;12(3):185–188. [PubMed]
  • Souryal TO, Freeman TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med. 1993 Jul-Aug;21(4):535–539. [PubMed]
  • LaPrade RF, Burnett QM., 2nd Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries. A prospective study. Am J Sports Med. 1994 Mar-Apr;22(2):198–203. [PubMed]
  • Cowan DN, Jones BH, Frykman PN, Polly DW, Jr, Harman EA, Rosenstein RM, Rosenstein MT. Lower limb morphology and risk of overuse injury among male infantry trainees. Med Sci Sports Exerc. 1996 Aug;28(8):945–952. [PubMed]
  • Wen DY, Puffer JC, Schmalzried TP. Injuries in runners: a prospective study of alignment. Clin J Sport Med. 1998 Jul;8(3):187–194. [PubMed]
  • Ilahi OA, Kohl HW., 3rd Lower extremity morphology and alignment and risk of overuse injury. Clin J Sport Med. 1998 Jan;8(1):38–42. [PubMed]
  • Giladi M, Milgrom C, Simkin A, Stein M, Kashtan H, Margulies J, Rand N, Chisin R, Steinberg R, Aharonson Z, et al. Stress fractures and tibial bone width. A risk factor. J Bone Joint Surg Br. 1987 Mar;69(2):326–329. [PubMed]
  • Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med. 1993 Jul;2(7):773–777. [PubMed]
  • Williams DS, 3rd, McClay IS, Hamill J. Arch structure and injury patterns in runners. Clin Biomech (Bristol, Avon) 2001 May;16(4):341–347. [PubMed]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...