Time for a Paradigm Shift in Conceptualizing Risk Factors in Sports Injury Research (Commentary) (Report‪)‬

Certified athletic trainers are positioned to play an integral role in sport-related, recreation-related, and exercise-related injury research and prevention efforts. The Centers for Disease Control and Prevention (1) have specifically identified certified athletic trainers and their potential to contribute to this important area of research in their recently published Injury Research Agenda for 2009-2018. From a public health perspective, identifying factors associated with injury is one of the initial steps in the injury prevention process. The ultimate goal of this line of research is to identify populations that are at greatest risk for subsequent injury and to develop effective screening and intervention strategies to reduce the incidence and burden of injury. Therefore, the manner in which risk factors are conceptualized in initial research has significant bearing on the development of subsequent screening and intervention strategies. In the current issue of the Journal of Athletic Training, Reinking et al (2) examined the factors associated with exercise-related leg pain in high school cross-country athletes. Alter a discussion of modifiable and nonmodifiable risk factors, the authors conceptualized risk factors for exertional leg pain as intrinsic (within the body) or extrinsic (outside the body) factors; sports injury researchers have traditionally conceptualized risk factors associated with injury in this manner. (3,5) This study provides an opportunity to discuss how risk factors are conceptualized in the context of sports injury research. The seminal work by sports injury researchers such as van Mechelen et al (3) and Meeuwisse (5) provided a theoretic framework for sports injury research, and although these models have evolved since they were first described, (6-9) they have consistently characterized risk factors for injury as intrinsic factors and extrinsic factors. It is important to consider that injuries often result from the complex interaction of multiple factors (3,7,10) in a dynamically changing environment, (6) but the characterization of risk factors as intrinsic or extrinsic limits the clinical importance and usefulness of results in relation to future injury screening and prevention efforts. More importantly, characterizing risk factors in this manner provides limited insight into whether something can be done to intervene and mitigate the contributing influence of any given factor or combination of factors with regard to subsequent injury. (11) Injury epidemiologists and public health professionals, on the other hand, use a different approach to conceptualizing risk factors for disease or injury by focusing on those risk factors that are modifiable and those that are nonmodifiable.