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Regular physical activity reduces the risk of premature mortality in general and coronary heart disease, hypertension, colon cancer, obesity and diabetes mellitus in particular. 1, 2 However, sports participation also entails a considerable risk of injury for elite, as well as recreational, athletes. Studies from Scandinavia document that sports injuries constitute 10-19% of all acute injuries treated in the emergency room, 3, 4 and the most common injury types are knee and ankle injuries.
Serious knee injuries, such as those to the anterior cruciate ligament (ACL), are a growing cause for concern. 5, 6 The highest incidence is seen in adolescents playing pivoting sports such as football, basketball, and team handball, and the incidence is 3-5 times higher in women than men. 7, 8 These injuries can have serious consequences for the injured athlete, in terms of not only treatment costs and time lost from sport, but also a greatly increased risk of early osteoarthrosis. 9 After 10 years, approximately half of all patients display radiological signs of osteoarthrosis, and it is expected that nearly all patients will suffer from osteoarthrosis after 15-20 years, regardless of treatment choice. 9 Recent years have seen an increased interest in research into sports injury prevention, not only related to ACL injuries in pivoting sports, but at least partly spurred on by the concern over ACL injuries in female athletes. In fact, recent studies show that it may be possible to reduce the incidence of knee and ankle injuries in adults 10- 12 and adolescents, 13, 14 by using various training programmes. However, the prevention programmes tested are multifaceted and address many aspects that could be related to the risk of injury (agility, balance, strength, awareness of vulnerable knee and ankle positions, playing technique). It is not known which programme component is the key ingredient in preventing knee and ankle injuries or how they work. At least in part, our ability to target and improve current prevention programmes is limited by an incomplete understanding of the causes of injuries. The purpose of this review is to examine current models used to describe the aetiology of sports injuries and to develop a more comprehensive approach to understanding injury causation.
THE SEQUENCE OF PREVENTION: THE EPIDEMIOLOGICAL PERSPECTIVE
Injury prevention research has...