Author: Bas van Hooren
Journal: SPORTgericht (2026)

Dr. Bas van Hooren challenges the traditional distinction between acute and overuse injuries in sports. He argues that many injuries typically labeled as “acute” (such as hamstring tears or ACL ruptures) may in fact have an accumulated overload component, where repeated submaximal stresses gradually weaken tissues until failure occurs during an apparently normal movement.

Key concepts and mechanisms

1. Overuse Injuries Defined
2. Non-linear Relationship Between Load and Damage
3. Practical Impact on Training and Monitoring

Evidence for Overload Mechanisms in ‘Acute’ Injuries

• Hamstring injuries:
  • Often occur during normal sprint strides without unusual movement patterns.
  • MRI and modeling studies show progressive microstructural damage in the muscle–tendon junction before rupture — consistent with overuse rather than a single trauma.
• ACL injuries:
  • Repeated submaximal loads (e.g., hundreds of direction changes per match) can lead to microscopic fiber damage.
  • Tissue examinations of ruptured ligaments reveal fatigue-like patterns, supporting an overuse accumulation model rather than purely acute mechanical failure.

Monitoring Internal Loads

• Measuring external loads (e.g., ground reaction forces, sprints, jumps) gives a poor approximation of internal tissue stress.
• Advances in wearable sensors, AI, and musculoskeletal models make it possible to estimate internal loads and tissue damage (e.g., via instrumented insoles predicting load at common injury sites).
• However, current models lack personalization and clear data on recovery time, so practical application is still limited.

Practical takeaway for coaches and practitioners

Monitor intensity-driven tissue load more closely than just total volume, build up training load gradually (prioritizing duration before intensity), and use biomechanical insights to recognize and prevent overload — even in injuries that seem to happen “out of nowhere.”

Note: This summary was prepared with the assistance of Claude Opus AI, based on the original article. The goal is to share academic findings for coaches, talent developers, and support specialists.