Systematic Review
Overuse-Related Injuries of the Musculoskeletal System:
Systematic Review and Quantitative Synthesis of Injuries,
Locations, Risk Factors and Assessment Techniques
Amaranta Orejel Bustos
1
, Valeria Belluscio
1
, Valentina Camomilla
1
, Leandro Lucangeli
1
, Francesco Rizzo
2
,
Tommaso Sciarra
2
, Francesco Martelli
3
and Claudia Giacomozzi
3,
*
Citation: Orejel Bustos, A.; Belluscio,
V.; Camomilla, V.; Lucangeli, L.;
Rizzo, F.; Sciarra, T.; Martelli, F.;
Giacomozzi, C. Overuse-Related
Injuries of the Musculoskeletal
System: Systematic Review and
Quantitative Synthesis of Injuries,
Locations, Risk Factors and
Assessment Techniques. Sensors 2021,
21, 2438. https://doi.org/
10.3390/s21072438
Academic Editor: Yvonne Tran
Received: 15 February 2021
Accepted: 30 March 2021
Published: 1 April 2021
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1
Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES),
Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
amaranta.orejel@gmail.com (A.O.B.); valeria.belluscio@gmail.com (V.B.);
valentina.camomilla@uniroma4.it (V.C.); l.lucangeli@studenti.uniroma4.it (L.L.)
2
Joint Veterans Defence Center, Army Medical Center, 00184 Rome, Italy; francesco.rizzo@tim.it (F.R.);
tommaso.sciarra@esercito.difesa.it (T.S.)
3
Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of
Health, 00161 Rome, Italy; francesco.martelli@iss.it
* Correspondence: claudia.giacomozzi@iss.it; Tel.: +39-06-49902864
Abstract:
Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in
preseason conditioning, and military populations; they may also occur, however, when pathological
or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load,
even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment
and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature
was conducted to support the development of a transportable toolkit (instrumentation, protocols
and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury.
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was
used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The
search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in
association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers
were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers
derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were
classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever
possible, quantitative syntheses were carried out with respect to the literature review process and
quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors,
assessment techniques and assessment protocols.
Keywords:
musculoskeletal injury; mechanical overload; stress fracture; muscle fatigue; functional
assessment; risk factors; assessment instrumentation; assessment protocol
1. Introduction
Overuse-related injuries, hereby grouped as stress fractures of the bones [
1
–
3
], stress
injuries of the musculoskeletal system [
4
–
6
], and muscle fatigue due to mechanical over-
load [
7
], occur when the involved structures fail to adapt to increased mechanical stress
resulting from an actual increase in the magnitude of the applied load, an unsustainable
number of repetitive loads, abrupt changes in load administration, deterioration of muscu-
loskeletal condition, or a combination of the above [
8
,
9
]. Overuse-related injuries mostly
affect athletes [
7
,
10
], particularly endurance athletes, athletes involved in preseason con-
ditioning [
11
], and military populations [
4
,
5
,
8
,
9
,
11
–
16
]. In the army context specifically,
most injuries occur during basic training of new recruits and in special training contexts
Sensors 2021, 21, 2438. https://doi.org/10.3390/s21072438 https://www.mdpi.com/journal/sensors
