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Developing a Fundamental Theoretical Definition for Athletic Injury

Logical Reasoning, Boundary Testing, and the Importance of Necessary and Sufficient Conditions

##article.authors##

  • Judd Kalkhoven Western Sydney University

DOI:

https://doi.org/10.51224/SRXIV.474

Keywords:

Athletic Injury, Definition, Necessity and sufficiency, Logic, Predictability, Mathematisation

Abstract

The lack of a conceptually robust and logically coherent theoretical definition of athletic injury is problematic in sports science and medicine, as such a definition provides an essential framework for scientifically studying this concept. Existing definitions are overly vague and lack logical coherence, failing to provide sufficient frameworks for the development of more precise understandings, operationalisations and identifications of athletic injury, which undermines the critical scientific principles of predictability, falsifiability, and reproducibility. Furthermore, related concepts that are often integrated into various operational definitions of athletic injury, such as pain and participation in sports, are commonly conflated as fundamental criteria. To address these concerns, this article proposes a new theoretical definition of athletic injury, developed through a systematic process of logical reasoning. This approach employs well-established tools such as thought experiments, boundary tests, and logical arguments to test for logical consistency and coherence in existing definitions, and to establish a set of necessary and sufficient conditions for an athletic injury to occur. Through this process, commonly conflated concepts are disentangled, and the development of a more refined conceptualisation and definition of athletic injury is achieved, capturing its fundamental essence as "Tissue damage and loss of physical function during sports participation, resulting from rapid or repetitive transfer of kinetic energy, that is not a normal part of the physical training and positive adaptation process, but exceeds the threshold of mechanical and physiological tolerance. This is dependent upon the nature and degree of tissue damage sustained." By introducing a demarcating threshold of tissue damage and loss of physical function to distinguish athletic injury from non-injury, this definition aligns athletic injury more closely to the definitions of injury proposed by the World Health Organization and International Classification of Diseases. Furthermore, by grounding athletic injury in objectively measurable physical parameters that can be appropriately mathematised for inclusion in mathematical models, and that also function within a mathematically unified physics-based framework, the predictability, falsifiability, and reproducibility of athletic injury research can be enhanced. Altogether, this transforms athletic injury from a vague concept, subject to inconsistent interpretations and applications i.e., bias, into a mathematical object with well-defined semantics and well-founded logic, guiding the formation of more precise, ideally tissue-specific, operational definitions of athletic injury. Over time, this will aid in the development of objective measurement tools that can more accurately assess and distinguish athletic injuries from non-injuries, supporting scientific advancements in the identification, measurement and prediction of athletic injuries.

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References

Noyes FR, Lindenfeld TN, Marshall MT. What determines an athletic injury (definition)? Who determines an injury (occurrence)? The American journal of sports medicine. 1988;16(1_suppl):S-65-S-8.

Fuller C. Injury definitions. Sports injury research. 2010:43-53.

Goldberg AS, Moroz L, Smith A, Ganley T. Injury surveillance in young athletes: a clinician’s guide to sports injury literature. Sports medicine. 2007;37:265-78.

Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, et al. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). Br J Sports Med. 2020 Apr;54(7):372-89.

Kalkhoven JT. Athletic Injury Research: Frameworks, Models and the Need for Causal Knowledge. Sports Med. 2024 May;54(5):1121-37.

Popper K. The logic of scientific discovery: Routledge; 2005.

Kuhn TS. The structure of scientific revolutions: University of Chicago press Chicago; 1997.

Lakatos I. Falsification and the methodology of scientific research programmes. Philosophy, Science, and History: Routledge; 2014. p. 89-94.

Fried EI. Theories and models: What they are, what they are for, and what they are about. Psychological Inquiry. 2020;31(4):336-44.

Suppe F. The structure of scientific theories: University of Illinois Press Urbana; 1977.

Ekstrand J, Bengtsson H, Walden M, Davison M, Khan KM, Hagglund M. Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men's professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22. Br J Sports Med. 2022 Dec 6;57(5):292-8.

Mayhew L, Johnson, M. I., Francis, P., Lutter, C., Alali, A., & Jones, G. Incidence of injury in adult elite women’s football: A systematic review and meta-analysis [Supplementary material]. BMJ Open Sport & Exercise Medicine. 2021;7(3):e001094.

Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scand J Med Sci Sports. 2006 Apr;16(2):83-92.

Ekstrand J, Spreco A, Bengtsson H, Bahr R. Injury rates decreased in men's professional football: an 18-year prospective cohort study of almost 12 000 injuries sustained during 1.8 million hours of play. Br J Sports Med. 2021 Oct;55(19):1084-91.

World Health Organisation. Injuries. (n.d.) [cited October 11, 2024]; Available from: https://www.who.int/westernpacific/health-topics/injuries

World Health Organization. International Classification of Diseases (ICD-11), injury definition. 2024 [cited 2024 October 14]; Available from: https://icd.who.int/browse/2024-01/mms/en#435227771

Hoegh M, Purcell C, Møller M, Wilson F, O’Sullivan K. Not All Pain in Sports Is Caused by Tissue Damage. What Are the Implications for Managing Pain? Journal of Orthopaedic & Sports Physical Therapy. 2024;54(11):1-14.

Aristotle A, Aristotle. Metaphysics: Harvard University Press Cambridge, MA; 1933.

Striker G. Aristotle's prior analytics book I: translated with an Introduction and commentary: Oxford University Press; 2009.

Kripke S. Naming and necessity. Harvard University Press; 1980.

Frege G. Begriffsschrift, a formula language, modeled upon that of arithmetic, for pure thought. From Frege to Gödel: A source book in mathematical logic. 1879;1931:1-82.

Plantinga A. The nature of necessity: Clarendon press; 1978.

Key L, Noble BP. An analysis of Ferdinand de Saussure's Course in general linguistics: Macat Library; 2017.

Peirce CS. Collected papers of charles sanders peirce: Harvard University Press; 1974.

Quine WVO. Word and object: MIT press; 2013.

Frege G. On sense and reference. na; 1892.

Tarski A. The semantic conception of truth: and the foundations of semantics. Philosophy and phenomenological research. 1944;4(3):341-76.

Kemeny JG. WV Quine. Two dogmas of empiricism. The philosophical review, vol. 60 (1951), pp. 20–43. The Journal of Symbolic Logic. 1952;17(4):281-3.

Nozick R. Philosophical Explanations: Cambridge University Press; 1981.

Tarski A. The concept of truth in formalized languages. 1956.

Bridgman P. The Logic of Modern Physics. Beaufort Brooks. 1927.

Cronbach LJ, Meehl PE. Construct validity in psychological tests. Psychological bulletin. 1955;52(4):281.

Zachar P, Stoyanov DS, Aragona M, Jablensky A. Alternative perspectives on psychiatric validation: OUP Oxford; 2014.

Centers for Disease Control and Prevention. Sources and definitions: Injury. n.d. [cited; Available from: https://www.cdc.gov/nchs/hus/sources-definitions/injury.htm#:~:text=The%20International%20Classification%20of%20External,at%20rates%20that%20exceed%20the

Kent M. Injury. In: Kent M, editor. The Oxford Dictionary of Sports Science & Medicine. 3rd ed. ed. Oxford, UK.: Oxford University Press.; 2006.

Cambridge Dictionary. Injury. Cambridge Dictionary,; (n.d.).

Okasha S. Philosophy of Science: Very Short Introduction: Oxford University Press; 2016.

Mill JS. A system of logic. Arguing About Science: Routledge; 2012. p. 243-67.

Toulmin SE. The uses of argument: Cambridge university press; 2003.

Hempel CG. Aspects of scientific explanation, and other essays in the philosophy of science. New York,: Free Press; 1965.

Hume D. A treatise of human nature: Oxford University Press; 2000.

Frege G. Grundgesetze der Arithmetik: begriffsschriftlich abgeleitet: H. Pohle; 1893.

McKeon R. The basic works of Aristotle: Modern Library; 2009.

Russell B. The philosophy of logical atomism: Routledge; 2009.

Holyoak KJ, Morrison RG. The Oxford handbook of thinking and reasoning: Oxford University Press; 2012.

Lewis D. Counterfactuals: John Wiley & Sons; 2013.

Davidson D. Inquiries into Truth and Interpretation: Philosophical Essays Volume 2: Clarendon Press; 2001.

Salmon WC. Four decades of scientific explanation: University of Pittsburgh press; 2006.

Hume D. An enquiry concerning human understanding. Seven masterpieces of philosophy: Routledge; 2016. p. 183-276.

Putnam H. The meaning of" meaning". 1975.

Mach E. The science of mechanics: A critical and historical exposition of its principles: Open court publishing Company; 1893.

Beecher HK. Pain in men wounded in battle. Annals of surgery. 1946;123(1):96-105.

Melzack R, Wall PD, Steptoe A, Wardle J. Pain mechanisms: a new theory. Psychosocial processes and health: A reader. 1994;150:112.

Butler RK, Finn DP. Stress-induced analgesia. Progress in neurobiology. 2009;88(3):184-202.

Oxford University Press. Illogical. Oxford English Dictionary; (n.d.).

Oxford University Press. Symptom. Oxford English Dictionary; (n.d.).

Loeser JD, Melzack R. Pain: an overview. The lancet. 1999;353(9164):1607-9.

Racine M, Tousignant-Laflamme Y, Kloda LA, Dion D, Dupuis G, Choinière M. A systematic literature review of 10 years of research on sex/gender and pain perception–part 2: do biopsychosocial factors alter pain sensitivity differently in women and men? Pain. 2012;153(3):619-35.

Tesarz J, Schuster AK, Hartmann M, Gerhardt A, Eich W. Pain perception in athletes compared to normally active controls: a systematic review with meta-analysis. Pain. 2012;153(6):1253-62.

Hainline B, Turner JA, Caneiro J, Stewart M, Moseley GL. Pain in elite athletes—neurophysiological, biomechanical and psychosocial considerations: a narrative review. British Journal of Sports Medicine. 2017;51(17):1259-64.

Hamilton G, Meeuwisse W, Emery CA, Shrier I. Examining the effect of the injury definition on risk factor analysis in circus artists. Scandinavian journal of medicine & science in sports. 2012;22(3):330-4.

Hagberg M, Christiani D, Courtney TK, Halperin W, Leamon TB, Smith TJ. Conceptual and definitional issues in occupational injury epidemiology. American journal of industrial medicine. 1997;32(2):106-15.

Langley J, Brenner R. What is an injury? Injury Prevention. 2004;10(2):69-71.

Norton R, Kobusingye O. Injuries. New England Journal of Medicine. 2013;368(18):1723-30.

Petridou ET, Antonopoulos CN. Injury epidemiology. 2017.

World Health Organization. Injury surveillance guidelines: World Health Organization; 2001.

Zitnay JL, Jung GS, Lin AH, Qin Z, Li Y, Yu SM, et al. Accumulation of collagen molecular unfolding is the mechanism of cyclic fatigue damage and failure in collagenous tissues. Sci Adv. 2020 Aug;6(35):eaba2795.

Carter DR, Caler WE. A cumulative damage model for bone fracture. J Orthop Res. 1985;3(1):84-90.

Carter DR, Caler WE, Spengler DM, Frankel VH. Fatigue behavior of adult cortical bone: the influence of mean strain and strain range. Acta Orthop Scand. 1981 Oct;52(5):481-90.

Gallagher S, Heberger JR. Examining the interaction of force and repetition on musculoskeletal disorder risk: a systematic literature review. Hum Factors. 2013 Feb;55(1):108-24.

Gallagher S, Schall MC, Jr. Musculoskeletal disorders as a fatigue failure process: evidence, implications and research needs. Ergonomics. 2017 Feb;60(2):255-69.

Herman BC, Cardoso L, Majeska RJ, Jepsen KJ, Schaffler MB. Activation of bone remodeling after fatigue: differential response to linear microcracks and diffuse damage. Bone. 2010 Oct;47(4):766-72.

Fung DT, Wang VM, Laudier DM, Shine JH, Basta-Pljakic J, Jepsen KJ, et al. Subrupture tendon fatigue damage. J Orthop Res. 2009 Feb;27(2):264-73.

Nagelli CV, Hooke A, Quirk N, De Padilla CL, Hewett TE, van Griensven M, et al. Mechanical and strain behaviour of human Achilles tendon during in vitro testing to failure. Eur Cell Mater. 2022 Apr 21;43:153-61.

Tidball JG, Salem G, Zernicke R. Site and mechanical conditions for failure of skeletal muscle in experimental strain injuries. Journal of applied physiology. 1993;74(3):1280-6.

Friden J, Lieber RL. Structural and mechanical basis of exercise-induced muscle injury. Med Sci Sports Exerc. 1992 May;24(5):521-30.

Tran DT, Tsai L. Eccentric contraction response of stimulated skeletal muscle fascicle at the various strain rates and stimulation timing. Meccanica. 2024:1-14.

Kalkhoven JT, Watsford M, Impellizzeri F. A conceptual model and detailed framework for stress-related, strain-related, and overuse athletic injury. 2019.

Kalkhoven JT, Watsford ML, Coutts AJ, Edwards WB, Impellizzeri FM. Training Load and Injury: Causal Pathways and Future Directions. Sports Med. 2021 Jun;51(6):1137-50.

Nosaka K, Newton M. Concentric or eccentric training effect on eccentric exercise-induced muscle damage. Med Sci Sports Exerc. 2002 Jan;34(1):63-9.

Higashihara A, Nakagawa K, Inami T, Fukano M, Iizuka S, Maemichi T, et al. Regional differences in hamstring muscle damage after a marathon. PLoS One. 2020;15(6):e0234401.

Carmona G, Moreno-Simonet L, Cosio PL, Astrella A, Fernández D, Cadefau JA, et al. Hamstrings on focus: Are 72 hours sufficient for recovery after a football (soccer) match? A multidisciplinary approach based on hamstring injury risk factors and histology. Journal of Sports Sciences. 2024;42(12):1130-46.

Edwards WB. Modeling overuse injuries in sport as a mechanical fatigue phenomenon. Exerc Sport Sci Rev. 2018 Oct;46(4):224-31.

Burr DB, Martin RB, Schaffler MB, Radin EL. Bone remodeling in response to in vivo fatigue microdamage. J Biomech. 1985;18(3):189-200.

Chamay A, Tschantz P. Mechanical influences in bone remodeling. Experimental research on Wolff's law. J Biomech. 1972 Mar;5(2):173-80.

Schoenfeld BJ. Does exercise-induced muscle damage play a role in skeletal muscle hypertrophy? J Strength Cond Res. 2012 May;26(5):1441-53.

McHugh PT, T. Muscle strain injury vs muscle damage: Two mutually exclusive clinical entities. Transl Sports Med. 2019;0(0):1-7.

McHugh MP. Recent advances in the understanding of the repeated bout effect: the protective effect against muscle damage from a single bout of eccentric exercise. Scandinavian journal of medicine & science in sports. 2003;13(2):88-97.

Damas F, Libardi CA, Ugrinowitsch C. The development of skeletal muscle hypertrophy through resistance training: the role of muscle damage and muscle protein synthesis. European journal of applied physiology. 2018;118(3):485-500.

Frost HM. Wolff's Law and bone's structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod. 1994;64(3):175-88.

Frost HM. A 2003 update of bone physiology and Wolff's Law for clinicians. Angle Orthod. 2004 Feb;74(1):3-15.

Osipov B, Emami AJ, Christiansen BA. Systemic bone loss after fracture. Clinical Reviews in Bone and Mineral Metabolism. 2018;16:116-30.

Miner MA. Cumulative damage in fatigue. J Appl Mech. 1945;67:A159-64.

Ju J. Isotropic and anisotropic damage variables in continuum damage mechanics. Journal of Engineering Mechanics. 1990;116(12):2764-70.

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