Why do we have a musculoskeletal injury? - Beyond biomechanics

Musculoskeletal injuries remain a prevalent challenge in healthcare, yet our understanding of their root causes and optimal prevention strategies still needs to be completed. While biomechanical approaches are widely favored, focusing primarily on biomechanics may not sufficiently address injury prevention. This manuscript discusses the often-overlooked roles of fortuity and unknown, non-modifiable factors in injury occurrence. Additionally, it questions the efficacy of biomechanical interventions, which, despite their popularity among healthcare providers, may have limited applicability and durability in altering established motor patterns. It explores whether attempting to teach perfect movement patterns, especially in adults, is realistic or beneficial, and consider the risk of unintentionally shifting mechanical stress to other structures. In light of these limitations, we advocate for greater emphasis on training load control, which offers a systematic approach to balancing stress and capacity. Key concepts, such as supercompensation, functional reserve, and load periodization, provide a foundation for more pragmatic and potentially effective injury prevention strategies. It also calls attention to the need for updated medical training curricula that include these principles to equip providers with practical, non-surgical strategies for managing musculoskeletal injuries. This perspective offers a shift from purely biomechanical frameworks, proposing a broader view that includes physiological and psychological load management as integral to comprehensive injury prevention.