The #1 Reason for Injuries We See in Clinic
Injury screen at North Naples CrossFit during 2026 CrossFit Games Open
As rehab doctors we like to get into the why behind people’s pain and injuries. The easy and obvious injuries are the ones with a “mechanism of injury” - think stepping off a curb and rolling your ankle because you were on your phone scrolling Instagram. This mechanism of injury is straight forward, not paying attention led to your misstep off curb and subsequent rolling of the ankle.
However, this specific mechanism is not the most common thing we see. So what is it? Training errors. Training errors are a result of doing more than what your body or specific tissue (like a knee or shoulder) can handle at the current time. Training errors can be very obvious like you decided to run a half marathon on a whim when you had never run more than a mile before in your life, but often are far more subtle. They can look like doing more volume, increased intensity, faster speeds, changing your terrain from flat roads to hills, or adding more weight to the bar.
A good rule of thumb for increasing your training is to aim for a 10-15% increase in volume, speed, OR load per week (choose one). This allows for gradual progressive loading that is considered the safe zone! This helps us to monitor large spikes in training which can help manage injuries in training.
We can monitor this increase in volume using the Acute to Chronic (A:C) workload ratio. This is a ratio of how much work has been done in the last 7 days compared to the workload done in the last 28 days.
Most of our research in A:C workload can be applied to things like strength training, running mileage or number of pitches in baseball.
So how do you monitor your A:C workload? Here’s an easy example using running mileage:
Week 1: 16mi
Week 2: 16mi
Week 3: 19mi
Week 4: 21mi
Chronic workload average = 18 mi
Acute workload = 21 mi
You will divide your acute workload by your chronic workload (21/18) and get your A:C.
A:C workload in the above example = 1.16
Here are some target workload ratio numbers based on research:
< 0.80 = undertrained and higher relative injury risk
.80 - 1.30 = Optimal workload “The Sweet Spot”
> 1.50 = “the danger zone” highest relative risk
It's important to recognize when things are training errors because these are things we can modify temporarily and work to prepare better for (aka, get stronger for).
Here’s the thing most people don’t realize, you can’t see training errors on an Xray or MRI. So you can have an incidental finding on an image at your doctor’s office that could lead to unnecessary surgery if they don’t ask you questions about recent changes in training or even recent time away from training.
We could go down an entire rabbit hole of imaging findings (and we will on another day!) But the important thing is, we help people work through training errors without surgery, injections or taking time away from the things they love!
