If the same hamstring has gone twice, or one ankle keeps rolling, you are not imagining the pattern. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health, lists “having had a prior injury” among the risk factors for sports injuries (NIAMS, Sports Injuries). Researchers have measured how much a past injury raises the odds of the next one. Why it happens is less settled.
Below is what that research shows, what may drive repeat injuries, and what published guidance says about getting back to activity after one.
Please read first: This article is general information, not medical advice. It does not diagnose, assess or treat any injury or condition. If you have pain, swelling or an injury, talk with a physician or physical therapist about your own situation before you change your training.
Key Takeaways
– A 2017 review in the British Journal of Sports Medicine calls previous injury “a strong risk factor for recurrent lower limb injury” in athletes.
– An old injury can be linked to a different injury later, not only a repeat of the same one.
– Studies find changes in strength and movement after an injury, but how those changes lead to re-injury is still being studied.
– Published guidance treats the return to activity as a gradual process shared with your clinician.
Is a past injury really a risk factor for the next one?
Yes. In 2017, a systematic review and meta-analysis by Toohey and colleagues in the British Journal of Sports Medicine stated that “previous injury is a strong risk factor for recurrent lower limb injury in athletic populations” (PubMed). Studies of individual sports point the same way.
One example comes from elite football (soccer). In 2006, Hägglund, Waldén and Ekstrand reported on players followed across two seasons. Players who were injured in the first season had a hazard ratio of 2.7 for any injury the following season, compared with players who were not injured (PubMed). Players with a previous hamstring injury, groin injury or knee joint trauma were “two to three times more likely to suffer an identical injury in the following season.”
That study found no such link for ankle sprains, but ankle research tells a different story. The International Ankle Consortium’s 2016 consensus statement says “the majority of patients with a history of lateral ankle sprain will sustain at least one additional sprain” (British Journal of Sports Medicine). One caution applies to all of this: most of the data comes from athletes, much of it about lower-limb injuries, and it describes groups of people rather than any one person’s odds.
Can one injury make a different injury more likely?
It can, according to the same 2017 review. Across three studies, a previous ACL injury was associated with an increased risk of a later hamstring injury, with a relative risk of 2.25 (Toohey et al., PubMed). The review also linked an earlier lower-limb muscle injury to a later muscle injury at a different site, and linked concussion and a variety of joint injuries to a higher risk of a later lower-limb injury. Not every pairing held up: a history of chronic groin injury was not associated with a later hamstring injury.
A 2014 systematic review by Fulton and colleagues in the International Journal of Sports Physical Therapy found similar patterns (PubMed). It linked ACL injury to a repeat injury of the same ligament, and hamstring strain to later hamstring and knee injuries on the same side. An ankle sprain was associated with re-injury of either ankle, and a previous Achilles tendon rupture increased the risk of the same injury on the other leg.
Why do injuries keep coming back?
Researchers have candidate explanations but no settled answer. Fulton’s review reported that “post-injury changes were present in strength, proprioception, and kinematics, which may have led to overall changes in motor control and function.” Proprioception is your sense of where a joint is and how it is moving. Kinematics describes the movement itself. The same review is candid about the gap: “how these deficits correlate or lead to re-injury requires further exploration.”
Healing time is part of the picture. The American Academy of Orthopaedic Surgeons (AAOS) says that “once a muscle strain occurs, the muscle is vulnerable to reinjury” (OrthoInfo, Muscle Strains in the Thigh). For ankles, AAOS explains that you “may continue to sprain it if the ligaments do not have time to completely heal.” That can happen when people return to activity before the ankle has healed and been rehabilitated (OrthoInfo, Sprained Ankle).
How fast you build back up matters too. NIAMS lists “increasing your intensity of physical activity too quickly” as a risk factor for sports injuries. The 2016 Bern consensus statement on return to sport notes that “workload may be linked to reinjury,” and adds that psychological factors should be taken into account during rehabilitation and at the point of returning to sport (British Journal of Sports Medicine).
What does the research say about returning to activity?
It treats the return as a process rather than a single green light. The Bern consensus, led by Ardern and colleagues, says return to sport “should be viewed as a continuum, paralleled with recovery and rehabilitation” (PubMed). It describes three stages: “return to participation, return to sport and return to performance.”
The same statement says “the RTS decision should be shared among all stakeholders,” except where the athlete’s health is at risk. RTS stands for return to sport. It is also frank that “research evidence to support return to sport decisions in clinical practice is scarce.” Groin injuries show what is at stake. The consensus reports a recurrence rate of 15 to 25 percent after groin injury.
Some guidance is more concrete, though it describes what a clinician checks rather than a test to run on yourself. AAOS soccer injury prevention material says “an injured player’s symptoms must be completely gone before returning to play.” For a joint problem, it lists “no pain, no swelling, full range of motion, and normal strength” (OrthoInfo, Soccer Injury Prevention). NIAMS adds that a rehabilitation program planned by a physical therapist or physiatrist “can help you return to your previous level of activity and reduce the chance of reinjury” (NIAMS, Diagnosis, Treatment, and Steps to Take).
Why does getting an injury assessed matter?
Many injuries never get looked at. The International Ankle Consortium notes that “half of those who incur a lateral ankle sprain may never seek initial treatment,” and that recurrence rates after a sprain are high. It recommends a structured examination and describes a lateral ankle sprain as “a noteworthy musculoskeletal injury that warrants treatment by a trained healthcare professional.”
NIAMS is direct about pain: “You should not try to ‘work through’ the pain of an injury.” It also lists signs of a serious injury that call for a health care provider, such as severe pain, swelling or bruising, or being unable to put weight on the area. That list describes serious injuries. It is not a test for ruling yourself out. If an old injury is flaring up and you are not sure what it means, have it assessed.
Where does training fit after an injury?
Training fits inside whatever your clinician has advised. The HHS Physical Activity Guidelines for Americans, second edition, state that “people who have had a past injury are at risk of re-injuring that body part.” They add that the risk “can be reduced by performing appropriate amounts of activity and setting appropriate personal goals” (HHS, Physical Activity Guidelines for Americans). After a past overuse injury, the guidelines say “a person should increase activity more slowly the next time.”
For a coach, that means hearing the full injury history, working inside a clinician’s restrictions, and adding load in small steps. We cover the practical side in lifting safely with past injuries after 40, and the case for movement quality in why biomechanics matter more than reps.
You may also come across Muscle Activation Techniques (MAT). MAT describes itself as “a hands-on neuromuscular therapy focused on identifying and correcting muscle inhibition.” It says its process uses a “Comparative Assessment of Mobility” in which the practitioner “measures and compares movement” (Muscle Activation Techniques, For Clients). That is MAT’s own description, not a research finding, and this article makes no claim about MAT’s effect on injury risk.
Frequently Asked Questions
Why do I keep injuring the same spot?
A previous injury is itself a risk factor. A 2017 review in the British Journal of Sports Medicine called it “a strong risk factor for recurrent lower limb injury” in athletes. Studies also find changes in strength, proprioception and movement after an injury, though how those changes lead to re-injury is still being studied.
Can an old injury cause a different injury later?
Some studies find a link. A 2017 meta-analysis found that a previous ACL injury was associated with an increased risk of a later hamstring injury, with a relative risk of 2.25. It also linked concussion and a variety of joint injuries to a higher risk of a later lower-limb injury, though not every combination showed a link.
Should I train through pain from an old injury?
No. NIAMS says you should not try to “work through” the pain of an injury, and that you should stop right away when a movement or activity causes pain. A physician or physical therapist can tell you what the pain means in your case and what to do next.
Who decides when I am ready to return to full training?
The 2016 Bern consensus on return to sport says the decision “should be shared among all stakeholders,” except where the athlete’s health is at risk. In practice, your clinician’s guidance comes first and your training works inside it. The consensus also calls the research evidence behind these decisions scarce.
Training in Santa Monica after an injury
If you are in Santa Monica and want to talk about training after an injury, once your clinician has weighed in, you can reach Integrative Training Institute at 310.570.6352 or through the contact page. The studio is at 1358 Michigan Ave, Santa Monica, CA 90404. You can also read the Advanced Rehab Solutions page.
Sources
- NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases, Sports Injuries, retrieved 2026-10-08, https://www.niams.nih.gov/health-topics/sports-injuries
- NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases, Sports Injuries: Diagnosis, Treatment, and Steps to Take, retrieved 2026-10-08, https://www.niams.nih.gov/health-topics/sports-injuries/diagnosis-treatment-and-steps-to-take
- Toohey et al., Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis, British Journal of Sports Medicine, 2017, retrieved 2026-10-08, https://pubmed.ncbi.nlm.nih.gov/28784622/
- Hägglund, Waldén and Ekstrand, Previous injury as a risk factor for injury in elite football, British Journal of Sports Medicine, 2006, retrieved 2026-10-08, https://pubmed.ncbi.nlm.nih.gov/16855067/
- Fulton et al., Injury risk is altered by previous injury: a systematic review, International Journal of Sports Physical Therapy, 2014, retrieved 2026-10-08, https://pubmed.ncbi.nlm.nih.gov/25328821/
- Ardern et al., Consensus statement on return to sport (Bern), British Journal of Sports Medicine, 2016, retrieved 2026-10-08, https://pubmed.ncbi.nlm.nih.gov/27226389/ and https://bjsm.bmj.com/content/50/14/853
- Gribble et al., International Ankle Consortium consensus statement on lateral ankle sprains, British Journal of Sports Medicine, 2016, retrieved 2026-10-08, https://bjsm.bmj.com/content/50/24/1493
- US Department of Health and Human Services, Physical Activity Guidelines for Americans, 2nd edition, retrieved 2026-10-08, https://odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
- American Academy of Orthopaedic Surgeons, OrthoInfo: Muscle Strains in the Thigh, Sprained Ankle, and Soccer Injury Prevention, retrieved 2026-10-08, https://www.orthoinfo.org/
- Muscle Activation Techniques, For Clients, retrieved 2026-10-08, https://muscleactivation.com/for-clients/