Wearable accelerometry provides a convenient surrogate measure of lower limb loads, which in combination with the concept of a daily load stimulus, can provide insight into fatigue-related injuries in the field. Lower limb injuries are common in sport and have a mechanical aetiology, either via acute or chronic loading to musculoskeletal tissue. Cumulative loading influences the onset and severity of injuries such as fatigue fracture or tendinopathy but is difficult to measure in the field. A field-based, simple method to quantify and monitor mechanical loads using wearable sensors may be the first step in the prevention and management of lower limb musculoskeletal injury. Furthermore, the application of a load metric based on concepts of musculoskeletal mechanobiology should be integrated within the load measurement system to account for tissue adaptation. Musculoskeletal tissue is influenced by mechanical loads, such that the loads can either be positive, leading to enhanced structural integrity; or harmful, resulting in injuries or disease. The purpose of this paper is to review the influence of cumulative lower limb mechanical load on musculoskeletal tissue homeostasis and injury risk and examine appropriate methods to quantify cumulative lower limb load in the field. Using the data in this way, coaches may be able to decrease musculoskeletal tissue load based on changes in training and mechanics more effectively than with counts of tasks, speed, or distance alone. Additionally, regular monitoring using the proposed methods may be useful in evaluating limb symmetry and fatigue-related changes.
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