Pillars of Sports Injury Prevention – Part 2
In my last article we went over the first two pillars of sports and weight training injury prevention – workload management and psychosocial factors. In this article we will cover the other four main pillars, providing you with a comprehensive approach to injury prevention.
Pillar 3: Strength Training
Arguably the most evidence-based method of sports injury prevention is through a proper strength and conditioning program (great article for physios on strength and conditioning here (1)). Research has shown the benefits of specific strengthening exercises on preventing specific injuries. Examples of these include the Nordic hamstring curl for hamstring injury prevention (2), and Copenhagen adduction exercise for groin strain prevention (3).
The way strength training should be programmed will depend on your athlete’s individual goals, physical demands, fitness, injury history and medical history; but I do recommend working with a good strength and conditioning coach who can design a proper program for your athlete’s to not only minimize their injury risk, but also maximize their performance.
Pillar 4: Movement Technique
Some would refer to this as movement quality – but that’s another complex topic for another time. While we can debate the role of biomechanics in pain until we’re blue in the face, I think we can all agree that it’s still an important factor to consider with respect to injury. Some common examples include dynamic knee valgus and ACL injuries (4), and inversion in lateral ankle sprains (5).
Research has shown injury prevention benefits to neuromuscular training with some injuries (4,5). Whether that’s due to specific biomechanical changes, or from just generally getting stronger, is debatable but it’s still important to consider.
Coaching and correcting movement technique is a topic that I intend to write about in far more detail in a separate article but some considerations include:
- Focus on coaching (and making your client aware of) the desired movement technique before automatically adding in a bunch of correctives. Some of the FMS research has shown that awareness of the scoring criteria automatically changes the way people move (6).
- Movement technique is variable and can be influenced significantly by a person’s structural anatomy.
- Motor learning has shown that skill development occurs best when spread out across multiple sessions and interspersed with other activities rather than doing large chunks of skill practice all at once (7).
- External focus of attention when coaching exercise technique has been shown to be better than internal focus (8). That said – if your clients aren’t understanding the external cueing that you give them you may need to resort to internal cueing.
Pillar 5: Avoiding Early Specialization
This pertains to the younger athletes. A lot of focus has been made in the research, media and sporting world on the benefits of playing multiple sports at an early age rather than specializing in one sport too early. The Soviet Union used this with their younger athletes and found improved performance and decreased injury rates in contrast to the early specialization model (9, 10).
This has a few shortcomings/limitations however. First – it can be difficult for parents to accommodate kids playing multiple sports from a time, resource and economic perspective. Also some sports, such as gymnastics, have athletes peaking at a young age. It’s also important to account for overall workload in athletes as too much too soon, even across different activities, can be problematic.
Bottom line though – don’t kill young athletes by having them play too much of one sport too soon.
Side note: my friend Travis Pollen takes a deeper dive into the topic in this article (11).
Pillar 6: Recovery Measures
This is the more simple, non-sexy stuff like making sure your nutrition is on point and getting enough good quality sleep.
Sleep hygiene is straightforward enough – it’s just a matter of doing it. Simple tips include:
- Going to bed and getting up at the same time every day
- Minimizing (if not eliminating) caffeine and alcohol consumption after the mid-afternoon
- If possible, waking up without an alarm clock
- Having a sleeping environment that’s cool, dark & quiet
- Only using your bed for sleep and sex
- Minimizing (if not eliminating) screen time within the last 1-2 hours of your day (12)
Beyond that it’s important to understand that many other factors can affect sleep such as psychosocial factors, and a condition that affects many larger athletes, sleep apnea. If following sleep hygiene isn’t giving your athletes the results you’re looking for then it may be worth looking at getting them to do a sleep study if they snore a lot, wake up tired, and/or are a bigger athlete who doesn’t have the luxury of leaning out for a sport.
What About Stretching and Footwear?
Stretching has been referenced by many as a key method in injury reduction. That said – the vast majority of research has shown that stretching before activity doesn’t reduce injury (except for maybe muscle strains) (13) and may actually impede performance. A small body of research on runners, sprinters and jumpers has suggested that tighter athletes may actually be better performers (14,15). This isn’t to say that mobility work doesn’t have a place, but that it needs to be thought of more critically than generically stretching before and after every session.
In the running world, shoes are a popular way people attempt to reduce injuries with the premise that fitting the running shoe to the person’s foot or strike type will prevent injuries. However – a series of papers in the military showed that customizing shoes to people’s foot types didn’t affect injury rates (16-18). My advice to people when picking shoes, and also with orthotics, is to try them with walking and (if possible) running to find something that’s comfortable, and to take the time to slowly get used to wearing them.
Sports injury prevention is a hot topic – and as long as sports exist there will be injuries. But working on the factors outlined in this article and the last one can help mitigate the risks associated with playing sport.
Want to master injury prevention?
Dr Travis Pollen has done a Masterclass lecture series for us on:
“Injury prevention: theory into practice”
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- van Dyk, N., Behan, F.P., Whiteley, R. (2019). Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British Journal of Sports Medicine, 53, 1362-1370.
- Harøy, J., Clarsen, B., Wiger, E.G., et al. (2019). The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. British Journal of Sports Medicine, 53, 150-157.
- Hewett, T. E., & Bates, N. A. (2017). Preventive Biomechanics: A Paradigm Shift With a Translational Approach to Injury Prevention. The American Journal of Sports Medicine, 45(11), 2654–2664.
- de Vasconcelos, G. S., Cini, A., Sbruzzi, G., & Lima, C. S. (2018). Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis. Clinical Rehabilitation, 32(12), 1581–1590.
- Frost, D., Beach, T., Callaghan, J., McGill, S. (2013). FMS™ scores change with performers’ knowledge of the grading criteria – Are general whole-body movement screens capturing “dysfunction”?, Journal of Strength and Conditioning Research, Volume Publish Ahead of Print.
- Kwon, Y.H., Kwon, J.W., Lee, M.H. (2015). Effectiveness of motor sequential learning according to practice schedules in healthy adults; distributed practice versus massed practice. The Journal Of Physical Therapy Science, 27(3), 769-772. doi: 10.1589/jpts.27.769. Epub 2015 Mar 31. PMID: 25931727; PMCID: PMC4395711.
- Winkelman, N. (2018). Attentional Focus and Cueing for Speed Development. Strength and Conditioning Journal, 40(1), 13-25 doi: 10.1519/SSC.0000000000000266
- Myer, G.D., Jayanthi, N., DiFiori, J.P., Faigenbaum, A.D., Kiefer, A.W., Logerstedt, D., Micheli, L.J. (2016). Sports Specialization, Part II: Alternative Solutions to Early Sport Specialization in Youth Athletes. Sports Health, 8(1), 65-73. doi: 10.1177/1941738115614811.
- Simpson, N.S., Gibbs, E.L., Matheson, G.O. (2017). Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scandinavian Journal of Medicine & Science in Sports, 27(3), 266-274. doi: 10.1111/sms.12703.
- Lauersen, J.B., Bertelsen, D.M., Andersen, L.B. (2014). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48(11), 871-877.
- Pruyn, E.C., Watsford, M., Murphy, A. (2014). The relationship between lower-body stiffness and dynamic performance. Applied Physiology, Nutrition, and Metabolism, 39(10), 1144-1150.
- Baxter, C., McNaughton, L.R., Sparks, A., Norton, L., Bentley, D. (2017). Impact of stretching on the performance and injury risk of long-distance runners. Research in Sports Medicine, 25(1), 78-90.
- Knapik, J.J., Brosch, L.C., Venuto, M., Swedler, D.I., Bullock, S.H., Gaines, L.S., Murphy, R.J., Tchandja, J., Jones, B.H. (2010). Effect on injuries of assigning shoes based on foot shape in air force basic training. American Journal of Preventive Medicine, 38(1 Suppl), S197-211.
- Knapik, J.J., Trone, D.W., Swedler, D.I., Villasenor, A., Bullock, S.H., Schmied, E., Bockelman, T., Han, P., Jones, B.H. (2010). Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. American Journal of Sports Medicine, 38(9), 1759-1767.
- Knapik, J.J., Swedler, D.I., Grier, T.L., Hauret, K.G., Bullock, S.H., Williams, K.W., Darakjy, S.S., Lester, M.E., Tobler, S.K., Jones, B.H. (2009). Injury reduction effectiveness of selecting running shoes based on plantar shape. Journal of Strength and Conditioning Research, 23(3), 685-697.
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