Pillars of Sports Injury Prevention – Part 1

Over the last two decades sports injury prevention has become a hot topic, and justifiably so! Multi-million dollar pro athletes are too vital to a team’s performance, and income, to be on the sideline with injuries. The methods we’ve used to prevent sports injuries are vast and complex, ranging from core activation to functional movement screening to stretching to monitoring heart-rate variability to blood tests, and so on.

Unfortunately, much of what is emphasized in sports injury prevention lacks a lot of evidence supporting its effectiveness. In addition, sports injuries are often so complex and multifactorial that there is no way to identify a single “cause and effect” with these conditions.

In this two part series I will outline the six main pillars of reducing sports injuries and weight training injuries. These will vary in importance based on the individual, the sport, and the types of injuries we are trying to prevent.

But first, if you’d like to dive deeper into injury prevention, be sure to check out this fantastic Masterclass by Dr Travis Pollen on Injury prevention: theory into practice.

The many pillars here are symbolic of the many factors involved in sports injury cause and prevention. Certain things such as genetics, anatomy, previous injury and the nature of contact sports aren’t going to be addressed here, but this article will focus on the modifiable factors.

Pillar 1: Workload Management

Around 70-80% of the non-contact injuries I see are the result of poor workload management. The term “overuse injury” is commonly used – but a better choice is “training volume error” (props to Bang Fitness coach Geoff Girvitz for the term).

Overuse injury implies that the cure is rest. Many athletes will train, have an injury, rest and/or rehab, jump back into training without modifying the training volume, re-injure, and go through the same cycle. By contrast – training workload error implies that correcting the training workload is the way to fix the issue.

Workload management has become a hot topic over the course of the past decade, largely thanks to Tim Gabbett’s research (1). While we can debate the external validity of the Acute:Chronic Workload Ratio (ACWR) , I don’t think anyone can argue with the idea of methodically building up your training volume.

There are a million different ways to track volume. For the purposes of this article, and for people who don’t have access to all the fancy technology out there, I’m going to keep it simple:

Running – For running I like to simply track total weekly volume in either distance or time.

Sprinting – Tracking weekly distance also works well for sprinting but it doesn’t take into account the frequency of sprints and the distance per sprint. Four 25m sprints versus 10 x 10m sprints represent two completely different animals in terms of technique, acceleration & deceleration forces, and programming considerations. So as such I like to track the frequency of sprints and distance per sprint as well.

Weights – The most popular method is tonnage (sets x reps x weight). I like to look at that as well as the number of weekly sets performed on main movements (squat, bench, deadlift, snatch, clean & jerk – depending on the sport), and on assistance exercises. While people like to fixate on maximum recoverable volume (MRV) – it is very exercise specific. Doing 10 sets of single leg RDLs with a 30-40 lb dumbbell is apples & oranges different from 10 sets of rack pulls with 300-400 lbs.

The next question is – how do I progress volume?

Running – I like to stick to the 10% rule as a general guideline. This means that if you run 10km this week, you shouldn’t try to run more than 11km next week. This is a very general recommendation and some athletes, particularly ones at a high level or ones with recurring injuries may need to progress more slowly; while people with low weekly running volumes may be able to progress a bit faster than 10% per week (e.g. if you are only running 5km per week, going to 5.5km is a very small jump).

Side note – I’ve heard of runners tolerating insane levels of volume. The way they properly built up their volume, participated in a proper strength training program, and managed psychosocial factors and recovery were likely all major contributors to their success.

Sprinting – Same rule as for running – as long as the speed and quality of sprint technique don’t decline as a result. Quality over quantity. I’d rather keep the sprinting volume the same, or increase it at an even slower pace, to ensure proper technique and speed.

Weights – I use two different options here:

1) If it’s someone who’s coming off of an injury or a layoff, and is able to train pain-free again, I recommend basing your training on the main movements off of Prilepin’s Chart which I’ve written about in this article (2).

2) If it’s someone who is well-trained and isn’t going to get strong fast – I prefer increasing weekly sets performed by no more than 10% per week. As you increase sets you may need to initially decrease the weight you’re using as well.

Pillar 2: Psychosocial Factors

Psychosocial factors have become a hot topic with the rise in popularity of pain science and the biopsychosocial model of pain and disease. Research has shown that psychosocial factors can represent a major risk factor for sports injury (3).

But what are psychosocial factors? Psychosocial factors can include various psychological conditions such as anxiety, depression and PTSD, as well as social factors such as poor socioeconomic status, low education and poor (or excessive) family support.

These can vary as well based on the athlete. On one extreme there are athletes that are very Type A, competitive, hard driving and risk taking. On the other extreme there are athletes with high levels of depression and low mood in general.

It’s important to discuss and be aware of this as a coach as athletes, particularly younger ones, are currently under more pressure than ever thanks to social media. Kids are being made into YouTube sensations before they can even read and write.

Psychosocial factors can be measured by questionnaires such as the GAD-7 (for anxiety) (4), and the PHQ-9 (for depression and potential suicidal ideation) (5). However, in my experience, athletes and patients aren’t always open about these issues – especially to a potential stranger that they may have never worked with before.

It’s important to never 100% rule out these factors and to build a rapport with your athletes such that they feel comfortable opening up to you about their mental health. When I look at coaches like Coach Travis Mash or someone like Joe DeFranco – they’re not just coaches, they’re friends to their athletes. Never forget the importance of the coach-athlete relationship.

Now – chances are if you’re reading this you’re not a psychologist, psychiatrist or psychotherapist (and if you are thanks for reading). If you have an athlete you’re concerned about you owe it to them to refer out to the appropriate professionals. Educating patients about hurt versus harm, pain science education (if interested and applicable), and how to reintegrate into activity is all within our scope…. but treating someone’s PTSD or grief counselling someone who lost their kid is not. In our efforts to manage psychosocial factors it’s important to know the difference between these things.

In this article we’ve covered the first two key pillars of sports injury prevention. In the second part of this series we’ll cover the other four. Stay tuned and thanks for reading!