Sports Injury Prevention & Risk Mitigation
By Laura Graham, Physiotherapist
While all sports naturally carry a level of risk for injury, whether the sport is golf, pickle-ball or rugby, it does not mean that sports should be avoided, in fact the exact opposite. Understanding the benefits that engaging in both team and individual sports have on mental and physical growth and development, suggests that early integration into sports should be emphasized. Parallel to sport participation however should be sport injury prevention education, allowing a life-long participation in sport.
Injury prevention vs risk mitigation.
In a perfect world, injury prevention via pre-rehabilitation (rehabilitation training prior to injury) would occur with every athlete, and injuries would never occur. Unfortunately this isn’t the case. Despite increased efforts, ongoing research, changes in training schedules, intensity, and techniques, injury prevention is never a guarantee. Instead, the focus becomes on risk mitigation. Knowing that ACL (anterior cruciate ligament) injuries are most common in female soccer players does not in it self eliminate the risk of an ACL from injury occurring, and unfortunately, despite best efforts, nor does specific training eliminate the risk of an ACL injury from occurring. However, training specifically triggered to ACL injury prevention can substantially decrease the risk of this injury occurring.
Risk mitigation interventions efforts should occur early in the developing athlete, regardless of the sport. When first commencing a new activity or sport, the learning curve both mentally and physically is steep. Our bodies will naturally take the path of less demand, however this doesn’t always equate to the path of most stability. Motor learning occurs with repetition of the task in various environments or situations; thereby emphasizing the importance of practicing ideal movement patterns with the necessary supplemental external supports sooner rather than later.
Knowing the sport demands and the most common associated injuries is crucial as it allows training appropriately and specifically for said sport. The key however, is understanding that not every body is built identical, and that there are numerous both intrinsic and extrinsic factors to account for. Intrinsic factors are considered non-modifiable factors, such as age, sex, height, bone composition, and structural development. While extrinsic factors are often commonly referred to as modifiable factors, these are factors that we have the ability to change. By adjusting modifiable risk factors such as: strength, flexibility, training volume, training intensity, equipment, environment, and coaching techniques, the risk of injury occurrence in sports can be considerably minimized.
For example, consider the risk of occurrence of an ankle injury in a basketball game between John (a 17-year-old 5’8” male who plays a point guard position) and Tim (a 17-year-old 6’5” male who plays a post position). Both players have identical intrinsic factors in that they are both 17-year-old males. However, the intrinsic factor of height differs, likely creating a greater risk for Tim secondary to a recent growth spurt and possible lack of joint stability development. Extrinsically, Tim is at a much greater risk of attaining an ankle injury due to his position, which requires him to jump into a crowded area during both offensive and defensive plays, significantly increasing the risk of landing on uneven ground (i.e. a foot) and spraining his ankle. Being able to differentiate the risks creates the ability to mitigate the risk.
Overuse injury (i.e. Chronic injury)1,2
Repetitive training without adequate rest and recovery can substantially increase the risk of developing an overuse injury, defined as an injury due to a “constant level of physiological stress without sufficient recovery time”. Acute muscle injuries occur when a sudden load or force is applied to a tissue, greater than the tissues ability to sustain (i.e. macrotrauma); conversely chronic or overuse injuries occurs when repetitive sub-maximal forces are applied to a tissue over a prolonged period of time (i.e. microtrauma). The optimal rest and recovery time will vary for each individual, and is dependent on the training intensity and type of training they are engaging in. As a rule of thumb, try incorporating one rest day into each week of intensive training. This rest day is best when seen as an active recovery day – such as going for a short walk or a light bike ride. When engaging in sport-specific training, studies encourage a 2-3 month scheduled break away from direct competition or training.
General Risk Mitigation Techniques:
- Gradual active warm up prior to activity participation:
Engaging in a thorough warm up lasting 5-15 minutes allows a steady increase in tissue warmth and thereby extensibility (the ability for a tissue to stretch, similar to an elastic band), decreasing the risk for muscle or tendon sprains/strains. A sudden stretch of a “cold” muscle is at a much greater risk for injury. A gradual warm up also allows for a steady increase in cardiovascular activity. This includes an increase in blood flow, a change in blood pressure, and an increase in both breathing and heart rate.
- Light jog with gradual increase in speed
- Skipping on spot
- Dynamic stretching: arm circles, leg swings
- Adequate cool down following activity cessation:
When engaging in exercise, various chemicals are released throughout the body. Following exercise cessation, partaking in a gradual cool down (5-15 min) can aid with “flushing” these chemicals out of the body, and thereby assist with muscle recovery and a decreased risk of muscle soreness the following day.
- Light jog with gradual decrease in speed
- Light bike ride
- Progression from dynamic (with movement) to static (without movement) stretching
- Hydration and nutrition
Significant energy is expelled when engaging in sports. This energy is created from the breakdown of carbohydrates and fats – consider this equivalent to the gas in your car, running on empty won’t get you very far; therefore, it’s important to replenish this source following sport cessation, as well as have adequate fuel prior to engagement. Protein as well is key; as it promotes tissue healing and growth, consider this the oil in your engine that keeps everything running smoothly. Lastly hydration, during activity a substantial amount of fluid is lost from the body, especially on a hot day, emphasizing the need to replenish this source – to keep with the car analogies, consider hydration your transmission fluid, often overlooked but pretty crucial. General health guidelines suggest drinking approximately 2L of water per day – this is not including water lost during exercise.
- Sport specific training/exercises:
As elaborated on previously, certain sports carry specific injury risks. Training appropriately with these risks in mind help focus our training and decease injury occurrence. Focussed training may involve a combination of strengthening, balance, stretching, and agility. Often there is a component of a dominant muscle in each sport or activity, and whiles it’s important to train this muscle appropriately, it’s also crucial to consider the strength of the antagonist muscle group (i.e the muscle that does the opposite movement, example: biceps and triceps). In doing so, it promotes symmetry and balance throughout the body, and once again mitigates the risk of an instability or overuse injury.
- Properly fitted footwear or equipment
Approximately 90% of sports will require protective or playing equipment, or at least specific shoes. Making sure that the equipment is fit correctly for each individual will ensure optimal performance of equipment and once again, mitigate sports related injuries. This is a factor that is often overlooked in junior sports, as parents purchase equipment with plans of the child growing into it.
- Rest and recovery
As competition grows, athletes often neglect to integrate rest and recovery into their training schedules, increasing their risk of developing an overuse injury. As mentioned previously, try to incorporate at least 1 active recovery/rest day into a training week, as well as a 2-3 month training break during the “off season”. This does not mean a 2-3 month break away from exercise in general, but rather a break from intensive training and competition, and opportunity train alternative muscles groups that are neglected throughout the season.
As physiotherapists, we inherently will always encourage physical activity and sport participation at any which level or age, always with the careful consideration of safety and applicability. We can help to identify any areas of weakness or compensation patterns present, review the most likely areas of injury during work or play, and provide you with the necessary tools to train appropriately and thereby minimize the risk of said injuries from occurring.
- Paterno M, Taylor-Haas J, Myer G, Hewett T. Prevention of overuse sports injuries in the young athlete. Orthopaedic Clinics of North America. 2013;44;553-564
- Arnold A, Thigpen CA, Beattie PF, Kissenbert MJ, Shanley E. Overuse physeal injuries in youth athletes: risk factors, prevention, and treatment strategies. Sports Health. 2017;9:139-147.