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Injury Prevention

Like most athletes, you undoubtedly want to reduce or eliminate your chances of injury while participating in your sport. Injuries decrease the amount of time you can spend in leisure activities, lower your fitness and impact competitive performance. Sports scientists suggest that injury rates could be reduced by 25% if athletes took appropriate preventative action.

Common Misconceptions

Coaches and athletes believe that males have higher injury rates than females - male and female athletes have about the same injury rate per hour of training.

Among runners it is considered that training speed is the cause of injuries (Speed Kills) but research indicates that there is no link between speed and injury risk.

Do not overdo it

The amount of training you carry out plays a key role in determining your real injury risk. Studies have shown that your best direct injury predictor may be the amount of training you completed last month. Fatigued muscles do a poor job of protecting their associated connective tissues, increasing the risk of damage to bone, cartilage, tendons and ligaments. If you are a runner, the link between training quantity and injury means that the total mileage is an excellent indicator of your injury risk. The more miles you accrue per week, the higher the chances of injury. One recent investigation found a marked upswing in injury risk above 40 miles of running per week.

The two best predictors of injury

If you have been injured before then you are much more likely to get hurt than an athlete who has been injury free. Regular exercises have a way of uncovering the weak areas of the body. If you have knees that are put under heavy stress, because of your unique biomechanics during exercises, your knees are likely to hurt when you engage in your sport for a prolonged time. After recovery, you re-establish your desired training load without modification to your biomechanics then your knees are likely to be injured again.

The second predictor of injury is probably the number of consecutive days of training you carry out each week. Scientific studies strongly suggest that reducing the number of consecutive days of training can lower the risk of injury. Recovery time reduces injury rates by giving muscles and connective tissues an opportunity to restore and repair themselves between work-outs.

Psychological factors

Some studies have shown that athletes who are aggressive, tense, and compulsive have a higher risk of injury than their relaxed peers do. Tension may make muscles and tendons tighter, increasing the risk that they will be harmed during workouts.

Weak muscles

Many injuries are caused by weak muscles which simply are not ready to handle the specific demands of your sport. This is why people who start a running program for the first time often do well for a few weeks but then as they add the mileage on, suddenly develop foot or ankle problems, hamstring soreness or perhaps lower back pain. Their bodies simply are not strong enough to cope with the demands of the increased training load. For this reason, it is always wise to couple resistance training with regular training. Weak or inhibited gluteal muscles can be the cause of lower back and lower limb injuries.

Muscle imbalance

Kemp (2000)[4] identified that screening for muscle imbalances is the current cutting edge of injury prevention. The rationale behind this is that there are detectable and correctable abnormalities of muscle strength and length that are fundamental to the development of almost all musculoskeletal pain and dysfunction. Detection of these abnormalities and correction before injury has occurred should be part of any injury prevention strategy. Assessment of muscle strength and balance and regular sports massage can be beneficial in this strategy.

Muscle Stiffness

Muscle stiffness refers to the ratio between the change in muscle resistance and the change in muscle length. Muscle stiffness is directly related to muscle injury risk and so it is important to reduce muscle stiffness as part of a warm up.

Research work by McNair (2000)[5] and Knudson (2001)[6] has indicated that only dynamic stretches - slow controlled movements through the full range of motion - decrease muscle stiffness. Static exercises did not decrease muscle stiffness.

This suggests that dynamic stretches are the most appropriate exercises for warming up and not static stretching exercises. Static stretches are perhaps more appropriate for the cool down as they help to relax the muscles and increase their range of movement. For further information see the following articles:

Trigger Points

A "trigger point" (TP) is a thick knot in a muscle that is palpable and tender (even painful to the touch).

Larsen (2002)[3] identified that trigger points can be caused by: training errors, inadequate preparation, worn shoes or equipment, poor biomechanics, muscle fatigue, poor flexibility, nutritional factors (vitamin deficiency), psychological factors (lack of sleep, stress).

Treatment of a TP (separating the fibres of the muscle knot) can be achieved by applying direct pressure to the point for 10 to 20 seconds, gradually releasing the pressure and repeating the process 4 of 5 times. The amount of pressure, which will depend on the sensitivity of the TP, can be applied by using one or both thumbs.

A number of treatments may be required but as the sensitivity (pain) of the TP reduces it will become harder to find. If after a couple of treatments the pain does not reduce then you should seek medical advice. Alternative approach to treating a TP is sports massage where petrissage, friction and effleurage techniques can be used to help breakdown the TP.

Trigger points are an early warning to a potential serious injury so checking for TPs is very beneficial. A regular massage is well worth is as the therapists, when conducting a massage, can check for TPs and treat them.

Problem in the Fascia chain?

Fascia is continuous uninterrupted, three-dimensional web of tissue that extends from head to toe, from front to back, from interior to exterior and an injury in one location may be due to a problem elsewhere in the fascia chain e.g. low back pain may be due to tight quads - tight quads cause the hip flexors to tighten, pulling the spine down and forwards resulting in low back pain. So working on the quads may alleviate the low back pain.

These connected muscles make up a fascia chain and Chew (2008)[9] explains how his Ming Method uses the plasticity of fascia to elongate tight, contracted areas in a fascia chain to relieve the pain they cause.

The "Q" angle

The "Q" angle is the angle between the line of pull of the quadriceps muscles on the knee and the line of pull of the patellar tendon.

The "Q" angle is greater in women as the hips are set wider apart.

A large "Q" angle may cause the kneecap to deviate from its normal pathway on the end of the thigh bone. This may result in a dislocation of the kneecap if, whilst bending it, an external force pushes the knee inwards.

Q angle

Make it specific

Resistance training can fortify muscles and make them less susceptible to damage, especially if the strength building exercises involve movements that are similar to those associated with the sport. Time should be devoted to developing the muscle groups with strength training as appropriate to the demands of the sport. If you are a thrower then lots of time should be spent developing muscles at the front of the shoulder that increases the force with which you can throw, but you must also work systematically on the muscles at the back of the shoulder which control and stabilise the shoulder joint.

Injury prevention tips

Tulloh (1995)[1] and Anderson (1995)[2] identified the following tips to help an athlete avoid injury:

  1. Avoid training when you are tired
  2. Increase your consumption of carbohydrate during periods of heavy training
  3. Increase in training should be matched with increases in resting
  4. Any increase in training load should be preceded by an increase in strengthening
  5. Treat even seemingly minor injuries very carefully to prevent them becoming a big problem
  6. If you experience pain when training STOP your training session immediately
  7. Never train hard if you are stiff from the previous effort
  8. Pay attention to hydration and nutrition
  9. Use appropriate training surfaces
  10. Check training and competition areas are clear of hazards
  11. Check equipment is appropriate and safe to use
  12. Introduce new activities very gradually
  13. Allow lots of time for warming up and cooling off
  14. Check over training and competition courses beforehand
  15. Train on different surfaces, using the right footwear
  16. Shower and change immediately after the cool down
  17. Aim for maximum comfort when travelling
  18. Stay away from infectious areas when training or competing very hard
  19. Be extremely fussy about hygiene in hot weather
  20. Monitor daily for signs of fatigue, if in doubt ease off.
  21. Have regular sports massage

Coaches

The key is rapid action when the injury first appears and a lot of psychological support to back up the remedial treatment. Educate yourself and your athletes in the art of Cryotherapy. It is when things are not going well that the athlete really needs their coach. It is important for the coach to have an alternative training program to help the athlete through the injury recovery period.

Our Genes may indicate liability to injury

Our genes control our biological systems such as muscle, cartilage and bone formation, muscle energy production, lactic acid removal, blood and tissue oxygenation. Research by Kambouris (2011)[7] identified that variations in the DNA sequence of these genes have an impact on an individual's vulnerability to sports injury, components of fitness (endurance, speed, strength etc.) and nutritional requirements.

Mauffulli & Merzesh (2007)[8] found that mutations in collagen called COL5A1 led to the structure that supports the tendon being more loosely connected, making the tendon less stable and perhaps more susceptible to injury.

Referenced Material

  1. TULLOH, B. (1995) Here are 10 practical guidelines that will help an athlete avoid getting injured. Peak Performance, 55, p. 5-7
  2. ANDERSON, O. (1995) How Likely are you to get hurt, and what steps can you take to reduce the risks? Peak Performance, 55, p. 1-3
  3. LARSEN, U. (2002) A trigger point in a muscle is a warning sign of a possible serious injury. Peak Performance, 165, p. 1-6
  4. KEMP, S. (2000) Why detecting muscle imbalance is an essential part of an injury prevention strategy. Peak Performance, 128, p. 4-6
  5. MCNAIR, P.J. et al. (2000) Stretching at the ankle joint: viscoelastic responses to holds and continuous passive motion. Medicine & Science in Sport and Exercise, 33 (3), p. 354-358
  6. KNUDSON, D et al. (2001) Acute Effects of Stretching Are Not Evident in the Kinematics of the Vertical Jump, Journal of Strength & Conditioning Research, 15(1), p. 98-101
  7. KAMBOURIS, M. (2011) Predictive genomics profiling in athletics and sports performance. Br J Sports Med, 45 (2), lecture 27
  8. MAUFFULLI, N & MERZESH, M. (2007) Genetic aspects of tendinopathy. Journal of Science and Medicine in Sport, 11 (3), p. 243-247
  9. CHEW, M. (2008) The Permanent Pain Cure. USA; McGraw Hill Publishers

Page Reference

The reference for this page is:

  • MACKENZIE, B. (1997) Injury Prevention [WWW] Available from: http://www.brianmac.co.uk/injury.htm [Accessed

Associated Pages

The following Sports Coach pages should be read in conjunction with this page:

Sports Injury Clinic