The Myth of Injury Prevention
When I left university I made a pretty bold statement: I would be able to develop physical preparation programmes for the athletes I worked with that would prevent all injuries. I was newly qualified and thought my shit didn’t stink. I believed in a couple of years, all physiotherapists and surgeons would be out of a job because my athletes would have zero injuries.
If injury prevention works, why are footballers constantly tweaking their hamstrings? [Photo credit: Pixabay]
The problem with my bold claim was I went to work with international gymnasts and soon discovered that injuries came with the territory. When you hang upside down on a set of rings in an inverted cross, your shoulders go really up against it. Do it day after day, year after year for fifteen years and guess what - your shoulders are knackered.
Injury prevention is a term borrowed from public health, and it’s a very poor one to use when working with athletes of any level. That’s why I'm calling bullshit on all the fitness specialists and rehabilitation experts who believe they can ‘prevent’ sport and training-related injuries.
Injury is Always Possible
They can’t prevent injuries, because if you train and take part in sport at any level there will always be a very real possibility you will pick up an injury.
If you still don’t believe me, I challenge you to pick an injury, any injury, and then look at all of the injury ‘prevention’ programmes that are out there. There are tonnes to choose from. If these injury ‘prevention’ programmes all worked we wouldn’t have any football players constantly pulling up with hamstring injuries. But hamstring injuries have increased by 4% annually in men's professional football, since 2001.1
In the same way, ACL ruptures in netball would be a thing of the past. But according to national data from Australia, knee injuries are the most common injury sustained by netballers and netball often ranks in the top five sports in Australia for incidents of ACL injuries.2 Patellar tendinopathy would no longer sideline athletes who jump a lot, but we know that the highest prevalence of patellar tendinopathy (14.4%) in recreational athletes is in volleyball players.3 If we’re all so good at injury prevention, even CrossFit competitors would be bouncing around injury free.
It's Time For a Reality Check
Let’s start being realistic and talk about injury reduction. You may shout at me that that’s just semantics or feel that I’m quibbling over terminology, but the reason I have a bee in my bonnet is because when you tell athletes, coaches, and parents that you can prevent an injury, you’re setting everyone up for a fall.
We need to have a reality check. The best we can do is reduce injury risk by establishing effective physical preparation programmes that improve robustness and resilience. If we get this right, we will in turn develop athletes capable of withstanding the demands placed upon their body during training and competition. If we do a really good job, the athlete will come to the end of their career without any serious injuries.
Even so, the reality remains that if an athlete's played football, rugby, tennis, golf, or even tiddlywinks for long enough, they’re probably going to pick up an injury. We can’t prevent that. What we can do is reduce the associated risk, occurrence, and severity of injuries. It’s a subtle difference, but an important one.
1. Jan Ekstrand, Mark Walden and Martin Hagglund “Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study.” British Journal of Sports Medicine 50 (2015) 744-750
2. Aliza Rudavsky and Jill Cook “Physiotherapy management of patellar tendinopathy (jumper's knee).” Journal of Physiotherapy 60 (2014) 122–129
3. Max Stuelcken, Daniel Mellifont, Adam Gorman and Mark Sayers “Mechanisms of anterior cruciate ligament injuries in elite women’s netball: a systematic video analysis.” Journal of Sport Sciences 34 (16) (2016) 1516-1522