Injury Risk Theory, Modeling, & Intervention
Injury risk is an extremely important component of sport and subsequently, the practices of strength and conditioning. This component deserves—requires—a high level of attention and active management. Perhaps counterintuitively, the application of strength and conditioning methodologies can sometimes prioritize the management of injury risk even over performance enhancement. This is because an athlete that is strong, powerful, and fast is of no use when they are significantly injured and absent from competition. An athlete’s performance can go from 100% to 0% very quickly if injury risk is not managed properly. Therefore, this area should never be overlooked when the aim is improved sport performance and athletic development.
A needs analysis is always required and can be conducted to ascertain relative likelihood of specific types of injuries. A needs analysis considers profiles of both the athlete as well as his/her sport. An athlete’s profile may consist of key performance indicators, strength ratios, range of motion deficits, and previous injury history. This should be combined with a sport-specific profile. There is an abundance of published peer-reviewed data on the injury profiles of virtually all sports. For instance, we know that striking and overhead sports such as baseball and tennis have higher occurrences of injuries to shoulders and elbows. We know that highly multidirectional sports such as soccer, football, and basketball have higher occurrences of injuries to knees and ankles. We know that hockey players have a greater susceptibility for hip-related injuries. We also know that sports that require high-speed sprinting are more likely to have hamstring, groin, and hip flexor strains. We truly have a tremendous amount of data that should inform our training decisions to better manage an athlete’s injury risk so that we can keep them healthy and actively competing.
If we are to manage injury risk, we must understand the fundamental mechanisms of injury (non-contact injuries). Foundationally, injuries occur due to external forces exceeding internal tissue capacities. This can be a problem in and of itself or it can be exacerbated by other factors such as inappropriate workloads, dysfunctional loading strategies, dysfunctional joint mechanics, and/or poor recovery. External forces can exceed internal tissue capacities in several ways:
1. The musculotendinous unit can lack adequate levels of strength. Muscle and connective tissues should have a surplus of capacity which consists of—at least—high levels of strength, adequate muscle lengths, and stiff connective tissues. This requires effective implementation of highly precise training protocols to ensure these adaptations are achieved to defend against potential injury.
2. Acute workloads can exceed chronic workloads. A high ACWR (acute:chronic workload ratio) can dramatically increase injury risk. Increasing workloads should always be managed and should be titrated incrementally and progressively by a coach. Sudden spikes to the ACWR are large contributors to injury and should be avoided whenever possible.
3. Load-distribution strategies can be dysfunctional. This is a neuromusculoskeletal issue that involves the nervous system’s contribution to proper/safe biomechanics. Poor mechanics and loading strategies can unnecessarily magnify internal forces and subsequently lead to injury. Highly informed training interventions need to be employed that consider various aspects of the nervous system in addition to the muscular system.
4. Dysfunctional joint mechanics can lead to “overuse” injuries. A maladapted neuromusculoskeletal system can lead to compromised arthrokinematics (the way joint surfaces interface with each other). This change in joint biomechanics requires training interventions that consider range of motion deficits and strength ratios to ensure that the nervous system has a balanced muscular system at its command.
These are all mechanistic underpinnings of preventable sport-related injuries. This does not include contact-related injuries as they introduce a greater degree of unpredictable randomness and cannot be as thoroughly controlled. The above listed components can be managed through informed and intelligent program design by a qualified strength and conditioning coach. Athletes need sport-specific preparation that entails progressive exposures to some combination of high forces and high velocities. These must be muscle- and contraction-specific as well as joint- and action-specific. Lastly, specific weaknesses need to be evaluated to identify potential red flags that act as indicators of potential injury risk. These discovered weaknesses must be rectified with the appropriate training interventions.
Takeaway Points:
>The management of injury risk is at least as important as direct sport performance and should never be overlooked. Stay healthy and keep competing.
> There is an abundance of scientific, peer-reviewed data on sport-specific injuries. A needs analysis specific to the athlete and sport must be conducted to properly implement the correct training interventions for decreasing injury risk.
>Fundamentally, non-contact-related injuries come from external loads exceeding internal tissue tolerance/capacity—this can be exacerbated by several known manageable metrics. All of which require management.
>A qualified coach is responsible for implementing the best evidence-based practices to assure comprehensive development. This includes training adaptations induced by multi-directional exposures to high forces and high velocities. Weak links are a big red flag and need to be evaluated and remedied.