Take Home Messages:
- Injuries are complex and the result of interplay between many different factors.
- Some of these factors are internal (related to the person participating) and some of these are external (occurring outside of the person playing the sport).
- Further, some factors are considered non-modifiable (age, previous injury) while others are considered modifiable (health, fitness, skills).
- If you are concerned about sports injuries, or have experienced a previous injury and want to reduce the risk of re-injury, a strategy focusing on modifiable risk factors such as undertaking a regular exercise program to address health, fitness, and skill-related risk factors could be beneficial.
SPORTS INJURY RISK
Local sport is back! (And hopefully without any further interruptions this year…..)
It’s great to see everybody getting active, spending time with friends and family, and enjoying all of the things that sport has to offer. Especially after the lack of opportunities for consistent sport over the past 2 years.
Unfortunately, sometimes with sport comes injuries. The Australian Institute of Health and Welfare reports that in 2016-17 almost 60,00 people required hospital treatment for sports injuries (AIHW, 2020), and a study published in 2015 suggests that in Victoria alone around 20,000-26,000 people per year required hospital treatment for sports injuries between 2004 and 2010 (Finch et al., 2015).
This is a significant number of people, and these injuries come at not just a financial cost, but potentially lost time at work, studying, participating in social activities and of course, time out of sport. Needless to say, any efforts which could potentially reduce the incidence or burden of sports injuries would be beneficial.
For the purpose of this article, there are broadly two areas which could be addressed to reduce the impact of sports injuries:
- Prevention of injuries, or perhaps more accurately: potential reduction of risk for injury severity/occurrence.
- Treatment of injuries, if they occur.
“An ounce of prevention is worth a pound of cure”
-
Benjamin Franklin
These areas could be broken down further into:
- Prevention of injuries
- Understanding rates of injury occurrence
- Identifying factors associated with injury (risk factors)
- Implementing programs to address risk factors (injury prevention programs)
- Re-evaluate injury rates to determine program effectiveness
- Treatment of injuries
- Acute/Sub-Acute treatment of injuries (First Aid, Medical Care)
- Rehabilitation post injury (Returning to Play/Function)
- Prevention (or reduction of risk…) of future injuries/re-injury
This blog post will cover 1b. of the above list: identifying risk factors for sports injury, and includes material from this references listed at the end of this article. If, rather than identifying risk you’re looking for advice on managing an injury that has already occurred, read this blog.
| KEY POINT #1: To develop an effective program to reduce injury risk, or to understand how injuries might occur, it’s a good start to identify the factors which could contribute to an injury occurring. |
Risk factors are considered to be information relevant to why an injury occurred. They are not necessarily directly responsible for an injury occurring (causative factor), or the way in which an injury actually happens (injury mechanism), but they are considered to contribute in some way to the development of an injury. This could be shown by statistical association (correlation), or hypothesised due to a particular physical or biological explanation (mechanistic reasoning), and are typically reported as a ratio (eg: people with “Y risk factor” are 2x more likely to experience “Z injury”) or a percentage (eg: 25% of people with “injury B” also had associated “factor C”).
It has been suggested that once risk factors are identified, they could then be sub-grouped into internal and external risk factors. That is, factors which could be attributed to the person playing the sport (internal risk factors), and factors which occur outside of the person playing the sport (external risk factors).
These factors include:
Internal risk factors
- Age
- Sex
- Biological factors (EG: body composition)
- Health
- Fitness
- Skill Level
- Psychological factors (motivation, risk-taking behaviour, etc)
External risk factors
- Sports factors (coaching, rules, referees, etc)
- Protective equipment use/non-use
- Sports equipment (racquets, balls, etc)
- Environment (weather, surface conditions, etc)
| KEY POINT #2: Each different sports activity will involve a different amount of risk associated to different Internal and External factors. Some of these factors will have little to NO association to injury in some sports, while other factors may be VERY associated with injury. |
So, due to this mix of factors, not everybody’s injury risk is equal.
Therefore, each individual will require a different combination of injury prevention strategies to address their own particular risk factors depending on the mix of risk factors relevant to them.
| KEY POINT #3: Even though some factors will be associated with a particular injury in a particular sport (For example, Hamstring strains in Australian Rules Football could be associated with high speed running loads and decreased hamstring strength), this will not be the case for every INDIVIDUAL person as their own mix of internal and external factors will be different (I.E: a player with poor hamstring strength may not experience hamstring injury due to other factors). |
Further, some risk factors are considered non-modifiable, while others are considered modifiable.
Example Modifiable Risk Factors
- Some Biological factors (body composition)
- Health & Fitness
- Skill Level
- Training Load
Example Non-Modifiable Risk Factors
- Age
- Genetic Predisposition
- Previous injury
- Weather / surface conditions
- Opponent behaviour
| Key Point #4: Not every risk factor is modifiable, and some people will experience injury at a higher or lower rate than others due to many differing factors. However, some risk factors are modifiable, and many of them can be addressed by good training and exercise practices. |
While non-modifiable risk factors can’t be changed, it could still be beneficial for you to address some modifiable risk factors in order to reduce your injury risk. One of the best ways to address multiple risk factors is by undertaking a regular exercise program.
Regular exercise can generally improve health related risk-factors both mentally and physically, and targeted exercise programs can be beneficial for fitness and skill-related risk factors. Some common examples (although sometimes controversial) of specific risk-reduction programs: the nordic hamstring curl, sprinting and other hip/knee exercises in reducing hamstring strains (Oakley, Jennings & Bishop, 2018), or the Fifa11+ program in reducing football-related injuries (Barengo et al., 2014).
By creating a comprehensive exercise or physical preparation program that includes regular, progressive exercise and addresses specific risk factors for injury you may be able to reduce your risk of injury or re-injury related to sports activities.
Another very important consideration: is returning to regular training and competition, especially after a prolonged period of reduced sport participation, whether due to illness, injury, government mandates, or just time out from sport. Without a gradual return, or consideration for physical preparation prior to commencing sport, you may be at a higher risk of injury.
This higher risk of injury is often attributed to the rate at which you are exposed to the physical loading related to sports activities, or to fluctuations (“spikes”) in your training/competition exposure (Windt & Gabbett, 2017). You can read more about this by clicking article link, or here.
| Key Point #5: Fluctuations in training andcompetition load, as well as exposure to higher amounts of sport activity than you are used to in a short period of time are associated with increased injury risk. To offset this risk, it is important to build and maintain consistent training habits, starting with pre-season and continuing on into the competition period. |
Given these associations, it’s important to train consistently in the pre-season period, and to maintain those good training habits once the season starts.
Better still, it may be a good idea for you to dip your toe in before the season starts to build up your body’s exposure to loading. Grab some friends and go for a kick on the weekend, see if there’s a free court on a weeknight to shoot on with your family, even just get out for a run or find your way back into the gym.
Why not go today?
To summarise:
If your goal is to prevent or reduce the likelihood of sports injury (or re-injury) it is best to understand which risk factors are relevant to your sport, and to you individually, and focus on factors which are in your control like maintaining good training habits and performing a regular exercise program to address modifiable health, fitness, and skill-related risk factors.
If you aren’t sure which risk factors could be relevant to you, you have experienced a sports injury, or you need help to develop an exercise program for yourself or your team to address physical preparation or injury rehabilitation, there are some great online references here and part 2 here, or Contact us on 1300 9 HILLS, book online.
References:
Australian Institute of Health and Welfare. (2020). Hospitalised sports injury in Australia, 2016–17. Canberra: AIHW.
Bahr, R., & Krosshaug, T. (2005). Understanding injury mechanisms: a key component of preventing injuries in sport. British journal of sports medicine, 39(6), 324-329.
Barengo, N. C., Meneses-Echávez, J. F., Ramírez-Vélez, R., Cohen, D. D., Tovar, G., & Bautista, J. E. C. (2014). The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review. International journal of environmental research and public health, 11(11), 11986-12000.
Finch, C. F., Kemp, J. L., & Clapperton, A. J. (2015). The incidence and burden of hospital-treated sports-related injury in people aged 15+ years in Victoria, Australia, 2004–2010: a future epidemic of osteoarthritis?. Osteoarthritis and cartilage, 23(7), 1138-1143.
Oakley, A. J., Jennings, J., & Bishop, C. J. (2018). Holistic hamstring health: not just the Nordic hamstring exercise. British journal of sports medicine, 52(13), 816-817.
Windt, J., & Gabbett, T. J. (2017). How do training and competition workloads relate to injury? The workload—injury aetiology model. British Journal of Sports Medicine, 51(5), 428-435.