In early 2024 we were invited by our friends at ClubSport Stirling to present a webinar on the topic of Injury Prevention and the vital role of physiotherapy in this field to club organisers. This is a very wide and constantly developing topic, so no shock the presentation ran on for about an hour. So let’s see if we can distil that down and highlight the main points.
First off is the brief matter of definition, “Injury Prevention” is ultimately impossible and instead our goal is to actively try to assess and reduce relative risk of future injury occurrence/recurrence.
Now we look at what factors, that we can control, increase our injury risk.
Risk
The biggest risk factor to injury is history of previous injury, highlighting the importance of Physiotherapy to:
Whilst further important factors influencing risk include:
Warm Up
An effective warm up prepares the body for exercise by slowly raising pulse levels, warming tissues and promoting mobility.
It should involve dynamic stretches with a short cardio session to bring the heart rate to anywhere around 65% MHR (Maximum Heart Rate).
Dynamic stretches are relatively constant motions where the position is not held but the joint is taken through its full movement ranges.
Warm-ups should mimic the motion and forces of the activity planning to be done – so the actual content of a warm-up can start fairly generic, but should also have a component closely mirroring the type of movement patterns you are about to undergo with your sport/activity. So if you are prepping for leg day at the gym, alongside some dynamic leg swings – you should also be doing some bodyweight squats and lunges if that’s what you have planned to do in your workout.
Cool Down
Done at the very end of each session in order to bring the heart rate back to resting levels, by doing any low intensity exercise. Again, the content and length of a cooldown should equate somewhat to the activity and duration of exercise you have just completed.
Cooldowns may also include static stretches in order to help reduce DOMS (Delayed Onset Muscle Soreness).
Static stretches involving positioning a muscle where it is on stretch for 10 – 30 seconds, doing so for each muscle group 1 – 4 times.
Case: FIFA 11+ Structured Warm Up Routine
For an example of a structured warm-up that has seen significant results in reducing injury occurrence (in this case ACL ruptures), we can look at the “FIFA 11+”.
The FIFA 11+ warm-up program reduced the risk of injury in football players by 30%.
However, the FIFA 11+ programme alone is not an effective enough teaching tool as injury prevention knowledge did not significantly change through completion of the programme. This is where the need for the guidance of trained physiotherapists became paramount.
There are a great many factors to consider in your training that impacts injury risk, all of which the team at ESP Physio take into account with our patients on a daily basis. Let’s briefly cover some of them.
Exercise Principles & Programming
Note: The best injury prevention programme is the one that will be adhered to. Simply put, your programme needs to not only effective but also realistic and actually fun to do! Which is why it is crucial your programme is personalised and tailored to you.
However, the most effective injury prevention programmes are known to include:
And not:
This effective programming is known as ‘neuromuscular training’.
This is not to say that stretching is bad, just that is less important than the other 3 components based on evidence.
Now if you’re not sure what the scientific evidence advises an exercise programme should look like prescription-wise (e.g. sets, reps etc), here’s a quick and easy guide.
ACSM (American College of Sports Medicine) outline four trainable characteristics of muscular fitness: –
| Strength | Power | Local Muscular Endurance | Hypertrophy | |
| Intensity | 80 – 100% 1RM | 30 – 60% 1RM | <70% 1RM | 70 – 100% 1RM |
| Reps / Sets | 1 – 8 / 2 – 6 | 3 – 6 / 1 – 3 | 10 – 25 / 2 – 4 | 1 – 12 / 3 – 6 |
(Key: ‘1RM’ stands for ‘1 Rep Maximum’, meaning the weight you would be using is the described percentage of your theoretical maximum you could do one rep of an exercise on – you do not need to physically find out your one rep max, it can either be calculated in different ways or just guessed based on feel)
ACSM provides very generalised guidelines to exercise which can be adapted to fit personal preferences. All four aspects of muscular fitness are trained regardless of programme chosen. Recommended: 8 – 10 reps on low weight exercises / 6 – 8 reps on high weight exercises / 3 – 4 sets.
Overload
For fitness and ability to improve the workout must provide progressive overload which allows for the positive adaptations to neuromuscular and physiological elements as well as body composition.
Using the FITT principle (Frequency, Intensity, Time, Type) gives multiple options as to how to progress exercises, increase the value of just one of the four components at a time.
If the difficulty of exercises is too low, the body will not adapt. However, overload must be progressed slowly as the body will not improve either if the difficulty level is too high. Always maintain good form for all exercises, if form worsens lower the difficulty.
Eccentric Training
An eccentric (lengthening) muscle contraction occurs when a force applied to the muscle exceeds the momentary force produced by the muscle itself, resulting in the forced lengthening of the muscle-tendon system while contracting.
In simple terms, it refers to a muscles lengthening phase of movement whilst under load. Injuries such as hamstring strains most commonly occur in this lengthened phase. Training eccentrics builds resilience towards these ‘risky’ movements. The ‘Nordic Hamstring Curl’ is perhaps the most frequently mentioned example of an eccentric-focussed exercise.
In one large-scale study, teams using injury prevention programs that included the Nordic Hamstring curl exercise reduced hamstring injury rates up to 51 % in the long term compared with the teams that did not use any injury prevention measures.
Remember, prevention is better than treatment! You don’t need to be currently injured to benefit from physiotherapy. The team at ESP Physio are well versed in working with those of all athletic abilities and backgrounds, and we very frequently see those who have recently started a new fitness endeavour and are needing some tailored advice and programme tweaking to keep things going.
You can book yourself in for a physiotherapy appointment with us here or if you prefer to speak to someone, call us at 01324 227 370 or drop us an email at info@espphysio.com and we will get you going in no time!
Written by Adam Gilmartin BSc (Hons), MSc, MCSP, MHCPC
