Injury prevention.

We are all encouraged to engage in sports and exercise. Therefore, we do not need to explain here the benefits of sports and exercise.Unfortunately, there are also disadvantages to sports. There is always a risk of injury. Ever seen an avid runner who is completely injury-free? Or a soccer team where there are no injuries at all in a running season? Wherever people play sports fanatically, people get injured.

We know that about 4.5 million people are injured each year as a result of their sports. That's a lot of injuries that are sometimes short-lived but can also last longer and affect your daily life or even your ability to perform your sport. Sports injuries can also come with a lot of costs. Not only the costs incurred by surgery, for example, but also consider costs incurred by work absences. Is there any way to prevent injuries and how does that work? We can never completely prevent injuries. However, we do know that certain factors contribute more to a higher risk of injury than others. We're going to go over these factors with you.

We are going to do this using a pyramid. With factors at the bottom that we cannot change and factors more at the top of the pyramid that we can change or improve. 

Intrinsic factors: 

Let's start with the intrinsic risk factors. These are factors that we cannot change such as: 

  • Age 
  • Gender 
  • Previous injury history
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Age 

As we age, we see that the risk of injury increases. Our flexibility, strength and fitness all decrease. These factors make us more likely to be injured. One example is the risk of falling. Complaints resulting from a fall is the biggest reason older people end up in the emergency room. When people fall at a younger age, strength, motor skills and agility are often still good enough to break the fall properly or catch yourself properly. Also, the risk of such things as a muscle injury is greater later in life. The strength to properly control and brake an explosive movement is less at a later age. 

 

Gender 

Regardless of how careful you are, we see that women have a higher risk of injury. This has to do with general strength but also anatomical variation between men and women. For example, an anatomical difference between men and women is the width of the pelvis. Because women have a wider pelvis, the angle between the knee joint and the pelvis is different, this puts the knee in a more vulnerable position for injuries to the knee, for example. This is why anterior cruciate ligament injuries are more common in younger women. Also we see that women generally have a little more slack on structures such as ligaments and capsules in the body. Another example is bone density. Women naturally have lesser bone density, especially later in life. The hormone estrogen which is partly responsible for maintaining bone mass decreases in later life. Despite the fact that women have a higher risk of injury, a well-structured training schedule can help reduce injury risk. 

Previous injury history:

The biggest risk factor for an injury, is an injury in history. This does involve the same anatomical structure. After an injury, we see that the load capacity of the area deteriorates significantly. Due to the sensitivity of the injury, we have less muscle strength and often choose a pain-avoiding strategy to move. Which is quite normal in the initial phase of an injury but which often persists unnecessarily for longer. An example is a hamstring injury in athletes. Within two months, 12-25% of those with a hamstring injury re-injure the same hamstring. Possibly due to inadequate rehabilitation or a persistent decrease in strength of the hamstring muscles. 

Physical factors 

Physical characteristics are always changeable to a greater or lesser extent. So you can do something about this yourself. These are factors such as: 

  • Force 
  • Range of motion 
  • Endurance/conditioning 

Injuries are not 100% preventable. But the more resilient you are to an injury the lower the risk of injury. Compare it to a bucket that slowly fills up. The bigger this bucket the bigger your buffer. Depending on your sport, mobility is also a factor that can potentially cause injury. If you do not have the range of motion to properly execute a serve in tennis then over time you will have to start forcing something in that area anyway. With regard to your fitness, we see that under fatigue a lot more injuries occur than when you start a practice or match fresh. 

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Sports Choice

The choice of sport and the motor skills involved greatly increase or decrease the risk of injury. We see a much higher injury risk in sports where there is a rapid change of direction, such as soccer, than when you train in the gym, for example. The predictability of the movements here compared to the unpredictability during ball sports ensures a much lower risk. Also, landing and applying force on one leg when sprinting and spinning creates a more vulnerable position of anatomical structures. Sports where you stand a lot on two legs gives a much lower risk of injury. 

Fatigue

We can distinguish here between acute fatigue and long-term fatigue. Acute fatigue means that at the end of a competition, for example, you may be tired and your movement control at that time is a lot less. This reduced control due to decrease in strength and coordination increases the risk of injury. We also see that fatigue in general carries a greater injury risk. This can often be prevented by listening to your body in time and taking rest in time by skipping a training session. 

Movement quality

Depending on the sport, the quality of movement is a greater or lesser risk factor for injury. This mainly has to do with being able to deliver control in movements with high speed or peak loads. The better you can control a movement the less technique or quality of movement will be a reason for an injury. This factor is at the very top of the pyramid and is the least important to injury prevention for the largest group of people. This is not to say that it is completely irrelevant! For a small group and especially elite athletes, it certainly contributes to reducing on injury. A professional football player who has to cut and turn at high speed or a high-level powerlifter who deadlifts at +300 pounds. Then quality of movement does play a big role. First of all, let's say you then have to move at the most favorable anatomical angles and positions for that particular skill. But technique or quality of movement is less relevant than the other factors. Think of it as a hierarchical model. When strength, conditioning or state of fatigue are not in order then the reason for your injury has often not been your technique. When this does get said, we see this especially a lot on social media this is very short-sighted and misleading. Often out of lack of knowledge of physiology, anatomy and the complexity of how injuries occur. Not to mention that there is no scientific agreement on what poor technique or quality of movement actually is. To a certain extent, it is personal preference. So-called experts or gurus telling you what is right or wrong, normal or abnormal, functional or dysfunctional is often something that depends on their personal preference. Just as someone may like a red sweater better than a blue sweater. This way of looking at things is far too simplistic.

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When we look at technique, we must consider differences between individuals. There are a lot of anatomical variations in length, width angles and positions of our bones and joints. For this reason, we do not all move the same way and have individual ways of moving. There are structures that are more changeable but also only to a certain extent. So trying to change these unchangeable structures can be very disappointing. Sometimes it is just not feasible to perform movements a certain way. For example, the way you squat is very person-dependent and has to do, among other things, with the innate position of the hips. So it's tricky when your coach or physical therapist wants to see it done differently because it's "better" in his or her eyes. 

Even when someone is in pain, a different pattern of movement is very normal. The body chooses the path of least resistance and there is nothing wrong with that! As time goes by we have to take a more critical look at this, especially when someone is afraid to move and thus maintains complaints. But in the first 10 days of back pain, for example, there is absolutely nothing wrong with pain avoidance behavior. 

In most cases, it is not the movement or technique that needs to be modified but the self-confidence and strength needed to make that movement properly. When people become stronger in a movement, the quality of movement often improves automatically. The positive experience and improvements in the motor system automatically produce better results. Without paying too much attention to technique. This is very difficult to really train. Just go run or sprint a different way. YOU OFTEN DON'T KNOW HOW. And once you do get the hang of it, you fall back into your old pattern from an automatism. So even if a certain exercise or movement does not yet look technically good, it is more important that you feel comfortable, have self-confidence and the strength to be able to do the movement. The rest goes by itself after that! 

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