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Injury prevention

We are all encouraged to play sports and exercise. We don't have to explain the benefits of sports and exercise here.Unfortunately, there are also disadvantages to sports. There is always a risk of injury. Ever seen a fanatical runner who is completely injury free? Or a soccer team with no injuries at all in a current season? Wherever people exercise fanatically, people get injured. We know that every year about 4.5 million people get injured as a result of their sport. That's a lot of injuries that can sometimes be short-lived but can also last longer and can affect your daily life or even the ability to perform your sport. Sports injuries can also involve a lot of costs. Not only the costs incurred by surgery, for example, but also costs due to work absences. Is there a 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 are 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 more at the top of the pyramid factors 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 injuries in history
Bjorge Janssen - @bstrongbybjorge

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 due to a fall is the biggest reason older people end up in the emergency room. When people fall at a younger age, their strength, motor skills and agility are often still good enough to break the fall properly or to be able to catch yourself properly. The risk of, for example, a muscle injury is also greater at a later age. The strength to control and slow down 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, which 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 like ligaments and capsules in the body. Another example is bone density. Women naturally have a lower bone density, especially in later 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 the risk of injury. 

Previous injuries in history:
The biggest risk factor for an injury, is an injury in the past. This does involve the same anatomical structure. After an injury, we see that the load capacity of the area deteriorates significantly. Because of the sensitivity of the injury, we have less muscle power and often choose a pain-avoidance strategy to move. This is quite normal in the first phase of an injury but often continues unnecessarily for longer. An example is a hamstring injury in athletes. Within two months, 12-25% of individuals with a hamstring injury re-injure the same hamstring. Possibly as a result of inadequate rehabilitation or a continued decrease in strength of the hamstring muscles. 

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

  • Power 
  • Range of motion 
  • Endurance/conditioning 

Injuries are not 100% preventable. But the more resilient you are to an injury the lower the risk of an injury. Compare it to a bucket that is slowly filling 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 be able to properly execute a service in tennis, then over time you will have to start forcing something in that area. With regard to fitness, we see that fatigue causes many more injuries than when you start a training session or match fresh. 

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

Fatigue: 
We can make a distinction here between acute fatigue and prolonged fatigue. Acute fatigue means that at the end of a race, for example, you may be tired and the movement control at that time is a lot less. This reduced control due to decreased strength and coordination creates a greater risk of injury. We also see that fatigue in general carries a greater risk of injury. This can often be prevented by listening to your body in time and taking a 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 is mainly related to being able to deliver control in movements with high speed or peak load. 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 for the largest group of people to prevent injury. This is not to say that it is not relevant at all! For a small group and especially top athletes, it certainly contributes to reducing on an injury. A professional football player who has to cut and turn at high speed or a high-level powerlifter who deadlifts with +300 kilos. Then quality of movement does play a big role. Let's say first of all that you have to move in the most favorable anatomical angles and positions for that specific skill. But technique or quality of movement is less relevant than the other factors. Think of it as a hierarchical model. When strength, fitness or state of fatigue are not in order then the reason for your injury has often not been your technique. When this is said, we see this especially a lot on social media it is very short sighted and misleading. Often from lack of knowledge of physiology, anatomy and the complexities of how injuries occur. Not to mention that there is no scientific agreement with what a poor technique or quality of movement actually is. To a certain extent, it is a 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.

When we look at technique we have to 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 don't all move the same way and have individual ways of moving. There are structures that are more changeable but also only up to a certain point. So trying to change these unchangeable structures can be very disappointing. Sometimes it is just not feasible to perform movements in a certain way. The way you squat, for example, is very person dependent and has to do with the innate position of the hips, among other things. So it's difficult when your coach or physiotherapist wants to see this differently because in his or her eyes this is "better". 

Also when someone is in pain a different movement pattern is very normal. At that moment the body chooses the path of least resistance and there is nothing wrong with that! Over time we have to look at this more critically, especially when someone is afraid to move and therefore maintains complaints. But on average, in the first 10 days of back pain, for example, there is nothing wrong with pain-avoiding behavior. 

In most cases it is not the movement or technique that needs to be adjusted but the self-confidence and strength needed to make this 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 give a better result. Without paying too much attention to technique. This is very difficult to really train. Go run or sprint differently. YOU OFTEN DON'T KNOW HOW. And once you have mastered it you fall back into your old pattern from an automatism. So even if a certain exercise or movement does not look technically good, it is more important that you feel comfortable, have confidence and the strength to make the movement. The rest goes by itself after that! 

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