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NL Injury prevention
We are all encouraged to take up sports and exercise. So we don't need to explain here the benefits of sport and exercise. Unfortunately, there are also disadvantages to sport. There is always a risk of injury. Ever seen an avid runner who is completely injury-free? Or a football team where there are no injuries at all in a running season? Wherever people play sports fanatically, people get injured.
We know that around 4.5 million people are injured every 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 involve a lot of costs. Not just the costs incurred through surgery, for example, but also think about costs due to work absence. Is there perhaps a way to prevent injuries and how does that work? We can never really prevent injuries completely. However, we do know that certain factors contribute more to a higher risk of injury than others. These factors we will go through 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 we cannot change such as:
- Age
- Gender
- Previous injury history
Age
As we get older, we see that the risk of injury increases. Our flexibility, strength and fitness all decrease. These factors make us more likely to get injured. One example is the risk of falling. Complaints due to falls are the biggest reason why elderly 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, say, a muscle injury is higher 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. We also see that women generally have a bit more slack on structures such as ligaments and capsules in the body. Another example is bone density. Women naturally have lower bone density, especially later in life. The hormone oestrogen which is partly responsible for maintaining bone mass decreases in later life. Despite women having 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 reduction 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/conditionality
Injuries are not 100% preventable. But the more resilient you are to 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, many more injuries occur 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 injury risk in sports where directions are changed quickly, such as football, than when training in the gym, for example. The predictability of 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 turning creates 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 distinguish here between acute fatigue and long-term fatigue. Acute fatigue means that at the end of a competition, for example, you may feel tired and your movement control is a lot less at that point. This reduced control through decreases 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 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 preventing injury for the largest group of people. This is not to say that it is completely irrelevant! For a small group and especially top athletes, it certainly contributes to reducing on injury. A professional footballer who has to cut and turn at high speed or a high-level powerlifter who deadlifts at +300 kilos. Then quality of movement does play a big role. Let's preface by saying that you then have to move at the most favourable 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, the reason for your injury has often not been your technique. When this is said, we see this a lot on social media in particular, it 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 jumper better than a blue jumper. 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 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 non-changeable structures can be very disappointing. Sometimes it is just not feasible to perform movements in a certain way. For example, the way you squat is very person-dependent and has to do with the innate position of the hips, among other things. So it's tricky when your coach or physiotherapist wants to see it done differently because it's "better" in his or her eyes.
Even 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 absolutely nothing wrong with that! Over time, we do need to take a more critical look at this, especially when someone is afraid to move and thus maintains complaints. But on average, in the first 10 days of back pain, for example, there is absolutely nothing wrong with pain avoidance behaviour.
In most cases, it is not the movement or technique that needs adjusting 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 for a different run or sprint. YOU OFTEN DON'T KNOW HOW. And once you do master it, you still 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 will take care of itself after that!
