Injury-proof. Is it possible?
To set the scene, I’ve been a state-level high performance gymnastics coach for a number of years, and now as a Physio, I work with athletes across a wide range of sports, including football, soccer, lacrosse, dance, basketball and surfing. What I hear from ALL athletes is that injury prevention is of number one importance.
I’m going to let you in on a little secret that I learned from the Chief Medical Officer, Dr Kathy Yu, at the Australian Gymnastics Championships this year.
Dr Yu told me: “now that you are on the medical side of the fence, you’ll see the sport completely differently.”
And I do. Here’s how.
Let’s start with the big picture.
The human body responds to the forces placed upon it. Under load, our bones become denser, our muscle fibres increase in size, and our nerves become more effective at signalling messages back to our brains.
These responses are calledadaptation, and they occur specificallyto the type of training.Except, if the body isn’t prepared properly, those same forces can result in overload and injury.
An example of this: For adistance runner, the joints in the foot, ankle and knee are under repetitive endurance loading. Although the lower limb bones adapt to grow stronger in response to that load, this same load can create other issues in other structures. Cue the “Runner’s Knee”.
Athletes know about these patterns. They prepare for them. Injury prevention exercise programs, or ‘prehabilitation’, focus on training muscle groups that are at risk for overuse in their sport.
I hear what you’re thinking. Why wouldn’t just “getting strong” build the invincible athlete then? Let me explain. I’ll use gymnastics as our example, but bear with me, as the principles are the same for ALL sports.
Gymnastics is complex. Let’s take a look at the typical movement patterns to see where the loading happens, or hotspots for injury.
Women’s Gymnastics: Men’s Gymnastics:
Apply this framework to ANY sport, and we can start to get an idea of what to look for.
A recent 10 year observational study substantiated this idea by reporting the top 3 injury sites as:
Women’s Gymnastics (all lower body)
Men’s Gymnastics (mostly upper body)
Approaching gymnastics from another angle, here’s what I wish I knew as a coach.
Injury prevention is based on thorough understanding of the sport, and of our athletes. We have to be on the front foot. Let’s ask ourselves then, why injuries occur, even to our strongest athletes.
Elite gymnasts train for 11 months of the year, for up to 32 hours per week. Long practice sessions and lapses in concentration can place the body at a higher risk for injury. Monitoring periods of growth in children and teenagers can also be helpful, to make sure we aren’t overlooking these periods of increased fatigue states.
On the flip side of the coin, highly energised states (low fatigue) can lead to increased injury rates as well. Overconfidence can predispose athletes to take risks, and train or compete at higher intensities.
Aiming too high too soon
Rushing to acquire a skill by a certain time is all too common. Every level of competition has a set curriculum of skills. This usually leads to athletes and coaches setting skill-based goals based on when the competitions are, or the age of the athlete, rather than when they are physically prepared to achieve them. This can lead to athletes attempting skills they are not ready for, putting them at unnecessary risk.
Trying to “stick it”
Injury tends to occur during training, where skills are being learned, rather than during competition, where skills have been mastered. Emphasising a “stuck” landing in gymnastics, with feet together and pelvis tucked under, is a stylistic technique which attracts a better score. This can be particularly dangerous for acute injuries during new skill learning, or during competition.
At the end of the day, gymnastics is one of the riskier sports out there. Athletes and coaches understand the level of risk involved, and prepare mentally and physically for it. Though occasionally, during multiple twists or rotations, gymnasts can become “lost” in the air, leading to landing mishaps. Practicing landing and “falling” drills in every training session prepares our athletes physically, spatially and mindfully.
Crashmats, bungeys, and foam pits are some examples of equipment that have been developed to provide safe landings during high-risk skill learning. However, we have to be careful that we are not using these safety mats to cut corners and attempt dangerous skills too early.
Now we know what to prepare for, what can we do to have the best chances of shaping injury-proof athletes?
Build strong prehabilitation programs for your sport
Optimising physical conditioning for skill development is key, to protect against acute and overuse injury. Prehabilitation programs should be in effect every single training session, and be adapted to the needs of the athletes and their stage of training.
Pace your athletes. Know your limits.
Mastering technique of high level skills through repetition of training drills, and upskilling when the athlete is confident and comfortable, rather than pushing to match an external timeframe.
Refine technique. And refine it again.
Coaches and physiotherapists can work together to redesign technique for injury-proof biomechanics. Be inquisitive about how to improve, and keep an open mind on your uptake of new ideas if things aren’t working.
Manage load. Manage rest.
Sharp spikes in training without the appropriate preparation by more than 15% can lead to an increased risk of injury, for example at the start of the season after a break. For the average coach, counting “elements per session” is a good way to get an idea of the total work an athlete is performing.
Lastly, monitoring your athletes day-to-day rest, sleep quality, nutrition, and mindset can help provide insight into their energy and fatigue levels. They can do this by way of training diaries or a simple score “out of 10” at the start and end of a session.
Let’s take control over those injury statistics.
If you don’t have a current prehabilitation program in place, or would like to gain an understanding of what one might look like for your athletes, get in touch with us at Good Physio for a chat!
1. Folland, J. & Williams, A. (2007). The adaptations to strength training: morphological and neurological contributions to increased strength. Sports Med. 37(2): 145-68.
2. Stabenhow Dahab, K. & Metcalf McCambridge T. (2009). Strength Training in Children and Adolescents. Sports Health. 1(3): 223-226
3. Westerman, R., Giblin, M., Vaske, A., Grosso, K., Wolf B. (2015) Evaluation of Men and Women’s Gymnastics Injuries: A 10 Year Observational Study. Sports Health 7(2): 161–165
Hamlin, M., Wilkes, D., Elliot, C., Lizamore, C., Kathiravel, Y. (2019) Monitoring Training Loads and Perceived Stress in Young Elite University Athletes. Front. Physiol 10, 1-1