7 ways to increase the chances acquiring an injury in sports

There are generally 7 major contributors to non-contact injuries acquired performing sporting like activities.   They are, in no particular order:  Age, injury history, improper warm-up, poor flexibility, posture, muscle strength imbalance and fatigue.  Two are these contributors (age and injury history) are non-modifiable, meaning, nothing can be done to change or alter them.  We cannot change our age, we can only get older; we cannot change our injury history, if I pulled my hamstring muscles during soccer practice last season, nothing can undo that now.

1. So how does age contribute to injury?  The older the athlete, the greater change of incurring a soft tissue injury.  The cut-off appears to lie somewhere around 23-25 years old (Yeah I know, that’s not old).  So once an athlete hits their mid twenties, regardless of how fit or conditioned they are, all things being equal, their injury risk will be higher then that of their younger counterparts.

2. Secondly, injury-history, previous injury to a joint or muscle automatically increases chances of re-injury.  That hypothetical hamstring injury I mentioned earlier, regardless of how diligently I rehabilitate it, my chances of re-injuring my hamstring muscles are higher than if I had never injured them.  Same story with ankle sprains, those with previous sprains are at higher risk of recurrence. The other aforementioned contributors to injury (improper warm-up, poor flexibility, posture, muscle/strength imbalance and fatigue,) are modifiable, meaning if addressed properly, their contribution to injury can be lessened or possibly eliminated.

3.  I can choose to warm-up properly prior to engaging in sporting activity, or I can ignore it, my choice.  Warming up improperly (which includes NOT warming up at all) increases chances of acquiring an injury.  Briefly, here’s the recommendation from the American College of Sports Medicine:  5-10 minutes of walking, slow jogging, or stationary cycling, followed by dynamic stretches that mimic the movements the athlete will be doing during the workout or competition.  Static stretching may be an option for some, power oriented sports participants beware (see my previous blog on this topic here).

4.  Posture, poor lumbar posture contributes to hamstring injury,  postural defects in the knees and feet have been found to contribute to overuse injuries in the lower extremities. 

5.  Poor flexibility can contribute to poor movement patterns, limited range of motion which contributes to injury.  For example, tight hip flexors can contribute to spinal injury during a bench press, as well as hamstring injury during sprinting.  

6.  Muscle imbalance, or a the inability of a muscle to absorb or withstand the forces generated by an opposing muscle at the same joint.  The agonist muscle generates force at a joint, while the antagonist muscle must contract eccentrically to slow down or “brake” the moving limb to prevent damage to the joint.  Examples include – sprinting, hamstrings must be able to withstand forces generated by the quadriceps and hip flexors, throwing, elbow flexors (antagonist) must withstand forces generated by elbow extensors (the agonist).  If the antagonist muscle cannot slow the movement down at the end of the action, injury ensues.  So muscles working in opposition must achieve a specific balance of strength and flexibility.  An imbalance is also used to describe a difference (usually >10%) in flexibility or strength among bilateral muscle groups (for example, muscles in the left leg compared to the same ones in the right leg).  When a single limb is considerably stronger than the contralateral (the other side), then risk for injury in the weaker limb increases.   

7.  Finally, fatigue.  Studies looking at leg injuries in soccer players find increased occurrences of muscle strains in lower extremities in the second half of a soccer match compared to the first half. This implicates fatigue is a contributor to these injuries.  Additionally, proper form, technique and mental focus can all be negatively affected by fatigued muscles.  A sport specific athletic performance assessment and/or a general fitness assessment can often identify asymmetry between opposing muscle groups, as well as postural deficits in hips, knees, and ankles. 

Now for the take home lessons:

• Always, always perform a proper warm up prior to sporting activity.
• Consider an appropriate physical assessment to identify muscle/strength imbalances, prior to training and competing.
• Be sure flexibility and core strength are getting attention in your training plan.
• Finally, the importance of proper training and conditioning before participation in competitive sports cannot be overstated.  While, for some a sport specific exercise training plan can mean training for weeks or months before participation in an actual competition, it is well worth it in the long run.

Hope this helps and thanks for reading!

Is a general fitness battery useful for competitive athletes?

My answer: Definitely!  A general fitness battery usually consists of five physical assessments.  Each test assess, one of the five components of fitness, which are: body composition, flexibility, cardiovascular endurance, muscle strength and muscle endurance.  One may also see assessments of balance and/or posture as well.

Examples of tests that assess the five major components of fitness are:

Cardiovascular endurance – King’s College step test, Rockport walk test, YMCA Submaximal bike test

Muscle strength – Grip strength test, 1RM leg press, 1RM chest press (each of these are generally estimated from a 3-5RM)

Muscle endurance – Push-up test, Canadian Trunk test, curl-up test, YMCA bench press test

Flexibility – Sit and reach, specific joint passive ROM assessment

Body composition – Skinfold measurement, Bioimpedence analysis (BIA)

These assessments are low-risk and appropriate for all healthy individuals.  I also like them because they have a lot of support in the scientific literature, meaning they have been tested on various populations and are valid (they test what they say they are testing) and reliable (repeated tests will provide similar scores).  I recommend assessing these components once a year, ideally following a training phase of active rest, prior to beginning a new preparation or pre-season training phase.  A general fitness assessment can provide useful insight into what the initial training phase should focus on.

Should an athlete do this instead of a more sport specific athletic testing battery?  The answer to that, it depends.  This is especially important if you are an athlete returning to competitive play after a long layoff.  Tests for power, agility, and speed, as well as exercises and drills to improve these attributes are often done at high velocity, and thus can be risky for the unprepared athlete.  Hence, athletes should be fit before taking on more advanced training.  For athletes who have been consistently training, many of the above mentioned tests are easily integrated into a sport-specific athletic testing battery (which, as mentioned in an earlier post, should be happening 3-4 times per year).  So once per year, the athlete could do an integrated test battery, and the other times stick with the sport specific athletic testing.

Depending on the training phase the athlete is entering, he/she should select tests that reflect the goals of that training phase. In the early training phase, weeks prior to the competition, the athlete should be focusing on general fitness components, which could be strength, cardiovascular endurance, or body composition.  In later training phases, still well prior to competition, transition into a more sport specific focus.  Thus it makes sense to do the general fitness testing initially, then use a more sport specific athletic testing battery to assess progress the later training phases.  Remember, the athlete should be relatively fit before undertaking a sport-specific training phase, which typically entails more complex and advanced routines.

In summary, a general fitness assessment can:

1. Assessing overall fitness can illuminate “holes” in the athlete’s training foundation.
2. Provide focus for early training phases
3. Allow for appropriate goal setting, especially in the early phases of the training program
4. Provide motivation
5. Serve as a stepping stone to more advanced testing and training

Thanks for reading

An Athletic Performance Testing Battery Primer

An athletic performance test battery is a series of valid and reliable physical tests that assess important physiological components which are necessary to meet the demands of the sport.  For instance, the sport of basketball demands lower body explosive power (for jumping and accelerating),  ability to change direction rapidly, upper body strength (pulling down rebounds, shooting, passing), speed (fast break, getting back on defense), and anaerobic endurance (running/sprinting up and down the court repeatedly).  Thus a basketball-specific athletic test should include a specific test for each of these components.  Each specific test should be valid (it test what is designed to test) and reliable (repeated tests result in similar scores).  The order that each test is administered matters, the least fatiguing tests are performed early, saving the more fatiguing tests for last.   Adequate rest between trials and tests is important as well.  Test selection may also be influenced by availability of equipment and facilities, as well as the number of athletes being tested.  For example, a maximum bench press test is wonderful for assessing upper body strength and is appropriate for basketball players however; it is time intensive and requires specific equipment that is not portable, so testing an entire team would not be easy.  Grip strength can be measured quickly and easily with a hand-grip dynamometer, granted it’s not as sexy as a 1RM bench press test but it is a valid measure of upper body strength.  Since both the bench press and hand-grip dynamometer test strength, including both tests in one battery would be redundant, so pick one.  Finally, a proper warm up is a necessary component of an athletic testing battery, for both safety, as well as accurate results.

So to summarize an athletic performance test battery:

• includes a warm-up
• has specific tests appropriate for the athlete,
• avoids redundancy,
• has a specific test order, and
• allows adequate recovery between trials.

I also recommend a cessation of intense physical activity 48 hours prior to the test battery, once again for both safety and accuracy of testing data.

With that, here is a sample basketball specific test battery:

Grip strength assessment
Standing broad jump
Vertical jump
Medicine ball put
Hexagon test
Sprint test
T-test
Line drill (suicide drill)

Mind you, this is a sample test battery meant to reinforce the tenets discussed above; there are other possible and effective permutations.  Having said that, with this sample test battery we can see the test order goes from least fatiguing to most fatiguing and all the components are addressed (upper body strength, upper and lower body power, agility, speed, and anaerobic endurance).  Each of these tests has been validated in athletic populations and deemed reliable.  As a bonus, each test requires minimal equipment and can be easily administered to large or small groups.

An athletic performance test battery performed once, is minimally useful.  Experienced athletes should consider a sport specific test battery, at minimum, 10-12 weeks prior to opening day.  Then undergo a second one after 7-8 weeks to allow time for adjustments in the training program before the season begins.  A third could happen at mid season, once again, this is to assure that training benefits are being maintained, and if not, you want to know sooner, to make adjustments.  For an endurance athlete, you must decide when your “season” is; perhaps building your training/testing schedule around the most important competitions or races would make the most sense.  I’ll talk more about endurance athletic testing in a future post.

Here are some additional examples of sport specific athletic testing batteries we use:

Consequently, former athletes planning a return after a long layoff, or novice athletes who haven’t been training or competing regularly, should first consider a general fitness battery.  They are suitable for nearly all healthy people, carry very low risk of injury or episode, and provide useful information for building a foundation for training, or putting together the early stages of a comprehensive training program.  I’ll address this scenario in more detail next week but take note athletic performance test batteries should only be undertaken by individuals who are fit and have been training for several weeks or longer.

Have you performed a testing battery before?  Did you find it helpful?  If you didn’t, or need help interpreting the results, or how to best use them to your advantage please reach out.  We offer athletic performance testing and consulting to teams and individuals.

Thanks for reading.

Matt