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We hear it all the time, but what does it actually mean? What kind of injury can we prevent?
Injuries can increase the burden of sport, and offset the benefits it provides. We often see things advertised for "injury prevention" but what does this mean and
how can we prevent injury?
Injuries occur in two ways: overuse or acute. In the first, an injury occurs due to the build up of small traumas to the tissue, eventually causing pain and/or dysfunction. An example of an overuse injury is a tendinosis. Acute injuries on the other hand occur via a single specific mechanism, for example falling and rolling an ankle, or landing poorly and spraining your ACL.
Injury prevention means reducing our risk of injury, whether acute or overuse, from occurring in the first place. While we cannot prevent accidents from happening, (and we know there is inherent risk in all sports, artistic or otherwise), we can employ strategies to decrease our risk of injury, decrease potential severity of injury, and to have better injury outcomes when they do occur.
Okay, but How Do We Do This?
Let's dive into some of these strategies and how they can decrease our risk for injury:
Equipment
First up, let’s talk about our equipment. This can be a whole whack of different things and is very sport specific, but it can come down to two aspects: ergonomics and protection.
Ergonomics means making sure something is designed to best work with our
bodies’ physiology and biomechanics, so we are not straining ourselves harder or putting ourselves at risk by using it. For ballerinas this can mean using preemptive blister pads and/or toe spacers. For gymnasts, this was the switch from a long and
thin vault table to the squatter and wider table. Gymnasts’ grips for bars and wrist support often worn for floor routines are great examples here as well. For an aerialist this can include choosing to tape or not tape their equipment, choosing to use or not use rosin or chalk. This can also include choosing stretchier or tighter silks depending on the movements they wish to train, or choosing wider or thinner bars/ropes as suited to one’s grip.
Protection refers to something that protects us from what we know will or can hurt us with or without an accident. This includes mats and foam pits, safety/spotting lines, proper rigging (deserving of a whole post in and of itself, I know), padding and other protective clothing. These things protect us against impact and abrasion.
Often we can use protective equipment while learning a trick or movement, and wean off of it as we get better and more comfortable with it. For example, learning a tumbling pass into a foam pit, then a crash mat, then a sting mat. In other cases, we continue to use protective equipment at all times when training, competing or performing, for example a trapeze artist training and performing their act with gaiters (leather booties that protect the feet and ankles).
Rules
Certain rules can also be in place to protect us against increased risk for injury. For example, there are certain skills that are banned due to risk of injury in artistic gymnastics and cheerleading, or that are not allowed to be attempted until a certain level. In many sports, such as football, hockey, and lacrosse, using padding is a rule for participation and players can be barred from playing without proper safety equipment.
Other such rules, especially in team sports can include banning how players can interact, such as no cross checking in younger ages of hockey, no slide tackling in
soccer, and no tackling above the waist in rugby. Other
similar rules may not completely ban these kinds of interactions, but rather have a high penalty, e.g. game suspensions, if they are done, and the penalties can increase based on the extent of harm done to another player.
Conditioning and Technique
One of the ways that has been repeatedly shown to decrease risk of injury in all kinds of athletes is proper strength training. Strength training helps build strength and resiliency in our bodies, therefore preparing it for the demands of sports.
The stronger our hips and legs are, the better power and stability we’ll be able to create, therefore decreasing our risk of injury. For example, if we do not jump high enough we can miss a landing, or we can land with a knee buckling in or an ankle rolling. A ballerina needs to be strong enough in the feet, ankles, and legs to be able to start dancing on pointe safely and successfully. The stronger our back, shoulders, and arms are, the better prepared they will be for demands of handsprings, handstands, or catching a bar. An appropriate strength and conditioning plan will also target muscles less used in the given sport so that the body stays balanced and our muscles do not get overworked.
Strength coaches and athletic therapists are the experts at designing training plans that will help an athlete develop strength and power that will keep them healthy for their sport, and can even help improve performance.
Good technique as taught by the coach for sport specific movements, and for fundamental movement patterns as taught by the strength coach or AT help reduce our risk of injury by reinforcing good biomechanics. This lets our body move the most efficiently and, often the most safely. Efficient movement keeps us from excessively straining the body, wasting energy that could be used elsewhere, and safe movement, well, keeps us safe! Aspects of this definitely overlap with ergonomics.
An example of efficient movement is arm positioning in acrobatic movements, or proper back bending where we utilize the bend from several parts of the spine, hips and shoulders, and not just one of those. An example of safe movement is tucking the chin in a ground somersault to avoid landing on the head/neck.
Follow this link to download your free Periodization Template for the Artistic Athlete, a printable resource to help you plan your training to prioritize recovery and optimize performance!
Education
Lastly here is education, and this is a doozy. Education encompasses a lot of the things that can be left up to the athletes and their support system (caregivers, specialty coaches, medical team, etc). This can include education around:
Proper Nutrition for Performance and Recovery:
Is the athlete eating enough and enough of the right kind of foods, before during and after training? Does the athlete and their support system know the effects and risks of under fueling?
Sleep Requirements and Sleep Hygiene:
Does the athlete and their support system know what the optimal sleep duration is for an athlete of their age range? If they have trouble with sleep, do they know how to manage it with good sleep hygiene? Does the athlete and their support system understand the potential effects of chronic poor sleep on performance, recovery, and injury risk?
Stress Management:
Does the athlete know how to manage their stress, and is their support system on board with these strategies? Do they understand the effects of unmanaged stress on performance, recovery, and injury risk?
Injury Management:
In the case of a minor injury, does the athlete or their support system understand how it can be managed to decrease risk of further injury?
Injury Rehabilitation:
When cleared to return to play, does the athlete and their support system understand how to gradually return to full practice and competition? Do they understand how to know when to slow down progression if necessary?
Appropriate Volume
Is the overall training volume appropriate for the athletes’ age and goals? Especially for gymnasts, does the athlete and their support system understand the ramifications of practicing and competing high level skills in a growing body? Do they know what signs to look out for for paediatric specific injury and how they can effect development?
Rest
Does the athlete and their support system understand the value of periodization, rest, and deloading, and the effect it can have on performance, recovery, and injury risk?
The moral of this blog post, folks, Is that the term “injury prevention” means reducing risk of injury occurring, and can refer to so many different aspects of sport and activity. Despite there being so many ways we can try to reduce our risk of injury, there will always be an inherent risk for injury in any sport, and we need to be ready and able to respond to that injury in the best way possible to optimize healing and return to activity outcomes.
Want to chat about how to reduce your or your athletes’ risk for injury? Message me here and let’s get started!
Sources:
Saragiotto BT, Di pierro C, Lopes AD. Risk factors and injury prevention in elite athletes: a descriptive study of the opinions of physical therapists, doctors and trainers. Braz J Phys Ther. 2014;18(2):137-43.
Emery CA, Pasanen K. Current trends in sport injury prevention. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):3-15.
Emery CA, Meeuwisse WH, McAllister JR. A survey of sport participation, sport injury and sport safety practices in adolescents. Clin J Sport Med 2006;16:20-26.
Emery C. Risk factors for injury in child and adolescent sport: a systematic review. Clin J Sport Med 2003;13:256e68
Timpka T, Ekstrand J, Svanström L. From sports injury prevention to safety promotion in sports. Sports Med 2006;36:733-45.
Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2014;48:871-7.
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