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Five Ways To Prevent Sports Injuries

Manage load, warm up, sleep well, train for co-ordination, play smart!

updated
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about PainScience.com

Sadly, medical science has yet to figure out how to identify people who are at risk for injury.12 Injuries happen, and we mostly don’t know why they happen to the people they happen to, so prevention is a bit of a crapshoot. This article reviews the some of the closest things we have to evidence-based or at least the most plausible options.

Stretching ain’t it

Weekend warriors and a lot of amateur athletes tend to believe that injury prevention is pretty much all about having a stretching regimen, and they are usually feeling guilty about not doing it enough. If I had a buck for every time I’ve heard someone say, just before a game of ultimate, “I should really do some stretching” … well, heck, I could afford to play ultimate for a living.

Lucky for them, they aren’t really missing anything important. As established elsewhere, stretching doesn’t really work for the things people think it does, and it is particularly useless at preventing injury.3 Here are five ways to prevent injury that are a much better use of your time …

Train in the Goldilocks Zone

One of the few things we know for sure is that injury is linked to training “load”4 — how hard and quickly your tissues are challenged. So load management is one of the best overall strategies for preventing injuries. And what “load management” mostly means is avoiding spikes and lulls in training and competition where possible… and when they do occur, be more cautious for a while. Train regularly and moderately, with only moderate increases in load. More detail in the form of this fine infographic from Yann Le Meur (@YLMSportScience):

Warm up

The best known way to prevent injury is to warm up.56 Prepare for any intense activity by doing a similar activity less intensely. In other words, start slow! To warm up your tissues, you need metabolic activity: the heat causes physical changes in connective tissues that make them more pliable. Many more complex benefits arise from the stimulus of mild physiological stress. Mobilizations7 are an excellent warmup method, but really it’s just a matter of starting intense activities slowly.

Conversely, don’t overdo it. I’ve seen sports teams scrimmage for an hour before game time. I think that’s crazy: players go into competition not only warmed up but worn out. In competition, you can’t afford to give up any resources, and you only have so much juice in a day — no matter how fit you are. Athletes get hurt far more when they are fatigued than when they’re fresh.

And speaking of being tired…

Get your zzzleep

As just mentioned, fatigue is a major driver of injury, both specific muscle fatigue and overall exhaustion from inadequate sleep. Sleep deprivation is an almost universally underestimated problem. It’s a major factor in chronic pain.8 It impairs athletic performance, getting more sleep boosts it,9 and injury rates and recovery are probably affected too.10

People who actually do get enough sleep are extremely rare, and of course actual insomnia is a common problem. Insomnia treatment is not as hard as people think, and it’s a great indirect injury prevention tip, something that is definitely relevant to performance and injury risk — but has nothing to do with what you’re doing before, during, or after workouts.

Cultivate coordination

Many traumatic injuries are probably caused by glitches in coordinating forceful movements — an inability to sense and respond to traumatic forces at just the right time, either from lack of developed skill and/or fatigue. Creating coordination takes practice at complex and specific tasks (working within genetic advantages and disadvantages). But you can make some progress simply challenging yourself with a wide variety of activity and sensations, and coordination can be improved.11 For instance, a particularly long-term study followed a men’s basketball team for six years, tracking their injury rates in response to “classic proprioceptive [coordination]12 exercises” — which seemed to clearly reduce ankle sprains, and possibly more.13

Balance is one of the most basic elements of coordination, and isn’t much of a concern for younger athletes, but it becomes one for older adults — and even fit older people fall just as much as their less active counterparts. Fortunately, if you practice tasks that require balance, your balance will usually get better (as long as there’s no medical issue). And better balance means fewer falls.

Play smart, not hard

Many injuries are caused by excessive and mis-directed effort! That might seem like a bit of a no brainer, but people need to learn this. I certainly did. It is one of the great lessons of martial arts.

I remember the day I learned this lesson in ultimate, watching an older woman play. She seemed unlikely to be competitive — she was simply too old, and a little overweight. In fact, it turned out that she was the best player on the field that day, entirely because she was clever. I particularly remember how little she ran. Although there were certainly bursts of intensity, her effort was precise and savvy, and time and again she got the better of other players with only a fraction of the sweat.

One particularly important way of playing smart is to relax into intense challenges…

Chill out, man

Adaptability prevents injury, and rigidity is the opposite of adaptability. Relaxation is more psychological than golf. To purge rigidity from your system, you will have to go on journey of self-exploration: most tension is emotional and protective. You won’t be able to relax and be “comfortable in your own skin” until you know yourself better. Meanwhile, you’ll get more injury prevention mileage.


About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Related Reading

What’s new in this article?

FebruaryNew tip, “Train in the Goldilocks Zone,” based on Drew. Several other improvements.

2017Minor science update, a couple citation drop-ins for the introduction.

Notes

  1. Bahr R. Why screening tests to predict injury do not work-and probably never will…: a critical review. Br J Sports Med. 2016 Jul;50(13):776–80. PubMed #27095747. “To date, there is no intervention study providing support for screening for injury risk.” note BACK TO TEXT
  2. Dorrel BS, Long T, Shaffer S, Myer GD. Evaluation of the Functional Movement Screen as an Injury Prediction Tool Among Active Adult Populations: A Systematic Review and Meta-analysis. Sports Health. 2015;7(6):532–7. PubMed #26502447. PainSci #53719.

    The first review of the predictive validity of The Functional Movement Screen (FMS), with a predictably and resoundingly negative result based on mediocre data from 7 studies: “Based on analysis of the current literature, findings do not support the predictive validity of the FMS. Methodological and statistical limitations identified threaten the ability of the research to determine the predictive validity of FMS.”

    See The Functional Movement Screen (FMS) for more information.

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  3. Stretching just doesn’t have the effects that most people hope it does. Plentiful research has shown that it doesn’t warm you up, prevent soreness or injury, enhance peformance, or physically change muscles. Although it can boost flexibility, the value of this is unclear, and no other measurable and significant benefit to stretching has ever been proven. Regardless of efficacy, stretching is inefficient, “proper” technique is controversial at best, and many key muscles are actually biomechanically impossible to stretch — like most of the quadriceps group (which runners never believe without diagrams). If there’s any hope for stretching, it might be a therapeutic effect on muscle “knots” (myofascial trigger points), but even that theory is full of problems. See Quite a Stretch: Stretching Hype Debunked: Stretching science shows that a stretching habit isn’t doing much of what people hope. BACK TO TEXT
  4. Drew MK, Cook J, Finch CF. Sports-related workload and injury risk: simply knowing the risks will not prevent injuries. Br J Sports Med. 2016 May 10. PubMed #27166288. BACK TO TEXT
  5. Soligard T, Myklebust G, Steffen K, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008;337:a2469. PubMed #19066253. PainSci #56160.

    Research has shown for years now that good ol’ stretching doesn’t really prevent athletic injuries. So what does? Warmups that “improve strength, awareness, and neuromuscular control” might just do the trick. Practicing coordination and control, basically (see Panics et al). In 2008, Norwegian researchers compared injuries in over a thousand female footballers who participated in such a warmup for a season, to another several hundred who didn’t. Athletes who warmed up had fewer traumatic injuries and fewer overuse injuries. Moreover, the injuries they did have were less severe. Static stretching was not part of the warmup, but “active” stretching was (i.e. Mobilize!).

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  6. Soligard T, Nilstad A, Steffen K, et al. Compliance with a comprehensive warm-up programme to prevent injuries in youth football. Br J Sports Med. 2010 Sep;44(11):787–93. PubMed #20551159. PainSci #54998.

    Researchers found that injury rates were significantly lower in soccer (football) teams that diligently performed warmup exercises (“The 11+”, a warmup program recommended by FIFA, which notably does not include stretching). On the one hand, there was not much difference between a little warming up (low participation) and a bit more warming up (average participation). But players and teams that did an especially good job of warming up (“twice as many injury prevention sessions”) got solid results: “the risk of overall and acute injuries was reduced by more than a third among players with high compliance compared with players with intermediate compliance.” That extra enthusiasm went a long way!

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  7. Mobilizations are rhythmical movements that gradually expand your comfortable range of motion, providing your tissues with a variety of stimuli and stresses. The basic philosophy of mobilization is “use it or lose it.” It is a specific method of warming up that also cultivates coordination and relaxation. It’s similar to stretching, but with a lot less emphasis on pulling on tissues. For more information, see Mobilize!. BACK TO TEXT
  8. Almost everyone needs to take sleep deprivation more seriously. We are used to thinking of insomnia as a symptom, but it can also be hazardous in itself in many ways. Chronic pain is probably aggravated by insomnia or even mild but chronic sleep deprivation. For more information, see Insomnia Until it Hurts: The role of sleep deprivation in chronic pain, especially muscle pain. BACK TO TEXT
  9. Bonnar D, Bartel K, Kakoschke N, Lang C. Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches. Sports Med. 2018 Jan. PubMed #29352373. Just getting more sleep at night “had the most beneficial effects” on athletic performance, compared to napping, sleep hygiene, and post-exercise recovery strategies for young athletes. BACK TO TEXT
  10. Watson AM. Sleep and Athletic Performance. Curr Sports Med Rep. 2017;16(6):413–418. PubMed #29135639. BACK TO TEXT
  11. Panics G, Tallay A, Pavlik A, Berkes I. Effect of proprioception training on knee joint position sense in female team handball players. Br J Sports Med. 2008 Jun;42(6):472–476. PainSci #56163.

    A general warmup with an emphasis on coordination has been shown to reduce athletic injury rates significantly (see Soligard, for instance). Perhaps it is the neuromuscular or proprioceptive training component of this that causes the effect. A 2008 experiment compared athletes’ with and without this kind of training. Those who did it had a greatly improved sense of joint position. In other words, they really knew where their joints were! “This may explain the effect of neuromuscular training in reducing the injury rate,” the authors concluded.

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  12. PS Ingraham. Proprioception, the True Sixth Sense: The vital and strange sensation of position, movement, and effort. PainScience.com. 710 words. BACK TO TEXT
  13. Riva D, Bianchi R, Rocca F, Mamo C. Proprioceptive Training and Injury Prevention in a Professional Men's Basketball Team: A Six-Year Prospective Study. J Strength Cond Res. 2016 Feb;30(2):461–75. PubMed #26203850. The study showed significant reductions in ankle sprains, knee sprains, back pain… but “significant” is a highly problematic term, and only the reduction in ankle sprains was really persuasive. The athletes also got really good at the propioceptive control exercises themselves… for whatever that’s worth. BACK TO TEXT