Chapter 12: Preventing injury

INTRODUCTION

An important role for the sports medicine clinician is to minimise activity-related injury, that is, to improve the benefit:risk ratio associated with physical activity and sport. The 2000s saw a remarkable acceleration in the focus on sports injury prevention. Fortunately, athletes can now benefit from the knowledge that interventions can prevent many major injuries, such as acute knee, ankle and hamstring injuries.

Sports injury prevention can be characterised as being ‘primary’, ‘secondary’ or ‘tertiary’. In this book, we use the term ‘prevention’ synonymously with what is technically known as ‘primary prevention’.¹ Examples of primary prevention include health promotion and injury prevention (e.g. ankle braces being worn by an entire team, even those without previous ankle sprain). Secondary prevention can be defined as early diagnosis and intervention to limit the development of disability or reduce the risk of re-injury. We refer to this as ‘treatment’ in this book (e.g. early treatment of an ankle sprain; see Chapter 17). Finally, tertiary prevention is the focus on rehabilitation to reduce and/or correct an existing disability attributed to an underlying disease. We refer to this as ‘rehabilitation’ (Chapter 18); in the case of a patient who has had an ankle sprain, this would refer to balance exercises and graduated return to sport after the initial treatment for the sprain.

The proactive clinician will give prevention advice during consultations where treatment is being sought. Health professionals working with teams will initiate injury prevention strategies, whether engaged in a traditional team sport like football, or working with a team of individual athletes such as in athletics or swimming. To guide this process, this chapter will introduce the concept of risk management,² which includes systematic injury surveillance, pre- and in-season strategy planning sessions with coaches, regular screening of athletes (see also Chapter 46), and the development of specific prevention programs for the team and for the individual athlete.

From there, this chapter will cover specific topics in injury prevention, including:

• prevention of hamstring strains, ankle sprains and acute knee injuries

• prevention of overuse injuries

• managing load to prevent injury

• protective equipment

• appropriate surfaces.

A CONCEPTUAL APPROACH TO INJURY PREVENTION

Willem van Mechelen et al. introduced the now classic conceptual model for research on sports injury prevention (Fig. 12.1).³ This model can be successfully applied by sports medicine clinicians as well. First, identify the magnitude of the problem and describe it in terms of the incidence and severity of sports injuries. If you are responsible for a team, this involves recording all injuries within the squad, as well as training and match exposure. Second, identify the risk factors and injury mechanisms that play a part in causing these sports injuries. For the clinician, this ...