How to prevent lower limb injuries

28 October 2013

By Tim McGrath, APA Sports and Musculoskeletal Physiotherapist, PhD Candidate The health benefits of sport and exercise are unquestionable, but staying injury-free is the 'holy grail' of both active people and sports medicine professionals alike. No one likes spending time on the sideline. It is beyond the scope of this article to give a 'one size fits all' approach to prevention of EVERY lower body injury related to work or sport. The reality is that the more you know about the subject, the more this becomes apparent. However, it is our experience that many people participate in sport without proper physical preparation, and thereby expose themselves to injury. A high percentage of injuries (particularly in social sports groups and work-related activity) could perceivably be prevented by better preparation prior to the chosen activity. The focus of this article then is to give practical examples backed by research to help you reduce your risk of injury. How ready are you for sport? Broadly speaking, good physical preparation can be broken down into 2 main categories: 1. Strength, plyometric and balance 2. General aerobic fitness / running conditioning Strength, balance and plyometric activity In simple terms, one of the main jobs of our muscular system is to dynamically control how the body moves. The better one is at this, the less the body is dictated to by external forces (e.g. landing from a jump) during sport. Without this system, the body is increasingly forced to use passive tissue structures (e.g.: tendon, ligament, cartilage and bone) to absorb force, which can cause damage to these tissues through trauma or progressive overload over a period of time. A key component in prevention of lower limb injuries is to have sufficient strength and dynamic balance to optimise movement during sport. Resistance training in general increases both athletic performance and contributes to injury prevention by increasing joint stability. Balance and plyometric activity relate to HOW these different structures coordinate movement in a safe and effective manner. They rely on both efferent (impulses coming from the brain to the tissues) and afferent signals (feedback from the tissues back to the brain about how movement is coordinated). We know from research that many movements (i.e. running, jumping etc.) are pre-planned activities within the brain. Poor movement habits are associated in research with increased injury risk. A review by Hubscher et al (2010) pooled the results of seven well-constructed studies which looked at the effectiveness of balance training in reducing the incidence of injuries (including acute knee injuries and ankle sprains) and found significant risk reductions in both. General aerobic fitness / running conditioning An important part of injury prevention is the ability to participate in a given activity without excessive fatigue. Fatigue is associated with an increased risk of injury as it is proposed to promote extreme (sub-optimal) lower limb biomechanics. This includes: 1. A more extended hip and knee posture 2. Increased hip rotations 3. Increased movements and loads at the knee joint (McLean, 2009) The important effect of this is that apart from poor performances, the worse our conditioning is, the more likely we will move in a 'lazy' fashion to try to conserve energy but expose ourselves to increased risk of injury. The 'double-whammy' is that should an injury occur in such individuals, the harder it is to optimise recovery due to starting from a 'poor base'. So What Can I do to reduce my risk of Injury? The simple answer is to better prepare yourself for the activity you aim to participate in. For example, don?t expect to turn up and play social netball after 12 months without any activity and expect to remain injury free. Some people can indeed get away with this, but many can?t. In attempt to promote this form of injury prevention, some organisations have attempted to develop specific programs to help combat this. The best programs attempt to combine the elements described above, as none of these appear to be individually worthy on their own right alone. An excellent example is the FIFA 11+ (http://www.f-marc.com/downloads/cards/11pluscards_e.pdf) program. The program is aimed at soccer players, though could be applied broadly across a range of team sports. Daneshjoo et al (2012) reported that the FIFA 11+ program was successful in improving dynamic balance and joint control in professional male soccer players. Although programs such as the FIFA 11+ are designed to be conducted as part of the pre-session warm-up, it is my own humble opinion that these training elements should ideally also be addressed in greater detail during an average training week to avoid both under stimulation (and therefore a reduced effect), or excessive fatigue prior to actually participating in the session (and thereby increase injury risk). However, it is generally accepted that an active warm-up that utilises many of the elements found in the FIFA 11+ program are the best way to immediately prepare the body for activity. If you would like any further information, please feel free to contact the practice.