Definition of Injury

"Unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy, or the absence of such essentials as heat or oxygen."

Causative factors for sports injuries:

Intrinsic factors
Age
Gender
Body size
Injury history
Fitness level
Muscle strength/Flexibility
Skill level
Psychological state
Extrinsic factors
Equipment
Environment
Type of activity
Conditioning errors

What is Injury Prevention?

Injuries are preventable by changing the environment, individual behavior, products, social norms, legislation, and governmental and institutional policies to reduce or eliminate risks and increase protective factors.

Primary & secondary prevention:

Primary prevention is prevention of occurrence of injury
Secondary prevention is prevention of re occurrence of injury

There are a number of factors responsible for injury prevention. They are:

1. Warm up, 2. Stretching, 3. Taping & bracing, 4. Protective equipment, 5. Correct biomechanics, 6. Suitable equipment, 7. Appropriate surfaces, 8. Appropriate training, 9. Adequate recovery, 10. Psychology, 11. Nutrition

1. Warm up:
The literary meaning of warm up is to raise the core body temperature. Warm up is further classified in to general & sports specific warm ups.

Benefits of warm up include:

1. Increased blood flow to muscles
2. Reduced muscle viscosity leading smooth muscle contractions
3. Enhanced muscle's mechanical efficiency
4. Favorable neuro- myo conductance
5. Favorable muscle receptor changes which decreases the sensitivity of muscles to stretch.
6. Enhanced cardiovascular compatibility
7. Enhanced mental concentration to sporting activities

How warm up helps in injury prevention:

1. Increase the pre-warm up ROM
2. Decrease the stiffness of the connective tissue- this further leads to greater forces and length of stretch required for a tear to occur.

2. Stretching:
The ability to move joints smoothly throughout a full ROM is an important component of good health.

Basic principles of stretching are:

1. Warm up prior to stretching
2. Stretch before & after exercise/sports
3. Stretch gently & slowly
4. Stretch to the point of tension but not up to the point of pain

How stretching helps in injury prevention:

There is considerable research evidence to claim;

Increased flexibility attended through stretching appears to result in decreased incidence of musculo-skeletal injuries, minimize & alleviate muscle soreness. Further stretching may enhance athletic performance.

3. Taping & bracing:

Taping and bracing are used to restrict unrestricted, potentially harmful motion & allow desired motion. There are two main indicators for use of tapes & braces:

1. prevention- from the above said two procedures taping is used used as a preventive measure for high risk activities. For example ankle taping of basketballers.
2. rehabilitation- taping is used as a protective mechanism during the healing & rehabilitation phase.

4. Protective equipments:

Protective equipment shields various vital body parts against injuries. The most important is that protective equipment must not interfere with sporting activities.

5. Correct biomechanics:

Correct biomechanics is an important factor in achieving maximum efficiency of movement and in prevention of injuries. Faulty biomechanics may result from static (anatomical) abnormalities or dynamic (functional) abnormalities.

Examples:

Static abnormalities: LLD, Genu valgum, pronated calcanium

Dynamic abnormalities: running with excessive anterior pelvic tilt.

What happens when there is altered biomechanics?

Poor techniques are the result of improper biomechanics. This poor technique results not only in injuries but also in reduced performance.

6. Suitable equipments:

Equipment may range from simple to complex.

Example of simple equipment is the sports shoes.
Examples of complex equipments are; racquets, sticks, bicycles, motor vehicles etc

According to Khan & Brukner 3 major injury producers are- foot wares, racquets & bicycles.

Parts of a sports shoe: heel counter, toe box, mid sole.

Parts of racquet: handle grip, shaft & racquet head

Important parts of a bicycle from sporting angle: seat height, saddle position, handle bear position. Pedaling technique is one of the most important aspect where injuries can be prevented.

7. Appropriate surface:

During walking & running, the body is subjected to high-repetitive, short duration forces, increasing the susceptibility to injury. Maximal impact forces during walking, running, jumping has been shown to approach 2 times, 3-4 times, 5-12 times respectively.

Surfaces alter the peak force that the body is subjected to during activity. Maximal impact forces are much higher on the hard than on the soft surfaces. Hence softer surfaces reduce the chances of sports injuries.

8. Appropriate training:

Training errors are the most common predisposing factors in the development of sporting injuries.

Training is a constant balance between performing sufficient quality & quantity of work to maximize performance, but not so much that injury occurs.

Full explanation of training is beyond the scope of this discussion.

In nutshell:

Principle of training are:

1. Periodization
2. Specificity
3. Overload
4. Individuality

Different training methods involves:

1. Aerobic training or endurance training
2. Anaerobic training or lactate training
3. Strength & power training
4. Flexibility training
5. Speed & agility training
7. Specific skill training
8. Cross training

9. Adequate recovery:

Adequate recovery is essential if the full training effect is to be gained & injuries are to be prevented.

"Over-reaching": inadequate recovery leads to impaired performance and associated symptoms such as tiredness & lethargy called "Over-reaching". If from this point onwards if training is continued injury may occur. How ever, frequently athletes respond to above said symptoms by an increase in training as they perceive it as "lack of fitness". This leads to what is called "over training syndrome". Hence it is important for the coach to monitor the training program keenly.

Adequate recovery includes:

1. Warm downs
2. Whirl pools & spa
3. Massage
4. Rest & sleep
5. Psychological & nutritional advices

10. Psychology & injury prevention:

Excessive arousal:
The detrimental effect of excessive psychological arousal is a well recognized entity. Excessive psychological arousal predisposes the athlete to injuries.

Excessive arousal leads to altered muscle tension. This further leads to alteration of fine balance between agonist & antagonist which is the hall mark of a quality performance. Once this synergy is lost between agonist & antagonist; a changed technique rather than the natural technique is used. There is also "Loss of rhythm". This factor predisposes to injury.
Excessive arousal also leads to loss of mental concentration. Consequently the feet & body are placed do not get into proper position on the sports field. Hence the participant gets in to a biomechanically poor position to play return shots. This predisposes to injury.

Excessive arousal leads to "narrow attentional focus"; hence he fails to read the play. This may result in them being easily tackled or bumped from the "blind side".

"The white line fever": this is another example of excessive arousal. Here the athlete loses all perception of danger on taking the field. Consequently he places his body in positions vulnerable to injury.

Over aroused players enter a competition without proper nutrition. This further lead the individual to sports injuries.

Under arousal: less common variety. It occur trial matches or lower level of competition.

The under aroused athlete shows following:

1. Impaired reading of visual cues.
2. Slow decision making.
3. Do not take appropriate evasive action.
4. Makes technical errors.

These above said points are responsible for sporting injuries in under-aroused athletes.

11. Nutrition & injury prevention:

1. Adequate nutrition may indirectly lead to injury through it's effect on the recovery process.
2. Due to continuous intense training; labile muscle proteins are channeled in gluco-neo-genesis to produce energy. Hence deficient dietary protein may lead to muscle soft tissue damage.
3. Inadequate hydration has immediate & acute impact on athletic performance especially exercising under thermal challenge.
4. Minerals such as calcium has very important role to play in muscle contraction physiology. Increased exercise draws upon the body stores of the calcium. Inadequate calcium intake weakens the bone and may lead to fractures. Electrolyte balance; further the internal milieu is maintained by Sodium & Potassium. Deficiency of these minerals leads to severe metabolic impairments. They may even cause death.
5. Low calorie diet may lead to dropping of the fat proportion to such an extent that females loose monthly period. This further leads to osteoporosis and fractures.

Satyajit Mohanty (specialist physiotherapist in sports injuries, sports nutrition & exercise expert in metabolic disorders) BPT,MSPT, PGD (D&NM), MIAP, MHPC author: A concise text book for the management of the overweight & obese