Non Contact Injury Risk Factors & Strategies for Prevention

Adrian Guyer CSCS, NSCA-CPT, RSCC, USAW 2, CSAC, USS L100

At XIP it's rare, that a week goes by where our staff isn't faced with injury related training modifications. In fact, I'd say there's never a week that goes by where we are not implementing injury related modifications or reconditioning protocol into our training. That doesn't mean athletes are getting hurt during training sessions every week, it just means that we are always attentive to movement limitations caused by past and present injury, surgical intervention, acute and chronic fatigue, overuse, repetitive stress, soreness, lack of sleep, dehydration, biomechanical risk factors, past sickness or disease, gender, medications, etc.

We work with a very diverse population of athletes, from young to old and everything in between. And over the years, through tons of experience, we have found strategies that work, and also some that don't. We're really good at making adjustments when something comes up, or when we are presented with a movement limitation like I mentioned above. We know that movement truly is medicine, so we find ways to keep the body moving and avoid shutting it all down.

But, nobody wants to be banged up in the first place, trust me I know. I'm currently nursing a chronic calf strain that I feel a bit foolish about. Yeah, even Coach Guyer gets hurt sometimes. In this case I feel foolish because it's not my first rodeo with this injury, and I know what lead me down this path. But I didn't play by the "rules", my own rules at that, and now I'm less than best and having to modify my training as a result. FACK!

But what happened with me is something we see with many of the "non contact" injuries we see with so many others, especially with young athletes who should be way more resilient than my 43 yr old self. We can typically describe the cause of these non contact injuries under the following categories.

Disclaimer: Please know that there are way more factors at play, this is just a few of the more "trendy" factors we see at XIP.

1) Too much volume or intensity too quick. Or a combination of both.

Ex: You went out all guns a blazing having not provided a "ramp up" to "the thing" and the tissue couldn't handle it.

**This was me with my calf. Snow melts, time to run hill sprints in the sun! 4th sprint = strain. "No shit Adrian, you've done like 1 sprint based interval session on a treadmill in the last 6 months, with a ton of time stuck in ski boots, what did you expect?"

2) Not enough volume or intensity leading up to "the thing".

Ex: You didn't prepare the system for the actual demands of the sport or the practice intensity and the tissue couldn't handle it.

3) You didn't prepare for the volume effectively. Ex: You trained at a high or hard enough intesity but only for short periods of time, whereas "the thing" was long and hard.

4) You repeatedly stressed the tissue with the same patterns and forces repetitively over time without adequate rest. Overuse. Ex: You play one sport year round and never give the tissue the chance to recover. As a result you can't train at a high enough intensity to prepare for the really hard stuff because the tissue and the system is chronically fatigued. Eventually something gives.

5) Your diet, hydration and recovery are not given enough respect in the whole process. Ex: You eat, sleep and hydrate like an A-Hole and continue to hammer your body. Eventually things break.

So how can we mitigate these injuries in training?

1. High chronic workload is protective - Tim Gabbett has some great data here.

Athletes who have built a high workload base over time tend to be more resilient to non-contact injuries than athletes with low fitness and low training exposure. The devil is also in the details here. Overuse will also lead you down a slipperly slope.

• A strong, well-conditioned athlete can tolerate hard practices.

• A deconditioned athlete is at greater risk when exposed to the same workload.

  We see this when athletes switch from one sport to another, thinking they are prepared but forgetting that the footwear is different, the playing surface is different, the movements are different, the speeds are different, etc.

  Basketball doesn't = soccer.

2. Spikes are a big problem

The biggest predictor of non-contact soft tissue injuries is often a sudden increase in workload and intensity that exceeds what the athlete has recently been prepared for.

Examples:

• Runners going from 15 miles/week to 30 miles/week.

• A soccer player doubling sprint volume trying to make up for lost time after returning from injury.

I really appreciate the work of Tim Gabbett when it comes to these concepts and helping to prevent non contact injury in sport. One of his take home points:

"The best way to prevent injury is to prepare athletes for the demands of competition."

His argument is that undertraining can be just as dangerous as overtraining. If competition requires sprinting, cutting, jumping, or repeated high-force efforts, athletes need exposure to those demands in training also.

3. Volume and intensity both matter

Load = Volume × Intensity

Examples:

• High volume + low intensity can create excessive load.

• Low volume + very high intensities or speeds can create excessive load.

• Either can increase injury risk if not progressed appropriately.

The body doesn't distinguish between "too much volume" and "too much intensity" if the total stress exceeds capacity.

• Acute load = roughly the last 7 days

• Chronic load = roughly the previous 4 weeks

When the recent workload greatly exceeded the athlete's established workload, injury risk increased. Ratios around 0.8–1.3 were proposed as a "sweet spot," while large spikes (often >1.5) were associated with greater injury risk.

I like to ask what an athlete has been up to recently. If they are generally fit vs unfit they will be able to handle more or less volume and intensity on day 1.

Examples:

Have they been playing a sport at high intensities or intensities similar to what the training will be?

Have they had a long period of no activity or injury?

Have they ever done this type of thing before? Ex: Playing soccer leading up to a summer speed camp on the field is much more preparatory than playing hockey on ice with skates on leading up to that same speed camp on the grass or turf field.

Are they overweight?

Some take home points:

1. Build a large fitness base with diverse movement patterns, speeds and volume to stay fit and durable throughout the year.

2. Gradually progress volume and intensity, especially if it's a new or different type of stress.

3. Avoid sudden spikes in running, sprinting, cutting, or practice loads. Short sprints vs long and less change of direction early in a program to start with.

4. Include high-speed work regularly throughout the year so athletes are prepared for competition. High speed and longer distances gets scary.

5. Don't deload athletes so much that they're unprepared for game demands.

6. New types of stress will typically yield some soreness. Listen to your body and recover effectively. As you adapt the soreness will improve.

I hope these concepts and ideas help you in your own training and/or program design for your athletes. Don't be like me and try to do too much too quick this season!