Which factors do we need to consider to prevent injury?

Here’s a mini-guide to minimising our risk of muscular injury.

Stretching
Stretching used to be the go-to exercise for injury prevention with advocates touting the benefits immediately prior to exercise and daily for flexibility. Whilst it is true that stretching does improve flexibility if performed consistently and correctly, what has now been proven is that doesn’t relate to injury risk. Indeed it is not an individual’s flexibility that predicts injury risk but instead the control and ‘robustness’ they demonstrate within that range of motion.

Therefore, stretching on a general level will not reduce injury risk and it is even debated whether stretching prior to exercise has a negative effect. Instead the current evidence shows us that there is likely a place for activity-specific stretching or mobility prior to an activity to improve performance but not likely to have much of an effect on injury. Stretching in fact is better for cooling down and helping the body return to a resting state post exercise.
 
Massage
Massage is often used by high performance athletes between events or sessions as a way of reducing injury risk. However, much like stretching, it is difficult to back this up with evidence, instead it appears likewise that massage may have some benefit on recovery from exercise, certainly at least as a placebo effect if not mechanical, but does not have much effect on injury risk. So those pre-races massages are for the mental preparation, routine and relaxation rather than injury prevention!

Exercise
Surprise, surprise, exercise seems to be very effective at preventing injury. If we look at this issue in reverse, the greatest predictors of injury risk are low strength, poor balance, poor technique, and previous injury. Therefore naturally any exercise that helps an individual to become accustomed to a certain movement is likely to reduce risk of injury in that movement. This clearly doesn’t eradicate risk and there still remains external risk factors, for example no amount of football training will prevent or reduce the risk of injury if another player comes flying in with a two footed tackle!

Specifically with exercise, resistance training has the greatest effect on injury risk, those who are stronger and leaner generally have a lower risk. This is because the soft tissues have a greater tolerance for stress, the nervous system is better able to adapt when placed under stress and generally the immune system is in a better state to deal with early injury effects such as inflammation or micro-damage.       

Balance exercises have also been shown to be particularly effective in those who have had previous injuries as it helps improves the body’s proprioceptive skills; in short improves the body’s awareness of where the joints are and what they are doing.
 
Nutrition
Away from physical activity, there is now good research to suggest that nutrition plays a part in injury prevention. Consistent low calorie intake is related to injury risk, this is because it can lead to under-nourishment of the soft tissues and immune system which can compromise injury tolerance.

In women, a very low dietary fat intake has been associated with injury risk, particularly in bone injuries and runners. This is due to an enhanced inflammatory response which can weaken the bone structure.

Iron is another dietary component that correlates to injury risk, the risk increases with iron deficiency. The mechanisms for this at the moment are unclear, however it may be related to a hormone called hepcidin which impacts the bodies inflammatory response.

There is still a lot of ongoing research in this area so it is likely there are plenty more factors that relate to injury risk, but here I can hopefully present a few simple myths busted and areas of focus.

To conclude, stretching and massage aren’t necessary for injury prevention, but maybe helpful for recovery and performance effects. The key areas that everyone can focus on for injury prevention are getting and staying strong, particularly in movements that are commonly repeated throughout the day, and focussing on keeping nutrition levels appropriate with reasonable calorie, iron and vitamin intake.

“An ounce of prevention is worth a pound of cure.” – Benjamin Franklin

Photo by Peter Conlan on Unsplash