How to Predict Injuries Before They Happen

               If you’ve ever suffered from an injury, you know how disruptive it can be. Maybe it’s something traumatic, like a torn meniscus, torn ACL, torn rotator cuff, or maybe it’s something more long term and nagging, like tendonitis. In either case, your life has been disrupted.

• You may have to attend rehab a couple times per week, plus do your own additional exercises at home
• You might need surgery
• You can’t do certain activities that you enjoy doing, like tennis, golf, hiking, gardening, etc.

But wouldn’t it be great to be able to figure out what injury (or injuries) you are at risk for, so that you could prevent it from ever happening? Wouldn’t it be great to predict injuries before they happen?

Fortunately, to some extent, you can.

I’m always looking for ways to offer a better and better service to our clients, so remember the researcher that I hired to research how to exercise for osteoarthritis? Well, after our arthritis research was complete, I had him turn to the topic of how to predict injuries before they happen.

The rules were the same: he was only allowed to look at scientific/medical research. No reading mainstream books, no reading magazines, no watching videos on Youtube. Just the highest quality of evidence.

That’s what we’ll talk about in this article:

• Factors that predispose a person to different injuries
• Predictive assessments to figure out the likelihood of an injury
• What can be done about them
• What we still don’t know

While all in all, we came up with 22 pages of research, I’m only going to give you the highlights here, so as not to bore you with technical details.

               If you want to assess your own injury risk, just email me with the subject line “Injury Risk Assessment.”

Factors that Predispose You to Injury

Factor 1: Lack of Strength

It’s no surprise that lack of strength can predispose us to injury, but “lack of strength” is relative not just between people, but also between muscle groups, and between limbs.

For instance, if the ratio of quadriceps to hamstrings is too skewed in favour of quads, the risk of injury is higher. If there is also a significant (more than 10%) discrepancy in strength between the same muscle but on different limbs, that can predispose someone to injury.

Case in point, in one study, researchers recruited 30 sprinters who had never injured their hamstrings. All the sprinters were tested for their quadriceps, hamstrings and glute strength. After that, they were followed for a year, to see who would sustain an injury to their hamstrings, and who wouldn’t.

Here’s what they found:

• The hamstrings strength of the injured limb was 8.4% weaker compared to the uninjured limb.
• The overall strength of both hamstrings was 10.8% lower in the people who got injured compared to the people who didn’t get injured.
• Interestingly enough, in those that injured their hamstrings, their quads were 3.2% stronger on the injured side, compared to the uninjured side. What I make of this is that it’s not just the absolute strength, but the relationship of the different muscles to each other.
• In the people who did injure their hamstrings, the glutes on the injured side were 8.9% weaker than the glutes on the uninjured side.
• The strength of the glutes on the injured side was on par with the glute strength of the people who didn’t get injured. Again, pointing to the fact that it’s not just absolute strength that puts us at risk of injury (since the glute strength of the injured side and the glute strength of people who didn’t get injured was identical), but the strength ratios of different muscles to each other.
• The glutes were stronger than the quads by 49.9% on the side that got injured, but only 33.2% stronger on the side that didn’t get injured. Again, showing that stronger isn’t necessarily better. Stronger in the right muscles is better.

Factor 2: Poor Core Stability

               There are tons of misconceptions about core strength, so I wrote an entire article about core strength myths. The below will make much more sense after you’ve read that article, so check it out.

               One study found a relationship between poor core stability (not to be confused with core strength) and a higher risk of lower body injuries.

               Although that one is quite controversial, because one study showed the opposing results: that core stability training had no impact on injury risk.

               As often happens in science, different conclusions are reached by different researchers based on differences in:

• Who was studied:
  • Men/women
  • Younger/older
  • Soccer players vs. sprinters vs. long distance runners, etc.
• What the intervention was. Perhaps the exercises they used weren’t effective, and that’s why there were no results
• Compliance: if there’s low compliance to the injury prevention program, it’s no surprise why results would be lackluster

…and others.

Factor 3: Presence of Fatigue

               This one is also probably not a surprise, but doing sports in a fatigued state predisposes you to injury more than doing them when you’re fresh. If we need a study to back that one up, here it is.

Factor 4: Previous Injury

               And of course, last but not least is previous injury. The greatest risk to getting injured is a previous injury, especially if it wasn’t properly rehabilitated. Proper rehabilitation involves:

• Restoring strength to above pre-injury levels
• Restoring flexibility
• Restoring proprioception (your brain’s awareness of your body’s position)
• The often-missed part of rehabilitation: sensory rehabilitation. Restoring sensations to the injured area (sensations like hot/cold, sharp/dull, light touch/deep touch, and others).

Predictive Assessments That Identify Your Injury Risk

               Now that we know some of the factors that can predispose us to injury, what assessments can we use to see if those factors are present in us?

               There are quite a few, but here are some highlights:

• Quad-to-hamstring ratio: you would sit on the knee extension machine (if gyms are open where you currently reside), set the weight to something you can only do 3-5 times, and do as many reps as you can on the right side. Then, do the left. Then, get on the hamstring curl machine, and do as many reps as you can on your right side (using the same method of weight selection as for the knee extension). Then on the left.
• Back extension: see how long you can hold it for (the target is 2-3 minutes)
• Plank: the target is 90-120 seconds
• Side plank: the target is 60-90 seconds
• Back squat: this is more of a qualitative assessment. That is, how does your technique look? How far forward are you leaning? Are your heels coming off the floor? Is there a shift to one side or the other? And more.
• Lying hip extension: this is a test of glute activation

Of course, we use 25 different tests to assess our clients’ injury risk, but they’re beyond the scope of this article.

How to Decrease Your Injury Risk

               The only point of testing is to figure out what you can do if you fail the test. Once you’ve completed a test, the rest is easy. Figuring out what’s wrong (assessments) are 80% of the puzzle. The “what to do” part is much easier.

               If you have a strength deficit, you correct it. If you have an imbalance between muscles or between side, balance it. If there’s a flexibility limitation, stretch. If there’s poor proprioception (body awareness), use specific drills that improve your brain’s perception of where your body is in space. If there are sensory deficits, restore sensations to the areas that are missing them.

               And there are multiple methods of accomplishing any one of these goals. There’s more than one way to strengthen. There’s more than one way to improve flexibility. The trick is selecting the most appropriate method for each person.

What We Still Don’t Know

               Just as it’s important to identify what we know, it’s important to identify what we don’t know, so that we can identify areas of future research. Here are some questions to which we don’t yet have (great) answers:

• What’s the real role of core stability in injury prevention?
• Part of the injury risk isn’t strength, but a delay in the contraction of certain muscles. They can assess that in a lab, but how do you assess that in a gym?
• How can you predict at what point overuse injuries will happen? After all, 2 people may do the exact same motion, the same number of times. Yet, one will develop an overuse injury, and one will not.
• There are certain uncontrollable risk factors (like your bone structure: wide hips, the ratio of the thigh bone to the trunk and others). Can you compensate for these risk factors with certain exercises?

You can bet that as more becomes known, we’ll integrate that into our work with clients.

               Fortunately, for all that is not known, there is now quite a bit that we do know. Hopefully the information in this article will be able to help you:

• Prevent injuries
• Avoid needing to go to rehab (it’s better to prevent than to rehabilitate)
• Potentially avoid surgery
• Avoid taking time off the activities that bring you pleasure

If you’d like some help determining what injuries you’re at risk for, and devising a preventative action plan, you can see if you qualify to work with us emailing me with the subject line “Injury Risk Assessment.”