PRINCIPLES OF INJURY PREVENTION
Mr. Chandrasekar.L
PHT 333 – 2nd SEM – 1435-1436H
LECTURE OUTLINE
2

This lecture deals about the principles of injury
prevention in following sub-categories;
1. Introduction – Sports injury prevention.
2. Injury Prevention model
3. Internal & External risk factors
4. Factors assist in the prevention of injury
5. Principles of
training.
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LECTURE OUTCOME
3

After completing this chapter, the student therapist should be able to do
the following:

Characterization of Sports injury prevention.

Systemic Injury Prevention model

Causation injury prevention model

Intrinsic risk factors

Extrinsic risk factors

Important factors that may assist in the prevention of injury.
PHT 333 - Unit - 2 - Principles of Injury Prevention

Principles of training. – Practical topic.
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Introduction
4

An important role for the sports medicine practitioner is to minimize
activity-related injury, that is, to improve the benefit-risk ratio
associated with physical activity and sport.

Sports injury prevention can be characterized as being

'primary:

'secondary'

'tertiary'.
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Introduction
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Examples of primary prevention include health
promotion and injury prevention (e.g. ankle braces
being worn by an entire team, even those without
previous ankle sprain).
 Secondary prevention can be defined as early
diagnosis and intervention to limit the development
of disability or reduce the risk of re-injury. We to
refer to this as 'treatment' in this book (e.g. early
RICE treatment of an ankle sprain)

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Introduction
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Finally, tertiary prevention is the focus on rehabilitation to
reduce and/or correct an existing disability attributed to
an underlying disease. We refer to this as 'rehabilitation'
E.G., in the case of a patient who has had an ankle
sprain, this would refer to wobble board exercises and
graduated return to sport after the initial treatment for
the sprain.
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Introduction
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
The proactive clinician will initiate injury prevention
strategies, give prevention advice during
consultations where treatment is being sought and
devise in-season strategy planning sessions with
coaches and during screening of athletes
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Systematic
injury
prevention
Research on sports injury prevention typically follows a sequence described by van Mechelen et
al. (Fig. 6.1).
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Systematic injury prevention
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
Sports clinicians who want to prevent injuries in a systematic
way could base their approach on a model of potential
causative factors for injury, which was first described by
Meeliwisse and later expanded by Bahr & Holme and Bahr
and Krosshaug (Fig. 6.2). The model not only takes into
account the multifactorial nature of sports injuries, but
also the timePHTsequence
of events
leading
to5:40injuries.
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Internal risk factors - that may predispose
to or protect the athlete from injury
11

One factor that consistently has been documented
to be a significant predictor is previous injury.

Internal risk factors can be modifiable and non-
modifiable, and both are important from a
prevention point of view.
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Internal risk factors
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
Modifiable risk factors may be targeted by specific
training methods.

Non-modifiable factors (such as gender) can be used to
target intervention measures to those athletes who are at
an increased risk.
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The external risk factors
13

Exposure to such external risk factors may interact
with the internal factors to make the athlete more
or less susceptible to injury.

When intrinsic and extrinsic risk factors act
simultaneously, the athlete is at far greater risk of
injury than when risk factors are present in isolation.
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The inciting event –
(violent or unlawful behavior)
14

It is usually referred to as the injury mechanism—what we
see when watching an injury situation.

Each injury type and each sport does have its typical patterns,
and for team medical staff it is important to consult the
literature to reveal the typical injuries and their mechanisms for
the sport in question.
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on-court training
several practice games
Floor surface is hard
Risk of lower leg overuse
strength exercises the athlete is not accustomed to
Plyometric training
Increase risk of tendinopathy and muscle strain
15
High risk of acute ankle and knee injuries
Worn out and tired players
treat low-level 'grumbling' injuries
Figure 6.3 Risk profile. Examples of periods of the season when a college basketball team may
be at particular risk of injury. The comments below concern the risk periods that are circled:
packed competitive schedule
overuse injury
heavy academic program, leading to additional fatigue
Practise games on unusually slippery courts.
Increased intensity during training and competition
between players
Change of time zone
off-court training surface
Climate
Altitude
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Emphasis on defensive PHT
stance
quickoflateral
movements
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
One limitation of the model is that it is not obvious how
the team's training routine and competitive schedule can
be taken into consideration as potential causes, and the
model has therefore traditionally been mainly used to
describe the causes of acute injuries.
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Important factors that may assist in the
prevention of injury:
17
•
warm-up
•
stretching
•
taping and bracing protective equipment
•
suitable equipment
•
appropriate surfaces
•
appropriate training
•
adequate recovery
•
psychology
•
nutrition.
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Warm-up
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
Prepares the body for exercise

To be effective it should consist of both general and specific
exercises

Benefits:

increased blood flow to muscles

increased oxyhemoglobin breakdown, with increased oxygen delivery
to muscles

increased circulation leading to decreased vascular resistance

increased release
oxygen
from
myoglobin
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
enhanced cellular metabolism

reduced muscle viscosity leading

increased speed of nerve impulses

increased sensitivity of nerve receptors

decreased activity of alpha fibers and sensitivity of muscles to stretch

increased range of motion

decreased stiffness of connective tissue

increased cardiovascular response to sudden strenuous exercise

increased relaxation and concentration.
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
Programme:
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Stretching
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

Increased flexibility:

Decrease musculo-tendinous injuries

Minimize and alleviate muscle soreness

Improve performance
stretching may be more important for preventing injury in sports
that have a high intensity of stretch-shortening cycles (e.g.
football, basketball) than in sports with relatively low demands
on the muscle-tendon stretch-shortening cycle (e.g. jogging,
cycling, swimming).
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Flexibility - Types
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
Static flexibility: the degree to which joints may be
passively moved to the end points of range of motion.

Dynamic flexibility: the degree to which a joint can be
moved as a result of muscle contraction.

Types of stretching exercises:
 static,
ballistic and proprioceptive neuromuscular
facilitation (PNF).
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Stretching - Types
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
Static stretching
 The
stretch position is assumed slowly and gently and held
for 30-60 seconds
 Should
not experience any discomfort in the stretched
muscle
 produces
the least amount of tension
 probably
the safest method of increasing flexibility
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Stretching - Types
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
Ballistic stretching

the muscle is stretched to near its limit, then stretched further with a
bouncing movement.

quick bouncing causes a strong reflex muscle contraction. Stretching a
muscle against this increased tension heightens the chances of injury.


not commonly used.
May be used by athletes in the latter stages of a stretching
program. It should be preceded by an adequate warm-up
and slow static stretching.
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Stretching - Types
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
Proprioceptive neuromuscular facilitation stretching

alternating contraction and relaxation of both agonist and
antagonist muscles.

May produce greater flexibility gains than other stretching
techniques.

there is a tendency to overstretch.
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Pushing against a wall or fence with leg straight out
behind, feeling a gentle calf stretch
Principles of stretching
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
warm-up prior to stretching

stretch before and after exercise

stretch gently and slowly

stretch to the point of tension but
Gastrocnemius.
never pain.
Supported by a wall or fence with knee flexed, bring leg to be
stretched underneath body and lunge forward, again feeling a
gentle steady calf stretch
Soleus
With the leg supported on a beam or
bench and keeping the leg straight,
gently bend forward at the hips until
a stretch is felt at the
hamstring. Do not bend the back in
order to get the chest closer to the
knee; rather bend at the hips with
the back kept straight
26
Hamstring.
Calf (general).
Sitting on the floor with the
knees flexed, soles of feet
together and the back
kept straight, gently push
the outside of the knees
towards the ground until a
stretch is felt in the groin
Groin
With the toes supported on a step or
gutter, allow the heel to drop beneath
the level of the toe. Allow gravity to
impart a gentle stretch
Sitting on the floor with the legs straight and the hips
abducted, bend forward at the hips until a stretch is
felt in the groin. By bending towards either leg, this
stretch can be used to stretch the hamstrings
Groin
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Gluteals/piriformis (left)
Low back
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Quadriceps.
Levator scapulae.
Pectoral girdle
Triceps
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Taping & Bracing
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
Restrict undesired, potentially
harmful motion and allow
desired motion
 Prevention
 Rehabilitation
There is good evidence to suggest that bracing may prevent re injuries
in athletes with a history of a previous ankle sprain
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Taping
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

Restrict undesired motion & Provide mechanical support
Enhance proprioception
A Good tape

adhesive, non-stretch (rigid) tape is appropriate

non-irritant and easily torn by the therapist
Guidelines for tape application

Preparation

Application

Removal

Complications
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Bracing
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
Better than taping

However, it has a number of
disadvantages
Hinged knee brace

Types:

Heat-retaining sleeves

thermoplastic material
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