Whether you’re a professional athlete or you’re training for your first 5k run, injury can be a huge setback in your journey. As a result, making sure you incorporate exercises to help you prevent injury can be beneficial. This post discusses how to plan an injury prevention program adapted from Sport Injury Prevention Anatomy.

An injury prevention program follows five steps:

1. Needs analysis
2. Exercise selection
3. Training frequency
4. Timing
5. Intensity and volume

The training must be specific to the movements common in the athlete’s sport. In this case, the program design should also be specific to the structure or body region to which the athlete is trying to prevent injury and also consider the athlete’s history of injury. Next, the program must challenge the athlete by providing sufficient stimulus (e.g., overload via increased weight or faster speed) necessary for adaptation. Lastly, the program must gradually and appropriately become more challenging through the deliberate management—i.e., progression—of select training variables.

Step 1: Needs analysis

When designing a program to reduce injury risk, it is important to evaluate the athlete’s injury prevention needs. To do this, you need to conduct a needs analysis, which includes the following:

• Sport and anatomy evaluation. Each sport and position has unique biomechanical or physiological requirements, and thus unique injury risks. Likewise, each anatomical structure is designed in such a way that unique movement, stabilization, and functional requirements exist. The goal of sport and anatomy evaluation is to determine these requirements (e.g., strength, muscle attachments and contraction types, speed of contraction, deceleration, changes of direction, joint structure).
• Injury history. Previous injury is one of the largest risk factors for both reinjury and subsequent injury. Reinjury is an injury following a previous injury to the same structure—for example, if an athlete sprains an ankle and then sprains the same ankle again three months later. Subsequent injury is any other injury that occurred after the initial injury—for example, if an athlete sprains an ankle and then injures the other (contralateral) ankle or an adjacent structure. Understanding an athlete’s injury history can guide programming to address common reinjuries and subsequent injuries.
• Goals and background. Each athlete has a unique background and goals for both general and injury prevention training. This component of the needs analysis allows some flexibility when designing the injury prevention program.

Step 2: Exercise selection

In this step, you will determine which mode of exercise will be chosen. Modes of exercise are strength training, plyometric training, speed and agility training, flexibility training, and aerobic endurance training. There is no specific research on the number of exercise modes to be included in an injury prevention program. In general, authors of Sport Injury Prevention Anatomy recommend four to six strengthening exercises, three to four plyometric exercises, and up to four special training exercises, though this will vary based on the season.

Step 3: Training frequency

Training frequency is the number of injury prevention sessions performed each week. Training frequency for general sports performance often changes depending on the time of the sporting year or season; the same is true with injury prevention training as well. Each season—preseason, in-season, and off-season—has a specific goal and training frequency. The goal of the preseason is to maximize performance prior to competition and to prepare for the season ahead.

Though they can be convenient, in-season injury prevention strategies can be limited. This phase tends to be performed at a lower intensity and is often considered a time to simply retain the improvements of technique gained during the preseason.

Because strength, power, and tolerance to stressors are important for injury prevention, off-season is the ideal time to develop a strong conditioning base for the more intense training that occurs during the preseason and in-season. Unfortunately, injury prevention strategies often end once the season ends. To be sure, it can be difficult from a scheduling standpoint to coordinate injury prevention sessions during this period, but we advocate for continuing to focus on technique while simultaneously training to improve muscular strength, power, and endurance.

Step 4: Timing

Injury prevention program timing is the placement or scheduling of injury prevention exercises when training. Injury prevention may be scheduled before practices, before games, after practices, or as standalone sessions. Timing decisions are most often based on convenience and how the injury prevention exercises affect the quality of games or other training sessions; they should be scheduled to allow for adequate recovery so that athletes do not become too fatigued to efficiently participate in upcoming practices or competitions. Several scheduling approaches are possible, but they can be best categorized as being performed with another training session (e.g., activity preparation or warm-up) or as a standalone training session.

Most approaches to injury prevention training combine those exercises with other training sessions. When used, it is very common for injury prevention exercises to be performed prior to practice or games. Performing exercises right after other training sessions is another option to consider (Potach et al. 2018). Not only is this convenient as well, there might be another added benefit: Decelerating, landing, and changing direction when fatigued may be an important component of injury prevention programs. Although this should not be done with all sessions, performing injury prevention exercises that focus on good alignment after other training sessions may provide additional novel stimulus.

Scheduling injury prevention exercise sessions as standalone training sessions, especially during the off-season, is a good option as well. Arranging the program in this way may allow athletes to better address strength, power, and tolerance to impact at intensities that are more likely to result in the sought-after adaptations to stressors (Augustsson 2013).

Step 5: Intensity and volume

Intensity is the relative difficulty of a given exercise or group of exercises and is most often measured by load (the amount of resistance used) or complexity. This is one of the most critical aspects of injury prevention program design. To achieve the desired adaptation, the program must provide both overload and progression. The intensity must be progressed to avoid plateaus in strength and motor control development (Augustsson 2013).

Another way to increase training intensity is by varying exercise complexity and novelty. Early in the injury prevention training process, progressing the relative complexity of exercise may be enough to provide an appropriate challenge that leads to the desired gains. Focusing on exercise difficulty requires more movement exploration as compared to actual strength and power gains. Because technique and alignment are risk factors for many injuries, it is important to attend to these factors.

Learn more about injury prevention and how to address this throughout your training in Sport Injury Prevention Anatomy.

References

• Augustsson J. Documentation of strength training for research purposes after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013 Aug;21(8):1849-1855.
• Potach DH, Myer G, Grindstaff, TL. Special consideration: female athlete and ACL injury prevention. In: Parikh SN, editor. The Pediatric Anterior Cruciate Ligament. Springer; 2018:251-283.

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