I moved away from using the term “injury prevention” years ago because:

1. everyone WILL get an injury, and
2. we can’t predict injury easily AND
3. there are probably six main reasons that injury risk is elevated so the best we can do is to identify those elements of an athletes athleticism and history that elevate their risk and in movement prep, mitigate that risk as much as possible.

From my article, Bulletproofing the volleyball knee

Big Bang for buck strategies force us to go for biggest risk reducers, like being warm, moving within a tolerance range and being robust enough to handle all sorts of challenges.

It doesn't matter what I used to say, but I used to say that the only people interested in injury prevention - I mean passionately and seriously interested in injury prevention - were physiotherapists who had discovered it might be possible, and researchers whose current and future livelihood hung on the possibility that they might be invited to do something and be paid to do something about injury prevention. That number is very small. 

So, that leaves everybody else. Everyone who is rightfully interested in what athletes, sporting and tactical, are really interested in - getting the job done, getting the win, or at the very least (and the very most ideally) staying in the game for the pure enjoyment of having fun and being competitive. So, when we focus on preventing something that a) probably can't be done, and b) if it can be done, is hard to know if it was related to what we did or not, then we are on a hiding to nothing. Better to prepare to perform and, WITHIN THAT PREPARATION TO PERFORM, find out what might reduce the likelihood of get in the game, stay in the game and win the game. If that is injury prevention, then we've named it wrong. It should be called.........preparing. Burn the bridges and train properly. Rehab properly. Step out of opinion and into objectively moving the needle of risk. 
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So if we say we work for injury prevention we are doomed to fail. If we say we include risk identification and lowering strategies we can be judged on systematic efforts to reduce risk and reduce severity when they do happen. In the process we improve the athletes resources to handle when they get injured - less time to rehabilitate when they do get injured. Prepare to perform and this will include risk identification, risk lowering and enhanced preparedness. 

When you get injured, you'll be better prepared to come out the other side. 
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I’m going to assume a few things when I provide this return to run recommendation. 

To get you to 10km, from your current 2km tolerance, I’m going to suggest for the first 2 weeks that you only do 1 run each week. I know that’s a small volume, but the goal is to get you there, not to rush and break down with an injury.

I’d recommend you then do 2 runs/week for 2 weeks, then dial it back to 1 run in the 5th week. It’s a slowish start but you could pack plenty of fitness around it. 

For example:
 
First macrocycle
 
Week 1: one run plus other fitness
Week 2: one run plus other fitness
Week 3: two runs plus other fitness
Week 4: two runs plus other fitness
Week 5: one run plus other fitness
 
Second macrocycle
 
Week 6: two runs plus other fitness
Week 7: two runs plus other fitness
Week 8: three runs plus other fitness
Week 9: three runs plus other fitness
Week 10: two runs plus other fitness
 
In the first macrocycle, your first run will be something like this: 
Run at 30% pace (slow) for 30 seconds, then speed up to 60% pace for 20 seconds, and for the last 10 seconds of the minute run at 90% speed.
Repeat 5 times. This takes 5 minutes. 
Walk for 2 minutes. 
Repeat the 5 minute run once more. Finish. 
You’ll probably have run about 2km in this effort. 
 
You’ll keep this pattern to your runs for each run through the first 2 weeks. 
In the first run of week 3 of the first macrocycle, you can increase it to 3 rounds of 5 minutes of 30s/20s/10s at 30%, 60%, 90% ... does that make sense?
In the second run of week 3 of the first macrocycle, dial it back to 2 rounds of 5 x 30/20/10 at 30/60/90%.
 
In week 4, both runs can be 3 rounds of 5 minutes of 30/20/10 at 30/60/90
In week 5, you’ll do only one run that week, and you can bring it up to 4 rounds of 5 x 30/20/10 at 30/60/90% if you want, or keep it at 3 rounds.
 
You are likely to be comfortably running 4km by week 5. 
Like I said, it’s a cautious approach, but getting there is priority. 

In my book, chapter 11 is all about non-run fitness that you can do around this program. Enjoy, run well. 

“The major work of the world is not done by geniuses. It is done by ordinary people, with balance in their lives, who have learned to work in an extraordinary manner.”
Gordon B. Hinckley

After a calf-tear, this female distance runner wanted to combine her training for a half-marathon with her womens football and netball commitments. By tracking her training load, I was able to advise her on adjustments to stress, balancing her three commitments to prepare her to handle all three without re-injuring herself. Click to download the summary file. The training load spreadsheet is available for purchase.

MacDonald, D., G.L. Moseley, and P.W. Hodges, Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain, 2009. 142(3): p. 183-8. https://www.ncbi.nlm.nih.gov/pubmed/19186001 



Clark, N., Voight, M., Campbell, A., Pierce, S., Sells, P., Cook, R., Henley, C., Schiller, L. . (2017). The relationship  between segmental  rolling ability and lumbar multifidus activation time. Int J Sports Phys Ther, 12(6), 921-930. 
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Tucker, K.J. and P.W. Hodges, Motoneurone recruitment is altered with pain induced in non-muscular tissue. Pain, 2009. 141(1-2): p. 151-5. https://www.ncbi.nlm.nih.gov/pubmed/19095357  


Tucker, K., et al., Similar alteration of motor unit recruitment strategies during the anticipation and experience of pain. Pain, 2012. 153(3): p. 636-43. https://www.ncbi.nlm.nih.gov/pubmed/22209423  


Shadmehr, A., Z. Jafarian, and S. Talebian, Changes in recruitment of pelvic stabilizer muscles in people with and without sacroiliac joint pain during the active straight-leg-raise test. J Back Musculoskelet Rehabil, 2012. 25(1): p. 27-32. https://www.ncbi.nlm.nih.gov/pubmed/22398264  




Renkawitz, T., D. Boluki, and J. Grifka, The association of low back pain, neuromuscular imbalance, and trunk extension strength in athletes. Spine J, 2006. 6(6): p. 673-83. https://www.ncbi.nlm.nih.gov/pubmed/17088198  


Radebold, A., et al., Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine (Phila Pa 1976), 2001. 26(7): p. 724-30. https://www.ncbi.nlm.nih.gov/pubmed/11295888  


Park, J. and J.T. Hopkins, Induced anterior knee pain immediately reduces involuntary and voluntary quadriceps activation. Clin J Sport Med, 2013. 23(1): p. 19-24. https://www.ncbi.nlm.nih.gov/pubmed/23103783  


Bank, P.J., et al., Motor consequences of experimentally induced limb pain: a systematic review. Eur J Pain, 2013. 17(2): p. 145-57. https://www.ncbi.nlm.nih.gov/pubmed/22718534  


Bley, A.S., et al., Propulsion phase of the single leg triple hop test in women with patellofemoral pain syndrome: a biomechanical study. PLoS One, 2014. 9(5): p. e97606. https://www.ncbi.nlm.nih.gov/pubmed/24830289  


Cholewicki, J., et al., Neuromuscular function in athletes following recovery from a recent acute low back injury. J Orthop Sports Phys Ther, 2002. 32(11): p. 568-75. https://www.ncbi.nlm.nih.gov/pubmed/12449256  


Cholewicki, J., et al., Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine (Phila Pa 1976), 2005. 30(23): p. 2614-20. https://www.ncbi.nlm.nih.gov/pubmed/16319747  


de la Motte, S., B.L. Arnold, and S.E. Ross, Trunk-rotation differences at maximal reach of the star excursion balance test in participants with chronic ankle instability. J Athl Train, 2015. 50(4): p. 358-65. https://www.ncbi.nlm.nih.gov/pubmed/25531142  


Deschamps, T., et al., Influence of experimental pain on the perception of action capabilities and performance of a maximal single-leg hop. J Pain, 2014. 15(3): p. 271 e1-7. https://www.ncbi.nlm.nih.gov/pubmed/24275316  


Elsig, S., et al., Sensorimotor tests, such as movement control and laterality judgment accuracy, in persons with recurrent neck pain and controls. A case-control study. Man Ther, 2014. 19(6): p. 555-61. https://www.ncbi.nlm.nih.gov/pubmed/24957711 


Graven-Nielsen, T., et al., Stimulus-response functions in areas with experimentally induced referred muscle pain--a psychophysical study. Brain Res, 1997. 744(1): p. 121-8. https://www.ncbi.nlm.nih.gov/pubmed/9030420  


Graven-Nielsen, T., et al., Inhibition of maximal voluntary contraction force by experimental muscle pain: a centrally mediated mechanism. Muscle Nerve, 2002. 26(5): p. 708-12. https://www.ncbi.nlm.nih.gov/pubmed/12402294  


Graven-Nielsen, T., P. Svensson, and L. Arendt-Nielsen, Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Electroencephalogr Clin Neurophysiol, 1997. 105(2): p. 156-64. https://www.ncbi.nlm.nih.gov/pubmed/9152211  


Greene, H.S., et al., A history of low back injury is a risk factor for recurrent back injuries in varsity athletes. Am J Sports Med, 2001. 29(6): p. 795-800. https://www.ncbi.nlm.nih.gov/pubmed/11734495  


Henriksen, M., et al., Experimental quadriceps muscle pain impairs knee joint control during walking. J Appl Physiol (1985), 2007. 103(1): p. 132-9. https://www.ncbi.nlm.nih.gov/pubmed/17412791  


Henriksen, M., et al., Adaptations in the gait pattern with experimental hamstring pain. J Electromyogr Kinesiol, 2011. 21(5): p. 746-53. https://www.ncbi.nlm.nih.gov/pubmed/21824788  


Hodges, P.W. and G.L. Moseley, Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol, 2003. 13(4): p. 361-70. https://www.ncbi.nlm.nih.gov/pubmed/12832166  


Hodges, P.W., et al., Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res, 2003. 151(2): p. 262-71. https://www.ncbi.nlm.nih.gov/pubmed/12783146  


Janssens, L., et al., Greater diaphragm fatigability in individuals with recurrent low back pain. Respir Physiol Neurobiol, 2013. 188(2): p. 119-23. https://www.ncbi.nlm.nih.gov/pubmed/23727158  



Moseley, G.L., et al., The threat of predictable and unpredictable pain: differential effects on central nervous system processing? Aust J Physiother, 2003. 49(4): p. 263-7. https://www.ncbi.nlm.nih.gov/pubmed/14632625  


Palmieri-Smith, R.M., et al., Pain and effusion and quadriceps activation and strength. J Athl Train, 2013. 48(2): p. 186-91. https://www.ncbi.nlm.nih.gov/pubmed/23672382
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For an increase in swimming speed of 10%, decrease your drag by 3% or increase your power by 30%. 

Read that again. 

Now, it seems like it's easier to drop 3% drag than gain 30% power. You're mostly right. IF.....IF the drag is related to swimming technique - that's a motor control issue. It might be harder to change drag if the technique relates to a mobility issue that prevents being able to get INTO a streamlined position. That takes trained movement assessment to reveal the region of concern, then trained local biomechanical testing to find the reason for the regional mobility dysfunction, then trained reset techniques to bring the local biomechanical dysfunction up to minimum competency. 

Here's a video of a Chinese swimmer doing a Y-hold with flutter kick. What can you see that might limit speed according to the above equation?

Why the new system?
We know that the return of impaired measures of isolated strength, joint mobility, muscle flexibility and balance can be normal or can occur while movement patterns can still represent dysfunction. 

Likewise, it is possible for some performance parameters to fall within normal limits even when acceptable movement patterns are not present.

The new system honours a simple understanding of a complex batch of science around movement learning and strength and conditioning that relates to injury. Get in the game, to stay in the game, win the game.

Click play on the sound file below to listen to these important revelations, extracted from the "Movement" book, by Gray Cook, with Dr. Lee Burton, Dr. Kyle Kiesel, Dr. Greg Rose & Milo F. Bryant. 

Click here to learn more about the Functional Movement Systems. 



To buy the "Movement" book, click here.

I want to use the topic to refer to you. Your rehab. Your training. Your deepest desires. 

Did you know? In the Chinese Harvest Moon Festival, the death rate drops 35% below average in the week of this festival, then rises by the same amount in the week following the festival. 

Did you know - three US Presidents have died on July 4th? John Adams, Thomas Jefferson and James Monroe.

What does this mean? 

At times of importance - to these people, national importance - their impending death is held off by highly energetic intent to remain alive long enough for these times. Imagine that. You can will yourself to stick around until something important has passed. 

How is that relevant to you? 

A pre-participation evaluation should include markers of health. They are typically looking "for signs or symptoms of underlying disease, or who may be at higher risk of an adverse event during exercise" (Essa, 2018)

The presence of increased risk in a screen should lead to further assessment.

Physical Activity Readiness Questionnaire (PAR-Q)
The PAR-Q has been designed to identify the small number of adults for whom physical activity may be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.

Answer yes or no to the following questions:

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

If you answered yes:

If you answered yes to one or more questions, are older than age 40 and have been inactive or are concerned about your health, consult a physician before taking a fitness test or substantially increasing your physical activity. You should ask for a medical clearance along with information about specific exercise limitations you may have.

In most cases, you will still be able to do any type of activity you want as long as you adhere to some guidelines.

If you answered no:

If you answered no to all the PAR-Q questions, you can be reasonably sure that you can exercise safely and have a low risk of having any medical complications from exercise.

It is still important to start slowing and increase gradually. It may also be helpful to have a fitness assessment with a personal trainer or coach in order to determine where to begin.

When to delay the start of an exercise program:

If you are not feeling well because of a temporary illness, such as a cold or a fever, wait until you feel better to begin exercising.
If you are or may be pregnant, talk with your doctor before you start becoming more active.
Keep in mind, that if your health changes, so that you then answer "YES" to any of the above questions, tell your fitness or health professional, and ask whether you should change your physical activity plan.

ESSA designed PPE Stage 1 Questionnaire
Exercise and Sports Science Australia (ESSA), in association with Sports Medicine Australia (SMA) devised a PPE, with some elements that pass criteria mentioned above.

Where this specific evaluation fails is in the following recommendation: 
"IF YOU ANSWERED ‘NO’ to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise." This recommendation fails to evaluate movement-based risk factors, thus presents probable false negatives for exercising. 

ESSA, 2018. https://www.essa.org.au/for-gps/adult-pre-exercise-screening-system/

F-MARC designed PPE​
This PPE fails to account for a major risk factor in injury - motor control. 

It is recommended that the FMS, SFMA and FCS are used as appropriate (in the absence of pain, presence of pain/injury and passing of the FMS) in addition to specific tests within the F-MARC PPE, for soccer players.