I moved away from using the term “injury prevention” years ago because:
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.
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.
When someone does not move well, the process can be described simply as this:
First, find an entry point. This means you need an objective movement diagnosis with criteria to protect you against your own subjectivity.
Then, rate and rank movement for efficiency.
Then, protect against getting worse.
Then, do something to improve information coming into their nervous system. This might mean a pain relieving treatment or a technique to change/improve mobility.
Second, we provide an exercise that gives the persons nervous system an opportunity to use that enhanced information, process it reflexively and manage their movement mistakes at the edge of their ability – this is Reactive Neuromuscular Training (RNT).
If corrective exercise is not working, it is because:
To the first point - a diagnosis is always first priority. Improve diagnostic systems.
To the second point - diagnosis will direct treatment choice. Improve treatment precision. Keep a baseline system to verify change.
To the third point - diagnosis will direct mobility treatment choice. Improve mobilisation technique. Keep a baseline system to verify change.
To the fourth point - motor control and motor learning science can be translated into artistic and systematic corrective exercise training. Improve this process. And, keep a baseline system to verify change.
Looking for strategies to do that? Reach out to me.
what is corrective exercise,
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.
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?
Well, my expertise is in rehab. I can tell you that time-based rehab is evil. Criteria-based rehab is good. I said good shits on bad. I'm not afraid to use such colloquialisms in a professional manner, because it gets your attention, and the first step to changing behaviour is to break on old pattern by getting attention. So, it's up to the good physio's and other rehab clinicians to help you with a meaningful step-by-step process. If you're not buying it, your intent is not fuelled by true desire to achieve. Haven't you heard of the clinician who says your injury will take X weeks to be right? And then it isn't? Because a time-frame is out of your control and you don't have to act to make it to that time-frame.
In training or competition mode, let's look at an example:
Wayne Rooney, current forward for DC United, formerly of Everton, Manchester United and the England football team, used to visualise his success. He would ask the property steward what colour kit they would wear in the game on the following day. Red top? White top? What colour shorts and socks. Then he would visualise scoring in that kit the night before, before he went to sleep. You see, his mind didn't know the difference between a real and imagined experience, so it would form a neural connection to create a movement program for scoring the goal. He could create multiple circumstances to score that goal and he would develop strong neural connections for that program. Time and time again his reaction time and ability to score would be faster than his defending opponents could handle - because his movement programs were more competent and capacious due to prior imaginative exposure.
You too have the capacity to do this, yet it takes a coach with a plan, and a rehab clinician with a plan that is based on criteria. Note well, criteria is not based on sets and reps but on levels of competence and performance.
All you have to do is want, to desire. We will shape your desire. If you have it. Think good - it's better than bad.
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.