Keeping Players Playing | Stonehenge Therapies

The Sports Therapist’s Role in Preventing Injuries

As Sports Therapists we are well used to treating players who have suffered an injury. We work in a reactive capacity. The sports person is injured and we are tasked with reducing their pain, healing their injury and rehabilitating them back to their preinjury condition.

It is my opinion that we need to go further. If sports therapists can advise sports people and their coaches on ways to reduce the incidence of injury, then we can add value to our service. If we can assist our local sports teams and individuals to complete a season while reducing the number of injuries, then we are truly working in a proactive and preventative manner.

Dr. Douglas Mangan, who is an orthopaedic surgeon at the Abrazo Medical Group, Scottsdale, Arizona, stated that most of the injury cases he has treated could have been prevented if the young athlete was given ample time to rest and heal. The Centres for Disease Control has stated that more than half of all sports injuries in children are preventable. An interesting statistic is that most injuries take place during practice, home practice and during leisure activities. Fewer injuries actually occur during competition. The reason put forward for this is that the safety precautions insisted upon for competition may not be fully enforced during training or home practice sessions. Research completed at John's Hopkins Hospital discovered that 62% of organized sports-related injuries occurred during practice.

Injury can occur during sport training and competition for many reasons. General accidents such as a collision or a fall are examples. There are also what I call “training induced injuries”, such as over-training, excessive intensity, progressing too quickly, inappropriate preparation, improper equipment, poor technique, lack of down-time and not allowing sufficient time for recovery or healing. These are the types of injuries that we should be aware of and work with sports people, teams and coaches to reduce the incidence of injury in order to keep players playing.

Sports people are keen to be successful in their sport. The higher their level, the more keen they are to be successful and improve. In team sports there can be a lot of pressure to play the big games, the regional or national championships. If a sports person is carrying an injury, they may be anxious to continue to play for those big competitions. They may feel under pressure to keep going. Their team or coach may be depending on them. Unfortunately this ultimately can lead to a more serious injury which will take more time to heal and therefore less time playing.

A sports person who is continuing to play with an injury is like a car with a slow puncture. The tyre requires continuous attention to keep working. Over time, if it is not fixed, it will let you down. Just like carrying an injury, if you only do the minimum to keep playing, it will get worse and eventually, you will have no choice but to stop. This can mean significantly more recovery time. In addition, the player will not have full confidence in themselves to compete at their full potential and neither will the coach or team mates.

The role of sports maintenance should not be under stated. When you compare sports such as formula 1 or horse racing to the local soccer or tennis player you can guess which sports have the best maintenance care. Once a racing car finishes a race, it will have a team of mechanics go over it checking for faults, damaged parts etc. A race horse will be inspected by its rider, owner and vet following an event. Compared to the local soccer or tennis player, they more than likely will have a shower and maybe use an ice pack if they feel sore. The most important piece of sports equipment, no matter the sport, is the sports person themselves. Similarly to other pieces of equipment, they deserve to be maintained regularly.

This is where the sports therapist can be of significant assistance. By explaining to the sports person and their coach that it is far better to have a player injury free for a game or event. To have both the sports person and the coach fully confident in the ability of the sports person to perform to their best, is the way to go. The sooner a sports person presents for treatment for an injury, the sooner they will recover.

There are times when the therapist does not have contact with nor permission to discuss an injury with the coach. This can be a difficult situation to manage and it would require a second article to discuss.

Having identified some of the causes of injury it is always important to give suggestions to reduce or eliminate those factors.

Here are some suggestions.

Impact & Falls: During training, where possible use playing surfaces that are not too hard, rough or slippery. Be aware of obstacles on or close to the playing area. Ensure players are wearing appropriate safety equipment where necessary.
Change of Intensity: Too much too quickly. In an effort to increase stamina or fitness players can be exposed to unrealistic targets. Remember the body requires time to adapt to changes in intensity. Not allowing for this adaptation can result in strain.

Overuse: Continuous repetition of an action without allowing time for recovery leads to injury. Variety of training and allowing sufficient recovery time will avoid overuse injury.
Improper Equipment: Check and ensure all personal equipment is safe and appropriate for use. Does the equipment do what it is supposed to do? Check playing surfaces.
Poor Warm-up: Ensure an adequate warm-up is done prior to commencing training or event. Watch for players missing parts of the warm-up.
Fatigue: Once a player becomes fatigued, they are at a greater risk of injury. They no longer have the physical fitness nor focus to be able to complete the necessary skills of their sport. A player suffering from fatigue should be rested.
Stops, changes in direction and twisting: Where sports require stopping and twisting, ensure there is appropriate training and drills to prepare the body for the forces involved in stopping, changing direction and twisting.

Poor technique: Having proper technique can reduce energy usage, reduce wear and tear on the body and reduce the effort required. When a player has not mastered the proper technique for the skills of their sport, they have increased energy usage, increased wear and tear on their bodies and increase the effort required. This can lead to early fatigue and the possibility of injury. Technical training should be a pillar of training sessions.
Unilateral movement: If a player constantly has the same movement pattern during their sport, they are basically working into repetitive strain. This can be a difficult factor to correct, depending on the sport, however multi-directional movement patterns should be encouraged. This can be accomplished during training sessions, active rest or rehabilitation programmes.

In addition to the factors listed above, we must consider rest. Everyone requires downtime. Sometimes, we can forget how active we are. I have had many occasions when I was treating a child or young person and during the consultation with their parent, I discovered that the child or young person was involved in multiple sports on nearly every day. Sometimes they has two sports on the same day. In some of these cases it was the multitude of activities that had caused the injury. I have asked the question, when is their rest day? In an effort to be active and healthy, a good diet, good hydration and an active lifestyle is beneficial. A fit and healthy child is a good thing, but are there times when the “dosage” is wrong? This does not only affect children and young people, but it also affects adults. Sports therapists should always encourage rest for recovery following an injury. This may even take the form of active rest if the therapist thinks it would be suitable.

In Summary, the role of the sports therapist can go beyond the treatment couch. Working with sports people, teams and coaches, the sports therapist can offer advice, corrective exercises and prehabilitation plans to help reduce the onset of injury and keep players playing.

A major part of the advice given is the benefits to sports players of maintenance treatment. Reducing the physical stresses of the sport on the players body and stopping the onset of a repetitive strain injury in its tracks can be vital to a serious sports person. In addition, informing the sports person of the importance of having minor injuries treated before they become major injuries will prevent that player being the “slow puncture” on the team.

Finally, the importance of rest for recovery and in general having rest days will greatly reduce wear and tear on the body and give it the time it requires for repair and adaption.

Dr. Neil Sheehan MISCP, MMedSE, PhD.

About the author:

Dr. Neil Sheehan is a Chartered Physiotherapist and President of the International College of Orthopaedic Therapy. He is author of “Orthopaedic and Manipulative Therapy. A Practical Guide for Students”, which is available on Amazon.

Neil is also involved in coaching gymnasts for the past 40 years and is a former National Coach.