Injury Prevention or Performance Enhancement?

Mick Hughes is a Physiotherapist at The Melbourne Sports Medicine Centre and writes a regular blog on exercise and conditioning. Here is some of his latest work.

Earlier today I posted about the financial cost of sporting injuries to teenage kids in Victoria between 2004-10. It's scary. REALLY, SCARY. The economic cost to the public health system was $265 million in a 7-year period on ALL sports injuries, including $110 million on lower limb injuries alone! And that is just the state of Victoria. I hate to think what all states combined would be. But what is more scary - which isn't counted in this figure - is the financial cost to both the individual (surgery, physio, time off work) and the healthcare system (surgery, medical resources) in the future. Its concerning because the stark reality is - previous sports injury can be a predictor of future osteoarthritis (OA) (reference). 

OA unfortunately progresses as we get older, and for some, the end result for severe (OA) is joint replacement. Joint deterioration has been shown in a 20-year follow up study on Anterior Cruciate Ligament Reconstruction (ACLR) patients, with 42% showing varying degrees of knee OA changes in their ACLR knee compared to their uninjured side (reference). Not only that, self - reported quality of life outcome measures and strength measures declined significantly over 5 years. The disturbing thing is, the average age of these patients is only 45!

I know I bang on about ACL injuries a fair bit, but they are one of the most common injuries in a very high risk age group - the 14 - 25 year-old age group who play sport. For females, the high risk group is 14-18 year-olds. For males, it is the 19-25 year-olds (reference). Unlike an ankle sprain or a muscle strain however, the problem with ACL injury is that it often results in surgery and a very lengthy time away from sports participation.

Now if you saw my last blog on ACL injuries, you'll remember that only 50% of people that have ACLR surgery return to their previous level of sport. This is concerning because, in my honest opinion, teenagers and young adults should be running around, having fun, playing sport and not worrying about if their ACLR is going to fail. It is no secret that decreased physical activity often results in weight gain and generalised deconditioning of the cardiovascular and muscular systems for which the knee relies upon. This sparks a vicious negative cycle where further decreased physical activity and generalised deconditioning can lead to further weight gain and increased loads across the knee joint, further exacerbating potential OA changes.

What really makes me concerned about this unfortunate sequence of events is the fact that a large portion of ACL injuries are preventable. In fact, a large percentage of all lower limb injuries are preventable. Here are some facts:

  • Between 50-80% of all non-contact ACL injuries can be prevented with injury prevention programs in adolescent females (reference)
  • Exercise-based injury prevention programs significantly reduced all sporting injuries in adolescent males and females (reference)
  • In community-based men's AFL, total knee injuries were reduced by 50% and all lower limb injuries were reduced by 22% with injury prevention programs carried out in pre-season and competition training sessions (reference)
  • The FIFA 11+ injury prevention program decreased injury rates by 46% and decreased time loss to injury by 28% (reference)

Any before you say "Here we go, Mick's on his high horse about injury prevention again. It's easier said-then-done old man". I get it, injury prevention isn't sexy. Never has. Never will be...In this 14-30 year-old population, who are apparently 10-foot tall and bulletproof, the message doesn't seem to be getting across. I think we need to be selling it differently, to not only the player, but the coach and the parents.

Maybe we need to sell it as "Performance Enhancement". Instead of saying to the player, "Do this exercise. It will stop you from spraining your ankle". Tell the player, "If you do this exercise, you'll run faster or you'll jump higher". And the fact is, we won't be lying to them. They will run faster. They will jump higher. But they'll also have a reduction in their chances of injury (reference).

The other key stakeholders that we need to sell this to are the coaching staff and the parents. For the coaches, it doesn't take much to implement these programs. These above-mentioned programs implemented in AFL and soccer only take 15-20mins to carry out, 2x per week. It may add a little extra time to the planned session, but you'll benefit too. How? Because with lower injury rates, this means you'll have more players to choose from (or the more skilled players being available for selection), more team cohesion and a better chance of winning.  The evidence is very clear on this – lower the injury rates = greater team success

For the parents, we just need you to encourage and support these programs if they have to do them outside of training hours due to training time constraints.

So if you're a GP, sports doc, physio, exercise physiologist, strength and conditioning coach, team coach, mother, father or guardian and you're reading this, it is up to us to do something about it now. Not only because that $285 million figure that I quoted at the start, is only going to start blowing out in the next 10-20 years if things don't change soon but  also this unfortunate sequence of events could affect a young person in your care.

  • That will do for today and I hope you got something useful out of this blog. Please share this one widely. I feel very strongly about this topic, and the more that we can educate coaches, parents and children and change their perception of "injury prevention" to a perception of "performance enhancement", the more I think we will see decrease injury rates, decreased burden on the healthcare system and improved quality of life now and in the future for these kids

Rant over.........

Mick Hughes, Physiotherapist.

To arrange an appointment to see Mick, please phone 9650 9372 or book online.