Could my injury have been prevented?
This is a question I hear a lot working as a physical therapist. It is also a very difficult question to answer.
Not all injuries can be prevented. There are just too many variables in playing sports that influence injury. I do believe, however, that you can reduce your risk of injury, potentially preventing one that might otherwise happen in the future.
Different sports will present higher risk for certain types of injuries. For example, baseball players are more likely to injure their upper extremity as opposed to female soccer players who have a higher risk of injuring their ACLs. This article, however, is going to discuss a generalized risk assessment for injury across different ages and different sports. In this post, you will learn:
Factors that influence your chances of getting injured
How psychological factors can play a role in injury
How to assess personal risk of injury
How to decrease risk of injury
Risk Factor That Influence Your Chances of Getting Injured
Previous Injury
There are numerous factors that influence your risk of injury but the single greatest predictor of future injury is whether or not you have had a previous injury. The easiest example I think most people can relate to is recurrent ankle sprains. I know this is something I dealt with growing up through youth and high school sports. I first rolled my right ankle in third grade at basketball tryouts. I took 1-2 weeks off and returned to playing but it seemed every year during basketball season I would end up spraining that ankle again.
Why is that?
I believe there are two reasons that are very closely related to each other. First, there are changes that occur in how we move after experiencing an injury. The motor control of our muscles, limbs, and joints is altered not only at the site of injury, but also elsewhere in the body. In the example of chronic ankle sprains, there is a delay in muscle firing patterns seen at the hip and knee in those with recurrent sprains. The injury at the ankle alters how we move proximally at the hip and knee. Because we see changes in how the body moves after injury, the importance of a structured rehabilitation program is paramount.
This leads us to the second reason why people are more likely to get injured after an initial injury: we are not thorough enough in the evaluation, treatment, and most specifically discharge testing of injured athletes. I know I can speak personally about this. I feel confident in my ability to evaluate and treat, but I know I have been lacking in true discharge performance testing to determine whether or not someone is ready to return to sport. Fortunately, I have learned as a clinician and now know the importance of a thorough discharge evaluation.
Movement Capacity and Pain
Other factors that influence injury are what I like to describe as someone’s “movement capacity” and whether or not someone experiences pain with movements. Movement capacity refers to how capable a person is at performing numerous movements. There are many different ways to test this, but most involve having someone perform foundational, sport-specific movements and giving them an overall score based on how well they are able to do the movements.
There are numerous movement assessments out there but they all generally follow the same guidelines. The movements involve the upper extremity, lower extremity, and trunk, and test the strength, flexibility, mobility, balance, and stability of each body part. They often involve forward bending, backward bending, overhead movements, squats, and lunges. You are given a score for each movement which is summed together to give you a composite score. Pain automatically qualifies you for the lowest score of each movement. If you are able to perform the movement with compensation, you get a lower score than if you are able to perform the movement without compensation.
Besides a cutoff score, pain with any one of the movements increases your risk of injury. This makes sense when you couple it with a low composite score. Pain with movement generally will be scored as a 0, leading to a lower composite score. We also know pain alters how you move not only at the site of pain, but elsewhere in the body. If you have pain with sport-specific movements in a controlled environment, you’re likely to have pain while playing which alters how you move and increases your risk of injury.
Sleep
Sleep not only is essential for health and well-being. The amount of sleep you get each night plays a role in your ability to perform at peak levels and how likely you are to get injured.
In a younger population (grades 7-12), sleeping an average <8 hours per night increased their risk of injury by 1.7x compared to those who slept ≥8 hours per night. That is almost double the risk of getting injured. In a military cohort where the population was mainly men under the age of 35, those who slept on average ≤4 hours per night were 2.35x more likely to injure themselves compared to those who slept ≥8 hours per night.
This again stresses the role of sleep and how essential it is for you to get a good night’s sleep to remain healthy and reduce your risk of injury.
Psychological Factors
Your perception of yourself and pain also play a role in your risk of injury. The Single Assessment Numeric Evaluation (SANE) is a simple, two-question test that asks you about your perceived recovery after an injury. You rate your perceived function of the injured area from 0% to 100%. Scoring ≤92.5% puts you at increased risk for future injury.
Fear-avoidance beliefs are also associated with higher pain intensity and disability. If you are afraid to move it will not only affect your rehabilitation, it will affect how you move and perform.
Fear of movement is totally normal and expected after a significant injury. There are a lot of psychological components involved with the injury and rehabilitation process. It is important for both athlete and therapist to know if you are not mentally ready to get back to sport. Faking it will not help you either. Putting yourself out there before you feel truly ready only increases your risk of injury.
An Algorithm to Determine Injury Risk
In a clinical setting, we have several different tools and test kits that we use for discharge testing and injury screening. Since most people don’t have those things lying around at home, I wanted to give you something you can do at home without having to purchase any equipment. This is by no means an all-inclusive test, but it should give you a better understanding of how at-risk you are of injury. The goal of this self-assessment is not to give you a specific percentage of risk for injury, but just a general overview of where you stand and what you can improve on.
Sleep assessment
Are you sleeping ≥8 hours per night on average?
Yes: lower risk for injury (score: 0)
No: increased risk for injury (score: 1)
SANE Score
“How would you rate your affected joint/region of interest today as a percentage of normal (0% to 100% scale with 100% being normal)?”
≥92.5%: lower risk for injury (score: 0)
<92.5%: increased risk for injury (score: 1)
The Tampa Scale of Kinesiophobia (https://orthotoolkit.com/tampa-scale/)
Complete this 17-item questionnaire to determine your degree of kinesiophobia
Scores closer to 17 indicate a lower degree of fear
Scores closer to 68 indicate a higher degree of fear
Movement Assessment (score each movement 0 (no pain) or 1 (pain))
Forward Bending
reach forward and try to touch the ground in front of your toes
Squat
fold your arms across your chest and bring your elbows up to shoulder height, squat as low as you can
Single-leg reach
Pick one leg up and straighten your knee, bend your stance knee and reach forward to touch your heel on the ground as far as you can in front of you
Forward Lunge
Keeping your trunk upright, step one foot forward and bend your knees until your back knee touches the floor, return
Lateral Lunge
Keeping your trunk upright, step sideways and bend your knee, keep the stance leg knee straight, return
Rotation
stand with toes forward and turn to look behind you as far as you can, hold for one second
Overhead Reach
keeping your elbows straight raise both arms above your head
Push-Up
either on the ground of elevated surface, push your body away until your elbows are straight
Pull
start with your elbows straight and arms out in front of you, bend your elbows and pull you arms backward
Note: You will not be able to score yourself for movement quality. You would need a trained eye (ideally mine) to assess your movement quality and determine if you can actually complete the movement correctly or have any compensations.
Quantifying Your Risk of Injury
This is by no means predictive of injury, but I do think it will give you a good idea of certain risk factors you may have that influence your chance of injury. To calculate your score, add up all of the numbers from each category. The lowest number you can score would be 17, indicating you have few risk factors for injury. The highest number you can score is 79, indicating you have numerous risk factors for injury.
Injuries are something that unfortunately most of us will go through at some point during our athletic careers. Not all injuries can be prevented, but there are things you can do in order to decrease your risk. Sleep, not being afraid of movement, and improving your movement capacity are all ways to not only decrease your chances of getting significantly injured, but also a great way to improve your performance.
If you are curious about your risk for injury, try the simple test at home to get a good idea of where you stand. If you want a more specific, detailed assessment or are overcoming injury and want to go through thorough return to sport evaluation, schedule an appointment with us today.
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