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Injury Resistance- Practice Like you Play

Injury in sport can happen to anyone.  As speed and impact increase in higher level competition, so does the likelihood of injury.  This is why, in most sports, injuries are more likely to happen (and to require surgery) during competition rather than practice (Nagle, et al).  This should intuitively make sense to anyone who has ever experienced the difference between practice and competition speed.  Other findings in the scientific literature show the association between injuries in competition and time on the game clock.  As neural, cardiovascular, and local muscular fatigue set in, dynamic joint stabilization and protection can suffer, ultimately, leading to a deterioration in movement accuracy and control.  So, as the game progresses and athletes are getting tired, the likelihood of injury can increase (Nagle et al).

It goes without saying that as athletes (current or former), we must prepare our bodies for the demands that will be placed on them in competition or even in our general recreation.  To boil it down further, nothing should shock the body in competition—or perhaps the saying “you play like you practice” states this more succinctly.  This is an important consideration and one that the physical therapists at OPTI are working to implement as comprehensively as possible.  Research has already established the increased likelihood of a subsequent ACL injury following the initial one (Paterno et al).  This could be a matter of too fast of a return to sport timeline, missed or ignored deficits, psychological elements such as confidence, or even just inadequate conditioning as mentioned previously.  Patients, MD’s, physical therapists, trainers, and coaches must work together to determine when full competition is appropriate after any injury—and here are some things to consider:

  • Is the original injury fully resolved (no swelling, pain, or joint restriction lingering at rest or reactively to activity)?

 

  • Is muscle strength adequate? Does the uninjured limb serve as a good comparison for baseline strength and neuromuscular control?  In other words, did it become weak or deconditioned over the course of the athlete’s recovery, and if so, has it been restored before being used for comparison?

 

  • Is the conditioning level appropriate? In considering this we should consider the demands of the sport.  What elements of conditioning are needed to perform well, and has the athlete been trained in this manner?  Do we need to consider true muscular strength?  Power?  Muscular endurance?  Aerobic capacity?  As stated previously, if an element of an athlete’s conditioning is absent or subpar, return to sport early can be a recipe for disaster.

 

  • What does practice look like? Practice is important for the development of fundamentals and coordinating team play to improve execution.  But does practice truly simulate competition?  Is the athlete getting enough reps (in a gradually progressive manner through graded exposure) that are reaching the level that will be seen in competition in terms of intensity, variability/reaction, and intensity x duration to assess fitness level.

Novelty and fatigue seem to be consistent elements to injury and re-injury rates.  Fitness level aside, if an athlete is truly exposed to game intensity, game situations and movements, and game duration in practice, then it can be assumed they will be more injury-resistant.

If you have any questions, please feel free to contact Omaha Physical Therapy Institute!

Matt Vetter, PT, CSCS

 

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435151/

https://bjsm.bmj.com/content/bjsports/36/5/354.full.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205204/

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