How to Prevent Sports Injuries
- Nazan Garcia
- Sep 20
- 6 min read
Updated: Oct 14
Sports injuries are an inherent risk for athletes and fitness enthusiasts alike. Defined as damage to the tissues of the body resulting from sport or exercise (Bahr and International Olympic Committee, 2012), these injuries can broadly be classified into two categories: acute injuries and overuse injuries. While acute injuries tend to have a sudden onset with an identifiable cause, overuse injuries are more insidious, developing gradually over time and often presenting unique challenges in prevention and management.
Acute Injuries: Fast and Furious
Acute injuries occur suddenly and have a clear, identifiable cause. Examples include fractures, sprains, and dislocations, which typically result from a single, forceful event that exceeds the tissue’s capacity to withstand deformation or stress (Bahr and International Olympic Committee, 2012). These injuries are often dramatic, requiring immediate attention, and may involve significant pain and visible signs like swelling or deformity.
In most cases, the management of acute injuries involves immediate care to reduce further damage and manage symptoms, followed by a structured rehabilitation programme. This approach is essential for minimising long-term consequences and ensuring a safe return to activity.
Overuse Injuries: Slow and Steady
In contrast, overuse injuries develop gradually without a specific identifiable event triggering their onset (Franco et al., 2021). They exist along a spectrum, where initial damage occurs below the threshold for clinical symptoms. If the contributing factors are not addressed, the accumulation of microtrauma eventually results in clinical symptoms and noticeable tissue damage (Bahr and International Olympic Committee, 2012).
Overuse injuries stem from repetitive microtrauma and inadequate recovery, with tissues failing to repair adequately under continued stress (Franco et al., 2021). A notable concept is that all tissues have a characteristic ability to tolerate deformation and stress, and injuries occur when this tolerance is exceeded. While acute injuries result from a singular event, overuse injuries arise from repeated overloading without sufficient recovery time (Bahr and International Olympic Committee, 2012).
The gradual nature of overuse injuries often makes them difficult to detect early. Athletes may continue training despite minor discomfort, inadvertently exacerbating the condition. Early intervention, including adjustments to training load and recovery practices, is crucial in preventing these injuries from progressing.
Training Load and Injury Risk: Finding the Sweet Spot
The concept of training load plays a pivotal role in both injury risk and athletic development. Training load refers to the cumulative stress placed on an athlete’s body through physical activity. When managed appropriately, it drives adaptation, improving strength, endurance, and overall performance (Bahr and International Olympic Committee, 2012). However, when training loads are excessive or poorly distributed, they can lead to training load errors—mismatches in workload that result in overuse injuries.
Training load errors often occur when athletes train “too much, too often, too quickly, and with too little rest,” exceeding the tissue’s ability to adapt (Bahr and International Olympic Committee, 2012). For example, a runner increasing mileage by more than 10% per week is at higher risk of injury due to the rapid increase in mechanical stress. Recognising and addressing these errors is essential to preventing injuries and ensuring long-term performance.
The Acute-Chronic Workload Ratio tool
The acute-chronic workload ratio (A-C ratio) is a useful tool for monitoring an athlete’s workload. Acute workload refers to short-term training volume, while chronic workload measures long-term trends. A ratio of 1.5 or higher indicates an increased risk of injury, while maintaining a balanced ratio ensures readiness and reduces the likelihood of injury (Divya G and Mukunda, 2024). Properly applying the A-C ratio can help athletes strike a balance between achieving peak performance and avoiding injury.
The A-C ratio highlights the importance of balancing training intensity and recovery. When acute workloads spike dramatically relative to chronic workloads, tissues are placed under excessive stress, increasing the likelihood of overuse injuries. By maintaining consistent and moderate training loads, athletes can protect themselves from unnecessary harm while ensuring optimal performance.
Injury Risk: The Boom-Bust Cycle
Athletes frequently fall into a “boom-bust cycle,” wherein they attempt to compensate for lost training time by rapidly increasing their workload. This abrupt spike in activity often leads to injury or illness (Gabbett et al., 2016a; 2016b; Aschwanden, 2019). Maintaining consistent training loads and gradually increasing intensity is critical for injury prevention.
The term "training load error" emphasises the avoidable nature of these mismatches. However, some critics argue it oversimplifies a complex phenomenon, focusing too heavily on measurable metrics and ignoring other contributing factors such as recovery practices, biomechanics, and psychological influences (Kalkhoven, Coutts, and Impellizzeri, 2020). Despite these debates, the consistent message remains clear: gradual and intentional training progression is the cornerstone of injury prevention.
Injury Prevention: Balancing Intensity with Recovery
Moderate, consistent training loads offer protective benefits against injury. Athletes returning from off-season breaks should ramp up their training gradually to avoid injury due to deconditioning (Gabbett et al., 2016b). The term “overuse injury” can be misleading, as it may encourage unnecessary reductions in training load, potentially resulting in further deconditioning and higher injury risk during competition (Drew and Purdam, 2016; Divya G and Mukunda, 2024).
To mitigate risks, athletes and coaches should prioritise progressive training plans that allow for adequate recovery. Incorporating rest days, cross-training, and monitoring physical responses to training are effective strategies. It is equally important to educate athletes about the risks associated with both undertraining and overtraining, helping them understand how to maintain a sustainable balance.
The Hidden Complexity of Sports Injuries:
When Biomechanics, Psychology, and Environment Collide
The causation of sports injuries extends beyond training load. Modern research highlights the need for a complexity perspective, considering the interplay of biomechanical, physiological, social, psychological, and environmental factors (Fonseca et al., 2020). For instance, hamstring injuries result from interactions between flexibility, strength, fatigue, and even psychological factors like stress or inadequate sleep.
Practitioners often adopt a reductionist approach, focusing on singular risk factors or injury mechanisms for simplicity. However, this method overlooks the dynamic and evolving nature of injury causation (Tee, McLaren, and Jones, 2020). Effective prevention strategies must be adaptable and iterative, taking into account the unique and continuously evolving contexts in which injuries occur.
Conclusion
Understanding the intricate balance between training load, recovery, and the multitude of contributing factors to injury causation is essential for athletes, coaches, and medical professionals. By acknowledging the complexity of sports injuries and avoiding oversimplified explanations, we can develop more effective strategies for prevention and recovery, enabling athletes to achieve their full potential safely.
As our understanding of sports injuries evolves, embracing a holistic approach that accounts for the dynamic interactions of various risk factors will become increasingly important. This perspective not only enhances injury prevention but also fosters a culture of sustainable and informed athletic performance. The road to resilience lies in recognising the value of consistency, gradual progression, and the careful consideration of the many forces at play in the human body.
References:
Aschwanden, C., 2019. Good to go: what the athlete in all of us can learn from the strange science of recovery. First edition ed. New York: W.W. Norton & Company.
Bahr, R. and International Olympic Committee eds., 2012. The IOC manual of sports injuries: an illustrated guide to the management of injuries in physical activity. Chichester, West Sussex, UK ; Hoboken, NJ: Wiley-Blackwell.
Divya G and Mukunda, 2024. Overuse Injury versus Training Load Error: A Systematic Narrative Review Comparing the Terminology Accuracy. Indian Journal of Physiotherapy & Occupational Therapy - An International Journal, 18(2), pp.36–44. https://doi.org/10.37506/825z2307.
Drew, M.K. and Purdam, C., 2016. Time to bin the term ‘overuse’ injury: is ‘training load error’ a more accurate term? British Journal of Sports Medicine, 50(22), pp.1423–1424. https://doi.org/10.1136/bjsports-2015-095543.
Fonseca, S.T., Souza, T.R., Verhagen, E., Van Emmerik, R., Bittencourt, N.F.N., Mendonça, L.D.M., Andrade, A.G.P., Resende, R.A. and Ocarino, J.M., 2020. Sports Injury Forecasting and Complexity: A Synergetic Approach. Sports Medicine, 50(10), pp.1757–1770. https://doi.org/10.1007/s40279-020-01326-4.
Franco, M.F., Madaleno, F.O., De Paula, T.M.N., Ferreira, T.V., Pinto, R.Z. and Resende, R.A., 2021. Prevalence of overuse injuries in athletes from individual and team sports: A systematic review with meta-analysis and GRADE recommendations. Brazilian Journal of Physical Therapy, 25(5), pp.500–513. https://doi.org/10.1016/j.bjpt.2021.04.013.
Gabbett, T.J., Hulin, B.T., Blanch, P. and Whiteley, R., 2016a. High training workloads alone do not cause sports injuries: how you get there is the real issue. British Journal of Sports Medicine, 50(8), pp.444–445. https://doi.org/10.1136/bjsports-2015-095567.
Gabbett, T.J., Kennelly, S., Sheehan, J., Hawkins, R., Milsom, J., King, E., Whiteley, R. and Ekstrand, J., 2016b. If overuse injury is a ‘training load error’, should undertraining be viewed the same way? British Journal of Sports Medicine, 50(17), pp.1017–1018. https://doi.org/10.1136/bjsports-2016-096308.
Kalkhoven, J., Coutts, A.J. and Impellizzeri, F.M., 2020. ‘Training load error’ is not a more accurate term than ‘overuse’ injury. British Journal of Sports Medicine, 54(15), pp.934–935. https://doi.org/10.1136/bjsports-2019-101710.
Tee, J.C., McLaren, S.J. and Jones, B., 2020. Sports Injury Prevention is Complex: We Need to Invest in Better Processes, Not Singular Solutions. Sports Medicine, 50(4), pp.689–702. https://doi.org/10.1007/s40279-019-01232-4.
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