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Chapter 4
SPORTS-INJURY PREVENTION
I. Causative Factors in Injury. Causative factors of sports injuries must be identified before
developing a well-planned injury prevention program.
A. Two general categories of causative factors have been proposed.
1. Extrinsic factors include equipment, environment, type of activity, and
conditioning errors.
2. Intrinsic factors include athlete’s age, gender, body size, injury history, fitness
level, muscle strength, skill, and psychological status.
3. Specific intrinsic risk factors by body area: upper extremity—ligamentous laxity,
tight shoulder muscles, and shoulder girdle weakness; lower extremity—tight/weak
hamstrings, weak lower extremity muscles, joint malalignments, and poor stretching
and muscular conditioning.
II. Intervention Strategies
A. It is the responsibility of all members of the sports medicine team to identify causative
factors before an injury occurs. Extrinsic factors such as faulty equipment or dangerous facilities are
easily recognized. Athletes engaged in high-risk sports must be educated about hazards and
prevention strategies.
B. Both the NCAA and the NFHS have developed and implemented guidelines for medical
evaluations of student athletes.
1. NCAA guideline 1B requires a pre-participation physical evaluation (PPE) upon
entrance into the institution’s athletic program. Thereafter, only an updated medical history is
required, unless an additional medical examination is warranted based on the updated history.
2. NFSH policy states that “prior to the first year of participation in interscholastic
athletics, a student shall undergo a medical examination and be approved for interscholastic athletic
competition by the examining medical authority.”
C. The need to develop these guidelines resulted from the dramatic increase in the number
of participants and the fact that our society has become more litigious.
1. The primary purpose of a PPE should be to identify preexisting injury risk factors
as well as to ascertain any injuries or diseases that represent potential problems for the student
athlete.
D. Typically the PPE is administered by a licensed physician, although not all states require
that a physician conduct the exam.
1. Commonly identified problems include spina bifida occulta, the absence of one of
a paired set of organs, as well as postural problems, obesity, high blood pressure, cardiac
defects/disorders, allergies, and skin infections.
2. The two PPE formats are office-based and station-based screening.
a. Station-based screening is useful for evaluating large numbers of athletes.
b. Office-based screening works well when the physician is familiar with the
athlete’s medical history, but it costs more than station-based screening.
c. All information obtained during a physical exam should be handled to
protect the athlete’s confidentiality.
E. Although many school districts require a PPE annually, increasing health care costs may
require an updated physical exam whenever the child begins a new level of competition. A
physician should make a complete physical evaluation when a child has recovered from a serious
injury.
1. The American Academy of Pediatrics (AAP) and five other consensus groups
recommend athletes receive a PPE biannually or when an athlete enters Middle/High
School or transfers to another school. All athletes should receive annual updates that
include a comprehensive history, height, weight, and blood pressure.
III. Injury Prevention and Preseason Conditioning. Many intrinsic risk factors can be modified with
an effective conditioning program. A fit athlete is less likely to suffer an injury.
A. The two primary components of a conditioning program are general conditioning and
sports-specific conditioning.
1. General conditioning focuses on aerobic fitness, muscular strength and endurance,
flexibility, nutrition, and body composition.
2. Sports-specific conditioning focuses on all aspects of the particular sport that are
unique to it.
B. Aerobic Fitness. Aerobic fitness, or power, is the amount of work that can be
accomplished using the oxidative system of converting nutrients into energy. Continuous activities
that last a minute or longer use aerobic power for muscle energy.
1. Aerobic fitness can help athletes avoid injuries that result from general fatigue.
2. Aerobic fitness can be increased by regular participation in running, bicycling,
swimming, cross-country skiing, in-line skating, etc. Athletes who are not participating in an
aerobic sport should include aerobic training at least 3 days per week.
C. Muscle Strength, Power, and Endurance. Muscle strength can be defined as the
maximum amount of force that can be produced in one repetition. Muscle power can be
defined as the “time rate of performing work.” In most cases, muscle power is more
important to performance than strength because performance is often time dependent.
Muscle endurance is defined as the ability to sustain muscle activity. Weight training
improves muscle strength, power, and endurance.
1. Different types of weight training involve manipulating training volume, intensity,
and frequency. Moderate- to high-intensity training requires 24 to 48 hours for full recovery and to
avoid overuse injury.
2. Periodization is the process of arranging training around specific goals and
objectives with predetermined amounts of time spent training and resting. Periodization tailors the
training program to meet the athlete’s specific needs and maximize performance.
3. Strength training improves muscle strength, reducing the risk of injury.
Connective tissues become stronger, and bone density increases; bone becomes less susceptible to
trauma and fracture that can result from overuse. Additionally, strength ratios between opposing
muscle groups improves and increased muscular endurance can occur.
4. Flexibility is defined as “the range of motion (ROM) in a given joint or
combination of joints”; research indicates improved flexibility reduces the incidence of
musculoskeletal injuries.
a. Tissue temperature, bone structure, tissue mass, age, and gender all help
determine flexibility.
b. Two types of flexibility are static and dynamic flexibility. Static flexibility
involves the ROM achieved through passive manipulation of a given joint by another person while
muscles are relaxed. Dynamic flexibility is the ROM achieved by contracting muscles around the
joint.
c. Stretching exercises improve extensibility of muscle tissue and can prevent
muscle strains.
d. The four types of stretching exercises are ballistic, static, proprioceptive
neuromuscular facilitation (PNF), and passive stretching. Ballistic stretching involves powerful
contractions of muscles to force a joint to a greater ROM. Static stretching involves moving a joint
to a position of stretch that is sustained from 3 seconds or longer. Proprioceptive neuromuscular
facilitation uses the body’s proprioceptive system to stimulate muscles to relax. Passive stretching
involves having someone other than the athlete move the joint. Ballistic stretching is the least
effective method and not recommended because it may result in injury. Static stretching is probably
the most effective stretching method.
5. Nutrition and Body Composition. The body will respond better to any
conditioning program when adequate amounts of nutrients are consumed. Coaches, parents, and
athletes must take care to avoid an over-emphasis on leanness.
6. Periodization is the “organization of training into a cyclic structure, to attain the
optimal development of an athlete’s performance capacities.” Periodization is achieved by
manipulating the frequency, intensity, and duration of exercise and helps prevent training-induced
injury. Hypertrophy of leg muscles is an example a specific training goal that can be achieved by
periodization.
a. Most programs developed around a one-year training cycle, the
macrocycle. A microcycle, the smallest component of the training cycle,
consists of 2 to 4 weeks of specific training. The mesocycle consists of
several successive microcycles leading to a specific goal. The transition
phase is a 2 to 4 week period between training seasons or between
successive mesocycles.
D. Modification of Extrinsic Factors. Coaching personnel and administrators must monitor
these factors to identify and eliminate any potential risks.
1. Practice/ Competition Environment. Whether an activity is outdoors or indoors,
the environment must be assessed to determine if it represents a potential health risk, especially
when athletes exercise in relatively high heat and humidity.
2. Facilities. All sports facilities must be designed, maintained, and frequently
inspected for the safety of participants. For example, integrity of safety fences, batting cages,
location of dugouts in baseball/softball, types of bases used, soccer goal construction, location of
water and sanitation facilities, and EMS access routes.
a. With respect to indoor facilities, the primary safety concerns involve
lighting, playing surfaces, room dimensions, and locker rooms. Medical equipment such as
whirlpool baths and other therapeutic modalities should not be available for use in locker rooms.
3. Protective Equipment. Such equipment plays a vital role in prevention of injuries.
REVIEW QUESTIONS
1. Differentiate between intrinsic and extrinsic types of causative factors leading to sports injury.
Provide several examples of both.
Answer: Extrinsic factors include equipment, environment, type of activity, and conditioning errors.
Intrinsic factors include age, gender, body size, history of illness, fitness, muscle strength,
ligamentous laxity, skill, psychological status, and perhaps even overall intelligence.
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2. List four types of intrinsic factors related to sports injury that a medical doctor might identify
during a preparticipation physical examination.
Answer: Injuries to:
1.) Cervical spine
2.) Upper extremities
3.) Lumbar spine
4.) Lower extremities
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3. What are two disadvantages to using an individual format for a preparticipation physical
examination?
Answer: Cost; some physicians lack a thorough understanding of sports injuries
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4. List the seven components of fitness as described in the chapter.
Answer: Aerobic fitness, muscle strength, power, endurance, flexibility, nutrition and body
composition.
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5. Briefly describe the relationship between volume, intensity, and frequency of training as they
relate to periodization.
Answer: The smallest component (of periodization) is called a microcycle, which consists of 2 to 4
weeks of training with fluctuations in intensity, duration (volume) and frequency.
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6. Define the terms macrocycle, mesocycle, and microcycle as they relate to a sports training
program.
Answer: The periodization model includes several components that represent increasingly smaller
units of training time. The largest unit is known as a macrocycle and typically encompasses one
calendar year. The macrocycle can then be divided into smaller units known as mesocycles, which
last from several weeks to a month or more. The smallest component is called a microcycle, which
consists of 2 to 4 weeks of training with fluctuations in intensity, duration, and frequency.
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7. True or False: According to the chapter, athletes, regardless of sport, can benefit from possessing
a relatively high level of aerobic fitness.
Answer: True. In short, regardless of the sport, athletes who enter the season with a high level of
aerobic fitness are less prone to injury.
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8. What is the meaning of the acronym ROM.
Answer: Range of motion
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9. Discuss the advantages and disadvantages of the four categories of stretching exercises.
Answer: Some research indicates that, when comparing these techniques, static stretching is
probably the most effective, with effects lasting up to 90 minutes. Evidence suggests that the best
time to use static stretching is at the end of a workout when the tissues are warmer due to increased
blood flow. Ballistic stretching is considered the least effective method and may even result in
injury. The medical evidence is overwhelming in discouraging the use of ballistic forms of
stretching.
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10. True or False: Athletes in high-risk sports should be informed of the potential hazards and
prevention strategies.
Answer: False. Athletes must be informed about hazards and prevention.
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11. What injury risk factors may be present in the upper extremity?
Answer: Ligamentous laxity, tight shoulder muscles, and shoulder girdle weakness all increase risk
for injury.
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12. What injury risk factors may be present in the lower extremity?
Answer: Tight, weak hamstrings, weak lower extremity muscles, joint malalignments, and poor
stretching and muscle conditioning were all identified as risk factors.
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13. What are the two basic formats for preparticipation physical exams? Which is the ideal format?
Answer:
1.) The athlete’s personal physician performs the PPE in the physician’s office.
2.) The “coordinated medical team” approach, which accommodates groups of athletes in one
session. The ideal option is the first option.
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14. What advantages does the “coordinated team approach” have over the personal physician exam?
Answer: Possible cost savings for the athlete, a provision for athletes who do not have a personal
physician, and the opportunity to involve other health care professionals in the PPE.
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15. How often should PPEs be completed by athletes?
Answer: The secondary-school-level athlete should receive a physical biannually. Older athletes
should receive a physical at 2–3 year intervals. A comprehensive PPE should be administered to all
athletes entering middle or high school, or transferring from another school. All athletes should
also receive an annual update including a comprehensive history.
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16. True or False: The dietary habits of any athlete, regardless of sport, have a profound influence
on overall performance and on recovery from injury.
Answer: True
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17. Why is it important for coaches, administrators, and athletic trainers to monitor extrinsic risk
factors for sports injury?
Answer: They should monitor all of these risk factors in an effort to identify and eliminate any
potential risks for athletes.
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18. True of False: Indoor physical activity does not pose a significant risk for thermal injury.
Answer: False. Indoor activity can pose a significant risk for thermal injury, especially if the
participant is not properly hydrated or if the indoor temperature and humidity are high.
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19. List the primary concerns for safe participation with respect to indoor facilities.
Answer:
1.) Lighting
2.) Playing surfaces
3.) Room dimensions
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20. True or False: Protective equipment plays a vital role in the prevention of injuries.
Answer: True. This is especially true in sports such as football, ice hockey, baseball, and softball.
But, virtually all sports can benefit from the use of some form of safety equipment, even something
as simple as a mouth guard.
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