Discussing Sports Medicine: Are injury prevention strategies effective at grass-roots level?
Evaluating injury prevention strategies are just as important as developing them; but there is a clear need to evaluate whether or not injury prevention strategies are actually used at grass-roots level in the first place...
As an injury prevention strategy the FIFA 11+ programme is widely promoted as an effective tool for reducing non-contact injuries and evidence in its favour is presented by various authors (Barengo et al, 2014; Bizzini and Dvorak, 2015). The 11+ is an updated version of the original FIFA 11 introduced in 2007 and is thought to be an improvement on the earlier offering.
In both programmes, coaches lead the strategies employed and are generally the prime movers as far as ‘selling’ the concept of injury prevention is concerned to players and clubs.
But does this go far enough? Like its predecessor, the 11+ focusses on injury prevention through specific warming-up and physical conditioning techniques; but there is so much more to the topic of injury prevention than this.
Injury prevention is a huge subject on its own which is regularly discussed extensively in the literature. Bahr and Holme (2003) stated that injuries occur as the result of a complex interaction of multiple risk factors and events as opposed to being the result of one single entity.
So if we are going to take prevention of injury seriously as a topic then the first thing we need to do is identify the injuries that we are trying to prevent.
This is relatively easy within the confines of the professional game as previous studies have shown (Hawkins et al, 2000; Le Gall et al, 2006; Deehan et al, 2007) but not so easy elsewhere.
At grass-roots level studies of this nature are scarce and evaluation of any research into evaluating injury prevention strategies is even scarcer.
Historically, Van Mechelen et al (1992) defined the sequelae of injury prevention which still holds true to this day:
Key factors in auditing injury prevention therefore lie in evaluating preventative strategies developed from the above pathway; but this means assessing more than just the content and delivery of the warm-up.
Our aims need to include identifying and recognising potential injury risk factors, developing an awareness of how these risks may be addressed, and minimising the risk of avoidable injuries.
We know that injuries are multifactorial in nature (Meeuwisse, 1994), influenced by intrinsic and external factors. These include age and past medical history, poor techniques and inadequate equipment, together with previous injury.
The difficult part comes in attempting to prevent injuries which are in theory unavoidable; such as in the contact sports when one player deliberately sets out to injure another.
No amount of warming-up can legislate for the latter; and in these cases our preventative strategies need to be extended beyond the traditional boundaries of the medical teams.
Educating officials (and players) about the dangers of leading with the elbow in football is an obvious starting point; but identifying the incidence and nature of injuries that fall into the category of being theoretically unavoidable is just as important.
We also tend to assume that injuries sustained at professional level will be the same as those picked up in the public parks. Although in terms of injury mechanics that might well be the case, we often go our separate ways in terms of the actual treatment delivered.
This can have an effect on the prevention of recurrent and repeated injuries; something which the sports medicine world is particularly keen on at the moment.
Take the case of a lateral ankle ligamentous sprain for example. The injury to the professional player will likely have been diagnosed and a treatment plan started long before the non-professional footballer has even been seen by a clinician; but often the local player will just go home and rest.
In severe cases a trip to the nearest hospital will be on the cards if the injury is judged to be serious enough; but usually that decision is one that tends to be made by the player alone without having the benefit of medical input or advice.
Whereas the professionals will receive continuous treatment, ongoing advice and practical information about the injury together with a supervised rehabilitation programme, the non-professional players are frequently be left to their own devices.
Return-to-play fitness assessments and monitoring of the recovery protocols are therefore omitted. The player returns to the team too early as a result; and usually suffers a recurrence of the injury in the process.
Returning to training and playing at the correct stage is therefore considered an essential aspect of the prevention of recurrent or repeat injuries.
Clearly there is a need for further expansion of injury prevention strategies in addition to those concentrating solely on the warm-up phase; with future research targeting all the known components of injury risk.
Only then can the true effectiveness of preventative strategies can be formally assessed.
Bahr R, Holme I (2003). Risk factors for sports injuries: a methodological approach. British Journal of Sports Medicine. Vol. 37; 384 – 392
Barengo NC, Meneses-Echávez JF, Ramírez-Vélez R, Cohen DD, Tovar G, Correa Bautista JE (2014). The Impact of the FIFA 11+ Training Programme on Injury Prevention in Footballers: A Systematic Review. International Journal of Environmental Research and Public Health. Vol. 11 (11). 11986 – 12000.
Bizzini M, Dvorak J (2015). FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide—a narrative review. British Journal of Sports Medicine. Vol. 49; 577 – 579.
Deehan DJ, Bell K, McCaskie AW (2007). Adolescent musculoskeletal injuries in a football academy. The Journal of Bone and Joint Surgery, British Volume. Vol. 89 (1); 5 – 8.
Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M (2001). The association football medical research programme: an audit of injuries in professional football. British Journal of Sports Medicine. Vol. 35; 43 – 47.
Le Gall F, Carling C, Reilly T, Vandewalle H, Church J, Rochcongar P (2006). Incidence of injuries in elite French youth soccer players: a 10-season study. American Journal of Sports Medicine. Vol. 34 (6); 928 – 938.
Meeuwisse W (1994). Assessing causation in sports injury: A multifactorial model. Clinical Journal of Sports Medicine. Vol. 4; 66 – 170.
Van Mechelen W, Hlobil H, Kemper HCG (1992). Incidence, Severity, Aetiology and Prevention of Sports Injuries. Sports Medicine. Vol. 14 (2); 82 – 99.
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