Injury Risk Mitigation

In recent times, the role of physiotherapists has expanded considerably to not only treat injuries, but also develop strategies for injury risk mitigation. Patients who stay injury-free get more opportunity to partake in exercise. This leads to a positive cycle, as the more they train, the more robust they become, reducing likelihood of future injury.

The cycle diagram, pictured below, is a basic breakdown of the training planning process that underpins an effective injury risk mitigation programme with a soccer athlete. 

1. Needs Analysis:

There needs to be a clear rationale for every intervention you put into place and carrying out a thorough needs analysis is how it all begins. The following categories should be investigated:

• Sports Profile (general rules/time motion analysis/physiological demands/biomechanics demands)
• Injury Profile (type/mechanism/rate)
• Player Profile (age/gender/position/training age/injury history)

The following is a brief outline of soccer demands:

• Intermittent in nature (high intense actions intertwined with more prolonged low intense activity) (4).
• Players hit up to 9-14km in total distance, with 1-3km high-intensity distance (5).
• Sprinting occurs roughly every 90-120 seconds lasting 2-4 seconds (6).
• Players perform 150-250 short, intense actions, with 1200-1400 changes of direction (7)

2. Testing 

Once you’ve completed a full needs analysis, selecting the relevant tests should be straightforward. The needs analysis acts as the road map, providing a rationale for specific testing to be carried out.

Having in-depth knowledge of these principles is fundamental and understanding concepts such as variability (standard deviation), effect size, z-scores and confidence intervals are essential for test analysis and interpretation. This knowledge provides practitioners with reliable and valid information to aid in decision making further down the road. For further reading in these areas, readers are recommended to read the work of McGuigan (8). Due to time constraints and cost, laboratory testing can be inaccessible to many clinics; therefore, field-based tests are widely popular. It is recommended that testing is carried out up to 4 times a year (e.g., start of pre-season, end of pre-season, mid-season, and end of season). For a full testing battery outline for soccer, along with testing recommendations, readers are directed towards the work of Turner and Stewart (9).

3. Objectives 

By coming together as a multi-disciplinary team (MDT), a more holistic approach is taken to help the client reach their highest potential. It is essential that there must be a rationale for each goal set, and the implementation of a needs analysis and testing battery, along with talking to the client & technical coaches, helps identify this rationale.

4. Training Programme

An example of components of a hamstring rehab programme can be found in the case study section in the Sports Physio & Rehab Guide here!

5. Monitoring 

To maximise effect, physios need to understand how certain interventions will produce a specific physiological response. This is where the monitoring of training load has become a significant element in enhancing performance and reducing soccer injuries. These should be assessed regularly in order to track changes over time.

Internal  

• s- RPE  
• Session Load (Duration X  s-RPE)  
• Strain  

External 

• Jump Height 
• Mobility 
• Reactive Strength Index
• GPS 
• Volume Load

6. Review 

This is crucial as it helps identify what elements went well and not so well. In soccer, this can be done at the end of the season and can be completed through injury audits, post season performance testing & receiving feedback from the patient/client.

Download the full Sports Physio & Rehab Guide here!