Numerous variables can influence injury frequency in team sports, and many of them are highly interconnected. Success in reducing injury rates requires a thorough understanding of these potential risk factors in isolation, but we also need to know their relationships. The truth is that every time there is an injury, there is usually a confluence of many factors that make the examination of each situation more complicated.

A recent publication ¹ has proposed a pyramid of factors (from most to least relevant) that can help to understand better why people get injured and what decisions clubs can take to avoid them. There are 7 levels in this pyramid.

The first level of the pyramid is the player’s profile. If the club hires or holds athletes who cannot bear the stress of competition or the team’s style of play, then there will be difficulties in maintaining a consistently low injury rate. One of the factors that best predict future injuries is having suffered previous problems in that same area.² A good prevention program can help reduce this risk, but it will continue to exist. The clinical history of each player must be carefully studied, understanding that age and previous injuries have a high probability of being recurrent. Knowledge of technical and tactical aspects is also very relevant at this level. It is about analyzing how the athlete’s performance has been in the past and how it has been used in previous clubs and now comparing it with the new context in which they will participate. It can also have a modulating effect on the risk of injury. The profile of a new player can also affect the performance of other athletes or the team as a whole. The sports culture of the team is also a factor that has to do with injuries.The second level of the pyramid is load control. There is a maximum level of load that each athlete can bear. If it is above that threshold, injuries are very likely to appear. The coaching staff has to identify that level in each player and pass this information on to the coach to include it for training. The approach to follow at training is to propose a gradual increase in the training loads until the players adapt to a level higher than what will be required in the competition, avoiding exposure to very aggressive load peaks in this process.³The third level consists of developing strength and conditioning programs that lead to an improvement in the athletic ability of the players. We are therefore talking about Coadjuvant Training (EC).^4,5 The high demands that an athlete is subjected to at the highest level, make it necessary to work in parallel to achieve the best conditions to bear the loads that optimise performance. A limited individual preparation of the players can be an obstacle to reach the best state for competition. The preparation of the player is as necessary as that of the team.

The fourth level consists in checking that the players are strong enough and able to use their abilities in the game safely and efficiently. It is about working on motor skills and movement skills to reduce the probability of injury. The fifth level refers to the need for well-designed injury prevention programs. There is strong evidence that a good injury prevention program can reduce by 30% the time players lose with preventable injuries.⁶ Perhaps one of the most significant benefits of these programs is that they promote the players’ commitment, which helps to do any exercise better in the preparation program. The sixth level is the assessment of injury and recovery. Evaluating the level at which a player with an injury can work or how an athlete must progress to return to play after an injury is a critical factor. Good management of these moments has a significant impact on preventing future injuries. They should respect factors such as the physiological recovery times, the team’s culture, the player’s role in the group, and the way of training to decide the return to competition and the level of risk that may be acceptable. The seventh level is luck. In most aspects of our lives, no one can say for sure that everything is under control. Injuries should be classified on a continuum from “completely preventable” to “not preventable at all,” although the reality is that no injuries are ever at these extremes. 

References:

¹ Coles, P.A. (2018) an injury prevention pyramid for elite sports teams. British Journal of Sports Medicine, 52(15).

 ² Quarrie, K.L., Alsop, J.C., Waller AE, et al. (2001). The New Zealand rugby injury and performance project. VI. A prospective cohort study of risk factors for injury in rugby union football. British Journal of Sports Medicine, 35:157–166.

³ Hulin, B.T., Gabbett, T.J., Lawson, D.W., et al. (2016). The acute: chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. British Journal of Sports Medicine, 50: 231–236.

⁴ Seirul·lo Vargs, F. (1986). Entrenamiento coadyuvante (Coadjuvant training). Apunts. Medicina de l’Esport, 23, 38-41.

⁵ Gómez, A., Roqueta, E., Tarragó, J. R., Seirul·lo, F., & Cos, F. (2019). Training in Team Sports: Coadjuvant Training in the FCB. Apunts.  Educación Física y Deportes (Physical Education and Sports), 138, 13-25. doi: 10.5672 / apunts.2014-0983.

⁶   Silvers-Granelli, H., Mandelbaum, B., Adeniji, O., et al. (2015). Efficacy of the FIFA 11+ injury prevention program in the collegiate male soccer player. American Journal of Sports Medicine, 43: 2628–3267