Strength training and injury risk reduction

[Michael Ray]

Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis

Strength training continues to be demonstrated as a protective mechanism for athletes by reducing the risk for acute AND overuse injuries.

Lauersen et al demonstrated:
“Strength training programmes reduced sports injuries by an
average of 66% and were, with 95% certainty, able to more than
halve the risk of sports injury (95% CI 52% to 76%).”

How does strength training potentially aid with athletic injuries?

For acute injuries:

• Strengthen failure thresholds of tissue
• Instill sufficient technique
• Psychological preparedness

For overuse injuries:

• Gradual tissue conditioning
• Sufficient technique
• Training variation

Just more evidential support – we should be regularly strength training athletes.

[Dhruv4]

Im not sure if this was brought up in the recent podcast with Mike Isretal but the way he put the simpleness of rehab and how most people skip the "ramp up" period if you will was pretty interesting but not surprising to me.
More to the topic i definitely would agree that strength training is superior to the more common types of rehabilitation.
Definitely more useful than a stupid semi rubber ball beating into your skin at 100 rpm causing no beneficial physiological effect.

[kelleyhenry]

I'm a huge proponent of strength training to reduce injury risk as I believe it increases the load capacity and tolerance of the tissues. With that said, I have seen various criticisms on this article and similar in that the studies chosen were either on soccer players or military. Additionally, 3 of the 6 were on hamstrings. It would be more accurate to say that strength training is effective for reducing injuries in soccer players, military and for hamstring injuries. Evidence is piling up in support of strength training but it's bad science to generalize to other populations than those studied.

This current study suggests a mechanism for a reduction in injuries is enhanced technique. I'm not sure what they mean by this but I assume it means improvement in movement patterns or something similar. This may be the case of soccer players but so far in the literature, it has not been the case for running (cue memories of all the "functional" exercises of years passed - can still be useful, just not for strength). So again, we need to be careful to not extrapolate this paper to other populations that were not included.

in my biased opinion, being stronger is the way to go and strength training can probably solve most of not all that ails you.

[Michael Ray]

Im not sure if this was brought up in the recent podcast with Mike Isretal but the way he put the simpleness of rehab and how most people skip the "ramp up" period if you will was pretty interesting but not surprising to me.
More to the topic i definitely would agree that strength training is superior to the more common types of rehabilitation.
Definitely more useful than a stupid semi rubber ball beating into your skin at 100 rpm causing no beneficial physiological effect.

Yeah, we have a good amount of research on acute:chronic workload ratios and the need for "ramp-up" periods. In regards to rehab, if we are just addressing pain - then there's a solid chance we can discuss the contextual effects of exercise as it relates to pain having a larger impact than any particular exercise itself. I often state in clinic, you aren't in pain because you are under-exercising or not strong enough - this would be a false premise to operate form.

I'm a huge proponent of strength training to reduce injury risk as I believe it increases the load capacity and tolerance of the tissues. With that said, I have seen various criticisms on this article and similar in that the studies chosen were either on soccer players or military. Additionally, 3 of the 6 were on hamstrings. It would be more accurate to say that strength training is effective for reducing injuries in soccer players, military and for hamstring injuries. Evidence is piling up in support of strength training but it's bad science to generalize to other populations than those studied.

This current study suggests a mechanism for a reduction in injuries is enhanced technique. I'm not sure what they mean by this but I assume it means improvement in movement patterns or something similar. This may be the case of soccer players but so far in the literature, it has not been the case for running (cue memories of all the "functional" exercises of years passed - can still be useful, just not for strength). So again, we need to be careful to not extrapolate this paper to other populations that were not included.

in my biased opinion, being stronger is the way to go and strength training can probably solve most of not all that ails you.

@kellyhenry: yes, I would agree with the critiques of the article regarding included studies predominately from soccer and military. The authors do address this concern in the Strength and Limitations section. We could also analyze closely how they are defining "strength" training. One sentence in particular stood out at the end of the article,
"Put into perspective, we believe the evidence provided in this article is sufficient to warrant a paradigm shift from the current dominance of multicomponent prevention programmes towards strength training programmes as the primary intervention to prevent sports injuries." - I can get behind this statement (minus the prevention part - risk reduction is a far better and more supported phrase).

I also like studies like this one by Malone on protective mechanism strength (and other factors) can have: Can the workload–injury relationship be moderated by improved strength, speed and repeated-sprint qualities?

Regarding technique - I also am not entirely sure on the relevancy of this statement. The authors cite these two studies as support;

Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med 2005;39:324–9.

Myer GD, Ford KR, Palumbo JP, et al. Neuromuscular training improves performance
and lower-extremity biomechanics in female athletes. J Strength Cond Res
2005;19:51–60.

Although, it's unlikely Bahr argues for prevention still based on this article: Why screening tests to predict injury do not work-and probably never will…: a critical review.

"This may be the case of soccer players but so far in the literature, it has not been the case for running (cue memories of all the "functional" exercises of years passed - can still be useful, just not for strength). Can you elaborate on this point more as it relates to running and strength training?

Thanks for the discussion everyone.

[kelleyhenry]

There seems to be a difference between strength training for strength gains which don't seem to change mechanics and actual coordination exercises of which the goal is to change mechanics. People can confuse these by trying to add weight to coordination exercises (what happened with the functional training boom) to increase strength instead of using general strength training to increase strength. It seems that you also have to specifically engage in gait retraining to change gait.

[Joe_]

Just finished reading this tonight and everything was awesome! There was one aspect in the article that I have a kind of separate question about. They spoke very briefly on Coppack et al trying to "restore patellar alignment in the femoral groove to avoid localized excessive joint loads" and I was unsure as to the relationship between patellar tracking issues and pain/symptoms as well as the ability to diagnose this in a rehabilitation setting without imaging. The only reference that I have is this (https://www.ncbi.nlm.nih.gov/m/pubmed/17142409/) which plays into the "structure does not lead to/correlate with symptoms" that I have heard in the CA podcasts as well as the BBM podcasts and TLOR website. Do yall have more input on this or more research to shed some light on patellar tracking and clinical significance?

[rpatel]

Pain and injuries are inevitable during our active work-play life and don’t always happen at the most opportune times. For these times, Safer Pain Management is needed and can be achieved multiple ways without addictive opioids involving a variety of both non-medication and medication-based treatments that work in different ways to allow healing to occur.

https://saferpainmanagement.com/

[Bak2ThaBasix]

Pain and injuries are inevitable during our active work-play life and don’t always happen at the most opportune times. For these times, Safer Pain Management is needed and can be achieved multiple ways without addictive opioids involving a variety of both non-medication and medication-based treatments that work in different ways to allow healing to occur.
https://saferpainmanagement.com/

Oof, did you really just drop a self plug?