Active norfolk

Injury prevention
How to make every session count

www.nwconditioning.com

Neil Welch MSc ASCC
• BSc Sports science and physiology

• MSc Strength and conditioning

• S&C coach for the the England alpine ski team

• Work with athletes from multiple sports including rugby, cricket, rowing
and triathlon

• Founder of nw conditioning strength and conditioning consultancy

• Run biomechanist at Profeet


Session overview
• Common injuries and their mechanisms

• Practical - how to screen for these injuries

• Practical - injury prevention strategies

• Using the whole training session


Learning outcomes
• Learn to identify potential mechanisms of injury in athletes

• Learn what to do to help prevent injury occurrence

• Learn how to implement those strategies into your training
sessions


Common injury types
• Acute impact trauma - not much we can do about impacts,
nature of the sport, although better strength and
conditioning will mean better ability to concentrate

• Pulled muscles are definitely preventable, need;
– Appropriate strength through full range of motion
– No bilateral imbalances
– Limit agonist antagonist imbalances

• Connective tissue injuries such as tendon/ligament ruptures
we can have some say in reduction


Common injury areas
• Lower leg - achilles

• Shoulder injuries

• Hamstring

• Knee


Injury prevention or improved performance
• Injury prevention is a conservative approach

• As coaches we are looking to improve our athlete’s
performance

• Improved performance goes hand in hand with injury
prevention

• Developing strong, mobile and balanced athletes will reduce
injuries


Achilles tendon
• The connective tissue link
between the calf muscles and
the heel (calcaneous)
• It is the strongest tendon in the
human body
• Stores elastic energy while
running improving efficiency
• Has been suggested that the
limiting factor in human sprinting
speed is achilles tendon strength


Achilles injury mechanisms
• High impact forces force the tendon to dissipate force

• Lack of range of motion about the ankle

• Lack of strength in the muscles of the calf

• Growth spurts can cause a time lag in the change of length
of muscles overloading the tendon (known as Sever’s
disease)


Achilles injury prevention
• Increase the strength of the calf muscles

• Ensure appropriate range of motion about the ankle

• Improve shock absorption of the whole system (landing
mechanics)


Shoulder injury mechanisms
• The shoulder girdle is made up of 3
joints and is inherently instable
• This makes it particularly vulnerable
in an overhead position
• Common injuries therefore in
overhead sports e.g. tennis, cricket,
javelin
• Due to imbalance between internal
concentric movement and external
eccentric movement
• Poor scapula function

Shoulder injury prevention
• Need to be aware of whole body biomechanics and how
they effect range of motion

• Opening the hips improves range of motion and reduces
load on the shoulder

• Work on the brakes, ability to slow down the movement is
important

• Correct patterning of the scapula is very important


Hamstring injury
• Most prevalent muscle strain 6-29% of
all injuries
• High re-injury risk of 12-31%
• Recent research showing injury rates not
improving
– Ekstrand et al 2011 looked at injury rates for
7 consecutive seasons
– 23 professional European football clubs
– Unchanged competitive and training injury
rates
• Whatever strategies have been in place
haven’t been working

Hamstring injury links
• Lack of flexibility in hamstrings and hip flexors
• Lack of gluteal activation in extending the hip
• Weakness of core musculature
• Weakness in the hamstrings themselves – 2.5 x bodyweight
per running stride
• Chronic fatigue
• Previous injury
• Research is mixed on the exact causes, mainly because of
isolationist approaches, likely to be a mix of all these


The knee - ligaments
• 4 ligaments in the
knee

• Collateral ligaments
prevent lateral
movement

• Cruciate ligaments
prevent anterior
posterior movement


The knee - musculature
• Significant musculature
surrounding the joint

• Imbalance can put altered
load on the ligaments

• Lack of strength can
increase load on the
ligaments


Causes of ACL injury
• Weakness in musculature about
the hips and core
• Particularly vulnerable in a
position of knee valgus
• Knee valgus can lead to MCL
strain and increase risk of ACL
injury
• Usually involves a rapid
deceleration of the joint, therefore
increased strength is a
requirement
• More susceptibility with females


Female athletes and ACL injury
• More occurrence of ACL injury than males
• Due to hormonal, anatomical and neuromuscular
differences
• Neuromuscular control deficits: strength, power or activation
patterns
• Ligament dominance: imbalance between ligament and
neuromuscular control of knee stability
• Quadriceps dominance: imbalance between quads and
hamstrings
• Leg dominance: imbalance from leg to leg
• Trunk dominance: inability to activate core correctly


Knee injury prevention
• Ensure adequate hamstring strength

• Work on posture and pelvic alignment

• Correct takeoff and landing mechanics – work on the brakes

• Develop movement and force reduction and production in all
3 planes of motion


Screening
• Allows progression to be monitored

• Can show the athlete why they need to be doing
the exercises/training they have been set

• It can highlight those most at risk and allow the
coach to target specific work to those athletes


Methods of screening: Hop and stop
• Measures differences in force production and
stability relative to height

• Gives quantitative information to compare on an
ongoing basis

• Is quick and easy to administer

• For details and reminder of protocol see
athlete by design

Methods of screening: Tuck jumps
• Again, quick and easy to administer

• Feet 35cm apart, slight knee bend and jump using an arm swing
bringing the knees up to parallel with the floor

• On landing immediately go straight into the next jump continuing for 10
seconds

• The athlete should be encouraged to land softly using a toe to midfoot
rocker and keep the same footprint on landing

• The athlete should be instructed to stop if they show a sharp decline in
technique

Methods of prevention
• Now we have an idea of the mechanisms of injury, we can
target those areas to help prevent them

• You don’t have to train individual muscles unless to address
a specific imbalance or rehab program

• By training the correct movement it makes prevention
functional and will improve performance

• These movements will help long term physical preparation


Get stronger!
• The stronger your athletes, the greater the ability to produce
reduce and stabilise force

• Reduction in potential for injury, prevention is better than
cure

• Focus on whole body strength not individual muscles

• First strength gains are neuromuscular, you get better at the
movements.


Jumping and landing
• Focus on technique
– Maintain correct knee alignment
– Landing on forefoot rocking back to mid-foot
– Keep the noise down
– Brace core
• Progressions:
– Increase height
– Change direction
– Introduce rotation
– Single leg


Activating hip abductors
• To help maintain proper
alignment at the knee
• Exercises working against a
lateral resistance during uni or
bi-lateral exercises
– Band squats
– Split squats/lunges
– Monster walks
– Side lying leg raises


Addressing quad dominance: Hamstrings
• Looking to load the Hamstrings eccentrically

• Number of possible exercises to use
– Good mornings
– Stiff leg deadlift
– Stiff leg deadlift variations


Calf work
• Calf stretching – straight leg, bent leg and big toe raised

• Calf raises –
– slow eccentrics and bounces
– Whilst walking

• Plyometric work – ankle hops
– Low load short sets of below 10 on each leg


Addressing leg dominance
• Even out through correct bilateral technique

• Use of single leg exercises
– Single leg squats
– Split squats
– Lunges

• Increase the load on the non-dominant leg


Core
• Important to use and train core musculature in the correct
way
• Pelvic tilt awareness
• Use of the abdominal Brace
• The big 4!
– Curl ups
– Bird dogs
– Glute bridges
– Side bridges


Shoulder
• Thoracic mobility

• External rotations

• Wall angels

• Scapula activation


Athlete education
• Education plays an important role, create the all round
athlete
• Help the athlete to understand why they’re doing what
they’re doing
• Get the athletes to coach each other, will embed the
technique
• Will give greater adherence
• Encourage self awareness, the athlete should be able to
feel where they are going right and wrong


Flexibility
• Calf
• Hamstring
• Hip flexor
• Glute
• Quads
• 3D stretching


Making every session count
• Your time with your athletes is valuable, we need to make
sure none of it is wasted
• The warm up, it is a substantial percentage of training and
contact time
• Need to plan this as much as the technical components of
our sessions
• Include jumps, landings, lunges, squats, accelerations and
decelerations
• We have to do better than a run around the pitch and some
stretching


Use your down time
• Your athletes will need to rest during a session, especially if
it’s high intensity
• Technical sessions often lower in intensity
• Possible to plan small exercise blocks into the session


Get creative
• You can incorporate a lot of these movements into your
technical drills
• A jump, a lunge, a hop. These are all useable and the
beginning or mid way through a drill.
• Alter your start position
• Alter your finish position
• Alter the direction of the drill


Any Questions?


Thank you for your time
neil@nwconditioning.com


Active norfolk

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