Top 3 Injury Prevention Exercises

When it comes to injury prevention, there are a lot of claims made, but not a lot of proof.

As we discussed in our first blog in this series, we can’t prevent injuries, but we can reduce them – at least we potentially can.

What leads to an injury, and contributes to its occurrence can be a complex topic.

Factors like position of joints, forces imparted, time of play, fatigue, preparedness (physical, mental, technical, etc.), and so much more!

Due to the multifactorial nature of injuries, there is a lot that could be done in hopes of reducing the risk of them.

What we need to do is decide which are the things that will provide the best return on our investment.

For instance, resistance training in general shows a really high return on investment.

In a systematic review from Laurensen 2018, it was found that a 10% increase in strength training volume provided a minimum 4% reduction in injuries.

This bodes very well for encouraging physical preparedness with resistance training.

A recent systematic review found that when looking across different NCAA division 1 athletes, having a higher relative back squat to bodyweight ratio was beneficial for injury reduction.

While we see that resistance training as a general is beneficial, it’s valuable to know what is the most effective and most efficient usage of time.

We see a few different movements stand out as having a high utility for injury reduction.

These movements are:

1. The Nordic Hamstring Curl

If you haven’t heard about the Nordic, you must have been living under a rock the last few years.

This exercise has grown tons of attention in both the strength & conditioning community and the sports performance world.

A simple movement, just set up kneeling and have something secure your feet and try not to fall forward, but a massive set of research supporting it.

This exercise has been shown to be valuable for adaptations such as increased cross-sectional area of the hamstrings, improved eccentric hamstring strength, elongated muscle fascicle length – and most of all, a big reduction in hamstring strains.

In particular, they’ve shown that athletes can get a good reduction with relatively little investment.

For a lot of athletes, performing 3-4 sets of 3 challenging reps 2-3 times a week has been supported for having a significant reduction in hamstring strain rates.

Fighting to stop falling forward helps to build eccentric strength that is likely beneficial for the athlete to be able to resist challenging strain during sprinting activities.

There has been a recent exploration in comparing the nordic curl and the razor curl – where we bend at the hip – and see if one is superior to the other.

The razor curl is essentially the same as the nordic, but with the hip flexed instead of extended.

This was initially theorized to have a higher transfer because of more specificity, but the research is really mixed currently.

There has been some showing the razor curl superior for certain aspects, whereas it showing inferiority for others.

2. The Copenhagen Plank

If the Nordic Hamstring Curl is the king of injury prevention right now, the Copenhagen Plank or Copenhagen Adduction is the queen.

With probably the second most research on it for injury reduction, this exercise has begun popping up in most high level injury reduction programs.

If you’d like to learn more about this exercise, you should check out our Copenhagen Plank book where we discuss the movement, it’s applications, it’s research, and a progression for it.

3. Calf Raise

In many circles, training the calf is laughed at.

While it’s a small muscle group that we can’t see too well, it’s one that does deal with some significant injuries.

Achilles tendinopathy and various calf problems can set athletes back significantly.

Fortunately, we have some growing research that we can have a good impact on them by a basic addition of some challenging calf raises.

Across research we are seeing different papers pop up that are opening discussion about the role of bent knee strengthening – looking to target the soleus.

In contrast to the Nordic Curl and Copenhagen Plank, we don’t have a lot of substantial application based research, such as volumes, intensities, frequency, etc.

In general, implementing some straight knee and bent knee calf strengthening each week is likely going to be beneficial for the vast majority of athletes.

For the Nordic Curl, we see that the eccentric aspect is a major component of it.

For the Copenhagen Plank, the isometric/eccentric aspect is also a big deal.

Whereas for calf raises, we don’t see this.

While other forms of exercise have been shown to be useful in reducing injury risk, such as high speed running, we don’t have consistent data on them, or what aspect about them is beneficial – such as if it’s the general development of fitness, more running volume, etc.

Similarly, various lifestyle factors have shown injury reduction possibility by altering them – such as increased sleep, bodyweight management, load management, etc.

In future time we will see more and more programs emerge with comprehensive exercises, such as the FIFA 11+, that aim to provide a single package for injury reduction. Until more research can be done, these three exercises are our best starting points.

Thank you so much for reading! Leave any comments below and check out our YouTube videos on the topic!

References:

  1. Lauersen JB, et al. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. Br J Sports med. 2018;52(4).
  2. Zoulta S, et al. Strength training reduce injury rate in elite younger soccer players during one season. The Journal of Strength and Conditioning Research. 2016;30(5).
  3. Case M, et al. Barbell squat relative strength as an identifier for lower exremity injury in collegiate athletes. J Strength Cond Res. 2020.
  4. Presland JD, et al. The effect of Nordic hamstring exercise training volume on biceps femoris long head architectural adaptation. Scand J Med Sci Sports. 2018;28(7):1775-1783.
  5. Pollard Cw, et al. Razor hamstring curl and nordic hamstring exercise architectural adaptations: impact of exercise selection and intensity. Scand J Med Sci Sports. 2019;29(5):706-715.
  6. Hegyl A, et al. Impact of hip flexion angle on unilateral and bilateral nordic hamstring exercise torque and high-density electromyography activity. J Orthop Sports Phys Ther. 2019;49(8):584-592.
  7. Haroy J et al. The adductor strengthening programme prevents groin problems among male football players: a cluster-randomised controlled trial. BJSM. 2019;53:145-152.
  8. Thorborg K, et al. Copenhagen Five-second squeeze: a valid indicator of sports-related hip and groin function. BJSM. 2017;51(7):594-599.
  9. Bourne M, et al. Preseason hip/groin strength and HAGOS scores are associated with subsequent injury in professional male soccer players. JOSPT. 2019:1-34.
  10. Haroy J, et al. Including the Copenhagen Adduction exercise in the FIFA 11+ provides missing eccentric hip adduction strength effect in male soccer players: a randomized controlled trial. AJSM. 2017;45(13):3052-3059.
  11. Thorborg K, et al. Eccentric and isometric hip adduction strength in male soccer players with and without adductor-related groin pain: an assessor-blinded comparison. Orthop J Sports Med. 2014;2(2):2325967114521778.
  12. Ishoi L, et al. Large eccentric strength increase using the Copenhagen adduction exercise in football: a randomized controlled trial. Scand J Med Sci Sports. 2016;26(11):1334-1342.
  13. Crow JF, et al. Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players. J Sci Med Sport. 2010;13(2):202-204.
  14. Serner A, et al. EMG evaluations of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries. BJSM. 2013;48(14):1108-1114.
  15. O’Neil S, et al. Plantarflexor strength and endurance deficits associated with mid-portion Achilles tendinopathy: the role of soleus. Phys Ther Sport. 2019;37:69-76.
  16. Mahieu NN, et al. Intrinsic risk factors for the development of achilles tendon overuse injury: a prospective injury. Am J Sports Med. 2006;34(2):226-235.
  17. Mahieu NN, et al. Effect of eccentric training on the plantar flexor muscle-tendon tissue properties. Med Sci Sports Exerc. 2008;40(1):117-123.
  18. Malone S, et al. High-speed running and sprinting as an injury risk factor in soccer: can well-developed physical qualities reduce the risk? J Sci Med Sport. 2018;21(3):257-262.
  19. Janney CA & Jakicic JM. The influence of exercise and BMI on injuries and illnesses in overweight and obese individuals: a randomized control trial. Int J Behav Nutr Phys Act. 2010;7:1.
  20. Watson AM. Sleep and athletic performance. Curr Sports Med Resp. 2017;16(6):413-418.

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