When it comes to injury prediction and prevention, there is no magic bullet. And yet many teams are investing big money in little bands that sit on players’ wrists, in software that claims to evaluate training load and in so-called “smart” clothing that keeps tabs on vital signs. Then there’s the almost universal acceptance of heart rate variability (HRV) monitoring as the oracle for athlete recovery, readiness and preparedness.
But you know what the kicker is? Players are still getting injured! Every game, every practice session, it seems like you hear of an athlete who’s down for the count and ruled out of an upcoming match or longer. The simple yet inconvenient truth is that we’re never going to be able to accurately predict all injuries, much less prevent them. But over the course of working with a range of athletes I have a few simple guidelines for physical preparation that are important to help reduce injury rates. These tips don’t just apply to rugby, but to players of any sport and at any level.
1) Past and Present – Importance of symmetry!
I’m a big believer in basing a programme around staple bilateral movements such as squats, deadlifts, and Olympic variations as they provide an excellent opportunity to develop strength and power through numerous joints and muscles, linking the feet to the shoulders. And yet if athletes do these alone, they can still develop or possess imbalances.
We know that one of thebiggest predictors of future injury is previous injury (and of course severity is important). Any injury to a joint, muscle, ligament, tendon or motion segment naturally makes us overcompensate on the other side, while de-emphasizing the injured one as a self-protection mechanism. When performing bilateral movements, it’s possible for the side that hasn’t been hurt to compensate for the one that has, and the outcome – performing a squat, say – feels fine for the athlete and looks good to me, the coach. But then one day the athlete is running sprints in training and tweaks a hamstring. Or maybe they go down for the count in a game with a groin pull. This isn’t just an acute event, but the result of allowing bilateral movements to hide the asymmetry and combination of overcompensation and under-emphasis that has developed after they recovered insufficiently from injury.
As almost every athlete has been or will be hurt at some time, we need to add in more unilateral movements to our training. These can shine a light on an asymmetry, restriction or compensatory pattern, allowing us to then address it through mobility work, single-side strengthening, etc. So for example, a player who previously injured his left shoulder might do fine with a barbell bench press, at least until he doesn’t one day. But by switching him to dumbbell bench press, we see that he’s shaky on that injured side, even with a light weight. Well now we’ve identified a instability or weakness and can start remedying it. Personally, I have a dodgy left ankle, which has affected my entire left side and made me favor the right. So I know I need to be doing step-ups and other unilateral leg work to maintain strength on that weaker side, while also doing more proprioception and mobility on it…this never stops!
2) Beware Variety for Variety’s Sake
As coaches, we often fear that our athletes are going to get bored or, worse still, burned out by doing the same old routine in the gym time after time. So we start mixing things up. It’s fine if these are purposeful variations with clear rationale. However, if we start giving into the temptation, or even athletes’ requests, to follow the latest fad or trends we can soon run into trouble. This applies to exercise selection as well and loading / sequencing patterns. For example, maybe isometric work is in vogue one moment and a few months later, coaches have moved on and are now emphasizing eccentric training.
While every session does not need to be identical and there certainly is not always harm in changing things up a bit, we should avoid programming variety for variety sake. Every time an athlete has to learn a new movement there’s a change in neural and mechanical stress and an unknown “load” as it is unfamiliar. If you are in a sport like rugby union, you may only have one session a week to improve or maintain lower body strength at a high level. If we compromise the intensity of the session each week by changing the exercise we go nowhere fast. Unfamiliar exercises require an element of learning the movement and how to sequence and load it, which can impact fatigue and produced increased muscle soreness (DOMS). This lack of familiarity reduces the intensity we can push to and can produce unwanted risk of injury. On the flipside, the old adage “familiarity builds intensity” is very true. When your athletes are performing exercises they’ve mastered, they instinctively know when to push and when to back off, how to identify and self-correct errors and what a “good” or “bad” session feels like. The same is true of aerobic work. If you have your athletes do a 5K or 10K run weekly, they’re going to become adept at pacing themselves well to finish it, understanding their cadence and fine-tuning their form. They won’t achieve such competence if you keep switching up the distance just for the heck of it.
3) Consider External Environment
In a recent stretch with the All Blacks, we had 30 hours of travel from New Zealand to Argentina, another 30 hours to South Africa and then a third long flight home (another 30 hours!). After just four days we flew to Australia, and then five days later off on another travel ultra-marathon to the UK. Fortunately, there is usually a week in between landing and our next game, but when you’re crossing that many time zones and players are sitting for that long, it has a cumulative effect. Plus, the players’ sleep is severely impacted, with them losing up to three hours a night over five weeks. This example is probably quite unique however all teams, athletes and individuals will have their own stressors that should always be considered when it comes to health, exercise and performance to reduce the risk of injury.
Indeed, the desire to get back to full training after travel, illness or a period of rest is high but an element of common sense is required if you simply consider the likely state of the body and mind. An example for an individual could be having to take three or four weeks off from training or performance due to a virus, injury or chronically poor sleep. In such scenarios, it’s vital that we carefully consider how to progress back into training and what sort of volume and intensity should be prescribed. There’s a lot of chatter about “load” and while training and competition are big parts of the picture, we also need to consider environmental pressures such as travel, temperature, altitude, home stress, sleep and act accordingly.
4) Why so Serious?
What I do as a coach and how my athletes perform is important because results matter. But it’s not the only thing. It’s a privilege for me to work with them and they’re fortunate to play the game they love, so why not have a little fun with it? After all, we are doing what we do because we enjoy it! If someone walked into one of our sessions I think they’d be surprised by the light-hearted, jovial atmosphere. Yes, the guys are working hard and putting in their best efforts. But they’re also cracking jokes and ribbing each other. I believe this allows the players to sharpen their focus when it comes time to put in the required hard work. All the effort is put into the movement, task or block of training, not wasted on trying to be serious when the body is resting for the next effort.
Recovery from sessions is important for many reasons but essentially what we are trying to achieve is a state where our physiology is absorbing, adapting and hopefully improving. We’re starting to hear of anecdotal evidence around the benefits of social recovery. So when the lads are in the spa together they’re laughing at themselves and each other, wisecracking about me and the other coaches and enjoying some downtime. What we do day in and day out can’t become a soulless grind or both performance and recovery will suffer. We know recovery is vital to ensure training load is absorbed and adapted to so we’re ready for another day, week or month. If we don’t do this well, the likelihood of injury is elevated!
5) Don’t Go All Out, All the Time
When you have athletes who are self-motivated, genetically gifted and always striving to improve, you’ve got something special. But you’ve also got something potentially dangerous. The work capacity of some athletes is so big that sometimes we need to pull them back…... Just because an athlete is capable of going all out every day doesn’t mean they should. No matter how good you are, you need a chance to recoup. This is why some days following a game or an intense day’s training I tell my athletes that the goal for them is simply to finish the session or day, feeling good not smashed. This advice might seem a little nebulous, but they have sufficient self-awareness to respond to this by backing off on the weight and speed and resting longer between sets and exercises. In doing so, they’re not going to put themselves in harm’s way with too much cumulative load throughout the week.
Another important concept for athletes to buy into is self-care. Yes, we do movement prep, warmups and plenty of mobility work as part of our sessions. But what they do when I’m not watching is just as vital, if not more so. That’s why I encourage them to get massages and trigger point sessions, try hydrotherapy that will take the load off their muscles and connective tissues and to commit to getting adequate, high quality sleep. If you can combine such disciplines while varying the intensity of your sessions so everyone’s fresh for the next game, you’re much less likely to have a big injury list that you have to sheepishly hand to the head coach.