One of the most vital roles of a health/fitness/sports professional is assessing a person’s risk of injury doing an activity or sport. There are many ways to approach this injury risk assessment – as long as it works, its fine. While we treat pain guided by the SFMA, we combine this information with the FMS which is for individuals with no pain to evaluate their risk of injury. The SFMA is designed for clinicians to treat pain, while the FMS can be used clinicians, or non-clinicians alike – e.g. personal trainer/coach/athlete. The FMS scores your movement which shows your risk of injury with certain movements and directs the coach/trainer/clinician where to progress and which exercises to do and avoid.
How does it work? What predicts your risk of injury?
1. Previous Injury
The one most important factor to predict your risk injury is one that we cannot change – your previous injuries. Your previous injuries are results of your internal risk (e.g. tightness/weakness/lack of control) + external risk (e.g. impact/sports/activities). Your previous injuries may result in structural damage that cannot be fully repaired (e.g. torn ligaments, removed menisci ,ruptured discs). Structural damage that cannot be fully repaired would then expose you to a higher risk of injuring the same area or even different areas that are affected by it.
External risk from impact/sports/activities are things we normally change only temporarily. Following an injury, we may want to avoid certain movements to minimize aggravation of injury and risk of re-injury. An example of this would be avoiding overhead movements after a shoulder injury. However, after the injury has been treated, risk for overhead movements should be low, and you can continue doing them.
Risk of an injury is never zero, with any activity, there is always a risk – even inactivity carries a risk. Your trainer/coach/therapist’s job is to minimize this risk in your sport and/or training. However, in rare cases, there could be sufficient permanent structural damage that the activity you’re doing carries a significant risk no matter what we do, at this point your trainer/coach/therapist may suggest making a more permanent change in your activity to reduce the external risk of injury – this is rare, but it is present. We generally avoid this as our goals would be your goals in activities/sports/fitness.
If we avoid changing the external risk of injury permanently (e.g. stop you from doing your sport), what do we normally do? For the most part, we modify the internal risk of injury. This means getting your movement better, stronger muscles, better technique, improved control. This may involve a manual therapy, exercises, stretches, resistance training, technique training. We do this to control two things that contribute to your internal risk of injury: asymmetry and training progression.
2. Assymetry
Asymmetry is a major risk of injury in any sport and activity. If you can touch your toes on your left foot but not your right, it is an asymmetry – left-right asymmetry. This may cause you to run unevenly between your left and right hip resulting in a twist in your lower back, increasing the risk of injury. If you can touch your toes but you cannot lean back, it is an asymmetry – front-back asymmetry. Usually this comes in the form of tighter/stiffer front muscles, but injuries to the muscles behind: hamstrings, calves, back, neck.
Asymmetry can come in different forms :stiffness, tightness, weakness, lack of control, etc. The principles are relatively simple: try to get everything balanced and symmetrical again. If it is stiff, loosen it. If it is tight, foam roll, massage, stretch it. If it is weak strengthen it. If it has poor control, improve it. There’s 101 ways to change what you find asymmetrical, but ultimately the principle is to minimise the asymmetries, no matter where they are.
What happens if you are an asymmetrical athlete? There are many sports that are naturally asymmetrical, this can be obvious like tennis, cricket or throwing sports. However, it can be less obvious such as a track runner running in counter clockwise all the time, or a freestyle swimmer taking a breath only on 1 side all the time, or a football athlete kicking only with 1 foot primarily. Some people would even suggest triathlon is also asymmetrical, not left-right, but front-back where the quads is firing a lot more than the hamstrings. In these cases, it is expected that asymmetries are developed during training. However, it does not mean these asymmetries can be ignored in injury prevention.
The basic principles still apply even to asymmetrical athletes: minimise asymmetry. This can be stretching, foam rolling, improving control, strengthening or any other modality your coach/trainer/therapist may have at their disposal. However, a degree of asymmetry may remain. With asymmetrical athletes we may just try and conserve their current asymmetries and not let it get worse during their sports season. When they are not in their sports season we can try to reduce it before their next season.
What do we do once we’ve minimised asymmetries? At this stage it is time to load up the system and challenge it. This can be specific training in sports, weights, strengthening, challenging movements. Injuries occur when this stage isn’t handled properly. There are progressions for each movement and none of them should be skipped. The same way babies crawl before they can walk - you shouldn’t be running before you can walk.
3. Training Load
Load progression is another point of risk of injury. When we try to load up the body, it needs to be in stages, and progress to higher function and challenge. What this means is something that most of us already know yet still manage to stray away from: training should be individualised. A 15-year old amateur rugby player shouldn’t be doing the exact same training that a professional rugby player is doing in their sports team. That is a recipe for disaster.
The professional athlete may be doing what is the best training for them, but it may not be the best training for you. It does not mean, you aren’t as good as the athlete, but doesn’t mean you’re better either – it depends on your body and where you stand. Your load in training should be individualized depending on where you are in this progression. This can be as straight forward as “don’t lift 100kg if you can’t lift 80kg”, or it can be more debatable on what the “progression” is – but each trainer/coach/athlete/therapist should have their reasoning for it (e.g. you need to skip properly before being able to run well).
By the same principles, not all the athletes in a sports team should be doing exactly the same training if they are doing the same training it should be because it is appropriate for them, but they should have their individual needs addressed. This means not giving something too easy such that they make no progress, but not giving something too advanced such that they risk injuring themselves. The trainer’s/coach’s/therapist’s job is to maintain/maximise gains from training while minimising risk.
To sum it all up, we have multiple factors to predict injury risk. External factors can be from the activities and environment or specific sports. We try not to change these unless necessary and beneficial – we don’t want you to quit your sport or job, but a temporary change may be necessary. Internal risk factors are what we try to change.
There are many screening procedures to assess this – we use the FMS which also guides us in our progressions in training. The internal risk factors include: previous injury (which we can’t change), asymmetries and incorrect load progressions. As we minimise asymmetries and load appropriately, our risk is reduced and this is what most trainers/coaches/therapists do by nature – to maintain/maximise gains but also minimising risks. The risk is never zero! However, we can minimise it and move better! If you have any concerns about your risks your sports and activities, seek out a professional!
