The cornerstone of rehabilitation, and one most are familiar with, is recovery from injury. It’s a practice that has flourished for thousands of years with roots stretching back to the dawn of written history. Yet, many of us remain unaware of the other side of the coin – prehabilitation; the practice of reducing injury risk through targeted proactive exercises. Slightly paradoxically, although it’s supported by science, it’s overlooked by most, perhaps because awareness is low, but more likely because it requires patients to take the first step.
It’s hard to justify solving a problem before it even exists, and sports injuries are no exception. Most people don’t expect to get injured. If I told my mum she was going to sprain her ankle before her run last year, she probably would’ve laughed at me. Unfortunately, she did, and the result was injury, frustration, and lots of physiotherapy. What she didn’t do is visit a physiotherapist before she was injured – a seemingly counterintuitive idea, but one supported by both health boards and governments alike, who recognise that when it comes to health and injury, “prevention is better than cure”.
The ‘cure’ for most sports injuries usually involves the thrilling wait for tissue to regrow, punctuated by tedious, tentative exercise. Recovery is a long, frustrating, and painful process, ideally completely avoided by not getting injured in the first place. Yet for many people their preventive efforts comprise mainly blind hope; a strategy that works for the lucky few.
In reality, sporting injuries are less of a possibility, and more of a probability. Each year, around 2 million people attend Accident and Emergency departments due to sports injuries, with many more never making it to hospital. One study found that annually there are 9.8 million injuries resulting in treatment or reduced physical activity. Not only are these injuries inconvenient for individuals, but they also place financial strain on our NHS, costing us all as taxpayers.
So, what can we do? While injuries can’t be eliminated entirely, pre-habilitation can reduce the risk. Essentially, this involves personalised and specific training targeted at an individual’s risk factors, which are things that make injury more likely. By recognising these signs, we can take preventive measures.
The two broad categories of risk factors are shown in figure 1: Extrinsic (environmental) and intrinsic (personal). Extrinsic factors represent those arising from the external environment, such as the weather or the equipment used during exercise. Intrinsic factors are the individual biological (and psychological) characteristics unique to them, such as muscular imbalances or a history of injury. Some factors like age, sadly cannot be controlled, but others – like strength and flexibility, can, and it is this modifiability that provides the foundation for prehabilitation; if we can control it, we can improve it.
Everyone, from sedentary desk workers to exercise enthusiasts, are exposed to different risks. A piano teacher might have weak lower back muscles, an intrinsic, controllable risk factor, leading to poor posture and back pain while sitting. A construction worker may lack flexibility and have tight hamstrings, increasing the risk of a strain or tear during heavy lifting. A footballer could have strength differences between their left and right gluteal muscles, leading to poor running economy and potential joint strain. The list goes on.
The chances are we’re all going to get injured at some point, especially if we’re overconfident. If we want to mitigate the risk, step one is being aware of our own risk factors. If you already know yours, like inflexibility, muscular imbalances or a weak rotator cuff, and you know how to address them, you can start taking steps right away. For example, a tennis player with a history of sprains who knows he has poor ankle range of motion might start ankle taping: a strategy proven to significantly reduce the risk of recurrent sprains.
If, however, you don’t know your risk factors, find out! Self-assessments of mobility, balance, and strength are a great place to start. Alternatively, you could seek professional assessment; sometimes a few questions and exercise tests with a health specialist can reveal hidden vulnerabilities you might never notice on your own.
If there’s only two things you take away from reading this, I hope that it’s these; If you can control it, you can improve it, and prevention is always better than cure.
-Freddy Walker
