DOES STRENGTH TRAINING HELP PREVENT INJURY?

One of the reasons why somebody might do strength training is to help reduce their risk of injury. But does it? Does strength training help reduce your chances of injury?

Below we explore official guidelines (on how to reduce your chances of injury), the role of strength training, other factors you might want to consider, finishing up with a model as to how to predict your likelihood of injury.

Official Guidelines

The Australian Government provides guidelines on how much exercise you should do, but does it provide guidelines on how to reduce your chances of injury? It does, but much of it relates to:

• Workplace injury

• Motor vehicle related injury
• Slips and falls for elderly people

However, what we’re interested in is sports related injury. The Victorian Government makes some broad references to it in its public health and wellbeing plan (Public health and wellbeing planning, 2018) but nothing that you can do as an individual to reduce your chances of injury.

Interestingly neither Fitness Australia nor Sport Australia (AIS) had any relevant information on their websites. Nor the CDC (Centre for Disease Control & Protection) ‘the nation’s [U.S.A.] health protection agency (Centers for Disease Control and Prevention, 2019). Nor the American College of Sports Medicine (ACSM).

Note: The ACSM has ‘more than 50,000 members and certified professionals strong from 90 countries around the globe. Representing 70 occupations within the sports medicine field’ (American College of Sports Medicine, 2019).

More general resources including the Better Health (Better Health Channel, 2018) website, the American Academy of Orthopaedic Surgeons (2015) website and Sports Medicine Australia (2017) included, amongst other things, that incorporating strength training into an exercise routine could help to prevent injury.

However, I was after some more definitive statements. So, what does the research say? My hypothesis: strength training will help but it’s not quite as simple as that.

Laurensen, Bertelsen, & Anderson (2014) looked at feedback from 26,610 participants and concluded that:

• Strength training reduced sports injuries to less than 1/3 and overuse injuries could be almost halved. (Lauersen et. al, 2014)

Rössler, Donath, Verhagen, Junge, Schweizer & Faude (2014) looked at feedback from the other from 27,561 athletes, (median age 16.7 years) and suggested:

• The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. (Rössler et al., 2014).

So, it looks like strength training helps, but as the below paper asks, why?

• Compared with normative practices or control, IPPs (injury prevention programs) significantly reduced IRRs (injury rate ratio) in adolescent team sport contexts. The underlying explanations for IPP efficacy remain to be accurately identified’ (Soomro, Sanders, Hackett, Hubka, Ebrahimi, Freeston & Cobley, 2016).

Could load be a factor or more specifically load management?

There were a number of research papers (Gabbett, 2016), (Drew & Finch, 2016), (Jones, Griffiths, & Mellalieu, 2017) that suggest poor load management i.e. doing too much too quickly, increases your chances of injury.

And a consensus statement on load in sport and risk of injury International Olympic Committee suggested the following:

• ‘High loads can have either positive or negative influences on injury risk in athletes, with the rate of load application in combination with the athlete’s internal risk factor profile likely being critical factors’ (Soligard, Schwellnes, Alonso, Bahr, Clarsen, Dijkstra & Engebretsen, 2016) i.e. it looks like load management and athlete’s internal risk factor that are relevant

They also wrote:

• ‘There is evidence from some sports that if load is applied in a moderate and progressive manner, and rapid increases in load—relative to what the athlete is prepared for—are avoided, high loads and physically hard training may offer a protective effect against injuries’ (Soligard et al., 2016) i.e. if loads are managed, hard training may be protective

And finished with:

• ‘more research is needed on ‘ interaction with other physiological, psychological, environmental and genetic risk factors’ (Soligard et al., 2016).

So maybe biopsychosocial (BSP - the relationship between biology, psychology, and socio-environmental factors) factors play a role? Research from the German Young Olympic Athletes’ Lifestyle and Health Management Study (GOAL Study) which included information on squad athletes from all Olympic disciplines suggested that:

• ‘in many cases, injuries are the result of a complex interplay of biological, psychological and social processes.’ (Thiel, Schubring, Schneider, Zipfel, & Mayer, 2015)

A research paper from (Johnson & Ivarsson, 2017) suggested the following:

• ‘Based on substantial empirical evidence it is also shown that changes in stress and perceived recovery appear to predict injury occurrence in sport. Current studies, focusing on overuse injuries, also suggest that cultural norms and rules can be seen as factors that can indirectly influence the risk of becoming injured.

i.e. Stress and cultural norms, e.g. what the group tends to believe can affect likelihood of injury

So, it looks like there might be a number of factors at play; whether you engage in strength training, how you manage your load and biopsychosocial factors. There is also a suggestion that how the brain perceives stress could influence injury risk as well (McEwen, 2017).

Maybe that’s why there isn’t specific government advice on it – it’s complex?

Perhaps a complex problem requires a complex model to help solve it, one where:

• ‘Sports injury prevention relies on the identification of risk profiles, which means moving from risk factors to risk pattern recognition. This approach considers an interconnected and multidirectional interaction between all factors, which embrace the complex nature of the sports injury’ (Bittencourt, Meeuwisse, Mendonca, Nettel-Aguirre, Ocarino & Fonseca, 2016)

i.e.  Try to identify a range of factors (web of determinants (Bittencourt et al., 2016) that might contribute towards (or help protect against) injury and how they might interact. Some factors being more relevant than to certain individuals than others, or from one group to another or from one sport to another. However once identified they can be monitored and predictions made.

So maybe you could try to identify what factors are relevant to you or the group that you train/train with and start to monitor and see if any patterns emerge. Some potential factors for you to consider below:

• Whether you/they undertake strength training
• Load management
• Stress
• Sleep
• Fatigue
• Susceptibility to pain
• Self-efficacy
• Anxiety
• Beliefs about injury
• Previous injury
• Cultural beliefs about injury
• Complexity of activity

How reliable will this approach be?

One would assume that all predictive models carry an element of risk and therefore unpredictability. However if we use a horse racing analogy, you are probably more likely to be able to predict the winner if for example you know how quick the horses are in comparison to each other, what surfaces they like to race on and who their jockeys are, than if you knew nothing at all.

However, the question we set out to answer was does strength training help reduce your chance of injury? The research reviewed suggests that it does (alongside a wide range of other factors 😊). Perhaps a controlled stressor like strength training can help promote both mental and physical adaptation (McEwen, 2017) and therefore greater confidence in a person’s ability and body?

Got questions about the above? Ready to start your own training? Get in touch (1300 920 520) we would love to speak with you.

Bibliography:

• American College of Sports Medicine. (2019). [online] Available at: https://www.acsm.org/acsm-membership/about-us [Accessed August 20 2019]
• Better Health Channel. 2018. Sports Injuries. [online] Available at: https://www.betterhealth.vic.gov.au/health/HealthyLiving/sports-injuries#lp-h-6. [Accessed 17 August 2019].
• Bittencourt, N. F. N., Meeuwisse, W. H., Mendonça, L. D., Nettel-Aguirre, A., Ocarino, J. M., & Fonseca, S. T. (2016, November 1). Complex systems approach for sports injuries: Moving from risk factor identification to injury pattern recognition - Narrative review and new concept. British Journal of Sports Medicine, Vol. 50, pp. 1309–1314. https://doi.org/10.1136/bjsports-2015-095850
• Centres for Disease Control and Prevention. (2019). About CDC 24-7. [online] Available at: https://www.cdc.gov/about/default.htm [Accessed 19 Aug. 2019].
• Drew, M. K., & Finch, C. F. (2016, June 28). The Relationship Between Training Load and Injury, Illness and Soreness: A Systematic and Literature Review. Sports Medicine, Vol. 46, pp. 861–883. https://doi.org/10.1007/s40279-015-0459-8
• Gabbett, T. J. (2016). The training-injury prevention paradox: Should athletes be training smarter and harder? British Journal of Sports Medicine, 50(5), 273–280. https://doi.org/10.1136/bjsports-2015-095788
• Johnson, U., & Ivarsson, A. (2017, August). Psychosocial factors and sport injuries: prediction, prevention and future research directions. Current Opinion in Psychology, Vol. 16, pp. 89–92. https://doi.org/10.1016/j.copsyc.2017.04.023
• Jones, C. M., Griffiths, P. C., & Mellalieu, S. D. (2017, May 28). Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies. Sports Medicine, Vol. 47, pp. 943–974. https://doi.org/10.1007/s40279-016-0619-5
• Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2014, June 1). The effectiveness of exercise interventions to prevent sports injuries: A systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, Vol. 48, pp. 871–877. https://doi.org/10.1136/bjsports-2013-092538
• McEwen, B. S. (2017). Neurobiological and Systemic Effects of Chronic Stress. Chronic Stress, 1, 247054701769232. https://doi.org/10.1177/2470547017692328
• Rössler, R., Donath, L., Verhagen, E., Junge, A., Schweizer, T., & Faude, O. (2014). Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis. Sports Medicine, 44(12), 1733–1748. https://doi.org/10.1007/s40279-014-0234-2
• SMA. 2017. About. [ONLINE] Available at: https://sma.org.au/about-sma/. [Accessed 17 August 2019].
• Soligard, T., Schwellnus, M., Alonso, J. M., Bahr, R., Clarsen, B., Dijkstra, H. P., … Engebretsen, L. (2016). How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. British Journal of Sports Medicine, 50(17), 1030–1041. https://doi.org/10.1136/bjsports-2016-096581
• Soomro, N., Sanders, R., Hackett, D., Hubka, T., Ebrahimi, S., Freeston, J., & Cobley, S. (2016). The efficacy of injury prevention programs in adolescent team sports: A meta-analysis. American Journal of Sports Medicine, 44(9), 2415–2424. https://doi.org/10.1177/0363546515618372
• The American Academy of Orthopaedic Surgeons. (2015). [online] https://orthoinfo.aaos.org/en/diseases--conditions/sprains-strains-and-other-soft-tissue-injuries/ [Accessed August 20, 2019].
• The State Government of Victoria. (2018). [online] https://www2.health.vic.gov.au/about/health-strategies/public-health-wellbeing-plan [Accessed August 29, 2019].
• Thiel, A., Schubring, A., Schneider, S., Zipfel, S., & Mayer, J. (2015). Health in Elite Sports – a “Bio-Psycho-Social” Perspective. Deutsche Zeitschrift Für Sportmedizin, 2015(09), 241–247. https://doi.org/10.5960/dzsm.2015.194

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