Part One:
A Five Stage Process to Minimize Injuries in Elite Sport
Injury to an individual athlete will significantly reduce the amount of training and preparation time available to them, or even cause them to miss competitions, whilst it has been shown that the most successful teams in any sport are the ones who keep their best performers available for selection for the longest amount of time. In addition to this, the economic impact of injury can be substantial both to a sports organization and to the athlete themselves, not only through medical costs such as scans, treatment and rehabilitation specialists but also through lost wages, sponsorship and prize money. This makes it imperative that performance practitioners devote a significant part of their time and attention to ensuring that their athletes stay as healthy and as injury free as possible.
In this two-part series, we examine the principles of injury reduction training, identify the risk factors associated with specific injuries, and discuss the key stages in the injury reduction process for athletes.
Should We Be Talking About Injury ‘Prevention’ or Injury ‘Reduction’?
Some of the terminology which is regularly associated with athletes and injury can be misleading. The term ‘Injury Prevention’ is commonly used, but is this accurate? No matter what they do, no matter how sophisticated or detailed their training systems are, no matter how well coached they are, and no matter how experienced or knowledgeable their coach is, at some point or another, an athlete is likely to pick up some sort of an injury. There is very little that can be done when an NFL player receives a direct impact to the knee in a tackle, or a baseball player lands awkwardly on their shoulder sliding into a base. So, if that is the case, what can sports teams to address the injury problem?
With regard to injuries, any S&C coach or practitioner who is concerned with the physical preparation of athletes has a dual responsibility: firstly, to identify the common causes of an injury, and then secondly to apply appropriate training modalities in an attempt to decrease the likelihood of that injury from occurring. For this reason, instead of the term ‘Injury Prevention’, it might be more appropriate to use the term ‘Injury Reduction’. Practitioners can only ever reduce injuries; they can never eliminate them entirely.
Key Stages of the Injury Reduction Process
Having considered all of this, how do performance practitioners then approach the issue of injury reduction? One method which has been proven to be highly successful is an individualized, bespoke injury reduction program which is built into the athletes normal training schedule. To ensure that this becomes as effective as possible, it is important that coaches follow a specific process which is designed to optimize training outcomes and achieve the goal of keeping injuries to a minimum. This process is constructed through five key stages:
Stage One: Identify Common Injuries
If performance practitioners were to treat injury reduction as being a task in problem solving, the first part of that task would be to work out what the main problems actually are. For this reason, the first stage of the injury reduction process is for exercise professionals to identify the most frequently occurring injuries associated with their particular sport. For example, in men’s soccer the most frequently occurring injury is the hamstring strain, whereas ankle sprains are the most common injury in basketball. Practitioners working in these sports would be expected to prioritize their injury related training programs accordingly.
Alongside injury frequency, practitioners should also invest time in identifying any injuries which lead to a high loss of training and competition time, because these injuries may not always be the same. If we look again at basketball, studies into the NBA suggest that in terms of days lost in competition, patellofemoral inflammation is the most significant problem, meaning this is an issue which also requires serious attention.
Consideration should also be given to identifying any injuries which occur less frequently, but which lead to a prolonged athlete absence and may require a lengthy rehabilitation process. For example, despite ACL injuries contributing only 1-2% of all soccer injuries in the men’s game, they are associated with extensive time away from the sport and can lead to associated longer term health issues, therefore practitioners should consider reducing incidence of these injuries as being a high priority.
The injury identification process can be further refined to classify gender or positional variations. Let’s look again at ACL injuries in soccer – research tells us that female athletes are 2-8 times more likely to experience an ACL injury than their male counterparts, suggesting that practitioners working with female athletes should highlight ACL injury reduction when planning their programs. Finally, coaches working in team sports should analyze the physical demands associated with various positions, and then consider how this might impact risk of injury. For example, soccer players in wide positions complete more sprint distance than players in other positions, putting them at a relatively higher risk of sustaining a sprint related injury, such as a hamstring strain.
Stage 2: Identify Mechanisms of Injury
Once the most commonly occurring injuries have been identified, the next step in the injury reduction process is to determine the mechanisms behind them – in other words, the specific actions or sporting scenarios under which these injuries occur. This stage is important, because establishing the movement actions and the particular sporting conditions under which these injuries usually happen provides practitioners with a clearer understanding of how they might then be minimized.
If we use groin injuries as an example, analysis of injury mechanisms has enabled us to identify that most acute adductor injuries occur during non-contact situations following a quick reaction to a sport specific activity, such as a rapid change of direction, kicking a ball, jumping for a challenge, or reaching to make a tackle. These movements can cause a large stretch in muscles which are already highly activated, and this rapid muscle lengthening during high muscle activation appears to be the fundamental mechanism behind acute adductor injury.
Injuries can frequently have more than one underlying mechanism. For example, calf injuries can be divided into two distinct categories: acceleration/jump injuries, and deceleration injuries. Each of these movement actions require eccentric action in the gastrocnemius which, because it is a muscle which crosses two joints, leaves it at high risk to injury. However, the two mechanisms are slightly different: acceleration and jumping injuries occur when the gastrocnemius is contracted eccentrically, either during quick accelerations from stationary positions, or during rapid aerial movement actions. Injuries which are related to deceleration happen when horizontal braking forces cause substantial eccentric forces to be imposed on the gastrocnemius, thereby increasing the risk of injury occurrence.
Stage 3: Identify Injury Risk Factors
Having identified the predominant mechanisms of injury, practitioners can then advance to the third phase of the injury reduction process. This stage involves determining the intrinsic and extrinsic risk factors which contribute to an increased likelihood of these injuries happening, and by extension, which of those risk factors can be modifiable through training. By classifying any risk factors which are directly correlated with various injuries in this way, practitioners can then select specific exercises which have been shown to have positive outcomes in reducing them.
Certain risk factors are broad and can be applied to a number of different injuries, examples of which are core strength, proximal control, and movement mechanics. Probably the most significant injury risk factor, however, is for an athlete to have a history of previous injury. For example, a soccer player who has experienced just one previous hamstring injury may be 33% more likely to suffer a hamstring strain than a player with no hamstring injury history, whist 23% of soccer players with a groin injury would suffer from at least one more groin injury during the same season. Similar trends are seen for quadriceps and calf strains, and this raises some important questions. Does this happen because the player already had an existing predisposition to that particular injury, or does having had an injury lead to some form of maladaptation in the way the muscle functions, which leaves it weakened in some way and therefore more susceptible to injury?
Other risk factors are much more injury specific. For example, a reduced functional range of motion in the hip is a risk factor for groin injuries, because it increases the load on the pelvis and shortens the adductor muscles. In the quadricep muscle, a specific identified injury risk factor for muscle strains is the level of eccentric strength that the athlete is capable of generating in the rectus femoris. Identifying the risk factors associated with particular injuries, and understanding how they can potentially cause an injury to happen, means that training interventions can be put into place which are designed to positively modify the athlete, mitigating these injury risks, and reducing the potential for injuries to occur.
Stage 4: Identify Specific Athlete Injury Risk
Once the injury risk factors have been identified, the fourth stage of the process is for practitioners to then assess their athletes according to those risks, in order to evaluate the potential that they might have of sustaining specific and identified injuries. This screening process enables practitioners to identify those athletes who are more susceptible to injury.
Testing protocols must be specific to the injury, and provide data relevant both to the mechanisms of injury and to identified injury risk factors. For example, exercise professionals working in basketball may conduct force plate testing to assess asymmetries in landing mechanics that may predispose athletes to knee or ankle injuries. Baseball practitioners will perform range-of-motion assessments for pitchers to detect shoulder or elbow limitations that may predict overuse injuries. In soccer, sprint analysis and eccentric strength testing is utilized to identify any players at higher risk of hamstring injuries. This individualized process of assessment allows practitioners to prioritize interventions for high-risk players, rather than adopting a one-size-fits-all prevention strategy.
Stage 5: Apply Injury Reduction Protocols
Finally, once practitioners have progressed through this systematic identification process, they can then apply highly specific injury reduction protocols to those athletes who have been identified as having a higher potential for injury. This involves building exercises proven to have positive outcomes on modifiable injury risk factors into the athlete’s performance training and their strength programs.
Returning to the injury issues commonly associated with basketball, this might involve proprioceptive ankle training performed on balance boards, or plyometric landing programs supplemented with quad-strengthening for patellofemoral pain. In soccer, the injury reduction protocol is likely to be biased towards maximal sprint training and Nordic curls to reduce hamstring injury risk, whereas in baseball the program might include rotator cuff strengthening in conjunction with load management programs for pitchers to prevent overuse injuries.
Apollo is Critical to a Successful Injury Reduction Process
Apollo is the backbone that makes this entire process efficient and actionable. Instead of relying on disconnected spreadsheets, handwritten notes, or siloed medical reports, Apollo centralizes all athlete data. Injury history, screening results, workload metrics, wellness feedback, and rehab progress are all integrated into one platform, allowing practitioners to track injury trends across seasons, monitor at-risk athletes in real time, and assess the effectiveness of prevention protocols. For example, a strength and conditioning coach can quickly compare sprint load data with hamstring injury incidents in soccer, or analyze landing forces in basketball players following an ankle-prevention program. By integrating AI-driven analytics, Apollo doesn’t just store data – it transforms it into actionable insights, helping coaches make evidence-based decisions that reduce injury risk and improve athlete availability.
Final Word
Reducing injuries is one of the main pre-requisites for sporting success. The causes of injuries are multifactorial; therefore, a multi-faceted, integrated approach should be adopted to minimize the incidence of injury as effectively as possible. This holistic approach involves applying a systematic process which translates existing knowledge on injury risk factors into a sporting context and prescribes exercises which have been proven to be effective at reducing injury. The key stages of this process include:
1) Identification of injuries common to the sport
2) Identification of injury mechanisms
3) Identification of injury risk factors
4) Identification of specific athlete injury risks
5) Application of injury reduction protocols
In order to gain a complete understanding about how these steps come together to create an effective injury reduction process, it is useful to see how they might be applied in a particular sport. To illustrate this, part two of this series will analyze the injury reduction process as it might by implemented in soccer.
To learn more about using ApolloV2 for injury prevention email info@apollov2.com
Written by Adrian Lamb, Apollo Sports Scientist
