What are the best practices for advising patients on injury prevention in sports and exercise?

Advising patients on injury prevention during sports and exercise involves a combination of general self-care strategies and specific exercise interventions.

• General Self-Care Practices:
  • Patients should be advised to warm up before exercising by doing an aerobic activity at an easy pace to gently increase heart rate and prepare muscles for more intense activity ¹.
  • A cool down period after exercising is recommended, gradually decreasing intensity until breathing and heart rate return to normal, followed by gentle stretches while muscles are still warm ¹.
  • Using proper equipment is crucial, including wearing appropriate shoes that are replaced as they wear out, and comfortable, loose-fitting clothes that allow free movement ¹.
  • Patients should develop a balanced fitness programme that incorporates cardiovascular exercise, strength training, and flexibility ¹.
  • New activities and exercises should be added cautiously ¹.
  • It is important to avoid exercising or playing sport when tired or in pain ¹.
  • Patients should schedule regular days off from exercise ¹.
  • Managing any factors that increase the risk of re-injury or falls is also important ¹.
  • For competitive sports, counselling is essential, especially if treatment might interrupt regular training schedules ².
• Key Exercise Strategies:
  • Strength training programmes have been shown to reduce the risk of sports injury by more than 50% ¹. Increasing strength training volume and intensity are associated with sports injury risk reduction, with a 10% increase in volume reducing injury risk by over 4% ¹.
  • Exercise-based knee injury prevention programmes are recommended for athletes to prevent knee and anterior cruciate ligament (ACL) injuries, with no evidence of harm ¹.
  • Balance training is effective in reducing the incidence and relative risk of ankle sprains in athletes by 46% ¹. It is also an effective strategy to reduce hamstring injury rates ¹.
  • Eccentric exercise interventions have been shown to decrease hamstring injury risk (relative risk = 0.49) (Vatovec, 2019). Both eccentric exercise and balance training are effective strategies to reduce hamstring injury rates ¹.
  • Neuromuscular training and exercise interventions show moderate-quality evidence for preventing the recurrence of ankle sprain injury ¹. These programmes can prevent recurrent strains and reduce the risk of functional ankle instability, and are associated with a quicker time to recovery ¹.
  • For conditions like Osgood-Schlatter disease, advice on restriction or adjustment of pain-producing exercise is based on expert opinion, emphasizing continuing activity below the pain threshold ². Muscle stretching exercises may help maintain knee stability and reduce or prevent muscle shortening around the knee ². Proactive preventative measures, including quadriceps stretching, are suggested for Osgood-Schlatter disease ².
• Role of External Support:
  • The use of brace or tape functional support reduces the risk of both first-time and recurrent lateral ankle sprains, being particularly effective in preventing recurrent sprains, especially in those who participate in sports ¹. Athletes who wore braces had fewer ankle sprains and reduced their risk by 64% compared with controls ¹. External support with bracing or taping can provide a similar re-injury risk reduction of 50% for ankle sprains, and their beneficial effect can be improved with an appropriately designed exercise therapy programme ¹. Braces are recommended for all athletes with a previous history of ankle sprain, particularly when engaging in high-risk activities ¹.
• Nuances and Limited Evidence:
  • While some expert opinion supports muscle stretching for specific conditions like Osgood-Schlatter disease and as part of hamstring injury prevention ¹,², there is no evidence from six trials that general stretching reduces injuries ¹.
  • There is no evidence to support a training regimen of conditioning exercises to improve strength, flexibility, and coordination for injury reduction ¹.
  • Limited evidence suggests injuries were less frequent when running duration or frequency were reduced ¹.
  • There is no evidence that wearing running shoes based on foot shape, rather than standard running shoes, significantly reduces the rate of running injuries ¹. Similarly, there is no evidence for the role of footwear in the prevention of ankle sprains ¹.