Prevention the Key

Toby Conroy is a former state junior basketball player and VFL footballer who works as a Sports Physiotherapist in Canberra. He has worked with the Basketball ACT programs, as well as being the team physiotherapist for the Australian Under 17 Men. Here he shares from important points about injury prevention for young basketball athetes.

The adage that prevention is better than cure is certainly relevant to sports and sporting teams. High level sporting teams aim to keep their best player on the field or court for as long as possible and able to perform at a high level as possible. There is in many sports a correlation between overall team performance and the number of games lost due to injury. It is everyone best interests to avoid injuries where possible.

What injuries are most costly and problematic?

The type of injury an athlete is a risk of sustaining is often dependant on a variety of factors including the nature of the sport. These will be discussed in further detail later in article. The most common injuries in sport include

1. Ankle sprains- this includes joint capsule damage and ligament sprains and tears
2. Groin pain- groin strains and tears, osteitis pubis, hernias, adductor tendinopathy are all examples of groin pain
3. Hamstring strain- tends to be less common in basketball particularly in juniors but occur in all sports involving his speed running and rapid accelerations
4. Shin splints- is often an umbrella term for any shin pain including medial tibial stress (MTSS) tibial stress fractures, tibialis posterior tendinopathy, compartment syndrome and popliteal artery entrapment
5. ACL tear- anterior cruciate ligament in the knee very important for sport that involve change of direction, cutting and twisting or pivoting.
6. Other knee injuries- includes patellofemoral joint pain, patella tendinopathy (jumpers’ knee), meniscus tears, collateral ligament sprains, posterior cruciate ligament sprains, patella instability or dislocation
7. Tennis elbow- painful elbow overuse injury also called lateral epicondylalgia
8. Lower back pain- 80% of general population will have an episode of back pain in their life. Often hard to diagnose specifically but can be bone, muscle, joint, disc or ligament injury.
9. Concussion- is brain injury as a result of trauma to the brain cause by the brain being shaken inside the skull. Often caused by collisions but can be a result of whip lash
10. Achilles pain- in children is called severs disease and in adults is called Achilles tendinopathy. It is an overuse injury causing Achilles pain and often affects those running or jumping.

All the above injuries can occur in junior sports including basketball. The injury that gets the most publicity are the major joint injuries particularly ACL tears. There has been a 70% increase in ACL injuries to athletes under 18 years of age over the past 15 years. This is a major concern for both the athlete and the Australian healthcare system. For the athlete they are face with and expensive surgery usually coating thousands of dollars plus 50% of these athletes will develop post traumatic osteoarthritis which can cause pain and disability later in life. The onset of osteoarthritis 10-15 years after ACL injury and only 40-60% will return to the same level of sport as when they hurt themselves.

What factors contribute to injury risk and injury occurrence?

There are many factors that have been shown to increase the risk of sports injuries. Some of these things we cannot change and are considered non modifiable risk factors. Others can be changed via various strategies and are considered modifiable risk factors. the non-modifiable risk factors include

1. Age- there are different stages of the physical maturation that place athletes at greater risk of injury. During peak growth spurts during adolescence there is often higher rates of overuse injuries and things dubbed growing pains including tendinopathies, Osgood Schlatter’s, severs disease. During the transition from junior sports to senior participation is another time of high injury risk. This is usually around the age of 18-19, athletes have not yet reached full skeletal maturation and are competing against experienced fully mature athletes. The rapid increase in intensity can leave some athlete more vulnerable to injury. Finally, as we reach the late stage of a sporting career certain injuries become more common. From the age of around 30 for most athletes our bodies don’t regenerate as quickly, and our hormone begin to change. This leads to a rise in soft tissue and tendon injuries often dubbed “old person injuries”.
2. Genetic/ Hereditary Factors- as with many health and physical outcomes some athletes have a greater disposition to certain injuries. Those athletes who have a family history of ACL tears, shoulder dislocations, tendinopathy and other injuries are more likely to suffer a similar injury during their career.
3. Weather and environment- the type of surface athlete play on can contribute to injury risks. Players who compete on harder surfaces have higher risks of overuse injuries; players competing in contact sports have higher risk of shoulder injuries and concussion; there has also been some evidence that AFL players are more likely to hurt their ACL early in the season or during preseason when the ground are harder and faster.
4. Human factor- in most sports there are other athletes and officials in the field of play. On some occasions there is unexpected or unsportsmanlike contact between these different parties. This can lead to a host of injuries from minor to severe. A tackle gone wrong, and having another athlete fall on you are examples of this.

Modifiable risk factors can be controlled to a certain degree and can reduced the risk of injury. These include – 

1. Training loads- there is growing research that when training loads become too high or unsustainable the risk of injuries increases. This is even more prevalent with rapid spikes or peak in load over short periods of time. This is relevant to basketball and other sports whose major championships involve tournament play involving multiple games in a short period or camps involving multiple session in a day for a weekend. During these tournaments’ athletes are at higher risk of injury as they are used to training or playing once a day or evening with plenty of time to recover. There is no formula that can predict an athlete’s risk of injury and shouldn’t be rigidly implemented but athlete monitoring and understanding your athletes allows for better management of players and loads. There is some research discussing the acute to chronic workload ratio however there are flaws with this model particular in team sports and shouldn’t be used as a hard and fast formula but more a rough guide.
2. Fitness- athletes with better cardio fitness and lower body mass index have been shown to have reduced injury risks. This includes tendinopathies and ACL injuries. Ensuring athletes are well training and generally fit is important for injury prevention
3. Early specialisation- specialising in one sport and neglecting all others at increasingly younger ages is more common. There is growing evidence that this may actually increase the risk of injury. The professionalisation of junior sports and increase in high performance programs in has resulted in increased costs and time commitments for each sport. It has result in younger athletes competing at higher levels at younger ages and makes it more difficult for children to participate in multiple sports due to busy schedules. However, playing multiple sports builds injury resilience via improved variable stimulus and load response, better quality and more variation in movement patterns, better rounded fundamental movement skills, better general fitness. Current evidence suggests athletes should be allowed to play multiple sports until 16-18 years old.
4. Skill level/ expertise- better skilled athletes can execute sport specific skills with autonomy and variability. This means they are less likely to suffer an injury as they are technically more proficient and can handle more challenging situations. As discussed previously younger athletes competing at higher level and more intense competitions can also contribute to injury risk. This is due to athletes spending longer on ‘the redline’ which is the intensity where performance increases and the injury risk increase due to the extra stress on the body.
5. Equipment- appropriate and age specific equipment is important to reduce injury risk. This may include safety equipment and padding but also using equipment the correct size or weight. If equipment is incorrect young athletes can develop injuries as a result of inappropriate loads placed on the bodies tissues.
6. Previous injury- in sports medicine the single biggest risk factor is a similar previous injury in the preceding 12 months or season. Re-injury rates are very high, 50% of people who have an ankle sprain will suffer another ankle sprain at some point. Similarly, 30% of athletes who sustain a hamstring strain suffer another one in the same season. This may be due to premature return to sport, maladaptive movement patters, lingering weakness or genetic predisposition or loss of conditioning.
7. Chronic lack of sleep- sleep along with nutrition are the most important factors for recovery following a match. However, depending on the time, intensity or conditions of the game sleeping after a match can be challenging and the turn around to the next game may be short. Chronic lack of sleep can increase fatigue, reduce concentration and coordination and result in poor recovery. This can then lead to injury or a reduction in performance.

Injury Prevention Programs

Injury prevention programs have been developed and implemented in many sports. Some of these include Netball Australia Knee program, FIFA 11+ program, PEP program, AFL Footy first program, The Throwers 10 program and many others. These programs have been developed to minimise the risk of serious injuries in inexperienced and junior athletes. They do this through the following:

1. Increase strength in key muscles to stabilise joints
2. Improve neuromuscular control and proprioception of particular joints
3. Improve motor patterning and movement control of sport specific movements
4. Train adaptations or movement variability and difficulty.

These programs have shown a 40% reduction of serious injury, 26% reduction in time lost to injury, 50% reduction in risk of ACL and 30% reduction in hamstring strains.

So, if these programs are so beneficial why are they not implemented on a regular basis? This becomes challenging and is often a result of the following

1. Lack of coach education- often local sports coaches are volunteer parents so are unaware of the existence of these program and not confident in implementing them into their own sessions
2. Difficulty of exercises- often the exercises in these are challenging and can cause some delayed muscle soreness so some athletes are reluctant to do this on a regular basis
3. Time constraints- these programs often take 10-20 mins to complete which can occupy a significant chunk of a junior sports session and can have some athletes complaining for boredom and coaches not having enough time to work with athletes or other priority areas.

Any injury prevention program is only as effective as its implementation. If these are implemented consistently and regularly the benefits are significantly better. Working with experienced coaches, S&C coaches, Physios and other well-trained staff can help young or inexperienced coaches modify these programs to suit particular sports or situations to get the benefits of the program without compromising their integrity. If you have any further questions, please feel free to contact the author

Stay Safe and enjoy your sport.