The Journal Review: Preventing injury in Elite Sport Teams

Preventing injury is utterly vital. If you are performing in a team or as an individual you never want to get hurt; fortunately for anyone competing, there has been a huge push forward in the science behind preventing injury over the past decade. Looking at the studies undertaken for elite sports teams, we will go through the peer-reviewed suggestions which will hopefully help anyone competing today.


There are numerous factors that influence injury rates in elite sporting teams, and most of them are related. To reduce injury rates we must understand the relationships that exist between different factors.

Whilst an injury may occur during a certain event (for example a muscle strain), it is nearly always the case that this is the result of a long lead-up of various factors; the final event was just the straw that broke the camel’s back. Traditionally, sports science has looked at the event leading directly up to an injury; however science tells us that we should begin to look much further back.

Philip Alexander Coles wrote in the British Medical Journal That:

The ‘High Performance Unit’ should take the lead in responsibility for preventing injuries, but for them to achieve long-term success, they must collaborate closely with coaches, management and the players themselves, in creating an integrated approach to preventing injuries.

He continues to talk about the value of looking at the factors that lead up to an injury as part of the building blocks of a pyramid, seen below:


The first building block in the injury prevention pyramid for elite sporting teams is player recruitment. It stands to reason that recruiting players who are not physically suited to the sport or style of play you are going to have a high injury rate across the board.

Whilst it has been difficult to prove in a peer reviewed study that certain people are more ‘durable’, a major study of elite New Zealand Rugby players showed that past injury is a very strong predictor for future injury.

That is not to say that a player with a bad injury history is guaranteed to continue to get injured. In elite sports, we see consistent examples of players recovering from bad spells of injury. This is where the other building blocks of the pyramid come in.


The second building block in the pyramid is load management; however brilliant or gifted a player may be- if they are worked too hard, they will get injured. It is the coaching and high performance staff’s role to ensure that players are not being overburdened with training and playing the sport.

A close, personal knowledge of the player is absolutely vital for this stage. The way that people play, their physical gifts, their age and ability to recover are all considerable factors that come into play. Due to this, there is no ‘one size fits all’ approach that can be adopted, however there is a lot of debate when it comes to the assessment of training load and how this effects injury risk. Regardless of this, it has been shown (particularly in the Hulin et al study cited below) that a core consideration is to very slowly ramp up the training loads whenever you think you are going to push a player over the maximum they have seen before.

This factor is especially prominent when youth players begin to train with the full side of an Elite Sports Team. For the first time they will be training with other people with considerable experience in handling heavy workloads, and in an attempt to keep up they will find themselves pushing themselves closer and closer towards injury. In this case it is valuable for the player to be given the time to rest and recover, whilst knowing that they will be training fully within time.


If you are hiring the right players and managing their workload then you have a good base to be successful in injury prevention. To improve father, you may need to improve physically; doing so when trying to prevent injuries is a very hard balancing act to pull off.

This is why the next building block is a high quality, needs considered strength and conditioning program. This will lead to an overall improvement in the athletic qualities of the individuals in your squad, and there is also strong evidence to show that strength and conditioning has a primary role in preventing injuries. (Laureson


Even Philip Alexander Coles questions how high up the pyramid movement efficiency should be, pointing out:

Efficient movement patterns go hand in hand with improved athletic development. Its position in the injury prevention pyramid is likely to be debated, as some would argue that without moving in the most efficient way, a player can never truly use the strength he or she has, let alone improve it further.

Poor movement patterns will also contribute to increasing your injury risk, however the reason it is a bit lower down the pyramid is that an athlete needs to be strong, fit and not overworked enough to meet the demands of his sport.

That being said, it is still vitally important that movement patterns are optimised, as in doing so- injury will be reduced and performance will be increased.


The Silvers-Granelli journal article cited below suggests that a good structured Injury prevention programme can reduce time loss to ‘preventable injuries’ by 30%. Whilst this may be a generous assessment, as it doesn’t take into account Elite Sports programmes that have a strong base of the pyramid, and are(often at least) getting the various lead in factors perfect.

There is strong evidence to show that hamstring exercises decrease the risk of hamstring strains (Goode AP, cited below for example) but that is only true if they are done consistently enough to achieve the adaptations required. If they are included in a warm-up such as the FIFA 11+ prevention program, it can help to ensure that the whole team completes the minimum required amount to work effectively.

These programmes don’t have to be highly complex- it is vital that they are not overly long; athletes may get bored and lazy, thus not completing the exercises as needed.


The reason for this sitting so high up the pyramid is that rehab and injury assessment only occurs after a player has been injured. Regardless of this, managing these situations correctly can lead to a noticeable reduction in injuries on the team

The STARTT Process is an interesting decision-making tree outlining when you should decide to put a player back into the game after sustaining an injury. This process is a fantastic visualisation that is more than worth a read, but the reality is that every situation is unique and must be treated that way. The exact same injury (on a physiological basis) may require different rehabilitation and time frames. The final decision on return to play should only be reached after discussion with everyone who may be able to provide help (doctors, coaches, the player, physios etc.)


Well. At the tip of the pyramid is the factor that cannot be controlled, no matter how much time, money and effort you put in. Whilst it is always disheartening to know that even a perfectly executed plan may fail, the perfect execution has a huge effect on the final result!

Like with everything in life, you can just have some bad luck and lose out due to this- but by keeping a stranglehold on all other factors you have the best chance possible of remaining injury free!

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Coles PA An injury prevention pyramid for elite sports teams Br J Sports Med Published Online First: 25 March 2017. doi: 10.1136/bjsports-2016-096697

4 Hulin BT, Gabbett TJ, Lawson DW, et al. The acute:chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. Br J Sports Med 2016;50:231–6.

Quarrie KL, Alsop JC, Waller AE, et al. The New Zealand rugby injury and performance project. VI. A prospective cohort study of risk factors for injury in rugby union football. Br J Sports Med 2001;35:157–66

Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med

Silvers-Granelli H, Mandelbaum B, Adeniji O, et al. Efficacy of the FIFA 11+ injury prevention program in the collegiate male soccer player. Am J Sports Med 2015;43:2628–37

Shrier I. Strategic assessment of risk and risk tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med 2015;49:1311–5.

Goode AP, Reiman MP, Harris L, et al. Eccentric training for prevention of hamstring injuries may depend on intervention compliance: a systematic review and meta-analysis. Br J Sports Med 2015;49:349–56