Injury Prevention Models
Sports injury prediction and prevention is notoriously challenging. When considering how to reduce injuries in sport, it is important to first understand injury preventions models. This blog looks at some of the traditionally utilised models.
The impact of sports injury can be lessened through the monitoring, controlling and analysis of the contributing factors of the events and by adequate means of control. The objective is to ensure that the risk is lessened, and thus less time is lost from training and match play.
The multifactorial analysis models for injury prevention in sport started to come to light through the work of van Mechelen et al. in 1987 (van Mechelen et al. 1992) with their ‘sequence of prevention model’ (figure 1). This model includes four sequential steps; establishing the extent of the injury, identifying the mechanisms and causation of injury, introducing new preventive measures and finally, evaluating their effectiveness.
Fig 1 – The sequence of Prevention of sports injuries (Mechelen et al., 1987)
Meeuwisse (1994) later developed a model that considered the identification of a series of risk factors that should be identified in order to implement prevention strategies. This classification was divided into intrinsic and extrinsic factors, and showed these factors to combine to contribute to a ‘susceptible athlete’. This model was later added to in order to include the recursive nature of risk and causation (Meeuwisse et al., 2007). Figure 2 shows the changes representing a more dynamic approach incorporating the consequences of repeated participation in sport, both with and without injury. The paper argues that if we are to understand the etiology of injury and target appropriate prevention strategies, we must look beyond the initial set of risk factors that are thought to precede an injury and take into consideration how those risk factors may have changed through preceding cycles of participation, whether associated with prior injury or not.
Fig 2 - A dynamic, recursive model of etiology in sport injury (Meeuwisse et al. 2007)
Bahr & Krosshaug (2005) present their model, building on previous models (van Mechelen et al., 1992; and Hagel & Meeuwisse, 2004) arguing that an understanding injury mechanisms to be a key component of preventing injuries in sport.
Figure 3 aims to expand on the biomechanical approach and better our understanding of the internal and external risk factors that should be considers on a sport specific level. The ability to design specific prevention programs will then improve by a more complete understanding of the causes of injuries.
Fig 3 - Comprehensive model for injury causation. BMD, Body mass density; ROM, range of motion (Bahr & Krosshaug 2005)
Finch (2006) later proposed some additional steps in the implementation and evaluation stage (figure 4) in their Translating Research into Injury Prevention Practice (TRIPP) framework. Finch (2006) claims that the original model, although a valuable tool to guide injury research over the past decade, fails to adequately describe the directions required for research that leads to direct injury prevention. This important additions considers the importance of ensure that research can be taken up in the field and allow for a realistic approach to monitoring and adding to the body of evidence for the efficacy of an injury prevention method.
Fig 4 - The Translating Research into Injury Prevention Practice (TRIPP) framework for research leading to real-world sports injury prevention (Finch 2006)
Given the limited information available on risk factors and injury mechanisms, it comes as no surprise that very few studies are available on injury prevention. Krogsgaard et al. (2003) discuss the strategies for injury prevention that have been developed from other areas, particularly from research on motor vehicle accidents. One such example is the sporting application of the Haddon Matrix from 1980 (Haddon 1980), which takes an interesting view on injury prevention.
This model premises that the injury process is naturally divided into three stages prior to, during and after damaging interactions with environmental hazards, named ‘precrash’, ‘crash’ and ‘postcrash’.
Rather than ‘internal and external risk factors’ as the other models have described, this model considers the factos of ‘athlete’, ‘equipment’ and ‘environment’. The model provides examples of considerations that will support the lowering of risk and subsequent impact of injury before, during the event, and after an event.
Fig 5 – Haddon’s Matrix applied to sports injury prevention (Krogsgaard et al. 2003, p.311)
These injury prevention models have not only contributed to primary injury prevention in the first instance, but how that then feeds into prevention of re-injury. The knowledge of injury prevention also helps us build evidence-based RTP models such as the excellent Decision-Based RTP model (Creighton et al. 2010) that many now consider on a regular basis to inform RTP decisions.
Fig 6 – Decision-based RTP Model
Bahr, R. & Krosshaug, T., 2005. Understanding injury mechanisms: a key component of preventing injuries in sport. British journal of sports medicine, 39(6), pp.324–329.
Creighton, D.W. et al., 2010. Return-to-Play in Sport: A Decision-based Model. Clin J Sport Med, 20(5), pp.379–385. Available at: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00042752-201009000-00012.
Finch, C., 2006. A new framework for research leading to sports injury prevention. Journal of science and medicine in sport / Sports Medicine Australia, 9(1-2), pp.3–9; discussion 10. Available at: http://linkinghub.elsevier.com/retrieve/pii/S1440244006000235.
Haddon, W., 1980. Advances in the epidemiology of injuries as a basis for public policy. Public health reports, 95(5), pp.411–421.
Hagel, B. & Meeuwisse, W., 2004. Risk compensation: a “side effect” of sport injury prevention? Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 14(4), pp.193–6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15273524.
Krogsgaard, M. et al., 2003. Textbook of Sport Medicine 1st ed. M. Krogsgaard et al., eds., Oxford: Blackwell Science Ltd.
van Mechelen, W., Hlobil, H. & Kemper, H.C., 1992. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports medicine (Auckland, N.Z.), 14(2), pp.82–99. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1509229.
Meeuwisse, W.H. et al., 2007. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 17(3), pp.215–219.
Meeuwisse, W.H., 1994. Assessing Causation in Sport Injury. Clinical Journal of Sport Medicine, 4(3), pp.166–170. Available at: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00042752-199407000-00004.