How to prevent injury from sport and exercise

This article is part of our package looking at the benefits of exercise. Have a look at our interactive body map on the risks of inactivity.

Regular physical activity is an essential part of a healthy lifestyle, protecting us from a host of modern ills such as heart disease, obesity, type 2 diabetes, depression and some cancers. Sport and exercise are great ways to accumulate regular physical activity, but what about when they do us harm?

From team sports to extreme sports, all physical activities carry some risk of injury. But before you retreat to the safety of the couch, it’s important to remember the benefits far outweigh the risks, and avoiding physical activities altogether is likely to be the riskiest option of all.

Research suggests regular sports and exercise can reduce your risk of death by 20 to 40%, and a new study shows this may vary depending on your sport of choice. However, it’s important to consider how you can minimise your risk of injury so you can continue to reap the health benefits of sport for many years to come.

Who injures what?

Hospital records show the annual injury rate from sports and recreational activities is around 6% (of all participants). But this figure is likely to underestimate the true rate of sports injury, as many injured people don’t go to hospital for treatment.

A striking and consistent finding from aroundtheglobe is that around three quarters of all sports injuries occur among males. This is likely due to a number of factors including higher participation rates, the tendency for males to take greater risks, and the nature of traditionally male sports and activities.

About half of all sports injuries in Australia can be attributed to motor sports, water sports and football codes, which are usually dominated by males.

Injury risk is also strongly linked to age, with younger athletes and exercisers far more likely to suffer an injury than older adults. For example, two thirds of sports-related injuries occur in individuals under 35 years, and 15 to 17 year olds are almost ten times more likely to be injured than adults aged over 65. This is perhaps encouraging given “fear of injury” is a commonly reported barrier to physical activity among older adults.

Of the sports-related injuries requiring hospitalisation in Australia, most are due to fractures (49%), and “soft tissue” or muscle injuries (10%). But data from other countries suggest the majority of sports injuries are dislocations, sprains and torn ligaments (60%), with a smaller proportion accounted for by fractures (18%), and bruising or wounds (12%).

In terms of where injuries occur, the most common sites are the knee and lower leg (23%), followed by the elbow and forearm (20%), wrist and hand (20%), and head (11%). Most injuries are caused by awkward falls (28%), contact with another person (12%), and overexertion (10%) (including injuries caused by strenuous or repetitive movements).

Are sports and recreational activities becoming riskier?

Recently, medical professionals expressed concern at the number of children presenting with Anterior Cruciate Ligament (“ACL” - in the middle of the knee) tears that require surgery.

Physical fitness and motor coordination are protective against sports injuries.

With the decline in physical activity and fitness occurring among the current generation of young people, it’s possible today’s young athletes have a reduced tolerance for the physical demands of sport.

In older athletes, there is evidence to suggest rates of concussion and other sports injuries have been increasing. Although this may reflect better injury management and referral, it’s also possible sports are becoming faster and more competitive, increasing the likelihood of injuries occurring.

Injuries resulting in major trauma (such as spinal injuries) also appear to have increased, and are most prevalent in cycling, off-road motor sports, Australian rules football and, to a lesser extent, swimming.

While concerning, it’s important to recognise the absolute level of risk remains low (6.3 per 100,000 participants per year), and these findings should not discourage individuals or parents from enrolling themselves or their children in sport.

Should I avoid fitness trends like CrossFit?

The increasing popularity of fitness trends such as CrossFit has raised questions about the safety of these kinds of activities for the general population. CrossFit involves performing a range of high-repetition aerobic and resistance exercises, typically organised into a circuit known as a WOD (Workout of the Day).

Criticisms of CrossFit include the inappropriate use of highly technical lifts with inexperienced trainers, the emphasis on toughness and pain tolerance over proper exercise technique, the ease of certification for CrossFit coaches, and the fatiguing nature of CrossFit workouts, which are almost certain to cause deficits in technique.

In terms of the evidence, one study reported a high injury rate for CrossFit training of about 20%, whereas other studies suggest the injury risk is comparable to or lower than other common sports and recreational activities.

Some evidence suggests a high level of coach involvement, and having a mandatory training period for beginners, can significantly reduce injury risk among CrossFitters. However, with large groups it is often difficult for coaches to provide the level of supervision needed to manage the risks, and those participating in CrossFit the longest are the most likely to have experienced an injury.

How can I reduce my risk of injury?

Luckily there are some tried and tested methods for reducing your injury risk, and experts suggest up to 50% of sports injuries can be prevented. Follow these tips to keep yourself injury free:

1) Stretch: Having good flexibility decreases your risk of injury, so incorporate stretching into your training regimen. Make sure your stretching is planned and purposeful, as tokenistic stretching just before a game may not do much for you.

2) Always include a warm up: Muscles respond to heat and will have a greater tolerance to stretching when warm. An appropriate warm-up that mimics sports-specific movements will enhance blood flow, increase muscle elasticity, and help reduce sports injuries.

3) Stay strong: Regular resistance training has been shown to reduce sports injuries in both adults and young people, and it has the added benefit of improving sports performance. Incorporate age-appropriate resistance exercise into your weekly training plan.

4) Don’t go too hard too soon: Recent evidence suggests injury risk is essentially a function of “training load errors” (in other words, training too much or too little). This view suggests it is rapid or excessive fluctuations in training load that predisposes individuals to injury, rather than just training too hard. So progress gradually, maintain a moderate training load where possible, and if you have time off due to injury or illness, don’t return to pre-injury training levels too quickly.

5) Don’t get injured in the first place: Unfortunately, one of the strongest predictors of sports injury is having suffered the same injury previously. So one of the best things you can do to prevent your risk is to ensure you follow injury prevention guidelines early, as it may become harder to stay uninjured once an injury occurs. For some great advice on specific injury prevention and treatment, check out the Sports Medicine Australia injury fact sheets here.

Jordan Smith receives funding from the Hunter Medical Research Institute (HMRI), and is a member of Sports Medicine Australia.