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Injury Prevention Research – What works, and what doesn’t?

Always wear a helmet when doing stupid things.

What doesn’t work is a recurring theme on this website.

There are good reasons for that – myth busting is a good way to learn science, it prevents you from wasting time and money, and it’s actually quite fun. But too much of it can make things seem hopeless. Does anything actually work?

Thankfully, yes, there are things you can do to prevent injuries. There is hope!

In the spirit of looking at the glass half full, let’s review a recently published research article that describes what might actually work, and what doesn’t.


In June 2012, the Journal of Strength and Conditioning Research published an article about preventing and rehabilitation injuries during military operations 1. The authors reviewed numerous studies and compiled their results. They identified common risk factors for injury, and outlined which interventions for reducing injuries had strong evidence to support them (meaning they probably work), versus those that had limited evidence (meaning they probably don’t). Here’s what they found:

Risk factors for injuries within the military:

  • Female gender – unfortunately, women get more injuries.
  • High running mileage – more isn’t always better.
  • Low aerobic fitness and endurance – being easily fatigued increases risk of injury.
  • Extremes in flexibility– being “hyper-mobile” increases risk of injury.
  • Prior injury – having already had an injury strongly increases your risk of having another one (re-injury). That’s why proper rehab is so important.
  • Participation in recreational sports activities – In this study, they mean extra sports in addition to regular military training. But this is probably true for any athlete: the more you do, the more chances of injury.
  • Cigarette smoking – people who smoke get more injuries (maybe because it affects cardiovascular endurance – I’m not sure).
  • Limited history of prior physical activity – a previously sedentary lifestyle = poor endurance, poor coordination, etc = more injuries.
  • Age of running shoes – are they falling apart? Throw them out.

Keep in mind that these are risk factors – they are not causes of injury, they simply increase risk. You can have one or more of these risk factors and still avoid injury (which means you’re lucky).

Considering these risk factors, what can we do to prevent injuries? Here’s a list:

Interventions with strong scientific evidence:

  • Reducing running frequency, duration, and distance – running less leads to less injuries.
  • Training that includes neuromuscular, proprioception, and agility activitiescoordination training: being less clumsy = less injuries.
  • Wearing mouth guards – obviously depends on what kind of training you do.
  • Use of ankle braces for high risk activities – protective equipment like ankle braces works in some situations.
  • Improved aerobic fitness – maintain physical conditioning = less injuries.

And what doesn’t work so well?

Interventions with limited scientific evidence:

  • Wearing shock absorbing insoles – special shoes aren’t so special – (as discussed here for b-boying / dancers).
  • Replacing running shoes at regular intervals – rules like “replace shoes every six months” don’t really help much. Just replace them when they are worn out.
  • Stretching – being more flexible doesn’t prevent injuries. Learn more: Stretching 101 – Pros, Cons and Myths.
  • Targeted muscle strengthening – such as core strengthening and correcting “muscle imbalances”.
  • Smoking cessation – quitting smoking is a very good idea for your health, but not a magic bullet for reducing injuries (probably because you also need to improve your aerobic fitness and endurance).
  • Running on softer surfaces – your body actually adapts quite well to whatever surface it’s running on – the harder the surface, the softer you will run (without even realizing it) 2, 3.

While the study above was performed on military personnel, the results are in line with most of the research on athletes in general that I’ve come across. Some slight differences may exist (for example: dancers and martial artists may need more flexibility to properly perform, which might prevent some injuries). But for the most part, these principles are very generalizable.

Remember, these factors are discussed here in the context of injury prevention. Some of the “limited evidence” interventions may still be useful in other contexts. For example, targeted muscle strengthening may be important for some specific sports tasks, and quitting smoking is undoubtedly good for you!


What can you do with this information? Fine tune your training of course!

There may be things you can do less (like stretching and core strengthening), and some things you should probably pay more attention to (like improving coordination / stability / agility, and avoiding over-training).

If you’re looking to learn more about some of these things in particular, check out the Injuries and Recovery page, and subscribe to B-Boy Science for future articles!


– How many trainers and therapists out there are including neuromuscular training in their training or rehabilitation programs? It seems to be a vital component.

– How many athletes without trainers are including balance, stability, and agility drills? I’m looking at you b-boys / b-girls!


ResearchBlogging.org1. Zambraski EJ, & Yancosek KE (2012). Prevention and rehabilitation of musculoskeletal injuries during military operations and training. Journal of strength and conditioning research / National Strength & Conditioning Association, 26 Suppl 2 PMID: 22728983

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    6 Responses to Injury Prevention Research – What works, and what doesn’t?

    1. Curb says:

      Great stuff Tony. As to your question #1, I coach a lot of runners and teach them different neuromuscular drills and exercises. I like to include drills that emphasize frontal and tranverse plane movements as so much of our movement is saggital plane dominant esp. running. Make them a better athlete to make them a better runner. (works for non-runners too ;-) I’m also a fan of including different types of terrain regularly into a training schedule for movement variability.

      • Tony Ingram says:

        Hey Curb,

        Thanks for the comment! Great point about including frontal and transverse plane movements. Most exercises you see are in that saggital plane, yet almost every sport ever requires powerful lateral or rotational movements (hockey, soccer, baseball… etc.). Even running, which seems very saggital, involves rotation at the hip / waist. I’d bet those are the motions that are also most likely to cause injury. I feel like in the past training was all about avoiding those movements… but it’s probably a better idea to train them, and improve the quality of these movements, rather than fear them.

        Thanks again!


    2. Emelie says:

      Could you give an example of neuromuscular exercises?

      • Tony Ingram says:

        Hi Emelie,

        ‘Neuromuscular training’ usually refers to agility, stability, and balance exercises. The focus is on the form and quality of movement, to assure you do things safely. I wrote a quick article on it called ‘Coordination Training‘ – check it out.

        A really good example of a program is the 11+ warm-up that FIFA uses for their soccer players. There’s some promising research behind it and they have the manual and posters all free to download on their website.

        Of course, I think the exercises an athlete chooses should reflect the activity they are doing. For example, as a B-Boy, my drills would look pretty different than the 11+. They would look more like dance moves.

        Thanks for asking!


    3. Patrick says:

      Hehe, I know you don’t like static stretching much, but it’s a fundamental part of my training. I usually do it at night every two days. I obviously warm-up beforehand with a small cross-fit usually involving rope jumping, push ups and sit ups. I don’t do anything else in particular. Most of the time I start with top rock for at least 15 minutes and then I either do foot work or practice power. I spend a maximum of one hour on a single move during the learning process.

      It’s interesting in your article that being “hyper-mobile” increases risk in injury. I thought being more flexible increases your range of motion and so your muscle has more chance of getting out of a close shot.

      • Tony Ingram says:

        Hey Patrick,

        It’s not that I don’t like static stretching. I just think it’s important people know its limitations – especially it’s failure to prevent injuries. I do a lot of stretching too, but it’s because I want to be more flexible. But if flexibility isn’t a goal, don’t bother. Try the ‘neuromuscular training’ instead.

        Your second paragraph is what most people think of about stretching. But that’s not how injuries happen. Check out this article I wrote a while ago: How Injuries Happen. Being hyper mobile probably just puts you at the extremes of movement, which would only increase your risk of injury.

        It’s all really interesting stuff! I’m a nerd.


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