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Study: Strength Training and Proprioceptive Training Prevents Injuries

Does strength training prevent injuries?

Does strength training prevent injuries? Hint: yes.

Researchers in Denmark recently reviewed the current research on exercise programs for injury prevention, and crunched some numbers to see what does or doesn’t work.1 What did they find?

Strength training reduces sports injuries by about 68%, proprioception training reduces injuries by about 45%, and stretching programs do not reduce injuries reliably. Interestingly, combined programs only reduced injuries by about 35% (all of which included strength training)

First Thoughts

My first thought is: “damn strength training, you crazy!” Cutting injuries down to one third… those are some great results! And personally, my bias is confirmed – I’ve always thought strength training was important for injury prevention, especially strains, but wasn’t too sure what the research said. The good results with proprioceptive training are not surprising – which in this review included “neuromuscular training”, involving exercises for balance, coordination, agility, stability, etc.

That strength training was found very effective may seem “obvious” in hindsight. But don’t forget that before it was shown that stretching doesn’t prevent injuries, it was considered “obvious” that it did (maybe it does for particular athletes like dancers – but that’s another discussion). Either way, it’s good to have stronger evidence. See what I did there?

Reviewing the Review

Before people throw out everything except strength training, let’s take a closer look at the studies reviewed. There are some important details.

Strength training was shown to cut acute injuries down to one third, and overuse injuries down to one half. However, it should be noted that half of the strength training studies used hamstring strengthening, and only measured improvements in hamstring strain injury occurrence, rather than overall injuries. This may have made strength training look better than it actually is for injuries in general.

Other exercise methods (especially combined programs) typically looked at overall injury occurrence. This may have lowered the apparent impact – certain types of exercise simply shouldn’t be expected to prevent every type of injury. Proprioception exercises generally worked better when they were more specifically matched to a particular outcome – like ankle stability exercises for preventing ankle sprains.

Finally, stretching programs typically consisted of static stretching rather than dynamic stretching – so the poor results aren’t surprising. Furthermore, athletes studied were typically involved in activities that normally do not require large amounts of flexibility. Most studies investigated team sports – soccer and basketball players mostly – and no study looked at athletes who use larger ranges of motion like dancers, martial artists, gymnasts, etc.

Further Questions

It would be great for further research to inform us which types of exercise prevent particular injuries. This way programs can be designed more appropriately, considering the risk factors of both the activity, as well as the individual.

Strength training was effective at preventing injuries, but how much strength is needed? Can someone become “strong enough”, how can we know, and is it significantly different between sports? Is it even the level of strength that matters, or perhaps the training itself “priming” the neuromuscular system to increase preparedness? These questions are difficult to answer and will require a lot of research.

Perhaps all methods work as long as they are appropriately applied. This highlights the importance of designing prevention programs specifically for particular activities, matching the exercises with the demands placed on the athlete. There is no one perfect injury prevention program for every person and every activity.


Recommendations

For those of you who are reading this just for the practical take-home message, here are some recommendations.

This is just my (informed) opinion, of course – and all recommendations should be adapted for individual needs and sport specific demands.

Warm-up for Training and Practice:

  • Warm up with active, dynamic mobility exercises. Move through the range of motion you’ll need – if your sport requires a big range of motion / flexibility, and you don’t have this range yet, then sure, stretch (mostly after practice).
  • Make sure your warm up also includes coordination training – anything that challenges balance / stability and agility, preferably during sport-specific movements.
  • Include a few strengthening exercises (probably best to avoid fatiguing yourself) for muscles that tend to become strained in your sport – for many sports, this will be the hamstring and groin muscles.

Strength and Conditioning:

  • Perform one or two strength training sessions a week, perhaps at the end of practices. Exercise the whole body – but sport specific needs should be emphasized.
  • Perform conditioning exercises two to three times a week, perhaps at the end of practice. Improved endurance is correlated with reduced injury rates. Injuries often occur at the end of competition when athletes are most fatigued.

Reference

Lauersen JB, Bertelsen DM, & Andersen LB (2013). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British journal of sports medicine PMID: 24100287

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    2 Responses to Study: Strength Training and Proprioceptive Training Prevents Injuries

    1. Eric Troy says:

      Great review, Tony. Everything you say makes sense to me. My only comment would be on your question concerning how much strength is needed to prevent injuries. How strong is strong enough, and is there a such thing as too strong. This question, to me, illustrates how we do not routinely think about strength as being it’s own high level performance skill like anything else. You brought up gymnasts. Well, if you are a very high level gymnast at the peak of your career, then probably you have been injured and you’re carrying around some baggage from that. Well, same thing with strength. If you are almost as strong as you can be then, most likely, you’ve been injured somewhere down the line. Hardly anyone reaches “peak” strength while totally escaping injury, and probably will have been injured several times and had numerous ‘tweaks.’ It’s not inevitable but it does come with the territory. This is not to say that strength training is more likely to injure you only that injuries are part of any training for extreme performance. So, the question of is there a such thing as too strong for injury prevention…well, there you go. If you are strength training to prevent injury, but you train to be as strong as possible, then, you at times will have to risk injury. It may be a calculated risk but there is always going to have to be that time when you skate on the edge, just like in any sport or performance pursuit. Most people, including “strength training experts” never actually train people for maximum strength but for other benefits so they don’t really realize what it takes to become as strong as possible. Anyway, my point is, then, that yes, there is a diminishing return on strength training when it comes to injury prevention. It would make no sense to strength train for injury prevention while taking the same risks a person who trains only for maximum strength would take. There is no answer to how strong is strong enough, right now, but certainly, you should not seek to be ‘as strong as possible’ just for injury prevention.

      • Tony Ingram says:

        injuries are part of any training for extreme performance

        Absolutely! This is why I don’t believe we will see much better rates of injury prevention than what we see here – injuries just happen. No matter how strong, coordinated, and proficient at what you do, there will always be random accidents and mistakes. Especially team sports, where people will inevitably run into each other.

        Also, I completely agree with your sentiment on the risks of being as strong as possible. Good thoughts, thanks for sharing!

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