The concept of ‘prehabilitation’ exercise training is now becoming well-known with trainers and therapists involved in sports performance preparation. Prehabilitation involves strength and conditioning exercises for specific muscles that help to reduce injury risks, before an injury actually occurs. It’s the classic ‘an ounce of prevention is better than a pound of cure‘ approach to physical training. Prehabilitation is sport-specific and targets common injuries and strength imbalances that occur in the particular sport.
For example, a common injury suffered by tennis players (and famously Tim Henman last year) is shoulder tendinitis. This is often caused by the high forces involved in the overhead serving action on the shoulder and the fact that tennis players develop an imbalanced shoulder musculature. Specifically, the front shoulder muscles and internal rotators are too strong in comparison to the rear shoulder and external rotator muscles.
Armed with this information about the sport and knowing that shoulder injuries are common, the personal trainer or therapist working with a tennis player should recommend that exercises to develop rear shoulder and rotator cuff strength are included in the strength programme. This will avoid any potential strength imbalance and raise the player’s ability to withstand the forces of the serve – hence ‘prehabilitating‘ the injury.
The following is a brief summary of common injuries, the sports in which they often occur, and recommended prehabilitation exercises. From the head down.
Sports: Swimming, Tennis, Javelin, Discus, Shot Put
As mentioned earlier, shoulder tendinitis is related to weak rotator cuff musculature and an imbalance of strength about the shoulder. The following are exercises that would be very useful for shoulder injury pre-habilitation.
Sports: Tennis, Golf
Often this injury occurs because of poor technique, which places too much strain on the wrist musculature. This stress can be offset by strengthening the wrist muscles, particularly the wrist extensors.
Sports: Running, Squash, Tennis
Anterior knee pain often involves the patello-femoral joint and problems with the tracking of the patella. Another common over-use knee injury is patella tendinitis. The pain in both of these injuries is often at the front of the knee – hence the name anterior knee pain.
Strong quadriceps muscles are important for avoiding this injury, particularly the vastus medialis oblique muscle. The VMO is located on the inside of the knee just above the joint. The VMO muscle’s fibres are aligned inwards and pull the patella medially, keeping it aligned and running smoothly over the femur. Any misalignment and the cartilage under-surface of the patella can be damaged. The following is a useful exercise for strengthening the quadriceps.
Sports: Football, Netball, Skiing
This serious knee injury often occurs when the knee is extended and rotated at the same time, which can happen during landing from a jump and during falls.
The risk of this injury can be reduced by having strong quadriceps and hamstring muscles. In fact, a good ratio of hamstring-to- quadriceps strength has specifically been shown to reduce knee ligament injury risks since the hamstring supports the ACL’s pull on the tibia.
Sports: Rugby, Netball, Football
Ankle sprains tend to be accidental and sometimes related to the surface the sport is played upon. However, having strong lower leg muscles and good proprioception in the ankle joint can reduce the risk of this injury. The following are useful exercises.