I recently came across this injury risk formula that I thought was simple yet thorough.
Injury prediction, prevention and risk reduction can be a bit of a taboo topic in our industry. I often see it used as a marketing ploy to get people through the door. In reality, most do a poor job at identifying injury risk factors, let alone predicting injury.
Following this formula is a great way to identify possible risk factors for groin pain. It can help you identify those who may be at increased risk for groin injury. Once you’ve identified them, you can address the things that might be putting them at a higher risk of injury.
Unfortunately, most practitioners rely on one or two measures of injury risk. This doesn’t paint a broad enough picture for determining risk.
Injury occurs as a result of the interaction of many factors.
Injury is a multi-factorial event. It’s the perfect storm of risk factors intersecting at the perfect time to lead to disaster. Just like the natural disasters we see, they are very hard to predict because of this.
The 3 variables we need to identify injury risk are:
Predisposition to injury
Extrinsic risk factors
Injury mechanism
These three variables will give you a much better idea of an athletes true risk of injury. These variables should be monitored for change over the course of the season.
Here’s how to find the risk factors, step by step:
Step 1: Predisposition to injury
An athlete might be predisposed to injury because of their intrinsic risk profile.
This might include things like age, sex, injury history, weakness, etc.
The most common intrinsic risk factor for groin pain is previous groin injury. Previous injury may predispose athletes to another groin injury for multiple reasons including:
Remaining physical deficits
Reduced proprioception
Altered movement patterns
Additional intrinsic risk factors found in research might include:
Older age
High BMI
Early maturation
Low femur diameter
Reduced adductor strength
Loss of hip range of motion
Core muscle weakness
Step 2: Extrinsic Risk Factors
Extrinsic risk factors can include:
Weather
Sports rules
Training load
Extrinsic risk factors are often non-modifiable. But they are important to understand injury risk.
The most important modifiable risk factor for extrinsic risk factors is training load. This is one that is often monitored in professional sports. A large number of groin injuries in hockey that I see are overuse. By modifying training load, these injuries may be preventable.
A simple acute:chronic workload calculation can provide valid and reliable information on training load. Although not as precise as GPS tracking, it can help in flagging athletes who may be at risk of groin pain.
Step 3: Injury mechanism
The most common mechanism of groin injuries is an eccentric load in an over-stretched position. We can’t change the events and movements in a game to avoid this from happening. But we can train to build adequate strength in these positions.
One of my favourites is an elevated Copenhagen. With the elevation, we can load in a stretched position. You can use different methods like isometrics or heavy eccentrics to prepare the tissue for high forces in this position.
A lot of groin injuries occur in change of direction sports. Thererfore, we should be looking at cutting mechanics as an injury mechanism. I like using the Cutting Movement Assessment Score (CMAS) to identify potential altered movement in cutting.
The Injury Risk Formula
Now that we’ve identified the most common risk factors, we simply plug them into two simple formulae.
Predisposed athlete + Extrinsic Risk Factors = Susceptible Athlete
Susceptible Athlete + Injury Mechanism = Injury
If you have a predisposed athlete (high intrinsic risk factors) with high extrinsic risk factors (training load), they will be susceptible to injury. If this athlete performs a movement pattern that is a known injury mechanism, there’s a chance this athlete will get hurt.
Before this athlete gets injured, we want to minimize their risk as much as possible. From the risk factors, we can pull out the modifiable risk factors. These are the ones that we can change (ie strength, ROM, training load, altered movement patterns, etc.) to hopefully reduce the risk of injury.