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The Importance of Developing an Injury Prevention Program for High School Female Athletes

With incidents of female youth athlete injuries reaching almost epidemic proportions, the need for a comprehensive injury prevention program at the secondary school level has never been more important. Most injuries result in soft tissue damage that can have long lasting implications for joint health. Sports injuries also have negative impacts off the field as pain and rehabilitation interfere with scholastic duties.

Programs that are most successful in reducing the risk of injuries in female youth athletes include a multi-faceted approach:

  • Designing a fitness program that emphasizes flexibility training, core training, balance and neuromuscular training, and integrated strength training.
  • Identifying common injuries and possible root causes.
  • Developing a strategy to prepare youth athletes for both practice and competition.

Injury Prevention Program Goals and Implementation Strategy

School athletic departments should develop a well-balanced injury prevention program that includes:

  1. Implementation of a sport-specific pre-workout/game warm up protocol to properly acclimate the athlete’s body to the demands of her sport.
  1. A clinical regimen of exercises that addresses injuries common to female youth athletes. This program should target core strength and the muscles required for dynamic joint stabilization. Emphasis should be placed on flexibility, strength, and balance through progressions that help the body react appropriately to sudden changes in environment. 

Sport-Specific Pre-Workout/Game Warm-Up Protocol

The most important tool in injury prevention on any level of sports is a proper warm-up before practice and competition.

When switching from a sedentary to an active state, the body and mind need to go through a number of changes. A well-programmed warm up achieves these goals by:

  1. Increasing body temperature.
  2.  Increasing blood flow throughout the body.
  3. Preparing the cardiovascular system for increased activity.
  4. Preparing the mind to engage in physical activity.

As with all athletic training, warming-up needs to follow a progression that makes sense for both the body and the activity to follow. The most important things to consider are the planes and ranges of motion involved in each sport. Does the sport involve explosive movement with rapid changes in direction like soccer? Does the sport require lateral movement like tennis and basketball or is it mostly linear like track? Another important thing to keep in mind are the injuries common to each sport. Is there a high incidence of twisted ankles, torqued knees, hamstrings and quad pulls, or rotator cuff strains?

All of these questions require each coach’s individual knowledge and understanding of their sport and should be incorporated into the implementation of their individual warm-up continuum that includes: pre-workout jog, general warm up, dynamic stretching and sport specific drills and static stretching. After a practice or game, it is equally important to perform a cool down to allow the body to transition from dynamic activity and exertion to a rested sedentary state.

Injury Prevention Training

The Importance of Core Stability/Strength and Dynamic Joint Stabilization

The body’s ability to function properly during movement is heavily reliant on two important physical characteristics: core strength and dynamic stabilization.

Core strength refers to the ability of the deep and superficial muscles of the abdomen and back that facilitate proper movement and stabilization of the torso and lumbar pelvic hip complex. Dynamic stabilization refers to the ability of muscles supporting a joint to produce stabilization during functional, dynamic, multiplanar movements. Bodies function most effectively when we have proper spinal alignment, good posture, and strong joints capable of performing the duties required by a given activity.

Common Physical Problems in Youth Athletes and Injury Patterns

Before developing any strategy to help prevent injuries, it is important to have an understanding of postural issues and the most common injuries sustained in practice and competition.

The Importance of Static and Dynamic Postural Assessments

The posture youth athletes bring to the field of play has a tremendous effect on their ability to perform and their risk of injury. Improper postural alignment can lead to muscle imbalances and increased risk of injury.

  1. Static Posture Assessment – Static posture is how a person naturally present themselves in a motionless stance. The assessment is a basic kinetic chain checkpoint evaluation. With the athlete standing in anatomical position, the observer scans the body, paying close attention to the five kinetic chain points starting at the foot and ankle, looking for possible distortions. It is safe to assume that any dysfunction in a static position will only be exacerbated with movement and need to be addressed to help increase functionality and decrease the prospect of injury.
  2. Dynamic Posture Assessment – Dynamic posture is how a person maintains posture during tasks that involve movement. The same kinetic chain checkpoint principles still apply as with the static assessment, but also involve evaluating the athlete’s ability to exhibit dynamic joint stabilization while performing various movements.
  3. Sport-Specific Postural Assessment – It is important to educate coaches to understand how postural distortions effect performance and increases the chance of injury. Assessments involve coaches observing the movement patterns and possible distortions in their athletes during drills, practice, and games.

The Causes of Common Injuries and The Kinetic Chain

The majority of all sports-related injuries are caused by one of the following three categories. When developing an injury prevention program, it is important to have an understanding of these common causes as well as the most common injuries that occur along the kinetic chain:

  1. Collision/Impact: Collision and impact can result from player to player contact, which is often part of the game and hard to avoid in certain sports. Injuries in this category can also result from contact with sport-specific equipment.
  2. Hyper-Torsion/Flexion/Extension: This category is mostly associated with non-contact injuries. When an athlete with compromised joint stabilization makes sudden extreme deceleration, plants, cuts, jukes, and turns, the connective tissue at a joint can become strained, pulled, or torn. The joints most at risk tend to be the ankles and knees. Larger muscles such as the quad and hamstring complexes can also suffer from sudden acceleration/deceleration from these movements.
  3. Overuse: Overuse injuries are a problem that occurs on all levels of sports and are generally the result of repetitive behavior and movements. These injuries can often be treated with rest, but failure to identify these problems can result in long-term degenerative issues at joints. One way to prevent overuse at the adolescent level is to encourage sport rotation and discourage students from concentrating on one activity year-round.

Proposed Injury Prevention Program

A well-designed program should include the following:

  1. General Warm Up – It is important to increase the athlete’s body temperature before engaging in any exercise program.
  2. Flexibility Training: Benefits of flexibility training are relief of joint stress, improved posture, maintaining normal muscle function and lengthening by increasing range of motion. This includes:
    • Self-myofascial release – applying pressure of varying intensity to muscles causes the muscles to relax.
    • Active isolated and dynamic stretching – this involves movement at joints through various ranges of motion by different means. Dynamic stretching uses muscle force and momentum to move a joint through a full range of motion.
    • Static stretching uses the principle of gentle or low force and long duration. Stretches should be held for no less than 20-30 seconds.
  3. Core Training: Core training concentrates on function over power, strength or force production. The goal is to create a core capable of optimum neuromuscular efficiency allowing the body to stabilize itself during dynamic movement.
  4. Balance Training: A well-designed program increases the athlete’s ability to maintain balance through controlled instability. An athlete’s speed, agility, and strength are all subject to their ability to dynamically stabilize during these actions.
  5. Strength Stabilization Training: Similar to balance training, strength stabilization training aims to improve neuromuscular stability and efficiency by performing more traditional strength exercises progressing through different bases of support from stable to unstable.

Conclusion

The risk of injuries can be greatly reduced through the following:

  1. Education: Coaches need to be educated on the importance of following proper warm-up and conditioning protocol. They also need to understand and identify physical signs of athletes who might be at higher risk for injury based postural and muscular imbalances and pre-existing medical conditions.
  2. Sport Rotation: Encourage sport rotation in youth athletes to reduce the occurrence of overuse injuries and muscle imbalances.
  3. General Fitness and Nutrition: Promote general fitness programs to encourage a healthy life style and to improve the overall fitness level of female youth athletes.
  4. Injury Prevention: A well-designed injury prevention program.

Dexter Davenport is a graduate of Franklin and Marshall College with over 20 years of experience in the fitness industry. Since 2006, he has worked at the Marymount School of New York, where he currently serves as the Department of Physical Education Chairperson and coaches Varsity Cross Country, Indoor, and Outdoor Track and Field. During his tenure at Marymount, Dexter has coached his teams to 2 AAIS Track & Field Championships and 2 AAIS Cross Country Championships and multiple AAIS and NYSAIS individual titles.