How Athletes Can Be More Resilient To Injury Risks (you too!)
2025-03-24
For the past 20 years I have had the great fortune of being invited to consult on numerous sports programs, elite military programs, gyms all over the world, and even hospital wellness and physical therapy clinics. I share this with you not to give myself a nice pat on the back, but to explain there was a common through line on ALL of them.
In every one of these cases I was being asked to help build a program that reduced injuries. No matter the context of fitness, performance, or general health, injuries reduced the ability of anyone to really reach their goals and feel as though they were going the right direction.
In the British Journal Of Sports Medicine citing a symposium around knee injuries and athletics found that 41% of sports injuries were related to the knee and 1/5th of these were ACL injuries. More concerning was another study found that, “Knee injuries are among the most common serious injuries, accounting for 60% of high school sport-related surgeries.” (PMID: 24143905)
There are A LOT of reasons that someone in a sport can experience a knee injury. Sadly, a lot of “experts” on social media make it sound like it was maybe 1-2 things. Largely around the idea that a particular muscle just wasn’t strong enough. This does a great disservice to athletes (as well as the general public) as the issues are often much more than ONE thing!
Gait is one of the most complex human movement patterns yet, few know how to look at the movement as good or not great!
I do want to make the complexity a bit more digestible so my approach is going to be taking you from the ground up. As legendary physical therapist, Gary Gray has said, “when the foot hits the ground, everything changes.” So let’s start there!
There has been research that shows how foot positioning during specific actions, like changing direction for example, can place more risk of injury to the knee (1). So, practicing skill related activities are ALWAYS important not just in improving performance, but reducing injury risks as well.
What about the perfect foot position? What is really interesting in the information is pretty mixed. Something I found incredibly fascinating was this study that showed foot posture, not what the foot does in motion was more impactful to what would be related to something like a knee injury (PMID: 24591410).
This could point to our need in teaching our feet to be strong in standing and different positional postures. Such training doesn’t require a complex drawn out training program of the feet, but is much better integrated with movements that challenge foot posture like those below…
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Along with the foot, we see ankle mobility is very important. As this research paper explains, “Ankle dorsiflexion range of motion (DFROM) restrictions are common after injury and/or immobilization to the ankle and foot. The findings of the current study suggest that restricted ankle DFROM is associated with knee and hip biomechanics that may lead to differential loading patterns and subsequent injury.” ( PMID: 34096370)
Definitely want to get rid of those wedges on a variety of lower body exercises that take away the need and ability of the ankle to create dorsiflexion. Instead, we can use some integrated drills that use foot and core stability to enhance the mobility of our ankle. It isn’t as our ankle woke up one day and became tight. It could be injury, overuse, or poor stability at the foot and core that could all be having an impact.
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What about the hip? Wait, did you notice I JUST skipped everyone’s favorite the quadriceps? Yes, most people believe the quads are the primary guilty party in any knee injury situation. Often they mistaken the knee being injured and therefore seeing the quads being weakened as the quads being weak is why the knee got injured. Did you get that?
A study in the Journal of Orthopedic & Sports Physical Therapy took women with patellofemoral pain syndrome (one that people love to blame the quads for) and gave half the group either hip strengthening exercises and the other half thigh and quadriceps training. What did they find?
“By 4 weeks, the patients in the hip strengthening group had 43% less pain, while the knee strengthening group only had 3% less pain. Pain relief and function were similar for both groups by 8 weeks. However, only patients in the hip strengthening group had better hip strength on 1 of the hip strength tests.” (2)
I’m not suggesting the quads have no part in the knee injury, however, I DO think it gets blamed too much as the root cause. We can still train both the hips and quads (as well as much more) through exercises like these…
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You might guess what is coming next, but if you didn’t, spoiler alert it is the core! There are a BUNCH of studies to show how impactful the core is to knee injury prevention and treatment. I love THIS study that found, “The training group showed a significant increase in core endurance, hip abductor and external rotator strength, knee flexion angle, and a significant decrease in the knee valgus angle during single-leg landing in post-training tests compared to their baseline tests). Our results demonstrated that core stability exercise alters neuromuscular function… Because of the high incidence rate of secondary ACL injury after ACLR, it is recommended that athletes with a history of ACLR benefit from adding core stability exercises to warm-up routines or tertiary prevention programs even after completing post-operative rehabilitation. It is fast and not time-consuming to perform for athletes to reduce the risk factors of re-injury.” (3)
If you noticed anything about this discussion about being better about treating and reducing the rate of knee injuries, these can all be accomplished in much more integrated ways. This is so important on many levels. The first is that it is just flat out more effective and teaches all the influencers of the knee to work better together. Second, it is far more time efficient and leads to faster recovery rates, both are essentials when trying to help someone with a knee injury or helping your athletes, as well as non-athletes, be more resilient. Whenever anyone tells you that an injury is due to ONE thing, you know it is time to find someone else to get advice from.
We hope that you will join us for our upcoming Chronic Pain Masterclass where we will deal with knee pain and so much more! Get CEUs and a special discount with code “pain” when you sign-up HERE
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References:
- Exploring the Relationship Between Foot Position and Reduced Risk of Knee-Related Injuries in Side-Cutting Movements
- Knee Pain: Strengthen My Hips? But It’s My Knees That Hurt!
- The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction
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