From Rehabilitation to Prevention

As an avid athlete, I have always felt that participating in sports is essential to the overall health of our population. As a physiotherapist, I find it difficult to accept the sometimes debilitating nature of sports injuries. My recent research and work has focused on identifying risk factors for sports injuries, so athletes and their therapists can predict and prevent them before they occur.

I have worked as a clinician at Alberta's University of Calgary Sport Medicine Centre for the past eight years, while also pursuing an MSc and PhD in epidemiology. Most people think of epidemiology as the study of epidemics of illness (particularly infectious diseases), but similar research methodology can be implemented to study the epidemic of athletic injuries in our population. Many sports injuries are both predictable and preventable. If we can identify the risk factors for athletic injuries, then we will be able to create prevention strategies. Risk factors may include specific muscle weakness, decreased flexibility, poor balance, and limited sport-specific training.

Avoiding Injury in the NHL

While working on my Master's thesis at the University of Calgary between 1997 and 1999, I designed and coordinated a study to determine risk factors that contribute to groin injuries sustained by members of the NHL. (Groin injuries are among the top three injuries suffered by NHL players.) I modified a measurement device called a "manual muscle tester" to be applied to groin strength and sent the device to all 27 NHL teams (a total of 1,292 men from 23 teams participated). As part of the pre-season medical examinations, team therapists tested the players' groin strength, measured their flexibility, and obtained confidential questionnaires about their off-season training activities.

The following season, I accessed the NHL's central database that records all injuries. With this information, I demonstrated that players with limited (less than four weeks, three times a week) off-season, sport-specific training (such as ice skating or in-line skating) were at more than three times the risk of having a groin injury during the season than those players who skated regularly in the off-season.

Adolescent Balance Training

Sports injuries are also a serious issue among amateur athletes – they are the leading cause of injury among adolescents. Yet, although it is well understood that post-injury rehabilitation will reduce the risk of reinjury in many sports, there is still little recognition that preventative methods can stop them from occurring in the first place. Now in the process of completing my PhD at the University of Alberta in Edmonton, I am focusing my research on risk factors and injury prevention strategies in adolescent sport. In April 2002, I completed a study that examined balance training as a prevention method for high school athletes.

Balance training is an activity that is typically overlooked by athletes, but it can make a crucial difference for adolescents going through rapid skeletal growth, which often results in poor balance. Surprisingly, it is not uncommon to assess the star of a high school basketball team and find them unable to balance on one foot, with their eyes open, for even five seconds.

I began my study by randomly dividing 120 adolescents, aged 14 to 18 years, between a training group and a control group. Using an 18-inch (46-cm) wobble board (a circular board with half a wooden ball attached to the bottom), the members of the training group participated in a home-exercise program. For half an hour each day, the adolescents performed a variety of exercises such as standing on the wobble board on one foot, moving the board around in a circle, moving it forward, and moving it backwards – sometimes with their eyes open, other times with their eyes closed. I did an assessment of the youths' balance, strength, and endurance at the beginning of the study, and three more times over the six-week period.

We had an unusually high compliance rate of 95% (amazing for teens), so we were able to conclude that, although there was no noticeable change in the balance of the control group, the balance of the training group had improved twofold. We also found that the members of the control group, who did not do the wobble board training, were five times more likely to have an injury in the immediate six-month follow-up period. It became clear that balance training not only significantly increases the balance ability of healthy adolescents, but, more importantly, it reduces the overall rate of sports injuries.

As a mother, I am invigorated by the excitement of young athletes, their parents, and their coaches at the possibility of preventing sports injuries before they occur. Experiencing their joy at competing in a tournament, performing a more difficult routine in gymnastics, mastering a snowboard move, or completing a race is one of the greatest motivators in pursuing my research.

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