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Rehab is prehab

Injury Prevention

The exercises that heal are the same ones that prevent. Strength, sensible load progression, specific warm-ups and recovery are the pillars—ranked by how strongly they influence injury risk.

📖 Rehab Science
Diagram · Injury risk factors — most to least influentialOriginal illustration
1. Training variablesload volume · load magnitude · biomechanics · warm-up2. Physical variablesprevious injury · fatigue · strength · mobility · balance · laxity · nutrition3. Mental variablesstress · fear · anxiety · beliefs4. External variablesenvironment · footwear · equipment · medication
The book ranks risk factors in four groups; training variables (especially load) are the most common cause of injury, and strength is the most protective physical factor. — Based on concepts in Rehab Science Ch 9 (PDF pp. 162–179).

Load volume (how much, how often)

Most pain problems are overuse—doing something more times than your tissue is ready for (walking 5 miles a day on holiday when you normally walk 1). Build up gradually, start lower than you think, treat muscle soreness as a sign you did too much, and remember time off resets your conditioning.

Source: Rehab Science · Ch 9 · PDF pp. 163, 164show sources ▾

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Load magnitude (force and speed)

Heavy or sudden forces cause traumatic injuries—a detrained, heavier weekend volleyball player jumping explosively and tearing an Achilles is the book's example.

Source: Rehab Science · Ch 9 · PDF p. 165show sources ▾

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Biomechanics and posture

Good technique helps, but form is less tightly linked to injury than many believe. What matters most is whether your body is conditioned for the load. Avoid labelling movements as "bad".

Source: Rehab Science · Ch 9 · PDF pp. 165, 166show sources ▾

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Tissue temperature and warm-ups

Warming up makes tissue more elastic and muscles fire faster. Rehearse the coming activity at lower intensity. Before explosive sport use dynamic stretches (high-knee marching, leg swings); save long static stretches for afterwards, because they can reduce power.

Source: Rehab Science · Ch 9 · PDF pp. 167–170· 14 original research citationsshow sources ▾
  1. [Ch 9·1] McCrary JM, Ackermann BJ, Halaki M. A systematic review of the effects of upper body warm-up on performance and injury. Br J Sports Med. 2015;49(14):935-942. find original ↗
  2. [Ch 9·2] Fradkin AJ, Zazryn TR, Smoliga JM. Effects of warming-up on physical performance: a systematic review with meta-analysis. J Strength Cond Res. 2010;24(1):140-148. find original ↗
  3. [Ch 9·3] Herman K, Barton C, Malliaras P, Morrissey D. The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Med. 2012;10:75. find original ↗
  4. [Ch 9·4] Gray SR, De Vito G, Nimmo MA, Farina D, Ferguson RA. Skeletal muscle ATP turnover and muscle fiber conduction velocity are elevated at higher muscle temperatures during maximal power output development in humans. Am J Physiol Regul Integr Comp Physiol. 2006;290(2):R376-R382. find original ↗
  5. [Ch 9·5] Racinais S, Oksa J. Temperature and neuromuscular function. Scand J Med Sci Sports. 2010;20 Suppl 3:1-18. find original ↗
  6. [Ch 9·6] Close R, Hoh JF. Influence of temperature on isometric contractions of rat skeletal muscles. Nature. 1968;217(5134):1179-1180. find original ↗
  7. [Ch 9·7] Stewart D, Macaluso A, De Vito G. The effect of an active warm-up on surface EMG and muscle performance in healthy humans. Eur J Appl Physiol. 2003;89(6):509-513. find original ↗
  8. [Ch 9·8] Pearce AJ, Rowe GS, Whyte DG. Neural conduction and excitability following a simple warm up. J Sci Med Sport. 2012;15(2):164-168. find original ↗
  9. [Ch 9·9] Simic L, Sarabon N, Markovic G. Does pre-exercise static stretching inhibit maximal muscular performance? A meta-analytical review. Scand J Med Sci Sports. 2013;23(2):131-148. find original ↗
  10. [Ch 9·10] Behm DG, Chaouachi A. A review of the acute effects of static and dynamic stretching on performance. Eur J Appl Physiol. 2011;111(11):2633-2651. find original ↗
Also cited by the book on these pages:
  1. [Ch 9·11] Fulton J, Wright K, Kelly M, et al. Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. Int J Sports Phys Ther. 2014;9(5):583-595. find original ↗
  2. [Ch 9·13] Hägglund M, Waldén M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med. 2006;40(9):767-772. find original ↗
  3. [Ch 9·14] Gaal BT, Knapik DM, Karns MR, Salata MJ, Voos JE. Contralateral anterior cruciate ligament injuries following index reconstruction in the pediatric athlete. Curr Rev Musculoskelet Med. 2020;13(4):409-415. find original ↗
  4. [Ch 9·16] Arøen A, Helgø D, Granlund OG, Bahr R. Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture. Scand J Med Sci Sports. 2004;14(1):30-33. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Previous injuries and surgery

A past injury is one of the biggest predictors of the next one. After some injuries, such as an ACL tear, the other side is at risk too—so do the rehab exercises on both sides.

Source: Rehab Science · Ch 9 · PDF pp. 170, 171· 10 original research citationsshow sources ▾
  1. [Ch 9·11] Fulton J, Wright K, Kelly M, et al. Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. Int J Sports Phys Ther. 2014;9(5):583-595. find original ↗
  2. [Ch 9·12] Murphy DF, Connolly DA, Beynnon BD. Risk factors for lower extremity injury: a review of the literature. Br J Sports Med. 2003;37(1):13-29. find original ↗
  3. [Ch 9·13] Hägglund M, Waldén M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med. 2006;40(9):767-772. find original ↗
  4. [Ch 9·14] Gaal BT, Knapik DM, Karns MR, Salata MJ, Voos JE. Contralateral anterior cruciate ligament injuries following index reconstruction in the pediatric athlete. Curr Rev Musculoskelet Med. 2020;13(4):409-415. find original ↗
  5. [Ch 9·15] Swärd P, Kostogiannis I, Roos H. Risk factors for a contralateral anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2010;18(3):277-291. find original ↗
  6. [Ch 9·16] Arøen A, Helgø D, Granlund OG, Bahr R. Contralateral tendon rupture risk is increased in individuals with a previous Achilles tendon rupture. Scand J Med Sci Sports. 2004;14(1):30-33. find original ↗
Also cited by the book on these pages:
  1. [Ch 9·17] Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-133. find original ↗
  2. [Ch 9·19] Azboy O, Kaygisiz Z. Effects of sleep deprivation on cardiorespiratory functions of the runners and volleyball players during rest and exercise. Acta Physiol Hung. 2009;96(1):29-36. find original ↗
  3. [Ch 9·20] McLean SG, Samorezov JE. Fatigue-induced ACL injury risk stems from a degradation in central control. Med Sci Sports Exerc. 2009;41(8):1661-1672. find original ↗
  4. [Ch 9·22] Kekelekis A, Nikolaidis PT, Moore IS, Rosemann T, Knechtle B. Risk factors for upper limb injury in tennis players: a systematic review. Int J Environ Res Public Health. 2020;17(8):2744. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Fatigue — cognitive and neuromuscular

Poor sleep and stress reduce focus and coordination. Muscles and the nervous system both tire. If you feel "off", slow down, rest more or skip the session.

Source: Rehab Science · Ch 9 · PDF p. 171· 6 original research citationsshow sources ▾
  1. [Ch 9·17] Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-133. find original ↗
  2. [Ch 9·18] Viegas F, Ocarino JM, Freitas LS, et al. The sleep as a predictor of musculoskeletal injuries in adolescent athletes. Sleep Sci. 2022;15(3):305-311. find original ↗
  3. [Ch 9·19] Azboy O, Kaygisiz Z. Effects of sleep deprivation on cardiorespiratory functions of the runners and volleyball players during rest and exercise. Acta Physiol Hung. 2009;96(1):29-36. find original ↗
  4. [Ch 9·20] McLean SG, Samorezov JE. Fatigue-induced ACL injury risk stems from a degradation in central control. Med Sci Sports Exerc. 2009;41(8):1661-1672. find original ↗
  5. [Ch 9·21] Small K, McNaughton L, Greig M, Lovell R. The effects of multidirectional soccer-specific fatigue on markers of hamstring injury risk. J Sci Med Sport. 2010;13(1):120-125. find original ↗
  6. [Ch 9·22] Kekelekis A, Nikolaidis PT, Moore IS, Rosemann T, Knechtle B. Risk factors for upper limb injury in tennis players: a systematic review. Int J Environ Res Public Health. 2020;17(8):2744. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Strength

Stronger tissues—muscle, tendon, bone, discs, ligaments—can take more force before failing. Strength is more protective than flexibility, mobility or balance, which is why physios focus on resistance training.

Source: Rehab Science · Ch 9 · PDF p. 172· 5 original research citationsshow sources ▾
  1. [Ch 9·23] Steele J, Bruce-Low S, Smith D, Osborne N, Thorkeldsen A. Can specific loading through exercise impart healing or regeneration of the intervertebral disc? Spine J. 2015;15(10):2117-2121. find original ↗
  2. [Ch 9·24] Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Med Open. 2015;1(1):7. find original ↗
  3. [Ch 9·25] Grzelak P, Podgorski M, Stefanczyk L, Krochmalski M, Domzalski M. Hypertrophied cruciate ligament in high performance weightlifters observed in magnetic resonance imaging. Int Orthop. 2012;36(8):1715-1719. find original ↗
  4. [Ch 9·26] O’Bryan SJ, Giuliano C, Woessner MN, et al. Progressive resistance training for concomitant increases in muscle strength and bone mineral density in older adults: a systematic review and meta-analysis. Sports Med. 2022;52(8):1939-1960. find original ↗
  5. [Ch 9·27] Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Flexibility and mobility

You need enough range for the activities you want to do. Full-range strength exercises (squats, deadlifts, push-ups, pull-ups) build range and control together.

Source: Rehab Science · Ch 9 · PDF pp. 172, 173· 4 original research citationsshow sources ▾
Also cited by the book on these pages:
  1. [Ch 9·23] Steele J, Bruce-Low S, Smith D, Osborne N, Thorkeldsen A. Can specific loading through exercise impart healing or regeneration of the intervertebral disc? Spine J. 2015;15(10):2117-2121. find original ↗
  2. [Ch 9·26] O’Bryan SJ, Giuliano C, Woessner MN, et al. Progressive resistance training for concomitant increases in muscle strength and bone mineral density in older adults: a systematic review and meta-analysis. Sports Med. 2022;52(8):1939-1960. find original ↗
  3. [Ch 9·27] Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877. find original ↗
  4. [Ch 9·28] Papalia GF, Papalia R, Diaz Balzani LA, et al. The effects of physical exercise on balance and prevention of falls in older people: a systematic review and meta-analysis. J Clin Med. 2020;9(8):2595. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Balance and proprioception

Balance matters more with age and after injuries like ankle sprains or ACL tears. Strong ankles (calf and shin muscles) are key. Healthy young people can usually balance on one leg for 30–60 seconds.

Source: Rehab Science · Ch 9 · PDF pp. 173, 174· 1 original research citationshow sources ▾
  1. [Ch 9·28] Papalia GF, Papalia R, Diaz Balzani LA, et al. The effects of physical exercise on balance and prevention of falls in older people: a systematic review and meta-analysis. J Clin Med. 2020;9(8):2595. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Ligamentous and joint laxity

Some people are naturally very flexible (hypermobile) and need more stability training; stiff people need more mobility work. Well-performed strength training is stability training.

Source: Rehab Science · Ch 9 · PDF p. 175· 2 original research citationsshow sources ▾
Also cited by the book on this page:
  1. [Ch 9·29] Wall BT, Morton JP, van Loon LJ. Strategies to maintain skeletal muscle mass in the injured athlete: nutritional considerations and exercise mimetics. Eur J Sport Sci. 2015;15(1):53-62. find original ↗
  2. [Ch 9·30] Smith-Ryan AE, Hirsch KR, Saylor HE, Gould LM, Blue MNM. Nutritional considerations and strategies to facilitate injury recovery and rehabilitation. J Athl Train. 2020;55(9):918-930. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Protein and calorie intake

Healing needs energy and protein even if you are training less. The book cites 1.6–2.5 g of protein per kg of body weight to support healing; a dietitian can tailor this.

Source: Rehab Science · Ch 9 · PDF pp. 175, 176· 7 original research citationsshow sources ▾
  1. [Ch 9·29] Wall BT, Morton JP, van Loon LJ. Strategies to maintain skeletal muscle mass in the injured athlete: nutritional considerations and exercise mimetics. Eur J Sport Sci. 2015;15(1):53-62. find original ↗
  2. [Ch 9·30] Smith-Ryan AE, Hirsch KR, Saylor HE, Gould LM, Blue MNM. Nutritional considerations and strategies to facilitate injury recovery and rehabilitation. J Athl Train. 2020;55(9):918-930. find original ↗
  3. [Ch 9·31] Tipton KD. Nutritional support for exercise-induced injuries. Sports Med. 2015;45 Suppl 1:S93-S104. find original ↗
Also cited by the book on these pages:
  1. [Ch 9·4] Gray SR, De Vito G, Nimmo MA, Farina D, Ferguson RA. Skeletal muscle ATP turnover and muscle fiber conduction velocity are elevated at higher muscle temperatures during maximal power output development in humans. Am J Physiol Regul Integr Comp Physiol. 2006;290(2):R376-R382. find original ↗
  2. [Ch 9·12] Murphy DF, Connolly DA, Beynnon BD. Risk factors for lower extremity injury: a review of the literature. Br J Sports Med. 2003;37(1):13-29. find original ↗
  3. [Ch 9·32] Kvist J, Silbernagel KG. Fear of movement and reinjury in sports medicine: relevance for rehabilitation and return to sport. Phys Ther. 2022;102(2):pzab272. find original ↗
  4. [Ch 9·36] Hartigan EH, Lynch AD, Logerstedt DS, Chmielewski TL, Snyder-Mackler L. Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther. 2013;43(11):821-832. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Mental variables — stress, fear, anxiety and beliefs

Distraction from life stress raises risk. Fear of re-injury changes how you move and, ironically, makes re-injury more likely. Rebuild confidence step by step through the protocol.

Source: Rehab Science · Ch 9 · PDF pp. 176, 177· 9 original research citationsshow sources ▾
  1. [Ch 9·12] Murphy DF, Connolly DA, Beynnon BD. Risk factors for lower extremity injury: a review of the literature. Br J Sports Med. 2003;37(1):13-29. find original ↗
  2. [Ch 9·32] Kvist J, Silbernagel KG. Fear of movement and reinjury in sports medicine: relevance for rehabilitation and return to sport. Phys Ther. 2022;102(2):pzab272. find original ↗
  3. [Ch 9·33] Mir B, Vivekanantha P, Dhillon S, et al. Fear of reinjury following primary anterior cruciate ligament reconstruction: a systematic review [published online ahead of print, 2022 Dec 23]. Knee Surg Sports Traumatol Arthrosc. 2022;10.1007/s00167-022-07296-6. find original ↗
  4. [Ch 9·34] Hsu CJ, Meierbachtol A, George SZ, Chmielewski TL. Fear of reinjury in athletes. Sports Health. 2017;9(2):162-167. find original ↗
  5. [Ch 9·35] Tagesson S, Kvist J. Greater fear of re-injury and increased tibial translation in patients who later sustain an ACL graft rupture or a contralateral ACL rupture: a pilot study. J Sports Sci. 2016;34(2):125-132. find original ↗
  6. [Ch 9·36] Hartigan EH, Lynch AD, Logerstedt DS, Chmielewski TL, Snyder-Mackler L. Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther. 2013;43(11):821-832. find original ↗
Also cited by the book on these pages:
  1. [Ch 9·31] Tipton KD. Nutritional support for exercise-induced injuries. Sports Med. 2015;45 Suppl 1:S93-S104. find original ↗
  2. [Ch 9·4] Gray SR, De Vito G, Nimmo MA, Farina D, Ferguson RA. Skeletal muscle ATP turnover and muscle fiber conduction velocity are elevated at higher muscle temperatures during maximal power output development in humans. Am J Physiol Regul Integr Comp Physiol. 2006;290(2):R376-R382. find original ↗
  3. [Ch 9·37] Nuccio RP, Barnes KA, Carter JM, Baker LB. Fluid balance in team sport athletes and the effect of hypohydration on cognitive, technical, and physical performance. Sports Med. 2017;47(10):1951-1982. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Training environment and footwear

Heat, humidity, surfaces and equipment change the stress on tissues. Choose shoes that feel comfortable— comfort predicts lower running injury risk better than matching shoes to arch type. Switching from machines to free weights needs a lighter start.

Source: Rehab Science · Ch 9 · PDF pp. 177, 178· 8 original research citationsshow sources ▾
  1. [Ch 9·37] Nuccio RP, Barnes KA, Carter JM, Baker LB. Fluid balance in team sport athletes and the effect of hypohydration on cognitive, technical, and physical performance. Sports Med. 2017;47(10):1951-1982. find original ↗
  2. [Ch 9·38] Knapik JJ, Trone DW, Tchandja J, Jones BH. Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations. J Orthop Sports Phys Ther. 2014;44(10):805-812. find original ↗
  3. [Ch 9·39] Knapik JJ, Trone DW, Swedler DI, et al. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010;38(9):1759-1767. find original ↗
  4. [Ch 9·40] Molloy JM. Factors Influencing running-related musculoskeletal injury risk among U.S. military recruits. Mil Med. 2016;181(6):512-523. find original ↗
Also cited by the book on these pages:
  1. [Ch 9·41] Ghosh N, Kolade OO, Shontz E, et al. Nonsteroidal anti-inflammatory drugs (NSAIDs) and their effect on musculoskeletal soft-tissue healing: a scoping review. JBJS Rev. 2019;7(12):e4. find original ↗
  2. [Ch 9·43] Wiggins ME, Fadale PD, Barrach H, Ehrlich MG, Walsh WR. Healing characteristics of a type I collagenous structure treated with corticosteroids. Am J Sports Med. 1994;22(2):279-288. find original ↗
  3. [Ch 9·44] Hall MM, Finnoff JT, Smith J. Musculoskeletal complications of fluoroquinolones: guidelines and precautions for usage in the athletic population. PM R. 2011;3(2):132-142. find original ↗
  4. [Ch 9·45] Khaliq Y, Zhanel GG. Musculoskeletal injury associated with fluoroquinolone antibiotics. Clin Plast Surg. 2005;32(4):495-vi. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Medication

Anti-inflammatories can help in the first painful days, but steroids (including cortisone injections) and NSAIDs can delay healing, and some antibiotics carry warnings about strenuous exercise. Never use medication to mask pain so you can play. Medication decisions belong with your doctor or pharmacist.

Source: Rehab Science · Ch 9 · PDF pp. 178, 179· 8 original research citationsshow sources ▾
  1. [Ch 9·41] Ghosh N, Kolade OO, Shontz E, et al. Nonsteroidal anti-inflammatory drugs (NSAIDs) and their effect on musculoskeletal soft-tissue healing: a scoping review. JBJS Rev. 2019;7(12):e4. find original ↗
  2. [Ch 9·42] Kapetanos G. The effect of the local corticosteroids on the healing and biomechanical properties of the partially injured tendon. Clin Orthop Relat Res. 1982;(163):170-179. find original ↗
  3. [Ch 9·43] Wiggins ME, Fadale PD, Barrach H, Ehrlich MG, Walsh WR. Healing characteristics of a type I collagenous structure treated with corticosteroids. Am J Sports Med. 1994;22(2):279-288. find original ↗
  4. [Ch 9·44] Hall MM, Finnoff JT, Smith J. Musculoskeletal complications of fluoroquinolones: guidelines and precautions for usage in the athletic population. PM R. 2011;3(2):132-142. find original ↗
  5. [Ch 9·45] Khaliq Y, Zhanel GG. Musculoskeletal injury associated with fluoroquinolone antibiotics. Clin Plast Surg. 2005;32(4):495-vi. find original ↗
Also cited by the book on these pages:
  1. [Ch 9·38] Knapik JJ, Trone DW, Tchandja J, Jones BH. Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations. J Orthop Sports Phys Ther. 2014;44(10):805-812. find original ↗
  2. [Ch 9·39] Knapik JJ, Trone DW, Swedler DI, et al. Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010;38(9):1759-1767. find original ↗
  3. [Ch 9·40] Molloy JM. Factors Influencing running-related musculoskeletal injury risk among U.S. military recruits. Mil Med. 2016;181(6):512-523. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Diagram · Load vs capacity — movement has a doseOriginal illustration
capacity (grows with training)spike: too much, too soon → injury/flaregraded load stays under capacityweeksload / capacity
Injury and flare-ups happen when load exceeds what tissues are conditioned for—too much, too soon or too long. Progressive, graded loading raises capacity over time. — Based on concepts in Rehab Science Ch 4 (PDF p. 65) & Ch 9 (PDF pp. 163–165).

Read the full module Build a prehab programme