Prevent knee and shoulder injuries.

Prevent injuries with a list of exercises for injury prevention and stabilization training.

Injury prevention exercises are an important part of any athletic training program, whether that be for recreation or competition. These exercises help to strengthen the muscles and improve muscle pliability and joint range of motion which help to reduce the risk of injury.

Injury prevention exercises fall into one of three broad categories: resistance training to build muscle and strengthen the connective tissues that support muscle and joint function, flexibility training designed to improve muscle pliability and joint range of motion, and balance and stabilization training designed to promote overall function.

Resistance Training

When thinking about injury prevention and what exercises to do the best place to begin is with the most common injuries athletes are likely to incur. During training and competition the most common injuries are anterior cruciate ligament (ACL) tears, general knee injuries, and rotator cuff tears in the shoulder. Many times, injuries are not preventable; they are accidental and happen quickly even with the most conditioned athletes; however, by doing specific exercises designed to strengthen specific muscles the risk of severe injury can be reduced.

ACL injuries are one of the most common injuries in athletics. They are common in any sport that requires rapid changes in direction, jumping, or pivoting like in football, soccer, basketball, and tennis. Although ACL injuries are common, they can be prevented by doing exercises that target the muscles around the knee, in particular the hamstring muscles. Recommended exercises include:

1. Single leg bridge.
2. Prone hamstring curls/flexion.
3. Modified or Romanian dead lifts.

Other common knee injuries likely to be seen in athletics include patellofemoral pain syndrome, meniscus tears, and ligament injuries to the posterior cruciate ligament and the medial collateral ligament.

The reality is that knee injuries are common in athletes due to overuse. Overuse injuries are things like tendonitis and are often caused by poor biomechanics or can simply be the result of doing the same movement too much.

Developed from either overuse or acute injury, patellofemoral pain syndrome causes pain in the front of the knee, around the kneecap, usually underneath it. It is very common and often the result of repetitive running or jumping. To prevent general knee pain from too much training includes exercises that target the quadriceps, hamstrings, and gluteal muscles. When deciding on specific exercises, consider that research has shown that the most effective exercises for gluteal muscle activation are step-ups followed by basic squats, hip thrusts, deadlifts, and lunges (Neto et al., 2020).

Another common site of knee injuries is the meniscus. Meniscus tears are microscopic tears in the cartilage in the knee. The meniscus are shock absorbers. Because overuse is unavoidable, chronic meniscus overuse happens as well as injuries caused by sudden twisting movements or direct blows to the knee. Although it is hard to prevent an accidental injury to the meniscus from a collision, recommended exercise to strengthen the muscles that support the meniscus include:

1. Leg press.
2. Seated leg/knee extension.
3. Single leg lateral band walks.

So far, discussed injury prevention exercises have been targeted at the lower body; however, injury to the rotator cuff or shoulder is also very common in athletes. Rotator cuff injuries are caused by repetitive throwing or lifting. To prevent these tears, target the muscles of the shoulders that include the supraspinatus, infraspinatus, teres minor, and subscapularis. Recommended exercises include:

1. Internal/External Rotation.
2. The Pendulum. Resisted or no resistance.

Dynamic Flexibility Training

Dynamic flexibility training moves muscles and joints through a normal range of motion with the intent to prepare the body for training or competition. The warm-up motions should closely resemble the mechanics of the upcoming activity, both to the tissues and neuromotor system. When done prior to training and competition dynamic motions can help to improve mobility and reduce the risk of injury.

Stabilization Training

Stabilization training aims to increase balance and overall motor coordination and thus plays a supportive role in preventing athletic injuries. In male athletes with rehabbed ACL injuries, a recent study (Saki, et al., 2023) showed that eight weeks of core stability training improves core muscle endurance, hip abductor and external rotator strength, and thus positively impacted knee kinematics during activity and reduced the likelihood of future ACL injuries.

A favored stabilization exercise that both improves muscle strength and balance is eccentric step-downs. Eccentric step downs work by activating the quadriceps during the descent of the body as the knee bends, while at the same time the hamstrings and gluteal muscles stabilize the hip and knee. In addition to the large muscles of the hip and knee, the soleus muscle of the calf works to control the descent and maintain balance. Other recommended stabilization exercises include:

1. Calf-raises.
2. Single-leg exercises.
3. Core exercises.
   1. Planks. 
   2. Russian twists.

Although it is impossible to prevent all injuries, by including goal-specific exercises into a training and conditioning program, injuries can be prevented or reduced in severity.

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References

Neto WK, Soares EG, Vieira TL, Aguiar R, Chola TA, Sampaio VL, Gama EF. Gluteus Maximus Activation during Common Strength and Hypertrophy Exercises: A Systematic Review. J Sports Sci Med. 2020 Feb 24;19(1):195-203. PMID: 32132843; PMCID: PMC7039033.

Saki F, Shafiee H, Tahayori B, Ramezani F. The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction. Sci Rep. 2023 Feb 7;13(1):2202. doi: 10.1038/s41598-023-

Author Biography

Amy Ashmore, Ph.D. holds a doctorate in Kinesiology from the University of Texas at Austin. She is a physical therapy continuing education provider located in Las Vegas, NV.