Injury Prevention And Reducing The Risk Of Injury
We sat down with Chris Jenkins before he headed out as Lead Physio for the Russian Rugby Team at World Cup 2019. To ask him about all things to do with injury, recovery and improving performance.
1. What is the most useful piece of advice that you have given to all players at all levels?
“Look after your body. Don’t take your body for granted. These elite players are very well looked after – they get cardiovascular screening; they get concussion screening and full Musculoskeletal screening. This Elite Level approach to care is possible an all levels if you make an effort to research what is available. In a lot of countries, there is free heart screening going on for 18 to 45 year-olds at the moment. With regards to concussion screening, there are some fantastic free apps on your phone which parents can do their children if no medical access is available. You don’t always need pay for access to a sports doctor, if cost/access is an issue. Many physiotherapists can do the baseline concussion testing on you if they have had the training. So, depending on your age, you should be able to get some reasonably cheap, free screening just to make sure that from a cardiovascular view point, you are not at risk of some SCA- Sudden Cardiac Arrest- on the playing field and that you can monitor yourself. Self-knowledge and being able to screen yourself and look after yourself, that’s really important for these serious conditions. The next thing to consider really is all the sports injuries and musculoskeletal injuries, and I think – like I said at the beginning – don’t take your body for granted. We’ve seen these players and professional players, they’ve got very hard schedules and the ones that seem to do better and have fewer injuries – and I’m sure this is anecdotal, I’m not sure if any research has been done on this area – but the ones that seem to know their bodies better and look after themselves from a diet point of view and follow the strength and conditioning programmes, or if they don’t have strength and conditioning programmes set for them, follow some good strength and conditioning programmes that are out there, I think they have fewer injuries. They definitely have less soft tissue injuries, like hamstrings and calf problems. In contact sports and collision-based sports that trauma is inevitable. But again, if people are winning the collision, they are generally a lot stronger and faster. I think they potentially have a lower risk if they are used to high speed running, they have got a lower risk of hamstring and calf injuries. If they are strong and dominant, potentially they have less contact shoulder injuries and dislocations. I’ve seen a lot less dislocations in the stronger people. They may have other types of shoulder injuries, but you see a lot less shoulder dislocation injuries due to modern strength and conditioning programmes. So, I think it’s really important that these players can get access to that via local coaches or online coaches. Get a good plan and stick to it, that is specific to your sport.”
2. What can every player do to improve injury prevention and increase performance?
“What I like to do is almost teach them how to do a bit of a self MOT on themselves to figure out if they’re ready to train. It might be very individual, but there is some general stuff that I might teach someone. I might teach them to do a knee to wall test, just to measure out 15cm and they can check left to right the amount of ankle dorsiflexion they’ve got on one side or the other. Or teach them how to do a groin squeeze to check to see if their groins are strong and pain-free and teach them how to judge pain on a 0 to 10 scale. So, I kind of go through a few tests that are maybe individual to them. Let’s say their knee to wall ankle range is down, they’ve self-assessed it. Instead of just going running to the physio, teaching them to then go and foam roll those calf’s, do some ankle mobility work and they can then go and reassess that test and reassess how they feel and they might find that they have freed up their ankle, their calf feels less tight and they feel more normal on their hopping test. So, they become a bit more independent and I think it’s really important for the guys to do that because often, even in professional teams, especially in rugby, you’ve got 40/50 people and maybe a handful of physios who are not able to get around everyone and that is probably even more so in amateur sports. So, your ability to self-screen yourself, look at your ankle, hip mobility and then, seeing that something is not quite normal, and you may not be fully prepared for that day’s training and spending some time doing some hip/gluteal foam rolling, doing some hip mobility stretches and then retesting your deep squat, for example, and then that will potentially free up the problems and you become independent in looking after your body. So, it’s just trying to know your body and implementing a few tests that you might be able to use on yourself which can judge how prepared you are for the next training session or training day.
3. Over the course of your career in professional sport, what has been the biggest change that you have seen, and how has that affected your practice?
One of the key things is probably teamwork and the integration of various sports sciences and strength and conditioning into the sports injury and rehabilitation field. It’s always been there, but I think sometimes – you know, individually the physio is working over there rehabbing someone, the strength and conditioning coach are working over there working with a player who has got some injuries and niggles. The aim is to combine, share knowledge and problem-solve together. That integrated approach in high-performance teams and in sport has been one of the biggest changes. There’s a lot of good books that have come out in recent years – ‘High-Performance Training for Sport’ by Joyce and Lewindon – that talks about the integration of strength and conditioning from the very early stages in the rehab process. There was a time, maybe 10-15 years ago, where a lot of physios were doing a lot of hands-on manipulation, taking courses. That is still going on. I have recently completed a short strength and conditioning course myself, and there were quite a few physios on that course. A lot of the physios I meet that are working in sport some have gone on to do master’s degrees in strength and conditioning. It’s not because they want to become a strength and conditioning coach, they want to understand strength and conditioning and how it relates to injuries and rehabilitation and the worst-case scenarios of team playing and performance that these players have got to get back to. So, the integration of that strength and conditioning knowledge I just think has gone to another level. In some establishments back in the day, not all universities but some, that was left out or it was not covered very well. There are a lot of sports therapy and sports rehabilitation courses and a lot of the more modern physiotherapy courses will spend a lot more time on exercise therapy, strength and conditioning and how it relates to the tissue healing process, and I think that’s hugely important. There’s a lot of research going on out there into rehabilitation and strength and conditioning approaches into rehabilitation. Especially coming out of Australia, the Queensland Group, their work showing you can do painful rehabilitation during hamstring rehabilitation with good results. Not all rehabilitation needs to be pain-free, especially muscle rehabilitation and the hamstring rehabilitation work. It is actually ok to be working into pain, and maybe the results are better, and people recover faster.
4. What do you think amateur athletes can take from professional environments and athletes?
The amount that is being put on players, and not just at a professional level but amateur level as well, your off-seasons and pre-seasons are really important. The off-season is a fantastic time to get a strength and conditioning base. Yes, you need a break from contact sports, you need a break off collisions, but I don’t think after seven days – 10 days’ rest the physical state of the body – there’s no more benefits of rest and actually, you’ll start to deteriorate. Many elite players have to reach certain standards by the time they come back. Professional players, are in the gym – if they’ve got no injuries – in the same week that they finish the season and it might be a bit more of a global approach to their entire body. But it’s a chance to get some gains and set yourself up for pre-season while having a break from impact loading and collisions, so I think that’s key. If players keep themselves in great shape in the offseason and early pre-season they will find that they have fewer problems in the pre-season period with regards to injuries and soft tissue injuries. Hopefully, that will lead to them performing better across the season and reducing injury risk.
5. What can amateur players do to overall improve durability and reduce the risk of injuries?
Have Strength and conditioning and Injury knowledge. Know the sport. Even with just the internet these days, if you haven’t got access to physios and strength and conditioning coaches, you can quite easily find out the key injuries in your sport and find ways to protect against those, and I think that’s important. That information is freely available on the internet if you know where to look. Google scholar. Also, how important the recovery and restoration processes are as well. Everyone talks about training, training, training, but people don’t allow themselves good restoration days and good active recovery days. What I’ve noticed, especially being in Russia, and it’s been a big eye-opener, was the use of heat and sauna has gone through the roof. I think ice baths are yesterday’s news and used sparingly maybe post-game only. So many benefits seem to be coming through with, touch wood, relatively low injury rate. The Russians, before we really got involved and put protocols in place, they were already spending days mobilising and stretching in the sauna and staying well hydrated as well. That was quite impressive – the amount that they use heat and sauna in their recovery. It was phenomenal. The sports facilities were completely made for recovery and restoration as well as they were for the training itself. That was something I think people can look into, the use of heat and sauna in their active recovery days. Just be mindful of hydration and where they place that sauna session. Mark Bennett , the Russian Strength and Conditioning Coach suggests after their last training day and before their recovery day, that’s a good time to place that heat and sauna session.
6. What is the advice that you would give to someone in full-time work who is trying to play at the highest level possible?
I would suggest the easiest things to get right, the pillars of good training and recovery from a general point of view – not just for simply injuries – is sleep and diet. They are the two most important things, so make sure you optimise that. Getting in that good, high-quality nutrition and protein as soon as possible after training and then decent food that night after training and making sure you get a good sleep pattern right. That’s the first thing. The following day then, if you’re working, but you’re not training, you can always find time to do 5-10 minutes’ worth of mobility and stretching work. If you’re limited for time and you’ve got a foam roller vs. stretching, I would go for stretching, mobility work. I think that is absolutely key. Foam rolling is just a prerequisite to that stretching, not instead of. If you’re office-based, make sure you get up every hour, half-hour, walk to the water machine, purely just to get you out of that flexed position, that sitting position which is quite shortening for hamstrings and for hip flexors. That is something that we’ve got to counteract – going from sitting all day to then training in the gym in the evening and then expecting yourself to go into full triple extension, going into full training later in the day. I think you’re kidding yourself if you think you’ve prepared for that by 9 hours of sitting. So just try and get up and if you’ve got time for lunch, get out and don’t just go and sit in another room and have lunch. Try and get some fresh air and have a bit of a walk, mobilise. I think it makes the world of difference for you if you train that following day or evening. Those are the key things that I recommend for those people that are short and limited on time, and I think that is more important. That bit of active recovery. Their working posture and getting up and moving around. Good quality diet and sleep – I think that’s more important than gadgets and supplements.”
You can find out more about Chris at www.cjphysio.uk and at @welsh_rugby_physio on Instagram. Thanks to Chris for taking the time to talk about injury prevention and performance. If you are interested in developing yourself I suggest that you check out the article with Craig White High-Performance Coach here.
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