In an Unusual Season, the Key to In-Game Injury Prevention Lies in Preparation

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In kicking off their season last weekend, the Big Ten and Mountain West seemingly defied all odds to get to Week 1. The same will be true of the Pac-12 and MAC when they return early next month. But, along with COVID-19 safety, the biggest measure of success will come in the form of injury prevention, especially after a slew of disastrous injuries in the NFL that could foreshadow problems for college football.

Schools were forced to adapt to a spring spent at home, summer practices postponed and a season canceled by four conferences and then rescheduled. Programs will be tested again as they look to remain relatively injury-free after dealing with the most unusual preseason college football has ever seen.

Some of the NFL’s biggest names sit on the sidelines as torn ACLs, high ankle sprains and hamstring strains have ripped through rosters in the first half of the 2020 season. The official statistics will not be available for analysis until after the conclusion of the season, but the high injury rate is apparent.

Acclimating players to the physical demands of a regular-season game is one of the most important reasons for their preseason training. The NFL Players Association created a joint committee of doctors, strength coaches and trainers to establish its recommendations on how players should prepare before the 2020 NFL season. The committee suggested a 48-day preseason, with 21 days of strength and conditioning and 10 days of non-contact ramp-up. The league ignored the NFLPA’s requests in an effort to start the season on time, providing only six to seven days of strength and conditioning, and five days of non-contact ramp-up. NFLPA President J.C. Tretter published a statement expressing his displeasure with the NFL’s decision.

“Despite these experts’ assessment that teams face a serious risk of player-injury spikes this year (based on past NFL data and recent findings from sports leagues that have already returned to play this year), the NFL is unwilling to prioritize player safety,” Tretter said. His frustrations stemmed from evidence that players needed more time to prepare.

Data from the NFL’s 2011 lockout showed an increase in injuries by 25% as players returned to the sport after sitting out for an extended period of time. Hamstring injuries increased 44% and Achilles injuries more than doubled that same year, validating the joint committee’s concerns for this season.

A study published in the Journal of Arthroscopy in 2017 details the risks associated with football programs increasing their training in an insufficient amount of time. Using data from two NFL seasons, doctors analyzed the workloads from the week a player got injured compared to their average workload for that month. It concluded players were at a much higher risk of soft tissue injury when their workloads increased too quickly, as this exposed athletes to issues with fatigue and overuse. The study determined the best way to navigate this increased risk was to complete a gradual return-to-training program.

At the college level, an unusual offseason and preseason only accentuated this kind of concern. Sports medicine departments and athletic trainers were forced to navigate how to train their athletes while students were scattered all over the country during the pandemic’s lockdown. Knowing how important spring and preseason workouts were, Michigan senior associate athletic director Darryl Conway says trainers had to be creative while developing programs for various home environments. While some athletes had access to in-home gyms, others had to find ways to mimic the intensity of a college conditioning program at home.

“We were having them go out in the backyard and dig a hole and fill a bucket with dirt. On a bathroom scale, weigh how much it weighs, and create a squat bar on a two-by-four with two buckets on the side,” Conway said. “That was an incredible job by our staff to really tailor the programs to what everybody was doing.”

When athletes were allowed to return to campus, strength coaches had to deal with differing levels of conditioning as well. Dr. Doug Aukerman, the senior associate athletic director at Oregon State, explains how his department emphasized catching athletes up to the same level and easing into their preseason training.

“There’s been some modifications in terms of how even preseason practices and regular-season practices are going to be run from a coaching standpoint,” Aukerman said. “We’re spending a lot of effort on recovery, in sports medicine, in strength and in conditioning areas. I think that's going to be really important to pay attention to with our student athletes.”

Conway says the Michigan football program makes a conscious effort to re-acclimate its athletes every year when they return from an offseason break. But this year’s disruptions from COVID-19 did create more obstacles.

“We couldn't ramp up at the same level, speed and frequency that we may have ramped up when they only had two or three weeks off,” Conway said. “We do the same thing all the time, but we did it slower this time.”

This preparation was complicated by the cancellation of the Big Ten’s season and a subsequent reversal of that decision on Sept. 16 (the conference started padded practices on Sept. 30, and kicked off its season on Oct. 23–24). Sports medicine departments were forced to navigate an ever-changing training schedule, adapting to new start dates, cancelled practices and shortened summer camps. Conway directed his program to constantly monitor the effects practices were having on each player, surveying their fatigue and working to minimize their risk of injury. Even still, it was a tough balance to navigate this unusual preseason while combining conditioning, lifting and full football practice.

“You don't want to overdo it. But you need to have those movements done so that when you get out in a game that's not the first time you've done a football movement at full speed,” Conway said. “It's a fine line between doing just right, too little and too much.”

The next couple of weeks will be the true test, as programs that dealt with their most difficult preseasons bring their 2020 into high gear.