Injury Prevention Programmes

Build strength, movement capacity and resilience for sport

Sports injuries cannot always be prevented. Contact, falls, unexpected movements and competition are all part of sport. However, some injuries are influenced by factors that can be identified and addressed through appropriate training.

An injury prevention programme is designed to improve the physical qualities needed to tolerate the demands of your sport. This may include strength, balance, jumping and landing control, running capacity, mobility, conditioning and sport-specific movement.

Programmes can be used by athletes who have previously been injured as well as those who are currently training without symptoms but want a more structured approach to physical preparation.

The aim is not to eliminate every possible injury. It is to identify areas that may benefit from additional training and help your body cope more effectively with the demands placed on it.

What is an injury prevention programme?

An injury prevention programme is an exercise-based approach designed around the physical demands of a particular sport or activity.

Depending on the athlete, it may include:

• Strength training
• Balance exercises
• Running and sprint preparation
• Jumping and landing exercises
• Change-of-direction training
• Mobility work
• Conditioning
• Sport-specific drills
• Structured warm-ups
• Training-load management
• Recovery strategies

The programme should reflect your sport, position, previous injuries, current training and physical ability.

A runner, football player and tennis player will have different physical requirements and therefore should not necessarily follow the same programme.

Who may benefit from an injury prevention programme?

A programme may be useful if you:

• Train or compete regularly
• Have had previous sports injuries
• Experience repeated injuries in the same area
• Are returning after injury
• Are increasing your training volume
• Are preparing for a competitive season
• Are returning after a long break
• Are starting more demanding training
• Participate in running or jumping sports
• Play sports involving rapid changes of direction
• Want to improve strength alongside your sport
• Are a teenage athlete going through periods of growth
• Want structured physical preparation for competition

Athletes do not need to wait until something hurts before working on strength and physical capacity.

What happens during the initial assessment?

The first stage is understanding the athlete and the demands of the sport.

The physiotherapist may ask about:

• Your sport
• Position or event
• Competition level
• Weekly training
• Match or competition schedule
• Gym training
• Previous injuries
• Current symptoms
• Recent changes in training
• Upcoming competitions
• Previous rehabilitation
• Other sports or exercise
• Your goals

The physical assessment can then be adapted according to the information gathered.

Physical assessment

Depending on your sport and injury history, assessment may include:

• Joint movement
• Muscle strength
• Single-leg strength
• Balance
• Squatting
• Hopping
• Jumping
• Landing
• Running
• Sprinting
• Changes of direction
• Shoulder strength
• Trunk strength

Not every athlete needs every test.

Assessment should focus on the physical qualities that are relevant to your sport and injury history.

Strength training

Strength is an important part of preparing the body for sporting activity.

Depending on the sport, exercises may focus on:

• Quadriceps
• Hamstrings
• Calves
• Gluteal muscles
• Hip muscles
• Groin muscles
• Trunk
• Shoulders
• Upper body

Exercises may include:

• Squats
• Split squats
• Lunges
• Step-ups
• Deadlift variations
• Calf raises
• Rows
• Pressing movements
• Resistance machines

The amount of resistance can gradually increase as strength improves.

An injury prevention programme should provide enough challenge to develop strength rather than relying indefinitely on very light exercises.

Single-leg strength

Many sports involve repeated periods of supporting or producing force through one leg.

Examples include:

• Running
• Football
• Rugby
• Tennis
• Padel
• Basketball
• Netball
• Athletics

Single-leg exercises may therefore include:

• Split squats
• Step-ups
• Single-leg calf raises
• Single-leg deadlift variations
• Single-leg press
• Lunges

The aim is to develop strength that can eventually transfer into faster sporting movements.

Hamstring strength

Hamstrings are heavily involved in running, sprinting and rapid acceleration.

Athletes involved in sports with repeated high-speed running may benefit from progressive hamstring strengthening.

Exercises may involve:

• Hip-extension movements
• Knee-flexion exercises
• Deadlift variations
• Progressive eccentric strengthening

Strength exercises should eventually be combined with appropriate running and sprint exposure where the sport requires high-speed movement.

Calf strength

The calf muscles work repeatedly during:

• Running
• Jumping
• Sprinting
• Changing direction

A programme may include:

• Double-leg calf raises
• Single-leg calf raises
• Loaded calf raises
• Bent-knee calf exercises
• Hopping

The required level depends on the sport.

A recreational walker and a competitive footballer will require very different levels of calf capacity.

Hip and gluteal strength

The hip muscles contribute to running, jumping, landing and changing direction.

Exercises may include:

• Squats
• Split squats
• Step-ups
• Hip-extension exercises
• Single-leg strengthening

The goal is not simply to isolate one small muscle.

The hips need to produce and control force during demanding whole-body movements.

Groin strength

Sports involving:

• Kicking
• Cutting
• Side stepping
• Rapid direction changes

can place considerable demand on the groin muscles.

A prevention programme may therefore include progressive strengthening of the hip adductor muscles.

The exercises can become more demanding as strength develops and should eventually relate to the sporting movements required.

Balance and proprioception

Balance training can be particularly useful for athletes involved in sports requiring frequent single-leg loading or rapid movement.

Exercises may include:

• Single-leg standing
• Reaching
• Stepping
• Dynamic balance
• Hopping
• Landing

After ankle injuries, balance and control exercises may form an important part of reducing repeated instability.

For athletes, standing still on one leg is usually only the beginning.

Later exercises should become faster and more similar to sporting movement.

Jumping and landing

Sports such as football, basketball, netball, volleyball and athletics involve repeated jumping and landing.

Training may progress through:

• Double-leg jumping
• Single-leg jumping
• Forward jumps
• Side-to-side jumps
• Repeated jumps
• Drop landings
• Sport-specific jumping

The programme may focus on:

• Force production
• Landing control
• Balance
• Ability to repeat the movement

Jumping should be introduced progressively according to the athlete's current strength and experience.

Plyometric training

Plyometric exercises involve faster movements where muscles rapidly produce and absorb force.

Examples include:

• Hopping
• Bounding
• Jumping
• Repeated jumps
• Explosive step movements

These exercises can help bridge the gap between slower strength training and faster sporting activity.

They should usually be introduced once the athlete has an appropriate level of basic strength and control.

Running preparation

Running sports require more than general leg strength.

An injury prevention programme may include exposure to different running demands, such as:

• Easy running
• Faster running
• Acceleration
• Deceleration
• Sprinting

The amount and intensity depend on the sport.

For example, a football player may need repeated sprint exposure, while a distance runner may need greater emphasis on running volume and endurance.

Sprint exposure

Some sports require athletes to repeatedly reach high running speeds.

If an athlete trains only at slow or moderate speeds, the body may receive limited preparation for sprinting demands.

Where appropriate, a programme can gradually include:

• Progressive accelerations
• Faster running
• Near-maximal sprinting
• Repeated sprint efforts

This should be introduced progressively rather than suddenly adding maximum-speed running.

Acceleration and deceleration

Sport often involves repeatedly starting and stopping.

Acceleration requires the body to produce force quickly.

Deceleration requires the body to absorb force while slowing down.

Training may therefore include:

• Short accelerations
• Controlled stops
• Faster stopping drills
• Accelerating into direction changes

These movements can gradually become more demanding as the athlete develops strength and control.

Change-of-direction training

Football, rugby, hockey, tennis, basketball and many other sports involve rapid direction changes.

Training may include:

• Side stepping
• Cutting
• Turning
• Pivoting
• Forward-to-side movements

Early exercises may be planned and predictable.

Later exercises can become faster or involve reacting to another person, a ball or a visual signal.

Sport-specific conditioning

A physically strong athlete may still become vulnerable to problems if they are not conditioned for the duration and intensity of their sport.

Conditioning may therefore involve:

• Running intervals
• Repeated sprinting
• Circuits
• Sport-specific drills
• Repeated jumping
• Cycling or other cardiovascular work where appropriate

The aim is to prepare the athlete for repeated effort, not just one successful movement while completely fresh.

Fatigue and movement

Sporting technique naturally changes to some extent as fatigue develops.

However, an athlete may need enough conditioning to maintain useful strength and movement throughout training or competition.

Some programmes therefore include exercises or drills performed repeatedly rather than testing only one maximum effort.

This is particularly relevant in sports involving long matches or repeated high-intensity periods.

Structured warm-up programmes

A warm-up helps prepare the body for the activity that follows.

Rather than simply performing a few stretches, a sport-specific warm-up may include:

• Light running
• Dynamic movement
• Mobility
• Balance
• Strength exercises
• Jumping
• Direction changes
• Progressive accelerations

The warm-up can gradually increase in intensity until it begins to resemble some of the movements that will occur during training.

Dynamic warm-ups

Dynamic warm-ups use controlled movement rather than remaining in one position for long periods.

Examples may include:

• Walking lunges
• Squatting movements
• Leg swings
• Skipping
• Running drills
• Direction changes

The exact warm-up should reflect the sport.

A sprinter preparing for maximum-speed running requires a different warm-up from someone beginning a recreational gym session.

Is stretching enough to prevent injuries?

Stretching can be useful when a particular mobility requirement needs to be addressed, but an injury prevention programme should not usually rely on stretching alone.

Sport also requires:

• Strength
• Power
• Balance
• Running capacity
• Coordination
• Conditioning

For many athletes, these qualities require more attention than simply trying to become more flexible.

Mobility

Some athletes have genuine movement restrictions that affect the activities required by their sport.

Mobility exercises may then focus on areas such as:

• Ankles
• Hips
• Shoulders
• Upper back

However, greater flexibility is not automatically better.

Athletes who already have considerable joint movement may benefit more from improving strength and control.

Previous injury

A previous injury can be an important consideration when designing a prevention programme.

For example, following a previous:

• Ankle sprain
• Hamstring injury
• Knee injury
• Shoulder injury

the programme may include additional work for the area that was previously affected.

This does not mean the athlete should permanently protect the injured area.

The aim is to restore enough capacity for it to tolerate sport normally.

Preventing repeated ankle sprains

After an ankle sprain, an athlete may regain normal walking relatively quickly while balance and sporting control remain reduced.

A programme may include:

• Calf strengthening
• Ankle strengthening
• Single-leg balance
• Hopping
• Landing
• Changes of direction

For athletes with repeated ankle sprains, these exercises may continue after the athlete has returned to sport.

Knee injury prevention

Sports involving running, jumping and rapid changes of direction place significant demands on the knees.

A programme may include:

• Quadriceps strength
• Hamstring strength
• Hip strength
• Single-leg exercises
• Jumping
• Landing
• Cutting
• Deceleration

Knee position during sport should not be viewed in isolation.

Strength, speed, fatigue and the overall movement also matter.

ACL injury prevention

For athletes involved in sports with jumping and direction changes, programmes may include:

• Lower-limb strength
• Balance
• Jumping
• Landing
• Cutting
• Deceleration
• Progressive running

These exercises can be incorporated into regular training or structured warm-ups.

No programme can completely remove the possibility of an ACL injury, but appropriate physical preparation can address modifiable factors relevant to sport.

Hamstring injury prevention

Athletes who sprint regularly may benefit from a combination of:

• Hamstring strengthening
• General lower-limb strength
• Progressive running
• Exposure to faster speeds

A programme based only on stretching may not adequately prepare the hamstrings for high-speed running.

Groin injury prevention

Groin problems may occur in sports involving frequent:

• Kicking
• Cutting
• Side stepping
• Sprinting

Prevention programmes may include progressive groin strengthening alongside hip, trunk and lower-limb exercises.

Training should eventually be demanding enough to reflect the forces required during sport.

Shoulder injury prevention

Overhead athletes may need different physical preparation from running athletes.

Sports such as:

• Swimming
• Cricket
• Tennis
• Volleyball

place repeated demands on the shoulder.

A programme may include:

• Rotator cuff strengthening
• Shoulder blade strength
• Upper-back strength
• Trunk strength
• Progressive throwing or overhead activity

The shoulder needs to tolerate the amount and intensity of work required by the sport.

Training load

Injuries do not always happen because an athlete moves incorrectly.

Sometimes training demands increase faster than the body can adapt.

Examples include:

• Suddenly increasing running distance
• Adding extra training sessions
• Returning immediately to full training after a break
• Introducing repeated sprint sessions
• Increasing gym loads quickly
• Playing several matches close together

A prevention programme may therefore also look at how training progresses.

Sudden changes in training

When several training variables increase at the same time, total physical demand can rise quickly.

For example, an athlete might simultaneously:

• Add another training day
• Increase gym training
• Begin sprint sessions
• Start playing competitive matches

Gradual progression makes it easier for the body to adapt and also makes it easier to identify which training change is causing a problem if symptoms develop.

Returning after a break

Strength and fitness can decrease during time away from sport.

This may occur because of:

• Off-season
• Illness
• Travel
• Exams
• Previous injury

Returning immediately to the previous training volume may therefore be difficult.

A structured return may gradually increase:

• Training duration
• Running volume
• Speed
• Strength training
• Sport-specific drills

Pre-season preparation

Pre-season can provide an opportunity to rebuild physical capacity before competition begins.

A programme may focus on:

• General strength
• Running fitness
• Sprint exposure
• Jumping
• Changes of direction
• Sport-specific conditioning

Increasing these demands progressively before a busy competition period can help prepare the athlete for what the season will require.

In-season injury prevention

Strength and conditioning should not necessarily stop once competition begins.

During the season, the programme may be adjusted around:

• Matches
• Training
• Fatigue
• Travel

Some exercises can be maintained with fewer sets or sessions.

The goal is to maintain physical capacity without adding excessive workload during busy periods.

Off-season training

The off-season can provide time to work on areas that are difficult to address during competition.

This may include:

• Strength
• Muscle mass
• Mobility where required
• Conditioning
• Previous rehabilitation deficits

Training volume and intensity can then become more sport-specific as the next season approaches.

Injury prevention for runners

Running injury prevention may focus on:

• Calf strength
• Hip and leg strength
• Running volume
• Gradual progression
• Faster-running preparation where appropriate

A programme might include:

• Calf raises
• Squats
• Split squats
• Deadlift variations
• Single-leg exercises

The exact programme should reflect whether the runner is preparing for a 5K, marathon, sprinting or recreational running.

Injury prevention for football

Football requires:

• Running
• Sprinting
• Kicking
• Cutting
• Jumping
• Contact

A football programme may therefore include:

• Hamstring strength
• Groin strength
• Calf strength
• Lower-limb strength
• Jumping and landing
• Sprinting
• Direction changes

The programme can be adjusted depending on the player's position and training schedule.

Injury prevention for rugby

Rugby places significant demands on:

• Strength
• Sprinting
• Direction changes
• Contact
• Repeated high-intensity activity

Physical preparation may include:

• Whole-body strength
• Sprint exposure
• Lower-limb control
• Conditioning
• Position-specific exercises

Contact preparation also needs to form part of appropriate sports coaching.

Injury prevention for court sports

Sports such as:

• Tennis
• Padel
• Basketball
• Netball
• Badminton

involve frequent acceleration, deceleration and direction changes.

Programmes may therefore include:

• Lower-limb strength
• Calf strength
• Single-leg exercises
• Jumping
• Landing
• Cutting
• Repeated movement conditioning

For racket sports, shoulder and upper-body preparation may also be relevant.

Injury prevention for gym training

Gym-related problems can sometimes occur when training intensity or load increases quickly.

A programme may consider:

• Exercise technique
• Strength
• Training volume
• Recovery
• Gradual loading

The aim is not to make every repetition look identical.

Instead, the goal is to develop enough physical capacity and exercise skill to train safely and progressively.

Teenage athletes

Teenage athletes are still growing and may experience changing strength, coordination and training demands.

An injury prevention programme can be adapted around:

• Age
• Stage of development
• Sport
• Training volume
• Previous injuries

Appropriately supervised strength, balance and movement training can form part of physical preparation.

Young athletes should not simply be given an adult programme with heavier weights removed.

Athletes playing several sports

Teenagers and adults may train across several sports.

For example, total weekly activity may include:

• Club training
• School or university sport
• Matches
• Gym sessions
• Running

All of these contribute to physical demand.

Prevention planning should therefore consider the complete training week rather than looking at one activity in isolation.

Technique and injury prevention

Technique can sometimes be relevant to symptoms or injury risk, but there is rarely one perfect movement that every athlete must use.

Assessment may identify a particular movement that could benefit from modification.

However, improving:

• Strength
• Capacity
• Speed
• Conditioning

may sometimes be more useful than repeatedly trying to consciously control every joint position.

Footwear and equipment

Appropriate footwear and equipment can contribute to comfort and safe participation.

Considerations may include:

• Fit
• Surface
• Sport
• Condition of the equipment

However, footwear should not be viewed as the only way to prevent injury.

Physical preparation and appropriate training remain important.

Recovery between training sessions

Training creates physical demand and recovery provides time for adaptation.

Recovery can be influenced by:

• Training schedule
• Sleep
• Nutrition
• Other exercise
• Work or study demands
• Travel

An athlete completing several demanding sessions close together may need their prevention programme adjusted rather than simply adding more exercises.

More exercise is not always better

An injury prevention programme should complement your sport rather than become another excessive training load.

The programme may involve only a small number of well-selected exercises.

What matters is that they:

• Address relevant physical demands
• Are performed consistently
• Become appropriately challenging
• Fit around sport training

A programme with five useful exercises completed regularly may be more practical than a long routine that is rarely completed.

Individual programmes

An individual programme can be developed around:

• Previous injuries
• Strength findings
• Sport
• Training volume
• Goals

This can be useful for athletes who have specific concerns or recurring problems.

Exercises can be progressed as strength and physical capacity improve.

Team injury prevention programmes

Prevention exercises can also be incorporated into team training.

A team programme might include:

• Running
• Strength
• Balance
• Jumping
• Landing
• Direction changes

Individual athletes may still require additional exercises based on their own injury history or physical needs.

Screening and baseline testing

Some athletes may benefit from assessment before a season or major training period.

Testing may look at:

• Strength
• Balance
• Hopping
• Jumping
• Running
• Mobility

The purpose is not to predict exactly who will become injured.

Instead, testing can provide useful information about current physical ability and areas that may benefit from additional training.

Re-testing

Re-testing can be useful after a period of structured training.

It may help assess improvements in:

• Strength
• Balance
• Jump performance
• Physical endurance
• Sport-specific ability

The programme can then be adjusted according to progress.

Testing should support training decisions rather than simply producing scores.

Injury prevention after rehabilitation

Completing rehabilitation and returning to sport does not always mean every exercise needs to stop.

Some rehabilitation exercises can become part of an ongoing prevention programme.

For example, an athlete may continue:

• Hamstring strengthening
• Calf strengthening
• Balance work
• Groin strengthening
• Jumping exercises

The programme may require less time once normal training has resumed.

Confidence after injury

A previous injury can affect confidence even after strength has improved.

An athlete may remain cautious with:

• Sprinting
• Tackling
• Jumping
• Landing
• Cutting

A prevention programme can gradually expose the athlete to these movements so they remain familiar rather than being encountered for the first time during competition.

Injury prevention is not about avoiding movement

Avoiding every movement that could potentially cause injury would make meaningful sport impossible.

The aim is instead to prepare the athlete for those movements.

For example, a football player needs to:

• Sprint
• Cut
• Jump
• Kick

Rather than avoiding these movements, training should progressively build the ability to perform them.

No programme can prevent every injury

Sport always involves some level of risk.

An opponent may make contact, a player may fall awkwardly or an unexpected movement may occur.

An injury prevention programme cannot guarantee that you will remain injury-free.

A more realistic aim is to:

• Build strength
• Improve physical capacity
• Prepare for sporting demands
• Address previous rehabilitation deficits
• Progress training appropriately

This helps create a body that is better prepared for the sport you choose to perform.

When further assessment may be needed

An injury prevention programme is designed for physical preparation, not for ignoring an existing injury.

A physiotherapy or medical assessment may be appropriate if you experience:

• Persistent or worsening pain
• Significant swelling
• Repeated joint giving way
• Significant weakness
• Persistent numbness
• Difficulty putting weight through a limb
• Pain following a significant injury
• Localised bone pain
• Symptoms affecting normal daily activity
• Pain that regularly wakes you at night

If an injury is already present, rehabilitation may need to come before or alongside prevention training.

Programmes based on your goals

Your programme should reflect what you are preparing for.

Goals may include:

• Completing a sports season
• Increasing running distance
• Returning after injury
• Reducing repeated ankle sprains
• Improving hamstring strength
• Preparing for football or rugby
• Returning to competitive sport
• Increasing gym training
• Improving physical confidence
• Preparing for a major event

Exercises can then be selected around these specific demands.

How long should an injury prevention programme continue?

There is no fixed duration.

Some athletes may complete a focused programme during:

• Pre-season
• Return from injury
• A period of increased training

Others may keep selected exercises within their regular training throughout the year.

The programme should also progress.

As exercises become easy, they may need:

• More resistance
• More speed
• Greater balance demands
• More repetitions
• More sport-specific movement

The goal is to maintain enough challenge to continue developing physical capacity.