• Fitness & Health
• Sport & Exercise Science
• Physical Education
• Strength & Conditioning
• Sports Medicine
• Sport Management
• Dance

Risk reduction versus injury prevention

This is an excerpt from Dance Injuries With HKPropel Access by Jeffrey A. Russell.

By Caroline Bolling, PT, PhD; Robin Kish, MS, MFA; Jeffrey A. Russell, PhD, ATC

The idea of risk reduction (decreasing the likelihood of a problem by altering risk factors) is not new, but the concept of prevention (creating prophylaxis or safeguards to keep a problem from happening) has an ancient origin. The old saying An ounce of prevention is worth a pound of cure was first recorded in Latin in Henry de Bracton’s De Legibus et consuetudinibus Angliae [The Laws and Customs of England] in about 1240 (Ammer, 2003). The simple concept behind this axiom is to avoid a problem before it happens. Today, preventive health care has innumerable measures that exemplify this principle, such as using condoms to reduce risk of contracting sexually transmitted diseases, increasing physical activity to prevent obesity, or wearing a lead apron when undergoing an X-ray to prevent the negative effects of radiation exposure. When applying this concept to dance, you may wonder what strategies function effectively as the ounce of prevention—a good diet, enough sleep, or a proper warm-up? In actuality, a focus on reducing risk is more beneficial overall.

Scientific literature has long focused on prevention of injuries. Sports medicine has actively evolved the concept of injury prevention for more than 20 years, while dance medicine has been following a similar path, albeit for a shorter period of time. Traditionally, sport injury prevention approaches have followed the sequence of prevention, which was originally proposed by van Mechelen and colleagues (1992). This four-step model uses systematic logic, moving from injury problem assessment to the design of an evidence-based solution for preventing injuries (figure 1.6).

The first step aims to describe the extent of the injury problem, and the second step aims to investigate etiological factors and injury mechanisms (the way an injury occurs). The goal of the third step is to develop science-informed injury prevention measures, and the fourth step assesses whether the developed measures actually work to solve the problem. This four-step framework has guided research and practice toward injury prevention strategies since it was first proposed. The model has also been applied to dance injury prevention where many studies describe injury incidence (Allen et al., 2013; Hincapié et al., 2008; Lee et al., 2017), risk factors (Kenny et al., 2016; Biernacki et al., 2018; van Seters et al., 2020), preventive interventions (Allen et al., 2013; Vera et al., 2020), and outcomes regarding injury reduction (Fuller et al., 2020; Ojofeitimi and Bronner, 2011; Vera et al., 2020).

Despite the attention given to prevention and its common usage as a term, all possible safeguards—except for not participating in dance at all—are unlikely to help you avoid every injury. On the other hand, reducing the risk of dance injuries, and therefore their frequency, is possible, even though this is a relatively new topic in dance science. Keep in mind, however, that research evidence of efficacy of a risk reducing measure does not necessarily equal effectiveness in practice or effective implementation (Finch and Donaldson, 2010). In other words, the fact that something works under ideal conditions in a controlled study does not mean it has the same effect in the real world.

To account for this, implementation of evidence has been presented as a key process to bring controlled research findings into actual practice (McGlashan and Finch, 2010; O’Brien et al., 2016). Finch (2006) proposed the TRIPP (translating research into injury prevention practice) model, which added two steps to the sequence of prevention model. These two additional steps are related to (1) the understanding of the implementation context and (2) the evaluation of the implementation process of preventive measures; these provide an improved framework for reducing injury risk.

All current studies that present the concept of injury prevention and its challenges are theoretically trying to reduce injury risk. Once again, we assert that prevention is not the ideal term when discussing dance injuries because the word implies that there is a complete avoidance of injuries. Clearly this is not feasible. Consider the concept of exposure discussed earlier. In actuality, the main idea behind so-called preventive measures is to reduce the risk of injury occurrence, even though it is not possible to completely avoid sustaining all injuries. The primary reason for this is exposure; participating in dancing is associated with inherent injury risk. This explains why the phrase injury risk reduction is more accurate than injury prevention.

Considering this information, the best plan for you as a dancer is to continue dancing while simultaneously reducing your risk of injuries. To do so, you must know about likely injuries and their potential causes, as outlined by van Mechelen’s sequence of prevention. The next challenge is knowing how to measure dance injuries and how to explore the causes of these injuries.

---

Research Into Practice

When examining injury prevention research to reduce ankle sprains, evidence shows that introducing neuromuscular exercises into training helps reduce the risk of reinjury (Vriend et al., 2016). To build this type of evidence, researchers provided participants who had prior ankle sprains with neuromuscular training in a controlled environment (regular training sessions with supervision) during a specific period, while another group of participants did not receive exercises. The researchers then measured the number of injuries sustained by participants in both groups. The group that performed exercises had significantly fewer injuries, thus making it reasonable to conclude that the intervention of providing exercises was effective at reducing risk of reinjury in individuals who sustain an ankle sprain.

However, when this intervention is applied in a real-world environment (without regular exercise sessions and supervision by researchers), most people do not perform the exercises correctly nor do they modify the exercises according to their ability level and rehabilitation progress. Therefore, an implementation strategy is needed to ensure that the intervention shown to be effective in a research setting will also be effective in a specific real-world context.

Such an approach needs to follow the two additional steps of the TRIPP model, considering the implementation context and evaluating the implementation process. For example, some researchers have developed different ways to deliver exercises, such as preparing booklets, videos, and mobile phone apps to guide their participants (Vriend et al., 2015). Then researchers evaluate the processes of how the exercise-based measures are delivered along with how the participants implement the instructional materials to determine whether participants benefited and risk of reinjury truly was reduced.

More Excerpts From Dance Injuries With HKPropel Access

---