The importance of injury prevention: how good we are?

Dear referees,

We don't have a pleasant reason to write this long letter, but please read it carefully! Regrettably, we have seen our friend, and referee, Aleksandar Glisic suffer a severe knee injury in the match between Lenovo Tenerife and VEF Riga in the 3rd round of Basketball Champions League. Aleksandar was sprinting from his traill position to follow Tenerife´s fast break, tried to show an unsportsmanlike foul by raising his arms, and suddenly fell on the court. It was a clear example of a non-contact knee injury. Unfortunately, we now know that Aleksandar suffered one of the most devastating knee injuries; he's torn his ACL (Anterior Cruciate Ligament).

It has been well documented that athletes competing in sports that involves pivoting, jumping, landing, sprinting, acceleration, deceleration and cutting movements are highly susceptible to ACL injuries, with females being two to ten times more at the risk than their male counterparts. In fact, nearly 80% of all reported ACL injuries in team sports are non-contact in nature. Given that basketball referees are repeatedly engaged in sequences of intense activities that require rapid running, change of direction, acceleration and deceleration and constantly overcoming their own bodies inertia. It is easy to conclude these actions elicit a substantial physiological load, resulting in fatigue, which in return put referees at risk of injury. Recent, but rare studies on basketball referees, also confirmed that referees were mainly affected by lower-body injuries with knee injury being reported in more than 25% of cases.

We know that a lack of core and lower-body strength, excess of body weight, poor balance, loss of neuromuscular control and proprioceptive deficits have shown to be main risk factors for lower-body injuries. Fortunately, there is strong evidence that strength, power, balance, and proprioception training has the potential, not only to optimize performance on the court, but also to lower the risk of injury to the lower extremities. Specifically, optimal core strength provides a solid body foundation and posture, which in turn enables trunk and joints´ stability distant to the core such as the hip joint. This is extremely important in actions that require simultaneous movements of lower and upper-body movements (e.g., overhead movements) where the body´s centre of gravity is constantly moved up and down, which might impair movement control by inefficient muscular force production and transfer, and uncontrolled joint displacements. The latter could lead to so called: the position of no return, when joints are in an unnatural position and action (e.g., knee valgus, hip adduction, ankle eversion) which in return leads to the knee external rotation and the ligament(s) injury.

Moreover, balance and proprioception training have shown to reduce lower extremity injuries. It improves neuromuscular efficiency and optimizes movement quality by strengthening and stabilizing muscles and connective tissue (e.g., tendons, ligaments) around joints (e.g., hip, knee, ankle) and by increasing kinesthetics awareness and overall body stability. It is important to note, balance, stabilization and proprioception training improves your joints stability by teaching your lower extremities' muscles to efficiently contract and react in case of a sudden and unexpected lower body perturbations. This trained and learned neuromuscular control is crucial in injury prevention of the lower body.

Considering the nature of your job, we can conclude the importance of your physical preparation, recovery and nutrition are crucial for your physical and mental health. You officiate several games in a week, you experience a high movement load during each game, and you are supposed to move as quickly as players to see their actions and make correct decisions. As we talked many times, one of your worse enemies are fatigue and stress.

Consequently, to increase your resistance to fatigue and stress, to make good decisions on the court and to reduce injury risk, you must be physically well prepared, which means having optimal body composition, levels of cardiovascular fitness, strength, power, speed, balance, and flexibility. In other words, the higher fitness level you have the more resistant to fatigue and stress you´ll be! In turn, you´ll be a better decision maker on the court and less suspected to injuries! Please remember that our main priority are your long-term careers without injuries and other health related issues! Please try consistently to apply the preventive strategies that include morning activation, proper warm-up and re-warm-up (both on and off court), optimal hydration and nutrition, enough recovery and sleep and consistent physical training. We want to emphasise the referee-specific training that considers a combination of physical training and the Individual Officiating Techniques (IOT) that must be mastered in advanced and applied correctly and consistently in any situation irrespectively of if you train or officiate.

In the end, one may ask if the injury could be prevented. We strongly believe that it could, or at least that the injury risk could be substantially decreased. We think all of you who suffered some musculoskeletal injury should ask yourself this question. Reflecting over it you might come up with the potential causes and answers for how it could be prevented. At the end, we want to finish our letter with a quote of Jim Rohn,a human resource manager, writer, and entrepreneur: "Take care of your body. It's the only place you have to live."

We wish a quick recovery to our friend Aleksandar, and rest of you who are in the rehabilitation process, hoping this letter will rise your awareness of the importance of the injury preventive strategies we have shared.

Kind regards,

Your fitness team,

Haris, David, and Alejandro