Limits of Prevention

This paper opens a few paths for reflection. Do
injury prevention efforts contribute more to performance
enhancement than injury reduction? Is there a
threshold level of injuries below which it is difficult to go
without losing the ‘learning effect’ of injuries? In a
performance-based, limit-seeking environment, is it
possible to stop people from exceeding their limits?
Considering the constantly evolving demands on sportspeople,
the importance of performance in sports and
society, and the intrinsic ‘limit-seeking’ nature of
the human being, it seems difficult to imagine that
performance will continue to evolve without any injury
risk.

Injury prevention is a priority in the field of sports medicine
and in physical activity promotion, in particular for youth.
Injuries can lead to long term handicaps and disengagement
from physical activity. The follow up of young sportsmen in
the canton of Geneva over the last 35 years has permitted to
get an idea of the prevalence of injuries in young sportsmen
and allows a comparison with the general population. It has
also permitted to get an idea of the influence prevention has
had on injuries. We found that injuries were not significantly
different in youth sportsmen (0.27 injuries/child/year) than in
the general age matched population, but that injury’s among
sporting youth occurred mainly during their sporting activities.
Traditional prevention did not decrease injury prevalence
but reduced the proportion of overuse injuries. Since performance
level and training time increased over the study period,
without a concomitant increase in injury’s, it can be hypothesized
that prevention contributed to performance
enhancement. The concept of a learning effect, or the preventive
influence, of an injury is evoked. The idea that injuries
are part of athletic development (performance) and might not
be reducible below a certain threshold is also discussed.