This book is the latest offering in a series by the Medical Commission of the International OlympicCommittee. Sports Injury Prevention provides a comprehensive review of the literature regarding the identification of risk factors, understanding injury mechanisms, and risk management suitable to sports participation.

The book follows a similar format to their previous publications utilizing an editorial team and 36 contributing authors who all have earned international respect and recognition within sports medicine and sports science.

Primarily it is targeted at physicians and physiotherapists working with sports teams, although it is also applicable to athletes and coaching staff. Bahr and Engbretsen illustrate the extent of the task in hand in their preface, stating that ''this book is the first of its kind. Never before has anyone attempted to provide a guide to injury prevention over different sports''.

If, as the text unfolds, they have achieved this goal successfully, then clinicians such as myself, athletes, and coaches alike must surely rejoice at the revelation of what to many is the Holy Grail. The initial chapters set the scene, detailing the extent of the problem of injury to the sporting fraternity.

They highlight the genre of sports injury prevention as a fast evolving entity discussing the rapid rise in the evidence and quality of literature. They provide supporting evidence of an apparent 200-300% increase in published clinical studies and randomised controlled trials between 2000 and 2007. The virtue of this text is so to aid the dissemination of such material to the masses.

The book has a systematic approach to the topic of injury prevention, recognizing that the area is complex and that risk factors for injury can be both intrinsic and extrinsic. Injury prevention matrices from motor vehicle accidents, risk management, and injury surveillance are but a few ways postulated to help promote grounded strategies for injury prevention which are auditable to show their worth.

Reference is drawn to pre-season screening and the need for it to be sport specific to achieve maximum benefit. Rather than using the sport as the focus for discussion, the authors opted for a more segmental approach, concentrating on the body part of the athlete that they were trying to protect from injury.

There are detailed chapters on prevention of injuries to the ankle, knee, hamstring, groin, low back, shoulder, elbow, tendons, head, and cervical spine. In addition, they have devoted chapters to large-scale injury prevention implementation and the organization of major sporting events.

Segmenting the topic makes for an easier basic understanding, but the reader must not forget that prevention of injury is a complex interaction of the athlete as a whole and not simply each segment, a factor not always transparent within the text.

Each chapter has an identical structure that aids clarity covering the injury epidemiology, key risk factors, mechanisms of injury, identification of risk factors, and preventative measures. To summarize each chapter there is a ''take home message'' of the most salient points.

This structure allows the reader a freedom to dip in and out of the text as they wish focusing on areas of particular interest. However, for the more serial reader this can lead to a rather repetitive read, as a number of factors are duplicated chapter on chapter.

Each chapter attempts to cite well-written applied research and where possible uses photographic examples to illustrate mechanism of injury or appropriate prevention or rehabilitation protocols. Of particular interest are the pictorial representations of dynamic neuromuscular analysis training/anterior cruciate ligament prevention protocols and the stability training/neuromuscular control exercises within Chapters 5 and 8 respectively.

Prevention of tendon overuse injuries is also a well-written succinct chapter, which would act as a good point of reference for any athlete, coach, physiotherapist or physician. Although the section on hamstring injuries is both well written and based on sound theoretical and practical principles, I would advocate caution when presenting a rehabilitation framework, especially if the book is a resource for the athlete and coach.

The authors do not address how the varying degrees of insult to this muscle differ when they are exposed to the rehabilitation process. The sections on balance and postural sway pertaining to risk of ankle injury are noteworthy but are somewhat dated.

The training and research into enhancing an athlete's proprioception has evolved further than ''standing on one leg for 15 seconds''. More objective measures are now available with the use of force plates to document change and challenge the athlete.

Furthermore, the realization that balance is linked intrinsically to control, and that both are dynamic factors, needs to be addressed in more detail. Where relevant gaps in knowledge from current research are identified, this is acknowledged and reference is made to clinical expertise to substantiate their points further.

Each chapter is referenced and further readings are recommended. It is apparent that in some areas, particularly the section on groin injuries, there is a paucity of reference articles with only four being cited.

To some extent, this highlights the main problem that while the topic under investigation and the rationale behind such a text is commendable, the current body of literature to support it is not sufficient. Historical biases remain in numerous sports and although the text does not formally highlight the need for researchers, clinicians, and coaches to become more responsible in the practices of injury prevention, this is surely the case.

Perhaps if researchers and clinicians alike are to get closer to finding the Holy Grail, they need to focus on targeting practices, or risks, that have a notable effect on the athlete's performance. This may lead to a reduction in such opposition or resistance.

I see this book not as the Holy Grail that I as a clinician would like it to be, but more of a step towards finding it. Undoubtedly, it acts as a good reference guide to any athlete, coach, physiotherapist or physician.

I hope it will stimulate others to realize their responsibility in the process, acting as the necessary catalyst to drive knowledge forward to the important goal, that of true sports injury prevention.

David Rennie 2009
Head Physiotherapist, Leicester City Football Club