701
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Buchheit M. Applying the acute:chronic workload ratio in elite football: worth the effort? Br J Sports Med 2016; 51:1325-1327. [PMID: 27852586 DOI: 10.1136/bjsports-2016-097017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Martin Buchheit
- Performance Department, Paris Saint-Germain Football Club, Saint-Germain-en-Laye, France
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702
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Sampson JA, Fullagar HHK, Murray A. Evidence is needed to determine if there is a better way to determine the acute:chronic workload. Br J Sports Med 2016; 51:621-622. [DOI: 10.1136/bjsports-2016-097085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/04/2022]
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703
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Cunningham DJ, Shearer DA, Drawer S, Pollard B, Eager R, Taylor N, Cook CJ, Kilduff LP. Movement Demands of Elite Under-20s and Senior International Rugby Union Players. PLoS One 2016; 11:e0164990. [PMID: 27824865 PMCID: PMC5100986 DOI: 10.1371/journal.pone.0164990] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022] Open
Abstract
This study compared the movement demands of elite international Under-20 age grade (U20s) and senior international rugby union players during competitive tournament match play. Forty elite professional players from an U20 and 27 elite professional senior players from international performance squads were monitored using 10Hz global positioning systems (GPS) during 15 (U20s) and 8 (senior) international tournament matches during the 2014 and 2015 seasons. Data on distances, velocities, accelerations, decelerations, high metabolic load (HML) distance and efforts, and number of sprints were derived. Data files from players who played over 60 min (n = 258) were separated firstly into Forwards and Backs, and more specifically into six positional groups; FR-Front Row (prop & hooker), SR-Second Row, BR-Back Row (Flankers & No.8), HB-Half Backs (scrum half & outside half), MF-Midfield (centres), B3 -Back Three (wings & full back) for match analysis. Linear mixed models revealed significant differences between U20 and senior teams in both the forwards and backs. In the forwards the seniors covered greater HML distance (736.4 ± 280.3 vs 701.3 ± 198.7m, p = 0.01) and severe decelerations (2.38 ± 2.2 vs 2.28 ± 1.65, p = 0.05) compared to the U20s, but performed less relative HSR (3.1 ± 1.6 vs 3.2 ± 1.5, p < 0.01), moderate (19.4 ± 10.5 vs 23.6 ± 10.5, p = 0.01) and high accelerations (2.2 ± 1.9 vs 4.3 ± 2.7, p < 0.01) and sprint•min-1 (0.11 ± 0.06 vs 0.11 ± 0.05, p < 0.01). Senior backs covered a greater relative distance (73.3 ± 8.1 vs 69.1 ± 7.6 m•min-1, p < 0.01), greater High Metabolic Load (HML) distance (1138.0 ± 233.5 vs 1060.4 ± 218.1m, p < 0.01), HML efforts (112.7 ± 22.2 vs 98.8 ± 21.7, p < 0.01) and heavy decelerations (9.9 ± 4.3 vs 9.5 ± 4.4, p = 0.04) than the U20s backs. However, the U20s backs performed more relative HSR (7.3 ± 2.1 vs 7.2 ± 2.1, p <0.01) and sprint•min-1 (0.26 ± 0.07 vs 0.25 ± 0.07, p < 0.01). Further investigation highlighted differences between the 6 positional groups of the teams. The positional groups that differed the most on the variables measured were the FR and MF groups, with the U20s FR having higher outputs on HSR, moderate & high accelerations, moderate, high & severe decelerations, HML distance, HML efforts, and sprints•min-1. For the MF group the senior players produced greater values for relative distance covered, HSR, moderate decelerations, HML distance and sprint•min-1. The BR position group was most similar with the only differences seen on heavy accelerations (U20s higher) and moderate decelerations (seniors higher). Findings demonstrate that U20s internationals appear to be an adequate 'stepping stone' for preparing players for movement characteristics found senior International rugby, however, the current study highlight for the first time that certain positional groups may require more time to be able to match the movement demands required at a higher playing level than others. Conditioning staff must also bear in mind that the U20s players whilst maintaining or improving match movement capabilities may require to gain substantial mass in some positions to match their senior counterparts.
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Affiliation(s)
- Daniel J. Cunningham
- Applied Sport Technology Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, Wales
| | - David A. Shearer
- School of Psychology and Therapeutic Studies, University of South Wales, Rhondda Cynon Taff, Wales
- Welsh Institute of Performance Science, College of Engineering, Swansea University, Swansea, Wales
| | - Scott Drawer
- The Rugby Football Union, Greater London, England
| | - Ben Pollard
- The Rugby Football Union, Greater London, England
| | - Robin Eager
- The Rugby Football Union, Greater London, England
| | - Neil Taylor
- The Rugby Football Union, Greater London, England
| | - Christian J. Cook
- Applied Sport Technology Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, Wales
| | - Liam P. Kilduff
- Applied Sport Technology Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, Wales
- Welsh Institute of Performance Science, College of Engineering, Swansea University, Swansea, Wales
- * E-mail:
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704
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Carey DL, Blanch P, Ong KL, Crossley KM, Crow J, Morris ME. Training loads and injury risk in Australian football-differing acute: chronic workload ratios influence match injury risk. Br J Sports Med 2016; 51:1215-1220. [PMID: 27789430 PMCID: PMC5537557 DOI: 10.1136/bjsports-2016-096309] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/10/2022]
Abstract
Aims (1) To investigate whether a daily acute:chronic workload ratio informs injury risk in Australian football players; (2) to identify which combination of workload variable, acute and chronic time window best explains injury likelihood. Methods Workload and injury data were collected from 53 athletes over 2 seasons in a professional Australian football club. Acute:chronic workload ratios were calculated daily for each athlete, and modelled against non-contact injury likelihood using a quadratic relationship. 6 workload variables, 8 acute time windows (2–9 days) and 7 chronic time windows (14–35 days) were considered (336 combinations). Each parameter combination was compared for injury likelihood fit (using R2). Results The ratio of moderate speed running workload (18–24 km/h) in the previous 3 days (acute time window) compared with the previous 21 days (chronic time window) best explained the injury likelihood in matches (R2=0.79) and in the immediate 2 or 5 days following matches (R2=0.76–0.82). The 3:21 acute:chronic workload ratio discriminated between high-risk and low-risk athletes (relative risk=1.98–2.43). Using the previous 6 days to calculate the acute workload time window yielded similar results. The choice of acute time window significantly influenced model performance and appeared to reflect the competition and training schedule. Conclusions Daily workload ratios can inform injury risk in Australian football. Clinicians and conditioning coaches should consider the sport-specific schedule of competition and training when choosing acute and chronic time windows. For Australian football, the ratio of moderate speed running in a 3-day or 6-day acute time window and a 21-day chronic time window best explained injury risk.
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Affiliation(s)
- David L Carey
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Peter Blanch
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Essendon Football Club, Melbourne, Victoria, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Kok-Leong Ong
- SAS Analytics Innovation Lab, La Trobe Business School, La Trobe University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Justin Crow
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Essendon Football Club, Melbourne, Victoria, Australia
| | - Meg E Morris
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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705
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Ball S, Halaki M, Orr R. Training volume and soft tissue injury in professional and non-professional rugby union players: a systematic review. Br J Sports Med 2016; 51:1012-1020. [PMID: 28525884 DOI: 10.1136/bjsports-2015-095926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/04/2022]
Abstract
AIM To investigate the relationship between training volume and soft tissue injury incidence, and characterise soft tissue injury in rugby union players. DESIGN A systematic search of electronic databases was performed. The search strategy combined terms covering: training volume and injury, and rugby union, and players of all levels. DATA SOURCES Medline, SPORTDiscus, Web of Science, Embase, PubMed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they reported: male rugby union players, a clear definition of a rugby union injury, the amount of training volume undertaken by participants, and epidemiological data for soft-tissue injuries including the number or incidence. RESULTS 15 studies were eligible for inclusion. Overall match and training injury incidence ranged from 3.3 to 218.0 injuries/1000 player match hours and 0.1-6.1 injuries/1000 player training hours, respectively. Muscle and tendon as well as joint (non-bone) and ligament injuries were the most frequently occurring injuries. The lower limb was the most prevalent injury location. Injury incidence was higher in professional rugby union players than non-professional players. Contact events were responsible for the greatest injury incidence. For non-contact mechanisms, running was responsible for the highest injury incidence. Inconsistent injury definitions hindered reliable comparison of injury data. The lack of reporting training volumes in hours per player per week limited the ability to investigate associations between training volume and injury incidence. CONCLUSIONS A higher level of play may result in higher match injury incidence. Muscle and tendon injuries were the most common type of soft tissue injury, while the lower limb was the most common location of injury in rugby union players, and running was responsible for the highest injury incidence during non-contact events.
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Affiliation(s)
- Shane Ball
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Rhonda Orr
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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706
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Williams S, West S, Cross MJ, Stokes KA. Better way to determine the acute:chronic workload ratio? Br J Sports Med 2016; 51:209-210. [DOI: 10.1136/bjsports-2016-096589] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/04/2022]
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707
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Drew MK, Blanch P, Purdam C, Gabbett TJ. Yes, rolling averages are a good way to assess training load for injury prevention. Is there a better way? Probably, but we have not seen the evidence. Br J Sports Med 2016; 51:618-619. [PMID: 27647857 DOI: 10.1136/bjsports-2016-096609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2016] [Indexed: 11/03/2022]
Affiliation(s)
- M K Drew
- Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
- Department of Physiotherapy, University of Canberra, Canberra, Australia
| | - P Blanch
- Essendon Football Club, Melbourne, Victoria, Australia
- School of Health Sciences, Griffith University, Gold Coast, Australia
| | - C Purdam
- Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
- Department of Physiotherapy, University of Canberra, Canberra, Australia
| | - T J Gabbett
- Gabbett Performance Solutions, Brisbane, Queensland, Australia
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708
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Booth M, Orr R, Cobley S. Call for coordinated and systematic training load measurement (and progression) in athlete development: a conceptual model with practical steps. Br J Sports Med 2016; 51:559-560. [PMID: 27628647 DOI: 10.1136/bjsports-2016-096358] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Mark Booth
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Rhonda Orr
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Cobley
- Faculty of Health Sciences, Discipline of Exercise and Sport Science, The University of Sydney, Sydney, New South Wales, Australia
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709
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Caparrós T, Alentorn-Geli E, Myer GD, Capdevila L, Samuelsson K, Hamilton B, Rodas G. The Relationship of Practice Exposure and Injury Rate on Game Performance and Season Success in Professional Male Basketball. J Sports Sci Med 2016; 15:397-402. [PMID: 27803617 PMCID: PMC4974851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/21/2016] [Indexed: 06/06/2023]
Abstract
The objectives of this study were to determine the relationship among game performance, injury rate, and practice exposure in a professional male basketball team. A retroospective analysis of prospective collected data was conducted over seven consecutive seasons (2007/2008 to 2013/2014). Data collection included sports performance during competition (statistical evaluation), injury rate, and total exposure (games and practices). Over the surveillance period, 162 injuries (91 practice; 71 matches) occurred over 32,668 hours of exposure (556 games and 2005 practices). There was a strong positive correlation between: 1) exposure (total number of practices and hours of exposure) and the total number of injuries (r = 0.77; p = 0.04); 2) exposure (total hours of exposure and total hours of practice exposure) and performance (total team ranking) (r = 0.77 and p = 0.04, and r = 0.8 and p = 0.03, respectively); and 3) total number of injuries and performance (total team ranking) (r = 0.84; p = 0.02). While increasing practice and competition time is related to greater team performance, it also increases the number of injuries. However, higher injury rates were not associated with worse overall team performance. Efforts to reduce high-risk activity during practice, optimally replaced with injury prevention training, might help to reduce injury risk.
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Affiliation(s)
- Toni Caparrós
- Insititut Nacional d'Educació Física de Catalunya (INEFC), Barcelona, Spain; SPARG Research Group, Universitat de Vic, Vic, Spain
| | | | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA; The Micheli Center for Sports Injury Prevention, Boston, MA, USA
| | - Lluís Capdevila
- Laboratory of Sport Psychology, Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Kristian Samuelsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Bruce Hamilton
- High Performance Sport New Zealand , Auckland, New Zeland
| | - Gil Rodas
- Medical Department, Futbol Club Barcelona , Barcelona, Spain
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710
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Teramoto M, Cross CL, Cushman DM, Maak TG, Petron DJ, Willick SE. Game injuries in relation to game schedules in the National Basketball Association. J Sci Med Sport 2016; 20:230-235. [PMID: 27622705 DOI: 10.1016/j.jsams.2016.08.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/11/2016] [Accepted: 08/25/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Injury management is critical in the National Basketball Association (NBA), as players experience a wide variety of injuries. Recently, it has been suggested that game schedules, such as back-to-back games and four games in five days, increase the risk of injuries in the NBA. The aim of this study was to examine the association between game schedules and player injuries in the NBA. DESIGN Descriptive epidemiology study. METHODS The present study analyzed game injuries and game schedules in the 2012-13 through 2014-15 regular seasons. Game injuries by game schedules and players' profiles were examined using an exact binomial test, the Fisher's exact test and the Mann-Whitney-Wilcoxon test. A Poisson regression analysis was performed to predict the number of game injuries sustained by each player from game schedules and injured players' profiles. RESULTS There were a total of 681 cases of game injuries sustained by 280 different players during the three years (total N=1443 players). Playing back-to-back games or playing four games in five days alone was not associated with an increased rate of game injuries, whereas a significant positive association was found between game injuries and playing away from home (p<0.05). Playing back-to-back games and away games were significant predictors of frequent game injuries (p<0.05). CONCLUSIONS Game schedules could be one factor that impacts the risk of game injuries in the NBA. The findings could be useful for designing optimal game schedules in the NBA as well as helping NBA teams make adjustments to minimize game injuries.
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Affiliation(s)
- Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, United States.
| | - Chad L Cross
- Department of Physical & Life Sciences, Nevada State College, United States
| | - Daniel M Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, United States
| | - Travis G Maak
- Department of Orthopaedic Surgery, University of Utah, United States
| | - David J Petron
- Department of Orthopaedic Surgery, University of Utah, United States
| | - Stuart E Willick
- Division of Physical Medicine & Rehabilitation, University of Utah, United States
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711
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Fagher K, Jacobsson J, Timpka T, Dahlström Ö, Lexell J. The Sports-Related Injuries and Illnesses in Paralympic Sport Study (SRIIPSS): a study protocol for a prospective longitudinal study. BMC Sports Sci Med Rehabil 2016; 8:28. [PMID: 27579170 PMCID: PMC5004301 DOI: 10.1186/s13102-016-0053-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/21/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Paralympic sport provides sporting opportunities for athletes with a disability, with the Paralympic Games as the main event. Participation in sport is, however, associated with a significant risk for sustaining injuries and illnesses. Our knowledge of sports-related injuries and illnesses in Paralympic sport is very limited and there are no large-scale epidemiological cohort studies. The purpose here is to present a protocol for a prospective longitudinal study: The Sports-Related Injuries and Illnesses in Paralympic Sport Study (SRIIPSS). METHODS/DESIGN An argument-based method for investigation of design problems was used to structure the study protocol. The primary requirement of the protocol is to allow prospective studies over time and include exposure to both training and competition. To reflect the complexity of Paralympic sport with athletes' pre-existing impairments, use of assistive equipment, pain and other and medical issues, it is required that the data collection system is specifically adapted to Paralympic sport. To allow the collection of data, at the same time as there is limited access to coaches and medical personnel, it is advantageous that data can be collected online directly from the athletes. Based on this a self-report athlete monitoring system will be developed, where the athletes can enter data weekly via their mobile phones or lap-tops. Data will be collected from around 100 Swedish Paralympic athletes for approximately 1 year, which will allow us to i) prospectively estimate the annual incidence of sports-related injuries and illnesses and ii) explore risk factors and mechanisms for sustaining sports-related injuries and illnesses based on athlete exposure and training loads. DISCUSSION For effective implementation of injury and illness prevention measures, comprehensive epidemiological knowledge is required. This study will be the first prospective longitudinal self-report study of sports-related injuries and illnesses in Paralympic sport over a longer period of time. The results will eventually contribute to the development of evidence-based preventive measures specifically adapted to Paralympic sport in order to provide safe and healthy sport participation. Thereby, the project will be of relevance for Paralympic athletes at all levels and to the Paralympic Movement. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov (Identifier: NCT02788500; Registration date: 22 May 2016).
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Affiliation(s)
- Kristina Fagher
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, PO Box 157, 221 00 Lund, Sweden
| | - Jenny Jacobsson
- Department of Medical and Health Sciences, Athletics Research Center, Linköping University, 581 83 Linköping, Sweden
| | - Toomas Timpka
- Department of Medical and Health Sciences, Athletics Research Center, Linköping University, 581 83 Linköping, Sweden
| | - Örjan Dahlström
- Department of Medical and Health Sciences, Athletics Research Center, Linköping University, 581 83 Linköping, Sweden ; Department of Behavioural Sciences and Learning, Linköping University, 581 83 Linköping, Sweden
| | - Jan Lexell
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, PO Box 157, 221 00 Lund, Sweden ; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, 221 85 Lund, Sweden ; Department of Health Science, Luleå University of Technology, 971 87 Luleå, Sweden
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712
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Thornton JS, Vinther A, Wilson F, Lebrun CM, Wilkinson M, Di Ciacca SR, Orlando K, Smoljanovic T. Rowing Injuries: An Updated Review. Sports Med 2016; 47:641-661. [DOI: 10.1007/s40279-016-0613-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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713
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Nikolaidis PT, Ruano MAG, de Oliveira NC, Portes LA, Freiwald J, Leprêtre PM, Knechtle B. Who runs the fastest? Anthropometric and physiological correlates of 20 m sprint performance in male soccer players. Res Sports Med 2016; 24:341-351. [DOI: 10.1080/15438627.2016.1222281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - M. A. G. Ruano
- Faculty of Physical Activity and Sport Sciences, Universidad Politecnica de Madrid, Madrid, Spain
| | - N. C. de Oliveira
- Research Group in Physical Exercise, Lifestyle and Health Promotion, Adventist University of Sao Paolo, Sao Paulo, Brazil
| | - L. A. Portes
- Research Group in Physical Exercise, Lifestyle and Health Promotion, Adventist University of Sao Paolo, Sao Paulo, Brazil
| | - J. Freiwald
- Research Center for Performance Diagnostics and Training Advice, University of Wuppertal, Wuppertal, Germany
| | - P. M. Leprêtre
- UFR-STAPS, Université de Picardie Jules Verne, Amiens, France
| | - B. Knechtle
- Instutute of Primary Care, University of Zurich, Zurich, Switzerland
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714
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Soligard T, Schwellnus M, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, Gabbett T, Gleeson M, Hägglund M, Hutchinson MR, Janse van Rensburg C, Khan KM, Meeusen R, Orchard JW, Pluim BM, Raftery M, Budgett R, Engebretsen L. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med 2016; 50:1030-41. [DOI: 10.1136/bjsports-2016-096581] [Citation(s) in RCA: 453] [Impact Index Per Article: 56.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 01/02/2023]
Abstract
Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.
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715
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Quarrie KL, Raftery M, Blackie J, Cook CJ, Fuller CW, Gabbett TJ, Gray AJ, Gill N, Hennessy L, Kemp S, Lambert M, Nichol R, Mellalieu SD, Piscione J, Stadelmann J, Tucker R. Managing player load in professional rugby union: a review of current knowledge and practices. Br J Sports Med 2016; 51:421-427. [DOI: 10.1136/bjsports-2016-096191] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 11/04/2022]
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716
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Charlton PC, Kenneally-Dabrowski C, Sheppard J, Spratford W. A simple method for quantifying jump loads in volleyball athletes. J Sci Med Sport 2016; 20:241-245. [PMID: 27566896 DOI: 10.1016/j.jsams.2016.07.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/04/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Evaluate the validity of a commercially available wearable device, the Vert, for measuring vertical displacement and jump count in volleyball athletes. Propose a potential method of quantifying external load during training and match play within this population. DESIGN Validation study. METHODS The ability of the Vert device to measure vertical displacement in male, junior elite volleyball athletes was assessed against reference standard laboratory motion analysis. The ability of the Vert device to count jumps during training and match-play was assessed via comparison with retrospective video analysis to determine precision and recall. A method of quantifying external load, known as the load index (LdIx) algorithm was proposed using the product of the jump count and average kinetic energy. RESULTS Correlation between two separate Vert devices and three-dimensional trajectory data were good to excellent for all jump types performed (r=0.83-0.97), with a mean bias of between 3.57-4.28cm. When matched against jumps identified through video analysis, the Vert demonstrated excellent precision (0.995-1.000) evidenced by a low number of false positives. The number of false negatives identified with the Vert was higher resulting in lower recall values (0.814-0.930). CONCLUSIONS The Vert is a commercially available tool that has potential for measuring vertical displacement and jump count in elite junior volleyball athletes without the need for time-consuming analysis and bespoke software. Subsequently, allowing the collected data to better quantify load using the proposed algorithm (LdIx).
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Affiliation(s)
- Paula C Charlton
- Department of Physical Therapies, Australian Institute of Sport, Australia.
| | | | | | - Wayne Spratford
- Department of Movement Science, Australian Institute of Sport, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Australia; University of Canberra Research Institute for Sport and Exercise, University of Canberra, Australia
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717
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Dijkstra HP, Pollock N, Chakraverty R, Ardern CL. Return to play in elite sport: a shared decision-making process. Br J Sports Med 2016; 51:419-420. [PMID: 27474390 DOI: 10.1136/bjsports-2016-096209] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 11/04/2022]
Affiliation(s)
- H Paul Dijkstra
- Sports Medicine Department, ASPETAR, QATAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Noel Pollock
- British Athletics, Hospital of St Johns and St Elizabeth, London, UK
| | | | - Clare L Ardern
- Research Department, ASPETAR, QATAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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718
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Bowen L, Gross AS, Gimpel M, Li FX. Accumulated workloads and the acute:chronic workload ratio relate to injury risk in elite youth football players. Br J Sports Med 2016; 51:452-459. [PMID: 27450360 PMCID: PMC5460663 DOI: 10.1136/bjsports-2015-095820] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 11/08/2022]
Abstract
Aim The purpose of this study was to investigate the relationship between physical workload and injury risk in elite youth football players. Methods The workload data and injury incidence of 32 players were monitored throughout 2 seasons. Multiple regression was used to compare cumulative (1, 2, 3 and 4-weekly) loads and acute:chronic (A:C) workload ratios (acute workload divided by chronic workload) between injured and non-injured players for specific GPS and accelerometer-derived variables:total distance (TD), high-speed distance (HSD), accelerations (ACC) and total load. Workloads were classified into discrete ranges by z-scores and the relative risk was determined. Results A very high number of ACC (≥9254) over 3 weeks was associated with the highest significant overall (relative risk (RR)=3.84) and non-contact injury risk (RR=5.11). Non-contact injury risk was significantly increased when a high acute HSD was combined with low chronic HSD (RR=2.55), but not with high chronic HSD (RR=0.47). Contact injury risk was greatest when A:C TD and ACC ratios were very high (1.76 and 1.77, respectively) (RR=4.98). Conclusions In general, higher accumulated and acute workloads were associated with a greater injury risk. However, progressive increases in chronic workload may develop the players' physical tolerance to higher acute loads and resilience to injury risk.
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Affiliation(s)
- Laura Bowen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Southampton Football Club, Southampton, UK
| | | | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | - François-Xavier Li
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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719
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Murray NB, Gabbett TJ, Townshend AD, Hulin BT, McLellan CP. Individual and combined effects of acute and chronic running loads on injury risk in elite Australian footballers. Scand J Med Sci Sports 2016; 27:990-998. [DOI: 10.1111/sms.12719] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/28/2022]
Affiliation(s)
- N. B. Murray
- School of Exercise Science; Australian Catholic University; Brisbane Queensland Australia
| | - T. J. Gabbett
- School of Exercise Science; Australian Catholic University; Brisbane Queensland Australia
- School of Human Movement Studies; The University of Queensland; Brisbane Queensland Australia
| | - A. D. Townshend
- School of Exercise Science; Australian Catholic University; Brisbane Queensland Australia
| | - B. T. Hulin
- Centre for Human and Applied Physiology; School of Medicine; University of Wollongong; Wollongong New South Wales Australia
| | - C. P. McLellan
- Institute of Health and Sport; Bond University; Gold Coast Queensland Australia
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720
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Windt J, Gabbett TJ. How do training and competition workloads relate to injury? The workload-injury aetiology model. Br J Sports Med 2016; 51:428-435. [PMID: 27418321 DOI: 10.1136/bjsports-2016-096040] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2016] [Indexed: 01/29/2023]
Abstract
Injury aetiology models that have evolved over the previous two decades highlight a number of factors which contribute to the causal mechanisms for athletic injuries. These models highlight the pathway to injury, including (1) internal risk factors (eg, age, neuromuscular control) which predispose athletes to injury, (2) exposure to external risk factors (eg, playing surface, equipment), and finally (3) an inciting event, wherein biomechanical breakdown and injury occurs. The most recent aetiological model proposed in 2007 was the first to detail the dynamic nature of injury risk, whereby participation may or may not result in injury, and participation itself alters injury risk through adaptation. However, although training and competition workloads are strongly associated with injury, existing aetiology models neither include them nor provide an explanation for how workloads alter injury risk. Therefore, we propose an updated injury aetiology model which includes the effects of workloads. Within this model, internal risk factors are differentiated into modifiable and non-modifiable factors, and workloads contribute to injury in three ways: (1) exposure to external risk factors and potential inciting events, (2) fatigue, or negative physiological effects, and (3) fitness, or positive physiological adaptations. Exposure is determined solely by total load, while positive and negative adaptations are controlled both by total workloads, as well as changes in load (eg, the acute:chronic workload ratio). Finally, we describe how this model explains the load-injury relationships for total workloads, acute:chronic workload ratios and the training load-injury paradox.
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Affiliation(s)
- Johann Windt
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim J Gabbett
- School of Human Movement Studies, The University of Queensland, Brisbane, Queensland, Australia.,Gabbett Performance Solutions, Brisbane, Australia
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721
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McLaren SJ, Smith A, Spears IR, Weston M. A detailed quantification of differential ratings of perceived exertion during team-sport training. J Sci Med Sport 2016; 20:290-295. [PMID: 27451269 DOI: 10.1016/j.jsams.2016.06.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/25/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the application of differential ratings of perceived exertion (dRPE) to team-sport training. DESIGN Single cohort, observational study. METHODS Twenty-nine professional rugby union players were monitored over a six-week intensified training period. Training sessions were classified as: high-intensity intervals, repeated high-intensity efforts, speed, skill-based conditioning, skills, whole-body resistance, or upper-body resistance. After each session, players recorded a session rating of perceived exertion (sRPE; CR100®), along with differential session ratings for breathlessness (sRPE-B), leg muscle exertion (sRPE-L), upper-body muscle exertion (sRPE-U), and cognitive/technical demands (sRPE-T). Each score was multiplied by the session duration to calculate session training loads. Data were analysed using mixed linear modelling and multiple linear regression, with magnitude-based inferences subsequently applied. RESULTS Between-session differences in dRPE scores ranged from very likely trivial to most likely extremely large and within-session differences amongst dRPE scores ranged from unclear to most likely very large. Differential RPE training loads combined to explain 66-91% of the variance in sRPE training loads, and the strongest associations with sRPE training load were with sRPE-L for high-intensity intervals (r=0.67; 90% confidence limits ±0.22), sRPE-B for repeated high-intensity efforts (0.89; ±0.08) and skill-based conditioning (0.67; ±0.19), sRPE-T for Speed (0.63; ±0.17) and Skills (0.51; ±0.28), and sRPE-U for resistance training (whole-body: 0.61; ±0.21, upper-body: 0.92; ±0.07). CONCLUSIONS Differential RPE can provide a detailed quantification of internal load during training activities commonplace in team sports. Knowledge of the relationships between dRPE and sRPE can isolate the specific perceptual demands of different training modes.
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Affiliation(s)
- Shaun J McLaren
- Sport & Exercise Subject Group, School of Social Sciences, Business and Law, Teesside University, UK.
| | - Andrew Smith
- A S Strength and Conditioning Limited, UK; Nottingham Rugby, UK
| | - Iain R Spears
- Sport & Exercise Subject Group, School of Social Sciences, Business and Law, Teesside University, UK
| | - Matthew Weston
- Sport & Exercise Subject Group, School of Social Sciences, Business and Law, Teesside University, UK
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722
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Gabbett TJ, Kennelly S, Sheehan J, Hawkins R, Milsom J, King E, Whiteley R, Ekstrand J. If overuse injury is a 'training load error', should undertraining be viewed the same way? Br J Sports Med 2016; 50:1017-8. [PMID: 27251895 DOI: 10.1136/bjsports-2016-096308] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Tim J Gabbett
- School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia
| | | | | | | | | | - Enda King
- Department of Life Sciences, University of Roehampton, London, UK Sports Surgery Clinic, Dublin, Ireland
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jan Ekstrand
- Football Research Group, Linkoping University, Linkoping, Sweden Division of Community Medicine, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden UEFA Medical Committee, Nyon, Switzerland
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723
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Drew MK, Cook J, Finch CF. Sports-related workload and injury risk: simply knowing the risks will not prevent injuries: Narrative review. Br J Sports Med 2016; 50:1306-1308. [PMID: 27166288 DOI: 10.1136/bjsports-2015-095871] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 01/16/2023]
Abstract
Training loads contribute to sports injury risk but their mitigation has rarely been considered in a sports injury prevention framework. A key concept behind monitoring training loads for injury prevention is to screen for those at increased risk of injury so that workloads can be adjusted to minimise these risks. This review describes how advances in management of workload can be applied as a preventive measure. Primary prevention involves screening for preparticipation load risk factors, such as low training loads, prior to a training period or competition. Secondary prevention involves screening for workloads that are known to precede an injury developing so that modification can be undertaken to mitigate this risk. Tertiary prevention involves rehabilitation practices that include a graded return to training programme to reduce the risk of sustaining a subsequent injury. The association of training loads with injury incidence is now established. Prevention measures such as rule changes that affect the workload of an athlete are universal whereas those that address risk factors of an asymptomatic subgroup are more selective. Prevention measures, when implemented for asymptomatic individuals exhibiting possible injury risk factors, are indicated for an athlete at risk of developing a sports injury. Seven key indicated risks and associated prevention measures are proposed.
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Affiliation(s)
- Michael K Drew
- Department of Physical Therapies, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Jill Cook
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia.,La Trobe University, Bundoora, Victoria, Australia
| | - Caroline F Finch
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
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724
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Gabbett HT, Windt J, Gabbett TJ. Cost-benefit analysis underlies training decisions in elite sport. Br J Sports Med 2016; 50:1291-1292. [PMID: 27105900 DOI: 10.1136/bjsports-2016-096079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Heath T Gabbett
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Johann Windt
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim J Gabbett
- School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia.,School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia
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725
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Windt J, Gabbett TJ, Ferris D, Khan KM. Training load--injury paradox: is greater preseason participation associated with lower in-season injury risk in elite rugby league players? Br J Sports Med 2016; 51:645-650. [PMID: 27075963 DOI: 10.1136/bjsports-2016-095973] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 01/09/2023]
Abstract
AIM To determine whether players who completed a greater number of planned preseason training sessions were more or less likely to be injured during the competitive season. METHODS A cohort of 30 elite rugby league players was prospectively studied during their 17-week preseason and 26-round competitive season. Injuries were recorded using a match time loss definition. Preseason participation was quantified as the number of 'full' training sessions that players completed, excluding modified, rehabilitation or missed sessions. In-season training load variables, collected using global positioning system (GPS) data, included distance covered (m), high-speed distance covered (m) and the percentage of distance covered at high speeds (%). Multilevel logistic regression models were used to determine injury likelihood in the current and subsequent week, with random intercepts for each player. Odds ratios (OR) were used as effect size measures to determine the changes in injury likelihood with (1) a 10-session increase in preseason training participation or (2) standardised changes in training load variables. RESULTS Controlling for training load in a given week, completing 10 additional preseason sessions was associated with a 17% reduction in the odds of injury in the subsequent week (OR=0.83, 95% CI=0.70 to 0.99). Increased preseason participation was associated with a lower percentage of games missed due to injury (r=-0.40, p<0.05), with 10 preseason sessions predicting a 5% reduction in the percentage of games missed. CONCLUSIONS Maximising participation in preseason training may protect elite rugby league players against in-season injury.
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Affiliation(s)
- Johann Windt
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim J Gabbett
- School of Human Movement Studies, The University of Queensland, Brisbane, Queensland, Australia.,School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia
| | - Daniel Ferris
- High Performance Unit, Manly Sea Eagles, Sydney, New South Wales, Australia
| | - Karim M Khan
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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726
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Pluim BM, Drew MK. It's not the destination, it's the 'road to load' that matters: a tennis injury prevention perspective. Br J Sports Med 2016; 50:641-2. [PMID: 27034125 DOI: 10.1136/bjsports-2016-095997] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Babette M Pluim
- Medical Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amersfoort, The Netherlands
| | - Michael K Drew
- Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
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727
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Nassis GP, Gabbett TJ. Is workload associated with injuries and performance in elite football? A call for action. Br J Sports Med 2016; 51:486-487. [PMID: 26941279 DOI: 10.1136/bjsports-2016-095988] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/04/2022]
Affiliation(s)
- George P Nassis
- National Sports Medicine Programme, Excellence in Football Project, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tim J Gabbett
- School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia.,School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia
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728
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Gabbett TJ, Hulin BT, Blanch P, Whiteley R. High training workloads alone do not cause sports injuries: how you get there is the real issue. Br J Sports Med 2016; 50:444-5. [PMID: 26795610 DOI: 10.1136/bjsports-2015-095567] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Tim J Gabbett
- School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia
| | - Billy T Hulin
- Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peter Blanch
- High Performance Unit, Essendon Football Club, Melbourne, Victoria, Australia School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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729
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McCall A, Dupont G, Ekstrand J. Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams’ head medical officers. Br J Sports Med 2016; 50:725-30. [DOI: 10.1136/bjsports-2015-095259] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/03/2022]
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730
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Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men's professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med 2016; 50:731-7. [DOI: 10.1136/bjsports-2015-095359] [Citation(s) in RCA: 347] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 11/04/2022]
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