Injury Risk in Elite Young Male Soccer Players: A Review on the Impact of Growth, Maturation, and Workload

ABSTRACT

Ribeiro, N, Martinho, DV, Pereira, JR, Rebelo, A, Monasterio, X, Gonzalo-Skok, O, Valente-dos-Santos, J, and Tavares, F. Injury risk in elite young male soccer players: a review on the impact of growth, maturation, and workload. J Strength Cond Res XX(X): 000-000, 2024-The long-term development of young male soccer players involves a prolonged period of significant adjustments, highlighting the importance of studying the complex interaction between dynamic variables, including workload, and inherent elements like growth and maturity. This analysis examines the intricate connections involving the development, maturity, workload, and susceptibility to injuries among adolescent male soccer players. Significantly, these connections become prominent at the peak height velocity (PHV) period, a crucial moment in maturation. Growth rates vary among individuals, and higher rates have been associated with an increased risk of injury in young soccer players, particularly during periods of rapid growth. Identifying possible risk factors and understanding the complex connections between them is crucial to developing specific methods for reducing the risk of injury. Sharing this valuable information with essential stakeholders is crucial for guaranteeing young athletes' comprehensive growth and maturation process. Furthermore, this review emphasizes the immediate need for long-term studies and thorough injury analyses to comprehend better the dynamic interactions that influence injury patterns in young male soccer players. This review will allow practitioners to better understand the main modifiable and nonmodifiable risk factors for injury and provide essential information focusing on practical strategies, facilitating more informed decision making by all stakeholders. The review aims to clarify these complexities and offer crucial insights that can assist in designing and implementing efficient strategies to reduce the risk of injury, specifically for the challenges faced during PHV and within the broader framework of long-term athletic development in young soccer.

Relationship between external and internal load indicators and injury using machine learning in professional soccer: a systematic review and meta-analysis

This study verified the relationship between internal load (IL) and external load (EL) and their association on injury risk (IR) prediction considering machine learning (ML) approaches. Studies were included if: (1) participants were male professional soccer players; (2) carried out for at least 2 sessions, exercises, or competitions; (3) correlated training load (TL) with non-contact injuries; (4) applied ML approaches to predict TL and non-contact injuries. TL included: IL indicators (Rating of Perceived Exertion, RPE; Session-RPE, Heart Rate, HR) and EL indicators (Global Positioning System, GPS variables); the relationship between EL and IL through index, ratio, formula; ML indicators included performance measures, predictive performance of ML methods, measure of feature importance, relevant predictors, outcome variable, predictor variable, data pre-processing, features selection, ML methods. Twenty-five studies were included. Eleven addressed the relationship between EL and IL. Five used EL/IL indexes. Five studies predicted IL indicators. Three studies investigated the association between EL and IL with IR. One study predicted IR using ML. Significant positive correlations were found between S-RPE and total distance (TD) (r = 0.73; 95% CI (0.64 to 0.82)) as well as between S-RPE and player load (PL) (r = 0.76; 95% CI (0.68 to 0.84)). Association between IL and EL and their relationship with injuries were found. RPE, S-RPE, and HR were associated with different EL indicators. A positive relationship between EL and IL indicators and IR was also observed. Moreover, new indexes or ratios (integrating EL and IL) to improve knowledge regarding TL and fitness status were also applied. ML can predict IL indicators (HR and RPE), and IR. The present systematic review was registered in PROSPERO (CRD42021245312).

Growth-related sports injuries among young male professional football players in the Netherlands: a prospective cohort study concerning injury incidence, severity and burden

OBJECTIVES

To investigate the incidence, type and location of growth-related sports injuries (GRSI) in youth professional football in the Netherlands. Secondary, to gain more knowledge on the injury severity and burden of GRSI.

METHODS

In this prospective, longitudinal cohort study, 813 players aged 10-18 are included. Data collection is performed by instructing the medical staff of six professional football club academies to register GRSI by means of standardized forms. Training and match exposure are registered individually on a weekly basis. Injury incidence was calculated as number of GRSI per 1000 hours, injury severity as the median number of days lost in categories and injury burden as the number of days lost per 1000 hours.

RESULTS

A total of 62 GRSI were documented in the football season 2021-2022. The total incidence of GRSI was 0.62/1000 hours football exposure. Morbus Osgood Schlatter and Morbus Sever were most common types of GRSI, both with incidence rates of 0.22/1000 hours exposure. About 58.3% of the documented GRSI were classified as major (>28 days lost). Within this group, the mean severity was 55 days time-loss to football.

CONCLUSIONS

GRSI are relatively common in youth professional football. The most common types are Morbus Sever and Morbus Osgood Schlatter. Morbus Osgood Schlatter has the highest injury severity and burden compared to other types of GRSI.

Comparison of Match External Loads across a Men's and Women's Lacrosse Season

The purpose of this study was to compare external workloads between collegiate men's (MLAX) and women's lacrosse (WLAX) matches and examine positional differences across the season. Athletes (MLAX: n = 10; WLAX: n = 13) wore a global positional system device during all matches. External load metrics included in the analysis were total distance (TD), sprint distance (SD), accelerations (>3 m/s2), sprint efforts, player load per minute (PL/min), top speed, and distances spent in various speed zones. WLAX had higher TD (p = 0.001), SD (p < 0.001), distances in SZs 2-5 (p < 0.001), PL (p < 0.001), and sprint efforts (p < 0.001) compared to MLAX. However, MLAX performed more acceleration (p < 0.001) and deceleration (p < 0.001) efforts. WLAX midfielders (M) and defenders (D) reached higher top speeds and performed more accelerations than attackers (p < 0.001). Midfielders covered the greatest distance at high speeds (p = 0.011) and the smallest distance at low speeds (<0.001) for WLAX. For MLAX, midfielders performed the highest SDs, top speeds, accelerations, decelerations, and distances in higher speed zones (p < 0.001) compared to attackers and defenders. Results indicate that there are significant gender and positional differences in external workload demands during match play, specifically for volume- and intensity-derived workload parameters, between men's and women's lacrosse. Therefore, sports performance coaches should create gender- and position-specific conditioning programs to prepare athletes for match demands.

Methods of Monitoring Internal and External Loads and Their Relationships with Physical Qualities, Injury, or Illness in Adolescent Athletes: A Systematic Review and Best-Evidence Synthesis

BACKGROUND

With the increasing professionalisation of youth sports, training load monitoring is increasingly common in adolescent athletes. However, the research examining the relationship between training load and changes in physical qualities, injury, or illness in adolescent athletes is yet to be synthesised in a systematic review.

OBJECTIVE

The aim of this review was to systematically examine the research assessing internal and external methods of monitoring training load and physical qualities, injury, or illness in adolescent athletes.

METHODS

Systematic searches of SPORTDiscus, Web of Science, CINAHL and SCOPUS were undertaken from the earliest possible records to March 2022. Search terms included synonyms relevant to adolescents, athletes, physical qualities, injury, or illness. To be eligible for inclusion, articles were required to (1) be original research articles; (2) be published in a peer-reviewed journal; (3) include participants aged between 10 and 19 years and participating in competitive sport; (4) report a statistical relationship between a measure of internal and/or external load and physical qualities, injury or illness. Articles were screened and assessed for methodological quality. A best-evidence synthesis was conducted to identify trends in the relationships reported.

RESULTS

The electronic search yielded 4125 articles. Following screening and a review of references, 59 articles were included. The most commonly reported load monitoring tools were session ratings of perceived exertion (n = 29) and training duration (n = 22). Results of the best-evidence synthesis identified moderate evidence of positive relationships between resistance training volume load and improvement in strength, and between throw count and injury. However, evidence for other relationships between training load and change in physical qualities, injury, or illness were limited or inconsistent.

CONCLUSIONS

Practitioners should consider monitoring resistance training volume load for strength training. Additionally, where appropriate, monitoring throw counts may be useful in identifying injury risk. However, given the lack of clear relationships between singular measures of training load with physical qualities, injury, or illness, researchers should consider multivariate methods of analysing training load, as well as factors that may mediate the load-response relationship, such as maturation.

Reliability and validity of Polar Team Pro measurements in running at different velocities in an indoor setting

The purpose of this study was to test the reliability and validity of Polar Team Pro measurements of velocity, acceleration, and distance covered in a rectangular run at different intensities in an indoor setting. In two test sessions, 10 women (age 15.7 ± 0.4 years, body mass 61.3 ± 5.3 kg, body height 1.69 ± 0.07 m) performed 100 m runs at different intensities, ranging from 8 to 18 km/h. The 100 m runs were performed on a rectangular track at an indoor handball facility. The main finding revealed that Polar Team Pro underestimated the running distance and velocity (10%-15% at 10 km/h), especially at higher speeds (15% and 6% at 15 and 18 km/h, respectively). Between test days, coefficients of variance varied from 4.2% to 12.4%, when measuring at different speeds. However, a significant difference was found for the two runs only at 15 km/h between the two test days. It was concluded that Polar Team Pro underestimated the running distance and velocity when measuring a rectangular run at different speeds in an indoor setting, especially at higher speeds. This underestimation is probably caused by the inaccuracy of the inertial measurement unit algorithm that calculates the distance, as body height influences the distance and velocity measurements. The variability between the different units is, thereby, also influenced, causing variable coefficients of variance between the sensors. Test-retest variability was acceptable. Based on the findings of this study, practitioners should be cautious when measuring speed and distance using Polar Team Pro Sensors in indoor settings, as these measurements are underestimated with increasing speed.

Perspectives from research and practice: A survey on external load monitoring and bone in sport

Introduction

There is limited information regarding the association between external load and estimated bone load in sport, which may be important due to the influence exercise can have on bone accrual and injury risk. The aim of this study was to identify external load measuring tools used by support staff to estimate bone load and assess if these methodologies were supported in research.

Methods

A survey was comprised of 19 multiple choice questions and the option to elaborate on if/how they monitor external load and if/how they used them to estimate bone load. A narrative review was performed to assess how external load is associated to bone in research.

Results

Participants were required to be working as support staff in applied sport. Support staff (n = 71) were recruited worldwide with the majority (85%) working with professional elite athletes. 92% of support staff monitored external load in their organisation, but only 28% used it to estimate bone load.

Discussion

GPS is the most commonly used method to estimate bone load, but there is a lack of research assessing GPS metrics with bone load. Accelerometry and force plates were among the most prevalent methods used to assess external load, but a lack of bone specific measurements were reported by support staff. Further research exploring how external load relates to bone is needed as there is no consensus on which method of external load is best to estimate bone load in an applied setting.

Weekly External Load Performance Effects on Sports Injuries of Male Professional Football Players

One of the most challenging issues professional football players face throughout their careers is injuries. Those injuries often result from suboptimal training programs that were not designed according to the players' individual needs. This prospective study aimed to examine in detail the effects of sports injuries on professional football players' weekly external load performances. Thirty-three male professional football players were monitored using 10-Hz Global Positioning System (GPS) units (Apex pro series, StatSports) during an entire season. The variables considered in the analysis were total distance (TD), high-speed running (HSR), accelerations (ACC), and decelerations (DEC). The comparisons were made between the four-week block before injury (-4T), four-week block after return (+4T), and players' season averages (S). Players displayed significantly higher values of TD, HSR, ACC, and DEC in the -4T, compared to the other two moments (+4T and S). Furthermore, the comparison between the +4T and S showed no significant variations in the GPS metrics. It was shown that a significant increase in players' weekly external load performance over a four-week period may have a negative effect on the occurrence of injuries from a professional football standpoint. Future research should consider the effects of injury severity on players' external load variations.

Growth, maturation and injuries in high-level youth football (soccer): A mini review

Understanding the challenges football (soccer) players face during adolescence is fundamental to avoid disruptions in their development due to injury. This mini review will describe basic concepts of somatic growth and biological maturity, examine data from 53 prospective epidemiological studies on high-level youth football players and discuss how age, growth and maturity may affect the injury patterns observed. Based on the existing evidence, at least every third player sustains an injury during a football season. The thigh (median for studies of boys: 25%, median for girls: 21%), ankle (b: 18%, g: 30%), knee (b: 17%, g: 18%) and hip/groin (b: 14%, g: 10%) are the body parts injured most often, while muscle strains (b: 31%, g: 25%), sprains (b: 20%, g: 27%) and contusions (b: 17%, g: 16%) are the most common injury types. Injury trends are, however, not consistent throughout adolescence, and players' age, maturity status and position relative to peak height velocity (PHV) have shown to influence the number, type and location of injuries sustained. Despite a high volume of observational injury studies published on high-level youth players, girls (7 studies) and settings outside of Europe (included in 23% of studies) are underrepresented and should receive extra attention in the future. Based on the available epidemiological data, tailored injury reduction programmes can be considered in youth football, alongside application of general training principles such as progression, variation and individualization which may be especially important during vulnerable phases such as the adolescent growth spurt.

Association of Training and Game Loads to Injury Risk in Junior Male Elite Ice Hockey Players: A Prospective Cohort Study

BACKGROUND

Training and game loads are potential risk factors of injury in junior elite ice hockey, but the association of training and game loads to injuries is unknown.

PURPOSE

To investigate the association of chronic training and game loads to injury risk in junior male elite ice hockey players.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

In this prospective cohort study, we monitored all health problems among 159 male junior ice hockey players (mean age, 16 years; range, 15-19 years) at sports-specific high schools during the 2018-2019 school year. Players reported their health problems every week using the Oslo Sports Trauma Research Center Overuse Questionnaire on Health Problems (OSTRC-H2). The number of training sessions and games was reported for 33 weeks. We calculated the previous 2-week difference in training/game loads as well as the cumulative training/game loads of the previous 2, 3, 4, and 6 weeks and explored potential associations between training/game loads and injury risk using mixed-effects logistic regression.

RESULTS

The players reported 133 acute injuries, 75 overuse injuries, and 162 illnesses in total, and an average of 8.8 (SD ±3.9) training sessions and 0.9 (SD ± 1.1) games per week. We found no association between the difference of the two previous weeks or the previous 2- 3- and 4-week cumulative, training or game load and acute injuries, nor the difference of the two previous weeks, or the previous 4- and 6-week cumulative, training or game load and overuse injuries (OR, ∼1.0; P > .05 in all models).

CONCLUSION

In the current study of junior elite ice hockey players, there was no evidence of an association between cumulative exposure to training/game loads and injury risk.

A Systematic Review of the Relationship between Workload and Injury Risk of Professional Male Soccer Players

The number of studies on the relationship between training and competition load and injury has increased exponentially in recent years, and it is also widely studied by researchers in the field of professional soccer. In order to provide practical guidance for workload management and injury prevention in professional athletes, this study provides a review of the literature on the effect of load on injury risk, injury prediction, and interpretation mechanisms. The results of the research show that: (1) It appears that short-term fixture congestion may increase the match injury incidence, while long-term fixture congestion may have no effect on both the overall injury incidence and the match injury incidence. (2) It is impossible to determine conclusively whether any global positioning system (GPS)-derived metrics (total distance, high-speed running distance, and acceleration) are associated with an increased risk of injury. (3) The acute:chronic workload ratio (ACWR) of the session rating of perceived exertion (s-RPE) may be significantly associated with the risk of non-contact injuries, but an ACWR threshold with a minimum risk of injury could not be obtained. (4) Based on the workload and fatigue recovery factors, artificial intelligence technology may possess good predictive power regarding injury risk.

Elit genç futbol akademisi sporcularında yaralanma insidansı: 3 yıllık geriye dönük takip

Aim: The aim of this study was to investigate the incidence and characteristics of injuries suffered by elite soccer academy athletes. Materials and Methods: A retrospective analysis was made of the health records between 2016 and 2019 of athletes in the elite male soccer academy of an elite football club. The cause, type, location, recurrence, and severity of the injuries, where the injuries occured and time lost due to the injuries were recorded. The injury incidence and prevalence were calculated. Results: Overall, total injuries and seasonal incidence rate were 1.49 (1.33-1.68) and 8.06 (7.16-0.04) per 1000 hours, respectively. The injury burden ranged between 11.83 (10.53-13.29) days and 51.43 (49.11-53.85) days. The injury characteristics were not statistically different according to age groups (p˃0.05). Conclusion: Youth soccer players in the U19 and U21 age groups had more injuries than other junior age groups in a typical soccer season. It was concluded that there were more match injuries, the thigh was the most injured area, muscle injuries were more common, and the hamstring was the most frequently injured muscle.

Playing Position is Associated with Injury Incidence Rate in Male Academy Soccer Players

CONTEXT

It is unclear whether playing position influences injury in male academy soccer players (ASP).

OBJECTIVE

To determine if playing position is associated with injury in ASP.

DESIGN

Descriptive Epidemiology Study.

SETTING

English, Spanish, Uruguayan and Brazilian soccer academies.

PARTICIPANTS

369 ASP from Under 14 (U14) to U23 age groups, classified as 'post-peak height velocity' using maturity offset, and grouped as goalkeepers (GK), lateral defenders (LD), central defenders (CD), lateral midfielders (LM), central midfielders (CM) and forwards (FWD). Additional analysis compared central (CENT) with lateral/forward (LAT/FWD) positions.

MAIN OUTCOME MEASURES

Injuries were recorded prospectively over one season. Injury prevalence proportion (IPP), days missed and injury incidence rate (IIR, injuries per 1000 training/match hours, n=116) were analysed according to playing position.

RESULTS

No association with playing position was observed for any injury type/location regarding IPP (P≥0.089) or days missed (P≥0.235). The IIR was higher in CD than LD for general (9.30 vs. 4.18 injuries/1000h, P=0.009), soft-tissue (5.14 vs. 1.95 injuries/1000h, P=0.026) and ligament/tendon injuries (2.69 vs. 0.56 injuries/1000h, P=0.040). Regarding CENT vs. LAT/FWD, there were no associations with IPP (P≥0.051) or days missed (P≥0.083), but general IIR was greater in CENT than LAT/FWD (8.67 vs. 6.12 injuries/1000h, P=0.047).

CONCLUSIONS

ASP playing position was not associated with IPP or days missed but the higher general, soft-tissue and ligament/tendon IIR in CD suggests this position warrants specific attention regarding injury prevention strategies. These novel findings highlight the importance of including training/match exposure when investigating the influence of playing position on injury in ASP.

Use of GPS to measure external load and estimate the incidence of muscle injuries in men's football: A novel descriptive study

Measurement of external load in players provides objective information to optimise the weekly balance between training and recovery to improve performance and prevent injuries. Our aim was to evaluate the incidence of sports-related muscle injuries of the lower limb in relation to external load, measured by global positioning system (GPS), in football players. A descriptive study was carried out. Data were collected from 71 professional male football players (30 professionals and 41 youth players) from an elite football club competing in the Spanish and European League in the 2017-2018 season. As external load variables, we measured High Metabolic Load Distance (HMLD), High Speed Running (HSR), Player Load (PL), and Total Distance (TD) through GPS. Injury rate (IR) was calculated both in relation to such GPS load metrics and to load exposure time. We considered categories (youth and professional), playing positions (centre back, full back, midfielder, and forward), and training day with respect to match-day (-4MD, -3MD, -2MD, -1MD, MD, +1MD, +2MD). The GPS load metrics HMLD, HSR, PL, and TD showed very similar patterns across categories and positions, but varied according to training session or MD. The highest loads were observed on MD and three days prior to the match (-3MD). Similarly, the overall IR, both calculated per load exposure time and per GPS load metrics, was highest on MD and -3MD. Again, no differences were observed between youth and professional players. Midfielders demonstrated the highest IR in all metrics, followed by the forwards. In conclusion, this study suggests that external load and incidence of muscle injuries are directly proportional. Therefore, the measurement of more external load variables other than load exposure time, such as the GPS metrics HMLD, HSR, PL, and TD may help to describe the pattern and magnitude of injuries. Future studies based on ours may help to further improve the understanding of the incidence of muscle injuries on the basis of external loads measurements in different football teams.

Increased Lower Extremity Injury Risk Associated With Player Load and Distance in Collegiate Women's Soccer

BACKGROUND

There is limited research regarding the impact of workload on injury risk specific to women's soccer. Wearable global positioning system (GPS) units can track workload metrics such as total distance traveled and player load during games and training sessions. These metrics can be useful in predicting injury risk.

PURPOSE

To examine the relationship between injury risk and player workload as collected from wearable GPS units in National Collegiate Athletic Association (NCAA) Division I women's soccer players.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

Lower extremity injury incidence and GPS workload data (player load, total distance, and high-speed distance) for 65 NCAA Division I women's soccer players were collected over 3 seasons. Accumulated 1-, 2-, 3-, and 4-week loads and acute-to-chronic workload ratios (ACWR) were classified into discrete ranges by z-scores. ACWR was calculated using rolling averages and exponentially weighted moving averages (EWMA) models. Binary logistic regression models were used to compare the 7:28 rolling average and EWMA ACWRs between injured and noninjured players for all GPS/accelerometer variables. The prior 1-, 2-, 3-, and 4-week accumulated loads for all GPS/accelerometer variables were compared between the injured and uninjured cohorts using 2-sample t tests.

RESULTS

There were a total of 53 lower extremity injuries that resulted in lost time recorded (5.76/1000 hours "on-legs" exposure time; 34 noncontact and 19 contact injuries). The prior 2-week (7242 vs 6613 m/s2; P = .02), 3-week (10,533 vs 9718 m/s2; P = .02), and 4-week (13,819 vs 12,892 m/s2; P = .04) accumulated player loads and 2-week (62.40 vs 57.25 km; P = .04), 3-week (90.97 vs 84.10 km; P = .03), and 4-week (119.31 vs 111.38 km; P = .05) accumulated total distances were significantly higher for injured players compared with noninjured players during the same time frames. There were no significant differences in player load, total distance, or high-speed distance ACWR between injured and noninjured players for both the rolling averages and EWMA calculations.

CONCLUSION

Higher accumulated player load and total distance, but not ACWR, were associated with injury in women's soccer players.

Maturity-associated considerations for training load, injury risk, and physical performance in youth soccer: One size does not fit all

Biological maturation can be defined as the timing and tempo of progress to achieving a mature state. The estimation of age of peak height velocity (PHV) or percentage of final estimated adult stature attainment (%EASA) is typically used to inform the training process in young athletes. In youth soccer, maturity-related changes in anthropometric and physical fitness characteristics are diverse among individuals, particularly around PHV. During this time, players are also at an increased risk of sustaining an overuse or growth-related injury. As a result, the implementation of training interventions can be challenging. The purpose of this review was to (1) highlight and discuss many of the methods that can be used to estimate maturation in the applied setting and (2) discuss the implications of manipulating training load around PHV on physical development and injury risk. We have provided key stakeholders with a practical online tool for estimating player maturation status (Supplementary Maturity Estimation Tools). Whilst estimating maturity using predictive equations is useful in guiding the training process, practitioners should be aware of its limitations. To increase the accuracy and usefulness of data, it is also vital that sports scientists implement reliable testing protocols at predetermined time-points.

Load Measures in Training/Match Monitoring in Soccer: A Systematic Review

In soccer, the assessment of the load imposed by training and a match is recognized as a fundamental task at any competitive level. The objective of this study is to carry out a systematic review on internal and external load monitoring during training and/or a match, identifying the measures used. In addition, we wish to make recommendations that make it possible to standardize the classification and use of the different measures. The systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted through the electronic database Web of Science, using the keywords "soccer" and "football", each one with the terms "internal load", "external load", and "workload". Of the 1223 studies initially identified, 82 were thoroughly analyzed and are part of this systematic review. Of these, 25 articles only report internal load data, 20 report only external load data, and 37 studies report both internal and external load measures. There is a huge number of load measures, which requires that soccer coaches select and focus their attention on the most useful and specific measures. Standardizing the classification of the different measures is vital in the organization of this task, as well as when it is intended to compare the results obtained in different investigations.

Personalized machine learning approach to injury monitoring in elite volleyball players

ABSTRACTWe implemented a machine learning approach to investigate individual indicators of training load and wellness that may predict the emergence or development of overuse injuries in professional volleyball. In this retrospective study, we collected data of 14 elite volleyball players (mean ± SD age: 27 ± 3 years, weight: 90.5 ± 6.3 kg, height: 1.97 ± 0.07 m) during 24 weeks of the 2018 international season. Physical load was tracked by manually logging the performed physical activities and by capturing the jump load using wearable devices. On a daily basis, the athletes answered questions about their wellness, and overuse complaints were monitored via the Oslo Sports Trauma Research Center (OSTRC) questionnaire. Based on training load and wellness indicators, we identified subgroups of days with increased injury risk for each volleyball player using the machine learning technique Subgroup Discovery. For most players and facets of overuse injuries (such as reduced sports participation), we have identified personalized training load and wellness variables that are significantly related to overuse issues. We demonstrate that the emergence and development of overuse injuries can be better understood using daily monitoring, taking into account interactions between training load and wellness indicators, and by applying a personalized approach.Highlights With detailed, athlete-specific monitoring of overuse complaints and training load, practical insights in the development of overuse injuries can be obtained in a player-specific fashion contributing to injury prevention in sports.A multi-dimensional and personalized approach that includes interactions between training load variables significantly increases the understanding of overuse issues on a personal basis.Jump load is an important predictor for overuse injuries in volleyball.

The Association Between Training Load and Injury Risk in Elite Youth Soccer Players: a Systematic Review and Best Evidence Synthesis

BACKGROUND

Injury risk in elite youth soccer players is high. Implementing an optimal training load is of utmost importance to reduce the risk of injuries.

OBJECTIVE

To conduct a systematic review and best evidence synthesis to explore the effects of internal and external training load on injury risk in elite youth soccer players.

METHODS

MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL were searched up until 17 January 2020. Each article had to meet all of the following criteria: (1) the study population consisted of male elite youth soccer players aged between 12 and 21 years; (2) a longitudinal, prospective study design was used; (3) soccer-related injuries were registered (i.e., self-reported or by medical staff); (4) external and/or internal load parameters were described; and (5) the article was published in an English peer-reviewed scientific journal. The quality of the included articles was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). A best evidence synthesis was performed to rank the level of evidence.

RESULTS

Five studies (2 high quality, 3 low quality) were included. Best evidence synthesis highlighted that there was moderate evidence for (1) no association between 2-, 3-, and 4-week cumulative loads for total distance covered; (2) no association between 1-week workloads (sRPE × duration); and (3) no association between A:C workload ratios (4 weeks) and injury risk. For all other comparisons, only insufficient or conflicting evidence was found.

CONCLUSION

There is a paucity of evidence for an association between internal and external training load parameters and injury risk in elite youth soccer players.

Workload a-WEAR-ness: Monitoring Workload in Team Sports With Wearable Technology. A Scoping Review

OBJECTIVES

To (1) identify the wearable devices and associated metrics used to monitor workload and assess injury risk, (2) describe the situations in which workload was monitored using wearable technology (including sports, purpose of the analysis, location and duration of monitoring, and athlete characteristics), and (3) evaluate the quality of evidence that workload monitoring can inform injury prevention.

DESIGN

Scoping review.

LITERATURE SEARCH

We searched the CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, HealthSTAR, MEDLINE, PsycINFO, SPORTDiscus, and Web of Science databases.

STUDY SELECTION CRITERIA

We included all studies that used wearable devices (eg, heart rate monitor, inertial measurement units, global positioning system) to monitor athlete workload in a team sport setting.

DATA SYNTHESIS

We provided visualizations that represented the workload metrics reported, sensors used, sports investigated, athlete characteristics, and the duration of monitoring.

RESULTS

The 407 included studies focused on team ball sports (67% soccer, rugby, or Australian football), male athletes (81% of studies), elite or professional level of competition (74% of studies), and young adults (69% of studies included athletes aged between 20 and 28 years). Thirty-six studies of 7 sports investigated the association between workload measured with wearable devices and injury.

CONCLUSION

Distance-based metrics derived from global positioning system units were common for monitoring workload and are frequently used to assess injury risk. Workload monitoring studies have focused on specific populations (eg, elite male soccer players in Europe and elite male rugby and Australian football players in Oceania). Different injury definitions and reported workload metrics and poor study quality impeded conclusions regarding the relationship between workload and injury. J Orthop Sports Phys Ther 2020;50(10):549-563. doi:10.2519/jospt.2020.9753.

The Training-Performance Puzzle: How Can the Past Inform Future Training Directions?

Over the past 20 years, research on the training-load-injury relationship has grown exponentially. With the benefit of more data, our understanding of the training-performance puzzle has improved. What were we thinking 20 years ago, and how has our thinking changed over time? Although early investigators attributed overuse injuries to excessive training loads, it has become clear that rapid spikes in training load, above what an athlete is accustomed, explain (at least in part) a large proportion of injuries. In this respect, it appears that overuse injuries may arise from athletes being underprepared for the load they are about to perform. However, a question of interest to both athletic trainers (ATs) and researchers is why some athletes sustain injury at low training loads, while others can tolerate much greater training loads? A higher chronic training load and well-developed aerobic fitness and lower body strength appear to moderate the training-injury relationship and provide a protective effect against spikes in load. The training-performance puzzle is complex and dynamic-at any given time, multiple inputs to injury and performance exist. The challenge facing researchers is obtaining large enough longitudinal data sets to capture the time-varying nature of physiological and musculoskeletal capacities and training-load data to adequately inform injury-prevention efforts. The training-performance puzzle can be solved, but it will take collaboration between researchers and clinicians as well as an understanding that efficacy (ie, how training load affects performance and injury in an idealized or controlled setting) does not equate to effectiveness (ie, how training load affects performance and injury in the real-world setting, where many variables cannot be controlled).

Global Positioning System-Derived Workload Metrics and Injury Risk in Team-Based Field Sports: A Systematic Review

OBJECTIVE

To evaluate the current literature regarding the utility of global positioning system (GPS)-derived workload metrics in determining musculoskeletal injury risk in team-based field-sport athletes.

DATA SOURCES

PubMed entries from January 2009 through May 2019 were searched using terms related to GPS, player workload, injury risk, and team-based field sports.

STUDY SELECTION

Only studies that used GPS metrics and had injury as the main outcome variable were included.

DATA EXTRACTION

Total distance, high-speed running, and acute : chronic workload ratios were the most common GPS metrics analyzed, with the most frequent sports being soccer, rugby, and Australian rules football.

DATA SYNTHESIS

Many distinct workload metrics were associated with increased injury risk in individual studies performed in particular sport circumstances; however, the body of evidence was inconclusive as to whether any specific metrics could consistently predict injury risk across multiple team-based field sports.

CONCLUSIONS

Our results were inconclusive in determining if any GPS-derived workload metrics were associated with an increased injury risk. This conclusion is due to a myriad of factors, including differences in injury definitions, workload metrics, and statistical analyses across individual studies.

Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes?

The back is subjected to a great deal of strain in many sports. Up to 20% of all sports injuries involve an injury to the lower back or neck. Repetitive or high impact loads (e.g., running, gymnastics, skiing) and weight loading (e.g., weightlifting) affect the lower back. Rotation of the torso (e.g., golf, tennis) causes damage to both, the lumbar and thoracic spine. The cervical spine is most commonly injured in contact sports (e.g., boxing, football). One of the factors that increases the odds of injuries in athletes is excessive and rapid increases in training loads. In spite of currently emerging evidence on this issue, little is known about the balance between physiological loading on the spine and athletic performance, versus overloading and back pain and/or injury in athletes. This scoping review aims (i) to map the literature that addresses the association between the training load and the occurrence of back pain and/or injury, especially between the Acute:Chronic Workload Ratio (ACWR) and back problems in athletes of individual and team sports, and (ii) to identify gaps in existing literature and propose future research on this topic. A literature search of six electronic databases (i.e., MEDLINE, PubMed, Web of Science, SCOPUS, SportDiscus, and CINAHL) was conducted. A total of 48 research articles met the inclusion criteria. Findings identified that fatigue of the trunk muscles induced by excessive loading of the spine is one of the sources of back problems in athletes. In particular, high training volume and repetitive motions are responsible for the high prevalence rates. The most influential are biomechanical and physiological variations underlying the spine, though stress-related psychological factors should also be considered. However, limited evidence exists on the relationship between the ACWR and back pain or non-contact back injuries in athletes from individual and team sports. This may be due to insufficiently specified the acute and chronic time window that varies according to sport-specific schedule of competition and training. More research is therefore warranted to elucidate whether ACWR, among other factors, is able to identify workloads that could increase the risk of back problems in athletes.

Systematic Review and Meta-Analysis of Candidate Gene Association Studies With Fracture Risk in Physically Active Participants

Background: Fractures are common in physically active populations and genetic differences may mediate injury risk.

Objective: To meta-analyse the pooled results of candidate gene association studies with non-osteoporotic fracture risk in physically active humans.

Methods: Systematic searching of databases returned 11 eligible studies published in English. Pooled odds ratios (ORs) with 95% confidence intervals (CI) were produced using allele contrast, recessive and homozygote contrast meta-analysis models to evaluate associations of risk alleles in the COL1A1 (rs1800012), COL2A1 (rs412777), CTR (rs1801197), ESR1 (rs2234693 and rs9340799) LRP5 (rs3736228), VDR (rs10735810, rs7975232, rs1544410, and rs731236) genes with fracture incidence.

Results: Eligible study quality was generally low (7/11) and no significant overall effect was found for any genetic variant with any comparison model (p > 0.05). A trivial reduction in fracture risk was found for female participants with the COL1A1 Sp1 (rs1800012) T allele (OR = 0.48, 95% CI = 0.25–0.91, p = 0.03, d = –0.18).

Conclusions: No overall effect was found from the pooled results of included genetic variants on fracture risk in physically active participants. The COL1A1 Sp1 rs1800012 T allele may reduce fracture risk in physically active females but further high-quality research with sex-specific analysis is required.

Trial Registration: (PROSPERO; CRD42018115008).

Validity and Reliability of a 10 Hz GPS for Assessing Variable and Mean Running Speed

Our purpose was to assess the 10 Hz Viper GPS devices’ validity and reliability (STATSport) in both instantaneous and mean speed measuring in accelerations and decelerations in straight-line running conditions. Eight amateur team sport players participated in the study, performing firstly 21 x 40 m sprints at submaximal incremental speed, and secondly 21 x 40 m sprints, with the first stage consisting of submaximal incremental speed, and the second stage of subsequent submaximal decreasing speed. Criteria systems used to evaluate the GPS validity were a radar gun for instantaneous speed, and timing-gates for mean speed. Reliability was measured with two GPS devices carried by the same athlete, running 10 x (20 m + 20 m) sprints with a 180º change of direction and a 10 s inter-set rest interval. Results showed an agreement between GPS devices and the criteria systems measuring instantaneous speed (r = 0.98; standardized mean bias (SMB) = -0.07; standard typical error (STE) = 0.22) and mean speed (r = 0.99; SMB = 0.38; STE = 0.17). The reliability study presented a nearly perfect correlation between devices, a trivial SMB and a small STE (r = 0.97; SMB = 0.04; STE = 0.23). 10 Hz GPS devices are an adequate solution to monitor straight-line running speed in acceleration and deceleration conditions, but we would like to draw attention to the small errors and bias detected, such as the speed overestimation compared with timing gates.