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Gabbett T. Load Management: What It Is and What It Is Not! Sports Health 2023; 15:478. [PMID: 37260145 PMCID: PMC10293561 DOI: 10.1177/19417381231179946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Tim Gabbett
- Gabbett Performance Solutions, Brisbane, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
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Nyhus Hagum C, Tønnessen E, Hisdal J, Shalfawi SAI. The effect of progressive and individualised sport-specific training on the prevalence of injury in football and handball student athletes: a randomised controlled trial. Front Sports Act Living 2023; 5:1106404. [PMID: 37346384 PMCID: PMC10279870 DOI: 10.3389/fspor.2023.1106404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Objective To evaluate the effectiveness of communication and coordination combined with designing a progressive and individualised sport-specific training program for reducing injury prevalence in youth female and male football and handball players transitioning to a sports academy high school. An additional aim was to investigate the characteristics of the reported injuries. Methods Forty-two Norwegian athletes were randomised into an intervention or control group. Mean age, height, weight and BMI was 15.5 ± 0.5 years, 178.6 cm ± 6.3 cm, 71.3 ± 9.8 kg, 22.3 ± 2.7 BMI for the intervention group (IG) (n = 23), and 15.4 ± 0.5 years, 175.6 cm ± 6.6 cm, 67.1 ± 9.8 kg, 21.7 ± 2.4 BMI for the control group (CG) (n = 19). During the summer holiday, the intervention group received weekly progressive, individualised sport-specific training programs and weekly follow-up telephone calls from the researchers. All athletes completed a baseline questionnaire and a physical test battery. Training data and injuries were recorded prospectively for 22 weeks using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). A two-way chi-square (χ2) test of independence was conducted to examine the relationship between groups and injury. Results Average weekly prevalence of all injuries was 11% (95% CI: 8%-14%) in IG and 19% (95% CI: 13%-26%) in CG. Average weekly prevalence of substantial injuries was 7% (95% CI: 3%-10%) in IG and 10% (95% CI: 6%-13%) in CG. The between-group difference in injuries was significant: χ2 (1, N = 375) = 4.865, p = .031, φ = .114, with 1.8 times higher injury risk in CG vs. IG during the first 12 weeks after enrolment. Conclusions For student athletes transitioning to a sports academy high school, progressive individualised, sport-specific training programs reduced the prevalence of all-complaint injuries following enrolment. Clubs and schools should prioritise time and resources to implement similar interventions in periods where student athletes have less supervision, such as the summer holidays, to facilitate an optimal transition to a sports academy high school.
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Affiliation(s)
- Cathrine Nyhus Hagum
- Department of Education and Sports Science, University of Stavanger, Stavanger, Norway
| | - Espen Tønnessen
- Faculty of Health Sciences, Kristiania University College, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Shaher A. I. Shalfawi
- Department of Education and Sports Science, University of Stavanger, Stavanger, Norway
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3
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Chen Z, Du J, Hu Y, Ou K, Li H, Meng T, Zhao H, Zhou W, Li X, Shu Q. Weekly cumulative extracurricular core training time predicts cadet physical performance: A descriptive epidemiological study. Heliyon 2023; 9:e14756. [PMID: 37151653 PMCID: PMC10161248 DOI: 10.1016/j.heliyon.2023.e14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 05/09/2023] Open
Abstract
Background Core training can enhance athletic performance by enhancing core strength and stability. To achieve this outcome, however, a tailored training program is required; the normal military training curriculum is inadequate. The connection between cumulative weekly extracurricular training time, cumulative weekly extracurricular core training time and cadet performance is unknown. Methods The association between cumulative weekly extracurricular training time, cumulative weekly extracurricular core training time and performance has been discovered using a descriptive epidemiological study methodology. Questionnaires were used to collect information on personal characteristics and weekly cumulative extracurricular (core) training time, as well as the results of the Chinese Army Physical Fitness Test (C-APFT), which included 100-m dash, 5000-m run, 3000-m armed training run, 400-m steeplechase, 800 m breaststroke, horizontal bar pull-ups, 2-min sit-ups, 2-min push-ups, and hand grenade throwing. This study recruited two hundred and twenty male cadets (aged 18 to 23 years, 19.68 ± 0.91) from a military medical university. Results (a) The correlation between cumulative weekly extracurricular training time and C-APFT score is significant. The 100-m dash, 5000-m run, 3000-m armed training run, 400-m steeplechase, and 2-min push-ups performed the best when participants exercised for 5 to 10 h per week. (b) The number of cadets scoring good or excellent on the C-APFT improves with cumulative weekly extracurricular core training time. The recommended amount of core training for cadets per week is 120 min. (c) The average cumulative weekly extracurricular core training time was a effective predictor of performance on the 400-m steeplechase (R2 = 0.470, F = 10.641, P<0.01), horizontal bar pull-ups (R2 = 0.238, F = 68.191, P<0.01), 2-min sit-ups (R2 = 0.280, F = 84.710, P<0.01), 100-m run (R2 = 0.031, F = 6.920, P<0.01), 3000-m armed training run (R2 = 0.025, F = 5.603, P<0.05), 2-min push-ups (R2 = 0.019, F = 4.295, P<0.05), and hand grenade tossing (R2 = 0.025, F = 5.603, P<0.05). Conclusions Active participation in extracurricular core training can improve cadets' C-APFT scores. An average cumulative weekly extracurricular training duration of 5-10 h showed the most progress, and more than 120 min per week was ideal for extracurricular core training. The amount of extracurricular time spent on core training exercises each week can be used as a predictor of the C-APFT.
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Affiliation(s)
- Zenghui Chen
- Department of Military Joint and Force Management, Army Training Base for Health Care, Army Medical University, Chongqing, 400038, China
| | - Jiang Du
- Department of Military Joint and Force Management, Army Training Base for Health Care, Army Medical University, Chongqing, 400038, China
| | - Yan Hu
- Department of Military Joint and Force Management, Army Training Base for Health Care, Army Medical University, Chongqing, 400038, China
| | - Kai Ou
- Department of Military Joint and Force Management, Army Training Base for Health Care, Army Medical University, Chongqing, 400038, China
| | - Haiming Li
- Department of Military Joint and Force Management, Army Training Base for Health Care, Army Medical University, Chongqing, 400038, China
| | - Tao Meng
- Department of Military Joint and Force Management, Army Training Base for Health Care, Army Medical University, Chongqing, 400038, China
| | - Hang Zhao
- Army Training Base for Health Care, Army Medical University, Chongqing, 400038, China
| | - Wei Zhou
- Department of Military Joint and Force Management, Army Training Base for Health Care, Army Medical University, Chongqing, 400038, China
| | - Xuanjun Li
- The Fourth Team of the Cadet Management Brigade, College of Basic Medical Sciences, Army Medical University, Chongqing 400038, China
| | - Qin Shu
- Department of Field Care, Nursing School, Army Medical University, Chongqing 400038, China
- Corresponding author.
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Simonson R, Piussi R, Högberg J, Senorski C, Thomeé R, Samuelsson K, Senorski EH. Effect of Quadriceps and Hamstring Strength Relative to Body Weight on Risk of a Second ACL Injury: A Cohort Study of 835 Patients Who Returned to Sport After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231157386. [PMID: 37152619 PMCID: PMC10155024 DOI: 10.1177/23259671231157386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/01/2023] [Indexed: 05/09/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injuries are common sports-related injuries with a high risk of reinjury after return to sport (RTS). Rehabilitation aims to regain symmetrical knee strength and function to minimize the risk of a second ACL injury after RTS. Purpose To determine the effect of absolute quadriceps and hamstring strength, normalized by body weight, on the risk of a second ACL injury during the first 2 years after RTS in patients who have undergone ACL reconstruction (ACLR). Study Design Cohort study; Level of evidence, 3. Methods Data from patients after index ACLR at the time of RTS were extracted from a rehabilitation registry-Project ACL. Patients who had performed isokinetic tests for quadriceps and hamstring strength and hop tests before RTS were included. The endpoint was a second ACL injury or a follow-up of 2 years after RTS after ACLR. Results A total of 835 patients (46% women), with a mean age of 23.9 ± 7.7 years, were included. During the study period, 69 (8.3%) second ACL injuries (ipsilateral and contralateral) occurred. Greater relative quadriceps strength in the injured leg increased the risk of a second ACL injury (relative risk [RR], 1.69 [95% CI, 1.05-2.74]; P = .032). In patients who had recovered symmetrical quadriceps strength (limb symmetry index ≥90%), there was no effect of quadriceps strength on the risk of second ACL injury (RR, 1.33 [95% CI, 0.69-2.56]; P = .39). Quadriceps strength on the healthy side or hamstring strength, regardless of side, had no effect on the risk of a second ACL injury. Conclusion Greater relative quadriceps strength in the injured leg at the time of RTS after ACLR was associated with an increased risk of a second ACL injury. There was no effect of relative quadriceps strength on the risk of a second ACL injury in patients who had recovered symmetrical quadriceps strength.
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Affiliation(s)
- Rebecca Simonson
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
- Rebecca Simonsson, PT, MSc,
Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of
Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden; Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden,
Sahlgrenska Sports Medicine Center. Box 455, SE-405 30, Gothenburg, Sweden
() (Twitter:
@BeccaSimonson2)
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Senorski
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Department of Orthopaedics, Institute
of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
- Department of Orthopaedics, Sahlgrenska
University Hospital, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
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Nye NS, Grubic T, Kim M, O'Connor F, Deuster PA. Universal Training Precautions: A Review of Evidence and Recommendations for Prevention of Exercise-Related Injury, Illness, and Death in Warfighters and Athletes. J Athl Train 2023; 58:232-243. [PMID: 35724358 PMCID: PMC10176841 DOI: 10.4085/1062-6050-0400.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Facing pressure to train for victory, warfighters and athletes encounter numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTPs) signifies universal processes designed to prevent unnecessary bodily harm, including injury, illness, and death, during physical training programs. Although no formal guidelines exist for collectively implementing a defined set of UTPs to address a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to preventing sudden death during high school sports and collegiate conditioning sessions. A long list of critical topics must be considered as UTPs, including physical fitness factors, transition-period accommodation, hydration, environmental factors and acclimatization, appropriate recovery, use of medications and dietary supplements, and importantly, leadership. In this article, we outline in detail, with corresponding Strength of Recommendation Taxonomy ratings, what should be considered universal recommendations to minimize the risk of warfighters and athletes coming to harm when participating in group physical activities.
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Affiliation(s)
| | - Tyler Grubic
- Aviation Survival Training Center, NAS Patuxent River, MD
| | - Michael Kim
- Sports Medicine Clinic, Fort Belvoir Community Hospital, VA
| | | | - Patricia A. Deuster
- USU/MEM Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Silver Spring, MD
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Donnelly GM, Moore IS. Sports Medicine and the Pelvic Floor. Curr Sports Med Rep 2023; 22:82-90. [PMID: 36866951 DOI: 10.1249/jsr.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT The female athlete is seen as a specialist population meaning female considerations, such as pelvic floor dysfunction, are not widely taught within sports medicine. Females have unique anatomical characteristics compared with males including a wider pelvic diameter and an additional orifice in the form of the vagina. Furthermore, symptoms of pelvic floor dysfunction are prevalent among female athletes and transitional periods in their lifespan. They also are a barrier to training and performance. Therefore, it is essential that sports medicine practitioners understand how to identify and manage pelvic floor dysfunction. This report aims to describe the anatomy and function of the pelvic floor, outline the types and rates of pelvic floor dysfunction, discuss evidence-based management, and raise awareness of perinatal bodily changes. Practical recommendations are made to aid sports organizations and sports medicine practitioners in supporting the female athlete and in using a proactive approach to manage the perinatal athlete.
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Affiliation(s)
| | - Isabel S Moore
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, UNITED KINGDOM
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Alfonso Mantilla JI. Readaptación deportiva y retorno deportivo en el alto rendimiento. Del laboratorio al campo de juego: Una revisión de la literatura. REVISTA IBEROAMERICANA DE CIENCIAS DE LA ACTIVIDAD FÍSICA Y EL DEPORTE 2022. [DOI: 10.24310/riccafd.2022.v11i3.15381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introducción En la actualidad, la readaptación deportiva se conoce como un proceso dinámico a nivel estructural y funcional de elementos del movimiento corporal humano tales como la caracterización de cualidades físicas, sinergias articulares y musculares, eficiencia y eficacia del movimiento y potencialización de habilidades funcionales para el deporte de alto rendimiento después de una lesión deportiva Metodología revisión de la literatura basados en los criterios PRISMA donde se hizo la búsqueda en las principales bases de datos tales como: Pubmed, Ebsco, Medline, Scopus, Science Direct con los siguientes terminos DeCS: Return to sport, Performance, sports, Return to training, Return to play, Rehabilitation, sports idioma de evidencia inglés, español, portugués, catalán y francés Resultados se pudo obtener la información de 74 artículos donde se estableció que el proceso de readaptación deportiva se basa en pilares específicos tales como movimiento, patrones funcionales, control de carga, monitorización, criterios de seguimiento por fase que permiten desarrollar un retorno exitoso al alto rendimiento deportivo. Conclusión la readaptación deportiva es un proceso que permite tomar decisiones basados en un proceso sistematizado generando la evolución del concepto de readaptador deportivo como un pilar esencial en el trabajo en el deporte de alto rendimiento en cualquier disciplina deportiva.
PALABRAS CLAVE: Return to Sport, Performance, sports, Return to training, Return to play
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Emmet D, Roberts J, Yao KV. Update on Preventing Overuse Injuries in Youth Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Ertman B, Dade R, Vannatta CN, Kernozek TW. Offloading Effects on Impact Forces and Patellofemoral Joint Loading During Running in Females. Gait Posture 2022; 93:212-217. [PMID: 35183838 DOI: 10.1016/j.gaitpost.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Structure-specific loading is being increasingly recognized as playing a role in running related injuries. The use of interventions targeted at reducing patellofemoral joint loads have shown effectiveness in reducing symptoms of patellofemoral pain. Use of bodyweight support (BWS) has the potential to reduce loading on the patellofemoral joint during running to augment rehabilitation efforts. RESEARCH QUESTION How is patellofemoral joint loading different when using a harness-based BWS system during running? METHODS Twenty-five healthy females free from lower extremity injury were included. Participants completed four running trials on an instrumented treadmill with varying amounts of BWS using a commercially available harness system. Kinematic data from a 3D motion capture system and kinetic data from the treadmill were combined in a computer model to estimate measures of patellofemoral joint loading, knee kinematics, ground reaction force, and stride frequency. RESULTS Peak patellofemoral joint stress and time-integral were reduced when running under BWS conditions compared to control conditions. Incremental decreases in patellofemoral loading were not observed with incremental increases in BWS. Peak knee flexion angle was reduced in all BWS conditions compared to control but was not different between BWS conditions. Knee flexion excursion was reduced in only the high BWS condition. Peak ground reaction force and stride frequency incrementally decreased with increased amounts of BWS. SIGNIFICANCE Harness-based BWS systems may provide a simple means to reduce patellofemoral joint loading to assist in rehabilitation efforts, such as addressing patellofemoral pain.
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Affiliation(s)
- Bryce Ertman
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States
| | - Renee Dade
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States
| | - C N Vannatta
- La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; Gundersen Health System, Sports Medicine Department, 311 Gundersen Drive, Onalaska, WI, United States
| | - Thomas W Kernozek
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States.
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Taberner M, Allen T, O'keefe J, Cohen DD. Contextual considerations using the 'control-chaos continuum' for return to sport in elite football - Part 1: Load planning. Phys Ther Sport 2021; 53:67-74. [PMID: 34839202 DOI: 10.1016/j.ptsp.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 12/26/2022]
Abstract
The 'control-chaos continnum' is an adaptable framework developed to guide the on-pitch rehabilitation process in elite football. One of the key objectives of the continuum is to progressively return players to their preinjury chronic running load, while incorporating the qualitative aspects of movement and cognitive stresses integral to competitive match-play. Whilst injury and player-specific considerations are key to an individualised rehabilitation approach, a host of contextual factors also play an important role in return to sport (RTS) planning. In this article, we highlight some key intrinsic and extrinsic contextual factors for the practitioner to consider in the RTS planning process to help mitigate reinjury risk upon a return to team training. While a return to chronic running load is generally a critical component of the framework, we highlight circumstances in elite football where it is a less relevant factor in RTS decision-making.
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Affiliation(s)
- M Taberner
- Performance and Medical Department, Orlando Magic Basketball Club, Orlando, USA; School of Sport and Exercise Sciences, Liverpool John Moore's University, Liverpool, UK.
| | - T Allen
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK; Institute of Coaching and Performance, University of Central Lancashire, Preston, UK. https://twitter.com/tallen_5
| | - J O'keefe
- Academy Sports Science Department, Everton Football Club, Liverpool, UK. https://twitter.com/JasonOkeefe10
| | - D D Cohen
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia; Sports Science Center (CCD), Colombian Ministry of Sport (Mindeporte), Colombia. https://twitter.com/danielcohen1971
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Jayanthi N, Schley S, Cumming SP, Myer GD, Saffel H, Hartwig T, Gabbett TJ. Developmental Training Model for the Sport Specialized Youth Athlete: A Dynamic Strategy for Individualizing Load-Response During Maturation. Sports Health 2021; 14:142-153. [PMID: 34763556 DOI: 10.1177/19417381211056088] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CONTEXT Most available data on athletic development training models focus on adult or professional athletes, where increasing workload capacity and performance is a primary goal. Development pathways in youth athletes generally emphasize multisport participation rather than sport specialization to optimize motor skill acquisition and to minimize injury risk. Other models emphasize the need for accumulation of sport- and skill-specific hours to develop elite-level status. Despite recommendations against sport specialization, many youth athletes still specialize and need guidance on training and competition. Medical and sport professionals also recommend progressive, gradual increases in workloads to enhance resilience to the demands of high-level competition. There is no accepted model of risk stratification and return to play for training a specialized youth athlete through periods of injury and maturation. In this review, we present individualized training models for specialized youth athletes that (1) prioritize performance for healthy, resilient youth athletes and (2) are adaptable through vulnerable maturational periods and injury. EVIDENCE ACQUISITION Nonsystematic review with critical appraisal of existing literature. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS A number of factors must be considered when developing training programs for young athletes: (1) the effect of sport specialization on athlete development and injury, (2) biological maturation, (3) motor and coordination deficits in specialized youth athletes, and (4) workload progressions and response to load. CONCLUSION Load-sensitive athletes with multiple risk factors may need medical evaluation, frequent monitoring, and a program designed to restore local tissue and sport-specific capacity. Load-naive athletes, who are often skeletally immature, will likely benefit from serial monitoring and should train and compete with caution, while load-tolerant athletes may only need occasional monitoring and progress to optimum loads. STRENGTH OF RECOMMENDATION TAXONOMY (SORT) B.
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Affiliation(s)
- Neeru Jayanthi
- Departments of Orthopaedics and Family Medicine, Emory School of Medicine, Atlanta, Georgia.,Emory Sports Medicine Center, Johns Creek, Georgia.,Emory Sport Performance and Research Center, Flowery Branch, Georgia
| | | | - Sean P Cumming
- Department for Health, University of Bath, Bath, United Kingdom
| | - Gregory D Myer
- Emory Sports Medicine Center, Johns Creek, Georgia.,Emory Sport Performance and Research Center, Flowery Branch, Georgia.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
| | - Heather Saffel
- South Bend-Notre Dame Sports Medicine Fellowship, Beacon Bone & Joint Specialists, South Bend, Indiana
| | - Tim Hartwig
- School of Behavioural and Health Sciences, Strathfield Campus, Australian Catholic University, Strathfield, New South Wales, Australia
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, Queensland, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
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12
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Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
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Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
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Kupperman N, Curtis MA, Saliba SA, Hertel J. Quantification of Workload and Wellness Measures in a Women's Collegiate Volleyball Season. Front Sports Act Living 2021; 3:702419. [PMID: 34423291 PMCID: PMC8377283 DOI: 10.3389/fspor.2021.702419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
The purpose of this paper was to quantify internal and external loads completed by collegiate volleyball athletes during a competitive season. Eleven players were sampled (using accelerometers and subjective wellness surveys) during the practice (n = 55) and game (n = 30) sessions over the 2019 season. Longitudinal data were evaluated for trends across the preseason, non-conference play, and conference play periods. Data were also analyzed with respect to positional groups. Longitudinal analysis of accelerometer data showed higher workload demand during practices than games. Positional group differences were most when evaluating jump count and height. Setters accrued over twice as many jumps in a practice than during a game and had similar overall jump counts in practice to attacking positions. Average team wellness values varied with time in the season, especially during times of congested travel. This is the first study to look at both game and practice workload and wellness measures in collegiate women's volleyball. The results suggest athlete monitoring can be used to understand the demands of volleyball and used in the future to enhance practice and recovery day design to optimize athlete well-being.
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Affiliation(s)
- Natalie Kupperman
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
| | - Michael A Curtis
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
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14
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Jayanthi N, Saffel H, Gabbett T. Training the specialised youth athlete: a supportive classification model to keep them playing. Br J Sports Med 2021; 55:1248-1249. [PMID: 34380644 DOI: 10.1136/bjsports-2020-103880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Neeru Jayanthi
- Orthopaedics and Family Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Tim Gabbett
- Gabbett Performance Solutions, Brisbane, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
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15
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Ross R, Irvin L, Severin R, Ellis B. Return-to-Play Considerations Following a COVID-19 Infection in Elite Athletes. J Athl Train 2021; 56:1061-1063. [PMID: 34038943 DOI: 10.4085/1062-6050-0117.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The COVID-19 pandemic has created a unique challenge for sports medicine staffs as they are attempting to safely transition elite athletes into sport participation after a COVID-19 infection. Athletes must isolate for a period of time after testing positive for COVID-19 to prevent the spread of the virus within a community. After an isolation period, a battery of cardiac tests must be given to assess whether or not an athlete is ready to begin a reconditioning protocol. A return-to-play plan should be established to safely re-integrate high-level athletes into strength and conditioning, sport-specific drill work, and contact drill work. Elite athletes should also be gradually eased back into full training loads in order to avoid increases in orthopedic injuries after a prolonged absence from training.
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Affiliation(s)
- Ryan Ross
- Performance Transition and Recovery Specialist, Baylor Athletic Medicine,
| | - Laura Irvin
- Director of Primary Care Sports Medicine, Baylor Athletic Medicine,
| | - Rich Severin
- Clinical Assistant Professor, Baylor University Doctor of Physical Therapy Program, Waco, TX,
| | - Brian Ellis
- Athletics Performance Coach, Baylor Football, Waco, TX,
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16
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Nobari H, Silva R, Clemente FM, Akyildiz Z, Ardigò LP, Pérez-Gómez J. Weekly Variations in the Workload of Turkish National Youth Wrestlers: A Season of Complete Preparation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073832. [PMID: 33917536 PMCID: PMC8038824 DOI: 10.3390/ijerph18073832] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 04/04/2021] [Indexed: 01/29/2023]
Abstract
The aim of this study was twofold: (1) to describe the weekly acute workload (wAW), chronic workload (wCW), acute/chronic workload ratio (wACWR), training monotony (wTM), and strain (wTS) across the preparation season (PS), and (2) to analyze the variations of wAW, wCW, wACWR, wTM, and training strain (wTS) between periods of PS (early-, mid-, and end). Ten elite young wrestlers were monitored daily during the 32 weeks of the season. Internal loads were monitored using session rating of perceived exertion, and weekly workload measures of wACWR, wTM, and wTS were also calculated. Results revealed that the greatest differences were found between early- and mid-PS for wAW (p = 0.004, g = 0.34), wCW (p = 0.002, g = 0.90), wTM (p = 0.005, g = 0.39), and wTS (p = 0.009, g = -1.1), respectively. The wACWR showed significant differences between early- and end-PS (p ≤ 0.001, g = -0.30). We concluded that wAW, wCW, and wTM are slightly lower during the first weeks of the PS. The wTM remained relatively high during the entire season, while wAW and wCW remained balanced throughout the PS. The greatest workload changes seem to happen from the early to mid-PS season.
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Affiliation(s)
- Hadi Nobari
- Department of Physical Education and Sports, University of Granada, 18010 Granada, Spain
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran
- HEME Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain;
- Correspondence: (H.N.); (L.P.A.)
| | - Rui Silva
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal; (R.S.); (F.M.C.)
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal; (R.S.); (F.M.C.)
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
| | - Zeki Akyildiz
- Movement and Training Science Department, Gazi University, 06560 Ankara, Turkey;
| | - Luca Paolo Ardigò
- Department of Neurosciences, Biomedicine and Movement Sciences, School of Exercise and Sport Science, University of Verona, 37129 Verona, Italy
- Correspondence: (H.N.); (L.P.A.)
| | - Jorge Pérez-Gómez
- HEME Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain;
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17
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Platt BN, Uhl TL, Sciascia AD, Zacharias AJ, Lemaster NG, Stone AV. Injury Rates in Major League Baseball During the 2020 COVID-19 Season. Orthop J Sports Med 2021; 9:2325967121999646. [PMID: 33796594 PMCID: PMC7970198 DOI: 10.1177/2325967121999646] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The 2020 Major League Baseball (MLB) season was drastically altered because
of the COVID-19 pandemic. The changes included an extended layoff between
March and July as well as a shortened preseason. Purpose/Hypothesis: To determine the incidence and epidemiology of MLB injuries in the
abbreviated 2020 season compared with prior seasons. We hypothesized that
there was an increase in the overall injury rate in the 2020 season compared
with the 2018-2019 seasons and that it equally affected all body
regions. Study Design: Descriptive epidemiology study. Methods: The MLB transactions database was queried to find players who had been placed
on the injury list between 2018 and 2020. Injuries were categorized into
upper extremity, lower extremity, spine/core, and other injuries. Incidence
per 1000 athlete-exposures was calculated for the prior 2 seasons
(2018-2019) and for the 2020 season separately. Incidence for each category
was also calculated separately for pitchers and fielders. Incidence rate
ratios (IRRs) and confidence intervals were used to compare injury rates in
2018-2019 versus 2020. The z test for proportions was used
to determine significant differences between injury incidences. Results: In 2020, the overall incidence rate per 1000 athlete-exposures was almost
twice the rate compared with the 2 seasons before COVID-19 (8.66 vs 5.13;
IRR, 1.69 [95% CI, 1.53-1.87]; P < .001). Injury
incidence increased similarly in 2020 for both pitchers (IRR, 1.68 [95% CI,
1.47-1.91]; P < .001) and fielders (IRR, 1.68 [95% CI,
1.45-1.96]; P < .001). Increases in injury incidence
were seen in the upper extremity, spine/core, and other injury categories;
however, the incidence of the lower extremity did not change
significantly. Conclusion: There was a significant increase in injury incidence for both pitchers and
fielders in 2020. Injury rates increased in anatomic zones of the upper
extremity and spine/core but were not significantly changed in the lower
extremity. The overall increase in injury rate suggests that irregular or
insufficient sport-specific preparation prior to the start of the season
placed athletes at a greater risk of injury when play resumed.
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Affiliation(s)
- Brooks N Platt
- Division of Sports Medicine, Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Timothy L Uhl
- Division of Sports Medicine, Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA
| | - Aaron D Sciascia
- Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky, USA
| | - Anthony J Zacharias
- Division of Sports Medicine, Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Nicole G Lemaster
- Division of Sports Medicine, Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Austin V Stone
- Division of Sports Medicine, Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
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18
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Quantifying the Training and Match-Play External and Internal Load of Elite Gaelic Football Players. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11041756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current investigation quantified the training and match-play load of elite Gaelic football players across a two-season period using global positioning system technology (GPS), rating of perceived exertion (RPE) and sessional rating of perceived exertion (sRPE). Total weekly workload variables were collected across GPS, RPE, and sRPE across thirty-six elite Gaelic footballers (mean ± SD, age: 26 ± 5 years; height: 177 ± 8 cm; mass: 81 ± 7 kg) from one elite squad during a two-season observational period. External training load variables included: Total distance (m), High speed running (m; ≥ 17.1 km·h−1), Sprint distance (m; 22 km·h−1), Accelerations (n), Average metabolic power (W·kg−1), High-power distance (m; ≥ 25 W·kg−1). Internal load variables included: sRPE and RPE. Repeated measures ANOVA were used to understand the differences in loading patterns across phases, position, and week types when significant main effects were observed a Tukey’s post hoc test was applied and standardized effect sizes were calculated to understand the practical meaning of these differences. When total weekly loading across phases was considered total load was significantly greater in club 1 and provincial 1 with these phases showing the highest loading for players when compared to all other phases (p ≤ 0.001; ES: 2.95–7.22; very large). Furthermore, in-season 1 was greater for total loading when compared to in-season 2 and both championship phases (p ≤ 0.05; ES: 0.47–0.54; small). Total distance in training was greater during preseason 1 when compared to all other phases of the season (p ≤ 0.001; ES: 2.95–7.22; very large). During the in-season period, training based total distance was higher during provincial 1 when compared to other phases with similar trends across all measures (p ≤ 0.005). Finally, a positional profile for load measures was observed, with weekly context (match or non-match) having an impact on the internal and external loading players experienced across phases. The current data provide useful information for practitioners on the training periodization currently present within the elite Gaelic football training process. Specifically, the data provide positional profiles of loading across weekly and segmented phased of an elite Gaelic football season. These data can increase understanding as to the periods of increased and decreased loading across different phases of an elite Gaelic football season, while providing a framework for future analysis concerning Gaelic football periodization.
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19
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Gabbett TJ. The Training-Performance Puzzle: How Can the Past Inform Future Training Directions? J Athl Train 2021; 55:874-884. [PMID: 32991700 DOI: 10.4085/1062/6050.422.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
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).
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Affiliation(s)
- Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, and Centre for Health Research, University of Southern Queensland, Ipswich, Australia
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20
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Focused Issue on Workload and Injury to Share Practical Advice With Clinicians, Athletes, and Coaches. J Orthop Sports Phys Ther 2020; 50:536-537. [PMID: 32998616 DOI: 10.2519/jospt.2020.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anyone who works with athletes of any age and ability knows the best way for the athlete to avoid injury is to avoid playing sports. Anyone who works with athletes also knows that athletes want to play sports above almost all else. Understanding the relationship between how much sports activity an athlete participates in (ie, workload) and injury will help clinicians, athletes, and coaches know what to do to keep athletes healthy (injury free) and performing their best. In the October 2020 focused issue of JOSPT, we tackle workload and sports injury. J Orthop Sports Phys Ther 2020;50(10):536-537. doi:10.2519/jospt.2020.0108.
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21
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Debien PB, Márcio de Oliveira P, Timoteo TF, Ferezin C, Filho MGB, Gabbett T. TRAINING LOAD, RECOVERY AND INJURIES IN ELITE RHYTHMIC GYMNASTS DURING MAIN COMPETITIVE PERIODS: A CASE STUDY. SCIENCE OF GYMNASTICS JOURNAL 2020. [DOI: 10.52165/sgj.12.3.277-285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Competitive periods are critical periods where elite rhythmic gymnasts experience higher training loads and insufficient recovery. The aim of this short report is to describe individual training load, recovery and injuries in elite group rhythmic gymnasts during competitive periods. Six gymnasts from the Brazilian senior rhythmic gymnastics group were monitored daily over a 126-day period comprising regular training and four competitions. Training load was measured using the session rating of perceived exertion (session-RPE). Daily load, chronic load, and acute:chronic workload ratio (ACWR) were assessed. The Total Quality Recovery (TQR) scale was used to monitor recovery and a 3-day rolling average (3RA) TQR was also measured. Injuries were diagnosed and reported by the medical staff and their reports were used in the analysis. Descriptive statistics were used. The gymnasts presented distinct daily load, ACWR, and recovery patterns, as well as injuries across the competitive periods. All athletes had rapid increase (“spike”) in load. Three athletes were underrecovered more than 60% of the time. Four athletes sustained five injuries during the time of the study (all lower limb overuse injuries, two severe, two mild and one slight). Individual factors such as age and chronic load could moderate how each gymnast responds to training and tolerates spikes in load. Moreover, injuries sustained during competitive periods appear to affect the short and long-term careers of gymnasts, as well as impair training and competition organization of the team.
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