Training Load and Its Role in Injury Prevention, Part 2: Conceptual and Methodologic Pitfalls

Stress Drives Soccer Athletes' Wellness and Movement: Using Convergent Cross-Mapping to Identify Causal Relationships in a Dynamic Environment

PURPOSE

Prediction of athlete wellness is difficult-or, many sports-medicine practitioners and scientists would argue, impossible. Instead, one settles for correlational relationships of variables gathered at fixed moments in time. The issue may be an inherent mismatch between usual methods of data collection and analysis and the complex nature of the variables governing athlete wellness. Variables such as external load, stress, muscle soreness, and sleep quality may affect each other and wellness in a dynamic, nonlinear, way over time. In such an environment, traditional data-collection methods and statistics will fail to capture causal effects. If we are to move this area of sport science forward, a different approach is required.

METHODS

We analyzed data from 2 different soccer teams that showed no significance between player load and wellness or among individual measures of wellness. Our analysis used methods of attractor reconstruction to examine possible causal relationships between GPS/accelerometer-measured external training load and wellness variables.

RESULTS

Our analysis showed that player self-rated stress, a component of wellness, seems a fundamental driving variable. The influence of stress is so great that stress can predict other components of athlete wellness, and, in turn, self-rated stress can be predicted by observing a player's load data.

CONCLUSION

We demonstrate the ability of nonlinear methods to identify interactions between and among variables to predict future athlete stress. These relationships are indicative of the causal relationships playing out in athlete wellness over the course of a soccer season.

Elite Soccer Players' Weekly Workload Assessment Through a New Training Load and Performance Score

Purpose: Monitoring players' training load allows practitioners to enhance physical performance while reducing injury risk. The aim of this study was to identify the key external load indicators in professional U19 soccer. Methods: Twenty-four-professional Italian young (U19) soccer players were monitored by using the rating of perceived exertion (CR-10 RPE scale) and a wearable inertial sensor during the competitive season. Three main components were detected by a Principal Component Analysis (PCA): i) volume metabolic related component, ii) intensity mechanical stimuli component, and iii) intensity metabolic/mechanical component. We hence computed two scores (i.e. Performance [PERF] and total workload [WORK]) permitting to investigate the weekly microcycle. Results: Correlation analysis showed that scores (i.e. PERF and WORK) are low correlated (r = -0.20) suggesting that they were independent. Autocorrelation analysis showed that a weekly microcycle is detectable in all the scores. Two-way ANOVA RM showed a statistical difference between match day (MD) and playing position for the three PCA components and PERF score. Conclusion: We proposed an innovative approach to assess both the players' physical performance and training load by using a machine learning approach allowing reducing a large dataset in an objective way. This approach may help practitioners to prescribe the training in the microcycle based on the two scores.

Is a Maximal Strength-Training Program Effective on Physical Fitness, Injury Incidence, and Injury Burden in Semi-Professional Soccer Players? A Randomized Controlled Trial

The aims of the study were to analyze the effects of a 12-week maximal strength- training program on injury incidence, injury burden, and physical fitness in semi-professional soccer players and to compare the perceived exertion load and well-being state between injured and non-injured soccer players. Twenty semi-professional male soccer players participated in this study. Participants were randomly allocated to an experimental group (EG, n = 10 players), who performed a maximal strength-training program, or to a control group (CG, n = 10 players), who only performed their regular soccer training. Physical fitness was measured at baseline and after the training program. In addition, the injury incidence, burden, training/match load, and the state of well-being of the players were recorded. The EG showed significant improvements in vertical jumps, change in direction ability, linear sprints, repeated sprint ability, isometric strength (p < 0.003; effect size = 1.78-11.86), and quadriceps-hamstring imbalance in both legs (p < 0.001; effect size = 2.37-3.71) in comparison to the CG. In addition, the EG players showed a significantly (p < 0.05) lower injury burden (p < 0.001, relative risk = 5.05, 95% confidence interval = 3.27-7.79). This study demonstrated the beneficial effects of a 12-week maximal strength-training program on physical fitness attributes and injury burden in semi-professional soccer players.

Building Bridges Instead of Putting Up Walls: Connecting the "Teams" to Improve Soccer Players' Support

The increase in the economic value of soccer occurred in parallel with an increase in competing demands. Therefore, clubs and federations evolved to greater specialization (e.g., state-of-the-art facilities and high-profile expertise staff) to support players' performance and health. Currently, player preparation is far from exclusively club or national team centered, and the lack of control in each player's environment can be more prevalent than expected. For example, an elite group of professional players faces disruptions in the season club-oriented planification due to involvement in national teams. Moreover, as elite players' financial resources grow, it is common for them to employ specialized personal staff (e.g., strength and conditioning, nutritionist, and sports psychologist) to assist in their preparation, resulting in complex three-fold relationships (i.e., club, player's staff, national team). Although efforts have been made to improve communication with and transition from the club to the national team supervision, this new reality (club-players' staff) may generate serious compound role-related problems and difficulties in monitoring load and training adaptation and having a unified message. Therefore, efforts must be implemented to ensure a more informed management of the players' performance environment, where the existence and impact of these various personal staff are considered to avoid a long-term non-zero sum for all intervening parties. If left unchecked, current professional thinking may collide or overlap, potentially triggering conflict escalation and impairing athletic performance or health, especially if effective communication routes are not adequately established. Moreover, diluted personal responsibility regarding performance may ensue, resulting in decreased productivity from all involved, which may cause more harm than benefits for the player's overall health and performance. This emerging reality calls for developing a joint working framework (i.e., between the player's personalized support team and the clubs' team) and better managing of a player-centered process.

Injury incidence in male elite youth football players is associated with preceding levels and changes in training load

Objectives

Elite youth football players miss out on a large part of seasonal training due to injury. Limited research suggests an association between external and internal training load (TL) and injury incidence in elite youth football. This study analysed external and internal TL variables and their association with injury incidence in a group of male elite youth football players over four seasons.

Methods

Measures of external and internal TL and injury incidence of 56 male elite youth football players (age 17-19 years) were collected throughout four seasons. Heart rate, session rating of perceived exertion andGlobal Positioning System (GPS) variables were analysed. Individual players' TL during the 30 days leading up to injury was compared with 30-day injury-free control periods. Change in TL through the periods was also analysed.

Results

Eighty-five injuries were included for analysis, showing that for most TL variables, the average levels were significantly lower during the period leading up to injury. Significant increases for the majority of TL variables were also found during the periods leading up to injury, while the control periods did not show any significant change.

Conclusion

A lower and/or increasing average TL volume over 30 days might increase the risk of injury in male elite youth football players. Avoiding long-term drops in TL and balance increases in TL might be beneficial to reduce injury risk.

Validity and Reliability of Polar Team Pro and Playermaker for Estimating Running Distance and Speed in Indoor and Outdoor Conditions

Although global positioning systems and inertial measurement unit systems are often used to quantify physical variables in training, both types of systems need to be compared, considering their frequent use in measuring physical loads. Thus, the purpose of our study was to test the reliability and validity of speed and distance run measurements at different intensities in indoor and outdoor conditions made by Polar Team Pro and Playermaker. Four participants (age = 30.0 ± 5.1 years, body mass = 76.3 ± 5.3 kg, height = 1.79 ± 0.09 m), each wearing three Polar Team Pro and two Playermaker sensors, performed 100 m runs with different prescribed intensities (i.e., criterion measure) varying from 8 to 24 km h-1, in a straight line and/or rectangle under indoor and outdoor conditions. Both systems underestimated total distance; Playermaker underestimated speed, the extent of which increased as speed increased, while Polar Team Pro overestimated mean speed at 8 km h-1 for the straight-line condition. No differences emerged in mean speed estimated by Polar Team Pro at any intensities other than 20 km h-1, which was underestimated by 2%. The reliability of the sensors was good, given a coefficient of variation (CV) of <2% for all conditions except when measuring indoor conditions with Polar Team Pro (CV ≈ 10%). Intraclass correlations (ICCs) for consistency within the sensors varied from 0.47 to 0.99, and significantly lower ICCs were documented at 8, 10, and 12 km h-1. Both systems underestimated distance measured in indoor and outdoor conditions, and distance validity in different intensities seemed to worsen as speeds increased. Although Polar Team Pro demonstrated poor validity and reliability in indoor conditions, both systems exhibited good reliability between their sensors in outdoor conditions, whereas the reliability within their sensors varied with different speeds.

Players', Head Coaches', And Medical Personnels' Knowledge, Understandings and Perceptions of Injuries and Injury Prevention in Elite-Level Women's Football in Ireland

BACKGROUND

To manage injuries effectively, players, head coaches, and medical personnel need to have excellent knowledge, attitudes, and behaviours in relation to the identification of risk factors for injuries, the implementation of injury prevention initiatives, as well as the implementation of effective injury management strategies. Understanding the injury context, whereby specific personal, environmental, and societal factors can influence the implementation of injury prevention initiatives and injury management strategies is critical to player welfare. To date, no qualitative research investigating the context of injuries, has been undertaken in elite-level women's football. The aim of our study was to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish Women's National League (WNL) to injury prevention and injury management.

METHODS

We used qualitative research methods to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish WNL to injury prevention and injury management. Semi-structured interviews were undertaken with 17 players, 8 medical personnel, and 7 head coaches in the Irish WNL. The data were analysed using thematic analysis. Our study is located within an interpretivist, constructivist research paradigm.

RESULTS

The participants had incomplete knowledge of common injuries in elite-level football, and many held beliefs about risk factors for injuries, such as menstrual cycle stage, which lacked evidence to support them. Jumping and landing exercises were commonly used to reduce the risk of injuries but evidence-based injury prevention exercises and programmes such as the Nordic hamstring curl, Copenhagen adduction exercise, and the FIFA 11+ were rarely mentioned. Overall, there was dissatisfaction amongst players with their medical care and strength and conditioning (S & C) support, with resultant inadequate communication between players, head coaches, and medical personnel.

CONCLUSION

Poor quality and availability of medical care and S & C support were considered to be a major obstacle in the effective implementation of injury risk reduction strategies and successful return-to-sport practices. More original research is required in elite-level women's football to explore injury risk factors, injury prevention initiatives, and contextual return-to-sport strategies, so that players, head coaches, and medical personnel can use evidence that is both up-to-date and specific to their environment.

Case study of IMU loads and self-reported fatigue monitoring of water polo goalkeepers preparing for the Olympic games

Introduction

Measurement of training in water polo goalkeepers has focused first on psycho-physiological variables, but also on external volume estimated with wearable sensors. However, there are limited studies exploring training monitoring in water polo goalkeepers longitudinally.

Methods

Three female senior national team goalkeepers participated in this study from May to August 2021. Internal loads were defined using session rating of perceived exertion (sRPE). Tri-axial accelerations and angular velocities were measured with an inertial measurement unit (IMU) placed on the lower back to measure external loads. Relationships between self-reported and IMU-derived metrics were explored using Spearman correlations. Two-way ANOVAs were used to assess differences between session types and between athletes.

Results

In total, 247 sessions were collected (159 practices, 67 matches and 21 game warm up), with 155 sessions having complete data. IMU metrics, such as number of kicks, number of jumps or player-load showed high correlation with each other (ρ = 0.80-0.88). There was also a moderate correlation (ρ = 0.47, 95% CI = 0.33-0.58) between sRPE and player-load measured with the IMU. ANOVA tests showed that there were significant differences between athletes for sRPE (p < 0.01) but not for player load (p = 0.47). There were no interactions between athletes and training types, except for index score (p < 0.01).

Conclusions

This study shows that monitoring of training loads can be performed successfully in water polo goalkeepers using a combination of self-reported and IMU measures. Self-reported outcomes can be expected to vary significantly across athletes within the same session, while IMU metrics vary across training situations. Finally, coaches should be mindful of missing data, as they can skew the interpretation of training loads.

Healthcare providers have insufficient up-to-date knowledge of lower limb sports injuries, and their knowledge is similar to that of athletes

BACKGROUND

Being up-to-date with evidence-based knowledge of lower limb sports injuries is essential for Healthcare professionals (HCPs).

PURPOSE

To assess whether HCPs possess up-to-date knowledge of lower limb sports injuries by comparing their knowledge to that of athletes.

METHODS

With an expert panel, we developed an online quiz of 10 multiple-choice questions on various topics related to lower-limb sports injuries. Maximal score was 100. We used social media to invite HCPs (5 groups: Physiotherapists, Chiropractors, Medical Doctors, Trainers, and Other therapists) and athletes of all levels (amateur, semi-pro, and pro) to participate. We drafted the questions according to conclusions from the latest systematic reviews and meta-analyses.

RESULTS

1526 participants completed the study. Final quiz scores ranged from zero (n = 28, 1.8%) to 100 (n = 2, 0.1%) and were distributed normally with a mean score of 45.4 ± 20.6. None of the 6 groups' means surpassed the set threshold of 60 points. Multiple linear regressions of covariates indicated that age, gender, engagement in physical activity, learning hours per week, reading scientific journals, reading popular magazines and blogs, trainers, and other therapists' groups explained 19% of the variances (-5.914<β < 15.082, 0.000<p < 0.038).

CONCLUSIONS

HCPs have insufficient up-to-date knowledge of lower limb sports injuries, and their knowledge is similar to that of athletes of all levels. HCPs probably do not possess the proper tools to assess scientific literature Academic and sports medicine societies should look into ways to improve the scientific knowledge integration of HCPs.

Injury Surveillance and Training Load Methods Used by Health Professionals in Tennis: An Online Multinational Survey

CONTEXT

Injury surveillance and training load monitoring are both essential for the development of preventative strategies for gradual-onset musculoskeletal injuries in elite sport. Our aim was to survey health professionals working with elite tennis players on whether and how they monitor injuries and training load.

DESIGN

A cross-sectional multinational online open-survey.

METHODS

The survey was developed and advertised in English, Spanish, and Portuguese languages on social media channels, a tennis academic journal, professional tennis associations, and clinical networks of the research team, from December 2020 to April 2021.

RESULTS

72 health professionals from 27 different countries working with elite tennis players responded to the survey. Injury surveillance is performed by 94% (68/72) of the survey respondents, with only 10% (7/68) using the consensus-recommended Oslo Sports Trauma Research Center questionnaire. Most common barriers identified by health professionals to injury surveillance are time constraints (66%), lack of knowledge (43%), and technology (31%). Training load monitoring is performed by 50% (36/72) of the health professionals working with elite tennis players. Main metrics monitored are weekly differences in training load (72%) and acute:chronic workload ratio (58%). Most common reasons for training load monitoring are injury prevention (94%), training planning (81%), and player feedback (53%).

CONCLUSIONS

Despite a high percentage of health professionals implementing injury surveillance metrics, most of them do not use any validated method. Only half of health professionals working with elite tennis players monitor training load. Lack of knowledge and technology were the main barriers reported for adequately monitoring injuries.

Performance Adaptations to Intensified Training in Top-Level Football

Because physical demands are surging in football (soccer, USA), clubs are more and more seeking players who have a high capacity to perform repeated intense exercise. High-intensity interval training (HIIT), comprising exercise performed at intensities near or exceeding the capacity of aerobic energy systems, effectively enhances the physical conditioning of players. But given that HIIT imposes high loads, it increases the risk of overload-associated match performance decline and injury. This makes some coaches inclined to conduct HIIT in the weeks leading up to the season and during the season. Therefore, the challenge is how to optimize and dose HIIT during these phases, as they can be decisive. Studies have highlighted the utility of conducting periods of intensified training to overcome the risk of overload while at the same time enhancing performance. During intensified training periods of typically a few weeks, intensity is increased by enlarging the amount of HIIT, for example, aerobic high-intensity training or speed endurance training, while volume at low-to-moderate intensity is significantly reduced. The outcome depends on training composition and prescription-most notably, intensity and duration of bouts and recovery. When work intervals are prescribed for a few minutes at intensities > 90% heart rate max (i.e., aerobic high-intensity training), then beneficial adaptations pertaining to aerobic power and capacity are apparent. But when work intervals are conducted at much higher intensities, as all-out efforts or sprinting of typically 10- to 40-s duration with longer recovery periods (i.e., speed endurance training), beneficial adaptations pertaining to anaerobic energy systems, ion handling, and fatigue resilience are commonly observed. In this review, we discuss the utility of conducting intensified training periods to enhance performance in elite football players during the late preparation phase and competitive season.

Black Box Prediction Methods in Sports Medicine Deserve a Red Card for Reckless Practice: A Change of Tactics is Needed to Advance Athlete Care

There is growing interest in the role of predictive analytics in sport, where such extensive data collection provides an exciting opportunity for the development and utilisation of prediction models for medical and performance purposes. Clinical prediction models have traditionally been developed using regression-based approaches, although newer machine learning methods are becoming increasingly popular. Machine learning models are considered 'black box'. In parallel with the increase in machine learning, there is also an emergence of proprietary prediction models that have been developed by researchers with the aim of becoming commercially available. Consequently, because of the profitable nature of proprietary systems, developers are often reluctant to transparently report (or make freely available) the development and validation of their prediction algorithms; the term 'black box' also applies to these systems. The lack of transparency and unavailability of algorithms to allow implementation by others of 'black box' approaches is concerning as it prevents independent evaluation of model performance, interpretability, utility, and generalisability prior to implementation within a sports medicine and performance environment. Therefore, in this Current Opinion article, we: (1) critically examine the use of black box prediction methodology and discuss its limited applicability in sport, and (2) argue that black box methods may pose a threat to delivery and development of effective athlete care and, instead, highlight why transparency and collaboration in prediction research and product development are essential to improve the integration of prediction models into sports medicine and performance.

Integrative Proposals of Sports Monitoring: Subjective Outperforms Objective Monitoring

Current trends in sports monitoring are characterized by the massive collection of tech-based biomechanical, physiological and performance data, integrated through mathematical algorithms. However, the application of algorithms, predicated on mechanistic assumptions of how athletes operate, cannot capture, assess and adequately promote athletes' health and performance. The objective of this paper is to reorient the current integrative proposals of sports monitoring by re-conceptualizing athletes as complex adaptive systems (CAS). CAS contain higher-order perceptual units that provide continuous and multilevel integrated information about performer-environment interactions. Such integrative properties offer exceptional possibilities of subjective monitoring for outperforming any objective monitoring system. Future research should investigate how to enhance this human potential to contribute further to athletes' health and performance. This line of argument is not intended to advocate for the elimination of objective assessments, but to highlight the integrative possibilities of subjective monitoring.

Association Between Preseason Fitness Level and Risk of Injury or Illness in Male Elite Ice Hockey Players: A Prospective Cohort Study

BACKGROUND

Little is known about the association between physical fitness and the risk of injury or illness in ice hockey. The least-fit players may be more prone to injury and illness.

PURPOSE

To examine the association between preseason fitness level and injury or illness risk among elite ice hockey players during the regular season.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 133 male ice hockey players in the GET League (the premier professional league in Norway) completed 8 different exercises (40-m sprint, countermovement jump, 3000-m run, squat, bench press, chin-ups, brutal bench, and box jump) at the annual 1-day preseason testing combine. During the 2017-2018 competitive season, the players reported all health problems (acute injuries, overuse injuries, and illnesses) weekly (31 weeks) using the Oslo Sports Trauma Research Center Questionnaire on Health Problems.

RESULTS

Overall, the players reported 191 acute injuries, 82 overuse injuries, and 132 illnesses. The least-fit tercile of players did not report more health problems (mean, 3.0; 95% CI, 2.2-3.8) compared with the most-fit (mean, 3.4; 95% CI, 2.6-4.2) or the medium-fit (mean, 2.7; 95% CI, 1.9-3.5) players. The most-fit players reported more substantial health problems (mean, 2.0; 95% CI, 1.6-2.5) compared with the medium-fit (mean, 1.3; 95% CI, 0.8 -1.8) and least-fit (mean, 1.8; 95% CI, 1.3-2.3) (P = .02) players. There was no association between low physical fitness and number of health problems when comparing the least-fit tercile of the players with the rest of the cohort (P > .05); however, there was an association between low physical fitness and greater severity of all health problems when comparing the least-fit tercile of players to the rest of the cohort after adjusting for time on ice per game, playing position, and age (P = .02).

CONCLUSION

Low physical fitness was not associated with increased rate of injury or illness but was associated with greater severity of all health problems after adjusting for time on ice per game, playing position, and age.

Contextual considerations using the 'control-chaos continuum' for return to sport in elite football - Part 1: Load planning

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.

Quantification of Workload and Wellness Measures in a Women's Collegiate Volleyball Season

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.

Summated training and match load predictors of salivary immunoglobulin-A, alpha-amylase, testosterone, cortisol and T:C profile changes in elite-level professional football players: A longitudinal analysis

We examined how summated training and match load measures relate to salivary immunological and hormonal profile changes in professional football players. Data were collected from 18 elite-level professional male football players from one English Championship team across a complete 40 wk competitive season. Daily training (micro-technology) and match (computerised tracking) measures of total, high-speed and high-metabolic load running distance and sprint, acceleration, deceleration and sRPE load were converted into exponentially weighted moving average "acute" (7d), "chronic" (28d) and acute:chronic composite load measures. Bi-weekly morning saliva samples were analysed for immunoglobulin-A, alpha-amylase, testosterone, cortisol and testosterone:cortisol. A two-stage data reduction technique using partial least squares modelling and a backward stepwise selection procedure determined the most parsimonious model for each salivary variable. Testosterone had non-linear relationships with chronic total (P = 0.015; Cohen's D: large), high-metabolic load (P = 0.001;small) and high-speed (P = 0.001;trivial) running distance and linear relationships with chronic sRPE (P = 0.002;moderate ↓) and acute:chronic high-speed running distance (P = 0.001; trivial ↑). Cortisol had a non-linear relationship with chronic high-speed running distance (P = 0.001;trivial). Testosterone:cortisol had non-linear relationships with chronic decelerations (P = 0.039;small) and chronic summated acceleration and deceleration load (P = 0.039;small). Non-linear relationships typically indicated optimal hormonal responses at squad mean loads. No load variables clearly related to salivary immunoglobulin-A or alpha-amylase changes. We conclude that chronic total and high-intensity load measures relate to hormonal changes and might be useful indicators of player readiness. Acute load variables were not related to immunological or hormonal changes and consequently, should not be used as surrogate measures of player readiness in isolation.

The Association Between the Acute:Chronic Workload Ratio and Running-Related Injuries in Dutch Runners: A Prospective Cohort Study

OBJECTIVE

To investigate the association between the acute:chronic workload ratio (ACWR) and running-related injuries (RRI).

METHODS

This is a secondary analysis using a database composed of data from three studies conducted with the same RRI surveillance system. Longitudinal data comprising running exposure (workload) and RRI were collected biweekly during the respective cohorts' follow-up (18-65 weeks). ACWR was calculated as the most recent (i.e., acute) external workload (last 2 weeks) divided by the average external (i.e., chronic) workload of the last 4, 6, 8, 10 and 12 weeks. Three methods were used to calculate the ACWR: uncoupled, coupled and exponentially weighted moving averages (EWMA). Bayesian logistic mixed models were used to analyse the data.

RESULTS

The sample was composed of 435 runners. Runners whose ACWR was under 0.70 had about 10% predicted probability of sustaining RRI (9.6%; 95% credible interval [CrI] 7.5-12.4), while those whose ACWR was higher than 1.38 had about 1% predicted probability of sustaining RRI (1.3%; 95% CrI 0.7-1.7). The association between the ACWR and RRI was significant, varying from a small to a moderate association (1-10%). The higher the ACWR, the lower the RRI risk.

CONCLUSIONS

The ACWR showed an inversely proportional association with RRI risk that can be represented by a smooth L-shaped, second-order, polynomial decay curve. The ACWR using hours or kilometres yielded similar results. The coupled and uncoupled methods revealed similar associations with RRIs. The uncoupled method presented the best discrimination for ACWR strata. The EWMA method yielded sparse and non-significant results.

Training Load and Injury: Causal Pathways and Future Directions

Causal pathways between training loads and the mechanisms of tissue damage and athletic injury are poorly understood. Here, the relation between specific training load measures and metrics, and causal pathways of gradual onset and traumatic injury are examined. Currently, a wide variety of internal and external training load measures and metrics exist, with many of these being commonly utilized to evaluate injury risk. These measures and metrics can conceptually be related to athletic injury through the mechanical load-response pathway, the psycho-physiological load-response pathway, or both. However, the contributions of these pathways to injury vary. Importantly, tissue fatigue damage and trauma through the mechanical load-response pathway is poorly understood. Furthermore, considerable challenges in quantifying this pathway exist within applied settings, evidenced by a notable absence of validation between current training load measures and tissue-level mechanical loads. Within this context, the accurate quantification of mechanical loads holds considerable importance for the estimation of tissue damage and the development of more thorough understandings of injury risk. Despite internal load measures of psycho-physiological load speculatively being conceptually linked to athletic injury through training intensity and the effects of psycho-physiological fatigue, these measures are likely too far removed from injury causation to provide meaningful, reliable relationships with injury. Finally, we used a common training load metric as a case study to show how the absence of a sound conceptual rationale and spurious links to causal mechanisms can disclose the weaknesses of candidate measures as tools for altering the likelihood of injuries, aiding the future development of more refined injury risk assessment methods.