How do training and competition workloads relate to injury? This question was recently addressed in several articles published in the British Journal of Sports Medicine.
Workload is the total amount of stress applied over time. When an athlete trains or competes, they are exposed to various workloads. The nature of the workload and characteristics of the athlete (predisposition) together determine an individual's susceptibility for injury during any given training session or competition.
The Predisposed Athlete
Multiple factors may predispose an athlete to injury, such as:
The Susceptible Athlete
Increasing workload (the total amount of stress placed on an individual over time through training and competition) results in both increased fitness and fatigue, and either positive adaptation or injury (negative adaptation). Three factors are commonly manipulated to alter training workloads -- frequency, intensity, and duration. Remember that a key principle of training is individuality -- athletes respond to external loads differently based how characteristics of the external workload interact with their individual biomechanics and physiology (their predisposition).
Athletes who are exposed to sudden or chronically high external stress are susceptible to injury. These kinds of workloads decrease an individuals ability to adapt, and overwhelm their capacity for improvements in modifiable risk factors -- tissue resilience, neuromuscular control, etc. Interestingly, chronically low workloads can also increase risk of injury... not enough stress for adaptation, or the stress does not resemble competition stresses.
Finding the Right Workload
Considering all of the above, how do you find the right workload?
Drew, M., Cook, J., & Finch, C. (2016). Sports-related workload and injury risk: simply knowing the risks will not prevent injuries: narrative review. Br J Sports Med., 50, 1306-1308
Gabett, T. (2016). The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med, 16(50), 273-280 (Full Text)
Windt, J. & Gabbett, T. (2016). The workload-injury aetiology model. Br J Sports Med., Online First. (Great Info-graphic in this link)
In a recent article in the British Journal of Sports Medicine, 17 expert clinicians discussed key issues in, and presented recommendations for, return to sport decision-making. Here’s a link to the article. If you are a coach, athlete, or clinician, I recommend taking a look. The following is a summary.
What is return to sport (RTS)?
Return to sport is just as it sounds, returning an athlete to their sport after injury or illness. But successful RTS may be defined differently by those who are involved--coach, clinician, and athlete. Collaboration is important as RTS is a process of shared decision-making. Several contextual factors guide RTS. These include: type of injury, age of the athlete, sport played, physical requirements, level of participation, significance of upcoming competitions, and social and financial costs.
Return to sport is not a decision that occurs at the end of a rehab program, rather it is a process that parallels recovery. There are three elements of RTS:
Framework for RTS
A couple templates can be used to guide RTS. These include the StARRT framework and Biopsychosocial model. The StARRT framework is a 3 step process that includes the following:
Recall in a previous post that gradual and progressive overload is a key principle of training. This principle applies here too.
What is the Health Practitioner’s Role?
Using the above framework, clinicians can help determine readiness for RTS. In addition to treating and monitoring injury recovery, Chiropractors may use functional tests that challenge physical ability, including capacity to react and make decisions while fatigued. These functional tests are designed to replicate the sport experience. Psychosocial readiness should also be assessed. Talk to a practitioner you trust for more information.
Ardern et al. (2016). 2016 Consensus on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med., 50(14)