How do training and competition workloads relate to injury? The workload—injury aetiology model

Abstract

Injury aetiology models that have evolved over the previous two decades highlight a number of factors which contribute to the causal mechanisms for athletic injuries. These models highlight the pathway to injury, including (1) internal risk factors (eg, age, neuromuscular control) which predispose athletes to injury, (2) exposure to external risk factors (eg, playing surface, equipment), and finally (3) an inciting event, wherein biomechanical breakdown and injury occurs. The most recent aetiological model proposed in 2007 was the first to detail the dynamic nature of injury risk, whereby participation may or may not result in injury, and participation itself alters injury risk through adaptation. However, although training and competition workloads are strongly associated with injury, existing aetiology models neither include them nor provide an explanation for how workloads alter injury risk. Therefore, we propose an updated injury aetiology model which includes the effects of workloads. Within this model, internal risk factors are differentiated into modifiable and non-modifiable factors, and workloads contribute to injury in three ways: (1) exposure to external risk factors and potential inciting events, (2) fatigue, or negative physiological effects, and (3) fitness, or positive physiological adaptations. Exposure is determined solely by total load, while positive and negative adaptations are controlled both by total workloads, as well as changes in load (eg, the acute:chronic workload ratio). Finally, we describe how this model explains the load-injury relationships for total workloads, acute:chronic workload ratios and the training load-injury paradox.

Do Functional Movement Screen (FMS) composite scores predict subsequent injury? A systematic review with meta-analysis

“…However, this design does not account for changes in risk that may occur over time (both within and between participants) in response to factors such as training, competition and match exposure, subclinical adaptations to tissue loading and neuromuscular function. Although some studies addressed this issue (see table 4 ‘Maintenance of comparability’),41 43 45 46 59 not accounting for these potential confounding factors by either design or statistical analysis fails to address the recursive dynamic elements of injury aetiology described in classical60 and emerging aetiological models 61. Simply put, movement competency, as measured by FMS, may change over the course of a season such that, at the time of injury onset, the level of movement competence at the time of injury is different from that recorded at baseline, thus confounding the association.…”

Muscle injury rate in professional football is higher in matches played within 5 days since the previous match: a 14-year prospective study with more than 130 000 match observations

“…Furthermore, only external load (the amount of work performed by the athlete) was considered,29 while internal load (relative physiological and psychological stress imposed on the athlete) was not included. A concern with measurements of external load is that they may only measure specific aspects of the load that athletes are exposed to, that is, match congestion in the current study.…”

Monitoring Athlete Training Loads: Consensus Statement

“…Recent studies have reported simplified analysis or modeling of training-load data in a variety of athletes to make inferences on readiness to perform, 42 return to sport, 68 and injury risk. 69 However, at present, few studies have examined the sensitivity and specificity of these models to predict performance and injury.…”