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Biomechanics And Motor Control Of Human Movement

Generalized Linear Models (2nd ed.)

Exercise Physiology: Energy, Nutrition and Human Performance

Background There is dogma that higher training load causes higher injury rates. However, there is also evidence that training has a protective effect against injury. For example, team sport athletes who performed more than 18 weeks of training before sustaining their initial injuries were at reduced risk of sustaining a subsequent injury, while high chronic workloads have been shown to decrease the risk of injury. Second, across a wide range of sports, well-developed physical qualities are associated with a reduced risk of injury. Clearly, for athletes to develop the physical capacities required to provide a protective effect against injury, they must be prepared to train hard. Finally, there is also evidence that under-training may increase injury risk. Collectively, these results emphasise that reductions in workloads may not always be the best approach to protect against injury.

Main thesis This paper describes the ‘Training-Injury Prevention Paradox’ model; a phenomenon whereby athletes accustomed to high training loads have fewer injuries than athletes training at lower workloads. The Model is based on evidence that non-contact injuries are not caused by training per se , but more likely by an inappropriate training programme. Excessive and rapid increases in training loads are likely responsible for a large proportion of non-contact, soft-tissue injuries. If training load is an important determinant of injury, it must be accurately measured up to twice daily and over periods of weeks and months (a season). This paper outlines ways of monitoring training load (‘internal’ and ‘external’ loads) and suggests capturing both recent (‘acute’) training loads and more medium-term (‘chronic’) training loads to best capture the player's training burden. I describe the critical variable—acute:chronic workload ratio—as a best practice predictor of training-related injuries. This provides the foundation for interventions to reduce players risk, and thus, time-loss injuries.

Summary The appropriately graded prescription of high training loads should improve players’ fitness, which in turn may protect against injury, ultimately leading to (1) greater physical outputs and resilience in competition, and (2) a greater proportion of the squad available for selection each week.

https://bjsm.bmj.com/content/bjsports/50/5/273.full.pdf

The training—injury prevention paradox: should athletes be training smarter and harder?

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.

https://bjsm.bmj.com/content/bjsports/50/17/1030.full.pdf

How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness

The aim of this study was to assess the physical demands of elite English rugby union match-play. Player movements were captured by five distributed video cameras and then reconstructed on a two-dimensional plane representing the pitch. Movements based on speeds were categorized as standing, walking, jogging, and medium-intensity running (low-intensity activity), and high-intensity running, sprinting, and static exertion (scrummaging, rucking, mauling, and tackling) (high-intensity activity). Position groups were defined as forwards (tight and loose) and backs (inside and outside). Backs travelled more total distance than forwards (6127 m, s = 724 vs. 5581 m, s = 692; P < 0.05) and greater distances in walking (2351 m, s = 287 vs. 1928 m, s = 2342; P < 0.001) and high-intensity running (448 m, s = 149 vs. 298 m, s = 107; P < 0.05). Forwards performed more high-intensity activity than backs (9:09 min:s, s = 1:39 vs. 3:04 min:s, s = 1:01; P < 0.001), which was attributable to more time spent in sta...

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The physical demands of elite English rugby union

Background
Rugby Union has one of the highest reported incidences of match injuries amongst all professional team sports. The majority of research within this field has focused on elite male cohorts; in this study we present the first meta-analytic review of these data.

/pdf/a-meta-analysis-of-injuries-in-senior-men-s-professional-526kvh81b6.pdf

A meta-analysis of injuries in senior men’s professional rugby union

PURPOSE: To explore the association between in-season training load measures and injury risk in professional Rugby Union players. METHODS This was a one-season prospective cohort study of 173 Professional Rugby Union players from four English Premiership teams. Training load (duration x session-RPE) and time-loss injuries were recorded for all players for all pitch and gym based sessions. Generalised estimating equations were used to model the association between in-season training load measures and injury risk in the subsequent week. RESULTS: Injury risk increased linearly with one-week loads and week-to-week changes in loads, with a 2 standard deviation (SD) increase in these variables (1245 AU and 1069 AU, respectively) associated with odds ratios of 1.68 (95% CI 1.05-2.68) and 1.58 (95% CI: 0.98-2.54). When compared with the reference group (8651 AU (OR: 1.39, 95% CI: 0.98-1.98). CONCLUSIONS: Players had an increased risk of injury if they had high one-week cumulative loads (1245 AU), or large week-to-week changes in load (1069 AU). In addition, a 'U-shaped' relationship was observed for four-week cumulative loads, with an apparent increase in risk associated with higher loads (>8651 AU). These measures should therefore be monitored to inform injury risk reduction strategies. Language: en

/pdf/the-influence-of-in-season-training-loads-on-injury-risk-in-5exmh4bblx.pdf

The Influence of In-Season Training Loads on Injury Risk in Professional Rugby Union.

Aim To investigate incidence of concussion, clinical outcomes and subsequent injury risk following concussion.

Methods In a two-season (2012/2013, 2013/2014) prospective cohort study, incidence of diagnosed match concussions (injuries/1000 h), median time interval to subsequent injury of any type (survival time) and time spent at each stage of the graduated return to play pathway were determined in 810 professional Rugby Union players (1176 player seasons).

Results Match concussion incidence was 8.9/1000 h with over 50% occurring in the tackle. Subsequent incidence of any injury for players who returned to play in the same season following a diagnosed concussion (122/1000 h, 95% CI 106 to 141) was 60% higher (IRR 1.6, 95% CI 1.4 to 1.8) than for those who did not sustain a concussion (76/1000 h, 95% CI 72 to 80). Median time to next injury following return to play was shorter following concussion (53 days, 95% CI 41 to 64) than following non-concussive injuries (114 days, 95% CI 85 to 143). 38% of players reported recurrence of symptoms or failed to match their baseline neurocognitive test during the graduated return to play protocol.

Summary and conclusions Players who returned to play in the same season after a diagnosed concussion had a 60% greater risk of time-loss injury than players without concussion. A substantial proportion of players reported recurrence of symptoms or failed to match baseline neurocognitive test scores during graduated return to play. These data pave the way for trials of more conservative and comprehensive graduated return to play protocols, with a greater focus on active rehabilitation.

https://bjsm.bmj.com/content/bjsports/50/15/926.full.pdf

Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes

Background Injury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies. Aim To determine the efficacy of a movement control exercise programme in reducing injuries in youth rugby players and to investigate the effect of programme dose on injury measures. Methods In a cluster-randomised controlled trial, 40 independent schools (118 teams, 3188 players aged 14–18 years) were allocated to receive either the intervention or a reference programme, both of which were to be delivered by school coaches. The intervention comprised balance training, whole-body resistance training, plyometric training, and controlled rehearsal of landing and cutting manoeuvres. Time-loss (>24 hours) injuries arising from school rugby matches were recorded by coaches and medical staff. Results 441 time-loss match injuries (intervention, 233; control, 208) were reported across 15 938 match exposure-hours (intervention, 9083; control, 6855). Intention-to-treat results indicated unclear effects of trial arm on overall match injury incidence (rate ratio (RR)=0.85, 90% confidence limits 0.61 to 1.17), although clear reductions were evident in the intervention arm for concussion incidence (RR=0.71, 0.48 to 1.05). When trial arm comparisons were limited to teams who had completed three or more weekly programme sessions on average, clear reductions in overall match injury incidence (RR=0.28, 0.14 to 0.51) and concussion incidence (RR=0.41, 0.17 to 0.99) were noted in the intervention group. Conclusion A preventive movement control exercise programme can reduce match injury outcomes, including concussion, in schoolboy rugby players when compared with a standardised control exercise programme, although to realise the greatest effects players should complete the programme at least three times per week.

https://bjsm.bmj.com/content/bjsports/51/15/1140.full.pdf

Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial.

Grant Trewartha

Papers

The physical demands of elite English rugby union

A meta-analysis of injuries in senior men’s professional rugby union

The Influence of In-Season Training Loads on Injury Risk in Professional Rugby Union.

Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes

Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial.