(1991). Applied Linear Regression Models. Journal of Quality Technology: Vol. 23, No. 1, pp. 76-77.

Applied Linear Regression Models

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

Monitoring the load placed on athletes in both training and competition has become a very hot topic in sport science. Both scientists and coaches routinely monitor training loads using multidisciplinary approaches, and the pursuit of the best methodologies to capture and interpret data has produced an exponential increase in empirical and applied research. Indeed, the field has developed with such speed in recent years that it has given rise to industries aimed at developing new and novel paradigms to allow us to precisely quantify the internal and external loads placed on athletes and to help protect them from injury and ill health. In February 2016, a conference on "Monitoring Athlete Training Loads-The Hows and the Whys" was convened in Doha, Qatar, which brought together experts from around the world to share their applied research and contemporary practices in this rapidly growing field and also to investigate where it may branch to in the future. This consensus statement brings together the key findings and recommendations from this conference in a shared conceptual framework for use by coaches, sport-science and -medicine staff, and other related professionals who have an interest in monitoring athlete training loads and serves to provide an outline on what athlete-load monitoring is and how it is being applied in research and practice, why load monitoring is important and what the underlying rationale and prospective goals of monitoring are, and where athlete-load monitoring is heading in the future.

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Monitoring Athlete Training Loads: Consensus Statement.

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

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International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS))

Kinesio tape (KT) is an elastic therapeutic tape used for treating sports injuries and a variety of other disorders. Chiropractor, Dr Kenso Kase, developed KT taping techniques in the 1970s. It is claimed that KT supports injuredmuscles and joints and helps relieve pain by lifting the skin and allowing improved blood and lymph flow. The profile of KT rose after the tape was donated to 58 countries for use during the 2008 Olympic Games, and was seen on high-profile athletes. Practitioners are asking whether they should use KT over other elastic adhesive tapes. The aim of this review was to evaluate, using meta-analysis, the effectiveness ofKT in the treatment and prevention of sports injuries. Electronic databases including SPORTDiscus®, Scopus,MEDLINE, ScienceDirect and sports medicine websites were searched using keywords ‘kinesio taping/tape’. From 97 articles, ten met the inclusion criteria (article reported data for effect of KT on a musculoskeletal outcome and had a control group) and were retained for meta-analyses.Magnitude-based inferences were used to assess clinical worth of positive outcomes reported in studies. Only two studies investigated sports-related injuries (shoulder impingement), and just one of these involved injured athletes. Studies attending to musculoskeletal outcomes in healthy participants were included on the basis that these outcomes may have implications for the prevention of sporting injuries. The efficacy of KT in pain relief was trivial given there were no clinically important results. There were inconsistent range-of-motion outcome results, with at least small beneficial results seen in two studies, but trivial results in two other studies across numerous joint measurements. There was a likely beneficial effect for proprioception regarding grip force sense error, but no positive outcome for ankle proprioception. Seven outcomes relating to strength were beneficial, although there were numerous trivial findings for quadriceps and hamstrings peak torque, and grip strength measures. KT had some substantial effects on muscle activity, but it was unclear whether these changes were beneficial or harmful. In conclusion, there was little quality evidence to support the use ofKT over other types of elastic taping in themanagement or prevention of sports injuries. KT may have a small beneficial role in improving strength, range of motion in certain injured cohorts and force sense error compared with other tapes, but further studies are needed to confirm these findings. The amount of case study and anecdotal support for KT warrants well designed experimental research, particularly pertaining to sporting injuries, so that practitioners can be confident that KT is beneficial for their athletes.

/pdf/kinesio-taping-in-treatment-and-prevention-of-sports-24130p1w14.pdf

Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness.

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.

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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

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

We read with great interest the recent letter, “Time to bin the term ‘overuse’ injury: is ‘training load error’ a more accurate term?”1 and in particular its associated PostScript correspondence, “Are rolling averages a good way to assess training load for injury prevention?”2 We are currently investigating the association between training loads and injury risk,3 and so we have also been considering the best way to model this relationship. We share Dr Menaspa's concerns regarding the use of rolling averages for the calculation of ‘acute’ and ‘chronic’ loads. Namely, that they fail to account for the decaying nature of fitness and …

/pdf/better-way-to-determine-the-acute-chronic-workload-ratio-21wkg6dbsr.pdf

Better way to determine the acute:chronic workload ratio?

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.

Sean Williams

Papers

Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness.

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.

Better way to determine the acute:chronic workload ratio?

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