Figure - uploaded by Johann Windt
Content may be subject to copyright.
Examples of how mediating and moderating variables explain the association between a workload spike and subsequent injury. Top, neuromuscular fatigue is shown as a mediator (ie, domino) of the effect of workload spikes on injury. In this example, a spike in workload causes an increase in neuromuscular fatigue, and an increase in neuromuscular fatigue leads to an injury. Bottom, aerobic fitness acts as a moderator (ie, dimmer switch) of the relationship between workload spikes and injury. In this case, a given spike in workload will elicit a different injury risk dependent on an individual’s fitness level.
Source publication
Spikes in training and competition workloads, especially in undertrained athletes, increase injury risk. However, just as attributing athletic injuries to single risk factors is an oversimplification of the injury process, interpreting this workload-injury relationship should not be done in isolation. Instead, we must further unpack how (ie, throug...
Similar publications
Competitive alpine skiers are subject to substantial risks of injury, especially concerning the anterior cruciate ligament (ACL). During “landing back weighted” episodes, hamstrings may partially counteract the anterior shear force acting on the tibia by eccentrically resisting the boot-induced drawer of the tibia relative to the femur. The aim of...
The ‘‘foot doming’’ exercise is a simple but effective foundational exercise for running rehabilitation and injury prevention programs to improve activation of the foot muscles. This clinical pearl describes this exercise and provides key evidence of effects.
Background/objective:
The muscle activity before the initial contact between during jump landings is referred to as the pre-activity. The muscle pre-activity that occur during jump landing are considered to be an important predictor of non-contact anterior cruciate ligament (ACL) injury risk. ACL injury prevention programs have been widely conduct...
Il est crucial de mieux comprendre le comportement dynamique de la prothèse tibiale pour les athlètes amputés pratiquant le saut en longueur afin d’améliorer les performances tout en limitant le risque de blessure. Il s’agit ici d’étudier les interactions entre la prothèse, le sol et l’athlète et le rôle des éléments d’interface que sont le manchon...
Citations
... In the literature, it has been described that there is a relationship between sessions completed by preseason players and the likelihood of injury. In rugby players during an 18-week preseason, Windt et al. (2017b) found a significant inverse relationship (r = -0.40) between the number of training sessions completed and the percentage of games lost due to injury during the competitive season. Based on these results, there is a relationship between the athlete's participation during the preseason and the decrease in chances of sports injury during the in-season. ...
... The authors justify this protective effect that happens when completing the preseason in two non-exclusive hypotheses. On the one hand, athletes who complete the preseason may acquire a higher level of preparation, and this higher level of fitness has already been described as a modulator of the effects of the training load, causing more robust athletes to injury (Windt et al., 2017b). In addition, they accumulate higher values of chronic load, an aspect linked to the increase in fitness and which has also been shown as a modulator of the effect of the load, allowing athletes to withstand higher load levels without significantly increasing the likelihood of injury (Malone et al., 2017) and probably, players with good fitness (e.g. ...
Purpose: the main aim of this study was to quantify and compare the weekly external loads of pre-season in two professional football teams. Methods: GPS devices monitored forty-five players in two teams daily in a five-week pre-season period. The external load measures were: number of sessions, total duration, acceleration load (aLoad), total distance (TD), distance at >21 km·h-1 (TD21), distance at >24 km·h-1 (TD24) and Player-Load® (PL). Results: there were differences in the weekly external load between both teams. Team1 trained 30% more time and training sessions than Team2, so the weekly load for all external load variables was higher except for aLoad and TD21 for W1 (Team2>Team1, p<0.05). These differences between teams were not similar for all weeks, with higher differences in weeks 2, 3, and 4. While Team2 proposed a distribution more stable and progressive in high-speed distances (TD21 and TD24) among weeks, Team1 used the inverted U model. In this line, variations between weeks were lower for Team2 (from -4% to 38%) than for Team1 (from -26% to 1,653%). Conclusions: The study's main conclusion was that in addition to a load management with an inverted U model, more widespread in professional football, a more stable and progressive distribution strategy can be proposed in pre-season in a professional setting. Keywords: GPS, training load, team sports, periodization, monitoring.
... When applied consistently, large training volumes will induce physiological adaptations in athletes which prepare them for their sport and competition, and therefore might actually assist in the prevention of injuries (52). Whilst it must be acknowledged that increased training volume has been suggested to be associated with injury risk in athletes (53), it has equally been debated whether sudden and rapid spikes in training volume may be responsible for the increased injury risk, as opposed to training volume when considered as a consistent variable over a period of time (54). The results of the current study and others (5,9,55), indicate that future studies should be conducted to investigate the relationship between training volume and climbing overuse injuries, with an enhanced focus on the quality of the data collected. ...
... The findings of the current study support previous work by , who also described a relationship between increased climbing intensity/grade and an increase in injury risk, and this association has been discussed in other reviews in the literature (14). High intensity training maintained over long periods of time (52) or when introduced abruptly during the training process (54) appears to increase the likelihood of sustaining an overuse injury in athletes, and this risk likely exists in climbers. This result underlines the need for training to be programmed and monitored in a sensible and accurate way, in accordance with currently known best practice in training periodization and planning (52,56,57). ...
Introduction
Climbing is an increasingly popular activity and imposes specific physiological demands on the human body, which results in unique injury presentations. Of particular concern are overuse injuries (non-traumatic injuries). These injuries tend to present in the upper body and might be preventable with adequate knowledge of risk factors which could inform about injury prevention strategies. Research in this area has recently emerged but has yet to be synthesized comprehensively. Therefore, the aim of this study was to conduct a systematic review of the potential risk factors and injury prevention strategies for overuse injuries in adult climbers.
Methods
This systematic review was conducted in accordance with the PRISMA guidelines. Databases were searched systematically, and articles were deemed eligible based upon specific criteria. Research included was original and peer-reviewed, involving climbers, and published in English, German or Czech. Outcomes included overuse injury, and at least one or more variable indicating potential risk factors or injury prevention strategies. The methodological quality of the included studies was assessed with the Downs and Black Quality Index. Data were extracted from included studies and reported descriptively for population, climbing sport type, study design, injury definition and incidence/prevalence, risk factors, and injury prevention strategies.
Results
Out of 1,183 records, a total of 34 studies were included in the final analysis. Higher climbing intensity, bouldering, reduced grip/finger strength, use of a “crimp” grip, and previous injury were associated with an increased risk of overuse injury. Additionally, a strength training intervention prevented shoulder and elbow injuries. BMI/body weight, warm up/cool downs, stretching, taping and hydration were not associated with risk of overuse injury. The evidence for the risk factors of training volume, age/years of climbing experience, and sex was conflicting.
Discussion
This review presents several risk factors which appear to increase the risk of overuse injury in climbers. Strength and conditioning, load management, and climbing technique could be targeted in injury prevention programs, to enhance the health and wellbeing of climbing athletes. Further research is required to investigate the conflicting findings reported across included studies, and to investigate the effectiveness of injury prevention programs.
Systematic Review Registration
https://www.crd.york.ac.uk/, PROSPERO (CRD42023404031).
... 51 In this line, avoiding spikes in the daily and weekly workload has been demonstrated to prevent injuries in high-level athletes. 52 In the present case study one of the principles that has governed training programing is the overload principle, especially avoiding large sudden increases in load. To monitor the fatigue and the training intensity, movement velocity measured through linear encoders has been demonstrated to accurately measure the degree of effort through velocity loss. ...
Training process in elite padel players is influenced by travels and competitions density. The irregularity in the workloads, as well as demands of the season, could affect the musculoskeletal structures. Strength training has a protective role against the injury incidence, but the competitive context does not always allow adequate periodization of training and thus achieve adaptations. The aim of this study is to analyze, using technological tools, if improvements in player’s fitness are accompanied by improvements in sport performance through a case study. An elite padel player was analyzed during the 2021 season. Physical fitness was evaluated using different technological tools. Athlete monitoring was carried out using self-reported forms and sport performance was assessed through the results obtained in the World Padel Tour ranking at the end of the season. During the training process, multidimensional training was carried out in order to achieve the maximum availability of specific loads through coadjuvant training. Results of the assessment show slight improvements in all fitness tests. Assessment of sport performance reports an increased number of victories and a better position in the professional ranking. Musculoskeletal improvements helped the athlete’s workload tolerance, allowing overall improvement in padel performance. The training approach from this study has shown to be effective in maintaining or even improving force-producing capacity in lower and upper limbs, force-velocity relationship, agility and sport performance, despite the high competitive density. This work provides coaches with a practical approach to assess, monitor and design a competitive season for an elite padel player.
... While the Borg scale is widely used to control overload, some studies suggest that training pressure and monotony could be a more accurate indicator of players' risk of injury (Brink et al., 2010;Lu et al., 2017). The associations between training monotony and training strain with injury exposure or disease risk are likely to be complex (Windt et al., 2017). In this sense, moderators such as players' tness (ie, professional vs amateur) and season period (ie, preseason vs season) should be analyzed. ...
The present study was designed to investigate two aspects. Firstly, analysis of variations in acute load, chronic load, acute-chronic load ratio, monotony, and training strain during the preseason (PS), first and second half of the season (1st HS, 2nd HS). Secondly, comparing these indicators of training load in players' positions. Twenty-two elite soccer players from the Premier League of Iran (age: 27.2 4.5 years, professional experience: 6.2 4.3 years) were involved in this study. Players were monitored daily for 45 weeks through an 18 Hz global positioning system (GPS), to gather data on distance running (total running), distance running at 14 km/h (moderate intensity running), and distance running at a speed above 19.8 km/h (high-intensity running). One-way analysis of variance, followed by Tukey HSD post hoc test to analyze data. The pre-season has a significantly higher amount of acute load, chronic load, monotony and training strain, total running, and moderate-intensity running than the first half ( p < 0.05) and the second half ( p < 0.05). When comparing these training load indicators for high-intensity running, a significant difference was only observed between the PS and the 2nd HS (p 0.05, moderate ES). Also, no significant differences were observed between positions in total running and moderate intensity running. However, training load indices based on high-intensity running between positions showed external defenders vs center backs ( p < 0.05), midfielders ( p < 0.05) and strikers ( p < 0.05) were significantly different. Furthermore, wingers had a significant difference in high-intensity running compared to central defenders ( p < 0.05) and midfielders ( p < 0.05). To conclude, this study demonstrated that acute load, chronic load, monotony, and training strain were more prevalent in the pre-season and slowly decreased during the season. External defenders and wingers experienced more acute load, chronic load, monotony, and training strain for high-intensity running during the season compared to other positions. Therefore, the results indicate that pre-season had a higher physical load than competition season, and players' positions experienced varying physical loads.
... However, rather than focusing purely on the ACWR, Gabbett 36 recommend consideration of known moderators to the workload-injury relationship (eg, injury history and other factors known to influence the risk of injury). A moderator may either increase or decrease risk of injury at a given training load.37 Specific to MTSS, example moderators to the workload-injury relationship may include MTSS history and previous years of running experience. ...
Objectives Medial tibial stress syndrome (MTSS) is a common musculoskeletal injury in both sporting and military settings. No reliable treatments exist, and reoccurrence rates are high. Prevention of MTSS is critical to reducing operational burden. Therefore, this study aimed to build a decision-making model to predict the individual risk of MTSS within officer cadets and test the external validity of the model on a separate military population. Design Prospective cohort study. Methods This study collected a suite of key variables previously established for predicting MTSS. Data were obtained from 107 cadets (34 women and 73 men). A follow-up survey was conducted at 3 months to determine MTSS diagnoses. Six ensemble learning algorithms were deployed and trained five times on random stratified samples of 75% of the dataset. The resultant algorithms were tested on the remaining 25% of the dataset, with models then compared for accuracy. The most accurate new algorithm was tested on an unrelated data sample of 123 Australian Navy recruits to establish external validity of the model.
... However, rather than focusing purely on the ACWR, Gabbett 36 recommend consideration of known moderators to the workload-injury relationship (eg, injury history and other factors known to influence the risk of injury). A moderator may either increase or decrease risk of injury at a given training load.37 Specific to MTSS, example moderators to the workload-injury relationship may include MTSS history and previous years of running experience. ...
Objectives
Medial tibial stress syndrome (MTSS) is a common musculoskeletal injury in both sporting and military settings. No reliable treatments exist, and reoccurrence rates are high. Prevention of MTSS is critical to reducing operational burden. Therefore, this study aimed to build a decision-making model to predict the individual risk of MTSS within officer cadets and test the external validity of the model on a separate military population.
Design
Prospective cohort study.
Methods
This study collected a suite of key variables previously established for predicting MTSS. Data were obtained from 107 cadets (34 women and 73 men). A follow-up survey was conducted at 3 months to determine MTSS diagnoses. Six ensemble learning algorithms were deployed and trained five times on random stratified samples of 75% of the dataset. The resultant algorithms were tested on the remaining 25% of the dataset, with models then compared for accuracy. The most accurate new algorithm was tested on an unrelated data sample of 123 Australian Navy recruits to establish external validity of the model.
Results
Calibrated random forest modelling was the most accurate in identifying a diagnosis of MTSS; (area under curve (AUC)=98%, classification accuracy (CA)=96%). External validation on a sample of Navy recruits resulted in comparable accuracy; (AUC=95%, CA=94%). When the model was tested on the combined datasets, similar accuracy was achieved; (AUC=92%, CA=91%).
Conclusion
This model is highly accurate in predicting those who will develop MTSS. The model provides important preventive capacity which should be trialled as a risk management intervention.
... Escalas de percepção subjetiva de esforço (JIANG et al., 2022) e recuperação ( VAN DER DOES et al., 2017), tem se mostrado como ferramentas adequadas e de baixo custo para indicar possíveis riscos de lesão, sendo de suma importância para monitorar e assim prevenir aumentos abruptos de carga em curtos espaços de tempo e com um melhor gerenciamento da fadiga neuromuscular (WINDT et al., 2017), mostrando-se como uma excelente estratégia para reduzir o risco de lesões. Outros fatores como o repouso adequado e a nutrição tem papel importante, visto que um baixo volume de sono é fator que eleva o risco de lesão em atletas adolescentes (VIEGAS et al., 2022), sendo influenciado pelo uso constante de dispositivos eletrônicos antes de dormir e assim reduzindo a qualidade de sono (WANG et al., 2019), além da baixa disponibilidade de nutrientes, podendo ser derivada de uma ocorrência de distúrbios alimentares e também relacionados ao nível de estresse e ansiedade (WASSERFURTH et al., 2020). ...
OBJETIVO: Identificar a taxa de lesão de LCA em jovens atletas de futebol.MÉTODOS: A metodologia contou com a busca sistemática dos artigos em 4 bases de dados: “Pubmed/Medline”, “Science Direct”, “Web of Science” e “Lilacs” através dos seguintes descritores combinados: “Anterior Cruciate Ligament”, “Injury”, “Adolescents”, “Soccer Players” e “Athletes”. Foram selecionados para a revisão os estudos de 2016 a 2021 com dados referentes a lesões de LCA em atletas com idades dos 13 aos 18 anos de ambos os sexos. A revisão seguiu as diretrizes PRISMA, e avaliação da qualidade metodológica foi realizada através da lista de verificação STROBE.RESULTADOS: Foram encontrados 544 estudos, sendo selecionados os publicados no período de 2016 a 2021 (144). Através das etapas de leitura dos títulos (89), dos resumos (66), e dos artigos na íntegra (13), foram selecionados 4 estudos que atenderam o critério de inclusão apresentando desfecho sobre a taxa de lesões, onde se constatou maior incidência de lesões do LCA para meninas. Apesar disso, apenas dois dos estudos averiguou a incidência em relação a outras características (atividade, mecanismo, evento) de forma específica.CONCLUSÃO: Concluiu-se que a taxa de lesões de LCA é significativamente maior em meninas do que em meninos durante adolescência, tendo características de lesões sem contato e ocorrendo principalmente em competições, porém ainda são escassos os dados a respeito da natureza destas lesões.
... A recent British Journal of Sports Medicine editorial called for exploration of the mediators driving load related injuries, and more training-specific data informing injury resilience protocols (Windt et al., 2017). In responding to this call, I propose that the mechanical stressors, implicit in deceleration activities, are critical mediators serving as potent drivers of both neuromuscular fatigue and tissue damage. ...
Horizontal accelerations and decelerations are crucial components underpinning the many fast changes of speed and direction that are performed in team sports competitive match play. Extensive research has been conducted into the assessment of horizontal acceleration and the underpinning neuromuscular performance determinants, leading to evidence-informed guidelines on how to best develop specific components of a team sport players horizontal acceleration capabilities. Unlike horizontal acceleration, little scientific research has been conducted into how to assess horizontal deceleration, meaning the neuromuscular performance determinants underpinning horizontal deceleration are largely based on anecdotal opinion or qualitative observations. Therefore, the overall purpose of this thesis was to investigate the neuromuscular determinants of maximal horizontal deceleration ability in team sport players. Furthermore, since there are no recognised procedures on how to assess maximal horizontal deceleration ability, an important and novel aim of this thesis was to develop a test capable of obtaining reliable and sensitive data on a team sport player’s maximal horizontal deceleration ability. In part one of this thesis (chapter three) a systematic review and meta-analysis identified that high-intensity (< -2.5 m.s-2) decelerations were more frequently performed than equivalently intense accelerations (> 2.5 m.s-2) in most elite team sports competitive match play, signifying the importance of developing maximal horizontal deceleration ability in team sport players. In chapter four, a new test of maximal horizontal deceleration ability (named the acceleration-deceleration ability test – ADA test), measured using radar technology, identified a number of kinematic and kinetic variables that had good intra- and inter-day reliability and were sensitive to detecting small-to-moderate changes in maximal horizontal deceleration ability. The ADA test was used in chapters five to seven to examine associations with isokinetic eccentric and concentric knee strength capacities and countermovement and drop jump kinetic and kinematic variables, respectively. Using the neuromuscular and biomechanical determinants identified to be important for horizontal deceleration ability within this thesis, in addition to other contemporary research findings, the final part of this thesis developed an evidence-based framework that could be used by practitioners to help inform decisions on training solutions for improving horizontal deceleration ability – named the dynamic braking performance framework.
... The quantification of internal load, and the response to training, should be considered as part of a multivariate system alongside the external load data, in order to understand the dose-response relationship to training [16]. Including measures of the athletes' individual characteristics, such as fitness [52]or maturation [28], into such a system also merits consideration. The cycle of planning and monitoring is an ongoing, iterative process in which the quantification and evaluation of planned and implemented load alongside training responses and outcomes can be beneficial to practitioners and the coaches and athletes they strive to support. ...
Seeking to obtain a competitive advantage and manage the risk of injury, team sport organisations are investing in tracking systems that can quantify training and competition characteristics. It is expected that such information can support objective decision-making for the prescription and manipulation of training load. This narrative review aims to summarise, and critically evaluate, different tracking systems and their use within team sports. The selection of systems should be dependent upon the context of the sport and needs careful consideration by practitioners. The selection of metrics requires a critical process to be able to describe, plan, monitor and evaluate training and competition characteristics of each sport. An emerging consideration for tracking systems data is the selection of suitable time analysis, such as temporal durations, peak demands or time series segmentation, whose best use depends on the temporal characteristics of the sport. Finally, examples of characteristics and the application of tracking data across seven popular team sports are presented. Practitioners working in specific team sports are advised to follow a critical thinking process, with a healthy dose of scepticism and awareness of appropriate theoretical frameworks, where possible, when creating new or selecting an existing metric to profile team sport athletes.
... Further research is necessary to verify these suggestions. For example, the lack of intervention studies to understand the physical demands of amateur soccer (Clemente et al., 2017), the absence of quantification of the training and game demands in this level of the sport (Windt et al., 2017), the lack of information regarding the relationship between performance and the risk of injury (Soheil et al., 2018). Subsequently, our understanding of incident rates in amateur soccer players is significantly limited. ...
The objectives of the study were to examine the incident rate (IR), characteristics, and mechanisms of muscle injuries of 121 men amateur soccer players that voluntarily participated in this project. Sixty-five muscle injuries with an overall IR of 3.62/1000 h, 95% CI 2.7–4.5, were reported. The most frequently injured muscle groups were the hamstrings (IR 1.78/1000 h, 95% CI 1.1–2.3), followed by the adductors (IR 1.5/1000 h, 95% CI 0.93–2.06). Most muscle injuries were characterized as mild (IR 2.3/1000 h, 95% CI 1.53–2.92) or minimal (IR 1.28/1000 h, 95% CI 1.16–2.39. Higher incidence of injury sustained during matches (IR 14.09 injuries/1000 h, 95% CI 9.49–18.7), than in training (IR 1.88 injuries/1000 h, 95% CI 1.19–2.56). The most frequent injury mechanisms were high-speed running (84.4%) and change of direction (44.4%), for hamstring and adductors-related groin injuries, respectively. Players aged over 24 years had a 7-fold increased risk to sustain a hamstring injury but a lower risk to sustain an adductor-related groin injury. Injury prevention and rehabilitation management strategies may reduce muscle injury rates in amateur soccer.
