![Page 1: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/1.jpg)
CO
NT
AC
T
Dr
Sean
William
s|S
.William
s@
bath
.ac
.uk
DEPARTMENT FOR HEALTHSport, Health and Exercise Science
Presented by Dr. Sean Williams
Modelling the load-injury
relationshipLatest evidence and future directions
![Page 2: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/2.jpg)
2
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Theoretical basis for monitoring loads
Time
Tra
inin
g e
ffect
Fatigue
Fitness Performance
Banister, E., Calvert, T., Savage, M. & Bach, T. (1975) A systems model of training for athletic performance. Aust J Sports Med, 7,
57-61.
Injury risk?
![Page 3: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/3.jpg)
3
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Theoretical basis for monitoring loads
Soligard, T., Schwellnus, M., Alonso, J. M., Bahr, R., Clarsen, B., Dijkstra, H. P., ... & Van Rensburg, C. J. (2016). How much is too
much? International Olympic Committee consensus statement on load in sport and risk of injury. British Journal of Sports
Medicine, 50(17), 1030-1041.
![Page 4: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/4.jpg)
4
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Theoretical basis for monitoring loads
Windt, J., & Gabbett, T. J. (2016). How do training and competition workloads relate to injury? The workload—injury aetiology model. British Journal of Sports
Medicine, bjsports-2016.
![Page 5: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/5.jpg)
5
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Current best practice?
Acute:Chronic Workload Ratio [ACWR]
Acute | Recent loads (e.g. one week), analogous to state of ‘fatigue’
Chronic | Average loads over last 3-6 weeks, analogous to state of ‘fitness’
50
100
150
200
125
0
50
100
150
200
250
1 2 3 4
Load [
AU
]
Week
Load Chronic Load Acute:Chronic
= 200/125
= 1.60
![Page 6: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/6.jpg)
6
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Acute:Chronic Workload Ratio
Gabbett, T. J. (2016). The training—injury prevention paradox: should athletes be training smarter and harder?. British Journal of
Sports Medicine, 50(5), 273-280.
![Page 7: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/7.jpg)
7
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Acute:Chronic Workload Ratio
![Page 8: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/8.jpg)
8
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Smoothed averages
1.52
1.03
0.00
0.50
1.00
1.50
2.00
2.50
0
100
200
300
400
500
600
700
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41
Acu
te:C
hro
nic
Wo
rklo
ad
L
oa
d [A
U]
Loads EWMA ACWR Rolling ACWR
![Page 9: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/9.jpg)
9
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
ACWR and injury prediction
Fanchini, M., Rampinini, E., Riggio, M., Coutts, A. J., Pecci, C., & McCall, A. (2018). Despite association, the acute:
chronic work load ratio does not predict non-contact injury in elite footballers. Science and Medicine in Football, 1-7.
Sensitivity
Specificity
20%
85%
![Page 10: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/10.jpg)
10
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Acute:chronic workload ratioPre
dic
ted
pro
bab
ilit
y o
f in
jury
in
su
bse
qu
en
t 4
we
ek p
eri
od
Individual effects
• Using mixed models, it’s possible to get unique effects for each athlete:
ACWR
Su
bse
qu
en
t in
jury
ris
k
Warren, A., Williams, S., McCaig, S., & Trewartha, G. (2017). High acute: chronic workloads are associated with injury in England & Wales Cricket Board Development
Programme fast bowlers. Journal of Science and Medicine in Sport.
![Page 11: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/11.jpg)
11
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Moderators in workload–injury investigations
Windt, J., Zumbo, B. D., Sporer, B., MacDonald, K., & Gabbett, T. J. (2017). Why do workload spikes cause injuries, and which athletes are at higher risk?
Mediators and moderators in workload–injury investigations.
Malone, S., et al. "Aerobic Fitness and Playing Experience Protect Against Spikes in
Workload: The Role of the Acute: Chronic Workload Ratio on Injury Risk in Elite Gaelic
Football." International journal of sports physiology and performance (2016).
0
1
2
3
4
5
6
7
8
9
3.00 to 3.15 3.16 to 3.30 3.31 to 3.45 3.46 to 4.00
Od
ds r
atio
1 km time trial time
ACWR > 1.50
Aerobic fitness
![Page 12: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/12.jpg)
12
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Moderators in workload–injury investigations
Windt, J., Zumbo, B. D., Sporer, B., MacDonald, K., & Gabbett, T. J. (2017). Why do workload spikes cause injuries, and which athletes are at higher risk?
Mediators and moderators in workload–injury investigations.
Malone, S., Hughes, B., Doran, D. A., Collins, K., & Gabbett, T. J. (2018). Can the
workload–injury relationship be moderated by improved strength, speed and repeated-
sprint qualities?. Journal of Science and Medicine in Sport.
Strength
![Page 13: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/13.jpg)
13
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Moderators in workload–injury investigations
Windt, J., Zumbo, B. D., Sporer, B., MacDonald, K., & Gabbett, T. J. (2017). Why do workload spikes cause injuries, and which athletes are at higher risk?
Mediators and moderators in workload–injury investigations.
Blanch, P., & Gabbett, T. J. (2015). Has the athlete trained enough to return to play
safely? The acute: chronic workload ratio permits clinicians to quantify a player's risk of
subsequent injury. Br J Sports Med, bjsports-2015.
Previous injury
![Page 14: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/14.jpg)
14
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Moderators in workload–injury investigations
Heart Rate Variability
Williams, S., Booton, T., Watson, M., Rowland, D., & Altini, M. (2017). Heart Rate Variability is a Moderating Factor in the Workload-
Injury Relationship of Competitive CrossFit™ Athletes. Journal of sports science & medicine, 16(4), 443.
![Page 15: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/15.jpg)
15
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
HRV as a stress/recovery marker
p(t) = k1g(t)e –t / τ1 – k2h(t)e – t / τ2
p(t) = Performance k1 , k2 = Multipliers
g(t) = Fitness τ1 , τ2 = Time constants
h(t) = Fatigue t = Time
Performance Fitness Fatigue
![Page 16: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/16.jpg)
16
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Planning optimal workloads
Carey, D. L., Crow, J., Ong, K. L., Blanch, P., Morris, M. E., Dascombe, B. J., & Crossley, K. M. (2017). Optimising
Pre-Season Training Loads in Australian Football. International Journal of Sports Physiology and Performance, 1-19.
AIM:
Maximise total load, whilst keeping ACWR within safe
zone
https://progressiveathleticperformance.com/
![Page 17: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/17.jpg)
17
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Future Directions
Technology
Integration of loads
Analysis
Life loads
Match loads
Training loads
Sperlich, B., Düking, P., & Holmberg, H. C. (2017). A SWOT analysis of the use and potential misuse of implantable monitoring devices by athletes. Frontiers in
Physiology, 8, 629.
![Page 18: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/18.jpg)
18
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
Additional issues with ACWR?
![Page 19: Sport, Health and Exercise Science Modelling the load-injury ...medicine.exeter.ac.uk/media/universityofexeter/medical...CT Drn ams | S. ath. ac. uk DEPARTMENT FOR HEALTH Sport, Health](https://reader033.vdocuments.mx/reader033/viewer/2022050505/5f96d07008384f3acb63464c/html5/thumbnails/19.jpg)
19
MODELLING THE LOAD-INJURY RELATIONSHIP
CO
NT
AC
T
Dr
Sean
William
s|S
.Will
iam
s@
bath
.ac.u
k
ConclusionsConclusions
• Current best practice: High chronic loads are required to optimally prepare athletes
for competition demands, but these must be achieved gradually and rapid ‘spikes’
in workloads should be avoided.
• Calculating the ACWR using EWMA may be more sensitive to injury risk than rolling
averages.
• Our understanding of the moderators of this workload injury relationship is
developing.
• Optimisation techniques may be used to create objective training plan designs that
satisfy injury risk constraints.
• Technology, analysis and the integration of different forms of load are areas for
future direction.