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- Johansson, Fredrik, et al.
(author)
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Association between spikes in external training load and shoulder injuries in competitive adolescent tennis players : The SMASH cohort study
- 2022
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In: Sports Health. - : SAGE Publications. - 1941-0921. ; , s. 103-110
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Journal article (peer-reviewed)abstract
- BACKGROUND: Few studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload "spikes" in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio were associated with the rate of shoulder complaints/injuries in competitive adolescent tennis players. Additional aims were to report the incidence of complaints/injuries stratified by sex and level of play and to describe shoulder injury characteristics.HYPOTHESIS: Rapid increases in external workload are associated with the incidence of shoulder complaints and injuries.STUDY DESIGN: A cohort study.LEVEL OF EVIDENCE: Level 3.METHODS: At baseline, 301 adolescent competitive tennis players, 13 to 19 years, were screened and followed weekly for 52 weeks with questionnaires, in the years 2018 to 2019. Information about time-varying accumulated external workload spikes (uncoupled ACWR >1.3), and workload/age ratio, in 252 uninjured players were used in Cox regression analyses with the outcomes shoulder complaints (≥20) and injuries (≥40) (Oslo Sports Trauma Research Center Overuse Injury Questionnaire).RESULTS: For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.26 (95% CI, 1.13-1.40) for a shoulder complaint and 1.26 (95% CI, 1.15-1.39) for a shoulder injury. The HRR for fitness training was 1.11 (95% CI, 1.02-1.20) for a shoulder complaint and 1.18 (95% CI, 1.09-1.27) for a shoulder injury. Workload/age ratio was not associated with the rate of shoulder complaints or injuries.CONCLUSION: Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of shoulder complaints and shoulder injuries in competitive adolescent tennis players.CLINICAL RELEVANCE: Consistency in training load on a weekly basis is most likely more beneficial for adolescent tennis players regarding shoulder complaints/injuries than a training schedule comprising rapid increases (ie, spikes) in workload.
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- Johansson, Fredrik, et al.
(author)
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External training load and the association with back pain in competitive adolescent tennis players : Results from the SMASH cohort study
- 2022
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In: Sports Health. - : SAGE Publications. - 1941-0921. ; 14:1, s. 111-118
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Journal article (peer-reviewed)abstract
- BACKGROUND: In young tennis players, high loads on the spine and high training volumes in relation to age are associated with a high lifetime prevalence of back pain. The primary aim of this study was to investigate if accumulated external workload "spikes" in the acute:chronic workload ratio (ACWR) of tennis training, match play, and fitness training, and if high or low workload/age ratio were associated with back pain events in competitive adolescent tennis players. Additional aims were to report the incidence of back pain stratified by sex and level of play and to describe the characteristics of players with back pain.HYPOTHESIS: Rapid increases in external workload are associated with the incidence of back pain.STUDY DESIGN: Cohort study of 198 competitive tennis players, 13 to 19 years, with a weekly follow-up for 52 consecutive weeks.LEVEL OF EVIDENCE: Level 3.METHODS: Accumulated external workload spikes (uncoupled ACWR >1.3), and the workload/age ratio, were time-varying exposures in Cox regression analyses with the outcome back pain (pain intensity ≥2/10 in the lower back and/or in the upper back/neck with a pain-related disability).RESULTS: For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.17 (95% CI, 1.06-1.28) for back pain. The corresponding HRR for fitness training was 1.13 (95% CI, 1.05-1.22). Training workload/age ratio was not related to back pain.CONCLUSION: Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of back pain events in competitive adolescent tennis players.CLINICAL RELEVANCE: Back pain is a troublesome clinical problem that may affect the performance of talented young tennis players. Structuring the training schedule to minimize rapid increases (ie, spikes) of training load on a weekly basis may enhance performance and reduce back pain in adolescent tennis players.
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- Schwellnus, Martin, et al.
(author)
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How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness
- 2016
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In: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 50:17, s. 1043-1052
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Journal article (peer-reviewed)abstract
- The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of loadincluding rapid changes in training and competition load, competition calendar congestion, psychological load and traveland health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified.
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- Soligard, Torbjorn, et al.
(author)
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How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury
- 2016
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In: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 50:17, s. 1030-1041
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Journal article (peer-reviewed)abstract
- 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.
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- Windt, Johann, et al.
(author)
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Getting the most out of intensive longitudinal data: a methodological review of workload-injury studies
- 2018
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In: BMJ Open. - : BMJ PUBLISHING GROUP. - 2044-6055. ; 8:10
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Research review (peer-reviewed)abstract
- Objectives To systematically identify and qualitatively review the statistical approaches used in prospective cohort studies of team sports that reported intensive longitudinal data (ILD) (amp;gt;20 observations per athlete) and examined the relationship between athletic workloads and injuries. Since longitudinal research can be improved by aligning the (1) theoretical model, (2) temporal design and (3) statistical approach, we reviewed the statistical approaches used in these studies to evaluate how closely they aligned these three components. Design Methodological review. Methods After finding 6 systematic reviews and 1 consensus statement in our systematic search, we extracted 34 original prospective cohort studies of team sports that reported ILD (amp;gt;20 observations per athlete) and examined the relationship between athletic workloads and injuries. Using Professor Linda Collins three-part framework of aligning the theoretical model, temporal design and statistical approach, we qualitatively assessed how well the statistical approaches aligned with the intensive longitudinal nature of the data, and with the underlying theoretical model. Finally, we discussed the implications of each statistical approach and provide recommendations for future research. Results Statistical methods such as correlations, t-tests and simple linear/logistic regression were commonly used. However, these methods did not adequately address the (1) themes of theoretical models underlying workloads and injury, nor the (2) temporal design challenges (ILD). Although time-to-event analyses (eg, Cox proportional hazards and frailty models) and multilevel modelling are better-suited for ILD, these were used in fewer than a 10% of the studies (n= 3). Conclusions Rapidly accelerating availability of ILD is the norm in many fields of healthcare delivery and thus health research. These data present an opportunity to better address research questions, especially when appropriate statistical analyses are chosen.
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