Monitoring & Managing Training Load for a Safe Return to Sport - - PowerPoint PPT Presentation

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Monitoring & Managing Training Load for a Safe Return to Sport - - PowerPoint PPT Presentation

Mar 26, 2024 247 likes •517 views

Monitoring & Managing Training Load for a Safe Return to Sport OSET Orthopaedic Summit 2017 Las Vegas, NV December 6-9, 2017 Darin A. Padua, PhD, ATC Professor & Chair Load Management: A Missing Piece of the Safe RTS Puzzle? Training

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OSET Orthopaedic Summit 2017 Las Vegas, NV December 6-9, 2017

Darin A. Padua, PhD, ATC Professor & Chair

Monitoring & Managing Training Load for a Safe Return to Sport

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Load Management: A Missing Piece of the Safe RTS Puzzle? Mobility Stability Strength / Power Movement Quality / Biomechanics Load Tolerance Function and Perception

Training Load

  • Cumulative stress from

multiple training sessions

  • ver time
  • Combination of frequency,

intensity, and duration not typically considered Is pt. ready for  load upon RTS? Has pt. experienced enough load to tolerate RTS loads?

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Training Load & Injury Risk

  • Training load spikes precede injury Cross et al, Int J Sports Physiol Perform, 2016; Hulin et al, BJSM, 2014; Hulin et al,

BJSM, 2016

  • Weekly load changes ≥15%   injury risk Gabbett et al, BJSM, 2016
  • Doubling weekly training load  50% likelihood of injury Gabbett et al, BJSM, 2016

10 20 30 40 50 60 70 80 90 100 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Large increase in acute load (past 1 week) relative to chronic load (past 2-4 weeks)

Total Weekly Load

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Acute to Chronic Training Load “Spikes” and Injury Likelihood

Blanch & Gabbett, Br J Sports Med, 2015

  • Acute to Chronic Load

Spike > 1.5

– Acute = Past 1week – Chronic = Past 4 weeks

  • 53% of injury likelihood

variance in following week is explained by acute to chronic load ratio

Acute to Chronic Load Ratio .00 1.00 1.50 2.00 5 10 15 20 25 Likelihood of Injury (%)

Latent Effect of Loading Spike  Injury risk for next 4-weeks

Orchard et al, Am J Sports Med, 2009

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Does load management play a role in secondary ACL injury?

 RTS Time   Risk of Knee Re-Injury

  • RTS < 5 mos  100% re-injury
  • Sustained within 2 mos following RTS
  • RTS ≤ 9 mos  39.5% re-injury
  • RTS ≥ 9 mos  19.4% re-injury
  • 51% decrease in knee re-injury for each month

delaying RTS up to 9 mos

Grindem et al, Br J Sports Med, 2016

 RTS Time   Chronic Load Base Increased Likelihood of Loading Spike Upon RTS

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Does load management play a role in secondary ACL injury?

Grindem et al, Br J Sports Med, 2016

45.5% second knee injury within 2 months

Paterno et al, Am J Sports Med, 2014

30.4% second ACL injury < 20 AEs 52.2% second ACL injury < 72 AEs (short as 3 mos)

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Does load management play a role in secondary ACL injury?

45.5% second knee injury within 2 months 30.4% second ACL injury < 20 AEs 52.2% second ACL injury < 72 AEs (short as 3 mos)

Greatest increase in acute loading occurs likely occurs in first 2-3 months following return to sport Increased Likelihood of Loading Spike Upon RTS Need to Monitor and Manage for Safe RTS

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Record loads (in & out of rehabilitation) Understand load demands upon unrestricted RTS Establish moderate chronic load base prior to RTS initiation Minimize week-to- week fluctuations (acute load spike) Establish a chronic load base ≥ sport demands

Systematic Approach to Return to Sport Load Monitoring & Management

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Record loads (in & out of rehabilitation) Understand load demands upon unrestricted RTS Establish moderate chronic load base prior to RTS initiation Minimize week-to- week fluctuations (acute load spike) Establish a chronic load base ≥ sport demands

Monitor load 4-6 weeks prior to RTS testing

  • Establish chronic training

load at RTS testing

  • Chronic Training Load =

average training load

  • ver past 4-weeks
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Record loads (in & out of rehabilitation) Understand load demands upon unrestricted RTS Establish moderate chronic load base prior to RTS initiation Minimize week-to- week fluctuations (acute load spike) Establish a chronic load base ≥ sport demands

Establish a floor & ceiling

  • f safe loading
  • Understand the typical

load demands during unrestricted RTS

  • Frequency of training /

games

  • Duration of training /

games

  • Intensity of training /

games

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Record loads (in & out of rehabilitation) Understand load demands upon unrestricted RTS Establish moderate chronic load base prior to RTS initiation Minimize week-to- week fluctuations (acute load spike) Establish a chronic load base ≥ sport demands

Chronic moderate to high training loads are protective

  • Minimize risk of acute

load spike upon RTS

  • Is the athlete’s chronic

load (4 weeks prior to RTS) at or near the load demands of sport?

  • Within 10%
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Record loads (in & out of rehabilitation) Understand load demands upon unrestricted RTS Establish moderate chronic load base prior to RTS initiation Minimize week-to- week fluctuations (acute load spike) Establish a chronic load base ≥ sport demands

Continue monitoring following RTS

  • Maintain acute to chronic

load ratio < 1.5

  • Avoid load increases

>10% from week to week

  • In case of load spike:
  • Monitor closely
  • Reduce weekly load

increases over next 4- weeks

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Record loads (in & out of rehabilitation) Understand load demands upon unrestricted RTS Establish moderate chronic load base prior to RTS initiation Minimize week-to- week fluctuations (acute load spike) Establish a chronic load base ≥ sport demands

Gradually increase load demands above the avg. loads in sport

  • Chronic load base equal

to the average load demands in sport may not be adequate

  • Only prepared to tolerate

50% of the actual load in unrestricted sport

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Case Example - Training Loads in Soccer

Daily Load Avg (SD) Duration (min) 75 (26) Total distance (miles) 3.8 (1.14) High speed distance (miles) 0.15 (0.14) Heart Rate Max (%) 65.7 (5.7) Session RPE (0-10 scale) 4.7 (2.5)

Malone et al, Int J Sports Physiol Perform, 2015

Consider the individual’s loading history since ACLR until time of RTS? Chronic Load = 4 weeks prior to RTS

Projected Acute Load at RTS

  • 4 practices + 1 game during week
  • 6.25 training hours / week
  • 19 miles / week
  • 0.75 miles high speed running / week
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Case Example - Training Loads During Rehabilitation Until RTS

Weeks 1-6 Weeks 7-12 Weeks 13-20 Weeks 20+

Minimize pain & swelling Low to moderate intensity strengthening, endurance, & NM control exercises Increase intensity of strengthening, endurance, & NM control exercises Increasing intensity of plyometric, agility, & NM control exercises (multi- planar) Full symmetrical knee extension Single leg stability Low to moderate intensity plyometric & agility exercises Perform sport specific drills Normal gait Multi-planar loading Cardiovascular fitness Restore voluntary quadriceps activation RTS Testing

0% 5-10% 20-30% 40% Relative to Training Loads in Soccer 6.25 hrs/wk; 19 miles/wk; 0.75 miles high speed running/wk; 4.7 RPE

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Case Example - Training Loads During Rehabilitation Until RTS

Weeks 1-6 Weeks 7-12 Weeks 13-20 Weeks 20+

Minimize pain & swelling Low to moderate intensity strengthening, endurance, & NM control exercises Increase intensity of strengthening, endurance, & NM control exercises Increasing intensity of plyometric, agility, & NM control exercises (multi- planar) Full symmetrical knee extension Single leg stability Low to moderate intensity plyometric & agility exercises Perform sport specific drills Normal gait Multi-planar loading Cardiovascular fitness Restore voluntary quadriceps activation RTS Testing

0% 5-10% 20-30% 40% Relative to Training Loads in Soccer Prior to Injury (RTS loads)

6.25 hrs/wk; 19 miles/wk; 0.75 miles high speed running/wk; 4.7 RPE

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Unable to Train Recovering from Injury

Meters of High Velocity Running (90-100% of Maximum Velocity)

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Unable to Train Recovering from Injury Return to Sport

Meters of High Velocity Running (90-100% of Maximum Velocity)

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Unable to Train Recovering from Injury Return to Sport

Meters of High Velocity Running (90-100% of Maximum Velocity)

X X X X X X X X X X X X X X X X X X X X

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Unable to Train Recovering from Injury Return to Sport

Meters of High Velocity Running (90-100% of Maximum Velocity)

X X X X X X X X X X X X X X X X X X X X

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Unable to Train Recovering from Injury Loading Spike Return to Sport

Meters of High Velocity Running (90-100% of Maximum Velocity)

X X X X X X X X X X X X X X X X X X X X

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Unable to Train Recovering from Injury Loading Spike Return to Sport On-Field Load Reduction (Fatigue)

Meters of High Velocity Running (90-100% of Maximum Velocity)

X X X X X X X X X X X X X X X X X X X X

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Unable to Train Recovering from Injury Loading Spike Return to Sport On-Field Load Reduction (Fatigue) Secondary ACL Injury

Meters of High Velocity Running (90-100% of Maximum Velocity)

X X X X X X X X X X X X X X X X X X X X

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10 20 30 40 50 60 70 80 90 100

% of Healthy Control Athlete External Training Load

2 Months Prior to RTP

Secondary Injury Case No Secondary Injury Case

RTP

Secondary Injury

Manage the Load Upon RTS

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Key Points

  • High risk of secondary injury (~30%) upon RTS following ACLR
  • Training load monitoring and management may help mitigate secondary injury

risk (direct research is needed)

  • Recommendations:

– Monitor training load before and after RTS – Do not increase acute load (1 wk) more than 1.5x above chronic load (4 wk)

  • >10% load increase  ↑ injury risk for next 4 weeks

– Incrementally increase acute load until matching and exceeding the load demands of full participation in sport / activity