Load Management

Original Editor - Wanda van Niekerk

Top Contributors - Wanda van Niekerk, Admin, Tarina van der Stockt, Rachael Lowe, 127.0.0.1, WikiSysop and Lucinda hampton

Introduction[edit | edit source]

Athlete.jpeg

Load management is defined as the deliberate temporary reduction of external physiological stressors intended to facilitate global improvements in athlete wellness and performance while preserving musculoskeletal and metabolic health. Basically, you reduce the amount of training and/or competition an athlete takes on to help them recover better and perform better over the long term.[1]

  • Over the last few decades sport has become a competitive, professionalised industry.[2] Athletes have to deal with fuller competition calendars and face increasingly higher pressure to stay competitive.[3]  There is good evidence for load management to prevent illness and overtraining in athletes.[3]
  • Poorly managed training loads in conjunction with the full competition calendar may influence the health of athletes.[4][5][6] The balance between external load and tissue capacity plays a significant role in injury[7] and although there are various intrinsic and extrinsic factors[8] involved in injuries, there is evidence to suggest that load management is a key risk factor for injury.[9]

The relationship between load and health is considered as a well-being continuum, with load and recovery as mutual counter agents.[3] Also, during rehabilitation processes, initially, we might consider reducing the load to allow pain to settle and allow gentle specific exercise prescription. Later we will gradually increase the load by progressing the exercise prescription appropriate for restoring normal function specific for an individual and their disorder as symptoms allow.

Terminology[edit | edit source]

The IOC Consensus statement on load management[3] defines load as "the sport and non-sport burden (single or multiple physiological, psychological or mechanical stressors) as a stimulus that is applied to a human biological system (including subcellular elements, a single cell, tissues, one or multiple organ systems, or the individual). Load can be applied to the individual human biological system over varying time periods (seconds, minutes, hours to days, weeks, months and years) and with varying magnitude (i.e. duration, frequency and intensity)."[3]

  • External load refers to any external stimulus applied to the athlete that is measured independently of their internal characteristics.[10]
  • Internal load refers to the physiological and psychological response in an individual following the application of an external load.[10]

Monitoring of load and injury[edit | edit source]

Monitoring athletes is essential in order to define the relationship between load and risk of injury in the management of athletes as well as in research. This includes not only the accurate measurement and monitoring of the external and internal loads on the athlete but also the performance, emotional well-being, symptoms and injuries of the athlete.[3]

Benefits of scientific monitoring[edit | edit source]

  • explain changes in performance
  • increased understanding of training responses
  • identification of fatigue and accompanying needs for recovery
  • informing the planning and modification of training programmes as well as competition calendars
  • ensuring therapeutic levels of load to minimise the risk of non-functional over-reaching (fatigue lasting weeks to months), injury and illness[3][10]

Monitoring external and internal loads[edit | edit source]

Different measures of load are available, but the evidence for their validity as markers of adaptation and maladaptation is limited.[3] There is no single marker of an athlete's response to load that consistently predicts maladaptation or injury.[11][12]

Examples of measurement tools to monitor external loads[edit | edit source]

  • Training or competition time[13]
  • Training or competition frequency[14]
  • Type of training or competition[15]
  • Time-motion analysis[16]
  • Power output, speed, acceleration[17]
  • Neuromuscular function (eg. jump test, isokinetic dynamometry and plyometric push-up)[18]
  • Movement repetition counts (eg, jumps, throws, pitches, serves, bowls)[19]
  • Distance (eg kilometres run, swam or cycle)[20]
  • Acute:chronic load ratio[21]

Examples of measurement tools to monitor internal loads[edit | edit source]

  • Perception of effort (eg, rate of perceived exertion-RPE)[22]
  • Session rating of perceived effort (session duration (min) x RPE)[22]
  • Psychological inventories (eg, profile of mood states (POMS)[23]; Recovery stress questionnaire for athletes (REST-Q- Sport)[24]
  • Sleep (e.g. sleep quality and sleep duration)[25]
  • Biochemical/hormonal/immunological assessments[10]
  • Heart rate (HR)[26]
  • HR to RPE ratio[27]
  • HR recovery (HRR)[28]
  • HR variability (HRV)[29]
  • Blood lactate concentrations[30]
  • Blood lactate to RPE ration[31]

Monitoring external load is key to understanding the work completed, the capabilities of the athlete as well as the athlete's capacity. Internal load monitoring is vital in establishing the appropriate stimulus necessary for ideal biological change.[3] It is evident that individuals will respond differently to any given stimulus and that the load required will differ for each individual. There is no "one size fits all" solution.[3]

Practical guidelines for load management[edit | edit source]

The overall aim of proper load management is to ideally construct training, competition and other loads to enhance adaptation and maximise performance whilst also reducing the risk of injury.[3] It, therefore, entails the correct prescription of load as well as the correct monitoring and change in external and internal loads.

Prescribing training and competition load[edit | edit source]

  • High loads may have either positive or negative effects on injury risks in athletes. The key factors are the rate of load application and the intrinsic risk profile of the athlete. Athletes respond significantly better to smaller increases and decreases in load, than big variations in loading. Different sports will have different load-injury profiles. Current evidence from sports such as Australian football, cricket and rugby league recommends that athletes should limit weekly increases of their training load to less than 10% or maintain an acute: chronic load ratio within a range of 0.8 - 1.3, in order to maintain in positive adaptation and therefore reduce the injury risk.
    • Acute load is the absolute workload done in 1 week and chronic load is the average acute workload done in 4 weeks. The ratio between acute and chronic shows if the acute workload is greater or less than the total workload of the weeks before it[32]
    • An acute: chronic workload of 0.5 means that the athlete trained/competed half of what was prepared for the 4 weeks prior[33]
    • A ratio of 2.0 means the athlete did twice as much, anything more than 1.5 is seen as a spike in training and could be seen as an injury risk.[33]
[34]
[35]
[36]
  • In football, it has been shown that playing two matches (i.e., less than 4 days recovery between matches), compared to one match per week, increases the risk of injury. It is therefore suggested that football teams should contemplate squad rotations to protect individual players from large increases in match loads which may put them at higher risk of injury.
  • There is no "one size fits all" principle. Load should be prescribed or recommended on an individual and flexible basis, as there is a large variation in the time frame of response and adaptation to load.
  • The load management in developing athletes should be monitored closely, as these athletes are at higher risk for injury when introduced to new loads, changes in load or difficult competition calendars.
  • The prescription of training and/or competition loads should be guided by the variation in an athlete's psychological stressors.
  • Adequate recovery sessions should be incorporated after intensive training periods, competitions and travel. Furthermore, care should be given to nutrition, hydration, sleep, rest, active rest, relaxation strategies and emotional support.
  • The health of the athlete is paramount and sports governing bodies should consider this when planning their event calendars. Therefore, it is vital that there should be increased coordination between single-sport and multisport event organisers, and the development of a comprehensive calendar of all international sports events.

Monitoring loads[edit | edit source]

Scientific monitoring of an athlete's load is essential for ideal load management, athlete adaptation and injury management in sport.[3]

  • Coaches and support staff should invest in scientific methods to monitor the athlete's load and detect meaningful change.
  • Always monitor load individually.
  • Employ a combination of external and internal load measures relevant and specific to each sport.
  • Subjective load measures are useful and coaches and support staff are encouraged to make use of these measures.
  • Monitor load by using a comprehensive approach that takes into account interaction with other intrinsic and extrinsic factors such as the history of injury, age and sex.
  • Special care should be given to the monitoring of an athlete's acute and chronic workload, as well as the acute: chronic load ratio of an individual athlete.
  • Frequent monitoring is suggested to enable acute adjustments to training and competition loads.

Monitoring of injury[edit | edit source]

Monitoring athletes health can lead to early detection of symptoms and signs of injury, it can aid in early diagnosis and guide the appropriate intervention.[3]

  • On-going scientific injury surveillance systems should be employed in all sports
  • Monitoring tools should be sensitive to acute and overuse injuries, as well as early clinical symptoms such as pain and functional limitations
  • Injury monitoring should be on-going, but at least occur for a period of time (at least 4 weeks) after rapid increases in load.

Misconceptions about Training Load[edit | edit source]

Evidence-based guidelines to reduce workload related injury are often inadequately implemented.[37] Various reasons for this may be:

  • level of expertise or understanding of training load of the management team (medical team, strength and fitness coaches, skills coaches)[37]
  • the individual beliefs of the management team[37]
  • the individual experiences of the management team[37]

These factors create a gap between the evidence supporting training load and its role in injury and the actual training programs prescribed to athletes.[38]

Misconception #1: Load explains all injuries[edit | edit source]

The relationship between training load, performance and injury has been researched extensively.[39] Performance can, in part, be explained by training load - a higher training load is often associated with better performance.

There is also evidence that inappropriately described training load may cause injury (or an increased risk of injury) and pain.[40][41] When considering these findings, one might think that "load explains all injuries."[37]

However, there are many influencing factors of performance and injury. Adaptation to training may be influenced by numerous factors such as:

  • biomechanics[42]
  • emotional stressors[43]
  • lifestyle stressors[44]
  • sleep patterns[45]

It is therefore imperative to understand that the relationship between training load, performance and injury is complex and multifactorial.

Misconception #2: The "10% rule"[edit | edit source]

Hypothetical relationship between chronic training load and weekly changes in training load. Each block represents a 10% increase in weekly training load. Smaller increases (<10%) in weekly training load are recommended when the chronic training load is either extremely low or extremely high (indicated by red blocks). Larger increases (>10%) in weekly training load are likely to be well tolerated by athletes with moderate to high chronic load and may be necessary to accelerate the rehabilitation process (indicated by green blocks).[46]

A common method to introduce graded increases in training load is by using the 10% rule, where the guideline is that the training load increase should not exceed 10% per week. Although it has been shown that rapid increases in training load increase the risk of injury[47], there is no 10% rule. It is important to understand that risk of injury ≠ rate of injury.[37]

Changes in training load should be interpreted in relation to the chronic training load of the individual athlete. For example, an athlete with a low chronic training load who introduces small weekly increases in training load (≤ 10%), will have a delayed return to full capacity. On the other end, an athlete with a high chronic training load may only be able to tolerate smaller increases in training load.[37]

Smaller increases in training load (≤10%) can be recommended in athletes with either an extremely low chronic training load or in athletes with an extremely high chronic training load. Athletes with moderate to high chronic training loads may be able to tolerate larger increases (≥10%) in weekly training load.[37] These increases may also be needed to accelerate the rehabilitation process.

The 10% rule should rather be seen as a guideline rather than a rule or code.

Misconception #3: Avoid "spikes" and "troughs" at all costs[edit | edit source]

The acute: chronic work rate ratio (ACWR) is determined by the acute training load (size of the current week's training load) in relation to the chronic training load (longer-term training load). In various sports, it has been shown that rapid increases ("spikes") in training load have been associated with increases in injury risk.[21] An ACWR between 0.8 and 1.3 (meaning that the acute training load is more or less equal to the chronic training load) indicates that the risk of injury is relatively low. But, if the acute training load is much greater than the chronic training load and the ACWR is ≥ 1.5, there is an increased risk of injury. It has been suggested that athletes should therefore keep their ACWR ≤1.5 to minimise the risk of injury.[21] However, the nature of injuries is multifactorial. It is also evident that some athletes sustain injuries even with their ACWR ≤ 1.5 and other athletes can tolerate ACWR ≥ 1.5. This indicates that even if an athlete is at risk of injury, the injury might never happen. "Risk does not equal rate."[37]

There is also the possibility that too little training ("troughs" in workload) may also increase the risk of injury.[48] Overtraining and undertraining may therefore both contribute to the increased risk of injury.[37] Undertraining leaves athletes underprepared for competition demands and generally "troughs" in workload precedes "spikes" in workload. Although these changes in training workload can increase injury risk, it does not mean that practitioners should never rapidly increase training load or unload athletes.[37] Evidence shows that high-intensity training blocks do facilitate greater physiological adaptations and athletes who reduce their training load during the taper period have an improvement in performance.[49][50]

Misconception #4: 1.5 is the magic ACWR[edit | edit source]

As mentioned earlier, an ACWR ≥ 1.5 indicates that an athlete may be at an increased risk of injury, but this 1.5 ACWR is not a magic number. (Remember: Risk does not equal rate). Using the ACWR as a method to predict injury will not work as the nature of injuries are multifactorial.[51]

Relationship between workload, perceptual well-being and physical preparedness. Age, injury history, training history, lower body strength, aerobic fitness and heart rate variability have been shown to moderate the workload—injury relationship. Adaptation is influenced by biomechanical factors, academic and emotional stress, anxiety and sleep.

Moderators of the workload - injury relationship may explain why some athletes can't cope with an ACWR of ≤ 1.5 and why some athletes can cope with ACWR of ≥1.5. These moderators act to increase or decrease an athlete's risk of injury at a given workload.[52] Some of the known moderators include:

  • age[53]
  • training history
  • injury history
  • physical qualities

Instead of only focusing on the ACWR, practitioners should aim to stratify athletes according to these moderators and interpret training load variables in conjunction with well-being and physical readiness data, as well as the various factors that may influence the risk of injury. It is advised that practitioners should incorporate their knowledge of individual level risk factors (screening measures), physical quality tests (strength, aerobic fitness) and training load data in order to minimise the risk of injury to the athlete and to also improve performance.[37]

Misconception #5: It's all about the ratio[edit | edit source]

The ACWR is not the only thing that practitioners should be concerned about. Chronic training workload is important and its role in keeping athletes injury-free is easily overlooked. Evidence has shown that although spikes in training workload increase the risk of injury, athletes with higher chronic workloads have a significantly lower risk of injury than athletes with low chronic training workloads.

Remember: Training has a protective effect! For example:

  • exposure to load, allows the body to tolerate load[54]
  • training develops physical qualities (i.e. strength, aerobic fitness) that are associated with a reduced risk of injury.[54]
[55]
[56]

The Future of Load Management for Practitioners and Researchers[edit | edit source]

Future research into training load and how to debunk the misconceptions/myths around load management is necessary.[37]

Pushing the boundaries[edit | edit source]

Training helps an athlete's body to tolerate the load. To develop "robustness" in athletes, some limits need to be pushed. Evidence shows us that an ACWR of more than 1.5 increases an athlete's risk of injury, but by moving the ACWR -injury curve to the right (through athletes being able to tolerate more load because of training) it may allow athletes to:

  • have a reduced risk of injury at the same ACWR[37]
  • have a similar risk of injury at a higher ACWR[37]

The best approach to achieve this still needs to be determined.

How much sport is too much?[edit | edit source]

Many sports (i.e. football, basketball, ice hockey, baseball) require athletes to play multiple games per week and the number of competitive games per season is extremely high. Evidence has shown that high chronic training workloads are associated with lower injury rates, but not all athletes can safely cope with such a high and intense competition calendar. On the other hand, athletes still need to be able to play a minimum amount of games or minutes to maintain their fitness levels and health. Research needs to focus on:[37]

  • the total amount of games athletes can play without compromising their health and well-being in specific sports
  • the optimal number of games athletes can play in succession before requiring rest is warranted
  • the intensity of games/matches needs to be captured - this will provide greater insight into injury risk

Early loading is important when returning from injury[edit | edit source]

When rehabilitating athletes with injuries, healthcare providers need to understand the balance between developing adequate training loads to prevent reinjury and the need to return the athlete to play in the safest and quickest amount of time.[37] Recent research has compared the effect of early rehabilitation ( 2 days post-injury) or delayed rehabilitation (9 days post-injury) in athletes with acute thigh and calf injuries.[57] The study reported that earlier loading after an initial injury shortened the return to playtime without increasing the risk of reinjury. Furthermore, most sports injuries are not life-threatening and career-ending and athletes need to understand that some intolerance to training is usually temporary.

Gabbett[37] suggests that:

  • temporary training intolerance is to be expected after an initial injury and during the phases of tissue repair, but that it is unlikely to lead to long term intolerance
  • early loading may lead to a quicker return to play
  • focusing on developing high chronic training workloads that may protect against subsequent injury, may delay return to play
  • high sprinting workloads may protect an athlete against subsequent injury if attained gradually

[58]


Loading patterns and tissue response[edit | edit source]

A limited amount of research with large data sets is available on loading patterns and various tissue response, but from these studies, it is evident that the response of different tissue types will vary according to different loading patterns.[59] More research with large data sets is necessary to understand the loading tolerances of various tissue types. Furthermore, research into workload variables, loading patterns and specific injuries is needed.

Multiple moderators?[edit | edit source]

Competition level, age and playing experience are all moderators that can influence the response to training load. It is possible that:[37]

  • there may be a difference in the workload-injury relationship between elite, senior athletes and junior athletes
  • there may be a difference in the injured tissue type between older and younger athletes
  • both younger and older athletes at increased risk of injury when exposed to training workload "spikes"

See also[edit | edit source]

Principles of exercise rehabilitation

A great summary on load management is also available at Balancing training load and tissue capacity. by T. Goom, Running physio,2015.

References[edit | edit source]

  1. ↑ Stack What Is ‘Load Management’ and Why Does it Matter for Athletes? Available: https://www.stack.com/a/what-is-load-management-and-why-does-it-matter-for-athletes/ (accessed 27.11.2021)
  2. ↑ Hill J. Sport in history: an introduction. London: Palgrave Macmillan, 2010.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Soligard T, Schwellnus M, Alonso J, et al How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. British Journal of Sports Medicine 2016;50:1030-1041.
  4. ↑ McCall A, Carling C, Nedelec M, et al. Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues. Br J Sports Med 2014;48:1352–7
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  6. ↑ McCall A, Dupont G, Ekstrand J. Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams’ head medical officers. Br J Sports Med 2016;50:725–30.
  7. ↑ Kibler WB, Chandler TJ, Stracener ES. Musculoskeletal adaptations and injuries due to overtraining. Exerc Sport Sci Rev 1992;20:99–126. 
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  29. ↑ Plews DJ, Laursen PB, Stanley J, et al. Training adaptation and heart rate variability in elite endurance athletes: opening the door to effective monitoring. Sports Med 2013;43:773–81
  30. ↑ Beneke R, Leithauser RM, Ochentel O. Blood lactate diagnostics in exercise testing and training. Int J Sports Physiol Perform 2011;6:8–24
  31. ↑ Snyder AC, Jeukendrup AE, Hesselink MK, et al. A physiological/psychological indicator of over-reaching during intensive training. Int J Sports Med 1993;14:29–32
  32. ↑ Bowen L, Gross AS, Gimpel M, Li FX. Accumulated workloads and the acute: chronic workload ratio relate to injury risk in elite youth football players. Br J Sports Med. 2016 Jul 22:bjsports-2015 [Accessed 11 July 2018]
  33. ↑ 33.0 33.1 Blanch P, Gabbett TJ. 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. 2016 Jan 8:bjsports-2015 [Accessed 11 July 2018]
  34. ↑ Nicole Surdyka. Talking Training Load with Tim Gabbett - Part 1. Published on 9 July 2019. Available from: https://www.youtube.com/watch?v=KOmhKCtnlMY&t=55s [last accessed 3 January 2020]
  35. ↑ Metrifit. Training Smarter AND Harder with Dr Tim Gabbett. Published on 20 December 2016. Available from:https://www.youtube.com/watch?v=3koSvb8umGk&t=1230s [last accessed 3 January 2020]
  36. ↑ Physioworks, Sports and Wellness, Inc. Acute Chronic Workload Ratio. Published on 25 January 2018.Available from: https://www.youtube.com/watch?v=4YV0Qe0amdE&t=113s [last accessed 3 January 2020]
  37. ↑ 37.00 37.01 37.02 37.03 37.04 37.05 37.06 37.07 37.08 37.09 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 Gabbett T.J. Debunking the myths about training load, injury and performance: empirical evidence, hot topics and recommendations for practitioners. British Journal of Sports Medicine 2020;54:58-66.
  38. ↑ Gabbett T.J., Blanch P. Research, urban myths and the never ending story. British Journal of Sports Medicine 2019;53:592-593.
  39. ↑ Eckard, T.G., Padua, D.A., Hearn, D.W. et al. The Relationship Between Training Load and Injury in Athletes: A Systematic Review. Sports Med 48, 1929–1961 (2018).
  40. ↑ Dakic JG , Smith B , Gosling CM , et al . Musculoskeletal injury profiles in professional Women’s Tennis Association players. Br J Sports Med 2018;52:723–9
  41. ↑ Newlands C , Reid D , Parmar P . The prevalence, incidence and severity of low back pain among international-level rowers. Br J Sports Med2015;49:951–6.
  42. ↑ Vanrenterghem J , Nedergaard NJ , Robinson MA , et al . Training load monitoring in team sports: a novel framework separating physiological and biomechanical load-adaptation pathways. Sports Med2017;47:2135–42.
  43. ↑ Ivarsson A , Johnson U , Andersen MB , et al . Psychosocial factors and sport injuries: meta-analyses for prediction and prevention. Sports Med2017;47:353–65
  44. ↑ Li H , Moreland JJ , Peek-Asa C , et al . Preseason anxiety and depressive symptoms and prospective injury risk in collegiate athletes. Am J Sports Med 2017;45:2148–55.
  45. ↑ Milewski MD , Skaggs DL , Bishop GA , et al . Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop2014;34:129–33.
  46. ↑ Gabbett TJDebunking the myths about training load, injury and performance: empirical evidence, hot topics and recommendations for practitioners. British Journal of Sports Medicine 2020;54:58-66.
  47. ↑ Piggott B , Newton MJ , McGuigan MR . The relationship between training load and incidence of injury and illness over a pre-season at an Australian Football League club. J Aust Strength Cond 2009;17:4–17
  48. ↑ Stares J , Dawson B , Peeling P , et al . Identifying high risk loading conditions for in-season injury in elite Australian football players. J Sci Med Sport 2018;21:46–51.
  49. ↑ Fernandez-Fernandez J , Sanz-Rivas D , Sarabia JM , et al . Preseason training: the effects of a 17-day high-intensity shock microcycle in Elite tennis players. J Sports Sci Med 2015;14:783–91
  50. ↑ Bosquet L , Montpetit J , Arvisais D , et al . Effects of tapering on performance: a meta-analysis. Med Sci Sports Exerc 2007;39:1358–65.
  51. ↑ Hulin BT , Gabbett TJ . Indeed association does not equal prediction: the never-ending search for the perfect acute:chronic workload ratio. Br J Sports Med 2019;53:144–5
  52. ↑ Windt J , Zumbo BD , Sporer B , et al . Why do workload spikes cause injuries, and which athletes are at higher risk? Mediators and moderators in workload-injury investigations. Br J Sports Med 2017;51:993–4
  53. ↑ Blanch P , Orchard J , Kountouris A , et al . Different tissue type categories of overuse injuries to cricket fast bowlers have different severity and incidence which varies with age. S Afr J Sports Med 2015;27:108–13
  54. ↑ 54.0 54.1 Malone S , Roe M , Doran DA , et al . Protection against spikes in workload with aerobic fitness and playing experience: the role of the acute:chronic workload ratio on injury risk in elite gaelic football. Int J Sports Physiol Perform 2017;12:393–401
  55. ↑ Tim Gabbett. The myths of load management. Available from https://www.youtube.com/watch?v=SXByALyvMgc. Published on 13 January 2020. (last accessed 27 March 2020)
  56. ↑ Tim Gabbett. Should athletes be training smarter and harder. Available fromhttps://www.youtube.com/watch?v=aRcpVR9Fe6M. Published on 25 January 2020. (last accessed 31 March 2020)
  57. ↑ Bayer ML , Magnusson SP , Kjaer M . Tendon Research Group Bispebjerg. Early versus delayed rehabilitation after acute muscle injury. N Engl J Med 2017;377:1300–1
  58. ↑ Tim Gabbett. Preparing athletes for the worst case scenario. Available from https://www.youtube.com/watch?v=3x6XF1JTGvc. Published on 25 March 2020. (last accessed 31 March 2020)
  59. ↑ Orchard JW , Blanch P , Paoloni J , et al . Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries. Br J Sports Med 2015;49:1064–8.


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