Load Management

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Introduction[edit | edit source]

Over the last few decades sport has become a competitive, professionalised industry.[1] Athletes have to deal with fuller competition calendars and face increasingly higher pressure to stay competitive.[2] Consequently, athletes of all levels as well as their coaching staff are relentlessly aiming to improve performance[2]. Although there are a multitude of factors that can contribute, the main factor athletes focus on is usually their training methods.[2] Training and competition load causes a series of homeostatic responses and adaptations in the human body.[3] [4][5] The key factor in training theory is to implement this process of biological adaptation to improve fitness and eventually improve performance.[5] Furthermore, a principal goal in rehabilitation is improving capacity to manage load and this has been discussed in the literature in relation to tendinopathy[6] and cartilage repair[7].  There is also good evidence for load management to prevent illness and over-training in athletes.[2][8]

Poorly managed training loads in conjunction with the full competition calendar may influence the health of athletes.[9][10][11] The balance between external load and tissue capacity plays a significant role in injury[12] and although there are various intrinsic and extrinsic factors[13] involved in injuries, there is evidence to suggest that load management is a key risk factor for injury.[14]

The relationship between load and heath is considered as a well-being continuum, with load and recovery as mutual counter agents.[2] Also,during rehabilitation processes, initially we might consider reducing load to allow pain to settle and allow gentle specific exercise prescription. Later we will gradually increase load by progressing the exercise prescription appropriate for restoring normal function specific for an individual and their disorder as symptoms allow.

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Terminology[edit | edit source]

The IOC Consensus statement on load management[2] 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)."[2]

External load refers to any external stimulus applied to the athlete that is measured independently of their internal characteristics.[15] Internal load refers to the physiological and psychological response in an individual following the application of an external load.[15]

Monitoring of load and injury[2][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.[2]

Benefits of scientific monitoring[2][edit | edit source]

  • explaining changes in performance
  • increased understanding of training responses
  • identifying 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[2][15]

Monitoring external and internal loads[2][edit | edit source]

Different measures of load are available, but the evidence for their validity as markers of adaptation and maladaptation is limited.[2] There is no single marker of an athlete's response to load that consistently predicts maladaptation or injury.[16][17]

Examples of measurement tools to monitor external loads[2][edit | edit source]

  • Training or competition time[18]
  • Training or competition frequency[19]
  • Type of training or competition[20]
  • Time-motion analysis[21]
  • Power output, speed, acceleration[22]
  • Neuromuscular function (eg. jump test, isokinetic dynamometry and plyometric push-up)[23]
  • Movement repetition counts (eg, jumps, throws, pitches, serves, bowls)[24]
  • Distance (eg kilometres run, swam or cycle)[25]
  • Acute:chronic load ratio[26]

Examples of measurement tools to monitor internal loads[2][edit | edit source]

  • Perception of effort (eg, rate of perceived exertion RPE)[27]
  • Session rating of perceived effort (session duration (min) x RPE)[27]
  • Psychological inventories (eg, profile of mood states (POMS)[28]; Recovery stress questionnaire for athletes (REST-Q- Sport)[29]
  • Sleep (eg sleep quality and sleep duration)[30]
  • Biochemical/hormonal/immunological assessments[15]
  • Heart rate (HR)[31]
  • HR to RPE ratio[32]
  • HR recovery (HRR)[33]
  • HR variability (HRV)[34]
  • Blood lactate concentrations[35]
  • Blood lactate to RPE ration[36]

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.[2] 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.[2]

Practical guidelines for load management[2][edit | edit source]

The overall aim of proper load management is to ideally construct training, competition and other load to enhance adaptation and maximise performance whilst also reducing the risk of injury.[2] 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[2][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
  • In football it has been shown that playing two matches (ie, 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 an increased coordination between single-sport and multisport event organisers, and the development of a comprehensive calendar of all international sports events.

Monitoring loads[2][edit | edit source]

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

  • 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 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[2][edit | edit source]

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

  • 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.

See also[edit | edit source]

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. ↑ Hill J. Sport in history: an introduction. London: Palgrave Macmillan, 2010.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 Schwellnus M, Soligard T, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, Gabbett TJ, Gleeson M, Hägglund M, Hutchinson MR, Van Rensburg CJ. 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 Sep 1;50(17):1030-41.
  3. ↑ Booth FW, Thomason DB. Molecular and cellular adaptation of muscle in response to exercise: perspectives of various models. Physiol Rev 1991;71:541–85
  4. ↑ Hawley JA, Hargreaves M, Joyner MJ, et al. Integrative biology of exercise. Cell 2014;159:738–49. 
  5. ↑ 5.0 5.1 Brooks GA, Fahey TD, Baldwin KM. Exercise physiology: human bioenergetics and its applications. 4th edn. New York: McGraw-Hill, 2004
  6. ↑ Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. journal of orthopaedic & sports physical therapy. 2015 Nov;45(11):887-98.
  7. ↑ Hambly, K. The Role of Loading in Cartilage Repair Rehabilitation. Conference Paper, May 2015, International Cartilage Repair Congress, At Chicago.
  8. ↑ Soligard T, Schwellnus M, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, Gabbett T, Gleeson M, Hägglund M, Hutchinson MR, Van Rensburg CJ. 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 Sep 1;50(17):1030-41.
  9. ↑ 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
  10. ↑ McCall A, Davison M, Andersen TE, et al. Injury prevention strategies at the FIFA 2014 World Cup: perceptions and practices of the physicians from the 32 participating national teams. Br J Sports Med 2015;49:603–8
  11. ↑ 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.
  12. ↑ Kibler WB, Chandler TJ, Stracener ES. Musculoskeletal adaptations and injuries due to overtraining. Exerc Sport Sci Rev 1992;20:99–126. 
  13. ↑ Meeuwisse WH, Tyreman H, Hagel B, et al. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med 2007;17:215–19
  14. ↑ Drew MK, Finch CF. The relationship between training load and injury, illness and soreness: a systematic and literature review. Sports Med 2016;46:861–83
  15. ↑ 15.0 15.1 15.2 15.3 Halson SL. Monitoring training load to understand fatigue in athletes. Sports Med 2014;44(Suppl 2):S139–47
  16. ↑ Borresen J, Lambert MI. The quantification of training load, the training response and the effect on performance. Sports Med 2009;39:779–95
  17. ↑ Meeusen R, Duclos M, Foster C, et al. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med Sci Sports Exerc 2013;45:186–205
  18. ↑ Gabbett TJ. Incidence of injury in semi-professional rugby league players. Br J Sports Med 2003;37:36–43
  19. ↑ Dupont G, Nedelec M, McCall A, et al. Effect of 2 soccer matches in a week on physical performance and injury rate. Am J Sports Med 2010;38:1752–8
  20. ↑ Bengtsson H, Ekstrand J, Walden M, et al. Match injury rates in professional soccer vary with match result, match venue, and type of competition. Am J Sports Med 2013;41:1505–10
  21. ↑ Aughey RJ. Applications of GPS technologies to field sports. Int J Sports Physiol Perform 2011;6:295–310
  22. ↑ Jobson SA, Passfield L, Atkinson G, et al. The analysis and utilization of cycling training data. Sports Med 2009;39:833–44.
  23. ↑ Twist C, Highton J. Monitoring fatigue and recovery in rugby league players. Int J Sports Physiol Perform 2013;8:467–74
  24. ↑ Lyman S, Fleisig GS, Andrews JR, et al. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med 2002;30:463–8
  25. ↑ Macera CA. Lower extremity injuries in runners. Advances in prediction. Sports Med 1992;13:50–7
  26. ↑ Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 2016;50:273–80
  27. ↑ 27.0 27.1 Robinson DM, Robinson SM, Hume PA, et al. Training intensity of elite male distance runners. Med Sci Sports Exerc 1991;23:1078–82
  28. ↑ Morgan WP, Brown DR, Raglin JS, et al. Psychological monitoring of overtraining and staleness. Br J Sports Med 1987;21:107–14
  29. ↑ Kellmann M, Kallus KW. The recovery-stress-questionnaire for athletes. Frankfurt: Swets and Zeitlinger, 2000.
  30. ↑ Halson SL. Sleep in elite athletes and nutritional interventions to enhance sleep. Sports Med 2014;44(Suppl 1):S13–23
  31. ↑ Hopkins WG. Quantification of training in competitive sports. Methods and applications. Sports Med 1991;12:161–83
  32. ↑ Martin DT, Andersen MB. Heart rate-perceived exertion relationship during training and taper. J Sports Med Phys Fitness 2000;40:201–8.
  33. ↑ Daanen HA, Lamberts RP, Kallen VL, et al. A systematic review on heart-rate recovery to monitor changes in training status in athletes. Int J Sports Physiol Perform 2012;7:251–60
  34. ↑ 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
  35. ↑ Beneke R, Leithauser RM, Ochentel O. Blood lactate diagnostics in exercise testing and training. Int J Sports Physiol Perform 2011;6:8–24
  36. ↑ 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


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