Abstract
Aim: Relationships between athlete monitoring-derived variables and injury risk have been investigated predominantly in isolation. The aim of this study was to evaluate the individual and combined effects of multiple factors on the risk of soft-tissue non-contact injuries in elite team sport athletes.Methods: Fifty-five elite Australian footballers were prospectively monitored over two consecutive seasons. Internal and external training load was quantified using the session rating of perceived exertion and GPS/accelerometry, respectively. Cumulative load and acute-to-chronic workload ratios were derived using rolling averages and exponentially weighted moving averages. History of injuries in the current and previous seasons was recorded along with professional experience, weekly musculoskeletal screening, and subjective wellness scores for individual athletes. Individual and combined effects of these variables on injury risk were evaluated with generalized linear mixed models.Results: High cumulative loads and acute-to-chronic workload ratios were associated with increased risk of injuries. The effects for measures derived using exponentially weighted moving averages were greater than those for rolling averages. History of a recent injury, long-term experience at professional level, and substantial reductions in a selection of musculoskeletal screening and subjective wellness scores were associated with increased risk. The effects of high cumulative loads were underestimated by ~20% before adjusting for previous injuries, whereas the effects of high acute-to-chronic workload ratios were overestimated by 10–15%. Injury-prone players, identified via player identity in the mixed model, were at > 5 times higher risk of injuries compared to robust players (hazard ratio 5.4, 90% confidence limits 3.6–12) despite adjusting for training load and previous injuries. Combinations of multiple risk factors were associated with extremely large increases in risk; for example, a hazard ratio of 22 (9.7–52) was observed for the combination of high acute load, recent history of a leg injury, and a substantial reduction in the adductor squeeze test score.Conclusion: On the basis of our findings with an elite team of Australian footballers, the information from athlete monitoring practices in team sports should be interpreted collectively and used as a part of the injury prevention decision-making process along with consideration of individual differences in risk.
Highlights
Injuries can negatively affect team performance and impose substantial costs to sports clubs (Hägglund et al, 2013)
High smoothed acute-to-chronic workload ratios (ACWR) was associated with the largest absolute risk of injury compared to all other training load measures
Having 7+ years of professional experience and substantial reductions in sit-and-reach test, adductor squeeze tests, and mood were associated with a higher risk of injuries, and the effects of these risk factors were not confounded by training load and history of previous injuries
Summary
Injuries can negatively affect team performance and impose substantial costs to sports clubs (Hägglund et al, 2013). Quantification of injury risk factors through athlete monitoring is common practice in elite sports settings for the main purpose of injury prevention (Taylor et al, 2012; Akenhead and Nassis, 2016). These practices include monitoring individual training loads as well as the athletes’ response to training through measures such as regular musculoskeletal screening and subjective wellness (Morgan et al, 2014; Colby et al, 2017b). Non-modifiable injury risk factors such as professional experience and history of previous injuries affect training prescription and load modification practices (Rogalski et al, 2013; Blanch and Gabbett, 2016). The primary aim of this study was to evaluate the individual and combined effects of multiple factors on the risk of soft tissue non-contact injuries, and possible confounding effects between the risk factors
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