The mission of the International Journal of Sports Physiology and. Performance (IJSPP) is to advance the knowledge of sport and exercise physiologists,.
International Journal of Sports Physiology and Performance, 2016, 11, 561 -562 http://dx.doi.org/10.1123/IJSPP.2016-0207 © 2016 Human Kinetics, Inc.
EDITORIAL
Training for Elite Sport Performance: Injury Risk Management Also Matters! The mission of the International Journal of Sports Physiology and Performance (IJSPP) is to advance the knowledge of sport and exercise physiologists, sport scientists, sport physicians, and sport-performance researchers [promoting] the publication of research in sport physiology and related disciplines that has direct practical application to enhancing sport performance, preventing decrements in performance, or enhancing recovery of athletes. Nevertheless, of 902 IJSPP articles listed on Medline as of January 2016, only 7 have specifically investigated injuries and only 1 considered the effect of injury incidence on sport performance.1 Recent studies confirmed that there is a significant relationship of injury rates and time loss with performance in elite team sports.2–4 Injuries significantly influenced performance in male professional soccer (European Football) during 11 years of league and European Cup competitions.2 More specifically, higher final league team ranking were associated with lower injury burden (P = .011) and higher match availability (P = .031). Similarly, increased points per league match were associated with lower injury incidence (P = .035), lower injury burden (P < .001), and higher match availability (P < .001).2 Similar results were observed in a professional Middle Eastern soccer league,3 with lower injury rate strongly correlating with team success: team ranking position (r = .929, P = .003), more games won (r = .883, P = .008), more goals scored (r = .893, P = .007), greater goal difference (r = .821, P = .003), and total team ranking points (r = .929, P = .003). Aside from soccer, team success over a 7-year period in professional rugby4 has also been negatively associated with injury measures (70–100% likelihood). Injury-burden reduction of 42 days (90% CI 30–70) per 1000 player hours (22% of mean injury burden) was associated with the smallest worthwhile change in league points tally. Data such as these highlight the importance of evidence-informed injury prevention and management to increase positive match and competition outcomes in elite sport. Risk management is the overall process of identifying, assessing, and controlling risks.5 Relative to sport, this process is not possible without quantifying the incidence and severity of injuries, as well as associated risk factors and mechanisms. One important factor in that regard is to monitor training load. Recently, the relationship between training load and injuries in sport has been discussed.6 Challenging the dogma that high training loads cause high injury rates, many studies across a range of sports have shown that excellent fitness reduces injury risk. Well-structured intensive training can have protective effects against noncontact soft-tissue injuries. On the other hand, undertraining has also been related to increased injury risk. Also, very high and/or steep increases in training load are associated with a substantial increase in risk. For instance, a recent review6 reported a strong relationship (r = .86) between training loads (derived from the session rating of perceived exertion) and training injury rates across a playing season in semiprofessional rugby league players. As a consequence, the acute:chronic workload ratio has been proposed as a promising predictor of training-related
injuries.6 Ideally, future studies should define criteria for establishing appropriate training loads that promote development of physical fitness yet afford an acceptable/minimal risk of injury for reaching peak elite sport performance. Risk (and subsequent injury) management in elite sport should be underpinned by robust longitudinal data. In most sports, there is ample literature describing the incidence, severity, and pattern of injuries that can be expected. However, stakeholders are encouraged to establish their own injury and illness surveillance in their program, preferably using standardized tools and validated measures of training load. There may be some notable differences in the methodology needed to establish valid data between team and collision sports, where acute, traumatic (sudden-onset) injuries are expected to dominate, and technical and endurance sports, where overuse (gradual-onset) problems and illness are more prevalent. Most existing injury-surveillance programs are solely based on team medical personnel’s reports of time-loss injuries. This limitation can result in gross underestimation of the burden of overuse injuries and illness, as demonstrated by Bahr.7 In individual sports, minor to serious injury can negatively affect training and/or competition capacity. Subsequently, athletes and their support staff have managed to develop strategies to maintain training load and competition success despite the many niggles, aches, and health problems encountered along the way.7 However, evidence for this practice is sparse, especially in elite sports, and publications on these issues are encouraged to inform daily practice management of elite athletes. Finally, as detailed in IJSPP,8,9 not only are epidemiological studies welcome but also case studies and brief reports on the injury risk and patterns along with corresponding training loads of elite athletes, especially as they relate to performance. Ultimately, evidence is required for practitioners and stakeholders aiming for elite sport performance to model injury risk and implement riskmanagement strategies (injury prevention) while optimizing injury treatment and management. Karim Chamari Associate Editor, IJSPP Roald Bahr, Aspetar, Doha, Qatar; Sports Trauma Research Center, Oslo, Norway
References 1. de Hoyo M, Pozzo M, Sañudo B, Carrasco L, Gonzalo-Skok O, Domínguez-Cobo S, Morán-Camacho E. Effects of a 10-week in-season eccentric-overload training program on muscle-injury prevention and performance in junior elite soccer players. Int J Sports Physiol Perform. 2015;10(1):46–52. http://dx.doi.org/10.1123/ijspp.2013-0547 PubMed ID:24910951 2. Hägglund M, Waldén M, Magnusson H, Kristenson K, Bengtsson H, Ekstrand J. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League 561
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injury study. Br J Sports Med. 2013;47(12):738–742. doi:10.1136/ bjsports-2013-092215 PubMed ID:23645832. 3. Eirale C, Tol JL, Farooq A, Smiley F, Chalabi H. Low injury rate strongly correlates with team success in Qatari professional football. Br J Sports Med. 2013;47(12):807–808. doi:10.1136/bjsports-2012-091040. PubMed ID:22904292 4. Williams S, Trewartha G, Kemp SP, et al. Time loss injuries compromise team success in Elite Rugby Union: a 7-year prospective study [published online ahead of print November 9, 2015]. Br J Sports Med. doi:10.1136/bjsports-2015-094798 PubMed ID:26552415 5. McIntosh A, Bahr R. Developing and managing an injury prevention program within a team. In: Bahr R, Engebretsen L, ed. Sports Injury Prevention. West Sussex, UK: Wiley-Blackwell; 2009;17–29. Handbook of Sports Medicine and Science. 1st ed. An IOC Medical Commission Publication. ISBN-13:978-1-4051-6244-9
6. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273–280. doi10.1136/bjsports-2015-095788 PubMed ID:26758673 7. Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Br J Sports Med. 2009;43(13):966– 972. doi:10.1136/bjsm.2009.066936 PubMed ID:19945978 8. Beneke R. The brief report: a multitasking, concise feature of high quality. Int J Sports Physiol Perform. 2015;10(4):417. http://dx.doi. org/10.1123/IJSPP.2015-0180 PubMed ID:25928751 9. Mujika I. Sharpshooting in sport science and elite sports training. Int J Sports Physiol Perform. 2015;10(7):821–822. http://dx.doi. org/10.1123/IJSPP.2015-0492 PubMed ID:26437176
IJSPP Vol. 11, No. 5, 2016
