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What is “load” and how does it impact athletes’s risk of injury ?
Torbjorn SOLIGARD
Friday, Sept. 22, 2017 · 2:49 p.m. · 21m 43s
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00:00:01
oh
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little social experiment to see how we can stay silent before people start looking at you weirdly i guess
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um it is the last talk of the day and have to learn start frank boris um for uh
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putting up here for the challenging daunting task of trying to reach through to you this point
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i'm i'm very excited about the topic i'm going to talk about and i hope uh a number
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of you are as well um it is um concerning mode and i want to talk about
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what load in sport yes and how it can impact at these risk of injury
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so first i have one or two slides on why athletes get injured um
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i think it's important to just look at the background and the number
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of speakers have already done so um there are many reasons um
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for why you might get injured uh their intrinsic and extrinsic or a
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risk factors and um these are just a number of them
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some have solid evidence in the literature and others are based more on anecdotal
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um we added in such as you know clinical experience uh which doesn't make them not true
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but we need more work to verify that someone talk about load um and uh
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the one of the big questions i wanted to stay one step
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back and think look at what load really comprise um
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what is the first thing we think about when we think about load in sport
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it's probably training right that's i think that's the first thing that comes to mind circular for me and
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to understand load in the context of sport we need to first understand how athletic training works
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when at the trains or competes he senses still is to the
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body which trigger series of a home you know um
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what's the word on a static responses and accompanying adaptation from various organ systems in the body
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the paramount principle in training theory is to use this process of
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biological adaptation occurring for cycles of appropriate loading and recovery
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to gradually over time increase fitness and intern improve performance
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now uh so so i i come i i'm a physiologist um sort
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of by trade that i crossed over to sports medicine so
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from my point of view i uh i have to say that a young one can only praise the virtues of
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this concept and you know the ability uh shown by this uh this graph
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or bodies are the most amazing and fine tuned organism that is
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able to take almost anything you throw at it um and it will not
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only be able to just puts than load you troll for what it
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but actually returned to higher level um and the moral busts state
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so this concept in graph right here is one of the fundamental pillars of human biology as far as i see it
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and sets the sets the foundation for work uh sports scientists sports mad visit therapists doctors
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for prevention work and uh the work would be would we had from injuries you name it this is key
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for most people in the room to learn how to know when i'm sure you most you already know this is it's it's it's it's quite fundamental
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so if we go back to this screen right here um
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training is listed i think the next one on the list certain it's competition um
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it's normally when i talk about this uh is at least if it's a smaller audience i will ask you guys what what
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would you think it belongs here um and it's not a trick question it's it's it's a very important question and
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and i think one that i would like to put up this what about if the frequency
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of competitions or is that just several games or competitions in the short amount of time
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we see this in the in the number of sports um you know the the sort of calendar saturation kind of thing
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what about here or long distance travel to invent
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now what about getting groceries finding time to get a gift for that's social
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event you're going to preparing for your exam should that be under load
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how about the loss of a family member or good friend or problems with your relationship or parker
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uh_huh
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last year um the international committee set out to try
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to answer some of these questions um so
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a group of experts from around the world were invited to laws on
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and um to tackle the this this issue what is loaded but also more
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important perhaps to try to find out what the relationship of remote is
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to the risk of injury and in the since work so i realise of course this is these are very twos small
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pictures but these are the two papers like a moderate um that's one and you're in one analysis and they're free
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so you can download them for free from the ritual sports medicine
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um and uh this is this is um almost all the people in the group um
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and one of the coming back to the definition of load uh one of the
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t. take away from that meeting that i was really satisfied and happy with was was
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what you see here which is how this consensus group defined load in sport
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and we agreed that load in sport is more than just workload alone
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rather we defined load ass the sport and on sport burden
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consisting single or multiple physiological psychological or mechanical stress hours
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as a stimulus that is applied to a human biological
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system including sub cellular elements a single cell
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tissues one or multiple organ systems or the individual as a whole
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the implications of this definition or tremendous and um
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ooh services so which is the reason why i mention it as one of the
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key she sort of um take a ways for me to um no
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i'll apologise in advance for the um what will turn out as
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a come back slide as like keep clicking on here
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but because the slight you could have you know would would be worthy of a
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conference all of its own so that the topic is how to measure
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load on different types of molds because load can be
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split into a different categories one is external and
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internal load an intern uh sorry extra load
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is defined as a external stimulus apply to the athlete measured independently
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of their internal characteristics or independently of the intern load and
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number of you work with that meets so you will then you know
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uh recognise a number of these examples of measures of how to um
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measures of extra load such as the training a competition time or frequency
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distance so just kilometres run cycle or swam power output very
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popular in cycling and some of the sports not
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speed acceleration sprints also late addition to this list i would say you know through the
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mm introduction of more sort of micro technology unit such as e. g. p. s. and uh monitors
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and movement repetition count searches pitches roles bowls certain jobs
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now on the other side uh it's the
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when an external stimulus is a platter body there's an internal response and
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this is the internal load and that can be measured by um
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nash and physiological psychological or other factors such as these perceptions percent
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perception of effort has been mentioned already here yesterday in
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e. twenty plus psychological invent trees such as profound mood states no these
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aren't many of these are questionnaires to cover stress questionnaire for athletes
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different sleep carriers by can cover mono assessments heart rate based measurements
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and but left lactate concentrations and you will if you look at this is that it does feel you will see
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that some of these are man made most of these are objective measures and some are subjected as well
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and we can discuss um what's is what are better because this is relevant
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to your submissions what which of the should be used to monitor iraqis
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and that's a difficult um discussion there but there is a very helpful systematic
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review that came out last year firms uh and also under coworkers
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and they concluded that subjective measures are more precise than objective
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measures to my surprise i would say um at
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least one some perspective so the the something to discuss um tonight and and and and later on
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alright i think this it's a uh it's fair to say that this
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is perhaps the traditional view of the relationship between load an injury
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service linear relationship where if if you'd grease the load of interest go goes up as well
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and that might be true um and and part of the work of this consensus group was to try to drill down on this issue
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anyway you will notice yes we go on that this is sort of a two dimensional relationship
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you have loaded your injury and learn later that the it might not be that easy
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so i'll um we uh_huh drill down on the literature which is a very
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difficult task especially for this wide um wide field of load an injury
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and that we in the end file uh ended up with
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one hundred and four studies um which we uh analyst
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and uh you can see on the right at the sort of the overall general topics that they covered
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training a competition load 'em mm which consists of the absolute load basically what i just
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showed you just can't you just can't load at the at the dos and
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um that's that's you know that's your absolute load um and then the relative load right below there which is
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um with which takes into account for the rate of remote application so how fast you add on
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load today compared to what you did or have done before
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and then there's the competition calendar congestion no psychological and psycho social
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load and travel load three studies on that as well
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um if we start with the first one and just go straight through here you will see that fifty of
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the studies found well absolute load that uh i'm sorry
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that high absolute load increased interest in athletes
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fifteen of the studies found a high loads did not increase interest so no
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difference there and wasn't nine of them found that high loads decreased injuries
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now there are choose ways um
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or support poorly managed training and competition loads can increase injuries for a variety
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of mechanisms operating either adaptation level or a hole at the level
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right so this quickly go through them or at the tissue level training in competition load can
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lead to biological mal adaptation in the form of excessive tissue micro damage a an injury
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and that is if micro ruptures in the tissue uh_huh
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accumulate faster than they are repaired and regenerated
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so here they are at least two ways that this can happen and the first is
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if the magnitude of loading is beyond the tissues current load bearing capacity
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right so this is sometimes referred to as the envelope of function of the tissue
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or if the recovery between load in such a a loading cycles is insufficient
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again this is not revolutionary but it's the fundamental of how we worked once uh with that it's
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and this mechanism forms the basis of pathological models of a range of overuse injury
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types including bone stress injuries tendon up with the and telephone role playing
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now it has even been suggested that cumulative tissue for t. due to
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repetitive loading may increase athlete susceptibility to injury types that we
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thought were or for that that we think are entirely
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acutely nature such as um anterior crucial ligament ruptures
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but this sorely needs further corroboration because it's from just one study as far
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as i know that has a and found some indications in this direction
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not only am i'm cool athlete level inappropriate loading can increase into risk by
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uncaring factors such as decision making ability coordination and your muscular control
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and uh fifty from training and competition leads to
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reduce muscular force development and contraction a velocity
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these are sort of physiological uh fundamentals that we work uh that we know from i'm working with athletes
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um and though that may in turn 'em increase the forces in post and pass it issues
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it can in turn again adversely alter kinetic schematics and neural feedback
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which can reduce joint stability and therefore contribute to
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increased risk of both acute and overuse injury
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now as alluded to earlier studies on absolute loaded failed to
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take into account um the rate of load application
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um so which is again that just to get this right this is this the
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time component so early wrecked i mention a sort of a two dimensional
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way to look at the relationship between injury unload um
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and that's what these seventeen studies on the relative training load
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a um on the other hand take into account
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and they more or less seems to say the same thing which is that high absolute
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loads might not be the problem but rather excessive in rapid increases in the load
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and i do think this fifth fits well with what is
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shown by these nine studies high loads decreased injuries
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so there there there is a potential link there um hum that we're gonna discuss now now
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i'm sure number of you are from there were familiar with this graph here uh
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you see the name don't in the right corner it's ten guy that um
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he has adapted um oh he's he he units co workers they have um
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describe the uh the ratio between the acute load which is defined as the loading the current we
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the most recent week so the ratio between that load on them and that what they call
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the chronic load which is the average of the load in the last four weeks
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and uh the seventeen studies i just refer to the uh i think more less all of
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them had used this acute chronic low ratio and they have demonstrated that the injury likelihood
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is low when the acute chronic load ratio is within the range
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the green range here from zero point eight one point three
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uh_huh whereas um when the acute chronic
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low ratio exceeds one point five
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in other words the loading the current weeks we used one point five
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times higher than what you did in the last four weeks
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the studies have found that the likelihood of injury um more than doubles
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furthermore uh provided that the athlete reaches these loads in a gradual
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and control fashion there are indications that high loads and
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physically hard training may offer protective effect against injury
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due to the mediating effect on adaptation and the development of physical qualities
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i think this is a feel that will need to research a lot more in in
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different ways in in the future but it's really interesting from official logic perspective
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as i'm getting closer to the end um we should mention
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this issue of uh a competition calendar congestion um
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and here most of the available data seems to demonstrate that a congested calendar is associated with
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an increased risk of competition injury with eight out of the twelve studies showing association
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and one of those studies or uh your son your intent is um in football where
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most of this work has been done in this in this um sub topic
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a pattern is emerging where to compare to one match
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per week significantly increases the risk of match injury
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now as interesting as that was for me this is perhaps one of
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the very most interesting slides that i had today which is um
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the one on psychological load and all of the twelve studies we
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fart on psychological load variables from the linked to increased interest
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so the psychological stress or secluded negative life events stress daily hassles
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and sports related stress such is feeling a feeling of insufficient breaks
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and rest stiffen tense muscles and feeling vulnerable to injuries
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in addition to the psychological structures so the external
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psychological structures um there's also solid evidence for number of personality variables
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such a as well as mel mel adaptive coping strategies
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the proposed mechanism uh by which psychological stress was responses increase injury risk
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it's true attention all and semantic changes such as increased distract ability and peripheral now when
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as well as much muscle tension again for t. v. and we'd use timing in coordination
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so uh_huh
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there is evidence i think it's fair to say that there was evidence demonstrating a large part of injuries in sport
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are down to athletes coaches of the supports that failing
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to recognise how the athlete should train and one
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so if you want to significantly reduce your injuries speech carefully manage
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your training competition and a psychological load and the recovery
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we want to keep the athlete in physiological adaptation rather than pathological not adaptation
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there's no question that successful training must involve overload but it must at
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the same time avoid the combination of excessive loading and inadequate recovery
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we have to train when we can but rest when we must
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hi loads can have either positive or negative influences or injuries in athletes with
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the rate of load application and intrinsic risk factor profile being critical factors
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um we know that athletes now respond significantly better to relatively
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small increases and decreases rather than larger fluctuations unloading
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current evidence suggests that athletes should limit weekly increases of their training load to less than ten percent
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or will maintain an acute chronic load ratio within range of zero point eight two one point three
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there is evidence from some supports that if load a is applied in a moderate and progressive manner
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hi load and physically hard training may offer a protective effect against injuries
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load should always be prescribed on an individual inflexible basis
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as there is large inter an inter individual variation in
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the time frame response and adaptation to load
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finally a variation in an athlete psychological stress there's must
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guide the prescription of training and competition lot
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we have the evening ahead of us if you uh are are interested in these uh issues don't hesitate to
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come talk to me i have a lot to learn um and i've learned last uh integrated already that
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yesterday and today and look forward to discussing these issues with you
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um in the discussions like today think are much higher
Conference Program
Opening address
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Designing pathways to success – part kaleidoscope, part microscope
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BIOLOGICAL DEVELOPMENT AND PATHWAYS TO SUCCESS - Q&A
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Sept. 21, 2017 · 2:41 p.m.
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Resistance training during long-term athlete development
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The development of aerobic power in young athletes
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Fueling the young athlete
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Training young athletes: challenges and opportunities
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TRAINING THE YOUNG ATHLETE - Q&A
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Keep your athletes close and their parents closer: Working effectively with parents
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Combine sport and studies, are the schools doing enough ?
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Sept. 21, 2017 · 6:11 p.m.
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COACHING, PARENTING AND DEVELOPMENT - Q&A
Panel
Sept. 21, 2017 · 6:28 p.m.
DÉBAT PUBLIC (IN FRENCH) : Children and competitive sport, for the best or the worst ?
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Sept. 21, 2017 · 8:07 p.m.
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Knee ligament injuries in immature athletes
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Osteochondral lesions
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The influence of athletic activities during growth on hip development
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Sept. 22, 2017 · 8:35 a.m.
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INJURIES WITH THE ORTHOPEDISTS - Q&A
Panel
Sept. 22, 2017 · 8:54 a.m.
Back pain in young athletes
Liba SHEERAN
Sept. 22, 2017 · 9:34 a.m.
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Injuries and illnesses amongst young elite athletes – so healthy it hurts?
Christine HOLM MOSEID
Sept. 22, 2017 · 9:57 a.m.
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Long term sequelae of youth overuse injuries
Mark BATT
Sept. 22, 2017 · 10:19 a.m.
OVERUSE INJURIES - Q&A
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Sept. 22, 2017 · 10:40 a.m.
Concussions in young athletes : myths and reality
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Sept. 22, 2017 · 10:52 a.m.
Screening for heart disease in sports – nonsense or necessary?
Matthias WILHELM
Sept. 22, 2017 · 11:16 a.m.
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Energy deficiency in young athletes – prevalence, consequences and screening
Anna MELIN
Sept. 22, 2017 · 11:39 a.m.
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Competitive Sport & Health: hidden issues
Gordon MATHESON
Sept. 22, 2017 · 12:04 p.m.
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THE COMPLEX MEDICAL PROBLEMS - Q&A
Sept. 22, 2017 · 12:33 p.m.
Injury prevention in youth : What is learned in the cradle is carried in the tomb ?
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Sept. 22, 2017 · 1:46 p.m.
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Sept. 22, 2017 · 2:12 p.m.
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Sports specialized training: what are the true effects and is it really all bad ?
Neeru JAYANTHI
Sept. 22, 2017 · 2:29 p.m.
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What is “load” and how does it impact athletes’s risk of injury ?
Torbjorn SOLIGARD
Sept. 22, 2017 · 2:49 p.m.
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Instituting a unique public health approach to ACL injury risk management
Joseph Janoski
Sept. 22, 2017 · 3:47 p.m.
Instituting a unique public health approach to ACL injury risk management - Q&A
Joseph Janoski
Sept. 22, 2017 · 3:54 p.m.
Parents’ Knowledge of Sport Psychology and Nutrition
Dr Camilla J. Knight
Sept. 22, 2017 · 3:57 p.m.
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Injuries and injury risk factors in youth alpine ski racing: A two-season prospective study
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Sept. 22, 2017 · 4:09 p.m.
FREE COMMUNICATION AND BEST ABSTRACT PRESENTATION - Q&A
Panel
Sept. 22, 2017 · 4:21 p.m.
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Closing Address
Frederic Koehn, President Young Athletes Forum Foundation
Sept. 22, 2017 · 6:04 p.m.
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