Increase in the Acute:Chronic Workload Ratio relates to Injury Risk in Competitive Runners

Abstract

Injuries of runners reduce the ability to train and hinder competing. Literature shows that the relation between potential risk factors and injuries are not definitive, limited, and inconsistent. In team sports, workload derivatives were identified as risk factors. However, there is an absence of literature in running on workload derivatives. This study used the workload derivatives acute workload, chronic workload, and acute: chronic workload ratios to investigate the relation between workload and injury risk in running. Twenty-three competitive runners kept a daily training log for 24 months. The runners reported training duration, training intensity and injuries. One-week (acute) and 4-week (chronic) workloads were calculated as the average of training duration multiplied by training intensity. The acute:chronic workload ratio was determined dividing the acute and chronic workloads. Results show that a fortnightly low increase of the acute:chronic workload ratio (0.10–0.78) led to an increased risk of sustaining an injury (p<0.001). Besides, a low increase of the acute:chronic workload ratio (0.05–0.62) between the second week and third week before an injury showed an association with increased injury risk (p=0.013). These findings demonstrate that the acute:chronic workload ratio relates to injury risk.

Key words

injury and prevention - prediction - rating of perceived exertion

Publication History

Received: 26 November 2019

Accepted: 17 April 2020

Article published online:
02 June 2020

• References

• 1 Kluitenberg B, van Middelkoop M, Diercks R. et al. What are the differences in injury proportions between different populations of runners? A systematic review and meta-analysis. Sports Med 2015; 45: 1143-1161
• 2 Hreljac A. Impact and overuse injuries in runners. Med Sci Sport Exerc 2004; 36: 845-849
• 3 Finch C. A new framework for research leading to sports injury prevention. J Sci Med Sport 2006; 9: 3-9
• 4 Hulme A, Nielsen RO, Timpka T. et al. Risk and protective factors for middle- and long-distance running-related injury. Sports Med 2017; 47: 869-886
• 5 Saragiotto BT, Yamato TP, Hespanhol Junior LC. et al. What are the main risk factors for running-related injuries?. Sports Med 2014; 44: 1153-1163
• 6 Damsted C, Glad S, Nielsen RO. et al. Is there evidence for an association between changes in training load and running-related injuries? A systematic review. Int J Sports Phys Ther 2018; 13: 931-942
• 7 Nielsen RØ, Buist I, Sørensen H. et al. Training errors and running related injuries: a systematic review. Int J Sports Phys Ther 2012; 7: 58-75
• 8 Esmaeili A, Hopkins WG, Stewart AM. et al. The individual and combined effects of multiple factors on the risk of soft tissue non-contact injuries in elite team sport athletes. Front Physiol 2018; 9: 1280
• 9 Murray NB, Gabbett TJ, Townshend AD. et al. Individual and combined effects of acute and chronic running loads on injury risk in elite Australian footballers. Scand J Med. Sci Sport 2017; 27: 990-998
• 10 Ruddy JD, Pollard CW, Timmins RG. et al. Running exposure is associated with the risk of hamstring strain injury in elite Australian footballers. Br J Sports Med 2018; 52: 919-928
• 11 Hulin BT, Gabbett TJ, Lawson DW. et al. The acute:chronic workload ratio predicts injury: High chronic workload may decrease injury risk in elite rugby league players. Br J Sports Med 2016; 50: 231-236
• 12 Hulin B, Gabbett TJ, Blanch P. et al. Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. Br J Sports Med 2014; 48: 708-712
• 13 Jaspers A, Kuyvenhoven JP, Staes F. et al. Examination of the external and internal load indicators’ association with overuse injuries in professional soccer players. J Sci Med Sport 2018; 21: 579-585
• 14 Griffin A, Kenny IC, Comyns TM. et al. The association between the acute:chronic workload ratio and injury and its application in team sports: A systematic review. Sports Med 2019; 50: 561-580
• 15 Murray NB, Gabbett TJ, Townshend AD. et al. Calculating acute:chronic workload ratios using exponentially weighted moving averages provides a more sensitive indicator of injury likelihood than rolling averages. Br J Sports Med 2017; 51: 749-754
• 16 Menaspà P. Are rolling averages a good way to assess training load for injury prevention?. Br J Sports Med 2017; 51: 618-619
• 17 Lolli L, Batterham AM, Hawkins R. et al. Mathematical coupling causes spurious correlation within the conventional acute-to-chronic workload ratio calculations. Br J Sports Med 2019; 53: 921-922
• 18 Gabbett TJ, Hulin B, Blanch P. et al. To Couple or not to couple? for acute:chronic workload ratios and injury risk, does it really matter?. Int J Sports Med 2019; 40: 597-600
• 19 Malone S, Owen A, Newton M. et al. The acute:chonic workload ratio in relation to injury risk in professional soccer. J Sci Med Sport 2017; 20: 561-565
• 20 Wallace LK, Slattery KM, Coutts AJ. The ecological validity and application of the session-rpe method for quantifying training loads in swimming. J Strength Cond Res 2009; 23: 33-38
• 21 Halson SL. Monitoring training load to understand fatigue in athletes. Sports Med 2014; 44: 139-147
• 22 Foster C, Florhaug JA, Franklin J. et al. A new approach to monitoring exercise training. J Strength Cond Res 2001; 15: 109-115
• 23 Haddad M, Stylianides G, Djaoui L. et al. Session-RPE method for training load monitoring: Validity, ecological usefulness, and influencing factors. Front Neurosci 2017; 11: 612
• 24 Johnston R, Cahalan R, O’Keeffe M. et al. The associations between training load and baseline characteristics on musculoskeletal injury and pain in endurance sport populations: A systematic review. J Sci Med Sport 2018; 21: 910-918
• 25 Bredeweg SW, Zijlstra S, Buist I. The GRONORUN 2 study: Effectiveness of a preconditioning program on preventing running related injuries in novice runners. The design of a randomized controlled trial. BMC Musculoskelet Disord 2010; 11: 196
• 26 Fuller CW, Ekstrand J, Junge A. et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006; 40: 193-201
• 27 Borg A. Psychophysical bases of perceived exertion. Med Sci Sport Exerc 1982; 14: 377-381
• 28 Gabbett TJ, Hulin BT, Blanch P. et al. High training workloads alone do not cause sports injuries: how you get there is the real issue. Br J Sports Med 2016; 50: 1-2
• 29 Carey DL, Blanch P, Ong KL. et al. Training loads and injury risk in Australian football - Differing acute:chronic workload ratios influence match injury risk. Br J Sports Med 2017; 51: 1215-1220
• 30 Sampson JA, Murray A, Williams S. et al. Injury risk-workload associations in NCAA American college football. J Sci Med Sport 2018; 21: 1215-1220
• 31 Altman DG. Practical Statistics For Medical Research. London: Chapman and Hall; 1991
• 32 Sheskin DJ. Handbook of Parametric and Nonparametric Statistical Procedures. 3rd Aufl Boca Raton: Chapman and Hall/CRC; 2004
• 33 Altman DG, Bland JM. Diagnostic tests. 1: Sensitivity and specificity. BMJ 1994; 308: 1552
• 34 Harriss DJ, Macsween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
• 35 Jakobsen BW, Króner K, Schmidt SA. et al. Prevention of injuries in long-distance runners. Knee Surg Sports Traumatol Arthrosc 1994; 2: 245-249
• 36 Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med 1987; 15: 168-171
• 37 Fanchini M, Rampinini E, Riggio M. et al. Despite association, the acute:chronic work load ratio does not predict non-contact injury in elite footballers. Sci Med Footb 2018; 2: 108-114
• 38 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; 50: 471-475