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

Abstract

The return to sport from injury is a difficult multifactorial decision, and risk of reinjury is an important component. Most protocols for ascertaining the return to play status involve assessment of the healing status of the original injury and functional tests which have little proven predictive ability. Little attention has been paid to ascertaining whether an athlete has completed sufficient training to be prepared for competition. Recently, we have completed a series of studies in cricket, rugby league and Australian rules football that have shown that when an athlete's training and playing load for a given week (acute load) spikes above what they have been doing on average over the past 4 weeks (chronic load), they are more likely to be injured. This spike in the acute:chronic workload ratio may be from an unusual week or an ebbing of the athlete's training load over a period of time as in recuperation from injury. Our findings demonstrate a strong predictive (R(2)=0.53) polynomial relationship between acute:chronic workload ratio and injury likelihood. In the elite team setting, it is possible to quantify the loads we are expecting athletes to endure when returning to sport, so assessment of the acute:chronic workload ratio should be included in the return to play decision-making process.

Non-operative Care of the Patient with an ACL-Deficient Knee

“…Finally, the progression of load experienced during the injured state should be gradually advanced during this phase to insure a safe return to sport. Recent evidence from Blanch and Gabbett suggests that athletes returning too quickly from an injury are at increased risk for future injury [29]. Appropriately progressing the intensity of the rehabilitation program as well as a complimentary cardiovascular conditioning program is critical to reduce future injury risk.…”

Designing a Return to Training Model for Professional Athletes after Sport Injury

“…The model must be previously planned in an individual and progressive context [4,12]. Including the acute: chronic workload ratio (ACWR) on that model it's a key tool to manage and reduce risk during all the return to play process, specially avoiding load "spikes" (>1.5 ACWR) during this period [12].…”

“…The model must be previously planned in an individual and progressive context [4,12]. Including the acute: chronic workload ratio (ACWR) on that model it's a key tool to manage and reduce risk during all the return to play process, specially avoiding load "spikes" (>1.5 ACWR) during this period [12]. This periodisation design is a complex process that integrates conditioning adaptations, workout programing, the physical and cognitive complexity of exercises and the specificity of the drills [1,12,13].…”

“…This periodisation design is a complex process that integrates conditioning adaptations, workout programing, the physical and cognitive complexity of exercises and the specificity of the drills [1,12,13]. Always following sport physician *Corresponding author: Toni Caparrós, Insititut Nacional d'Educació Física de Catalunya (INEFC), Barcelona, España, Tel: +34636789552; E-mail: info@tonicaparros.eu guidelines and timing, the design must to achieve the same competition patterns [9,11,14], which will define the thresholds, in terms of functional quantity (load) and quality (intensity) [1,12]. Prevention protocols, both general and specific, can't be avoided on the design.…”

“…Workouts and training are functional, oriented to the sport motions [3] and at its specific facility or surfaces. Finally, the third phase will aim to reach competition intensity and loading, this progression had to be achieved with the gradual entry of the athlete into different phases of training sessions with the team, according to the ACWR premises [12]. Intensity will increase progressive, not just in terms of execution, as well in tactical decisions.…”