Training Load Capacity, Cumulative Risk, and Bone Stress Injuries: A Narrative Review of a Holistic Approach

Abstract

Bone stress injuries (BSIs) are a common orthopedic injury with short-term, and potentially long-term, effects. Training load capacity, influenced by risk factors, plays a critical role in the occurrence of BSIs. Many factors determine how one's body responds to repetitive loads that have the potential to increase the risk of a BSI. As a scientific community, we have identified numerous isolated BSI risk factors. However, we have not adequately analyzed the integrative, holistic, and cumulative nature of the risk factors, which is essential to determine an individual's specific capacity. In this narrative review, we advocate for a personalized approach to monitor training load so that individuals can optimize their health and performance. We define “cumulative risk profile” as a subjective clinical determination of the number of risk factors with thoughtful consideration of their interaction and propose that athletes have their own cumulative risk profile that influences their capacity to withstand specific training loads. In our narrative review, we outline BSI risk factors, discuss the relationship between BSIs and training load, highlight the importance of individualizing training load, and emphasize the use of a holistic assessment as a training load guide.

Overtraining Syndrome as a Risk Factor for Bone Stress Injuries among Paralympic Athletes

“…A narrative review by Hamstra-Wright et al highlighted the importance of a holistic approach to monitoring training load in relation to bone stress injuries. The authors emphasized the need for a personalized assessment that considers individual risk factors and cumulative risks associated with the training load capacity [18].…”

Prévention et prise en charge de la blessure liée à la course à pied

“…Les pathologies de stress osseux (Bone Stress Injuries, BSI) illustrent la nécessité de travailler en rééducation et en prévention à l'aide de la charge optimale, en connaissant la réponse physiologique de l'os au stimulus de la course à pied. 28, 29 La capacité de l'os à tolérer la charge suit une loi de puissance inverse : une légère augmentation de l'intensité du stress appliqué diminue fortement le nombre de foulées tolérées. 28 Deux problématiques apparaissent : qu'est-ce qui accroît le stress et peut-on en augmenter la quantité tolérée ?…”

Intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers in cricket: a systematic review

“…Since intrinsic and extrinsic variables do not act in isolation, intrinsic variables may determine the level of risk predisposed [ 15 ] to a fast bowler, as elevated risk may cause subsequent exposure to fast bowling to become an inciting event associated with injury [ 15 ]. Identifying intrinsic variables is important because they can affect the load tolerance of tissues [ 23 ], and an improved understanding of their significance may contribute to the formation of a “cumulative risk profile” [ 24 ] for an individual fast bowler. This would represent a holistic assessment of the cumulative influence of intrinsic variables on injury risk with thoughtful consideration of their interaction with one another and with extrinsic variables [ 24 ], as this may determine a fast bowler’s capacity to withstand specific training and competition bowling loads, and influence planning and management of the same.…”