Injury Prevention, Data and the Mad Hatter

Can we really predict injury…or should we be focused on preventing it?  Don’t train enough and your players won’t tolerate the demands of the game = injuries!  Train too much and the players don’t recover = Overload = injuries!  Must seem insurmountable to those new to the game!

A lot has been written recently about the need to train hard in a progressive manner in order to best prepare your athletes for competition (who would have thought we actually needed to state that?).  Tim Gabbett has been prolific in his research and commentary on the need to avoid "training spikes" while maintaining training loads that develop the ability for the athlete to handle what is being asked of them in competition.  I couldn’t agree more!  

That being said, I think it is of critical importance to add to the discussion some commentary on the interplay of fatigue-decay and training monotony.

Here’s my Top Five management tips for avoiding injury.

Build enough work into your athletes to tolerate the extremes of game demands.

This has been written about ad infinitum so I won’t banter on too much.  We must train our athletes to handle the most demanding aspects of their chosen game.  The most critical issue with respect to getting sufficient work in is being able to clearly quantify what “enough” is.  For the guys just getting started here’s the bad news…this is a function of experience.  There is no research paper that will tell you how many kilometers to run in a 15wk pre-season, what percentage at high speed and what percentage in SSG.  That type of information is generally regarded as industry specific intellectual property and the only way to get it is to work in the environment. Building experience at lower or developmental levels will also help you develop a paradigm for how much is required to succeed.  Always keep in your mind the challenge is to get the greatest performance with the least amount of work i.e. greatest ROI (return on investment) for the athletes training input.  There are no prizes for who survived the most in pre-season!  Cause & effect…assess critically everything you do for its safety, effectiveness and efficiency.

Plan, monitor and adapt load individually as required to allow sufficient recovery from the game and training.

“Write your plan in pencil and then make sure only the most experienced coaches have erasers”…a quote from somewhere deep in my development years.  I don’t recall who said it…but I haven’t forgotten it.  Your plan should be based on clear and concise strategic intent.  You need to know it and so does the Head Coach.  If the Head Coach doesn’t buy it then it won’t work.  Tactical changes to the program are inevitable based on the myriad of challenges that can eventuate throughout the course of a season.  Just make sure any changes are well considered and not spur of the moment (good luck with that one…I can hear the conversation now…”no F^&k your plan Jason, they can just keep going”…heard it before and I’m sure I’ll hear it again).

Tactical Periodsation is the buzz word in town among the more progressive skill coaches.  Sounds great in theory, but it means nothing unless the Head Coach is willing to commit not only to the process but to executing the plan.  Don't get me wrong, in any season things change and plans need to be adapted, but wholesale bailing out on a plan when things get tough doesn't solve anything.  Acute overloading of physical output in order to achieve changes in tactical or skill areas is fraught with danger.  Worse still, trying to create “mental toughness” by radical changes in training content, particularly an acute increase in heavy contact work can lead to disaster…I’ve seen it happen and it costs people their jobs!  We need to work hard…real hard.  But for every gram of “hard” we need a kilogram of “smart”.  Plan the work…work the plan!

The notion that a training load "spike" contributes to injury is really a no-brainer.  What is less well accepted is that it may take 3-4 weeks for the risk associated with a training "spike" to recede.  Be cognizant of the peak loading component of any phase and the loading that follows it.  Ensure recovery is programmed.

Limit Training Monotony.

In team sport there is an inescapable routine associated with long seasons.  Irrespective of sport, we alternate almost subconsciously with breathing-like regularity between training and playing.  Often, training prescription, particularly that dominated by team based sessions, becomes almost indistinguishable from week to week, meaning that training load effectively remains constant, but training monotony (avg. load / stdev load), can go through the roof.  High Training Monotony in general means a static load, which goes against every contemporary theory of training planning.  A static load will ultimately lead to an athlete who is "cooked" (high load) or one that is failing to progress (low load).  Get work load and recovery addressed and this will not be a problem

For every training load imparted on an athlete there is a period following the training load that performance capacity is diminished.  What exactly is diminished...force generating capacity.  Some sessions only require 24hrs recovery…some more.  What about weeks?  How long does it take to recover from a big week?

There are a myriad of physiological factors driving reduction in force capacity.  Irrespective of the exact mechanism, what is of most importance is that for a period the athlete can not do one of two things.  Either they can not acutely produce the magnitude of force required at all, or they can produce it for a period but ultimately part way through a task their force generating capacity is reduced and they typically “slow-down”.  To further confuse the issue…a “slow down” may be required, however it is my observation that in a competitive environment the athlete, who at an autonomic level is a very effective redundant system, will “find” a way to generate the required force output (at least for a time) by recruiting muscles in different patterns a.k.a. load transfer. 

Load transfer based on chronic fatigue leads to any number of muscular or connective tissue issues (say that fast three times).  The fun bit is overload injuries generally take time to reveal themselves and when they do the “horse” may not quite have bolted, but in generally tends to be headed for the gate at a good speed.  By managing training monotony you are providing the athletic organism with a more appropriate stimulus to adapt by offering a variable load.  This has the added benefit of improving recovery and reducing injury rates.

Understand Individual Thresholds.

Again, the good news here for young coaches is this is a function of experience.  Tracking individual player’s loading characteristics over time gives you the perfect platform from which to develop appropriate programs. Just starting in the industry?  Use some of these concepts as guidelines;

• Physically immature athletes tolerate less load.

• Because a player is skilled, doesn’t mean he/she will tolerate high load.

• Athletes with training age lower than 5yrs at a senior level will likely struggle with higher volumes.

• Fast twitch athletes generally require more recovery and may need to be managed to higher volumes in team sport.

• Athletes with lower limb injury history may struggle with load (particularly significant joint issues).

• Older athletes (>28yrs in AFL) will begin to slow in their recovery from higher loads.

Read the Cues…Not just the Numbers

The concept of an athlete “finding a way” mechanically is not unique to running sports.   In swimming when an athlete can hit the required times in a given set, but in a fatigued state, the time may be achieved with a supra-optimal stroke rate (additional strokes).  Essentially, the output is being achieved but the cost of the output has now changed from what it originally was, and what you as the coach might expect it to be.  Extrapolate this idea to field sport.  GPS data looks good.  Accelerations and deceleration's look good.  But the athlete still gets injured.  The answer is often not in the output itself, but in the capacity to deliver the output…essentially the cost, which cannot explicitly be known, only guesstimated by any one of several “monitoring” methods.

Want to know the dead give-away?  For me it is Movement Efficiency.  Changes in the way an athlete moves will be driven by their level of tissue preparedness for a given activity.  Slow to warm up, poor in basic movement patterns, unusually awkward in drills.  All signs that the athlete has not recovered well and is not prepared to train. 

Are they just signs preparation / warm up for the session was off?  Could be!   If you think so, isolate the athlete and address your concerns (additional mobility, WU etc).  If you can't change the pattern think strongly about the prescription for the day.  The signs are often very subtle.  A missed step here, poor dorsi-flexion in drills there.  Picking up the pattern may not be something that stops training on that day, but it may be something that alerts you to a change that can be more specifically addressed with treatment or in the gym.

"When we move mechanically well, we put the body in an advantaged position to accept, absorb, and produce force.” Dr Gerry Ramogida 

"I'm a believer that coaches have been doing movement screens for over 100 years and it's called watching practice." pic.twitter.com/p9aV9PoMNz

— ALTIS (@ALTISworld) November 3, 2015

There is a fundamental truth about injury prevention: it is all about managing risk, not predicting outcomes.  Even the most advanced technology available cannot accurately predict injury.  Organize and understand the data you propose to use, demonstrate clearly and concisely to those around you what you intend to do with the data, the associated metrics and how it will be communicated.   Then get on with being a coach!  

If you are not careful this area of high performance sport can all become so convoluted and all consuming that you will start to sound like the Mad Hatter at Alice’s tea party. Not a good look if we are trying to get head coaches on board - which at the end of the day is one of the keys to administering a successful program.

Go well!

JW

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