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Chiropractor Victoria: Research Review: Athlete Load Management & Injury


•Review of the paper

•How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury.


•Sport has evolved for commercial demands

•Athletes are constantly trying to improve performance and push their personal limits

•Load management becomes a concern regarding injury risk

•Insufficient balance between loading and recovery can lead to fatigue, abnormal training responses and increase injury risk

•This is considered a “well-being continuum”

•There is no one size fits all for training and competition


•The IOC convened a consensus from November 24th to 27th in 2015

•Review of scientific evidence for relationship of load and health outcomes in sport

•Load defined to include: rapid changes, competition, calendar congestion, psychological and travel

•Load is the sport and non sport burden as a stimulus that is applied to a human biological system

Monitoring load

•IOC looked at both internal and external load on the athlete

•Internal – self perceived

•External - competition and training

•No single marker to load consistent predicted maladaptation or injury

•Systematic review (n=104) on internal load had shown subjective measures were more sensitive and consentient than objective measures for determining changes in athletes load both chronic and acute.

•New recommendations include prospective monitoring and continuous or serial measurements •Use of prevalence and not incidence of injury

•Classification of injury according to functional level rather than time lost in sport

Inclusion criteria

•IOC used the following criteria:

•Studies with athletes of all levels ( recreational to elite)

•Injuries reported by clinical diagnosis or self report

•Injuries related to completion, training, calendar, psychological or travel

•Single load or multiple load risk factors

•Research designs of systematic review, RCT, prospective and retrospective cohort, cross sectional and case control

Load types

•Absolute load – undetermined relationship with injury risk and varies with sport specific training

•Goal is proper management to build tissue capacity to withstand load

•Inappropriate or low absolute loads may increase injury risk due to inability to cope with load demands.

Load types

•Relative load: the rate of the load being applied

•Gabbett et al Acute and Chronic Load Model

•Acute – previous week •Chronic – previous 4 week rolling average

•Load ratio >1.5 had 1.5x greater injury risk

•Latent period of injury risk may occur, load ratio >1.5 had a significant impact on the 2nd week following training with a 2-4x greater injury risk

Load types

•Competition congestion

•Exuberated demands on athlete

•Rapid increase in acute load

•12 studies assessed

•Conflicting results and varying data on sport specific loading responses

•Must know your sport well!

Load types

•Psychological load

•Negative life events, Type A behaviors, mistrust all relate to increase injury risk through attentional and somatic changes

•Travel load

•No link has yet to be established

•High load can have positive or negative effects varying with sport

•Load application and internal factors are key

•Load prescribed on an individual and flexible basis

•Special attention with developing athletes due to increased risk with calendar congestion •Variations in psychological and social stressors

•Coaches and support must provide adequate rest

•Sport governing bodies must consider the health of the athlete with scheduling

Practical guidelines

•Scientific methods to detect load

•Individually monitored

•No single marker has been identified, use a combination of internal and external

•Subjective measures are practically useful

•Load is not in isolation and must include all other factors

•Actue:Chronic Ratio

•Performed frequently

•Strategies for athlete to understand the link and impact

•Education on stress management techniques

•Reducing training or load if athlete is under high stressors

•Periodical stress assessments

Monitoring injury

•Ongoing surveillance systems

•Tools must be sensitive to acute and clinical symptoms such as pain and function

•On going process

Research direction

•Development of training and competition programs tailored to individual needs

•Large scale dose-response relationships

•Increased understand of psychological and psychological factors

•Inter and intra individual variation and optimal training

•Impact of acute and chronic load ratio

•Short and prolonged competition congestions effects

•Travel fatigue and injury risk

•RTC on load monitoring relationships

•Reviewing sport governing bodies on assessing effectiveness of current interventions


1. Soligard T e. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. - PubMed - NCBI [Internet]. 2016 [cited 13 November 2016]. Available from:


Dr. Mike Hadbavny

Chiropractor, Sports Sciences Resident RCCSS(C)

If you are interested in learning more about how chiropractic care can be effective for your particular condition or health goals, contact Dr. Mike Hadbavny at 250-881-7881 today to make an appointment and discover the many benefits of seeing a chiropractor in Victoria, BC. Contact us today.

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