By Jason Laird (@PhysioReel)
Within elite sport the use of data and technology is now commonplace. In particular, the use of athlete monitoring tools is now the norm for many sports looking to prevent injury. These tools are primarily aimed at monitoring training load (exposure) and an individual’s response to this exposure. The link between this monitoring data and injury incidence is now being closely analysed.
Prevention of Injury
In order to fully understand the role of athlete monitoring in the prevention of injuries we first need to delve a little deeper into the types of prevention available in sports medicine.
Within epidemiology research there are examples of different types of prevention; primary, secondary, and tertiary (1, Health Knowledge Link). In the context of elite sport, primary prevention is aimed at removing or controlling the exposure to risk factors. Screening for these risk factors (most commonly in pre-season) often leads to targeted prevention strategies (2, 3). For more information on other types of risk factors in sport see Bahr and Holmes’ paper (4).
Secondary prevention aims to detect changes from a normal baseline (usually via a screening tool) in order to intervene and stop a problem from progressing. A good example of this in the medical world is screening for cervical cancer, that well establishes the link between screening findings and the disease (5, WHO link).
Athlete monitoring is a type of secondary prevention that analyses subjective and objective data in order to detect a change in the athlete. This information gives us a real-time snapshot of how the individual is responding to their current exposure level and shows any occurrence of trends.
Linking monitoring findings to prevention
Identifying a causal link between monitoring findings and injury incidence in order to prevent injuries before they happen is perhaps the ‘holy grail’ in this field. This requires plenty of ongoing research, particularly in the areas of validity and reliability of tests and their possible combinations. See this great blog on ‘Diagnostic Validity’ by Andrew Cuff via Tom Goom (6) for more information on how to understand validity and reliability within physiotherapy research.
There is now a huge selection of tools at our disposal to collect subjective and objective data from athletes. Some of these require relatively expensive equipment and bespoke analytical programs whereas others need just a pen and paper and a chat with the athlete and coach. A great video to use as an introduction is one from Dr Bryan Mann (7) and shows how simple and effective monitoring can be in a busy sports environment.
Some further examples of athlete monitoring in elite sport can be seen here in Rugby Union (8) and the NFL (9). With these types of tools having the potential to keep players fit and available for longer, some sports teams are placing serious investment into staff and technologies aimed directly at collecting monitoring data and researching the output.
There are some recent studies investigating how factors such as hamstring strength (10) and increases in training load (11,12) can link to injury risk in elite level sport and the evidence base surrounding athlete monitoring and injury is sure to grow. In the meantime, different types of monitoring continues to be commonplace in elite sport. There is a whole host of technology companies and equipment manufacturers being used across the world and fully integrated into sports teams.
Practical tips for athlete monitoring
Finally, here are a few practical tips:
- Pick tests relevant to your sport
The tests you choose should relate well to your sport and look to target your key time loss injuries, as well as being valid and reliable tests for your athlete group. It may also be useful to look into the minimal detectable change and standard error of measurement of the tools you are going to use (13, Rehab Measures link).
- Start simple and small
Don’t make the tests too extravagant or time consuming from the outset. Start small and simple and add more as required. An easy start point for athletes is the use of subjective wellbeing data, with recent evidence indicating that this type of ‘self-report’ data may be of more use in detecting changes than objective tests (14).
- Create ‘Buy-In’ with the athlete and coaching team
Bringing the athlete and coaches on the journey with you regarding what you aim to achieve by collecting the data is perhaps the most important part of the whole process. As everyone begins to understand what the tests are showing and what the trends look like it will allow you to have more impactful contextual discussions around the data.
- Quick feedback of data
The faster you can feedback the data to athletes and coaches the better; this will help massively with buy-in and also provide an opportunity to have discussions on live data, rather than just what happened last week.
Happy monitoring!
Reference List
1: Health Knowledge ‘Epidemiological basis for preventive strategies ‘: http://www.healthknowledge.org.uk/public-health-textbook/research-methods/1c-health-care-evaluation-health-care-assessment/epidemiological-basis-pstrategies
2: Pappas, E., Nightingale, E.J., Simic, M., Ford, K.R., Hewett, T.E., Myer, G.D. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis. British Journal of Sports Medicine. 2015, 49 (10), 673:680.
3: Clarsen, B., Bahr, R., Andersson, S.H., Munk, R., Myklebust, G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. British Journal of Sports Medicine. 2014, 48 (17), 1327-1333.
4: Bahr, R., and Holme, I. Risk factors for sports injuries–a methodological approach. British Journal of Sports Medicine. 2003, 37 (5), 384-392.
5: WHO- Human papillomavirus (HPV) and cervical cancer: http://www.who.int/mediacentre/factsheets/fs380/en/
6: Diagnostic validity: http://www.running-physio.com/diagnostic/
7: Monitoring Fatigue from A-Z, Dr Bryan Mann: http://www.nsca.com/videos/monitoring_fatigue_in_athletes/
8: ‘Kitman Labs Provides ‘Invaluable Tool’ For IRFU- Irish Rugby’: http://www.irishrugby.ie/news/31666.php#.Vd8Bnmfotdh
9: ‘Dolphins aim to prevent injuries with futuristic performance program’: http://espn.go.com/nfl/story/_/id/13665228/miami-dolphins-aim-prevent-injuries-futuristic-sports-performance-program-nfl
10: Freckleton, G., Cook, J., Pizzari, T. The predictive validity of a single leg bridge test for hamstring injuries in Australian Rules Football Players. British Journal of Sports Medicine. 2014, 48 (8), 713-717.
11: Hulin, B.T., Gabbett, T.J., Blanch, P., Chapman, P., Bailey, D., Orchard, J.W. Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. . British Journal of Sports Medicine. 2014, 48 (8), 708-712.
12: Cross, M.J., Williams, S., Trewartha, G., Kemp, S.P.T., Stokes, K. The Influence of In-Season Training Loads on Injury Risk in Professional Rugby Union. International Journal of Sports Physiology and Performance. 2015, in press.
13: Rehab Measures Database: http://www.rehabmeasures.org/rehabweb/rhstats.aspx
14: Saw, A.E., Main, L.C., Gastin, P.B. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. British Journal of Sports Medicine. In press.
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Jason Laird (@PhysioReel) works for the English Institute of Sport as Lead Physiotherapist for British Judo.