The importance of training loads in sports injury risk and return-to-play

The November issue of the IP’s sister journal, the British Journal of Sports Medicine, is largely devoted to the health and injury concerns of endurance athletes. By the very nature of endurance events, these athletes perform under extreme physical conditions and need to prepare by undertaking very large amounts of training, that would seem excessive to the rest of us who do not participate in this form of activity. As the editorial by Wortley and Islas points out, even though ultra-endurance events have a long history, at this extreme range of physical performance there is still a lot to learn about both risk and protective factors for injury.

In terms of adverse health outcomes, endurance athletes can experience varying problems and two papers in this issue describe and define outcomes at two ends of the spectrum: cramping and collapse. Schwellnus et al define muscle cramps as a transient problem but also highlight that little is known about their aetiology. Whilst cramps can be resolved easily, they may be associated with sub-clinical muscle damage and so are worthy of sports medicine attention. Risk factors appear to be previous history of muscle cramps and a faster running pace, particularly in the first half of a race. Asplund et al discuss exercise-associated collapse as an adverse side effect of participation in endurance sports. This condition occurs after an endurance event and is characterised by an athlete being conscious but with light headedness, faintness and dizziness or syncope. The paper gives clear guidance to clinicians about how to handle athletes with this condition and what life-threatening aetiologies need to be excluded as part of the assessment and treatment protocol.

A second editorial by Scott Marr in the same issue, reminds us that it is not just over or excessive training that is related to injury risk. In fact, those who train too little (i.e. the undertrained) can also be at high risk of injury. In the former instance, it is likely to be accumulated high levels of exposure to certain injury risks/hazards in both space and time that most explain this higher injury risk. For the undertrained, factors such as not being well prepared for the activity either physically or from a skills perspective are more important. Another training-related issue is when to allow children to return to sport participation after sustaining a musculoskeletal injury. Boudier-Revéret et al emphasise that such decisions need to be specific to children (and not just a direct translation of guidelines for adults). They conclude that this is an area where more work needs to be done, including development of interdisciplinary consensus guidelines. Of course, factors such as determining when a child can perform the sport-specific skills and return to training in a pain-free state is one of the key considerations.

Caroline Finch is an injury prevention researcher from the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Monash Injury Research Centre, Monash University, Australia. She specialises in implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch

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