Updated: Feb 3
· Bullock et al (2010) formulated recommendations for the military and other active populations based on expedited systematic reviews
· They recommended that formal exercise programs should control the amount of total body overload performed; particularly for the lower extremities.
· The authors suggested a number of strategies to limit the risk of over-training:
1. Monitor attendance rates, fitness test results and run times to determine signs that a group is overtraining include high or increasing lower body injury profile rates, decreased fitness test pass rates, and slower average run times.
2. Structure physical training injury prevention programs to target individuals at the highest risk of injury (those of average or below average fitness) by ensuring that the running mileage is appropriate for their fitness level.
3. Group individuals according to physical ability. For example, fitness test performance (run times) can be used to place individuals in groups of their peers with similar fitness levels. This provides each person with a more appropriate level of physiological stimulus to enhance fitness and minimize injury risk.
4. Avoid the practice of giving extra physical training sessions to the least fit individuals, since this will increase the risk of overtraining and injury with little or no fitness improvement.
5. Avoid exhaustive physical training on the same or successive days
6. Allow adequate recovery time between administrations of maximal effort physical fitness tests to prevent overtraining and increase the likelihood of improved physical performance.
7. Alternate training days that emphasize lower body–weight bearing physical activity with training days focused on upper body conditioning.
8. Minimize the accumulated weight-bearing stress on the lower body by not overscheduling such activities on the same or successive days.
9. Refrain from or modify use of physical training as a punitive, corrective, or motivational tool as it has the potential to cause excessive training overload that can lead to overtraining.
In season vs Off Season
· Two systematic reviews/meta-analyses investigated whether an exercise-based injury prevention program should be undertaken in-season, during the off-season, or both.
· In both reviews by Abernathy et al (2007) and Yoo et al (2011), the authors concluded that the benefit of the intervention appears to be optimised when the preventive programme is continued throughout the playing season (during both in-season and off-season).
· In contrast, Hewett et al (2006) concluded that in-season training alone is probably the most cost-effective and efficient method for achieving beneficial injury prevention effects.
· Similarly, Rossler et al (2014) compared programs that implemented ‘pre-season only’, ‘in-season only’ or ‘pre-season and in-season’, revealing very similar effects.
· Four systematic reviews reflected on the importance of adherence/compliance with an exercise-based injury prevention program.
o Hewett et al (2006)
o Emery et al (2015)
o Herman et al (2012)
o Al Attar et al (2016)
· Al Attar et al (2016) in their meta-analysis of studies using the Nordic hamstring exercise for injury prevention highlighted that compliance with sport injury prevention interventions is very important and can significantly affect study results.
· Hewett et al (2006) found that exercise-based prevention training may have compliance rates as low as 28%.
· Emery et al (2015) cited research evaluating the implementation strategy for delivery of a team-based neuromuscular training warm-up programme, which highlights greater adherence when a comprehensive coach workshop precedes the coach-delivered intervention in a team-based setting in youth soccer.
· They also identified that it may be important to focus on player performance improvement as a side effect to injury prevention strategies in youth sport to facilitate uptake by coaches and players.
· Hewett et al (2006) were in agreement with this, stating that “training for performance enhancement can have better compliance ranging from 80% to 90%.”
· On this basis, Hewett et al (2006) concluded that if protocols are designed for both performance enhancement and ACL injury prevention techniques, exercise-based injury prevention training may be instituted on a widespread basis with potentially higher athlete compliance.
· Herman et al (2012) in their systematic review recommended that to maximise compliance, programs be designed without the need for equipment such as balance boards. The authors suggested that this may be more practical and cost-effective.
· Soligard T, Schwellnus M, Alonso J, Bahr R, Clarsen B, Dijkstra H et al. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. 2017.
· Schwellnus M, Soligard T, Alonso J, Bahr R, Clarsen B, Dijkstra H et al. How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness. 2017.
· McGinley, J. L., C. Martin, F. E. Huxham, H. B. Menz, M. Danoudis, A. T. Murphy, J. J. Watts, R. Iansek and M. E. Morris (2012). "Feasibility, safety, and compliance in a randomized controlled trial of physical therapy for Parkinson's disease." Parkinsons Dis 2012: 795294.
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 chiropractic care in Victoria, BC. Contact us today.