Are internal load measures associated with injuries in male adolescent Gaelic football players?

Knee pain and function in retired male intercounty GAA players: an exploratory study

BACKGROUND

Knee injuries are common among elite intercounty Gaelic games players (collectively GAA players).

AIMS

The primary aim was to examine knee pain, function, and quality of life in retired elite male GAA players. Secondary objectives were to (i) report the incidence of previous knee surgery and total knee replacement, (ii) assess medication usage, and (iii) investigate any associations between a history of knee injury and/or knee surgery and knee pain, function, and quality of life among retired elite male GAA players.

METHODS

One hundred retired male senior intercounty GAA players were surveyed on their history of severe knee injury and previous knee surgery (68 completed survey; 47 Gaelic football, 20 hurling, 1 dual player). The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess level of function and pain.

RESULTS

Forty-seven (69%) of the retired players described experiencing at least one severe knee injury during their intercounty career. Fourteen (21%) participants retired due to a significant knee injury. Mean KOOS-SP score was 75.5 (SD 17). The Global Physical Health and Global Mental Health mean scores were 44 and 51. There was a low negative correlation between KOOS-SP scores and a history of severe knee injury (r = -0.35, p = 0.001). Moderate negative correlation between Global Mental Health scores and a history of severe knee injuries (r = -0.36, p = 0.386) and a very weak negative correlation between the number of surgeries during a participant's intercounty career and Global Mental Health score (r = -0.089, p = 0.234).

DISCUSSION

Severe knee injuries and knee surgery are common among male intercounty GAA players. These injuries lead to self-reported reduced performance and retirement and are potentially associated with worse health-related outcomes post-intercounty career. Further well-designed studies, including among retired women GAA players, are required to assess the relationship between knee injuries and long-term athlete outcomes. Improved injury prevention efforts, enhanced rehabilitation of knee injuries, and post-retirement care may mitigate the adverse effects associated with severe knee injuries among male GAA players.

A novel approach for sports injury risk prediction: based on time-series image encoding and deep learning

The rapid development of big data technology and artificial intelligence has provided a new perspective on sports injury prevention. Although data-driven algorithms have achieved some valuable results in the field of sports injury risk assessment, the lack of sufficient generalization of models and the inability to automate feature extraction have made it challenging to deploy research results in the real world. Therefore, this study attempts to build an injury risk prediction model using a combination of time-series image encoding and deep learning algorithms to address this issue better. This study used the time-series image encoding approach for feature construction to represent relationships between values at different moments, including Gramian Angular Summation Field (GASF), Gramian Angular Difference Field (GADF), Markov Transition Field (MTF), and Recurrence Plot (RP). Deep Convolutional Auto-Encoder (DCAE) learned the image-encoded data for representation to obtain features with good discrimination, and the classifier was performed using Deep Neural Network (DNN). The results from five repeated experiments show that the GASF-DCAE-DNN model is overall better in the training (AUC: 0.985 ± 0.001, Gmean: 0.930 ± 0.007, Sensitivity: 0.997 ± 0.003, Specificity: 0.868 ± 0.013) and test sets (AUC: 0.891 ± 0.026, Gmean: 0.830 ± 0.027, Sensitivity: 0.816 ± 0.039, Specificity: 0.845 ± 0.022), with good discriminative power, robustness, and generalization ability. Compared with the best model reported in the literature, the AUC, Gmean, Sensitivity, and Specificity of the GASF-DCAE-DNN model were higher by 23.9%, 27.5%, 39.7%, and 16.2%, respectively, which confirmed the validity and practicability of the model in injury risk prediction. In addition, differences in injury risk patterns between the training and test sets were identified through shapley additivity interpretation. It was also found that the training volume was an essential factor that affected injury risk prediction. The model proposed in this study provides a powerful injury risk prediction tool for future sports injury prevention practice.

Training Load Monitoring Practices Used by Strength and Conditioning Coaches in Hurling, Gaelic Football, Camogie, and Ladies Gaelic Football

BACKGROUND

No research has investigated the training load (TL) monitoring practices currently used by strength and conditioning (S&C) coaches in Gaelic games. The purpose of this study was to investigate the TL monitoring practices used by S&C coaches across senior intercounty male and female Gaelic game sports.

STUDY DESIGN

Cross-sectional.

HYPOTHESES

It was hypothesized that (1) TL is commonly monitored, (2) various methods are used by S&C coaches to monitor TL, and (3) the level of qualifications of the S&C coach is of a professional standard.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 33 (n = 32 male and n = 1 female) S&C coaches participated in the study by completing an online questionnaire that investigated coach biography, coach education, team biography, monitoring practices, rating of perceived exertion, acute:chronic workload ratio, and data implementation.

RESULTS

The results showed that S&C coaches had varying levels of experience and education. All 33 coaches (100%) stated they monitored the TL of the players. The most common method used to monitor TL was session rating of perceived exertion, which was used by 91% of coaches. Analysis of an open-ended question afforded each participant the opportunity to share additional information, highlighting 3 themes: (1) communication with players, (2) performance testing, and (3) clarity and support among other coaching staff.

CONCLUSION

Multiple methods are used to monitor TL in Gaelic games. Despite multiple forms of technology available, communication with players provides essential information regarding an athlete's state.

CLINICAL RELEVANCE

As this is the first study to explore TL monitoring practices used by S&C coaches in Gaelic games, the results may inform the development of educational resources for the guidance of coaches working in Gaelic games in best practice TL monitoring.

The Use of Recovery Strategies in Gaelic Games: A Mixed-Methods Analysis

PURPOSE

This study investigated Gaelic games players' (1) use of postexercise recovery strategies; (2) recovery strategies according to sport, biological sex, and playing standard; and (3) recovery strategy periodization.

METHODS

Participants were a total of 1178 Gaelic players (n = 574 female), age 24.6 (6.6) years. These players completed a questionnaire investigating postexercise recovery strategies. Participants were further dichotomized by playing standard into developmental (club/collegiate; n = 869) and national (intercounty; n = 309) levels and by sporting codes: Gaelic football (n = 813), Camogie/hurling (n = 342), and handball (n = 23).

RESULTS

Active recovery (90.4%), cold temperature exposure (79.5%), regular sleep routine (79.1%), strategic nutritional intake (72.3%), and massage (68.8%) were the most commonly used recovery strategies. Recovery strategy use was periodized by 30% of players. A significantly larger proportion of national-level players apply cold temperatures (86.7% vs 73.1%; P = .001) and nutritional strategies (80.1% vs 69.2%; P = .012) when compared with developmental players. A significantly larger proportion of female players have a regular sleep routine (82.6% vs 75.1%; P = .037), apply external heat (63.4% vs 48.5%; P = .002), and perform stretching (76.5% vs 66.4%; P = .002) postexercise when compared with male players. A significantly larger proportion of male players employ nutritional strategies (77.6% vs 67.5%; P = .007) and consume a combination of protein and carbohydrate (62.1% vs 28.0%; P < .001) postexercise when compared with female players.

CONCLUSION

Gaelic games players regularly implement a range of postexercise recovery strategies in an attempt to expediate the return of performance capacity and psychophysiological status to preexercise levels. The current findings may support practitioners who seek to prescribe effective and periodized recovery interventions targeting optimized preference/compliance.

Methods of Monitoring Internal and External Loads and Their Relationships with Physical Qualities, Injury, or Illness in Adolescent Athletes: A Systematic Review and Best-Evidence Synthesis

BACKGROUND

With the increasing professionalisation of youth sports, training load monitoring is increasingly common in adolescent athletes. However, the research examining the relationship between training load and changes in physical qualities, injury, or illness in adolescent athletes is yet to be synthesised in a systematic review.

OBJECTIVE

The aim of this review was to systematically examine the research assessing internal and external methods of monitoring training load and physical qualities, injury, or illness in adolescent athletes.

METHODS

Systematic searches of SPORTDiscus, Web of Science, CINAHL and SCOPUS were undertaken from the earliest possible records to March 2022. Search terms included synonyms relevant to adolescents, athletes, physical qualities, injury, or illness. To be eligible for inclusion, articles were required to (1) be original research articles; (2) be published in a peer-reviewed journal; (3) include participants aged between 10 and 19 years and participating in competitive sport; (4) report a statistical relationship between a measure of internal and/or external load and physical qualities, injury or illness. Articles were screened and assessed for methodological quality. A best-evidence synthesis was conducted to identify trends in the relationships reported.

RESULTS

The electronic search yielded 4125 articles. Following screening and a review of references, 59 articles were included. The most commonly reported load monitoring tools were session ratings of perceived exertion (n = 29) and training duration (n = 22). Results of the best-evidence synthesis identified moderate evidence of positive relationships between resistance training volume load and improvement in strength, and between throw count and injury. However, evidence for other relationships between training load and change in physical qualities, injury, or illness were limited or inconsistent.

CONCLUSIONS

Practitioners should consider monitoring resistance training volume load for strength training. Additionally, where appropriate, monitoring throw counts may be useful in identifying injury risk. However, given the lack of clear relationships between singular measures of training load with physical qualities, injury, or illness, researchers should consider multivariate methods of analysing training load, as well as factors that may mediate the load-response relationship, such as maturation.

Barriers and facilitators to injury prevention in ladies Gaelic football: A qualitative study

OBJECTIVES

Injury rates have remained high in ladies Gaelic football over the last decade and treatment costs continue to increase significantly. Injury prevention programmes are a proposed solution and their efficacy has been demonstrated in Gaelic games, however, anecdotally their adoption is low. The aim of this study was to determine the barriers and facilitators to uptake, implementation, and long-term adoption of an injury prevention strategy for adult Ladies Gaelic football players and coaches.

DESIGN

Semi-structured interviews were conducted with 23 participants (13 coaches, 10 players). Four coaches were at intercounty level and nine were at club level, while two players competed at intercounty and club level and eight played solely at club level. The interviews were audio-recorded, transcribed verbatim and thematically analysed.

RESULTS

Stakeholder attitudes, accessibility, education, communication, and injury prevention programme characteristics were perceived as key barriers to an injury prevention strategy succeeding. Injury prevention promotion, injury prevention programme characteristics, leadership, and communication, were identified as the main factors that would facilitate the success of a strategy.

CONCLUSIONS

By utilising the views of stakeholders, the initial uptake, adherence, and long-term adoption of an injury prevention strategy in Ladies Gaelic football may be maximised.

Is Cumulative Load Associated with Injuries in Youth Team Sport? A Systematic Review

Background

High cumulative external and internal load may predispose athletes to increased risk for injury across a variety of sports, competition levels, and age groups. However, evidence of an association between cumulative load and injury in youth sport remains inconclusive. The objective of this study was to determine the current evidence for cumulative load and injury risk relationships in youth team sport through a systematic review of the existing literature.

Methods

A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature searches were conducted in PubMed, Web of Science, SCOPUS, and CINAHL for relevant articles published between January 2010 and April 2021. The authors conducted independent review and quality assessment of the eligible studies. Eleven articles evaluating youth (less than 18 years old) team sport were included for qualitative synthesis.

Results

Fifty-nine percent (n = 39/66) of the relationships assessed revealed an association between cumulative load and injury across the team sports studied, including the presence of load–injury associations in 84% (n = 16/19) of assessments in youth soccer. Of those relationships where an association was present, 79% (n = 31/39) were positive associations between cumulative load and injury. Risk of bias assessment scores ranged from three to six out of seven possible (median = 5) for cohort studies and from four to seven out of 10 possible (median = 5.5) for cross-sectional studies.

Conclusions

There is some evidence for a positive association between load and injury in youth team sport. Youth soccer was the most studied team sport, and a substantial number of positive load–injury associations were reported. Current evidence lacks consistency in the measures and metrics used in defining load–injury relationships.

Trial Registration PRISMA ID - CRD42020203622.

Does Physical Conditioning Influence Performance Attenuation and Recovery in Gaelic Football?

PURPOSE

This study investigated the influence of components of fitness on measures of performance attenuation and recovery following Gaelic football match play.

METHODS

Measurements of players' anthropometric characteristics, body composition, running speed, lower-body strength and power, blood lactate concentrations, running economy, and maximal aerobic capacity (V˙O2max) were taken over 2 separate days 1 week prior to a competitive match. Creatine kinase, countermovement jump height, drop jump height, contact time, reactive strength index, and perceptual responses were tested prematch, at full time, 24 hours postmatch, and 48 hours postmatch.

RESULTS

Multiple components of fitness were associated with reduced performance attenuation and improved recovery responses (adjusted R2 = 9.8%-27.6%; P < .05). Players were divided into higher-standard and lower-standard V˙O2max (higher standard: 57.4 [4.2] mL·kg-1·min-1; lower standard: 45.3 [3.8] mL·kg-1·min-1) and relative squat (higher standard: 1.46 [0.11] 1-repetition-maximum kg·body mass-1; lower standard: 1.20 [0.08] 1-repetition-maximum kg·body mass-1) groups. After adjusting for prematch baseline differences, there were significant differences between V˙O2max groups in drop jump height at 24 hours postmatch (ηp2=.078-.154; P < .05) and countermovement jump height at 48 hours postmatch (ηp2=.134; P < .05), where the lower-standard group displayed larger decrements. In addition, there were significant differences between relative squat groups at all postmatch time points in contact time (ηp2=.156-.194; P < .05) and reactive strength index (ηp2=.127-.223; P < .05) and in perceptual responses at 24 hours postmatch (ηp2=.152; P < .05), where the lower-standard group expressed larger decrements.

CONCLUSION

Coaches should prioritize the development of aerobic capacity and neuromuscular function as an effective method of reducing performance attenuation and enhancing recovery kinetics in Gaelic football.

CHARACTERISTICS OF BODY LOAD IN PHYSICAL TRAINING FOR FOOTBALL PLAYERS

ABSTRACT Introduction: Overtraining in football is caused by an imbalance between body load, stress, and recovery. High-volume non-scientific physical training and continuous high-intensity football matches are often the main reasons for the overtraining of athletes. Objective: This article explores the characteristics of the changes in physical function of football players during a complete training cycle. Methods: We use experimental methods to analyze the changes in the physical load characteristics of football players during high-intensity training. Results: Creatine kinase, urea nitrogen, and oxygen transport indicators did not change significantly during football training. Testosterone and cortisol will gradually increase with an increase of exercise load. Conclusion: In football training, we need to reasonably arrange the total exercise volume, exercise intensity, and exercise interval time of the athletes according to the trainer’s physical adaptability and athletic ability, supplemented with nutrition and enthusiasm recovery measures. These methods can improve or enhance the physical function of football players. Level of evidence II; Therapeutic studies - investigation of treatment results.

Return to competitive gymnastics training in the UK following the first COVID-19 national lockdown

Following the outbreak of COVID-19 (coronavirus), the UK entered a national lockdown, and all sport was suspended. The study aimed to explore the process of returning to gymnastics training after several months away from the gym, with a particular interest towards training load and injury. Twenty-six, national programmed gymnasts from Men's artistic, Women's artistic and Trampoline gymnastics recorded training load and injury whilst returning to training. At the end of data collection, three coaches were interviewed to further explore the experiences and practices of returning to training. Home-based training during lockdown was seen as beneficial in maintaining a level of fitness. Coaches described a gradual increase in training to reduce the risk of injury, and this partly explains a non-significant association between training load and a substantial injury (p = 0.441). However, week-to-week changes in training load following periods of additional restrictions (additional lockdown, periods of isolation, or substantial restrictions) were not always gradual. There was a significant association between an injury in the preceding week (niggle or substantial injury to a different body part) and a substantial injury in the subsequent week (RR: 5.29, p = 0.011). Monitoring training was described to be a useful practice during the process of returning to training. Coaches believed that although the short-term development of their gymnasts was affected, the long-term development would not be impacted from COVID-19. It is anticipated that learnings from this study can be applied to future practices and situations, particularly when gymnasts are away from the gym for an extended period.

The influence of growth and training loads on injury risk in competitive trampoline gymnasts

There is currently limited research exploring the relationship between growth, training load and injury in gymnasts. Twenty-one national level, trampoline gymnasts recorded training load and injury for 8-weeks. Percentage of predicted adult height (%PAH) was calculated using the Khamis-Roche method and used to define growth spurt status. Training load was calculated using the session rate of perceived exertion and analysed as differential loads and as a 7-day exponentially weighted moving average (EWMA7day). There was a significant non-linear association between %PAH and the probability of injury when adjusting for either training load metric (differential load, P = 0.015; EWMA7day; P = 0.008), with the highest injury risk estimated at ~90% PAH (circa growth spurt). The probability of injury significantly increased with increases in EWMA7day training load (RR: 1.88 95% CI: 1.21- 2.91, P = 0.005) but not with differential load. No significant interaction between %PAH, training load and the probability of injury were observed. Data suggest that competitive trampoline gymnasts are at an increased risk of injury during the adolescent growth spurt or with higher weekly training loads. Coaches should be educated and encouraged to identify periods of rapid growth and monitor training load, to reduce the risk of injury.

Injuries in Irish male and female collegiate athletes

OBJECTIVE

To understand the incidence and burden of injury of student-athletes in four of the most popular collegiate sports.

DESIGN

Prospective cohort study.

SETTING

Collegiate sport.

PARTICIPANTS

Gaelic football, hurling/Camogie, soccer and Rugby (n = 672; male = 416, female = 256) student-athletes.

MAIN OUTCOME MEASURE

Injury incidence, burden of injury and total, match and training injury rates, and their 95% confidence intervals were calculated. The frequencies and proportions were also calculated. An injury was defined as any physical condition that prevents a student-athlete from full participation for a period greater than 24 h.

RESULTS

Over a quarter (0.266) of student-athletes sustained an injury in the academic season. Male student-athletes had a higher injury rate than females (21.6 vs 11.3 injuries/1000 h). Rugby (20.8 injuries/1000 h) had the highest injury rates with hurling/Camogie (6.3 injuries/1000 h) the lowest. Lower extremity injuries were predominant (68.8%) with ankle sprains demonstrating a large burden for all sports (20.6-280.2 days absent/1000 h). Hamstring strains (13.7-118.4 days absent/1000 h) had a large burden for all sports except male Rugby. Knee sprains had a large burden on the female Gaelic footballer (84.8 days absent/1000 h). Sprinting (27.4%) and the tackle (20.1%) were the most common mechanism of injury. Injuries were predominantly moderate (8-28 days) or severe (>28 days) (84.7%).

CONCLUSION

Injury reduction needs to be prioritised in the student-athlete, particularly in males. Specific focus is required on the lower extremity, especially in the hamstring muscles and ankle joint owing to the large burden of injury.

4BR: Educational Training Programme for the Prevention of Sports Injuries in Young Athletes

This article provides a vision of the importance of the recovery process for the prevention of injuries in young athletes. From a sports psychology perspective, it presents a proposal for an optimisation programme to reduce the negative impact of exertion and subsequent risk of injury. The 4BR programme consists of three sub-programmes (technician advice, vulnerability detection, and the implementation of four recovery habit blocks). An interdisciplinary approach is taken to configure the four healthy blocks: nutrition-hydration, relaxation-rest, social life and personal moments. It demonstrates the importance of personalised adaptation to the sports context and moment in order to achieve maximum effectiveness of the proposed 4BR programme, which comprises workshops, exercises, evaluation systems and information feedback. The presented programme facilitates recovery, optimizes the return to training and reduces the risk of intrinsic injuries in young people. The conclusion drawn from the study is that there is a need to conduct further research to find empirical evidence of the positive effects of applying the 4BR programme to different sports.

A Cherry, Ripe for Picking: The Relationship Between the Acute-Chronic Workload Ratio and Health Problems

OBJECTIVE

To investigate whether the relationship between the acute-chronic workload ratio (ACWR) and health problems varies when different methodological approaches are used to quantify it.

DESIGN

Prospective cohort study.

METHODS

An online questionnaire was used to collect daily health and training information from 86 elite youth footballers for 105 days. The relationship between players' training load and health was analyzed using a range of different definitions of ACWR and health problems. We used 21-day and 28-day chronic periods, coupled and uncoupled calculations, and the exponentially weighted moving average and rolling average. Acute-chronic workload ratio data were categorized as low, medium, or high, using predefined categories and z scores. We compared medium to high, medium to low, and low to high categories. The outcome was defined in 3 ways: "all health problems," "all injuries," and "new noncontact injuries." We performed random-effects logistic regression analyses of all combinations, for a total of 108 analyses.

RESULTS

We recorded 6250 athlete-days and 196 health problems. Of the 108 analyses performed, 23 (21%) identified a statistically significant (P<.05) association between the ACWR and health problems. A greater proportion of significant associations were identified when using an exponentially weighted moving average (44% of analyses), when comparing low to high categories (33%), and when using the "all health problems" definition (33%).

CONCLUSION

The relationship between the ACWR and health problems was dependent on methodological approach. J Orthop Sports Phys Ther 2021;51(4):162-173. Epub 20 Jan 2021. doi:10.2519/jospt.2021.9893.

Does load management using the acute:chronic workload ratio prevent health problems? A cluster randomised trial of 482 elite youth footballers of both sexes

BACKGROUND

The acute:chronic workload ratio (ACWR) is commonly used to manage training load in sports, particularly to reduce injury risk. However, despite its extensive application as a prevention intervention, the effectiveness of load management using ACWR has never been evaluated in an experimental study.

AIM

To evaluate the effectiveness of a load management intervention designed to reduce the prevalence of health problems among elite youth football players of both sexes.

METHODS

We cluster-randomised 34 elite youth football teams (16 females, 18 males) to an intervention group (18 teams) and a control group (16 teams). Intervention group coaches planned all training based on published ACWR load management principles using a commercially available athlete management system for a complete 10-month season. Control group coaches continued to plan training as normal. The prevalence of health problems was measured monthly in both groups using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems.

RESULTS

The between-group difference in health problem prevalence (primary outcome) was 1.8%-points (-4.1 to 7.7 %-points; p=0.55) with no reduction in the likelihood of reporting a health problem in the intervention group (relative risk 1.01 (95% CI 0.91 to 1.12); p=0.84) compared with the control group.

CONCLUSIONS

We observed no between-group difference, suggesting that this specific load management intervention was not successful in preventing health problems in elite youth footballers.

TRIAL REGISTRATION NUMBER

ISRCTN18177140.