Two training-load paradoxes: can we work harder and smarter, can physical preparation and medical be teammates?

The authors have observed that in professional sporting organizations the staff responsible for physical preparation and medical care typically practice in relative isolation and display tension as regards their attitudes toward training-load prescription (much more and much less training, respectively). Recent evidence shows that relatively high chronic training loads, when they are appropriately reached, are associated with reduced injury risk and better performance. Understanding this link between performance and training loads removes this tension but requires a better understanding of the relationship between the acute:chronic workload ratio (ACWR) and its association with performance and injury. However, there remain many questions in the area of ACWR, and we are likely at an early stage of our understanding of these parameters and their interrelationships. This opinion paper explores these themes and makes recommendations for improving performance through better synergies in support-staff approaches. Furthermore, aspects of the ACWR that remain to be clarified-the role of shared decision making, risk:benefit estimation, and clearer accountability-are discussed

The MyJump App is a Valid Method of Assessing and Classifying Limb Symmetry During Recovery from Anterior Cruciate Ligament Reconstruction

# Background Jump testing performance and limb symmetry measures are important metrics for clinicians to monitor during rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction, however they require hardware and software which is not commonly available in clinical practice. Video-based solutions may present a feasible alternative, but their veracity in classifying patients using limb-symmetry of 90% has not been established, nor have the clinimetric values for the performance measures been reported in this population. # Purpose To describe the diagnostic accuracy (pass/fail using 90% LSI) and clinimetrics of an iPad-based app ("MyJump") compared to reference force plate analyses for limb symmetry, jump/hop height, contact time, flight time, and reactive strength index # Study design Prospective cohort, diagnostic accuracy # Methods Fifty-one consecutive patients recovering from ACL reconstruction undertaking routine independent clinical evaluation of their hop and jump performance were concurrently and independently examined using force plates and the MyJump app. Diagnostic accuracy of MyJump was compared to reference force plate analyses using a criterion of 90% limb symmetry. # Results Diagnostic accuracy of the MyJump app was very good: positive predictive value for jump height was 0.83 and 1.0 for reactive strength index, and negative predictive value was 0.95 and 1.0 for the same metrics, respectively. Of the 131 classifications made using the MyJump app, there were five false positives and three false negatives -- all of these were in classification of jump height with no misclassifications of RSI. Irrespective of jump type, the MyJump app displayed excellent reliability (ICC\>0.95) for both height and reactive strength index. Minimum detectable changes were approximately 1cm for height, 0.1 for reactive strength index, 0.02s for contact time, and 0.3s for flight time. # Conclusion Where force plates are unavailable, the MyJump app is a valid and reliable substitute for criteria assessment of jump/hop height and reactive strength index in those recovering from ACL surgery using a 90% limb symmetry threshold. The minimum detectable changes vary by metric but are likely sufficiently accurate to detect clinical changes. # Level Of Evidence Level

Automatic detection of pitching and throwing events in baseball with inertial measurement sensors

Purpose: Throwing loads are known to be closely related to injury risk. However, for logistic reasons, typically only pitchers have their throws counted, and then only during innings. Accordingly, all other throws made are not counted, so estimates of throws made by players may be inaccurately recorded and underreported. A potential solution to this is the use of wearable microtechnology to automatically detect, quantify, and report pitch counts in baseball. This study investigated the accuracy of detection of baseball pitching and throwing in both practice and competition using a commercially available wearable microtechnology unit. Methods: Seventeen elite youth baseball players (mean ± SD age 16.5 ± 0.8 y, height 184.1 ± 5.5 cm, mass 78.3 ± 7.7 kg) participated in this study. Participants performed pitching, fielding, and throwing during practice and competition while wearing a microtechnology unit. Sensitivity and specificity of a pitching and throwing algorithm were determined by comparing automatic measures (ie, microtechnology unit) with direct measures (ie, manually recorded pitching counts). Results: The pitching and throwing algorithm was sensitive during both practice (100%) and competition (100%). Specificity was poorer during both practice (79.8%) and competition (74.4%). Conclusions: These findings demonstrate that the microtechnology unit is sensitive to detect pitching and throwing events, but further development of the pitching algorithm is required to accurately and consistently quantify throwing loads using microtechnology. © 2017 Human Kinetics, Inc

Cohen’s MRI scoring system has limited value in predicting return to play

Numerous authors have hypothesised that MRI scoring systems provide a valid means of predicting return to play duration following an acute hamstring muscle strain. The purpose is to prospectively investigate the predictive value of the MRI scoring system of Cohen for return to sport (RTS), following an acute hamstring injury. Male football (soccer) players (n = 139) with acute onset posterior thigh pain underwent standardised clinical and MRI examinations within 5 days after injury. All players underwent a standardised physiotherapy regimen with RTS documented. The MRI scoring was statistically evaluated against RTS. One hundred and ten MRI-positive hamstring injuries were evaluated with RTS duration ranging from 1 to 66 days. Total Cohen's MRI score accounted for approximately 4% of the variance in RTS duration. When comparing those with an MRI score of 10 or more took on average 9.8 days longer to RTS than those with an MRI score less than 10 (effect size: 0.85, p < 0.01). Utilising the Cohen's MRI scoring system previously described, we were unable to provide a clinically useful prognosis for RTS in male soccer players. This may reflect the broader challenges of attempting to accurately determine RTS duration from imaging performed at a single point in time. Prospective case series, I

Modeling the Risk of Team Sport Injuries: A Narrative Review of Different Statistical Approaches

Injuries are a common occurrence in team sports and can have significant financial, physical and psychological consequences for athletes and their sporting organizations. As such, an abundance of research has attempted to identify factors associated with the risk of injury, which is important when developing injury prevention and risk mitigation strategies. There are a number of methods that can be used to identify injury risk factors. However, difficulty in understanding the nuances between different statistical approaches can lead to incorrect inferences and decisions being made from data. Accordingly, this narrative review aims to (1) outline commonly implemented methods for determining injury risk, (2) highlight the differences between association and prediction as it relates to injury and (3) describe advances in statistical modeling and the current evidence relating to predicting injuries in sport. Based on the points that are discussed throughout this narrative review, both researchers and practitioners alike need to carefully consider the different types of variables that are examined in relation to injury risk and how the analyses pertaining to these different variables are interpreted. There are a number of other important considerations when modeling the risk of injury, such as the method of data transformation, model validation and performance assessment. With these technical considerations in mind, researchers and practitioners should consider shifting their perspective of injury etiology from one of reductionism to one of complexity. Concurrently, research implementing reductionist approaches should be used to inform and implement complex approaches to identifying injury risk. However, the ability to capture large injury numbers is a current limitation of sports injury research and there has been a call to make data available to researchers, so that analyses and results can be replicated and verified. Collaborative efforts such as this will help prevent incorrect inferences being made from spurious data and will assist in developing interventions that are underpinned by sound scientific rationale. Such efforts will be a step in the right direction of improving the ability to identify injury risk, which in turn will help improve risk mitigation and ultimately the prevention of injuries

The dose-response of the nordic hamstring exercise on biceps femoris architecture and eccentric knee flexor strength : A randomized interventional trial

Purpose: To examine the dose–response of the Nordic hamstring exercise (NHE) on biceps femoris long head (BFlh) architecture and eccentric knee flexor strength. Design: Randomized interventional trial. Methods: Forty recreationally active males completed a 6-week NHE training program consisting of either intermittent low volumes (group 1; n = 10), low volumes (group 2; n = 10), initial high volumes followed by low volumes (group 3; n = 10), or progressively increasing volumes (group 4; n = 10). A 4-week detraining period followed each program. Muscle architecture was assessed weekly during training and after 2 and 4 weeks of detraining. Eccentric knee flexor strength was assessed preintervention and postintervention and after 2 and 4 weeks of detraining. Results: Following 6 weeks of training, BFlh fascicle length (FL) increased in group 3 (mean difference = 0.83 cm, d = 0.45, P = .027, +7%) and group 4 (mean difference = 1.48 cm, d = 0.94, P = .004, +14%). FL returned to baseline following detraining in groups 3 and 4. Strength increased in group 2 (mean difference = 53.6 N, d = 0.55, P = .002, +14%), group 3 (mean difference = 63.4 N, d = 0.72, P = .027, +17%), and group 4 (mean difference = 74.7, d = 0.83, P = .006, +19%) following training. Strength returned to baseline following detraining in groups 2 and 3 but not in group 4. Conclusions: Initial high volumes of the NHE followed by lower volumes, as well as progressively increasing volumes, can elicit increases in BFlh FL and eccentric knee flexor strength. Low volumes of the NHE were insufficient to increase FL, although as few as 48 repetitions in 6 weeks did increase strength

Eccentric hamstring strength in young athletes is best documented when normalised to body mass: a cross-sectional study with normative data of 590 athletes from different age categories

Despite its widespread use in adults, the Nordic hamstring exercise remains underexplored in athletic youth populations. Further, given the dynamic nature of growth and maturation, comparisons with elite adult populations may be inaccurate. Here we describe absolute and body mass-normalised eccentric hamstring normative values for football, athletics and multi-sport youth populations. 676 routine standardised tests were conducted, including 244 U12–U18 student-athletes (football, athletics, multi-sport) and 346 Qatar Stars League (QSL) football players using the NordBord. The average maximum values for the left and right leg from 3 repetitions were recorded. Significant increases in absolute strength were seen across chronological (e.g., 150 N±15 for U12 to 330 N±40 for U18) and skeletal (142.9 N±13.9 for skeletal age of 12 compared to 336.2 N±71.2 for skeletal age of 18) age groups. The differences in values normalised to body mass were smaller at 3.6 N/kg±0.25 for the U-13 group, but similar for the U14 to U18 groups (4.5 N/kg±0.16, 4.6 N/kg±0.11, 4.6 N/kg±0.27, 4.7 N/kg±0.14, 4.5 N/kg±0.18). Students displayed lower absolute strength than the professional football players (272.1 N compared to 297.3 N, p < 0.0001) but higher relative strength (4.7 N/kg compared to 4.2 N/kg, p < 0.0001). Comparing Nordic hamstring strength values between athletes, and between skeletal and chronological age groups can be done when values are normalised to the athlete’s body mass. For the U14s and onwards age categories, body mass normalised values are comparable to professional football players

Automatic detection of pitching and throwing events in baseball with inertial measurement sensors

Purpose: Throwing loads are known to be closely related to injury risk. However, for logistic reasons, typically only pitchers have their throws counted, and then only during innings. Accordingly, all other throws made are not counted, so estimates of throws made by players may be inaccurately recorded and underreported. A potential solution to this is the use of wearable microtechnology to automatically detect, quantify, and report pitch counts in baseball. This study investigated the accuracy of detection of baseball pitching and throwing in both practice and competition using a commercially available wearable microtechnology unit. Methods: Seventeen elite youth baseball players (mean ± SD age 16.5 ± 0.8 y, height 184.1 ± 5.5 cm, mass 78.3 ± 7.7 kg) participated in this study. Participants performed pitching, fielding, and throwing during practice and competition while wearing a microtechnology unit. Sensitivity and specificity of a pitching and throwing algorithm were determined by comparing automatic measures (ie, microtechnology unit) with direct measures (ie, manually recorded pitching counts). Results: The pitching and throwing algorithm was sensitive during both practice (100%) and competition (100%). Specificity was poorer during both practice (79.8%) and competition (74.4%). Conclusions: These findings demonstrate that the microtechnology unit is sensitive to detect pitching and throwing events, but further development of the pitching algorithm is required to accurately and consistently quantify throwing loads using microtechnology

Hip strength and range of motion: normal values from a professional football league

To determine the normal profiles for hip strength and range of motion (ROM) in a professional football league in Qatar, and examine the effect of leg dominance, age, past history of injury, and ethnicity on these profiles.Cross-sectional cohort study.Participants included 394 asymptomatic, male professional football players, aged 18-40 years. Strength was measured using a hand held dynamometer with an eccentric test in side-lying for hip adduction and abduction, and the squeeze test in supine with 45° hip flexion. Range of motion measures included: hip internal and external rotation in 90° flexion, hip IR in prone, bent knee fall out and hip abduction in side-lying. Demographic information was collected and the effect on the profiles was analysed using linear mixed models with repeated measures.Strength values (mean±SD) were: adduction=3.0±0.6Nm/kg, abduction=2.6±0.4Nm/kg, adduction/abduction ratio=1.2±0.2, Squeeze test=3.6±0.8N/kg. Range of motion values: internal rotation in flexion=32±8°, external rotation=38±8°, internal rotation in prone=38±8°, bent knee fall out=13±4.4cm, abduction in side-lying=50±7.3°. Leg dominance had no clinically relevant effect on these profiles. Multivariate analysis demonstrated that age had a minor influence on squeeze strength (-0.03N/kg/year), external rotation (-0.30°/year) and abduction range (-0.19°/year) but past history of injury, and ethnicity did not.Normal values are documented for hip strength and range of motion that can be used as reference profiles in the clinical assessment, screening, and management of professional football players. Leg dominance, recent past injury history and ethnicity do not need to be accounted for when using these profiles for comparison purposes