Soft tissue injuries, is it overload, or perhaps underload......?

Woman increasing training load

This is a question that I am sure confuses you, as when we first heard the concept at The Melbourne Sports Medicine Centre, we too were confused. However when broken down, this concept is gaining growing support in light of research into injury risk and loading in elite and sub-elite sports.

Overload.

For many years you have most likely heard practitioners use the term “an overload injury”.  And whilst this is a correct generalisation of the categorical nature of the injury, it perhaps does not accurately describe the true causative factor of the injury.

The term overload can be defined as “load with too great a burden or cargo” or “an excessive amount of something”.  In relation to injury this can be thought of as doing too much exercise or activity. For years it has been a fine line for coaches and strength and conditioning coaches to train harder to get gains, but not too hard to cause injury.

How do we know what too much “load” is for each person?? Will we ever know??

What we do know is that this is relative to each individual’s baseline training load and the rate of increase of this training load.

Is the term “overload” a misconception?

A study performed in elite cricketers reported that cumulative load did not have a substantial effect on future injury risk. The authors found that a sudden increase in load over a 5-day period resulted in a 50% higher injury risk. Another study in 2014 in runners concluded that runners who increased their weekly workload by greater than 30% were at a higher risk to soft tissue injury, and another in AFL reported a high injury risk in players who exerted higher short term increases in loads in comparison to their baseline training load.

In light of this research, is it purely too much load, is it the fact that the tissues of the body have been relatively “underloaded” and then hit with a sudden high workload that overwhelms the soft tissues ability for adaptive changes and tissue repair?

So that one 45 minute run that you do after a 6 month inactive period could create the beginnings of a soft tissue injury, even though this might be considered an “easy” run that you used to do 5 years ago all the time!

Tissue and load.

What we also know from research is that load that is applied to a tendon promotes cell growth and production within a tendon leading to improved tendon structure. So it raises the question, do we need to keep slowly and progressively increasing load and in some circumstances even potentially train more to be able to cope with game or event day loading, in order to decrease the risk of injury? Does this answer the question as why there are non-Olympic athletes that are able to run ultra marathons?? How did a man manage to run a marathon everyday for a year if it was purely a high volume of activity that increased risk of injury?

What does this mean to a recreational athlete?

  • Consult one of the Physiotherapists or Sports Doctors at The Melbourne Sports Medicine Centre for advice into preparing a training schedule.
  • Avoid taking shortcuts or make up for missed training sessions by increasing time and intensity.
  • Stick to what you have planned out.
  • Avoid large spikes in training loads.
  • Train enough to match loads of game or event day requirements.
  • You can track training loads without GPS data by rating the session through RPE (your subjective rating of perceived exertion) times by the duration of the session. This will give you a numerical idea of your training load.

Good luck with your training and remember to train safely to decrease the risk of soft tissue injury. 

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