Gabbett T, Sancho I, Dingenen B, et alWhen progressing training loads, what are the considerations for healthy and injured athletes?British Journal of Sports Medicine Published Online First: 09 April 2021. doi: 10.1136/bjsports-2020-103769
Every sport requires specific physical capacities to enable success and minimise injury risk.
When referring to load capacity, sportspecific capacity is defined as the athlete’s ability to perform (and withstand) the demands of training and competition, whereas local tissue capacity is defined as a specific structure’s ability to withstand tissue-specific cumulative load.
Progressively applied sport-specific training load improves an athlete’s physical capacities (eg, strength, power and endurance) and performance. Conversely, injury risk increases if training loads grossly exceed the athlete’s current local tissue capacity.
For the injured athlete, local tissue capacity immediately decreases after acute injury, likely driven by tissue damage and pain, with psychosocial factors as effect mediators. In the early stages of injury, management may involve the temporary reduction of local tissue loads to promote healing and reduce irritability, followed by a restoration of local tissue capacity through progressive strengthening and improvements in neuromuscular control.
THREE KEY POINTS WHEN PROGRESSING TRAINING LOADS
1. Progressive loading using patientreported feedback is best practice. The inclusion of a patient-reported outcome (such as a session-RPE or a visual analogue pain scale), in combination with external loads are needed to address local tissue loads and progress exercises safely and efficiently.
2. Effective programmes employ local tissue loading to maintain local tissue capacity
3. Local tissue and sport-specific loading are needed for an injured athlete to return to sport safely. Restoring local tissue capacity of both injured and associated structures is required for injured athletes. However, without regular doses of load designed to improve sport-specific capacity, athletes are at risk of being underprepared for the demands of competition on return to sport. Within the constraints of biological healing, exposure to sport-specific loading allows safe re-integration into training and competition, while minimising the risk of re-injury.