Injury Risk From Returning To Sports Too Fast

Detraining during injury and a quick return will increase injury risk

The injury risk while returning to sports after time off is greater than most coaches realize.

That time off may be anything from offseasons, in-season holidays, or unfortunately injury.

Preventing injuries has to be one of the highest priorities for coaches, teams, and organizations as athletes return to sports after time off. 

What’s the point of getting back to practice, if our athletes are getting hurt and missing sport anyway?

The detraining they have gone through means the athlete’s returning aren’t the same ones who left.  Their physical capacities will be different.

So how do we know if they will be at risk?

Return To Sport Lessons For Elite Sports

We know athletes’ have increased risks when returning after significant injury or surgery.  And we aren’t talking about just reinjuring the same body part, but the increased risk of other injuries since they haven’t been training.

We also can look at data from years in pro sports with shorter seasons and lockouts.  Consistently the number of injuries is much higher when the athletes return.

One of the risk factors in all these scenarios is the accumulation of fatigue.  As athletes fatigue, their injury risks increase.  The athletes coming off lockdown restrictions will fatigue faster.  They aren’t in the same shape to train and have a lower ability to recover.

This also reinforces a key point about rehab and training during injury; maintain as much as possible. By keeping more training volume while injured you’re going to bounce back faster.

Stress As A Stimulus

Another factor in the injury risk returning to sports is how quickly they ramp up training again.

Practice, training, and competitions are a stimulus and stress for the athlete’s body.  We want some stimulus, so they adapt, putting some savings back in that bank account.  This is the increase in their readiness.  That’s the overall level of their abilities from training.

However, that same stimulus, when taken too far, overloads the athlete beyond their ability to adapt.  This level of stress can lead to immediate fatigue, which increases injury risk.  Remember, the athletes will likely have a diminished ability to recover as fast.  Both within a single practice session and between sessions.

When the stress overload is too high, it also damages tissues.  That damage may be a small injury that adds up to those chronic, overuse injuries.  It could also manifest as acute muscle strains and tendon sprains.

The Acute To Chronic Workload Ratio In Return To Sports

In elite sports, a lot of research and effort have gone into understanding how changes in training workload influence injury risk.  The general consensus is that if the volume of training drops too much, athletes detrain. Then their injury risk can go up.   If it increases too fast, then injury risks increase

For those planning the return to sport, this is an essential concept.

Chronic Training Load

Consider two measures of the training workload.  The first we call chronic workload.  This is the average workload that has been happening over time.  Often we look at the average of the last eight weeks, with some extra importance in the most recent weeks.

This should make intuitive sense for a coach.  The work, an athlete, has been doing in training over several weeks is what they can tolerate.  It’s what the athlete has adapted to.   Some practices are intense and some less severe, but it’s the average accumulated workload that they have adapted to.

Think about what this means for athletes right now.  They are getting drastically less workload.  Even if they are putting in their best efforts, they are getting far less than the total they were getting from practice, training, and competition before.

The workload is also relatively specific to the type and intensity of the work.  The workload from 60 minutes of high-intensity practice or games, is much different than 60 minutes of bodyweight training and modified conditioning programs.

So as each week of sports lockdown progresses, the athlete’s average for the last eight weeks is dropping.  Their chronic workload number is going down.  

Acute Training Load

On the other hand, acute training workload is what they are going through now.  This is typically looked at as the last 5-7 days.  Some days may be harder, others more relaxed, but the average is what the athlete’s bodies are working to recover from and adapt to.

The relationship to injury comes in when we see a significant gap in the acute and chronic training load.  This relationship is called the acute to chronic workload ratio (ACWR). 

Any time there is an increase in the training load, we see the acute: chronic greater than 1.  Although the exact number varies by sport and finer details of workload, we still know when that number gets too big we have a problem.

Coaches have been pushing athletes for decades to train more and train harder, so they adapt. A jump in the training load itself won’t automatically increase injury risk.

On the other hand, it’s not hard to understand that if you keep doubling the amount of training every week, at some point, they are going to break down.

Recent research in pro sports has explored this ratio.  A few years ago, there was a big push based on some excellent research that a ratio of around 1.5 increased injury risk.  

The exact number is not what we are worried about per se because the athlete’s age and level and the sport have an impact. What does matter is the basic premise; increasing workload too quickly leads to elevated injury risk.

Coaches, if you return athletes to practice without a progressive plan, and follow your normal approach, you might be putting your athletes in harm’s way.

Athletes will have a greater injury risk when returning to sports

Most athletes are looking to get back into training and competition quickly.

However, in doing so, we must recognize and plan for the unique situation we are in as coaches, and organizations.

So be proactive. If you’re not back to practice yet, get your athletes some help and programming that addresses their specific needs when they return.

Get with a knowledgeable sports performance professional who can help you put a plan together to ramp back up as quickly as possible.

The vital point for sports coaches is that if you increase the training load too fast, the injury risk returning to sports goes up.