1 Training Smarter and Harder: Improve Performance, Reduce Risk, Improve Return Your Tour Guides JC Andersen Tim Gabbett John Meyer Sameer Mehta 2

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1 1 Training Smarter and Harder: Improve Performance, Reduce Risk, Improve Return Your Tour Guides JC Andersen Tim Gabbett John Meyer Sameer Mehta 2 Our Objectives For You Describe current methods for monitoring training load. Discuss the concepts of training smarter and harder, internal training load and external training load. Illustrate the implementation of training load measurement to improve training and reduce primary injury risk. Apply training load monitoring during rehabilitation as part of rehabilitation progression and return to sport (RTS) decision-making 3 Working Definitions Internal Training Load the biological responses to training physiological psychological External Training Load work performed by the athlete speed, power, GPS, time 4 Some Background Is Monitoring Training Load New? Not really 5 Some Background Leading up to the Present Training Impulse (TRIMP) Fitness to Fatigue relationship Session RPE (srpe) Wellness Questionnaires 6 Some Background Technology arrives 7 Some Background Into the Future integration of total training load training intensity pattern daily training load variation into one variable at the individual level 8 Where is Load Monitoring Headed?

2 8 Where is Load Monitoring Headed? informed selection of internal & external data individualize load monitoring Acute:Chronic Workload Ratios Delivery of Load Monitoring Data reliable accurate easily interpreted 9 What is the Potential? h knowledge of training & competition responses by athletes coaches staff (S & C, MD, PT, AT, et al) h the design of training & recovery programs i the incidence of injury or illness h performance 10 What s Next Today Tim Gabbett Training Load Foundations, Concepts, and Applications J. C. Andersen Implementing Catapult System in D2 Soccer John Meyer Training Load in D1 Football Sameer Mehta Training Load Elite Youth Baseball

3 References: 1. Blanch P, Gabbett TJ. Has the athlete trained enough to return to play safely? the acute:chronic workload ratio permits clinicians to quantify a player's risk of subsequent injury. Br J Sports Med Chambers R, Gabbett TJ, Cole MH, Beard A. The use of wearable microsensors to quantify sport-specific movements. Sports Med. 2015;45(7): Cummins C, Orr R, O'Connor H, West C. Global positioning systems (GPS) and microtechnology sensors in team sports: A systematic review. Sports Med. 2013;43(10): Dellaserra CL, Gao Y, Ransdell L. Use of integrated technology in team sports: A review of opportunities, challenges, and future directions for athletes. J Strength Cond Res. 2014;28(2): Foster C, Rodriguez-Marroyo JA, de Koning JJ. Monitoring Training Loads: The Past, the Present, and the Future. Int J Sport Physiol Performance 2017; published ahead of print, 6. Gabbett TJ, Hulin BT, Blanch P, Whiteley R. High training workloads alone do not cause sports injuries: How you get there is the real issue. Br J Sports Med Hulin BT, Gabbett TJ, Lawson DW, Caputi P, Sampson JA. The acute:chronic workload ratio predicts injury: High chronic workload may decrease injury risk in elite rugby league players. Br J Sports Med. 2016;50(4): Saw AE, Main LC, Gastin PB. Monitoring the athlete training response: subjective selfreported measures trump commonly used objective measures: a systematic review. Br J Sports Med 2016;50: Wellman AD, Coad SC, Goulet GC, McLellan CP. Quantification of competitive game demands of NCAA division I college football players using global positioning systems. J Strength Cond Res. 2016;30(1): Ward PA, Ramsden S, Coutts AJ, et al. Positional differences in running and non-running activities during elite American Football training. J Strength Conditioning Res, published ahead of print Weinhandl JT, Earl-Boehm JE, Ebersole KT, et al. Reduced hamstring strength increases anterior cruciate ligatment loading during anticipated sidestep cutting. Clin Biomech 2014;29:

4 The Training Injury Prevention Paradox: Should Athletes be Training Smarter AND Harder? Dr. Tim Gabbett Gabbett Performance Solutions When an athlete sustains a preventable injury, those involved in the training process often blame high workloads. However, most of the dogma surrounding athlete workloads and injury is based around the incorrect assumption that high workloads lead to injury. In recent times, a wealth of evidence, from a wide range of sports, has shown that progressing athletes to high workloads not only provides better preparation for the physical demands of competition, but also may decrease the risk of injury. An important point that has been overlooked with the majority of workloadinjury literature, is that absolute high loads are not necessarily problematic, as long as they are prescribed safely and systematically. The acute:chronic workload ratio has allowed sports practitioners to safely prescribe increases in workload, based on the athlete s ability to tolerate those increases in workload. More importantly, skill coaches, sports medicine personnel, and fitness staff now have a common language that can be used when progressing athlete s through different (e.g. rehabilitation, recovery, or functional over-reaching) interventions. This presentation will discuss the importance of physically hard and appropriate training in protecting athletes against injury. A performance model will also be presented to describe how medical and performance staff can work effectively together to reduce injury risk and enhance athlete performance.

5 1 ImPLEMENTING CATAPULT IN NCAA DIVISION 2 WOMEN S SOCCER J C Andersen 2 Our Story Put the team together Sports Medicine, S & C, Human Performance, Coaches Catapult Demonstration in August 2016 Player & Coach response Our Team s response 3 Our Story Submitted Use Case to Deans, AD, VP, President Our Reasons Why Enhance & Expand collaborative efforts National Model for D2! Player Wellness Academics Student-Athlete & Coaching 4 Long Story Short Admin feedback great proposal, put it in the budget request We did that & waited Tim Gabbett workshop/consulting - Feb 2017 Funding for 3 year agreement approved - April Let the Fun Begin!? 5 Long Story Short How much? 40 units, first year cost $22,600 Challenges started with Men s and Women s Soccer learning curve staffing technology sharing of some units 6 Where Are We Now? We have some data!!! Limitations no away games tracked weird data sometimes quick turnaround between team practice times typically did not track if modified by medical

6 Where to From Here? 13 Deeper Analysis Practice/Game data Determine Key Metrics for Team Members Track more completely Deliver individualized reports to athletes Do we add a subjective measure? Propose Sport Scientist staff position

7 Training Smarter and Harder: Improve Performance, Reduce Risk, Improve Return Use of Training Load Monitoring in Division 1 Football APTA Combined Sections Meeting 2018 John L. Meyer, PT, DPT, OCS, FAFS University of Southern California Department of Athletic Medicine ACL injuries are debilitating result in significant amount of time loss from training and competition High rates of re-injury Return to play criteria Variables Timelines Compliance vs. Non-Compliance Proper load management to enhance performance outcomes Case Study: 21-year-old Division 1 football player Status post right ACL revision Autogenous semitendinosus/gracilis graft Prior high school right patellar tendon ACL reconstruction Consequences of graft choice Reduction in hamstring muscle volume Structural difference in hamstring after ACL reconstruction Fascicle length Muscle thickness Penation angle Eccentric strength Prolonged weakness Monitoring return of strength during the course of rehab Average peak force during Nordic hamstring exercise Nordboard testing Return to Play Criteria and the Use of Technology Proper Load Management through Catapult Athlete Monitoring: Position Specific Load Understanding Change from Center vs. tackle position specific demand Player load per practice period Return to Practice Periodization Total plays Live contact plays Average game week progression Percent change vs. fall camp average Average distance Distance >12 mph Player load per yard Total explosive movements High intensity load average

8 2/20/18 1 Relationship Between Workload and Throwing Injury in Elite, Baseball Players Combined Sections Meeting February 22, 2018 Sameer Mehta PT, DPT, SCS, CSCS Clinical Supervisor - Outpatient Physical Therapy MedStar Georgetown University Hospital Director of Rehabilitation/Sports Science & Analytics St. John's College High School Baseball Learning Objectives To understand the meaning of workload in baseball and how it is captured Review research and apply to case scenarios Improve data-driven decision making Utilize this methodology as a tool to assist clinicians, coaches, and athletes with reducing injury risk by modifying workload Introduction and Aims Baseball prevalence of injuries with a rise in Tommy John surgeries, time lost to injury, and significant revenue losses. 1-3 Link between throwing volume and upper limb injuries in youth baseball à USA Baseball establish pitch limits for youth pitchers. 1

9 2/20/18 youth baseball à USA Baseball establish pitch limits for youth pitchers. 4 Recent evidence from Australian sports supported that acute spikes in workload can lead to non-contact soft tissue injuries in the lower extremity, known as the acute-to-chronic workload ratio (ACWR). 5 4 Introduction and Aims Gabbett et al. found sweet spot of ACWR to reduce risk of non-contact soft-tissue injuries > 1.5 = danger zonezone 5 6 Conclusion Logistic regression suggests there IS a significant relationship between ACVR and injury occurrence à high ACVRs may increase injury risk. Players should avoid sudden spikes in acute workload to risk Load management can be achieved by modifying volume of throws, high effort throws, and variables impacting workload. 7 Case Scenario #1 17 y.o pitcher, D1 commit with c/o chronic medial elbow pain x 12 months feels better when I throw more Inc medial elbow pain after pitching bouts - valgus stress test, - milking maneuver, - pn with resisted pronation/flexion 2

10 2/20/18 pronation/flexion + TTP to common flexor tendon Dx Imaging: - MRI, US + thickened flexor tendon Dx: flexor/pronator reactive tendonopathy Case Scenario #1 Tendonopathy: A process where injury to the tendon is result of overload beyond capacity of that tendon. A tissue s capacity is only as great as the load you place upon it. Jill Cook Case Scenario #1 ACVR after pitching bout: 1.39 Bout 2-10 days later: 1.1 Bout 3-5 days later: 1.1 (41 game pitches) Case Scenario #1 Case Scenario #2 18 y.o pitcher, D1 commit with c/o ant SH pain day after pitching bout 5 IP Pn w/throwing, pn w/reaching behind back, end range Flex - empty can, - O Brien s, - Speed s, - Yergason s, - Biceps Load + TTP to LH Biceps tendon 3

11 2/20/18 + TTP to LH Biceps tendon Dx Imaging: MRI Dx: Biceps tendonitis (reactive tendonopathy) Case Scenario #2 Case Scenario #2 ACVR after pitching: 1.3 (75 game pitches, 5 IP) Bout 2-10 days later: 0.8 (20 game pitches, 2 IP) Bout 3 4 days later: 1.1 (26 game pitches, 3 IP) 14 Case Scenario # Coaching/Medical Insight Utilizing this tool completely changed the way I look at protecting pitchers and building pitch counts. The data allowed me to see the vast discrepancy between each pitcher s workloads revealing thousands of hidden or untracked practice throws each pitcher makes throughout the season. The dashboard showed when each pitcher was at his physical peak, impacting pitching decisions and keeping our staff at optimal levels. 4

12 2/20/18 physical peak, impacting pitching decisions and keeping our staff at optimal levels. Protected catchers by determining their true volume, and effort My Insight Summary Applying the ACVR and analytics allows us to practice metrics based medicine Significant relationship between ACVR and upper limb injury If unavoidable spikes in training occur, dec training loads over 1-4 weeks to return ACVR Under-training as bad as over-training High loads are not the problem, but how you get there Numbers do not lie! 19 References 5