UH Study Explores - Does More Training Cause More Injuries?

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Innovations in Orthopaedics | Winter 2020

A team of University Hospitals researchers — led by James E. Voos, MD, Chair of University Hospitals Department of Orthopaedics; Associate Professor of Orthopaedics, Case Western Reserve University School of Medicine, and Cleveland Browns Senior Vice President of Player Health and Development Joe Sheehan — recently conducted a study to explore ways to keep football players healthy. When they presented their results at a recent American Orthopaedic Society for Sports Medicine (AOSSM) conference, the Cleveland Browns became one of the first research teams to present findings at a scientific meeting.Cleveland Browns

The results, published in AOSSM’s January/February 2020 issue of Sports Health1, may assist football coaches in designing preseason and regular season training programs with less injury risk, thus optimizing performance.

“Our goal is to keep athletes safely on the field and prolong their careers,” says Dr. Voos. “We also plan to use this data to provide training recommendations to youth-level athletes to help them reduce their risk.”

“Our athletic trainers, doctors and additional team personnel spend a bulk of our time proactively working to prevent injuries and help athletes reach peak performance,” said Sheehan. “Through our research with UH, our focus is improving experiences for professional athletes while also identifying opportunities to advance health and safety for all sports and levels of play.”

RESEARCH METHODS

Researchers, including Dr. Voos and Michael J. Salata, MD, Director of University Hospitals Sports Medicine Institute and Associate Team Physician for the Cleveland Browns; Associate Professor Orthopaedics, School of Medicine, assessed player workloads during preseason and regular season practice sessions from 2014 to 2016. Player workload is calculated by measuring training time, distance covered and the intensity with which players train. “Intensity” for football players involves a number of factors, including speed, impact, spin, and acceleration and deceleration time.

The players wore wearable devices with GPS tracking and triaxial accelerometry. Using data generated from the wearables, researchers logged player workload during the week of an acute injury, as well as the average weekly workload during the four weeks prior. For a control, uninjured position-matched workload was measured during the same week. A matched-pairs test was used to determine differences in player workload. Subgroup analysis helped to determine whether observed effects were confounded by training period and injury type.

DATA RESULTS

Dr. Voos and team measured 136 total lower extremity injuries, including hamstring strains and other overuse injuries. Of those, 101 injuries had complete clinical and GPS data.

Crunching the numbers, researchers found a link between an increase in workload and injuries. Injured players had increased their workload by a remarkable 111 percent in the week of injury, while uninjured players had a 73 percent workload increase.

Those who had an acute-to-chronic workload ratio higher than 1.6 were one-and-a-half times more likely to sustain an injury relative to time- and position-matched controls (64.6 percent versus 43.1 percent; P = 0.004).

BENEFITS FOR ALL ATHLETES

UH and the Cleveland Browns collaborated on the study to explore how increases in training workload can raise injury risk. By understanding the training conditions that led to injury and the workload of uninjured players, UH sports medicine doctors can develop specific training protocols to improve injury prevention in all athletes.

Dr. Voos recommends that coaches gradually increase training intensity and duration during preseason. It’s a philosophy that applies to all levels of athletes.

“We can use this data to provide recommendations to youth-level athletes on training programs to help them reduce injury risk,” says Dr. Voos. “The results can translate to healthier, fitter youth sports teams.”

A TEAM EFFORT

Five years in the making, the football injury risk study involved researchers with experience in sports medicine, professional sports and data science.

“We have a wonderful partnership with Case Western’s Department of Biomedical Engineering,” says Dr. Voos. “We’re now working together on a clinical trial that involves using wearables to monitor patients’ rehab after ACL surgery, and hope to expand our collaboration to develop further studies using wearable devices.”

To learn more about the study and its findings, contact Dr. Voos at 216-553-1783.

References 

1. Li RT, Salata MJ, Rambhia S, Sheehan J, Voos JE. Does Overexertion Correlate With Increased Injury? The Relationship Between Player Workload and Soft Tissue Injury in Professional American Football Players Using Wearable Technology. Sports Health. 2020;12(1):66–73. doi:10.1177/1941738119868477. Accessed at: https://www.ncbi.nlm.nih.gov/pubmed/31469616

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