Injury Prevention Through Workload Monitoring – Part 1

 This post is prepared by West 4th Physiotherapy associate Peter Francis


Injury prevention is something that most people can get on board with and very few (if any) will admit is a bad thing. When designing an “Injury Prevention” Program, however, we must first be able to identify what it is we are trying to prevent. Aimlessly performing “preventative” exercises without a focus or intent is just eyewash.
Most injuries can be classified as:

Acute (contact) :Has a discernable moment in time where the injury occurred and was a result of contact from an external force (ie. contact with an opponent or sporting object).
Acute (non-contact): Has a discernable moment in time where the injury occurred and does not result from physical contact with an object or person, but from internal forces built up by the actions of the performer (ie. plant and twist ACL tear).
Repetitive Overuse: Difficult to determine an exact moment where the injury occurred. Comes on gradually over time, worsens, and is usually attributable to a specific position or activity performed (ie. gradual onset of shoulder pain with increasing throwing volume).
Acute contact injuries are difficult to prevent without, for example, taking hitting out of ice hockey. Less contact injuries would occur as a result but now you’ve changed the game. Most “Injury Prevention” Programs are aimed at acute non-contact and repetitive overuse injuries. This is because some of the factors that lead to such injuries are seen as potentially modifiable.
One such factor is the workload an individual or athlete is exposed to. This means a physical, social or psychological stressor that someone is exposed to over a given time period.

We must consider both the (1) acute workload (ie. within one session or over a week period) or the chronic workload (ie. rolling 4-week periods of workload or an entire training year). Before we get into the specifics of workload monitoring let’s go over how the body responds to stressors that we impose upon it.
The general adaptation syndrome (GAS) first coined by Hans Selye; an Austrian-Canadian endocrinologist from the 1900s. His key concept was focused on three stages of how the body responds to stress:
1. Alarm
2. Resistance
3. Exhaustion
The three stages are sequential in that initially the body is “alarmed” to the introduction of a stressor. The body then passes into a stage where its physiological systems put up resistance to this stress and attempts to have the tissues to adapt to the new demands. If the stressor stays around too long or is too high in magnitude the physiological systems will become exhausted and shut down.
John Garhammer, an American researcher, adapted Selye’s initial model to apply more specifically to resistance training and exercise conditioning. Even though a holistic model of care considers all of the above main categories of stressors as physiotherapists we tend to be focusing on the exercise and activity component. Most repetitive overuse-related injury are linked to exercise/load management.
1. Shock
2. Adaptation
3. Overtraining
Every person from a young elite athlete performing on-field training to an elderly person trying to stay mobile in the community goes though these stages when introduced to as new stressor. Each individual has a capacity to move at a certain speed for a given amount of time or execute a specific skill at a given intensity. This is based on their exercise workload history or activity preparedness.

Peter-FrancisPeter Francis, Registered Physiotherapist
MPT, BKin, Dip. Sports Science

West 4th Physiotherapy Clinic
Main Street Physiotherapy Clinic

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