The document discusses load management and its importance for injury prevention. It defines load as both external measures like distance run and internal measures like heart rate. The Acute:Chronic Workload Ratio (ACWR) compares an athlete's recent weekly load to their average load over the previous 4 weeks and can predict injury risk. An ACWR of 0.8-1.3 has the lowest injury risk, while over 2.0 has the highest. The document provides examples of calculating ACWR and modifying training based on this metric. It emphasizes gradually building load no more than 10% per week to minimize injury risk.

1. Load Management: The Basics

2. Overview
• What is Load?
• Acute : Chronic Workload Ratio (ACWR)
• The effects of detraining on performance

3. Load Management
• Load Management critical part of high performance and injury
management
• Can identify those at risk of future injury
• Individual and team success has an inverse relationship with injury
and illness  The less injuries/illnesses an individual or team has
over a pre-season/competitive season, the more likely the team is
going to perform and achieve their goals.
• 7x greater chance of achieving performance goals, if at least 80% of
planned training sessions carried out (Raysmith & Drew, 2016).

4. What is Load?
• External loads – Distance run, weight lifted
(tonnage), kms cycled/swam, repeated
sprints/jumps
• Internal loads – HR, RPE, well-being scores
• Takes into account training, gym, games

5. Why is Load important?
• Load is a contributing factor to non-contact,
soft tissue injuries – AFL, Cricket, Soccer,
Rugby League, AIS athletes.
• Very high, too low and rapid spikes in training
loads are the problem.
• Moderate-high loads are actually protective
from non-contact, soft-tissue injury,
• The problem is getting to these high training
loads.

6. Why is Load important?

7. How can you measure Load?
• Sessional RPE (sRPE)
• sRPE = Session time x RPE
– Eg. 60mins x 7/10 RPE = 420 units
– Correlates well with HR and lactate measures
when GPS equipment is not available.

8. Acute : Chronic Workload Ratio
• Evidenced-based, objective measure to monitor
training loads and predict future injury by using
sRPE.
• Acute workload:
– Absolute sum of sRPE across a rolling 7 days
– Eg. 5 training days in 1 week totalling 1500 units
• Chronic workload:
– Average of the weekly workload over a rolling 4 weeks
– Eg. 1500 (wk1) + 1650 (wk2) +1800 (wk3) + 2000
(wk4) = 1737.5 units

9. Acute : Chronic Workload Ratio
• Example 1:
– In week 5 the athlete decided to maintain their training load to
2000 units
– ACWR – 2000/1737.5 = 1.15
• Example 2:
– In week 5 the athlete decided to increase their training load to
3000 units
– ACWR – 3000/1737.5 = 1.72
• So what??

10. Acute : Chronic Workload Ratio
• Likelihood of injury recurrence or subsequent
injury using ACWR:
– “sweet spot” 0.8 – 1.3 = <4% chance
– <0.8 = 5-7%
– 1.5 – 2.0 = 7% -10%
– >2.0 = 15%-20%

11. Acute : Chronic Workload Ratio
(Gabbett)

12. Case Study #1
 30F training for 1/2 marathon (in 1 month)
 Presented at the end of her training week with with L)
distal-medial shin soreness at the commencement and cool
down of a run
 Trained consistently last 3 months, but in the last 2 weeks
started doing more speed work 2x per week (higher
intensity)
 Subjective history and clinical examination indicated MTSS
(“shin splints”) rather than tibial bone stress reaction
 Objective exam also revealed reduced L) ankle DF ROM and
poor L) > R) lumbo-pelvic control during DL and SL squat
functional assessment.

13. Case Study #1
• Training History:
• Week of presentation (acute):
– 0: 2x 60mins @ 7/10 RPE, 1x 140 @ 3/10 RPE (1260 units)
• 4 weeks prior (chronic)
– -1: 2x 45mins @ 7/10 RPE, 1x 120 @ 3/10 RPE (990 units)
– -2: 2x 45mins @ 5/10 RPE, 1x 110mins @ 3/10 RPE (780 units)
– -3: 2x 45mins @ 5/10 RPE, 1x 100mins @ 3/10 RPE (750 units)
– -4: 2x 45mins @ 5/10 RPE, 1x 100mins @ 3/10 RPE (750 units)
– Ave: 817
• ACWR = 1260/817= 1.54

14. Case Study #1
• Patient wanted to run the same this week to keep on
track of training plan (ACWR 1.54).
• Negotiation: Advised patient to run between 1050
units (1.3 ACWR) and 817 (1.0 ACWR) units this week.
• Advised to progress weekly program from now until ½
marathon by no more than 10% per week
• Treatment also consisted of usual manual therapies,
gait education, strength & conditioning plan.

15. Train Hard, Train Smart - The 10% Rule
(Gabbett)

16. Train Hard, Train Smart

17. Train Hard, Train Smart (Gabbett)

18. Train Hard, Train Smart – Consistency
is the KEY!! (Drew)

19. Train Hard, Train Smart – Consistency
is the KEY!! (Drew)

20. Train Hard, Train Smart – Spikes in
Load Don’t Discriminate

21. Detraining Effect
• Non-injured population who are planning a break
from exercise  Xmas holidays & off-Season
• Injured populations who have to reduce training
loads
– G2 lateral ankle sprain: Unable to train at 100% for 2
weeks and returns to training and develops a patella
tendinopathy.
• Impacts negatively on ACWR
• “Choose your own adventure”.

22. Choose Your Own Adventure (Drew)

23. Case Study #2
• 40 year old recreational male runner presented at the end
of the week with a 2 week history of worsening R) mid-
portion achilles tendon pain
• Usually runs between 30-35km a week
• Had 2 weeks off over Xmas and resumed his “normal”
running loads in the new year
• Subjective: No significant Phx LL trauma, occasional
episodes of AT pain, but settles with rest, no red/yellow
flags
• Objective: examination consistent with mid-portion
achillies tendinopathy, mild decrease in R) DF ROM, SL calf
raises test R) 20 reps L) 30 reps, Poor R) SL quat
performance vs L)

24. Case Study #2
• Training History:
• Weekly mileage at end of week presenting; 35km
(acute workload)
• 4 weeks prior (chronic);
– -4: 30km
– -3: 35km
– -2: 0km
– -1: 0km
• Ave: 16.25km
• ACWR = 35/16.25 = 2.15

25. Case Study #2
• Patient reluctant to stop running as he had New Years Resolutions
goals to meet. Wanted to run 30km again this week.
– -4: 35km
– -3: 0km
– -2: 0km
– -1: 35km
– Chronic 17.25
• ACWR – 30/17.25 = 1.73
• Advised patient to run 17-22km MAXIMUM this week only
• ACWR – 17/17.25 = 0.98
• ACWR - 20/17.25 = 1.15
• ACWR – 22/17.25 = 1.27

26. Load Management - Summary
• ACWR is evidence-based practice; get
comfortable with “hands-off” approach.
• High training loads are not the problem. It is how
you get to these high training loads that is.
• Train athletes/patients for the worst-case
scenario, not the average demands of their sport.
• Minimise absolute rest periods  look for
reduced or modified training options.
• Need to bin the term “overuse” and replace it
with “under-prepared”.

27. References/Bibliography
• 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.
British journal of sports medicine. 2016 Apr;50(8):471-5. PubMed PMID: 26701923. Epub
2015/12/25. eng.
• 2. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and
harder? British journal of sports medicine. 2016 Mar;50(5):273-80. PubMed PMID: 26758673.
Pubmed Central PMCID: PMC4789704. Epub 2016/01/14. eng.
• 3. Drew MK, Finch CF. The Relationship Between Training Load and Injury, Illness and Soreness:
A Systematic and Literature Review. Sports medicine (Auckland, NZ). 2016 Jun;46(6):861-83.
PubMed PMID: 26822969. Epub 2016/01/30. eng.
• 4. Raysmith BP, Drew MK. Performance success or failure is influenced by weeks lost to injury
and illness in elite Australian track and field athletes: A 5-year prospective study. Journal of Science
and Medicine in Sport.
• 5. Soligard T, Schwellnus M, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, et al. How much is too
much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of
injury. British journal of sports medicine. 2016 Sep;50(17):1030-41. PubMed PMID: 27535989.
Epub 2016/08/19. eng.
• 6. Schwellnus M, Soligard T, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, et al. How much is too
much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of
illness. British journal of sports medicine. 2016 Sep;50(17):1043-52. PubMed PMID: 27535991.
Pubmed Central PMCID: PMC5013087. Epub 2016/08/19. eng.