Starting Loads in Rehabilitation?

Mechanisms, risk factors, rehabilitation etc.
joclubbsportsci
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Starting Loads in Rehabilitation?

Postby joclubbsportsci » Sat May 14, 2016 3:21 pm

In response to the case study blog on the acute:chronic workload ratio (http://sportsdiscovery.net/journal/2016 ... ase-study/) we had the following comment from Jason Tee.

"Something that has always concerned me regarding return to play and the acute:chronic load ratio, was nicely illustrated in you post. When players come back after a long lay off, their chronic training load is essentially zero, and any percentage of zero is still zero. Therefore at the beginning of any training program, RTP or otherwise, there will be massive disparities between the acute and chronic load. Basically, we can’t progress training by safe increments of ±10% because it will take a ridiculously long time to get any player back on the field.
My point is that at the start of any training or rehabilitation program, there has to be a starting load. I’m sure we’ve all seen the effects of getting this starting load wrong, when a gym newbie over does it in the first day and is unable to walk properly for a few days after. My question to your readers is does anyone have any experience determining what a safe starting load might be? I’m sure that there must be a huge range among individuals determined by genetics, training history, hormonal and tissue qualities, regenerative capacity etc.
Like everything else, it would be helpful if we could be more precise with the starting load. Undershooting the mark may mean that the athlete takes longer to return to play, while over shooting clearly increases the risk of injury."


Any thoughts?
New Sports Discovery Blog Post --->

Is There a Tug of War Between Injury Risk and Performance?
http://sportsdiscovery.net/journal/2018 ... rformance/

davemckay16
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Re: Starting Loads in Rehabilitation?

Postby davemckay16 » Tue Jun 14, 2016 1:09 am

This is a great question, to add to it (not answer it, sorry!) what is the starting dose to day 1 of preseason with regards to acute to chronic loads. Are the first 4 weeks pretty much guess work if you don't have 100% control of the offseason loads?
Thanks
Dave

adstrength
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Re: Starting Loads in Rehabilitation?

Postby adstrength » Thu Jun 16, 2016 2:05 pm

Great first topic to start to discuss. I think it is hard to say the load needs to be "x" or a certain percentage of the average when starting Day 1 of preseason or the first session back from a long lay-off. Too many variables to consider, as self-answered in the original posting. My approach in ice hockey is to try to inform the coach to plan the first day with a low-to-average "typical" workload of both volume and intensity. We will then ramp for the first few days, with a keen eye on those to variables (increase practice duration, "2-a-days", etc, but also play around with the intensity distribution of a practice).

In my experience, I find that it is more about tempering the "excitement" of being back in session (first practice as a team, wanting to work the athletes hard) that is difficult for a coach/athlete to manage. I typically see that we over-shoot the proposed loading scheme on day one (athletes and coaches both eager to be back out there, a want to "prove" themselves are some proposed reasons)...but then we debrief and reevaluate with the coaches for day two, and build the rest of the week from there.

I have not yet had the opportunity to see Tim Gabbett present, but I believe I have read somewhere that he recommends you almost throw the acute:chronic out the window during preseason/training camp scenarios and use it for more in-season tracking of volume.

pward
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Re: Starting Loads in Rehabilitation?

Postby pward » Sat Jun 18, 2016 4:15 am

This is a very interesting topic. I'm not sure anyone really has the answer and this highlights one of the limitations of the acute:chronic model (e.g., the need for a period of time to begin to determine what the 'chronic' load is). Some things that I think about:

1) The athlete should never stop training altogether when they are in rehab. I think athletes tend to just shut it down once they are injured. This will certainly make the road back much more difficult. The more they can be encouraged to train the less out of shape they will get, making return-to-play easier. Of course there will be limitations and modifications to their training program and in some instances running will be contraindicated, so the training during this period might end up being non-specific in that regard but that doesn't mean it is useless.

2) When the athlete begins their return-to-play running program begin the monitoring process right away. Don't start monitoring them when they are fully returned to practices because, as adstrength eluded to, coaches tend to get excited to get the player in their and they easily overload them. Even if you start monitoring the early stages of return-to-play, getting the athlete re-integrated back into practice in a healthy manner can be a difficult conversation to have with a coach. I've seen jumps of over 100% from athletes coming out of rehab and being put into practice where the coaches just throw everything at them. The more you can control the progression the better, so start monitoring right from the start and begin your model from that, as this will reflect the loads that the athlete has been most recently exposed to, allowing for a smoother discussion regarding how much they should be doing when they get back into those first practices.

3) Start conservative. Generally, in the return-to-play paradigm, using pain as a guide is a good place to start. Begin the first few runs with a very minimal dose and just monitor the response and how the athlete tolerates the work. General heuristics around this could be something like looking at pre-injury workloads and beginning the first few sessions at ~40-50% of those loads (this of course would certainly depend on the injury and the amount of time lost due to the injury - it isn't so black and white).

patrick

Blanny20
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Re: Starting Loads in Rehabilitation?

Postby Blanny20 » Thu Jun 23, 2016 9:25 pm

Absolutely right, I don't think there are many occasions where an injury means absolute rest for anything more than a few days. So the chronic workload will rarely be zero.
Following any injury there needs to be a safe and logic progression of load specific to the involved tissues, which could be very low, but overall load can be increased by targeting non-effected systems and structures. The point where an athlete is handed over from physio / athletic trainer to the strength coach, the load should be incrementally working back towards pre-injury training levels (for long term injuries you should be monitoring squad loads which may be different to the leve that the athlete was pre-injury, in which case build to that).

Generally if managed correctly from the start, the levels of fitness should never drop so far away from baseline that it takes ages to bring back up.
The athlete should never return to training and have to do a task that was not covered in rehab. In essence, the end stage of rehab should be harder than training itself.
@SJBPhysio_sport

Milsomlfc
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Re: Starting Loads in Rehabilitation?

Postby Milsomlfc » Fri Jun 24, 2016 10:22 pm

I'm currently completing a prof doc in understanding RTP in football. This will include some loading studies around rehabilitation which may well add to this field.

My opinion is that it's very difficult to be precise in retuning loads and challenging to compare across individuals, clubs and even sports.

Bizzini has developed a 4 stage model which includes phases of immobilisation and training. My research has tried to objectify the model somewhat in a football setting.

In my experience the ambulation phase will determine the starting load / rehabilitation length and thus will determine chronic load. The forth-coming schedule will provide indications of potential returning loads, which certainly need to be factored into the planning. Elite premier league players will routinely be involved in 2 game weeks which is associated with higher injury rates (Dupont research). Additionally, re injury rates in football border 22% (Hagglund 2016) and more recently aspetar group have shown 50% of all hamstring re-injuries occur within 4 weeks.

Therefore it could be suggested that returning loads are a critical component of RTP (Blanch & Gabbett 2015). My opinion is there must be a sustainability period to give the players the best chance of surviving this returning demand. Staff and coach relationships become critical at this stage. Once the player is available the medical / science dept can become less dominant within the stakeholder process and coaches become the dominant stakeholders.

Understanding stakeholder view points across disciplines may help with improved decision making and could help reduce the high incidence of reinjury currently prevelant in elite football.

davemckay16
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Re: Starting Loads in Rehabilitation?

Postby davemckay16 » Wed Jun 29, 2016 3:15 pm

This is a little off the topic of Loads for Rehab but in relation to acute:chronic load monitoring can someone help me to understand how we include the game loads within this model.
All the examples of Acute:Chronic load monitoring I have seen involve training loads over multiple weeks in a nice linear fashion but how can this be done within a season where one week you have 4 training sessions and 1 game and the next 9 days you have 3 games and 2 recovery sessions and 2 MD -1 sessions. Then the next week 6 training days and 1 game.
This is just a random example but many of us deal with crazy schedules like this.
I am not trying to dismiss Acute:Chronic load monitoring by any means, just trying to get a better insight and understanding, any help or suggestions would be great,
Thanks

pward
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Joined: Sun Jun 12, 2016 4:41 am

Re: Starting Loads in Rehabilitation?

Postby pward » Thu Jun 30, 2016 11:34 pm

davemckay16 wrote:This is a little off the topic of Loads for Rehab but in relation to acute:chronic load monitoring can someone help me to understand how we include the game loads within this model.
All the examples of Acute:Chronic load monitoring I have seen involve training loads over multiple weeks in a nice linear fashion but how can this be done within a season where one week you have 4 training sessions and 1 game and the next 9 days you have 3 games and 2 recovery sessions and 2 MD -1 sessions. Then the next week 6 training days and 1 game.
This is just a random example but many of us deal with crazy schedules like this.
I am not trying to dismiss Acute:Chronic load monitoring by any means, just trying to get a better insight and understanding, any help or suggestions would be great,
Thanks
Why not just gather some data from the game (RPE, Running Volumes, HSR, etc. - Whatever you are using to build your model from training) and record the game load as part of the weekly load?


patrick

NColl
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Re: Starting Loads in Rehabilitation?

Postby NColl » Sun Jul 03, 2016 12:23 pm

As some have mentioned in this thread and many people work off when planning rehab in general, using percentages of weekly average loads is used.

However something I've been thinking lately, is should we not be planning rehab based off the highest weekly load. As if we plan for return to occur to average, then we are potentially only preparing the athlete for half the weekly load (extreme example I know) following RTP.

Obviously monitoring load following RTP does occur, but if we used the rehab period to prepare the athlete for all eventualities in terms of load then is he not better prepared for performance?

joclubbsportsci
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Re: Starting Loads in Rehabilitation?

Postby joclubbsportsci » Mon Jul 04, 2016 2:14 pm

davemckay16 wrote:This is a little off the topic of Loads for Rehab but in relation to acute:chronic load monitoring can someone help me to understand how we include the game loads within this model.
All the examples of Acute:Chronic load monitoring I have seen involve training loads over multiple weeks in a nice linear fashion but how can this be done within a season where one week you have 4 training sessions and 1 game and the next 9 days you have 3 games and 2 recovery sessions and 2 MD -1 sessions. Then the next week 6 training days and 1 game.
This is just a random example but many of us deal with crazy schedules like this.
I am not trying to dismiss Acute:Chronic load monitoring by any means, just trying to get a better insight and understanding, any help or suggestions would be great,
Thanks
Hi Dave, I have started a thread in the Data Analysis topic discussing the Acute:Chronic Workload Ratio in relation to the training environment rather than rehabilitation and included your questions above.

I am enjoying reading everyone's views on loading in rehab - Milsomlfc your Prof Doc sounds really interesting and I will keep an eye out for the loading studies which I'm sure will be really useful.
New Sports Discovery Blog Post --->

Is There a Tug of War Between Injury Risk and Performance?
http://sportsdiscovery.net/journal/2018 ... rformance/


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