“How do you program mobility training and rehab? How many reps and sets? Frequency? Intensity? How do you program FRC mobility training within a standard strength and conditioning program?”
The answer? “It depends.” However, this answer does not provide us with any useful information to apply to our practices. So, I will follow this question up with one of my own – “what does it depend on?”
Yet once again, there is no clear answer. The art of programming comes with knowledge, experience and experimentation. We can explain injury as the point when the demand of a task or load exceed capacity. However, capacity and demand are not fixed points. Thus, it is important to understand one’s capacity to except load (acute and chronic), and how much demand is necessary to elicit beneficial adaptations on any given day, in a safe manner.
Determinants of performance and injury are multifactorial, meaning that positive and negative responses to training are influenced by biomechanical factors, as well as various emotional and lifestyle factors. For example, academic/emotional stress and personality traits (self-blame, perfectionism) have been shown to influence response to training load. As well, those who sleep less than 8 hours per night have a 1.7 times greater risk of injury. Further, increases in training intensity and volume coupled with shorter sleep in elite adolescent athletes increased risk of injury two-fold.
In 2018, Tim J Gabbett completed a research review to help practitioners and trainers better understand training load, injury and performance. In his paper, Gabbett delves deeper to debunk common myths about load management which are still commonly practiced today.
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“The 10% rule”:
The 10% rule refers to the suggested weekly limit to increase the acute load. As we know, applying a non-dynamic “rule” to a dynamic system is unlikely to produce desirable results consistently. More so, rules are developed based on population averages, which don’t accurately represent the client in front of you. Some may benefit from much higher increases in workload, while others may sustain an injury at lower increments. More accurately, changes in training load should be interpreted in relation to the chronic load of the individual. Smaller increases (<10%) in weekly training load are recommended when the chronic training load is either extremely low or extremely high. Larger increases (>10%) in weekly training load are likely to be well tolerated by athletes with moderate to high chronic load and may be necessary to accelerate the rehab process.
Acute:Chronic Workload Ratio (ACWR):
ACWR (aka training-stress balance) refers to the size of the current week’s training load (acute training load) in relation to longer term training load (chronic load). In the practical setting, it is often calculated by:
RPE (Rated Perceived Exertion) x Time (minutes) = WORKLOAD
“Acute” most often refers to the workload for the current week. The chronic workload is often calculated based on an average from the previous 3 to 4 weeks, or more. Research has suggested that when the ACWR is between 0.8-1.3, injury risk is relatively low, while an ACWR >1.5 markedly increases the risk of injury. But remember – RISK DOES NOT EQUAL RATE!
Due to the multifactorial nature of load response (either adaptation or injury), some will sustain injuries at ACWRs much lower than 1.5, while some may tolerate much higher. Poorly planned acute workload increases or decreases can elevate an individual’s susceptibility to injury. Yet, acute workload modifications during training periodization can help mitigate injury, time peak performance and improve long-term performance.
These differences in ACWR tolerance can be explained largely by moderators of the workload-injury relationship. A moderator acts to either increase or decrease injury risk at a given workload. For example, a 500lb deadlift is not always the same workload even though the weight remains consistent, as moderators influence the demand of the deadlift. Moderators such as poorly developed physical qualities (aerobic capacity, speed, repeated-sprint ability, lower body strength), low HRV, and low chronic training load have increased risk of injury with a given spike in workload. Practitioners are advised to stratify individuals according to known moderators of the workload-injury relationship (ex. Age, training and injury history, physical qualities), and interpret any internal and external load variables in combination with well-being and physical readiness data, and factors known to influence the risk of injury.
Often overlooked is the importance of chronic training load in keeping individuals injury-free. This can be thought of as GPP – General Physical Preparedness. For example, although spikes in workload increase injury risk, those with greater chronic work-loads had a 5-fold lower risk of injury than those with low chronic workloads. The protective effect of training appears to arise from 2 sources:
- Exposure to load allows the body to tolerate load.
- Training develops the physical qualities (strength, prolonged high-intensity running ability and aerobic fitness) that are associated with reduced risk of injury.
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One of the goals of training is to improve one’s ability to tolerate training load. This would shift the ACWR injury curve to the right, allowing athletes to have either a reduced injury risk at the same ACWR, or similar injury risk at a higher ACWR. Unfortunately, the best approach to achieve this is currently unknown. This is very similar to how we incrementally load connective tissue to shift the stress-strain curve to the right to increase the tissue’s capacity to accept load.
When returning from injury, early loading is key. Rehab must balance the need to develop adequate chronic loads to prevent re-injury while also returning the individual as quickly and safely as possible. High rehab workloads delayed return to sport following injury, but longer rehab times provided greater opportunity to build chronic sprint distance which protected against subsequent injury. In the early stages, it is important to educate that any intolerance to training is likely to be temporary and is unlikely to result in long-term intolerance or incapacity.
Although high chronic workloads are associated with lower injury rates, not all athletes can safely participate in all competitive games. The activity and the environment to which the individual is returning to must be consider. For an athlete, returning to a practice, season game or championship game will pose different demands. Environmental and situational factors must be taken into consideration when determining acute workload and return to activity.
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So, going back to our original question: “How do we program mobility training and rehab?” Drew et al provides general evidence-based guidelines for practitioners prescribing training load:
- Establish a moderate chronic training load
- Minimize week-to-week changes in training load
- Avoid exceeding the ceiling of safety
- Ensure a minimum training load is maintained
- Avoid inconsistent loading patterns
- Ensuring training loads are proportionate to the demands of the sport
- Monitoring the athlete through the latent period (ie. Following the application of load or “spikes” in load).
To reiterate what was previously discussed:
- High chronic workloads are associated with lower injury risk as long as those workloads were achieved safely.
- Rapid increase in workload and low chronic work-loads are associated with greater injury risk.
Keeping this in mind, we can begin to program with greater intent. We must not forget that the training load CEILING (or capacity) may be a “moving target”. Regular monitoring of the physical demands and continual assessment of the “ceiling” is required to ensure that individuals are adequately prepared to perform. Biometrics such as HRV, resting heart rate, blood pressure, sleep quality, mental/emotional stress, and more can provide valuable information on day-to-day load capacity and allow us to prescribe load more effectively. Analyzing moderators of workload can help us better-understand these biometrics and prescribe workload with more precision to increase chances for success.
Updated: Sep 13, 2019
Reference:
Gabbett TJ. Debunking the myths about training load, injury, and performance: empirical evidence, hot topics, and recommendations for practitioners. BR J Sports Med. 2018