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Does load management using the Acute:Chronic Workload Ratio prevent health problems?


Load management using the acute:chronic workload ratio in a one-size-fits-all approach does not appear to prevent health problems among elite youth footballers of both sexes.

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This cluster-randomised trial of 482 Norwegian elite youth footballers of both sexes was recently published in British Journal of Sports Medicine.

Health problems are common among elite youth footballers, who experience similar injury and illness patterns and burden as senior professional players. Training load has been identified as a risk factor for injuries and has been widely implemented as an injury preventive measure. However, no study has investigated the preventive effect of a load management protocol. This cluster-randomised controlled trial aimed to assess the effect of an ACWR-based load management intervention on health problem risk among elite youth footballers of both sexes.

No significant effect on mitigation of health problem  

We did not identify any significant effect of the load management programme on neither substantial health problems nor all health problems. 

Although many practitioners, researchers, and players consider training load to be an important risk factor for health problems in football, supporting evidence is currently conflicting. Our intervention was a one-size-fits-all approach, which has recently been challenged by both scientists and practitioners, as the relationship between training load and health problems is affected by a large number of individual moderating factors.

In elite football, sports medicine and performance practitioners meticulously and continuously assess each player’s training load together with numerous other factors, such as history of previous injuries, injuries, player age, wellness, non-sporting load, communication with player, screening and strength test and the importance of next match. This is done to inform subjective decisions that aim to increase performance and reduce risk of health problems. Providing coaches with a one-size-fits-all metric does not seem to add much value to this process. We believe that, given the results of this study and the current state of knowledge in the field, load management remains just as much an art as a science.

What does this mean?

- The lack of a clear relationship between training load and health problems does not mean practitioners should abandon training load management. Its primary role has always been performance enhancement, and not health problem prediction or prevention.

- With a lack of models linking training load and health problems, practitioners should follow the general training principles such as the principle of progressive overload.


Download the paper.