Internal workload and non-contact injury: a one-season study of five teams from the UEFA Elite Club Injury Study

Br J Sports Med. 2018 Dec;52(23):1517-1522. doi: 10.1136/bjsports-2017-098473. Epub 2018 Apr 6.


Background: Internal workload (ie, from training and matches) is considered one of the most important injury risk factors for elite European football teams, however there is little published evidence to support this belief.

Objective: We examined the association and predictive power of internal workload and non-contact injuries.

Methods: Five elite European teams, 171 players (age: 25.1±4.9 years; height: 181.6±6.7 cm; body mass: 77.5±7.2 kg) participated over one full competitive season. Using the session-rating of perceived exertion (s-RPE) method player's internal workloads were calculated for acute week, week-to-week changes, cumulated weeks, chronic weeks and acute:chronic ratios and analysed for association with non-contact injury (using generalised estimating equations (GEE)). Associated variables from GEE analysis were categorised into very low to very high workload zones and checked for increased relative risks (RRs). Associated workload variables were also analysed for predictive power (receiver operating characteristics).

Results: Acute:chronic workload ratios at 1:3 and 1:4 weeks were associated with non-contact injury (P<0.05). Specifically, a greater risk of injury was found for players with an acute:chronic workload at 1:4 weeks of 0.97 to 1.38 (RR 1.68; 95% CI 1.02 to 2.78, likely harmful) and >1.38 (RR 2.13; 95% CI 1.21 to 3.77, very likely harmful) compared with players whose acute:chronic workload was 0.60 to 0.97. An acute:chronic workload 1:3 of >1.42 compared with 0.59 to 0.97 displayed a 1.94 times higher risk of injury (RR 1.90; 95% CI 1.08 to 3.36, very likely harmful). Importantly, acute:chronic workload at both 1:4 and 1:3 showed poor predictive power (area under the curve 0.53 to 0.58) despite previous reports and beliefs that it can predict injury.

Conclusions: This study provides evidence for the acute:chronic internal workload (measured using s-RPE) as a risk factor for non-contact injury in elite European footballers. However the acute:chronic workload, in isolation, should not be used to predict non-contact injury.

Keywords: injury; prevention; risk factor; soccer; training load.

MeSH terms

  • Adult
  • Athletic Injuries / epidemiology*
  • Humans
  • Physical Conditioning, Human
  • Risk Factors
  • Soccer / injuries*
  • Workload*
  • Young Adult