The most important concept I've learned in the last year and a half

Updated July 26, 2019             

                One of the most exciting parts of being a rehab & fitness professional in today’s age is there’s so much new and exciting information and research being disseminated. It makes for a very dynamic and ever-evolving career as there’s always something new to learn and implement into your work.

                One concept I’ve learned over the last year and a half has made a major impact in how I work with people with musculoskeletal pain as well as with weight training clients that I consult with.

                No the concept isn’t that of the nocebo effect and the importance of your choice of words. While it’s probably the most important concept I’ve learned, as well as the most important concept you can learn from my work, it was something I learned several years ago¹.

                The most important concept I’ve learned in the last year and a half is the concept of the baseline from Brian Carroll.

What is a baseline?

                A baseline is your starting point or what you’re currently doing in terms of

-          Training volume

-          Training frequency

-          Calorie intake

-          Supplementation

-          And any combination of the above²

Why is this concept so important?

                The importance of having a baseline is so you know what is effectively working and can make small adjustments as needed if changes need to be made. This is especially important when it comes to training volume as research has shown that huge spikes in training volume can increase an athlete’s risk of injury.

                Researcher Tim Gabbett’s work has looked a lot at the acute:chronic workload ratio and how it applies to athletes. Basically…

-          The acute workload is what you’ve been doing this week (ie running 25 miles)

-          The chronic workload is the average of what you’ve been doing over the previous 3 weeks (ie running an average of 20 miles per week over the last 3 weeks)

The acute workload is divided by the chronic workload to create the ratio. In the above example

the ratio would be 25/20 or 1.25. Research in a variety of sports has shown that once the ratio gets to 1.5 or greater the risk of injury rises considerably^3–6.

                As a side note this is why I get a bit grumpy when I hear people say “you need a high volume and/or high frequency training program” to lifters or athletes that are just getting their feet wet and haven’t built up much work capacity.

I used to think that lower training loads were the way to protect everyone. I was wrong. Now I think building people’s ability to better tolerate their training loads is a better idea. I also use the term “training load error” instead of “overuse injury.” Props to Bang Fitness owner Geoff Girvitz for teaching me that.

Knowing the above information you can see why its important to know what you’re doing right now so that you can make proper adjustments to your workload without considerably increasing your injury risk.

How can I apply it to my athletes or patients?

                Some clients may not have the desired work capacity to perform their desired activity – be it throwing 100 pitches, running a 5k, or doing a lot of weight training.

               Having an idea of what your client is capable of, and then slowly increasing their workload by about 10-25% per week (bear in mind that some clients tolerate workload increases better than others) is a way that you can build up a client’s training volume and work capacity while reducing (you can never fully eliminate) the risk of injury^3–6.

Some updates to this article based on recent research…

A recent editorial criticized the acute-chronic workload ratio for being flawed as it combined unpublished data as well as different measures from different sports to form the ratio. It is important to acknowledge this – but it doesn’t change the general idea and theme of increasing activity levels slowly and making sure your clients’ current fitness and work capacity matches the demand of the desired activity⁷.

And again – sports injury prevention is a complex, multifactorial topic. No matter what we do – we can’t 100% prevent injuries, we can only reduce them. And no one single measure can fully predict who will and won’t get sports injuries. 

I’m very grateful to Brian for all he’s done for me and his concept of a baseline has been the most influential concept in my career over the last year and a half.

References

1.          Petersen GL, Finnerup NB, Colloca L, et al. The magnitude of nocebo effects in pain: A meta-analysis. Pain. 2014;155(8):1426-1434. doi:10.1016/j.pain.2014.04.016.

2.          Carroll B. 10/20/Life Second Edition: The Professional’s Guide to Building Strength Has Gotten Even Bigger and Better: Brian Carroll: 9781542659291: Amazon.com: Books. Power Rack Strength ; 2017. https://www.amazon.com/10-20-Life-Second-Professionals/dp/1542659299. Accessed August 6, 2017.

3.          Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280. doi:10.1136/bjsports-2015-095788.

4.          Gabbett TJ, Hulin BT, Blanch P, Whiteley R. High training workloads alone do not cause sports injuries: how you get there is the real issue. Br J Sports Med. 2016;50(8):444-445. doi:10.1136/bjsports-2015-095567.

5.          Gabbett TJ, Kennelly S, Sheehan J, et al. If overuse injury is a “training load error”, should undertraining be viewed the same way? Br J Sports Med. 2016;50(17):1017-1018. doi:10.1136/bjsports-2016-096308.

6.          Bourdon PC, Cardinale M, Murray A, et al. Monitoring Athlete Training Loads: Consensus Statement. Int J Sports Physiol Perform. 2017;12(Suppl 2):S2-161-S2-170. doi:10.1123/IJSPP.2017-0208.

7.          Impellizzeri FM, Woodcock S, McCall A, et al. The acute-chronic workload ratio-injury figure and its 'sweet spot' are flawed. SportRxiv.