Resilience in sports: a multidisciplinary, dynamic, and personalized perspective.

Athletes are exposed to various psychological and physiological stressors, such as losing matches and high training loads. Understanding and improving the resilience of athletes is therefore crucial to prevent performance decrements and psychological or physical problems. In this review, resilience is conceptualized as a dynamic process of bouncing back to normal functioning following stressors. This process has been of wide interest in psychology, but also in the physiology and sports science literature (e.g. load and recovery). To improve our understanding of the process of resilience, we argue for a collaborative synthesis of knowledge from the domains of psychology, physiology, sports science, and data science. Accordingly, we propose a multidisciplinary, dynamic, and personalized research agenda on resilience. We explain how new technologies and data science applications are important future trends (1) to detect warning signals for resilience losses in (combinations of) psychological and physiological changes, and (2) to provide athletes and their coaches with personalized feedback about athletes' resilience.

Effectiveness of Recovery Strategies After Training and Competition in Endurance Athletes: An Umbrella Review.

BACKGROUND: Recovery strategies are used to enhance performance and reduce injury risk in athletes. In previous systematic reviews, individual recovery strategies were investigated to clarify their effectiveness for mixed groups of athletes. However, the current evidence is ambiguous, and a clear overview of (training) recovery for endurance athletes is still lacking. METHODS: We conducted an umbrella review based on a literature search in PubMed, Cochrane Database of Systematic Reviews, and Web of Science. Reviews published in English and before December 2022 were included. Systematic reviews and meta-analyses were eligible if they investigated the effectiveness of one or more recovery strategies compared with a placebo or control group after a training session in endurance athletes. RESULTS: Twenty-two reviews (nine systematic reviews, three meta-analyses, and ten systematic reviews with meta-analyses included) met the inclusion criteria. In total, sixty-three studies with 1100 endurance athletes were included in our umbrella review. Out of the sixty-three studies, eight provided information on training recovery time frame for data synthesis. Among them, cryotherapy and compression garments showed positive effects, while applying massage showed no effect. In general, none of the included recovery strategies showed consistent benefits for endurance athletes. CONCLUSION: There is no particular recovery strategy that can be advised to enhance recovery between training sessions or competitions in endurance athletes. However, individual studies suggest that compression garments and cryotherapy are effective training recovery strategies. Further research should improve methodology and focus on the different time courses of the recovery process. REGISTRATION: The review protocol was registered with the International Prospective Register of Systematic Reviews with the number CRD42021260509.

Monitoring the recovery-stress states of athletes: Psychometric properties of the acute recovery and stress scale and short recovery stress scale among Dutch and Flemish athletes.

The Acute Recovery and Stress Scale (ARSS) and the Short Recovery and Stress Scale (SRSS) are recently-introduced instruments to monitor recovery and stress processes in athletes. In this study, our aims were to replicate and extend previous psychometric assessments of the instruments, by incorporating recovery and stress dimensions into one model. Therefore, we conducted five confirmatory factor analyses (CFA) and determined structural validity, internal consistency, and construct validity. Dutch and Flemish athletes (N = 385, 213 females, 170 males, 2 others, 21.03 ± 5.44 years) completed the translated ARSS and SRSS, the Recovery Stress Questionnaire for Athletes (RESTQ-Sport-76), the Rating of Perceived Exertion (RPE) and the Total Quality of Recovery (TQR). There was a good model fit for the replicated CFA, sub-optimal model fit for the models that incorporated recovery and stress into one model, and satisfactory internal consistency (α=.75 - .87). The correlations within and between the ARSS and SRSS, as well as between the ARSS/SRSS and the RESTQ-Sport-76 (r = .31 - -.77 for the ARSS, r = .28 - -.63 for the SRSS), the RPE (r = .19 - -.23), and the TQR (r = .63 - -.63) also supported construct validity. The combined findings support the use of the ARSS and SRSS to assess stress and recovery in sports-related research and practice.

Discriminative validity of summarized hip and knee angular accelerations for lower extremity training load quantification in male soccer players during a standardised training drill.

This study assessed the discriminative validity of summarized hip and knee angular accelerations during a standardized training drill. Twenty-eight soccer players performed a standardized training drill that mimics game demands. Discriminative validity was examined by assessment of between-group differences of summarized preferred kicking leg hip and knee angular accelerations, and Playerload between national and regional soccer players for the full training drill, and parts based on locomotor intensity, or additional pass and jumping header activities. Furthermore, relationships were assessed between the summarized hip and knee angular accelerations and conventional load indicators derived from a local positioning measurement system, such as high-intensity running distance and Playerload. National players had higher summarized hip (Mean difference: 62.7 A.U. ES = 0.77, p = 0.049) and knee (Mean difference: 137.1 A.U. ES = 1.06, p = 0.008) angular accelerations. Significant interaction effects were observed during high-intensity running (Hip: 0.2 A.U./m, ES = 0.98, p = 0.005; Knee: 0.61 A.U./m, ES = 1.52, p < 0.001), and sprinting (Hip: 0.3 A.U./m, ES = 1.01, p < 0.02; Knee: 0.56 A.U./m, ES = 1.57, p < 0.001). Between-group differences were not present for additional passing or jumping header activities. Compared to summarized hip and knee angular accelerations, Playerload had less ability to discriminate between players and activities. Moreover, the lower extremity training load indicators were unrelated to conventional load indicators. Together these results confirm discriminative validity of summarized hip and knee angular acceleration training load indicators during a standardised training drill.

The results in this study substantiate the use and validity of summarized hip and knee angular accelerations as external training load indicators for the lower extremities in soccer. Based on the known-group difference technique, expected differences in summarized hip and knee angular accelerations between national and regional soccer players were observed during a standardized soccer training drill. These differences were present during high intensity running and sprint activities, but not for passing or jumping header activities. The limited ability of Playerload to discriminate between players and tasks, and insignificant relationships between measurement systems in this study demonstrate that summarized hip and knee angular accelerations can be used complementary to whole-body training load indicators for evaluating soccer training and match play. The presented methodology provides insights in the training load of individual limbs, which potentially can be used to assess the effectiveness of specific training drills to under- or overload specific limbs. Trainers, coaches, and sport practitioners can use this information to balance training load and recovery in soccer, aiming to improve performance and prevent overload.

New training load metrics in field hockey using inertial measurement units.

Field hockey players are exposed to high biomechanical loads. These loads often cannot be adequately estimated with global navigational satellite systems (GNSS) since on-field displacements during these movements are often small. Therefore, this study aims to explore the potential of different proxies of biomechanical load in field hockey with use of a simple inertial measurement unit (IMU) system. Sixteen field hockey players performed a range of field hockey specific exercises, including running with stick on the ground, running upright, and different types of shots and passes. All exercises were performed at two different frequencies (i.e. number of actions per minute). A variety of proxies of biomechanical load (time spent with forward tilted pelvis, time spent in lunge position, time spent with flexed thighs, and Hip Load) were obtained using wearable IMUs. In addition, total distance was quantified using a GNSS system. Linear mixed models were constructed to determine the effects of the different exercises and action frequency on all quantified metrics. All metrics increased approximately proportional to the increase in action frequency. Total distance and Hip Load were greatest for the running exercises, but the different types of shots and passes had greater effects on specific on the times spent in the demanding body postures. This shows that these proxies of biomechanical load can be used to estimate field hockey-specific biomechanical loads. The use of these metrics may provide coaches and medical staff with a more complete view of the training load that field hockey players experience.Highlights New proxies of biomechanical load derived with inertial measurement units were used to quantify field hockey specific biomechanical loads.These new biomechanical metrics are complementary to metrics obtained with global navigation satellite systems and increased proportionally to a doubling of the exercise intensity.The presented biomechanical load metrics can help field hockey coaches to achieve a better balance between load and recovery for their players.

A lab-based comparison of differential ratings of perceived exertion between a run and jump protocol involving low or high impacts on the lower extremities.

The rating of perceived exertion method (RPE) allows to describe training intensity in a single value. To better understand the underlying components, the separate rating of perceived breathlessness (RPE-B) and leg-muscle exertion (RPE-L) has been proposed. Here we hypothesised that the separation between the two components may (partly) be determined by the impacts on the lower extremities. In this study, we aimed to experimentally evaluate the differential effect of high versus low impact running and jumping on RPE-B and RPE-L in team sport activities by manipulating the movement strategy (heel strike and passive landing pattern versus forefoot strike and active landing pattern). Eighteen recreational team sport players participated in two submaximal tests consisting of a sequence of running and jumping bouts, whilst ground reaction forces (GRF) were collected. RPE-B and RPE-L data were collected after each bout using the CR100 scale. Paired-samples t-tests were used to analyse between-session differences in these variables. GRF analysis showed that absorption mechanics differed considerably between the two sessions. RPE-L was on average 6.50 AU higher in the low impact session (p = 0.006). However, RPE-B was also increased by 4.96 AU with low impact (p = 0.009). We conclude that the extent to which the lower extremities are being exposed to high or low impacts does not explain a possible separation between the two RPE types.HighlightsThe separate rating of the different underlying components of RPE (e.g. variables related to the cardiorespiratory and the muscular system) may provide more insight in the relationship between training load and training outcomes, which likely differs between these components.The findings of this study do not support the idea that the separation in rating between perceived breathlessness (RPE-B, cardiorespiratory) and leg-muscle exertion (RPE-L, muscular) is also rooted in the extent to which musculoskeletal structures in the lower extremities are being exposed to high or low impacts.

Construct Validity and Test-Retest Reliability of Hip Load Compared With Playerload During Football-Specific Running, Kicking, and Jumping Tasks.

PURPOSE: To determine the test-retest reliability of the recently developed Hip Load metric, evaluate its construct validity, and assess the differences with Playerload during football-specific short-distance shuttle runs. METHODS: Eleven amateur football players participated in 2 identical experimental sessions. Each session included 3 different shuttle runs that were performed at 2 pace-controlled running intensities. The runs consisted of only running, running combined with kicks, and running combined with jumps. Cumulative Playerload and Hip Loads of the preferred and nonpreferred kicking leg were collected for each shuttle run. Test-retest reliability was determined using intraclass correlations, coefficients of variation, and Bland-Altman analyses. To compare the load metrics with each other, they were normalized to their respective values obtained during a 54-m run at 9 km/h. Sensitivity of each load metric to running intensity, kicks, and jumps was assessed using separate linear mixed models. RESULTS: Intraclass correlations were high for the Hip Loads of the preferred kicking leg (.91) and the nonpreferred kicking leg (.96) and moderate for the Playerload (.87). The effects (95% CIs) of intensity and kicks on the normalized Hip Load of the kicking leg (intensity: 0.95 to 1.50, kicks: 0.36 to 1.59) and nonkicking leg (intensity: 0.96 to 1.53, kicks: 0.06 to 1.34) were larger than on the normalized Playerload (intensity: 0.12 to 0.25, kicks: 0.22 to 0.53). CONCLUSIONS: The inclusion of Hip Load in training load quantification may help sport practitioners to better balance load and recovery.

Adherence to an injury prevention program in male amateur football players is affected by players' age, experience and perceptions.

Objectives: Adherence to injury prevention programmes in football remains low, which is thought to drastically reduce the effects of injury prevention programmes. Reasons why (medical) staff and players implement injury prevention programmes, have been investigated, but player's characteristics and perceptions about these programmes might influence their adherence. Therefore, this study investigated the relationships between player's characteristics and adherence and between player's perceptions and adherence following an implemented injury prevention programme. Methods: Data from 98 of 221 football players from the intervention group of a cluster randomised controlled trial concerning hamstring injury prevention were analysed. Results: Adherence was better among older and more experienced football players, and players considered the programme more useful, less intense, more functional and less time-consuming. Previous hamstring injuries, educational level, the programme's difficulty and intention to continue the exercises were not significantly associated with adherence. Conclusion: These player's characteristics and perceptions should be considered when implementing injury prevention programmes.

A risk-reward assessment of passing decisions: comparison between positional roles using tracking data from professional men's soccer.

INTRODUCTION: Performance assessment in professional soccer often focusses on notational assessment like assists or pass accuracy. However, rather than statistics, performance is more about making the best possible tactical decision, in the context of aplayer's positional role and the available options at the time. With the current paper, we aim to construct an improved model for the assessment of pass risk and reward across different positional roles, and validate that model by studying differences in decision-making between players with different positional roles. METHODS: To achieve our aim, we collected position tracking data from an entire season of Dutch Eredivisie matches, containing 286.151 passes of 336 players. From that data, we derived several features on risk and reward, both for the pass that has been played, as well as for the pass options that were available at the time of passing. RESULTS: Our findings indicate that we could adequately model risk and reward, outperforming previously published models, and that there were large differences in decision-making between players with different positional roles. DISCUSSION: Our model can be used to assess player performance based on what could have happened, rather than solely based on what did happen in amatch.

Monitoring Elite Youth Football Players' Physiological State Using a Small-Sided Game: Associations With a Submaximal Running Test.

PURPOSE: To examine the utility of a standardized small-sided game (SSG) for monitoring within-player changes in mean exercise heart rate (HRex) when compared with a submaximal interval shuttle-run test (ISRT). METHODS: Thirty-six elite youth football players (17 [1] y) took part in 6 test sessions across an in-season period (every 4 wk). Sessions consisted of the ISRT (20-m shuttles, 30″:15″ work:rest ratio, 70% maximal ISRT) followed by an SSG (7v7, 80 × 56 m, 6 min). HRex was collected during both protocols, with SSG external load measured as high-speed running distance (>19.8 km·h-1) and acceleration distance (>2 m·s-2). Data were analyzed using linear mixed-effect models. RESULTS: Controlling for SSG external load improved the model fit describing the SSG-ISRT HRex relationship (χ2 = 12.6, P = .002). When SSG high-speed running distance and SSG acceleration distance were held constant, a 1% point change in SSG HRex was associated with a 0.5% point change in ISRT HRex (90% CI: 0.4 to 0.6). Inversely, when SSG HRex was held constant, the effects of a 100-m change in SSG high-speed running distance and a 21-m change in SSG acceleration distance on ISRT HRex were -1.0% (-1.5 to -0.4) and -0.6% points (-1.1 to 0.0), respectively. CONCLUSIONS: An SSG can be used to track within-player changes in HRex for monitoring physiological state. Given the uncertainty in estimates, we advise to only give meaning to changes in SSG HRex >2% points. Additionally, we highlight the importance of considering external load when monitoring SSG HRex.

Differential Ratings of Perceived Exertion: Relationships With External Intensity and Load in Elite Men's Football.

PURPOSE: To examine the utility of differential ratings of perceived exertion (dRPE) for monitoring internal intensity and load in association football. METHODS: Data were collected from 2 elite senior male football teams during 1 season (N = 55). External intensity and load data (duration × intensity) were collected during each training and match session using electronic performance and tracking systems. After each session, players rated their perceived breathlessness and leg-muscle exertion. Descriptive statistics were calculated to quantify how often players rated the 2 types of rating of perceived exertion differently (dRPEDIFF). In addition, the association between dRPEDIFF and external intensity and load was examined. First, the associations between single external variables and dRPEDIFF were analyzed using a mixed-effects logistic regression model. Second, the link between dRPEDIFF and session types with distinctive external profiles was examined using the Pearson chi-square test of independence. RESULTS: On average, players rated their session perceived breathlessness and leg-muscle exertion differently in 22% of the sessions (range: 0%-64%). Confidence limits for the effect of single external variables on dRPEDIFF spanned across largely positive and negative values for all variables, indicating no conclusive findings. The analysis based on session type indicated that players differentiated more often in matches and intense training sessions, but there was no pattern in the direction of differentiation. CONCLUSIONS: The findings of this study provide no evidence supporting the utility of dRPE for monitoring internal intensity and load in football.

Quantifying change of direction load using positional data from small-sided games in soccer.

PURPOSE: Quantifying change of direction (COD) load through positional data from small-sided games (SSG) and assess its criterion and construct validity. METHODS: Elite male youth soccer players (n = 25, 16.8 ± 1.3 years) played three SSG (5v5, 5×4 min) with different field dimensions (small [40×30 m], medium [55×38 m], large [70×45 m]). Positional data of the players was obtained with a Local Position Measurement system. COD load (AU) was quantified based on the combination of velocity and change in heading direction. Additionally, total distance covered, running distance, acceleration count, deceleration count, and Rating of Perceived Exertion were measured. Criterion validity was assessed by correlating COD load and the load indicators. Construct validity was determined by testing the differences between the SSG field dimensions. RESULTS: Strong correlations were determined between COD load and total distance covered (r = 0.74, p < .01) and running distance (r = 0.84, p < .01). Middle and large field size resulted in highest COD load (p < .05). CONCLUSION: These results suggest that the COD load measure shows sufficient criterion and construct validity.

Biomechanical Load Quantification Using a Lower Extremity Inertial Sensor Setup During Football Specific Activities.

Training load monitoring systems in football do not focus on lower extremities and therefore potentially neglect important information to optimise performance or reduce injury risk. The current study aims to present joint and segment angular accelerations as novel indicators to quantify lower extremity biomechanical load measured by a new inertial sensor setup. Relationships were explored with commonly used whole-body training load indicators using principal component analysis (PCA). Sixteen male amateur football players performed a linear sprint and an agility T-test. An inertial sensor setup, and local position measurement system were used to collect training load data. Hip Load, Knee Load, Thigh Load and Shank Load were introduced to quantify lower extremity biomechanical load. Three principal components were identified for both tests, explaining 91% and 86% of the variance. The indicators for the lower extremities contributed to the second principal component for both tests and provide distinct information compared to whole-body load indicators. The results show the potential to use an inertial sensor setup combined with common monitoring systems to evaluate training load, which may help optimise future performance and reduce injury risk. These relationships should be further examined during other football specific activities such as shooting or jumping.

Nonergodicity in Load and Recovery: Group Results Do Not Generalize to Individuals.

PURPOSE: The study of load and recovery gained significant interest in the last decades, given its important value in decreasing the likelihood of injuries and improving performance. So far, findings are typically reported on the group level, whereas practitioners are most often interested in applications at the individual level. Hence, the aim of the present research is to examine to what extent group-level statistics can be generalized to individual athletes, which is referred to as the "ergodicity issue." Nonergodicity may have serious consequences for the way we should analyze, and work with, load and recovery measures in the sports field. METHODS: The authors collected load, that is, rating of perceived exertion × training duration, and total quality of recovery data among youth male players of a professional football club. This data were collected daily across 2 seasons and analyzed on both the group and the individual level. RESULTS: Group- and individual-level analysis resulted in different statistical outcomes, particularly with regard to load. Specifically, SDs within individuals were up to 7.63 times larger than SDs between individuals. In addition, at either level, the authors observed different correlations between load and recovery. CONCLUSIONS: The results suggest that the process of load and recovery in athletes is nonergodic, which has important implications for the sports field. Recommendations for training programs of individual athletes may be suboptimal, or even erroneous, when guided by group-level outcomes. The utilization of individual-level analysis is key to ensure the optimal balance of individual load and recovery.

Load Monitoring Practice in Elite Women Association Football.

The description of current load monitoring practices may serve to highlight developmental needs for both the training ground, academia and related industries. While previous studies described these practices in elite men's football, no study has provided an overview of load monitoring practices in elite women's football. Given the clear organizational differences (i.e., professionalization and infrastructure) between men's and women's clubs, making inferences based on men's data is not appropriate. Therefore, this study aims to provide a first overview of the current load monitoring practices in elite women's football. Twenty-two elite European women's football clubs participated in a closed online survey (40% response rate). The survey consisted of 33 questions using multiple choice or Likert scales. The questions covered three topics; type of data collected and collection purpose, analysis methods, and staff member involvement. All 22 clubs collected data related to different load monitoring purposes, with 18 (82%), 21 (95%), and 22 (100%) clubs collecting external load, internal load, and training outcome data, respectively. Most respondents indicated that their club use training models and take into account multiple indicators to analyse and interpret the data. While sports-science staff members were most involved in the monitoring process, coaching, and sports-medicine staff members also contributed to the discussion of the data. Overall, the results of this study show that most elite women's clubs apply load monitoring practices extensively. Despite the organizational challenges compared to men's football, these observations indicate that women's clubs have a vested interest in load monitoring. We hope these findings encourage future developments within women's football.

Associations between Hamstring Fatigue and Sprint Kinematics during a Simulated Football (Soccer) Match.

PURPOSE: Neuromuscular fatigue is considered to be important in the etiology of hamstring strain injuries in football. Fatigue is assumed to lead to decreases in hamstring contractile strength and changes in sprinting kinematics, which would increase hamstring strain injury risk. Therefore, the aim was to examine the effects of football-specific fatigue on hamstring maximal voluntary torque (MVT) and rate of torque development (RTD), in relation to alterations in sprinting kinematics. METHODS: Ten amateur football players executed a 90-min running-based football match simulation. Before and after every 15 min of simulated play, MVT and RTD of the hamstrings were obtained in addition to the performance and lower body kinematics during a 20-m maximal sprint. Linear mixed models and repeated measurement correlations were used to assess changes over time and common within participant associations between hamstring contractile properties and peak knee extension during the final part of the swing phase, peak hip flexion, peak combined knee extension and hip flexion, and peak joint angular velocities, respectively. RESULTS: Hamstring MVT and sprint performance were significantly reduced by 7.5% and 14.3% at the end of the football match simulation. Unexpectedly, there were no indications for reductions in RTD when MVT decrease was considered. Decreases in hamstring MVT were significantly correlated to decreases in peak knee angle (R = 0.342) and to increases in the peak combined angle (R = -0.251). CONCLUSIONS: During a football match simulation, maximal voluntary isometric hamstring torque declines. This decline is related to greater peak knee extension and peak combined angle during sprint running, which indicates a reduced capacity of the hamstrings to decelerate the lower leg during sprint running with fatigue.

Load Monitoring Practice in European Elite Football and the Impact of Club Culture and Financial Resources.

Load monitoring is considered important to manage the physical training process in team sports such as Association Football. Previous studies have described the load monitoring practices of elite English football clubs and clubs with an established sports-science department. An examination of a broader international sample is currently not available. In addition, previous research has suggested factors that may improve the implementation of load monitoring practices, such as a strong club belief on the benefit of evidence-based practice (EBP) and high club financial resources. However, no study has examined yet the actual impact of these factors on the monitoring practices. Therefore, this study aims (1) to provide an overview of load monitoring practices in European elite football and (2) to provide insight into the differences in implementation between clubs by examining the impact of the club beliefs on the benefit of EBP and the club financial resources. An online survey, consisting of multiple choice and Likert scale questions, was distributed among sports-science and sports-medicine staff (n = 99, 50% response rate). Information was asked about the types of data collected, collection purposes, analysis methods, and staff involvement. The results indicated that external load data (e.g., global navigation satellite system, accelerometer…) was collected the most whilst respondents also indicated to collect internal load (e.g., heart rate, rating of perceived exertion…) and training outcome data (e.g., aerobic fitness, neuromuscular fatigue…) for multiple purposes. Considerable diversity in data analysis was observed suggesting that analysis is often limited to reporting the gathered data. Sports-science staff were responsible for data collection and analysis. Other staff were involved in data discussion to share decision-making. These practices were positively impacted by a stronger club belief on the benefit of EBP and greater financial resources. Creating an organizational culture, characterized by a strong belief on the benefit of EBP, is important to increase the impact of load monitoring. However, the actual potential may still be largely determined by financial resources. High-level clubs could therefore play a leading role in generating and sharing knowledge to improve training practices and player health.

Evidence of Widespread Mechanical Hyperalgesia but Not Exercise-Induced Analgesia in Athletes With Mild Patellar Tendinopathy Compared With Pain-Free Matched Controls: A Blinded Exploratory Study.

OBJECTIVE: The aim of the study was to assess centrally induced pain processing with pressure pain thresholds bilaterally and remotely in active volleyball and basketball athletes with mild patellar tendinopathy compared with asymptomatic control athletes. Secondary objective was to explore the role of exercise-induced analgesia during a training session in athletes with patellar tendinopathy. DESIGN: In this exploratory study, pressure pain thresholds of 21 patellar tendinopathy athletes and 16 age- and sex-matched asymptomatic team members were measured by a blinded assessor bilaterally on the patellar tendon and unilaterally on the elbow extensor tendon with a pressure algometer before, during, and after a regular training session. RESULTS: Patellar tendinopathy athletes had a significantly higher average body mass index compared with asymptomatic athletes (mean difference 1.75 kg/m2; 95% confidence interval = 0.35-3.15, P = 0.02). At baseline, athletes with patellar tendinopathy showed lowered pressure pain thresholds in the affected knee (P = 0.001), unaffected knee (P < 0.001), and elbow (P = 0.01) compared with controls. No clear patterns were identified to explain between-group differences in pressure pain thresholds before, during, and after exercise. CONCLUSIONS: This exploratory study found primary and secondary mechanical hyperalgesia in athletes with patellar tendinopathy compared with asymptomatic athletes. Further research is required on the effects of an acute exercise bout on pain thresholds in this population.

Managing Load to Optimize Well-Being and Recovery During Short-Term Match Congestion in Elite Basketball.

In elite basketball, players are exposed to intensified competition periods when participating in both national and international competitions. How coaches manage training between matches and in reference to match scheduling for a full season is not yet known. PURPOSE: First, to compare load during short-term match congestion (ie, ≥2-match weeks) with regular competition (ie, 1-match weeks) in elite male professional basketball players. Second, to determine changes in well-being, recovery, neuromuscular performance, and injuries and illnesses between short-term match congestion and regular competition. METHODS: Sixteen basketball players (age 24.8 [2.0] y, height 195.8 [7.5] cm, weight 94.8 [14.0] kg, body fat 11.9% [5.0%], VO2max 51.9 [5.3] mL·kg-1·min-1) were monitored during a full season. Session rating of perceived exertion (s-RPE) was obtained, and load was calculated (s-RPE × duration) for each training session or match. Perceived well-being (fatigue, sleep quality, general muscle soreness, stress levels, and mood) and total quality of recovery were assessed each training day. Countermovement jump height was measured, and a list of injuries and illnesses was collected weekly using the adapted Oslo Sports Trauma Research Center Questionnaire on Health Problems. RESULTS: Total load (training sessions and matches; P < .001) and training load (P < .001) were significantly lower for ≥2-match weeks. Significantly higher well-being (P = .01) and less fatigue (P = .001) were found during ≥2-match weeks compared with 1-match weeks. CONCLUSION: Total load and training load were lower during short-term match congestion compared with regular competition. Furthermore, better well-being and less fatigue were demonstrated within short-term match congestion. This might indicate that coaches tend to overcompensate training load in intensified competition.

Effective But Not Adhered to: How Can We Improve Adherence to Evidence-Based Hamstring Injury Prevention in Amateur Football?

OBJECTIVES: To investigate adherence to a Nordic hamstring exercise (NHE) program in a real-world context of male amateur football, and the perceptions of end users (players) and intervention deliverers (coaches and medical staff) about adherence to this proven effective program. DESIGN: Retrospective cohort study. SETTING: Dutch amateur football. PARTICIPANTS: Two hundred sixty-four players, 23 coaches, and 29 medical staff from Dutch amateur football teams that participated in a national randomized controlled trial 2 years earlier. INDEPENDENT VARIABLES: Nordic hamstring exercise program. MAIN OUTCOME MEASURES: Nordic hamstring exercise program adherence during 2014 and 2015. Intervention or control group allocation during the trial, transfers, and personal perception about adherence to the program were also examined. RESULTS: Of all players, 69% reported never, 16% sometimes, 6% frequently, 5% often, and 4% always performing exercises of the NHE program. Adherence to the NHE program was higher among players who had been in the NHE arm of the previous trial and among players who had not been transferred to another club compared with players who had been transferred. Key factors in stimulating players to adhere to the NHE program were knowledge of the NHE and personal motivation. Coaches and medical staff members also mentioned personal motivation and consensus with team staff as key factors to encourage NHE adherence. CONCLUSIONS: Among high-level male amateur football players, adherence to an evidence-based hamstring injury-prevention program was very low. It is essential to recognize factors that stimulate or limit adherence to injury-prevention programs for effective programs to actually lead to a reduction in hamstring injuries in a real-world context.