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BJSM Online First, published on February 5, 2016 as 10.1136/bjsports-2015-095364
Original article

Low chronic workload and the acute:chronic

workload ratio are more predictive of injury
than between-match recovery time: a two-season
prospective cohort study in elite rugby league
players
Billy T Hulin,1,2 Tim J Gabbett,3,4 Peter Caputi,5 Daniel W Lawson,6 John A Sampson1
1
Centre for Human and ABSTRACT than during longer between-match recovery times
Applied Physiology, School of Background Between-match recovery time, and acute (7 or more days).5 However, at least two studies
Medicine, University of
Wollongong, Wollongong, New
and chronic workloads likely affect subsequent match- failed to find any association between congested
South Wales, Australia injury risk in elite rugby league players. fixture periods and higher injury incidence in other
2
Football Department, Methods Workloads of 28 players throughout two team sports.8 9
St. George Illawarra Dragons seasons were calculated during short (<7 days), and The equivocal evidence in relation to shorter
Rugby League Football Club, long (≥7 days) between-match recovery times. ‘Acute’ between-match recovery times and increased injury
Wollongong, New South
Wales, Australia workloads (1 week) greater than ‘chronic’ workloads risk may be due to the fact that previous studies
3
School of Exercise Science, (4-week rolling average acute workload) resulted in have not investigated player workloads between
Australian Catholic University, acute:chronic workload ratios above 1. matches.4 5 8 9 Higher workloads can occur during
Brisbane, Queensland, Results No difference was found between the match- longer between-match recovery times10 and higher
Australia
4
School of Human Movement injury risk of short and long between-match recovery workloads1 3 or abrupt increases in workloads2 3 11
Studies, University of periods (7.5±2.5% vs 6.8±2.5%). When players had a can increase injury risk. However, no study has
Queensland, Brisbane, short recovery between matches, high chronic workloads investigated the combined influence of workloads
Queensland, Australia (18.9–22.0 km) were associated with a smaller risk of and between-match recovery time on the risk of
5
School of Psychology,
match injury than chronic workloads <18.9 km (relative subsequent match injury in elite team sport
University of Wollongong,
Wollongong, New South risk (RR) range 0.27–0.32 (CI 0.08 to 0.92); likelihood athletes.
Wales, Australia range 90–95%, likely). Players who had shorter recovery Regardless of the recovery time between
6
Baimed Physiotherapy and and acute:chronic workload ratios ≥1.6, were 3.4–5.8 matches, higher acute (ie, 1 week) workloads are
Sports Injury Clinic, times likely to sustain a match injury than players with associated with winning more matches in an elite
Wollongong, New South
Wales, Australia lower acute:chronic workload ratios (RR range 3.41–5.80 team sport.12 However, when acute workload
(CI 1.17 to 19.2); likelihood range 96–99%, very likely). exceeded chronic workload (ie, 4-week average
Correspondence to Acute:chronic workload ratios between 1.2 and 1.6 acute workload), resulting in an acute:chronic
Billy T Hulin, Football during short between-match recovery times demonstrated workload ratio greater than 1, the probability of
Department, St. George
a greater risk of match injury than ratios between 1.0 and losing matches increased.12 Furthermore, Hulin
Illawarra Dragons RLFC, 1/5
Burelli Street, Wollongong, 1.2 (RR=2.88 (CI 0.97 to 8.55); likelihood=92%, likely). et al11 recently demonstrated that acute and
NSW 2500, Australia; Conclusions Contrary to the philosophy that high chronic workloads can have both positive and
billyhulin@hotmail.com workloads and shorter recovery equate to increased injury negative influences on injury risk in elite rugby
risk, our data suggest that high and very-high chronic league players. When players had an acute:chronic
Accepted 18 January 2016
workloads may protect against match injury following workload ratio close to 1, higher chronic work-
shorter between-match recovery periods. Acute:chronic loads were associated with a smaller risk of injury
workload ratios ∼1.5 are associated with a greater risk of than lower chronic workloads. Conversely, a large
match injury than lower acute:chonic workload ratios. spike in acute workload relative to chronic work-
Importantly, workloads can be manipulated to decrease load (ie, ratios of >1.5) resulted in a threefold to
the match-injury risk associated with shorter recovery time fivefold increase in injury risk.2 11
between matches. The effect of: (1) higher chronic workloads or
(2) abrupt increases in acute workload, on the risk
of sustaining a match injury following different
INTRODUCTION between-match recovery times is currently
The likelihood of sustaining an injury in team sport unknown. Therefore, we modelled acute and
can be influenced in part by: (1) the workloads that chronic workloads with the risk of sustaining a
athletes are subjected to,1–3 or (2) the recovery match injury following short (5 and 6 days) and
time that is provided between matches.4 5 Three to long (7, 8 and 9 days) between-match recovery
5 days recovery is required for match-induced times in elite rugby league players.
To cite: Hulin BT, reductions in neuromuscular and endocrine func-
Gabbett TJ, Caputi P, et al.
Br J Sports Med Published
tion to return to prematch values in team sport ath- METHODS
Online First: [ please include letes.6 7 During the shortest between-match Participants
Day Month Year] recovery times in rugby league (5 and 6 days), Twenty-eight players (mean±SD; age, 24.8
doi:10.1136/bjsports-2015- training and preparation between matches is con- ±3.4 years; height, 184.5±4.9 cm; body mass,
095364 gested and there is a greater incidence of injury 99.5±8.0 kg) from one elite rugby league club
Hulin BT, et al. Br J Sports Med 2016;0:1–5. doi:10.1136/bjsports-2015-095364 1
Copyright Article author (or their employer) 2016. Produced by BMJ Publishing Group Ltd under licence.
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Original article

participated in this study over two Australian National Rugby

Table 1 Description of between-match workloads, chronic
League (NRL) seasons. This study was conducted over the com-
workloads and acute:chronic workload ratios during short and long
petition phase of each season (2×27 weeks). Only players par-
between-match recovery times
ticipating in first-team matches and completing workloads
between those matches were included in the analysis. Players Between-match recovery time
received a clear explanation of the study and written consent Percentile rank (%) Short Long
was obtained. Experimental procedures were approved by the
Institutional Review Board for Human Investigation. Between-match workload (km)
Very-low ≤5 ≤9.0 ≤12.0
Low ≤25 9.1–12.5 12.1–16.2
Injury definition
Moderate-low <50 12.6–15.5 16.3–18.8
Injury records were updated and maintained by the club’s senior
Moderate-high ≥50 15.6–17.8 18.9–21.6
physiotherapist. An injury was defined as any time-loss injury
High ≥75 17.9–21.4 21.7–25.3
that resulted in a player being unable to complete full training,
Very-high ≥95 ≥21.5 ≥25.4
or missing match time.11 13 14 Only injuries that were sustained
Chronic workload (km)
in a match or reported subsequent to a match, prior to the next
Very-low ≤5 ≤10.5 ≤11.4
training session, were included in the combined analysis of
Low ≤25 10.6–14.3 11.5–14.7
workload and between-match recovery time.
Moderate-low <50 14.4–16.5 14.8–17.0
Moderate-high ≥50 16.6–18.8 17.1–20.0
Workload and between-match recovery time analysis High ≥75 18.9–22.0 20.1–23.0
Workload was defined as absolute total distance (m) covered Very-high ≥95 ≥22.1 ≥23.1
during all field training sessions and matches and was measured via Acute:chronic workload ratio
GPS (GPSports, SPI-HPU 5 Hz (interpolated 15 Hz), Canberra, Very-low ≤5 ≤0.66 ≤0.80
Australia). The GPS equipment used in this study has demonstrated Low ≤25 0.67–0.86 0.81–0.99
adequate accuracy and reliability for measuring total distance Moderate-low <50 0.87–1.01 1.00–1.09
covered15 16; however, this equipment is not accurate or reliable Moderate-high ≥50 1.02–1.22 1.10–1.20
when measuring changes in velocity,15 17 high-speed running15 18 High ≥75 1.23–1.61 1.21–1.49
and collisions.19 Therefore, these variables were excluded from Very-high ≥95 ≥1.62 ≥1.50
analysis. In the event that a player did not wear a GPS unit or the
GPS unit failed to collect data (<1% of the dataset), the player was
given either the average workload of that training session or their The influence of between-player heterogeneity on the number
average match workload over the season.20 of injuries sustained was examined used a Poisson regression
Between-match workloads were calculated as the total distance model. In this model, positional group (forwards=1, backs=2)
covered during all field training sessions and the following match. was used as a factor, while age, body mass and height were used
Data were categorised into between-match recovery times compar- as covariates.
able with previous studies.5 10 Specifically, these recovery times Statistical analysis was performed in a similar fashion to other
consisted of <7 days (5 and 6 days, also referred to as ‘short’) investigations of acute and chronic workloads and injury risk.11
between matches, or ≥7 days (7, 8 and 9 days, also referred to as The p value derived from binary logistic regression and the
‘long’) between matches. Chronic workloads and acute:chronic value of the RR between groups were entered into a customised
workload ratios were calculated in accordance with previous spreadsheet, which calculates 90% CI and the probabilities that
work.2 11 21 22 Briefly, data from Monday to Sunday represented the true effect was harmful, trivial and beneficial.24 25 These
the acute workload, while the 4-week rolling average acute work- values were reported in quantitative and qualitative terms
load represented the chronic workload. An acute workload greater according to the following: ≥1%, very unlikely; ≥5%, unlikely;
than chronic workload was indicated by an acute:chronic work- ≥25%, possibly; ≥75%, likely; ≥95%, very likely.24–26 Practical
load ratio greater than 1, and vice versa.2 11 21 22 significance occurred when the probability that the true effect
Workload data for short, and long between-match recovery was either harmful or beneficial was ≥75%, likely.24
times were further categorised into very-low through very-high
categories according to percentile rank. These categories are dis- RESULTS
played in table 1. Injury–workload relationships were calculated There were 44 match, and 9 training injuries. No difference was
among very-low through very-high between-match workloads, found between the risk of match injury following short (injury
chronic workloads and acute:chronic workload ratios. risk=7.7±2.5%) and long (injury risk=6.8±2.5%) between-
match recovery periods (figure 1). However, 8 of the 9 training
Statistical analysis injuries occurred when recovery time was <7 days (short).
Match-injury risks were calculated as the total number of match The Poisson regression model did not demonstrate any rela-
injuries sustained relative to the total number of exposures to tionship among the number of injuries sustained and positional
each workload classification.2 11 23 Null hypothesis testing was group (p=0.303), age ( p=0.325), height ( p=0.221) or body
conducted using a binary logistic regression model with injury/ mass ( p=0.167).
no injury as the dependent variable. Between-match workloads,
chronic workloads and acute:chronic workload ratios were inde- Between-match workloads
pendently modelled as predictor variables. Relative risk (RR) Figure 2A depicts the risk of match injury with very-low
and 90% CI (lower-upper) were calculated to determine which through very-high between-match workloads during short, and
workload variables increased or decreased the risk of match long between-match recovery times. During short between-
injury.23 A RR of greater or less than 1 implied an increased or match recovery times, a high between-match workload (17.9–
decreased risk of injury, respectively. 21.5 km) was associated with a risk of match-injury that was:
2 Hulin BT, et al. Br J Sports Med 2016;0:1–5. doi:10.1136/bjsports-2015-095364
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Original article

Figure 1 Risk of match injury±90% CI subsequent to short (5 and

6 days) or long (7, 8 and 9 days) recovery time between matches.

(1) 87% smaller than low between-match workloads (RR=0.13

(CI 0.02 to 0.67); likelihood=97%, very likely), (2) 82% lower
than moderate-low between-match workloads (RR=0.18 (CI
0.03 to 0.95); likelihood=94%, likely), and (3) 85% lower than
very-high between-match workloads (RR=0.15 (CI 0.02 to
1.03); likelihood=94%, likely).

Chronic workloads
No match injuries were sustained when players (n=17) had a
very-high chronic workload (≥22.1 km) during short between-
match recovery times. A high chronic workload (18.9–22.1 km)
was associated with a risk of match injury that was: (1) 73%
lower than a moderate-low chronic workload (RR=0.27 (CI
0.08 to 0.92); likelihood=95%, very likely), and (2) 68% lower
than a low chronic workload (RR=0.32 (CI 0.08 to 1.22); like-
lihood=90%, likely; figure 2B). During short between-match
recovery times, there was a linear trend for lower risk of subse-
quent match injury as chronic workload increased (figure 2B).

Acute:chronic workload ratios

A high acute:chronic workload ratio (1.23–1.61) during short
between-match recovery times demonstrated a risk of match
injury that was 2.88 times greater than a moderate-high acute: Figure 2 Risk of match injury±90% CI subsequent to short (5 and
chronic workload ratio combined with short recovery between 6 days) or long (7, 8 and 9 days) recovery time between matches
matches (RR=2.88 (CI 0.97 to 8.55); likelihood=92%, likely; combined with between-match workloads (A), chronic workloads (B) and
figure 2C). The risk of match injury with a very-high acute: acute:chronic workload ratios (C). (a)Likely (≥75%) different from
chronic workload ratio (≥1.62) combined with short recovery moderate-high between-match workload and very likely (≥95%) different
between matches was: (1) 5.80 times greater than a moderate- from high between-match workload, during short between-match recovery
high acute:chronic workload ratio (RR=5.80 (CI 1.75 to 19.2); times. (b)Likely (≥75%) different from high between-match workload
likelihood=99%, very likely), and (2) 3.41 times greater than a during short between-match recovery time. (c)Likely (≥75%) different from
high chronic workload during short between-match recovery time. (d)
low acute:chronic workload ratio (RR=3.41 (CI 1.17 to 9.91);
Likely (≥75%) different from low, and moderate-high acute:chronic
likelihood=96%, very likely; figure 2C). workload ratios during short between-match recovery time and high
Long between match recovery times, combined with a very- acute:chronic workload ratio during long between-match recovery time. (e)
high acute:chronic workload ratio (≥1.50) displayed a risk of Very likely (≥95%) different from low, and moderate-high acute:chronic
match injury that was 4.46 times greater than a moderate-high workload ratio during either between-match recovery time, and high
acute:chronic workload ratio (RR=4.46 (CI 0.91 to 21.91); acute:chronic workload ratio during long between-match recovery time.
likelihood=92%, likely; figure 2C). Likely (≥75%) different from moderate-low acute:chronic workload ratio
With the exception of high acute:chronic workload ratios, during either between-match recovery time and very-low and high acute:
when players’ acute:chronic workload ratios were taken into chronic workload ratio during short between match recovery time. (f)
account, the recovery time between matches did not have a sig- Likely (≥75%) different from low, and moderate-high acute:chronic
workload ratio during either between-match recovery time. Likely (≥75%)
nificant independent effect on injury risk in the subsequent
different from high acute:chronic workload ratio during long
match (figure 2C). between-match recovery time.

DISCUSSION injury risk in elite rugby league. We found no difference in the

This study investigated the combined influence of recovery time risk of match injury, subsequent to short (7.7% injury risk) or
between matches and player workloads on subsequent match- long (6.8% injury risk) recovery between matches. Our findings

Hulin BT, et al. Br J Sports Med 2016;0:1–5. doi:10.1136/bjsports-2015-095364 3

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Original article

demonstrate that higher chronic workloads can reduce match between matches. However, attention to the myriad of factors
injury risk following short between-match recovery times. other than workload, which are related to injury risk27 and to
However, increases in acute:chronic workload ratios are asso- the risk factors for overtraining and illness should also be con-
ciated with a higher risk of match injury following short and sidered when planning and prescribing between-match work-
long between-match recovery times. loads.28 For example, long-term excessive workload can cause
non-functional over-reaching, characterised by decreases in per-
The influence of workload and workload ratios on injury formance and vigour and increased fatigue.28 29
risk: does congestion matter? Previous studies may support our findings that a high chronic
We demonstrated that a controllable factor (workload) is asso- workload can reduce the risk of match injury. Specifically,
ciated with higher match-injury risk than non-modifiable between- Gabbett et al demonstrated that rugby league players with
match recovery time in isolation. Specifically, during short greater aerobic capacity,30 and prolonged high-intensity running
between-match recovery times, chronic workloads were associated ability31 have a lower risk of injury. Furthermore, only 2 weeks
with a linear trend for lower risk of injury as chronic workload of low-volume sprint interval training is required to elicit
increased. Additionally, high (1.2–1.6) and very-high (>1.6) acute: improvements in the high-intensity, intermittent running ability
chronic workload ratios combined with a short recovery between and aerobic capacity of team sport athletes.32 Therefore, consid-
matches were associated with a risk of match injury that was 2.8 ering that rugby league training and match play involves sprint-
and 5.8 times higher than an acute:chronic workload ratio ing efforts interspersed with low-intensity activity,33 34 the
between 1.0 and 1.2. Furthermore, with a long recovery between athletes in the current study that achieved a higher chronic
matches, very-high acute:chronic workload ratios (≥1.5) displayed workload may have improved or maintained these physical qual-
a fourfold increase in match injury risk compared with ratios of ities and in turn decreased their risk of sustaining a match injury
1.1–1.2. These findings demonstrate that higher workloads prior when provided a short recovery between matches. However, for
to short between-match recovery times can decrease injury risk, chronic workloads to be increased and provide resistance to
while sudden upgrades in workload will increase match-injury injury, an acute:chronic workload ratio greater than 1 must be
risk, regardless of the recovery time provided between matches. cautiously prescribed at strategic periods throughout the season.
In this study, the two greatest risks of match injury were The findings of the present study suggest that the associated
observed when players had a very-high acute:chronic workload injury risk would be lower if workloads were increased during
ratio combined with short (22% injury risk) or long (15% between-match recovery times of 7 or more days, with an acute:
injury risk) recovery between matches. Additional match-injury chronic workload ratio between 1 and 1.5.
risk factors in this study were when players had very-low to
moderate-low chronic workloads during short between-match
recovery times. Lower chronic workloads and sudden spikes in Limitations and future directions
workload likely function together to increase the risk of match Valid analysis of injury risk in relation to collisions, high-speed
injury. That is, a high chronic workload may reduce the risk of running and accelerations is not possible with the GPS equip-
injury due to the protection it provides against a very-high ment used in this study.15–19 Injury risk in team sport athletes
acute:chronic workload ratio. For example, chronic workloads can also be attributed to multiple factors that have not been
of 19 and 12 km would be classed as high and low, respectively. included in this study.23 27 However, to achieve the statistical
Therefore, an acute workload greater than 20 km would result power required to investigate other factors such as previous
in moderate-high (ie, 1.1) and very-high (ie, 1.7) acute:chronic injury, age and physical fitness, in conjunction with the modifi-
workload ratios for athletes with high and low chronic work- able and non-modifiable injury risk factors in the present study,
loads, respectively. As such, higher chronic workloads may would require a considerably larger data set comprising many
provide protection against a spike in acute workload, which was teams over a number of seasons.23 Of course that brings with it
associated with the greatest risk of match injury in this study the confound of different training regimens (an inherent limita-
and overall injury in previous investigations.2 11 tion of ‘ecological’ research).
Low through very-high between-match workloads demon-
strated a slightly ‘V’-shaped relationship during short between-
match recovery times. Specifically, high between-match work- Summary and conclusion
loads were associated with a lower risk of match injury than low Our data demonstrated that when short and long between-
through moderate-high and very-high between-match workloads match recovery times are viewed in isolation, no difference in
(figure 2A). These findings demonstrate that some, but not injury risk occurred. This study suggests that low chronic work-
excessive, workload is essential to decrease the risk of match loads, and the acute:chronic workload ratio are more predictive
injury when short recovery has been provided between matches. of injury than merely the recovery time provided between
Additionally, no injuries were sustained when players completed matches. Specifically, a higher chronic workload provides pro-
very-high workloads during long between-match recovery times. tection against a spike in acute workload, which was associated
Collectively, these findings are in agreement with others—abso- with the greatest risk of match injury in this study. Furthermore,
lute acute workloads are not as predictive of injury as acute: provided that very-high acute:chronic workload ratios (∼1.5)
chronic workload ratios.11 Furthermore, previous research has are avoided, higher between-match workloads can be achieved
shown that when acute:chronic workload ratios below 1 are pre- without increasing injury risk in elite rugby league players. This
scribed, higher workloads between matches are associated with study offers practitioners fresh insight of how a controllable
a greater number of victories in team sport.12 factor (workload) can be modified to decrease match-injury risk
during elite rugby league competition.
Practical implications for team coaches and strength/
Contributors BTH, TJG and JAS are responsible for the concept and design of this
conditioning personnel project. Injury and workload data were collected by DL and BTH, respectively. BTH
Collectively, these findings may be attractive to coaches and was responsible for data analysis. PC revised this manuscript and provided statistical
practitioners hoping to implement higher training workloads expertise.

4 Hulin BT, et al. Br J Sports Med 2016;0:1–5. doi:10.1136/bjsports-2015-095364

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Original article
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Funding Technical or equipment support for this study was not provided by any 22 Gabbett TJ, Hulin BT, Blanch P, et al. High training workloads alone do not cause
outside companies, manufacturers or organisations. BTH was funded by a sports injuries: how you get there is the real issue. Br J Sports Med Published
postgraduate research scholarship supported by the University of Wollongong and Online First: 21 Jan 2016 doi:10.1136/bjsports-2015-095567
the St. George Illawarra Dragons Rugby League Football Club. 23 Bahr R, Holme I. Risk factors for sports injuries—a methodological approach. Br J
Competing interests None declared. Sports Med 2003;37:384–92.
24 Hopkins WG, Marshall SW, Batterham AM, et al. Progressive statistics for studies in
Patient consent Obtained. sports medicine and exercise science. Med Sci Sports Exerc 2009;41:3–13.
Ethics approval UOW and ISLHD Health and Medical Human Research Ethics 25 Hopkins WG. A spreadsheet for deriving a confidence interval, mechanistic inference
Committee. and clinical inference from a P value. Sportscience 2007;11:16–20.
26 Batterham AM, Hopkins WG. Making meaningful inferences about magnitudes. Int
Provenance and peer review Not commissioned; externally peer reviewed.
J Sports Physiol Perform 2006;1:50–7.
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Hulin BT, et al. Br J Sports Med 2016;0:1–5. doi:10.1136/bjsports-2015-095364 5

 Downloaded from http://bjsm.bmj.com/ on February 5, 2016 - Published by group.bmj.com

Low chronic workload and the acute:chronic

workload ratio are more predictive of injury
than between-match recovery time: a
two-season prospective cohort study in elite
rugby league players
Billy T Hulin, Tim J Gabbett, Peter Caputi, Daniel W Lawson and John A
Sampson

Br J Sports Med published online February 5, 2016

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