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Why do workload spikes cause injuries, and which athletes are at higher risk? Mediators and moderators in workload–injury investigations
  1. Johann Windt1,2⇑,
  2. Bruno D Zumbo3,
  3. Ben Sporer4,5,
  4. Kerry MacDonald6,
  5. Tim J Gabbett7
  1. 1 Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Department of Educational and Counselling Psychology, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Vancouver Whitecaps Football Club, Vancouver, Canada, British Columbia
  5. 5 Faculty of Medicine, Division of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
  6. 6 Department of Athletics and Recreation, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7 Gabbett Performance Solutions, Queensland, Australia
  1. Correspondence to Johann Windt; johannwindt{at}gmail.com

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Spikes in training and competition workloads, especially in undertrained athletes, increase injury risk.1 However, just as attributing athletic injuries to single risk factors is an oversimplification of the injury process,2 3 interpreting this workload-injury relationship should not be done in isolation. Instead, we must further unpack how (ie, through which mechanisms) workload spikes might result in injury, and what characteristics make athletes more robust or more susceptible to injury at any given workload. In other words, which factors mediate the workload-injury relationship, and which moderate the relationship.

Domino or dimmer? Differentiating ‘mediators’ and ‘moderators’

Like dominoes being knocked over, mediators can be viewed as the intermediary steps that explain the association between an observed variable and an outcome.4 In this context, mediating variables help to explain ‘why changes in workloads might cause injuries?’ For example, it is known that rugby league players exposed to spikes in running workloads, indicated by a high acute:chronic workload ratio, are at an increased risk for non-contact injuries.5 One potential explanation is that neuromuscular fatigue mediates this relationship, such that increased …

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