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Internal workload and non-contact injury: a one-season study of five teams from the UEFA Elite Club Injury Study
  1. Alan McCall1,2,
  2. Gregory Dupont1,2,
  3. Jan Ekstrand2,3
  1. 1 Research and Development Department, Edinburgh Napier University, Edinburgh, UK
  2. 2 Football Research Group, Linköping University, Linköping, Sweden
  3. 3 Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  1. Correspondence to Dr Alan McCall, Research and Development Department, Edinburgh Napier University, Edinburgh WD7 9AD, UK; alan_mccall{at}


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.

  • injury
  • soccer
  • training load
  • prevention
  • risk factor

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  • Contributors All three authors came up with the idea for the study. JE recruited the teams. AM and GD collected the data and performed the statistical analysis. All three authors contributed to interpretation of the results and writing of the manuscript, and to the revision and second version of the manuscript.

  • Funding This study was supported by grants from UEFA and the Swedish National Centre for Research in Sports.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval UEFA Football Department Division and the UEFA Medical Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.