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Spikes in acute:chronic workload ratio (ACWR) associated with a 5–7 times greater injury rate in English Premier League football players: a comprehensive 3-year study
  1. Laura Bowen1,2,
  2. Aleksander Stephan Gross2,
  3. Mo Gimpel3,
  4. Stewart Bruce-Low3,
  5. Francois-Xavier Li1
  1. 1 Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  2. 2 Southampton Football Club, Sports Medicine and Science, Southampton, UK
  3. 3 Performance Support, Southampton Football Club, Southampton, UK
  1. Correspondence to Miss. Laura Bowen, Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; lbowen{at}


Objectives We examined the relation between global positioning system (GPS)-derived workloads and injury in English Premier League football players (n=33) over three seasons.

Methods Workload and injury data were collected over three consecutive seasons. Cumulative (1-weekly, 2-weekly, 3-weekly and 4-weekly) loads in addition to acute:chronic workload ratios (ACWR) (acute workload (1-week workload)) divided by chronic workload (previous 4-week average acute workload) were classified into discrete ranges by z-scores. Relative risk (RR) for each range was then calculated between injured and non-injured players using specific GPS variables: total distance, low-intensity distance, high-speed running distance, sprint distance, accelerations and decelerations.

Results The greatest non-contact injury risk was when the chronic exposure to decelerations was low (<1731) and the ACWR was >2.0 (RR=6.7). Non-contact injury risk was also 5–6 times higher for accelerations and low-intensity distance when the chronic workloads were categorised as low and the ACWR was >2.0 (RR=5.4–6.6), compared with ACWRs below this. When all chronic workloads were included, an ACWR >2.0 was associated with a significant but lesser injury risk for the same metrics, plus total distance (RR=3.7–3.9).

Conclusions We recommend that practitioners involved in planning training for performance and injury prevention monitor the ACWR, increase chronic exposure to load and avoid spikes that approach or exceed 2.0.

  • GPS
  • injury
  • football
  • Premier League
  • workloads

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  • Contributors All authors listed met the conditions required for full authorship. LB designed the initial study proposal, which was presented to ASG, SB-L and MG. From there, all five authors met regularly to ensure a scientifically sound study design was created. LB collated and analysed the data with the help of both ASG and MG throughout the process. F-XL and SB-L advised and checked the statistical analysis. LB wrote the main body of the article, which was revised multiple times by all authors before being approved for publication. LB modified the article following revisions with contributions from SB-L. All authors are fully aware and understanding of the findings of the study and confident in the integrity of the research.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Approval was obtained from the University of Birmingham Ethical Review Committee.

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

  • Data sharing statement All data analysed are included in the article.

  • Patient consent for publication Not required.

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