Improvement of Prediction of Noncontact Injury in Elite Australian Footballers With Repeated Exposure to Established High-Risk Workload Scenarios

Objectives: To assess the effect of multiple high-risk-scenario (HRS) exposures on noncontact injury prediction in elite Australian footballers. Design: Retrospective cohort study. Methods: Sessional workload data (session rating of perceived exertion, global positioning system-derived distance, sprint distance, and maximum velocity) from 1 club (N = 60 players) over 3 seasons were collated; several established HRSs were also defined. Accumulated HRS sessional exposures were calculated retrospectively (previous 1-8 wk). Noncontact injury data were documented. Univariate and multivariate Poisson regression models determined injury incidence rate ratios (IRRs) while accounting for moderating effects (preseason workload volume and playing experience). Model performance was evaluated using receiver operating characteristics (area under curve). Results: Very low (0-8 sessions: IRR = 5.76; 95% confidence interval [CI], 1.69-19.66) and very high (>15 sessions: IRR = 4.70; 95% CI, 1.49-14.87) exposures to >85% of an individual's maximal velocity over the previous 8 wk were associated with greater injury risk compared with moderate exposures (11-12 sessions) and displayed the best model performance (area under curve = 0.64). A single session corresponding to a very low chronic load condition over the previous week for all workload variables was associated with increased injury risk, with sprint distance (IRR = 3.25; 95% CI, 1.95-5.40) providing the most accurate prediction model (area under curve = 0.63). Conclusions: Minimal exposure to high-velocity efforts (maximum speed exposure and sprint volume) was associated with the greatest injury risk. Being underloaded may be a mediator for noncontact injury in elite Australian football. Preseason workload and playing experience were not moderators of this effect.