"Pokemon Go-itis": A new injury classification?

It was only a few years ago that the world was struck down with "Nintendo Wii-itis". Now with the world wide phenomenon Pokémon Go app growing in popularity by the day, I think it's only a matter of time before GP clinics and physiotherapy practices around the world are going to see an influx of Pokémon Go-related soft tissue injuries. Not to mention lower limb ligament sprains and head injuries from reckless and careless walking. I'm not sure if the app developers intentions were to try and increase physical activity in a population of people who are notoriously sedentary (teenagers & "gamers"), but they have done just that. And if that was the case, well that's just a stroke of genius!

Regardless of the app's original intention, what I expect to happen over the next 1-4 weeks, is see a spike of previously sedentary people, limp into their GP or physio with complaints of hip, knee or ankle/foot pain. This is all in large to the fact that, since the app went "live" last week, there has been a spike in the amount of previously sedentary people walking and running around the streets looking for Pokemon characters than ever before.

Now don't get me wrong. I love the fact that people are out exercising!! What my concern is that, with all this extra physical activity that people are simply not accustomed to, it will result in injuries.

I have written extensively in the past on Load Management, and if you have missed it, you can read it here. But because of the boom in Pokemon Go's popularity, I think it's the perfect time to give a friendly reminder to all of you that..

If you rapidly increase your physical activity in a short period of time and sustain it, it's not a matter of IF you'll get injured, but a matter of WHEN.

For those of you that have read the research on Load Management, it seems that sometime in the next 1-4 weeks we'll be seeing a lot of overuse/under-prepared soft tissue injuries limp through the doors of our clinics. For those of you that haven't read the research on Load Management, the main principle behind it is the Acute:Chronic Workload Ratio (ACWR), and I’ll break it down simply below:

• The Acute training load refers to the activity performed over a rolling 7 days.

• The Chronic training load refers to the average physical activity performed over a rolling 4 weeks.

• To get your ACWR, you divide the Acute load by the Chronic load.

• Ideally you get a number between 0.8-1.3 (also known as the "sweet spot").

• If your ACWR is above 1.5, you have a significantly increased risk of sustaining a soft tissue injury within 1-4 weeks after rapidly increasing your training, with the increase in risk rising the greater the ACWR is.

Now let’s put the ACWR to the test with a practical example in a typical Pokemon Go user.

For starters, let’s just simply use "total walking time" as our training measure, and let’s assume that the Pokemon Go users are playing the app every day this week for at least 60mins.

• Acute load – 7x60mins = 420 units

Now let’s assume that since the release of the game 1 week ago, they have also played the game daily for 60mins last week. Let’s also assume prior to the release of the game they did no exercise for the previous 1 month.

• Chronic load

• Week -1 : 420 units

• Week -2: 0 units

• Week -3: 0 units

• Week -4: 0 units

• Chronic load = 420 / 4 weeks = 105 units

Now we divide the Acute load by the Chronic load to get our ACWR

• ACWR = 420/105 = 4.0

As you can see with an ACWR of 4.0, we are well and truly off the charts with our ACWR, and in a high-risk zone of soft tissue injury within the next 1-4 weeks. Even if the person did the recommended guidelines of exercise per week of 150mins for the previous 1 month, the ACWR would still be at 1.93.

Now, we must understand that the ACWR is based on elite-level AFL, Soccer, NRL and cricket players, not sedentary Pokemon Go app users. So we do need to be careful with generalising this research to the general public. But the basic principle of the ACWR can and should be applied to the general public when it comes to physical activity. And the basic message is:

"Exercise too little, or exercise too much, and you'll get injured. Just like Goldilocks would say, we just need to find the exercise load that is "just right".

My simple solution to this potential rise in soft tissue injuries presenting to clinics all over the world is this:

• Advise the patient to limit the amount of playing time to 30mins every day, or 60mins every 2nd day. That way your body gets a dose of exercise but has a day off to recover and adapt to the new exercise stimulus. With either option, you will still meet the recommended guidelines of physical activity of 150mins of moderate exercise per week.

In closing up today, although I don't play this app, I absolutely love the fact that this game has encouraged a large percentage of the world's population up from the couch and outside for some fresh air and some moderate physical activity. I think there is definitely something in this clever approach to increase physical activity in sedentary individuals that public health promotion advisors and public health researchers should be looking at in years to come to sustain this physical activity boom.

For further reading on Load Management, please check out my blog in the link provided above. It is a summary of a weekend Load Management symposium I attended earlier on this year. Alternatively, make sure you get a hold of some research papers on this topic written by Tim Gabbett or Mick Drew.

Have an active weekend!

Bibliography

1. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? British journal of sports medicine. 2016 Mar;50(5):273-80. PubMed PMID: 26758673. Pubmed Central PMCID: PMC4789704. Epub 2016/01/14. eng.

2. Drew MK, Finch CF. The Relationship Between Training Load and Injury, Illness and Soreness: A Systematic and Literature Review. Sports medicine (Auckland, NZ). 2016 Jun;46(6):861-83. PubMed PMID: 26822969. Epub 2016/01/30. eng.