football medicine & performance The official magazine of the Football Medicine & Performance Association
Issue 26 Autumn 2018
Exclusive: Are we squeezing the life out of adductor monitoring
In this issue: Cardiac Screening Life After Football
Legal
Contents Welcome 4
Members’ News
Features 5
The Barcelona Way Damian Hughes
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Research and Development What you should know about R&D
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Cardiac Screening Saves Footballers’ Lives – But We Can Do More David Oxborough
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Are we Squeezing the Life out of Adductor Monitoring Gary Silk
CHIEF EXECUTIVE OFFICER The launch of the FMPA Register is the culmination of much endeavour by the FMPA team and we are delighted with the response to date and the momentum that is starting to build. The Register was largely designed as an initiative to support members who leave the game often at a time of real need, giving them a platform to showcase their experience, helping them to maintain a presence in the game and supporting their private practice ventures. The needs of these members are clearly different to members in full time posts, hence why the register was set up as a separate entity and viewed as a potential bolt- on to membership, to be used as required. Continued support for colleagues, whether currently in the game or not, is what the FMPA is all about. Our membership is hugely diverse, covering more than a dozen disciplines, with a variety of specific needs. While this can be challenging at times, our profound belief is that ALL disciplines providing health care services to players and Clubs have an important role to play and individuals therein are an invaluable part of our membership. The change of title to FMPA underpins this belief. It is in working together that we have strength as an organisation and a significant voice in the professional game.
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What do sports medicine professionals working in football need to know about sport psychology? Dr Caroline Heaney
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The Supply of Medicines to Sports Teams Roni Lennon Bsc
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The FMPA Register
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Life After Football – Rob Swire
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A Commonly Misdiagnosed injury – Lisfranc Fracture Dislocation in a Professional Soccer Player Ashley Jones MSc Rodger Wylde BSc Richard Moss MSc
One of our main aims has always been to improve standards but there are many questions still to be addressed; areas such as governance, indemnity, safeguarding, fitness to practise and the increasing `brain drain` of skilled practitioners from the game, to name but a few. We should be very concerned that, in some areas, standards are actually falling Some of this is centred around cost saving measures at clubs who seem to think that as long as they have the minimum requirements in place, then everything is ok. Let me give one example for all to consider. If healthcare insurers determined long ago that their members (the public) can only be treated by practitioners who have a minimum of 5 years post graduate experience, why is it that `football` is happy for new graduates to treat professional players the day after graduation?
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The (Return to Play) Times, They are a Changin’ Markus Waldén Clare Ardern
While the foundations of the FMPA are firmly in place, all Medical and Performance practitioners working in professional football should recognise the role that the FMPA is playing and grasp the opportunity, not only to take the organisation forward, but to be an even louder voice in the game, raising standards to the world class level that you all deserve.
Eamonn Salmon CEO Football Medicine & Performance Association Football Medicine & Performance Association 6A Cromwell Terrace, Gisburn Road, Barrowford, Lancashire, BB9 8PT T: 0333 456 7897 E: info@fmpa.co.uk W: www.fmpa.co.uk
Chief Executive Officer
Eamonn Salmon Eamonn.salmon@fmpa.co.uk
Executive Administrator Lindsay Butler Lindsay.butler@fmpa.co.uk
COVER IMAGE
Swansea City’s Martin Olsson on the ground after picking up an injury. Richard Sellers/EMPICS Sport/PA Images Football Medicine & Performance Association. All rights reserved. The views and opinions of contributors expressed in Football Medicine & Performance are their own and not necessarily of the FMPA Members, FMPA employees or of the association. No part of this publication may be reproduced or transmitted in any form or by any means, or stored in a retrieval system without prior permission except as permitted under the Copyright Designs Patents Act 1988. Application for permission for use of copyright material shall be made to FMPA. For permissions contact admin@fmpa.co.uk.
Project Manager
Angela Walton Angela.walton@fmpa.co.uk
Design
Oporto Sports - www.oportosports.com
Marketing/Advertising
Charles Whitney - 0845 004 1040
Photography
PA Images, FMPA.
Contributors
David Oxborough, Gary Silk, Dr Caroline Heaney, Roni Lennon Bsc, Ashley Jones MSc, Rodger Wylde BSc, Richard Moss MSc, Markus Waldén, Clare Ardern, Damian Hughes.
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football medicine & performance
feature
CARDIAC SCREENING SAVES FOOTBALLERS’ LIVES – FEATURE/ DAVID OXBOROUGH, READER IN CARDIOVASCULAR PHYSIOLOGY, LJMU Sudden cardiac death in young football players is a worrying phenomenon, and, according to our latest study, it is also more common than previously thought.
other sporting organisations have now increased screening frequency so that players are tested between the ages of 14 and 25.
For our study, published in the New England Journal of Medicine, we evaluated more than 11,000 football players, aged 1517, over a 20-year period. The data revealed a prevalence of sudden cardiac death of seven in 100,000 players – higher than previous estimates of about two in every 100,000 players.
Saving more players The fact that six of the players who died had normal cardiac screening results highlights the need to develop a greater understanding of the hearts of teenage athletes and the subtle development of these heart conditions.
Sudden cardiac death is often the result of an undiagnosed inherited heart condition, but these heart conditions can usually be detected by routine cardiac screening. Screening involves a questionnaire to determine any worrying cardiac symptoms or a family history of heart disease. This is followed by an electrocardiogram (a graphical display of the electrical activity within the heart) and an echocardiogram (an ultrasound of the heart). A diagnosis can be difficult, though, as athletes tend to have bigger hearts – which may look like diseased hearts – while some heart conditions appear mild and may be difficult to detect.
So, as well as frequent screening, sport scientists, cardiac physiologists and cardiologists at Liverpool John Moores University are collaborating to understand more about the heart’s structure and the nature of inherited heart disease. This will give us greater insight into the difference between normal athletic cardiac adaptation and heart disease. By using new imaging techniques to detect subtle changes in the heart that may previously have been missed, we can make cardiac screening more sensitive and help to provide diagnosis, management and therapy to athletes with cardiac disease.
Although these initiatives may improve our ability to detect these conditions and save young footballers lives, there is still a risk of false negative results – where the tests wrongly show that the condition is absent. So it is important to encourage sporting organisations to have pitch-side defibrillators and trained staff to help resuscitate a player if they suffer a cardiac arrest from a condition that had not been previously detected during screening. This is certainly what saved Fabrice Muamba who survived after his heart stopped and he collapsed during an FA Cup match. Overall, our study highlights the importance of an increased frequency of cardiac screening, continued research on the heart’s structure and the techniques used to diagnose an inherited condition. Hopefully, this strategy will help to reduce the rates of sudden cardiac death in athletes and save young people’s lives.
Originally published on
In our study, we identified 42 players out of 11,000 who had heart conditions that could put these players at risk of sudden death. During a follow-up period, eight players died from a heart condition. Of those who died, six had had a normal cardiac screening result. The other two had been identified with a serious heart condition but continued to play against medical advice. It is important to note that some of the deaths occurred up to seven years after their cardiac screening tests. Our study highlights the importance of cardiac screening, as it did detect a number of serious conditions, but it also demonstrates the limits of one-off cardiac screening. In view of this, the English Football Association (FA) and
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