football medicine & performance The official magazine of the Football Medicine & Performance Association
Issue 25 Summer 2018
Exclusive:
How can we make it work in the elite football environment?
In this issue: 2018 FMPA Conference Review Long-Term Injury & Mental Health
Legal
Football Medical Association, 6A Cromwell Terrace, Gisburn Road, Barrowford, Lancashire, BB9 8PT T: 0333 456 7897 E: info@footballmedic.co.uk W: www.footballmedic.co.uk
Chief Executive Officer
Eamonn Salmon Eamonn@footballmedic.co.uk
Executive Administrator Lindsay Butler Lindsay@footballmedic.co.uk Project Manager
Angela Walton Angela@footballmedic.co.uk
Design
Oporto Sports - www.oportosports.com
Marketing/Advertising
Charles Whitney - 0845 004 1040
Photography
PA Images, Liverpool Football Club, Football Medical Association
Contributors
Jack D Ade, Jill Alexander, Andy Barker, Paul S Bradley, Georgie Bruinvels, Mark Evans, Andy Laws, Scott Pearce, Mayur Ranchordas, Damian Roden, Andrew Wiseman
Media Village www.media-village.co.uk
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Contents Welcome 4
Members’ News
Features 8
5th Annual FMPA Conference & Awards 2018
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Hand Injuries in Goalkeepers Sam Haines, Raj Bhatia
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Great Toe Plantar Plate Injury Mr loan Tudur Jones
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Why long-term injury to players is a mental health problem Dr Misia Gervis
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Nordic hamstring exercise - how can we make it work in the elite football environment Adam Johnson
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Musculoskeletal ultrasound: a summary of its uses, limitations and training opportunities Stuart Wildman The 5th Asian Indoor and Martial Arts Games: Ashgabat, Turkmenistan (2017). FMPA members’ experiences of working as part of the event medical team Richard Evans, Kevin Petersen, Alan Rankin
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Keeping your finger on the pulse! Jim Moxon
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Lisfrang injuries in watersports Nick Savva
CHIEF EXECUTIVE OFFICER As we start the new campaign there is real sense of irony in that we are already collating figures for the number of members who have departed from Clubs in this 2018/19 season. We gather these figures from the 1st June, and even as players and staff report back for training, we still see staff being released while the initials on their kit are still drying. While we might all suspect there will be a lull in this regard, as the training programme gets underway, and that should indeed be the case, but this is football, and you never know. You will notice that when talking about our members leaving clubs we refrain from using the word “sacked”. This is because in general the word infers that someone has done something wrong or has failed in their job and, while this might be appropriate for some industries to use this term, it rarely fits with the departure of our members from the game. As the table in our article on page 4 suggests, the vast majority of our members (60%), exit a club when a new manager is appointed, as this is a time when they are likely to bring their own personnel with them. Notably, the number of backroom staff following their managers, particularly international ones is on the rise, as illustrated by Arsenal and other leading clubs in recent weeks. While the introduction of overseas personnel can be an illuminating feature within the backroom team, we need to also recognise the disruption this can cause to the existing set up. Upheaval is never in the best interests of a Club or player and indeed players themselves value the stability of the medicine and performance teams when a new manager is appointed and there is uncertainty around the club and even their careers. Clearly there is discussion to be had surrounding this situation but ultimately it is up to the clubs to value and protect their medicine and performance teams while still allowing a manager to bring in his own personnel, who might then act as a conduit between the incumbent and the established.
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
COVER IMAGE
Liverpool’s Mohamed Salah reacts after picking up an injury during the UEFA Champions League Final at the NSK Olimpiyskiy Stadium, Kiev. Nick Potts/PA Wire/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.
Eamonn Salmon Eamonn.salmon@fmpa.co.uk
Executive Administrator Lindsay Butler Lindsay.butler@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, Liverpool Football Club, FMPA, Ashgabat 2017 / LAUREL Photo services, Paul Hazlewood
Contributors
Sam Haines, Raj Bhatia, Mr Loan Tudur Jones, Misia Gervis, Adam Johnson, Stuart Wildman, Richard Evans, Kevin Petersen, Alan Rankin, Jim Moxon, Nick Savva
Media Village www.media-village.co.uk
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BSN MEDICAL PROUDLY SPONSORS THIS YEARS FMA CONFERENCE
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feature
Photo Credit – Angelos Zymaras / LAUREL Photo services
THE 5TH ASIAN INDOOR AND MARTIAL ARTS GAMES: ASHGABAT, TURKMENISTAN (2017). FMPA MEMBERS’ EXPERIENCES OF WORKING AS PART OF THE EVENT MEDICAL TEAM. The 5th Asian and Martial Arts Games (AIMAG) were held in September 2017 - Ashgabat, Turkmenistan. The event boasted 21 different sports and 6,000 athletes from the Oceania, Asia and Middle East region. In addition, it had three FMA members present! The FMA met up with them to discuss the event. Richard Evans Private practitioner physiotherapist www.rehab-retreats.com Kevin Petersen Private practitioner massage therapist www.completewellbeing.co.uk Alan Rankin Physiotherapist -Scottish Football Association Physiotherapist - British Gymnastics
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FMA- Can you give a bit of background on yourself? RE- I graduated from the University of Huddersfield in 2008, moving straight into a private practice role on the Costa Del Sol in Spain. After 9 months there I began working in the NHS. To increase the variety of my experience I sought entry into the sports realm, alongside my NHS work, where Sean Connolly, Jon Alty, and Stu Wardle all opened their doors to me. These three provided me with fantastic
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insight and the opportunity to deepen my experience in the football world. As a keen traveller since a visit to Italy as an 11year old, I didn’t hesitate when the Right to Dream Academy offered me a role in 2010, in Ghana. After 7 and a half years in Ghana, and more experiences than I can mention here, it was time for a change. KP- Prior to my role of Soft Tissue Therapist I had a career in specialist recruitment and in 1996 I started my own firm ACR Solutions, specialising in
football medicine & performance Automotive and Motorsport placements. Over the next 10 years the company grew, working with many of the top car manufacturers and motorsport teams. Having reached a £2.5M turnover I decided to sell and follow my dream of working as a soft tissue therapist. The past 11 years I’ve established my own clinic and worked at most of the world’s leading sporting events including, London Olympics and Paralympics, Commonwealth Games, European Games and World Athletics. As part of these roles and current activities in Football I provide pitch side medical cover. AR- I graduated from Glasgow Caledonian University in 1995 and pretty much went straight into full time football at Rangers FC with fellow FMA committee member Grant Downie leading the medical team. The opportunity to go into English football was always appealing and I headed up the medical side at Port Vale FC when they were in the English Championship. I then became part of the medical team at Charlton Athletic FC when they were in the English Premiership. Heading back to Scotland, I was part of the medical team at Hamilton Academical FC for the best part of 9 years and have been part of the medical staff at the Scottish FA for the past 12 years. I was also part of the medical staff for the FA Wales A squad under the management of Mark Hughes for a couple of years. It’s safe to say my football experience has been varied over different levels!
Turkmenistan was one of my first steps in assessing what I wanted to do after my time in Ghana. KP- As a very active part of the soft tissue team at London Olympics and other events I was approached to work in Turkmenistan. The chance of working in a country not easily accessible normally was one I couldn’t miss. AR- I was lead physiotherapist at the hockey arena for the Glasgow Commonwealth Games in 2014 and then was part of the medical staff at the gymnastics and boxing arenas for the 1st European Games in Baku 2015. Most of these multi-sport events have a “neutral” event medical staff who can provide medical input for any of the athletes and field of play trauma management. I was asked to be part of the AIMAG by the organising medics and jumped at the chance to work in such an unusual country and with new sports which I had limited experience with.
FMA- What was your role at the games? KP- I treated athletes and worked with our team of local massage staff, helping them to develop new skills and provide an enhanced service to the athletes we treated. With an established polyclinic we had great facilities to see athletes from all sports and all countries. Dealing with nonEnglish speaking athletes and unfamiliar sports was a challenge but with a lot of hand gestures and patience we succeeded in delivering a successful games. FMA- How did you end up in Turkmenistan? RE- A friend of mine was part of the AIMAG organisational committee and presented my credentials to the medical team who offered me the opportunity to achieve one of my goals of working at an international, multi-sport event. It was a bonus that it was to be held in a country that had been on my long list of places to visit but is difficult to visit. The role in
ACL ruptures and meniscus tears to deal with. We also saw a fair amount of shoulder injuries including complete pectoral tears. A big part of the medical staff role was inputting the athlete medical records to the data base which allow a justification for the service at future Games. Interesting, there was about 6,000 medical staff/ athlete contacts throughout the Games. The clinic opened each day at 07.00 and closed at 23.00 and any athlete could come and access the service and my primary role was to assess and treat any injuries. Due to the full range of services, I had instant access to excellent massage therapists, osteopaths/ chiropractors, sports medicine doctors and pharmacists to input with myself for athlete care. This allowed a complete care package for each athlete and can be followed up each day for the individual as their injury requires. In addition, the polyclinic had an onsite radiology department which I could access for instant imaging and results. I will never forget the night where we must have seen six ACL tears within the space of twenty minutes as athletes were transferred from the sport venues into the polyclinic for assessment. That night quickly turned from a steady physiotherapy clinic into what resembled an inner-city A/E Department on a Saturday night! I then spent the final part of the games working along side Richard at the futsal arena. By the later stage of the Games, Richard already had the venue medical input running like clockwork. It made sense from the medical organisers to base Richard and myself at the futsal arena as we had experience of football medical provision.
AR- I was primarily working at the polyclinic which is usually based within the Athletes’ Village at these events and becomes the nerve centre of the event medical service. In Turkmenistan, my role was to be part of the fully functioning physiotherapy department treating a whole range of injuries. When you are dealing with sports such as wrestling and Muay Thai, there are a great number of
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feature
Photo Credit – Lazaros Koukorikos / LAUREL Photo services
RE- The organisational and medical committee of the games did an incredible job in providing top quality facilities for the games, and central to this was the polyclinic. This was a complete multidiscipline team (MDT) from sports medicine physicians and pharmacists to radiologists and physiotherapists who are mostly UK based. I did a couple of shifts within the clinic and was then the continual presence at the futsal arena for the 10-day duration of the male and female futsal events. A big part of that role was assisting in player preparation pre-match and assessing injuries postmatch with a view to the player’s future management. If any player required additional support in terms of radiology or access to doctors, I would organise this with the player and team official and refer them into the polyclinic for followup. Most of injuries we saw at the futsal were ankle, knee and lower limb muscle problems. In addition, there was a good amount of toe injuries due to playing on the hard floor. Alan and myself were there to support the medical staff of the teams and pass on knowledge to the local medics who were led by the extremely competent Begench Gadamov, the Venue Medical Manager, in terms of field of play evacuation during matches.
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FMA- How was the experience of working with athletes from more far-flung countries than you were used to? RE- I am accustomed to working with a diverse patient base but requiring a translation chain of 4 people to conduct an assessment was a new and novel challenge. Being involved in an event such as this was amazing and the diversity of people I encountered was a highlight. It emphasised just how similar we are on a human level, regardless of whether we are from a huge country such as China or a small Island in the Pacific. Honourable mentions need to go to the Iranian, Iraqi and Afghan teams who were some of the most educated, fun and friendly people I’ve met. The mainstream media never present these demographics in this way. KP- As I’ve said previously, language, culture and varied sports was not a barrier in anyway. I really enjoyed getting to know the local therapists and although they seemed cautious of us at first, we all parted with gifts and as great friends. It helped that the facilities were excellent, and the polyclinic was staffed with a comprehensive medical team.
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AR- The AIMAG was made up of about 6,000 athletes from Oceania, Asia and the Middle East. I found the diversity in cultures and sports fascinating to work with. Richard is right, having a few interpreters to get through can be tricky but it also adds to the fun!! It was a humbling experience working with athletes from the likes of Iraq, Afghanistan and Syria who were producing amazing performances with limited resources. I also agree that the athletes from Afghanistan were special people. They have a hard struggle just to get through each day at home and yet they were always pleasant and warm to the medical staff and had an infectious personality which was hard not to have a soft spot for!
football medicine & performance
Photo Credit – Alexandros Avramidis / LAUREL Photo services
FMA- What was the best part of the event? RE- Aside from being part of such a competent, supportive and collaborative team of practitioners (and Alan!), the highlight was the semi-final game between Afghanistan and Turkmenistan. The meeting of the two local neighbours in a high scoring game that showcased the best elements of the game of futsal and eventually went to penalties. The noise generated by the crowd was unreal. KP- Well it has to be about the team and the great friendships created. Outside of that experiencing a completely different culture never disappoints. I hope to do many more events, with World Indoor athletics March 2018 my next. AR- Best part for me was that sense of team spirit amongst the medical staff. You are thrown together and must live and work with each other in a foreign country. Coincidently, Richard, Kevin and myself were all staying in the same flat within the Athlete’s Village! You can’t have an ego and you need to be a team player with the athlete’s best interest central to your mind. Also, these events are great for networking and making new contacts to
keep in touch with from different sports which you can then bounce ideas off about your own athlete care. When you experience life in an Athletes’ Village it’s something you never forget, there is an addictive sense of wellbeing in the place. As Richard pointed out, the atmosphere generated by the locals in the futsal arena will always live with me as well.
FMA- Would you advise others to work at these events to give a broad base of experience with other sports outside football? RE-As a profession, we are incredibly lucky as our skills can allow us to travel and experience many different countries and their cultures. Events such as these bring you into contact with a huge range of athletes and professionals and there is something to be learnt from every one of them. I personally think it is important that we take chances to push out of our comfort zones and to explore the world. One opportunity that came from AIMAG was the chance to spend some time at the Cuban Sports Medicine Institute in Havana. KP- Definitely, in my pitch side role I’ve chatted with many others about experience
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and I was amazed at the lack of experience in other sport people have. I also think working as a disciplinary team as we do gives you a greater appreciation for others roles. AR- 100% agree with that question. I totally understand that working full-time in football is all consuming and takes over your whole life, but I think working in a broader range of sports is healthy and constantly challenges you as a practitioner. I was part of the event medical staff at the World Athletics Championships in London 2017 and for those FMA members working full-time in football, an event like this would have been perfect as it was UK based and you could commit to a few days work spread out of the duration of the event. For the FMA members working part-time in football I would strongly recommend getting involved in these multisport events. These events also offer elite sport work not only for physiotherapists and doctors but also massage therapists, dentists, podiatrists, pharmacists and osteopaths/ chiropractors. I would be pleased to be contacted through the FMA office for information about getting involved in these multi-sport events.
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BSN MEDICAL PROUDLY SPONSORS THIS YEARS FMA CONFERENCE
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THERAPIES. HAND IN HAND. www.bsnmedical.co.uk
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