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.
Media Village www.media-village.co.uk
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LIGHTFORCE® Wolverhampton Wanderers achieved promotion to the Premier League with one of the lowest injury rates in the Championship last season. fcbusiness speaks to 1st team physiotherapist Oliver Leaper, about his use of laser treatment within the medical department. How long have you been using your LightForce therapy laser and what ailments is it used to treat? We introduced the system to our medical department in November 2017 and all of our therapists were trained in its use when we purchased it. It’s primarily used to treat acute and chronic musculoskeletal problems but we also use it for pre-training and on the rehabilitation of players that we have in the department. Due to it being a Class 4 therapy laser, it’s very good for a range of deeper musculoskeletal problems or injuries because the infrared light can penetrate more deep tissue structures. We deal a lot with sub-acute muscle injuries, so in the initial acute stage, we use it to speed up the recovery of those problems. We found it very useful for managing tendinopathies - so the patella, achilles and perennial tendinopathies respond well to treatment with the system. Tendinopathy is a degenerative condition of the tendons – as a result of that it can become a more chronic problem and takes time to heal but we found using the LightForce system it reduces the stiffness and discomfort that the players would experience with these problems. Is that a common problem among footballers? Yes, especially at the start of the season and usually follows a change in training load. For instance players come back into pre-season after having a period off or they go from a hard pitch to a soft pitch – the change in load can create problems with tendons. We found those pathologies responded quite well to the LightForce treatment. What is your opinion of the LightForce system and the general opinion of those that use it? Within our department all of our therapists are trained to use the system and we’ve found that it’s been positively received. I find that it’s something that, depending upon the pathology, you use it in different ways. Even post-op it can be used to help with the recovery of scar tissue.
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Are there any specific cases where you’ve used the treatment? We had a had a player who came to us during the transfer window last season who’d had a chronic problem with his foot and ankle for quite a while which he unfortunately injured further and required surgical intervention. Post-surgery other treatment options were limited but we were able to start fairly early with a low intensity laser treatment programme once the initial operating wound had healed.
How do you identify and monitor the damage of injuries and the progress being made during treatment? Primarily following injury or upon a complaint of an injury to our department, they would be assessed by a physiotherapist initially through a standard musculoskeletal assessment. But we’re very lucky to also have a very experienced doctor who is experienced in ultrasonography – so using an ultrasound machine and he can perform a scan in the treatment room which can give us more information and detail about a problem area and subsequently there could also be an MRI scan depending on whether the doctor requests it.
We were then able to adjust the power and the associated treatment during the rehabilitation process to assist with the healing of that area. We continued to use it once he was fit to help his body fully heal the area in which he’d had the injury and operation. He’s a player that comes to the treatment room and requests the LightForce treatment which is a good sign that the player is feeling it’s having a positive effect on them.
Are you planning to use the LightForce system in the new season ahead? Yes. It’s a very good system and its able to be used by a range of our therapists within the department as well as being very portable. As it has a battery pack, when we travel to away fixtures or to training camps it’s easy to take with us and means we can continue any treatment wherever we are - we’re not confined to the training ground. So it will travel with us to every game this season.
info@fmpa.co.uk
football medicine & performance
Medics are using laser therapy more often than ever before to help reduce pain and inflammation related to many common conditions. Thousands of medics and patients have experienced the benefits of laser therapy and are familiar with its therapeutic effects, but for those who aren’t, there are 5 key things to know. 1. It reduces pain and inflammation without side effects Laser therapy uses a process called photobiomodulation. Photons enter the tissue and interact with the cytochrome c complex within mitochondria. This interaction triggers a biological cascade of events that leads to an increase in cellular metabolism and a decrease in both pain and inflammation. Unlike medications, laser therapy reduces pain without undesirable side effects. It is also important to point out that patients report long-lasting pain relief. While the number of treatments required may vary depending on the acuity of the condition, many patients experience lasting relief after only a couple treatments. 2. Can be used for acute and chronic conditions When treating acute conditions with laser therapy, it is particularly effective when it is administered as soon as possible following injury (assuming there is no active hemorrhaging). The faster the inflammation is reduced and the healing process can begin, the better. In the case of acute injury, laser therapy helps restore the body to normal function quicker. With chronic conditions, laser therapy is used most often to help
combat persistent pain and inflammation. 3. Treatments can be customised for each situation Lasers that have larger power ranges offer versatile treatment options. A laser that can be set to operate from 0.5w all the way up to 25w allows the clinician flexibility to treat ‘low and slow’ or at maximum output. The availability of multiple treatment heads offers additional flexibility for the clinician. The LightForce Empower™ Delivery System, for example, features 5 different treatment heads, each designed to facilitate optimal delivery in different scenarios. It is important to have several delivery options to ensure the delivery method is appropriately matched to the situation. For instance, when treating over bony prominences, an off-contact treatment method is advisable. However, when treating deep-tissue structures, such as a hamstring muscle, an on-contact ‘massage ball’ attachment is best to reduce reflection and scattering, and also encourage deeper penetration by displacing excess fluids.
Depending on the laser, it can create little to no sensation or it can create a gentle, soothing warmth. Many patients receiving laser therapy treatments report enjoying the experience, especially when a massage-ball treatment head is used to deliver what is often referred to as a “laser massage.” Patients receiving treatments with higher-power lasers also frequently report a rapid decrease in pain. For someone suffering from chronic pain, this effect can be particularly pronounced. 5. Treatments Are Fast
With LightForce Class 4 lasers, treatments are quick, usually 5-10 minutes depending on the size, depth, and acuteness of the condition being treated. High-power lasers are able to deliver a lot of energy in a small amount of time, so therapeutic dosages are achieved quickly. For people with packed schedules, patients and clinicians alike, fast and effective treatments are a must. www.lightforcelasers.com
4. Treatments Feel Good
One common question related to laser therapy is, “What does it feel like?”
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football medicine & performance
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