Football Medic & Scientist Issue 4

FOOTBALL MEDIC & SCIENTIST

The official magazine of the League Medical Association

WHAT DO PLAYERS REALLY THINK OF US?

We ask Ugo Ehiogu

LIFE AFTER FOOTBALL Setting up a private practice

CHIROPODY IN FOOTBALL: A FOOT IN THE DOOR With Dave Tinker Issue 4: Spring 2013

Russell James Walker Lawyers Advert

Contents Welcome 4 A message from our CEO / Members News

Editorials 5 Touchline Rants/ Diary Dates 6 What do players really think of us?

We ask Ugo Ehiogu 8 From pain to performance Physio UK 10 Management of player training load EPPP 15 A pain in the groin Simon Marsh 16 Life after Football Eamonn Salmon 19 Importance of a Good Website Sean Redfern

EDITOR’S LETTER/JANINE NELSON

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t’s April already and the finishing line is in sight. I hope it’s been a good season for you all.

It has been great catching up with friends old and new this issue. Our members get up to some pretty exciting stuff!

I had an interesting trip to Burnley FC this month, joining chiropodist Dave Tinker at his weekly afternoon ‘surgery’ at the club. Dave and the rest of the medical team – as well as the players – made me most welcome (even toning down the usual bad language!) and it was a fascinating insight into the day-to-day running of a club and the interaction between the players and the medical staff. It’s a far cry from the calm of general practice but I’m guessing you wouldn’t have it any other way?!

The Burnley players were very vocal – and positive – about the importance of the medical staff, sentiments which were also endorsed by former England international Ugo Ehiogu in our exclusive interview with him. Ugo has a wealth of experience in the game. Find out what he had to say on page six.

As the season draws to a close, it’s inevitably a time to reflect on your career in football.

Whilst the rewards can be great, it’s also a very demanding job, requiring a lot of weekend and evening work, so perhaps you’re thinking of making a move into private practice? If that’s the case, then our ‘Life After Football’ feature has all the information you need. And don’t forget that, even if you do move into private practice, LMedA will still be there to support you.

Wishing you a wonderful end to the season,

Features

Janine Nelson

20 Where are they now?...

Derek French 21 Chiropody in Football: A Foot in the door Dave Tinker 22 Bringing Partners On-Board 25 On the Couch with...

Richard Evans 27 Transporting Players Paul Reddy

Courses 29 Physio UK 30 HE Seminars 31 Welbeing League Medical Association. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, or stored in a retreval 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 LMedA.

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Football Medic & Scientist Gisburn Road, Barrowford, Lancashire BB9 8PT Telephone 01282 614505 Email info@lmeda.co.uk Web www.lmeda.co.uk Editor Janine Nelson Chief Executive Officer Eamonn Salmon Senior Administrator Lindsay McGlynn Administrator Nichola Holly IT Francis Joseph Design Soar Media - www.soarmedia.co.uk Marketing/Advertising Charles Whitney - 01582 659555 Published by Buxton Press Limited Photography LMedA, PA Photos (Cover, page 6&7)

FOOTBALL MEDIC & SCIENTIST | 3

A MESSAGE FROM THE OFFICE WELCOME/EAMONN SALMON In the ever-evolving world that is LMedA, you will notice a distinct change to this edition of Football Medic & Scientist as we bring on board a new publishing company to oversee the magazine development.

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his change gives further momentum to the whole concept of our industry magazine and “Football Medic & Scientist” is now very much the “face” of LMedA to members, football administrators and the general public.

To compliment this development we are also making sweeping changes to our website. This will see improvements across the board but particularly to the job section which will effectively become “LMedA Recruitment” with a much more dynamic approach to this facility.

Other enhanced features will also be evident and the consultant finder section will become active as a “Professional Sports

MEMBERS NEWS

Medicine Register”. This will be of great value to those of you who currently run or intend to run a private practice and clinicians using this facility to promote their practice must have worked in professional sport or with national and international individuals or teams. It is not open to the wider medical community thereby setting members listed apart and giving them the high profile necessary to promote their practice.

As you will see – LMedA is certainly not standing still!

Eamonn Salmon CEO League Medical Association

ENGLAND TEAM SCOOP BRONZE IN JAPAN

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MedA member Dr Joyce Watson has recently returned from Japan with the England partially-sighted futsal team.

Dr Watson, who is also the team doctor for Accrington Stanley FC, applauded the team on scooping the bronze medal in the World Championships.

She said: “As a disability team they have exceptional fitness and have a very professional attitude to the game of futsal.”

OBE FOR LMEDA’S GRANT DOWNIE

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MedA’s Grant Downie has been recognised in the Queen’s New Year’s Honours list.

His Order of the British Empire has been awarded for his services to physiotherapy in sport and to young people.

Grant is Manchester City Academy’s head of sports medicine and has a quarter of a century of experience working in professional football.

“It’s very touching, very humbling – it’s one of those things you just don’t believe and takes time to process,” he said. “I knew nothing about it until I got an official letter through the post from the cabinet explaining that I was to be recognised on the Honours list with The Most Excellent Order of the British Empire.

“I was reading it, thinking, ‘is this real?’”

Grant moved to Man City after an eight-year spell at Middlesbrough, and eight years as head physiotherapist at Rangers.

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Touchline ! s Ratnct e t e P e d i s h

by Pi

HEADSETS AND MICROPHONES

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t seems as though nearly every medical team these days has an on the pitch walkie-talkie system. I guess that the Gaffer needing a blow-by-blow account of the injury diagnosis and whether they can stay on the pitch has brought this development.

What was wrong with the thumbs up/ down or the universally understood rolling action of the forearms to indicate ‘get the sub on quick’?

The crossed arms above the head for a stretcher seems a clear and simple instruction, which has been well-accepted across the board.

Some medical staff like to think of themselves as rock stars with the ‘Madonna’ style microphone across the cheek, which

says ‘look at me – I’m uber-cool’.

Or maybe the more subtle D-shaped earpiece with a clip on microphone which is always tricky to ‘click-to-speak’ when it’s freezing, you can’t feel your fingertips and you have to remember which layer of clothing you clipped it on to!

Don’t get me started on the ‘nightclub bouncer’ style earpieces… far too much ear wax!

A colleague once asked why I didn’t use one of the microphones which switched on when I started talking to the injured player…I certainly don’t want the car park attendant to overhear what I say to players – it’s often not fit for repeating in polite company and contains far too many ‘F’s’!

DIARY DATES DATE

EVENT

20th-22nd April 2013

Football Medicine Strategies for Muscle & Tendon Injuries

22nd April 2013

Science in Football Summit

18th May 2013

Pain to performance - Sport and Exercise symposium

21st–22nd May 2013

Functional Movement Based Assessment

22nd–23rd May 2013

Knee & Shoulder Controversies

31st May 2013

Medico-legal Course for Physiotherapists in Elite Sport

10th–11th June 2013

Sports Foot & Ankle Surgery 2013

London www.footballmedicinestrategies.com

Wembley Stadium www.footballmedicinestrategies.com

London Heathrow Marriot www.sports-rehab-and-education.co.uk

Kilmarnock FC Rugby Park www.lmeda.co.uk/Conference

Sixways Stadium, Worcester www.midlandskneeandshoulder.org

Old Trafford, Manchester www.lmeda.co.uk

Scarman House, University of Warwick www.sportsfootandanklesurgery.org

Advertise your conference or event here. Contact info@LMedA.co.uk for more information

FOOTBALL MEDIC & SCIENTIST | 5

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WHAT DO PLAYERS REALLY THINK OF US?

WE ASK UGO EHIOGU...

COVER STORY/UGO EHIOGU As a player, Ugo Ehiogu wore his heart on his sleeve and endeared himself to the supporters of each of his clubs, as a brave and talented central defender. Today, the former England international begins his fledgling coaching career, working with the under 16s of Tottenham Hotspur, alongside his other business interests.

In this interview with Ugo, the inaugural feature in a series with non-medical staff and explayers, we discover his views on the medical side of the game…

Ugo, during your playing days, how did you view the medical staff you worked with?

I think my opinion evolved with age. In the early days, I simply followed what I was told to do without thinking about the consequences to me or my future health. In my latter years as a player, I spent more time thinking about how I trained and I knew what my body could take and what I felt was too much. I think the relationship between the player and the medical staff is crucial and an understanding is critical to any success they are going to experience.

Since retiring, has your view changed at all? If so, why?

I’d say no, it probably hasn’t changed at all, but I strongly believe that players should take more interest in their bodies and their anatomy.

A player’s career is short compared to other professions and therefore taking more interest and care over their bodies and their health in general should be very high on their priority list.

I mention this to the young players I work with and hope that they will remember the advice in years to come.

Do you believe that medical staff are seen as part of a club’s management staff, or are they treated as a separate entity?

I think that in the past, the medical staff, and I’m talking many years ago here, were treated as a separate department with little interaction. Recently though, and this is encouraging, I have noticed that they have been treated as part of the management set-up, with regular contact between them, the coaches and managers. If you look at the top level of the game especially, the value of just one player can be astronomical, so the medical staff’s role in preserving them is crucial, and I guess even at the lower levels, it is proportionally just as important.

Often medical staff are responsible for liaising between players and managers, sometimes

dishing out fines for lateness at the training ground, for example. Did you ever experience or witness any friction in these roles?

No, not at all. I would say, and this is speaking from my own experience at the clubs I played for, the medical staff have always had the power to dispense fines, and that is just part of the culture of the game.

Do you feel there is any complacency from players relating to medical staff? If so, why do you feel this is?

I think that at times it has perhaps existed, probably because the medical staff were not considered as ‘football people’, more like a form of doctor. I think that as the game has modernised and the number of medical staff has increased at each club, due to improvements to the knowledge and research in this area of the game, the complacency has disappeared and there is a more combined team ethic.

Any funny medical-related stories that you remember from your career?

I recall hearing from a player, and this was true, that after he had gone in for surgery on a knee injury, it wasn’t until a day later that everyone realised it was the wrong knee that had been operated on! Nothing like that ever happened to me and I’m sure it was just an isolated incident, well at least I would hope so anyway.

Finally Ugo, what are you up to these days?

I currently assist with the under 16s at Tottenham Hotspur, as well as mentoring current players with my agent, having a part ownership in a record label, and being involved in a bespoke bridging company. I became a patron of Happy Soul Festival, a charity and have done various media work, including a weekly radio show, Colourful Radio and general TV work, from Sky Sports analysis, commentating, fun shows and Channel 5 news sport.

What improvements would you like to see made to the medical side of the game?

In my opinion, the most important factor, and this is quite a general point, is for the medical staff to be given complete control to administer treatment, fines and everything else needed, for the speedy recovery of the player. From what I have seen, most forward thinking clubs already have this in place, but every club should work in this manner to reap the results they want.

Ugo Ehiogu Factfile

Ugo, are there any members of medical staff you would like to mention or praise from your time as a player? Anyone who helped you that you’d like to praise?

Yes, without doubt Jim Walker from my days at Aston Villa and especially Grant Downie.

Grant was a good, positive influence during my time at Middlesbrough, when unfortunately I encountered some serious injuries. Both were fair with me and supportive and were examples of good medical staff.

Did you know?

Ugo scored an overhead-kick goal for Glasgow Rangers, in a 1-0 Old Firm Derby win over Celtic, in 2007.

Clubs played for: West Bromwich Albion, Aston Villa, Middlesbrough, Leeds United (loan), Glasgow Rangers, Sheffield United, Wembley FC.

And finally…

Ugo came out of retirement to play for Wembley FC in the FA Cup in August 2012, alongside the likes of Brian McBride, Ray Parlour, Martin Keown, Claudio Caniggia and Graeme Le Saux.

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“The power to transform is at your fingertips”

FROM PAIN TO PERFORMANCE EDITORIAL/PHYSIO UK Previous articles in LMedA have focussed on the story of individuals within their team whilst others have discussed clinical issues relevant to the day to day management of players.

The following blends these by presenting a personal story from a health professional on Be Activated techniques which are taught by Doug Heel. Doug, a South African physio has worked with a multitude of sporting teams and professionals including LA Galaxy, Jack Nicholas and Wladimir Klitschko.

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is Be Activated techniques use simple physical tests and treatments to produce instant changes in range, pain, strength and performance. Interests in his methods have led to an invite to speak at the FA conference in June 2013 at St Georges Park.

There are numerous videos demonstrating the changes possible with these techniques which you can access at the end of this article. Research is limited, but the questions raised by the instant and profound changes possible with these methods should promote

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a healthy discussion.

The following is a story written by Simon Anderson, a previous course participant who has completed both Level 1 and 2 and now uses the techniques in his work. The goal is to provide a simple explanation of what the Be Activated method is, to begin to demonstrate the instant changes possible and then, through the videos show live examples of it in action from which you might ask, would that be helpful in your daily practice?

The power to transform is at your fingertips We are living in the technological age. An age which grants us immense power to learn, develop and communicate – all at the touch of a button. We have keypads to activate our phones, car alarms, and computers… but what about the human body? We’re often told that we only access 10% of our mind’s capacity. Could the same be true of our own bodies?

Is it possible that by the flick of a switch we could access far more power, strength, mobility, agility and performance from our

Simon Anderson at Active Transform Perform own bodies?

As a health practitioner and keen athlete it came as a shock when it had reached the stage when back pain and tight hamstrings prevented me from running at all. Despite employing all my knowledge as a health and movement practitioner and the additional support of a multitude of physiotherapy and bodywork therapies, it left me no better off.

Eventually, in my search for answers, I came across an online video which absolutely astounded me. It was demonstrating the power of the Be Activated techniques and showed Doug Heel assessing a woman`s hamstring flexibility which was pretty poor, around 45 degrees. He then proceeded to place his hand over her abdomen and then lifted her leg again, only this time it continued to move beyond 90 degrees!

I was amazed as to how such dramatic and instant changes could be possible.

From as far back as 1600 B.C. the Chinese have been aware of the human body having powerful energy nodes that we know today as acupuncture points. These are linked by meridians which essentially function to transport energy or chi around the body.

Much like today`s modern technology, they understood the body`s software and how energy could be directed to areas needing support.

Now imagine your body as one giant electrical circuit, connecting all your muscles and their related organs. If this circuit were to be overloaded or pushed to a limit, it would blow a fuse. In effect, the body shuts down the neural drive to the muscles in the same way a fuse cuts the electric power to protect itself from further damage.

It can be hypothesised that an injury sets

up a compensatory pattern in the body, which essentially means the body must modify movement, while ‘defending’ the injury. This is nature`s way of protecting us, the issue is, the shift from protection mode back to performance mode does not always occur and residual dysfunction can continue.

This lack of optimal return to function might begin to explain reoccurring or recalcitrant injuries which appear confusing using traditional rehab models.

What if, like our home computer, we had an option to reset the software back to factory settings?

Let us continue with the example of the hamstring and ask, why is it that so many footballers have tight hamstrings and how can this change very quickly?

The Be Activated model of thinking gives you an alternate view and explains why the hamstring is short and tight? If the idea that muscle is being asked to do a job it was never designed for? In other words, it is compensating for a short circuit elsewhere in the body. Is it possible, that like an electrical circuit, by finding the fuse box and flicking the right switch; we could reconnect and reactivate the foundation muscles?

Let us try an experiment to get a feel for what can happen when we ‘reactivate’ the body.

Stand up and sit down several times and note how it feels. If in a pair, you could also perform a lying hamstring flexibility test.

Next, using the index and middle finger of both hands, rub about 2cm either side of the navel for 20 seconds and then the back of your neck at the base of the skull for 10 seconds.

Now repeat the sit to stand movement and notice how it feels.

You may notice that your body shoots up the second time. The theory underpinning the Be Activated techniques is, because you have released a defensive pattern, it now allows the body to connect and sequence better, hence giving more power. The points that you have just rubbed correlate with releasing the psoas at the navel and the glut and hamstring complex at the neck. With each muscle now free to engage, a more optimal pattern is seen and subjectively the movement is noticeably different.

The suggestion is that injury and pain represents the body’s best effort to function with what it has. When we further understand the mechanism that drives the breakdown in the body, you can rapidly move beyond the presenting injury and facilitate the body to achieve its full potential.

The applications of the Be Activated system can range from improved athletic performance and greater gains in training to releasing stress and tension. The result is immediate improvements in strength, power, flexibility, mobility and endurance and in this lays one of its major strengths.

The method is easy to apply and can be used before, during and after training to enhance performance gains and reduce the risk of injury.

Simon Anderson (www.activatetransformperform.com) is a Movement and Performance Kinesologist and founder of Activate Transform Perform

Doug Heel Physio UK If you want to see the video that first amazed and inspired me to apply Doug Heel’s Be Activated system, plus 5 more FREE videos from Douglas Heel, visit www.physiouk.co.uk/transform.

FOOTBALL MEDIC & SCIENTIST | 9

MANAGEMENT OF PLAYER TRAINING LOAD: INCREASED SIGNIFICANCE IN ACADEMY FOOTBALL SINCE THE INTRODUCTION OF THE ELITE PLAYER PERFORMANCE PLAN EDITORIAL/CARL WELLS The multi-disciplinary ethos of the Elite Player Performance Plan (EPPP) has had a huge influence on how professional football academies operate since its official implementation at the beginning of the 2012 season.

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uch a comprehensive review of player development has impacted not only on the technical and tactical coaching of players but also their physical development from the ages of eight to twenty one.

Consequently, a major challenge has been to ensure that players within the ProDevelopment Phase (PDP) receive sufficient physical conditioning while also complying with the stipulated 12 to 14 hours of technical / tactical coaching per week as outlined by the EPPP. For Sheffield Wednesday Academy Sport Science and Medicine Department to successfully meet this challenge, it is imperative that the training load placed upon players is closely monitored to allow optimum

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physical development while preventing the manifestation of chronic fatigue due to the increased training hours. Consequently, we have implemented strategies for monitoring a variety of training stresses to achieve a holistic measure of player loading. The design of periodised multi-disciplinary training programmes are also fundamental to this process, as they enable efficient use of training time so that a player’s physical conditioning can be performed in synergy with their technical and tactical coaching. Here is an overview of these strategies and how they have helped to keep players within our PDP phase progressively improving their physicality while also performing this high number of coaching hours.

v two game might require players to exercise for a sustained period above 85% of their MHR, however it does not involve a large number of high-speed runs due to the size of the playing area and nature of play. At Sheffield Wednesday Academy, we have utilised GPS technology to determine the typical running speeds, distances and muscular loading that various game formats place upon players. This allows us to design training programmes that provide appropriate levels of external physical loading relevant to playing position and the team’s style of play.

TRAINING LOAD ASSESSMENT Internal Load: Heart Rate Analysis Utilising live analysis of heart rate responses to training, the internal or cardiovascular load placed upon our PDP players is recorded for every training session. Each player has a target number of minutes they must spend above 85% of their maximum heart rate (MHR) per training week and training phase specific to their playing position and individual cardiovascular responses. Such an approach allows the internal loading that has been placed on players to be calculated for the session, day, week and training phase.

External Load In conjunction with the analysis of the internal stress placed upon players, the external loading must also be determined. This relates specifically to the amount, speed and type of physical movements a player performs during training. For example, a conditioned two

Psycho-physiological Load Although data from heart rate and GPS technology is a great tool to objectively assess a player’s training load, we have also found that recording more subjective measures such as “rating of perceived exertion” (RPE) and “Readiness to Train” provide a valuable insight into how hard each player has perceived training to have been. It provides a global measure of loading and has in specific cases highlighted players who have started to find the training load too high even though the objective data did not indicate any physical concerns.

responses for a training week but needs to achieve more distance at a high-intensity.

Subsequently, the type of game format employed in training during subsequent training days can be adjusted accordingly to provide the desired external load.

Multi-disciplinary Programme Design As eluded to in the above text, the efficient management of training time is necessary for a player to receive appropriate levels of physical and technical / tactical development.

We therefore decided that all metabolic conditioning work (i.e. aerobic and anaerobic energy system development) should take place within the player’s technical and tactical coaching. Although this is not a new concept per se, by utilising previously collected heart rate and GPS data, we were able to design a periodised small-sided games programme that provided a non-linear progression in training load through the manipulation of both game type and playing conditions. The intensity of training weeks would be determined by how much time was spent playing the various game formats. Heavy weeks where high external and internal loads were required

Total Player Loading Ultimately, we have found that the combination of internal, external and psychophysiological indicators of physical stress to provide the clearest and most robust measure of training load. It allows us as a sport science and medicine department to precisely determine which aspect of loading needs targeting to ensure a player stays in optimal physical condition. For instance, a PDP player might have achieved sufficient cardiovascular

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would contain more playing time in 2 v 2s and 4 v 4s formats. Alternatively, lighter training weeks to allow recovery and adaptation would involve more time spent playing 8 v8 s and 11 v 11s. Furthermore, such a structured approach allowed the conditioning of the player’s metabolic systems to be closely aligned with the academies technical / tactical curriculum.

PSYCHOPHYSIOLOGICAL LOADING EXTERNAL PHYSICAL LOADING

TOTAL PLAYER LOAD

INTERNAL PHYSICAL LOADING

PERIODISED MULTI-DISCIPLINARY TRAINING PROGRAMMES Diagrammatical representation of the various physical and psychological stresses that should be considered when assessing total player loading.

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Summary The specified coaching hours outlined by the EPPP has led to an increase in training volume for many PDP players in the English academy system. Although the rational for raising coaching hours is to develop more technically and tactically elite players, the impact of changes to training volume must be closely monitored to prevent any detrimental effects on a player’s physical progression.

This has further emphasised the importance of monitoring the training load placed upon players in academy football, where ideally, a holistic measure combining internal, external and psycho-physiological load of training is recorded. However, where finances are limited, the inexpensive reporting of RPE after training will still provide a valuable insight into the load being placed upon players. Furthermore, if this is used in combination with appropriately designed multi-disciplinary training plans, sport scientists will have a good understanding of whether players are being exposed to appropriate levels of training load to enable physical and tactical / technical development.

A PAIN IN THE GROIN EDITORIAL/Simon Marsh - Surgical Director at The Gilmore Groin and Hernia Clinic The syndrome of Gilmore’s Groin (or groin disruption) was first described in 1980, by the London Surgeon Jerry Gilmore, following the successful treatment of 3, what were then, first division footballers with apparently career ending groin injuries. All three were able to return to top flight soccer after surgical repair of the groin.

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ince 1980 over 8,000 cases have been seen and over 4,500 operations performed. The operation is successful in 94% of professional soccer players and 86 English league clubs have referred players, whilst many have come from other parts of the UK and abroad. Over 2,000 professional sportsmen have undergone surgery with more than 400 internationals from 35 countries.

As sports medicine has developed we have continually looked for ways to improve the diagnosis and treatment of groin problems.

The Gilmore Groin and Hernia Clinic has led to the establishment of The London Sports Injury Clinic, also based at 108 Harley Street, London. We have established a multidisciplinary team that includes groin surgeons, sports and exercise consultants, orthopaedic surgeons, physiotherapists, musculoskeletal radiologists and pain specialists as well as specialist nurses.

In the second half of 2010, as Jerry Gilmore approached retirement, and I became the new director of The Gilmore Groin and Hernia Clinic, I decided to see if the classical repair could be improved. With this aim in mind we contacted experts from around the world, including Europe, Australia and the USA to discuss the technique of surgical repair.

Several international surgeons came to visit us at our clinic. From the discussions we had I introduced some new aspects to the original repair, so that the technique is now termed the “Marsh Modification of the Gilmore Technique”. Before we go into the

modifications it is worth going through the symptoms of Gilmore’s Groin and outlining the classical repair.

Sufferers get a fairly characteristic set of symptoms including pain with running, twisting, turning and kicking. After playing sport they are stiff and sore and this is often much worse the next day. Rising from a low position and coughing and sneezing make the pain worse. Only a third of patients can remember a specific injury, usually involving overstretching.

To understand Gilmore’s Groin it is helpful to understand the anatomy of the groin.

The muscles of the wall of the abdomen may be pictured in three layers. The outer layer (the external oblique) runs at about 45 degrees downwards and inwards. The middle layer (the internal oblique) runs at 45 degrees upwards and inwards. The inner layer (the transversus abdominus) runs straight across. Towards the middle all these muscle fuse together into a common tendon (the conjoined tendon) and are fixed to the pelvis in the middle (the pubic tubercle).

Although it is often also called a sportsman’s hernia there is no hernia present. In a hernia there is a hole in the muscle wall that allows the abdominal contents (bowel, or fat) to poke through. Gilmore’s groin is a complex musculoskeletal disruption.

In men the external oblique has an archway in it through which the blood vessels and nerves go down into the testicle, along with the vas deferens. When the groin is torn this archway opens up and becomes much

wider. There are also tears in the muscle around the archway. The internal oblique is pulled up and away from the pelvis, allowing the unsupported transversus abdominus to become loose and floppy.

The surgical technique involves exploring the muscles of the groin, identifying the muscle tears and stitching the muscles back into their normal positions. In the classical repair the muscles were repaired with dissolvable sutures with a single supporting layer of a thick nylon, permanent, stitch.

A structured rehabilitation programme is a fundamental part of the treatment and a multidisciplinary approach increases the chance of a full recovery. The method developed by Jerry Gilmore has stood the test of time as the definitive method of surgical repair for the condition that carries his name.

Whilst the fundamental principles remain, two distinct modifications are now incorporated. Firstly the stitch used for the reinforcing darn is now much thinner and less reactive. The importance of the original nylon darn in the standard repair is well recognised in that it provides immediate strength that persists as the non-permanent sutures dissolve at around 2 weeks. Without this layer there is the risk that the repair breaks down around this time. By replacing the nylon suture with a thinner, but still permanent, “prolene” darn the aim is the produce less tissue reaction, and therefore less discomfort, allowing more rapid rehabilitation.

A further, important, modification had been inguinal ligament “tenolysis”. In many suffers there is an element of pubic bone stress injury (previously known as osteitis pubis). It is likely that this is secondary to the groin disruption causing tension at the pubic tubercle. Division of the inguinal ligament reduces this stress and contributes to the relief of the symptoms.

At a recent international meeting of groin surgeons it was decided that the condition be called “inguinal disruption”. Whilst this is medically correct it is likely that the condition will remain known as “groin disruption” or, of course, Gilmore’s Groin. The importance of identifying all the tears, releasing the tension and restoring the normal anatomy were all considered fundamental. The Marsh modification seems, to us, to be the only technique that fully meets these fundamental criteria. www.thegilmoregroinandherniaclinic.co.uk Email info@108harleystreet.co.uk Telephone 0207 563 1234

FOOTBALL MEDIC & SCIENTIST | 15

Sports scientists often find themselves working in a gym environment after leaving professional football

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LIFE AFTER FOOTBALL EDITORIAL/EAMONN SALMON As will no doubt unfold as we continue our section ‘where are they now?’, the vast majority of our members who leave the game go on to set up in private practice of some sort. As the season end is approaching, it is perhaps timely to offer some guidance and advice to those who anticipate doing the same whether by choice...or not!

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iven the high profile we all enjoy whilst working in the game – a small perk indeed – it will come as no surprise that the “shock” of alternative employment hits us most hard when we leave the game.

For Doctors the fall is perhaps not too hard since many are part-time and are also working as GPs for some part of their working week. The potential to pick up or expand their practice is likely to be relatively straight forward.

For Sports Scientists who have found their vocation in football, positions outside the game are somewhat limited and the prospect of plying one’s trade in the alternatives available may take some considerable adjusting too.

Physiotherapists, of course, have one or two options available should they find themselves out of work, but the prospect of working in a hospital setting again will send shivers down the spine. Imagine running out on the pitch one week in front of thousands and walking a patient with a Zimmer frame on some orthopaedic ward the next?

This is not fiction, but reality.

So upon leaving the game what should they do?

LMedA would always suggest that members take a week or two to adjust to the new situation and then focus on what you want for the future.

Gather your thoughts and consider the

options. If, ultimately, the “Zimmer” option doesn’t appeal then thoughts will generally turn to private practice.

On the face of it this is by far the best option. It retains a sense of self-esteem professionally: capitalises on a high profile position in football; can give a reasonable income; and being self-employed with weekends off seems a dream! So as an option, it ticks the boxes.

We asked LMedA’s CEO, Eamonn Salmon, who has been there, done that, for his thoughts on life after football.

“Setting up in private practice is often the only option for physiotherapists who have worked at an elite level, and for all the reasons mentioned above. But I suppose there’s little point in telling everyone how good it is, rather it’s more important to look at and anticipate the difficulties that lie ahead. When deciding on such a pathway, there’s a lot to learn about the market out there: healthcare providers, medical insurance companies and how they operate; preferred provider status; the medico-legal network; the competition; the professional guidelines to adhere to, what kind of set up you need; your clinical shortfalls and needs (which have been very football specific), web design and advertising and the costs involved for all of this.

“I can give some guidelines, of course, but will start with this word of warning: The private medicine market is currently

“Whatever you do, avoid the tracksuit and trainers for uniform. You are effectively setting up as an orthopaedic physician. Think and act like a GP and you probably won’t go far wrong.”

FOOTBALL MEDIC & SCIENTIST | 17

going through a crisis and this will impact on therapists entering this line of work. The last labour government ploughed millions at the black hole that is the NHS but it served to at least temporarily get waiting lists down in most areas of medicine. Physiotherapy outpatients being one of them!

“Contracting out and patient choice has led to private hospitals seeing NHS patients.

Private patients, often in a room next door to NHS patients began to question why they were paying for their treatment. Widespread cancellation of policies duly followed. The recession has also hit companies who considering austerity have cancelled private care plans for employees. The reduction therefore in those with private health insurance at their disposal has been very severe, shrivelling the market. On top of this, individuals and families caught up in the ‘austerity’ brainwash have been quick to cancel now very expensive private health policies. Who can blame them?

“Finally, consider the competition. Eighteen years ago when I set up there was only one other major private practice in the area.

Today there are more than 10 made up of physiotherapists, osteopaths, acupuncturists, Bowen therapists and a raft of other therapists.

“This is by far the most difficult period in which to set up privately for the past 20 years.

Worth considering!”

So what can we do if we decided to embark on this path?

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Eamonn advises: • First of all don’t set up a sports injury clinic. The market for this is too small and you won’t survive. It has to be a general physiotherapy practice in order to get the volume needed to make it work.

• Brush up your physio skills now in terms of spinal care, shoulders, general post-surgical care, arthritis and the range of electrotherapy modalities this market demands.

• Don’t set up at home in a spare room – it cheapens your professionalism and image, especially if the theme from Eastenders is playing next door!

• Choose an existing practice in which to base yourself or set up yourself in a relatively affluent area if possible.

• Write to all the consultants and GPs in the area letting them know you are around.

• Flag up your football background to give you that USP but be careful of pigeon holing yourself in the market.

• Register with all healthcare insurance companies eg Bupa, AXA PPP, Aviva etc.

• Contact solicitors referencing your expertise in treating whiplash claimants and offer credit facilities to the law firm.

There are lots of other bits and pieces that can make or break a business but which will only come to light once up and running.

A final tip, adds Eamonn: “Whatever you do, avoid the tracksuit and trainers for uniform. You are effectively setting up as an orthopaedic physician. Think and act like a GP and you probably won’t go far wrong.”

Sports Therapists can also heed the advice above but clearly their scope of expertise is more limited clinically. Using your time in professional football there is of course, potential to help semi-pro clubs who will be delighted to have you on board. Perhaps a private practice based at the club would be a good option. The same applies for Soft Tissue Therapists whose hands-on practice will be appreciated at any level in the game.

And if you do set up in practice, make sure you remain a member of LMedA in case a position comes up, and absolutely make sure you pitch yourself and your website on our Consultant Finder section (currently being developed), where members of the public can find those that have worked for their team and at the elite level that is football.

IMPORTANCE OF A GOOD WEBSITE FOR PRIVATE PRACTICES EDITORIAL/SEAN REDFERN Sean Redfern is the managing director at one of the UK’s leading web design and development companies ‘Red-Fern Media Limited’ and has been supporting the LMedA website for the last four years.

In this feature article we have asked Sean to discuss the main aspects and pitfalls of promoting a private practice website on the internet.

“We’ve been designing and developing successful websites for over 10 years now and in this time there have been many changes in the way that a business needs to market themselves on the internet.”

F

IVE Components you must adhere to when selecting your web design company and developing your website.

1. Design Making sure your website looks the part is the first step to gaining the confidence of the potential customers. If your site looks like it’s been designed by the guy at the end of the street, then don’t be surprised if you never generate leads. Carefully choose a professional web design company the company to develop your site, take a look at their portfolio and make sure they have a good mix of well designed sites.

2. Content Seemingly many businesses do not know how to relay what services they offer on their website, in a way that will engage the customer and prompt them into making that all important enquiry. Most reputable web design companies will offer professional copyrighting services, they will advise you on how to create engaging calls to action and make sure the browsers know how to take advantage of your services.

point having the best looking site in the world if you don’t know how to promote it.

Getting page 1 rankings is getting harder and harder due to the number of websites competing for the top spot, but do not despair there is hope.

Make sure the keywords on your website are targeted for your specific search terms, for example if your website has the keyword ‘Physio’. in the title, you will never get any business from this as the word ‘Physio’ is to broad of a search term, you need to get more targeted, so we would use keywords such as, ‘Physio Burnley’, ‘Physio in Burnley’, ‘Back Physio in Burnley’. The more targeted your keywords, the better your site will rank on Google.

The other tactic you can use to advertise your site is called ‘Google Adwords’, this is Google’s advertising tool and you can get your website to position one on google within 15 minutes, but you pay each time a customer clicks on your advert. A typical ‘Google Adwords’ campaign may cost you around £10-£20 per day in advertising costs, but your site will start receiving potential customers almost immediately.

3. Technology This is the engine that is behind your website, most modern websites will be run on what is called a ‘Content Management System’ (CMS). A Content Management System will allow you to create, edit and manage the content on your website without having to go back to your web design company and getting charged each time you want to edit the website.

DISCOUNTED

WEB DESIGN FOR LMedA MEMBERS

4. Project Management When your deciding which web design company to use, ring some of their previous customers and ask them how they are to deal with. We see to often breakdowns in communication and websites never getting finished.

5. Promotion I’ve left the most important to last, there is no

If you need any help or advice setting up your private practice why not take a look at our website and let us know if we can help you, just go to: www.red-fern.co.uk

FOOTBALL MEDIC & SCIENTIST | 19

WHERE ARE THEY NOW? FEATURES/DEREK FRENCH Former “sponge man” Derek French describes his 35 years in football as “the most fantastic time of his life” - but what is he up to nowadays?

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s sports therapist for a number of professional clubs, including Wimbledon, Watford, Sheffield United, Notts Forest, Barnsley and Mansfield, Derek loved every minute of his career in football, which he jokingly refers to as the “not so normal life”!

After trials at Watford (“They obviously didn’t realise my potential!”) and a spell playing for Barnet Reserves, Derek qualified as a sports therapist at Lilleshall – and found himself part of professional football after all.

“Everybody who loves football dreams

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of becoming part of a pro club and that dream came true for me,” he says. “I loved every minute of it - the camaraderie of a football club is unique. I made more friends in football than I would ever have done in a normal life!

“I have travelled the world and have been treated like a king wherever I went, and I was only the physio. I adored the buzz of matchdays, running on to the pitch in front of 40,000 fans and getting untold abuse as you walk back, going into the boot room at Liverpool and chatting with the legends of the old Liverpool, and the heated marble floors of the Highbury dressing rooms.”

The game has changed substantially since Derek first qualified.

“In the early days it was the manager, his assistant, the physio and, if you were lucky, a kit man. Things have, of course, changed dramatically and there is now a huge support staff, untold coaches, physios, masseurs, fitness coaches, psychologists, physicians.

“The wellbeing of the players is paramount so the investment is well worth the money but maybe you lose a bit of the closeness of a small staff.”

Derek left the game four years ago and now works in private practice in Sheffield, although he still has a role in football – albeit a very different one to physiotherapy. He explains: “I now work for Sheffield United on match days doing corporate entertainment, which is good fun and keeps me involved in football.”

The job allows him to reminisce about his long career in the game.

“I’ve had 35 years in football and they were the best times of my life,” he adds. “I’ve been very privileged. I could write a book - but probably won’t!”

Derek runs his private clinic from the Active Health Care Clinic, Ecclesall Road, Sheffield, S11 8PJ, offering sports massage and sports injury treatment to a variety of different clients of all ages and sporting levels.

For more information visit www.derekfrench.co.uk

CHIROPODY IN FOOTBALL: A FOOT IN THE DOOR FEATURES/DAVE TINKER Most chiropodists spend the majority of their working day carrying out one-on-one consultations with their patients in calm, relaxing surroundings, but this is not necessarily the case at a professional football club - as Football Medic & Scientist editor Janine Nelson found out when she joined Burnley FC chiropodist Dave Tinker during his weekly visit to the club.

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s well as all of the usual qualifications, there’s one very important character trait that a club chiropodist needs – and that’s a sense of humour. Like the skin on the majority of players’ feet, you’ll need a thick layer to survive the banter and camaraderie of the team medical room!

For the last 20 years, LMedA member Dave Tinker has spent every Thursday afternoon working alongside the other members of the medical staff at Burnley FC’s training ground, attending the podiatry needs of the Championship club’s players.

It’s rowdy and raucous (though I suspect there was rather less swearing and rather more good manners on display during my visit!) but it’s clear to see that Dave is a valued member of the team.

“I love the camaraderie,” says Dave, whom the players have fondly nicknamed ‘Homer Simpson’. “Being a chiropodist attached to a football club brings its own pleasures.

Getting to know how a professional footballer deals with the highs and lows of the game, how he deals with injuries and so on. I find it fascinating.

“But one of the most important factors of this job is that you get on well with the footballers. You’ve got to have a good sense of humour!

“As I’ve got older I do less practice work and now have two associates at my practice, but I wouldn’t give my Thursday afternoons up for the world!”

Nail trauma, ingrowing toenails, blisters and fungal infections are all in a day’s work

for Dave, who landed the job at Burnley back in 1993 after being approached by the then club physio Mark Leather.

New technology in football boot manufacturing has sparked a growing need for clubs to employ their own chiropodists and podiatrists, Dave believes.

“Football boots are lighter now and they offer very little protection for the foot,” he explains. “Plus the game has become faster.

The players are more like athletes and they cover a lot of ground.

“Breaking boots in is a big problem, although leather boots expand more quickly than synthetic varieties, and a lot of footballers seem to want smaller boots and choose a half a size smaller than their usual shoe size so that they can feel the ball better, but this inevitably leads to more foot problems too.”

Dave and the club’s head physiotherapist Ally Beattie work side by side in the medical

room and Ally regularly rings Dave to discuss the players’ podiatry needs.

Adds Dave: “Ally will ask my advice about whether I think players with foot injuries and problems are fit enough to play and I know he genuinely values my opinion.”

Ally continues: “Dave is an integral part of the medical team here at Burnley FC. We have a good working relationship and we know that we are in safe hands.”

Players can attend additional appointments at Dave’s practice when necessary, though it’s an oasis of calm compared to the noise and bustle of the medical room.

In spite of the jokes and tomfoolery, it’s clear that the players see the importance of looking after their feet. As Clarets striker Sam Vokes says: “It’s a specific area that physiotherapists can’t necessarily treat. It’s important to keep your feet healthy – they are the tools of our trade after all!”

FOOTBALL MEDIC & SCIENTIST | 21

BRINGING PARTNERS ON-BOARD FEATURES/BUSINESS PARTNERSHIPS LMedA continues to attract interest from companies who are keen to forge partnerships and connect with members. This is great news for all concerned and establishes us as a credible and commercially viable entity within football and elite sport.

World Football Academy

WFA are beginning to make inroads in to the football community with their refreshing approach to training and education. Partnering with innovative and dynamic thinking is exactly what LMedA is about! www.worldfootballacademy.com

Physique Management UK

We are a leading company in the sports injury treatment, foam roller and gymball exercises and sports massage products field since 1998, working with the best sports injury treatment, exercise ball exercises and sports massage products therapists in the industry, to offer a wide range of sports injury, rehabilitation, sports massage, personal trainer and fitness equipment. We are a major supplier of sports injury treatment, exercise ball exercises and sports massage products to hundreds of individuals, therapists and sports teams including football, rugby, athletics, hockey and many more throughout Europe. www.physique.co.uk

Perform Better

We are the UK’s most innovative supplier of Performance Training and Monitoring equipment specialising in meeting the needs of the Professional Sports market. Established by Mark Gladwin and Alastair Yule who have over 20 years experience working in the Performance Sport sector- we are committed to providing the latest and most cutting edge equipment from around the World. By specialising in the Performance Sport market- Perform Better offer a depth of knowledge and experience to our customers and a product range that has been selected specifically for this market. Whilst offering a wide range of Performance Training and Monitoring equipment- working closely with leading Strength and Conditioning Coaches, Physiologists and Physiotherapists- Perform Better is constantly updating its product range to ensure that we can offer our customers the latest products and technologies from around the World. www.performbetter.co.uk

Hilton or Hampton by Hilton at St Georges Park

LMedA has negotiated a corporate rate for Members for stays at the Hilton or Hampton by Hilton at St Georges Park.

This discounted rate is inclusive of VAT and wifi facilities and at the Hilton free use of all leisure facilities. Use of this facility will be via a client ID which will be posted on the Members only section of the website. www.lmeda.co.uk.

Soar Media

Soar Media is an award-winning, multidiscipline marketing agency. Our team of creatives deliver comprehensive and contemporary media solutions, whilst our communications staff guarantee accuracy and reliability when representing you or your product. Soar Media is dedicated, passionate and plays an integral part in off and online marketing for numerous companies. www.soarmedia.co.uk

Clockwork

CLOCKWORK M A R K E T I N G

We are a bespoke marketing company with a passion for providing an unrivalled, personal and professional service across the entire marketing mix. Our dedicated and talented team specialise in web design and development, search engine optimisation, digital marketing, marketing strategy, graphic design, print, direct mail and data management. In 2013 we celebrate our 21st year of marketing brilliance. www.clockwork.co.uk

Polar Electro

Listening to your body is one thing, understanding what it is telling you is an altogether different story. Polar helps you get under the skin of your training. We put it down to a combination of expertise in sports, physiology and electronics, coupled with a deep understanding of customer needs. It’s no surprise then that we’ve been leading the way in technological innovations and heart rate monitors since 1977.

And we cater for all levels of fitness by offering a comprehensive product range, along with essential support and advice.

www.polarelectro.co.uk

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FOOTBALL MEDIC & SCIENTIST | 23

ON THE COUCH...

FEATURES/RICHARD EVANS 1. Profession.

Head of sport science, Wigan Athletic 2. Where did you train? What course?

When?

FA Treatment & Management of Injuries course, Lilleshall Sport science degree, Loughborough University, graduated 1999 PFA-sponsored physiotherapy degree, Brunel University, graduated 2005 3. How did you get into football?

I was a professional player at Bristol Rovers for three seasons but then got a Lisfranc injury to my left foot, which took a long time to diagnose. I struggled after that and, when my contract was up, I wanted to do something to complement my footballing career. When I was doing my finals at Loughborough, I got a phonecall from John Hollins, the sports therapist at Swansea City, offering me a job. I did six games and then the play-offs and I remember turning up for my first game at the same time as the players! I quickly learned on my feet after that.

4. Talk us through your career to date.

I did 11 seasons at Swansea City and I was proud to see them rise from the second division to the Championship. The club did have financial struggles at one point and I worked for seven different managers. I had a very good relationship with Roberto Martinez when he was a player and, when he came back as manager in 2007, we shared the same philosophy about fitness and training methods.

5. Which clubs have you worked for (past and present)?

When Roberto moved from Swansea to Wigan in 2009 I went with him. It was a dramatic step because I had strong ties with Swansea (my dad played for them)but I felt I had given them great service over the years and I was ready for a change.

6. How’s the job going at the moment?

We’re battling at the wrong end of the table at the moment but the job hasn’t changed and we are working hard to improve the performance of our players. Our training

method does work – it’s just a matter of improving what we’ve got. Unfortunately we can’t pluck £25million players off the top shelf but we are holding our own. It’s a great challenge.

7. What’s your long-term career plan?

You never stop learning in this game and I’m always picking up other people’s gems, updating my CPD and getting golden nuggets from people from different cultures and backgrounds in the game. My long-term career goal is to keep making things better for the players.

8. Dream job.

This is my dream job! I love what I do.

However, I suppose it would be nice to experience what it’s like to work for clubs in different cultures or countries. Barcelona maybe?! Ultimately I would like to work for a club in the Champions League or a World Cup team.

FOOTBALL MEDIC & SCIENTIST | 25

TRANSPORTING PLAYERS FEATURES/PAUL REDDY Paul Reddy is a Road Traffic Defence Solicitor at leading law firm Slater & Gordon. Here he discusses the finer details of road traffic law and how it may impact on your job.

“When most of us think about carrelated offences we conjure up images of drunk drivers and boyracers but there’s more to it than that. There are a number of offences that often go unconsidered and that even the most diligent, professional person could unwittingly commit in a bid to best serve their clients’ needs”

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fter recently celebrating yet another birthday, I’m beginning to accept that I may not ‘make-it’ as a professional footballer. Luckily for me though a few of my friends did, so I can live vicariously through them.

I have friends in the Premier League, Championship and Scottish Premier League. Last month I arranged to meet one of these friends after an away game.

When I asked what time he’d be back he told me that the club physiotherapist was driving his car down to the game so he’d be able leave before the team bus and get back at a reasonable time.

As I am a road traffic lawyer, and he is a good friend, I asked whether he‘d checked if the physiotherapist was insured to drive his car. He hadn’t. This concerned me to hear as what may seem like a slight over-sight to many, could actually end up with penalty points for both the player and the medic.

When we met I asked whether this sort of thing was common and he told me it’s not unusual for medical staff to: • Drive a player’s car to the ground if they’re on the club coach and want to shoot off after the game.

• Drive players to/from the training ground to medical appointments (hospitals/clinics etc…) in their own cars.

• Come in early to work to meet players on extra treatment/re-hab • Drive from the training ground to the stadium or academy I asked my friends at other clubs and was told that this was common practice in football and that, generally, the further a club is down the football league the more responsibilities the medical staff members have.

When most of us think about car related offences we conjure up images of drunk drivers and boy-racers but there’s more to it than that. There are a number of offences that often go unconsidered and that even the most diligent, professional person could unwittingly, commit in a bid to best serve their clients needs: Driving a player’s car- Did you check if you’re insured? If you’re not, you could face at least 6 points on your licence, on

top of a hefty fine.

Driving a player to/from medical appointments - Are you insured for business use on your own car? Most people are insured for ‘social, domestic and commuting’. If insurance companies investigate, they could decide not to cover you and you could be charged with driving without insurance.

Going to work early for extra treatment/re-hab - Have you ever headed to work extra early? Did you work late the night before? Are your tired? If you had an accident, you could be accused of driving whilst unfit. Did you have few drinks the night before?

Most people think of drink driving as something that happens immediately after a drinking session, but you could still be over the legal limit in the morning. Also, impairment can have less obvious causes than alcohol, such as prescription drugs.

Driving from the training ground to the stadium/academy - How many miles do you drive per year? The more you do the higher the likelihood of offences on the roads, especially speeding offences.

If you accumulate 12 points within a three year period, you’ll be disqualified for a minimum of six months.

The consequences of conviction can be severe. A disqualification can seriously affect your life, livelihood and relationships.

It’s important to think outside the realms of more obvious driving offences.

Have you thought about what might happen if you lost your licence? Could you do your job?

Paul Reddy Slater Gordon www.slatergordon.co.uk

FOOTBALL MEDIC & SCIENTIST | 27

Course Listings

CPD Courses for 2013 ACUPUNCTURE FOUNDATION & DRY NEEDLING COURSES - A SIX DAY COURSE Tutor: Kam Wah-Mak BSc DipAC CertEd MCSP Chartered Physiotherapist, Acupuncture Tutor and Founder Member of Acupuncture training courses for Health Professionals (ATCHP) September 6th-8th Part 1 & October 11th – October 13th Part 2 - Belfast

ANKLE LIGAMENT DISTRUPTION – A Clinical & Functional Dilemma

A TWO-HOUR INTERACTIVE SEMINAR AND WORKSHOP Tutor: Professor Graham N Smith GradDipPhys FCSP DIP TP CertEd, Chartered HCPC Registered Physiotherapist Rehabilitation & Sports Injury Consultant May 31st - Thirsk, June 21st - Belfast

ATACP ACCREDITED FOUNDATION & INTERMEDIATE COURSES IN AQUATIC PHYSIOTHERAPY A TWO DAY COURSE Tutor: Mike Maynard Grad Dip Phys MCSP MSOM HT ATACP Accredited Tutor in Aquatic Physiotherapy 27th & 28th April - Cork , Milton Keynes Intermediate Date TBA

HIGH PERFORMANCE SHOULDER - A ONE DAY COURSE Tutor: Julia Headey MA(Oxon)MCSP SRP September 28th - Bedford

INJURIES OF THE HIP & GROIN - A ONE DAY COURSE

Tutor: Professor Graham N Smith GradDipPhys FCSP DIP TP CertEd, Chartered & HCPC Registered Physiotherapist, Rehabilitation & Sports Injury Consultant June 1st – Thirsk, June 22nd - Belfast, September 11th - Aston Villa Football Club

THE KNEE - A TWO DAY COURSE Tutor: Professor Graham N Smith GradDipPhys FCSP DIP TP CertEd, Chartered & HCPC Registered Physiotherapist, Rehabilitation & Sports Injury Consultant September 7th & 8th - Bury St Edmunds THE PROBLEM FOOT & ANKLE - EVENING LECTURE + DEMONSTRATION Tutor: Alison Middleditch MCSP MMACP April 18th - Harrogate, June 15th - Bury St Edmunds

PROBLEM SOLVING THE SHOULDER - A TWO DAY COURSE

Tutor: Angu Jaggi MSc MCSP – Clinical Physiotherapist Specialist May 18th & 19th - Winchester, October 12th & 13th - Maidenhead, November 23rd & 24th - Bradford

SPECIFIC SOFT TISSUE MOBILISATION - A ONE DAY COURSE

Tutor: Glenn Hunter MSc MCSP, SPR, Cert ED FE April 13th - Manchester, May 11th - Oxford, October 19th - Bury St Edmunds

THE SACROILIAC JOINT SIMPLIFIED - A ONE DAY COURSE Tutor: Alison Middleditch MCSP MMACP April 19th - Harrogate, June 15th - Bury St Edmonds THE SHOULDER: STEPS TO SUCCESS - PART 1 - A ONE DAY COURSE Tutor: Jo Gibson MCSP - Clinical Physiotherapy Specialist May 22nd - Aston Villa Football Club

UNDERSTANDING SHOULDER INSTABILITY - A ONE DAY COURSE Tutor: Angu Jaggi MSc MCSP – Clinical Physiotherapist Specialist) June 29th - Birmingham

WELBEING CPD LIMITED COURSES TO BE HELD THROUGHOUT UK & IRELAND. FOR FULL PROGRAMMES, VENUES & DATES PLEASE CONTACT US Telephone: +44(0)1375 893820 Email: enquiries@welbeing-cpd.co.uk Visit: www.welbeing-cpd.co.uk