Issue 11 - Winter 2015 by Football Medicine & Performance Association

FOOTBALL MEDIC & SCIENTIST

The official magazine of the Football Medical Association

NIGEL ADKINS Gives his viewpoint on being a Manager & Physiotherapist

Indemnity

- Where do we go from here? - Latest questions answered

2015 FMA CONFERENCE Full programme details announced

Issue 11: Winter 2014/15

FMA FOOTBALL MEDICAL ASSOCIATION

Contents

FMA FOOTBALL MEDICAL ASSOCIATION

Welcome 4 Members News 7 Touchline Rants 7 On the Couch Niam Mohammed

Editorials & Features 8 CSP to Withdraw Indemnity for Physiotherapists Eamonn Salmon 11 Football Recovery Strategies Serge Berthoine, Grégory Dupont, Alan McCall, Nicola A. Maffiuletti, Mathieu Nédélec 16 2015 FMA Conference Announcement 20 An interview with Nigel Adkins Dean Eldredge 24 The F Word! Jumping off the Functional Bandwagon Alex Manos

WELCOME/EAMONN SALMON First of all, belated best wishes to everyone for 2015. On a professional note, this is by far my favourite time of year for the Football Medical Association.

he start of a New Year provides great opportunity to reflect on the last year’s achievements and also set out plans for the coming year.

I can honestly say that the vast majority of aims set out at the start of 2014 now have a big tick next to them. This shows that we are making terrific progress on so many fronts and is so rewarding, especially to those who do so much work behind the scenes. That being said, 2015 seems set to be our most important year yet. Our endeavours of the past five years have achieved an enormous amount but fundamentally what these achievements show is that we have consolidated our presence as a representative body, and are set to play a progressively significant role alongside our colleagues in football. This itself has already been recognised through increasing engagement by the Football Association and the League Managers Association these past few months, and we feel sure that the Premier League, Football League and Professional Footballers Association will continue to see the value in further dialogue with us in the coming months. It is worth remembering that everything we achieve, that benefits our members, will be to the benefit of the players, clubs and leagues alike. In what is a win-win situation for all concerned, therefore, 2015 should be the year of engagement! Eamonn Salmon CEO Football Medical Association

26 Monitoring Fatigue Ross Herridge 29 Where are they Now? Dave Butler

Pictured: (Above) Burnley’s Jason Shackell lies injured and is treated by a physiotherapist during their New Year’s Day tie versus Newcastle United. (Left, top) Southampton’s Toby Alderweireld receives treatment for an injury during the recent Premier League match against Manchester United. (Left, bottom) Charlton Athletic’s Andre Amougou receives treatment from physiotherapist Erol Umut.

CSP TO WITHDRAW INDEMNITY FOR PHYSIOTHERAPISTS FEATURE/EAMONN SALMON The Chartered Society of Physiotherapy(CSP) announced recently that it is to withdraw Indemnity cover from Physiotherapists working in sections of Professional football.

ore specifically and according to the CSP website; “The CSP will be amending the terms of the main CSP PLI scheme for members. From 1 July 2015. The policy will exclude cover for the treatment of professional footballers from clubs within the top two divisions of UK Football Association leagues and worldwide overseas clubs. This includes Academy players and those on loan to lower league clubs. It will also exclude cover for players with UK and worldwide National teams of

all age groups. The facility for members to purchase individual top-up indemnity for the treatment of professional footballers is also being withdrawn” The announcement goes on to say: “Holding appropriate indemnity for work is a requirement of ongoing Health and Care Professions Council (HCPC) registration for physiotherapists. Members affected by this forthcoming change will need to ensure they have appropriate alternative indemnity in place if they wish to continue working with affected footballers.

The forthcoming changes will affect CSP members who are: • employed or self-employed with an affected football club, and/or national/international squad • employed or self-employed with any football club accepting players from affected clubs, • private practitioners treating affected footballers within their own, or another physiotherapist’s clinic. For clarity the FMA understands that this includes Women`s football and the top two tiers of Welsh and Northern Ireland leagues even though the majority of the players in these leagues may not be technically “Professional” The implications of this announcement are understandably a little uncertain . Several meetings where the FMA have been in attendance recently, have thrown up additional scenarios that have not been anticipated and which will undoubtedly affect physiotherapists working outside of the aforementioned areas of the game. While many questions remain to be answered what is clear is that these changes will have considerable implications for our physiotherapy members. The bottom line is that they are now in great need of an alternative Indemnity policy as soon as possible. Given that there are currently no known policies out there that meet the needs of our members it is an onerous task to get a policy on the table in the given time frame.

The CSP make mention in their announcement that the SEMPRIS scheme ( currently used by some Doctors and medical personnel working in professional football ) may be a viable option. This policy is underpinned by Health Partners Europe (HPE) who are a respected and reliable organisation within the football industry. “The FMA has been around for some 5 years now and in that time we have forged many partnerships and relationships with key groups within the industry. HPE are trusted and valued associates of ours and indeed had a strong presence in supporting our Conference last year. As a result of this relationship we have been in constant contact with developments regarding the provision of the SEMPRIS policy for Physiotherapists and are continuing to work towards a final solution well ahead of the 1st July deadline. “What is really important at this stage is that there is no panic into producing a policy that is not suitable. This policy needs to be considered, robust, able to meet the needs of our members and be absolutely fit for purpose. We need to make good use of the time available to make sure any proposed policy meets all these requirements and more. In many ways this is a great opportunity to finally get things right for Physiotherapists and their colleagues working in the medical and science departments throughout the game.“ Eamonn Salmon

In view of the Indemnity changes, it is also worth reminding our physiotherapy members of the requirements needed to work as a Physiotherapist. Since the introduction of statutory regulation, the only legal requirement to work as a physiotherapist in the UK once qualified, is that an individual must be registered with the Health and Care Professions Council and hold appropriate Indemnity Insurance. Any HCPC registered physiotherapist therefore has the freedom to choose where they purchase this insurance and whether they also wish to belong to a profession specific organisation. In addition, as the CSP has chosen not to indemnify physiotherapists working at some levels in professional football, the Football Association and other administrations will need to review their regulations with the use of ‘Chartered’ in relation to physiotherapists in the game. As is often the case, Physiotherapists within football are seen to lead the way for their profession in many circumstances. With these changes afoot, once again members will be steering a course that others may follow in the future. It is timely that the FMA have emerged,firmly established itself and are now in a great position to step in and protect our member’s interests going forwards. Going forward the FMA will do everything in its power to protect the interests of our physiotherapy members, as would be the case with any of our medical professionals.

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NIGEL ADKINS FEATURE/DEAN ELDREDGE

He’s worn the boots, held the magic sponge and is now the gaffer. Nigel Adkins has done it all and has the t-shirt to prove it. After a playing career which included spells at Tranmere Rovers and Wigan Athletic, and a player/ manager role at Bangor City, Adkins graduated from the University of Salford with a degree in Physiotherapy, before joining Scunthorpe United’s physiotherapy department.

he rest, as they say, is history, as Nigel went on to great success as a manager at Scunthorpe United and Southampton, leading the Saints to back-to-back promotions and reaching the Premier League, before his most recent spell as manager of Reading. Adkins, who has previously endorsed the FMA, has agreed to become an Official FMA Ambassador and gave an exclusive interview recently to Football Medic & Scientist, and talks changes, challenges and his unlikely ‘fizzio’ debut at Chelsea, aged just 17…

Dean Eldredge: Nigel, you are in a unique position, having worked on the medical

side of the game, and as a manager… Nigel Adkins: “Spending 10 years in the role as physiotherapist at Scunthorpe United has undoubtedly aided my development as a manager. Listening to what people say is an art and very important, as is asking the right questions. If you can do these then you are in a better position to understand the requirements and the needs of a player. “At Scunthorpe United we had two promotions whilst I was the physiotherapist. The first one was at the old Wembley, as we defeated Leyton Orient 1-0 in the Play-Off Final, the winning goal from Alex Calvo-Garcia. Alex was Spanish speaking and couldn’t

speak English when he joined us, so it gave me a good insight into a foreign player having to settle in to a new country and culture. ‘Amigo’ broke his leg when we played against Reading at the Madejski Stadium and we grew close during his rehabilitation, and still keep in touch today. The next promotion was as runners-up in League 2. Both promotions highlighted the need for team spirit, unity, resilience and harmony within the group. Not everyone will get on, the players not in the starting 11, and the fit non-selected (FNS) need looking after just as much, if not more, than the starting 11. “Injuries are a major factor in football. Minimising the risk of injury and thus the

Football Medic & Scientist Gisburn Road, Barrowford, Lancashire BB9 8PT Telephone 01282 614505 Email info@footballmedic.co.uk Web www.footballmedic.co.uk Chief Executive Officer

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Senior Administrator

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Administrator

Nichola Holly

Francis Joseph

Contributors

Nigel Adkins, Serge Berthoine, Gavin Blackwell, Dave Butler, Grégory Dupont, Dean Eldredge, Ross Herridge, Nicola A. Maffiuletti, Alex Manos, Alan McCall, Mathieu Nédélec, Niam Mohammed, Carl Wells

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Cover Image Nigel Adkins on the touchline. Barrington Coombs/EMPICS Sport Football 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 FMA.

FOOTBALL MEDIC & SCIENTIST | 3

MEMBERS’ NEWS

WORKING ALONGSIDE the LMA

f all the football administrators and representative bodies we have been in liaison with these past few years, the League Managers Association (LMA) have perhaps been the most engaging. Having held several meetings lately, covering a variety of topics, we have always been made to feel welcome, and there have been positive outcomes from all discussions so far. We have enjoyed the support of the same lawyers as the managers for the past three years and this of course has been a vital service to offer our members. We are now able to announce that in the coming weeks, our members will also be able to consider the option of joining the LMA’s ‘Managers Health Insurance Scheme’. The idea to search for a health insurance policy came from the last FMA committee meeting, where it was identified that currently some members’ policies do not enjoy the benefits of a group scheme. It was

also noted that for the majority of policy holders the schemes they currently hold are not transportable when changing clubs. Lack of continuity means new policies have to be taken out which disrupts some claims and means further moratorium periods are needed for existing conditions. Rather than roll out new schemes, it is common practice for ‘affinity groups’ to combine their membership, thereby maximising reductions in costs. With this in mind, the LMA’s insurance scheme was the obvious choice for us to partner with and thankfully the LMA were amiable to discussions on this. The administration side of the arrangement is currently being ironed out, but it is hoped we will have this set in place at the beginning of June 2015. Discussions have also taken place with the LMA with regards to notifying managers of the FMA and in particular with reference to our database and recruitment section.

We are keen for managers seeking medical and science personnel to source candidates from within the FMA membership, thereby ensuring our members will have the very best opportunities to get into football, or gain that all-important career move to the very top. Again, the LMA has been very helpful with this, and will disseminate information about the FMA’s recruitment options to the managers in the coming weeks. Speaking about the proposed partnership, FMA Chief Executive Officer, Eamonn Salmon, said: “The LMA has been terrific and always willing to engage in dialogue with us at the FMA. We have had several meetings during the past 12 months, which have all resulted in positive outcomes. “I hope we can reciprocate in the future and act as a valuable resource and contact medium for the LMA, with any of their medical and science needs.”

FMA Conference set to partner with RCSEd

iscussions are under way to forge a partnership with the Royal College of Surgeons Edinburgh ahead of the forthcoming Conference in June of this year. Many of you will remember the link between the former FA Conferences and the RCSEd some years ago. There was no doubt that the Royal Colleges involvement underpinned the course programme and

giving substance to the event helped to establish the Conference as a firm fixture on the footballing calendar. Our involvement will be on the agenda for the forthcoming FMA committee meeting where we will discuss the arrangement in more detail. “

Diesel on the move MEET AND GREET W ayne Diesel, currently Head of Medicine & Science at Tottenham Hotspur is set to leave at the end of this month to take up a position at Miami Dolphins. As a valued member and supporter of the FMA since the beginning, we are very sorry to see Wayne go. We would like to thank Wayne for his considered input into the FMA these past few years and wish him every success in his new venture. Wayne added: “In today’s ever changing world of football it’s reassuring to have an Association that is truly committed to representing medical and Science staff at all levels of the beautiful game. Club medics and scientists, the team behind the team, are integral to the success of our respective Club’s and keeping abreast of potential issues that may impact on our work as well as cutting edge technology is essential. The FMA provides us with this and more! What we need to do in return is support the FMA

in its activities and encourage colleagues to join and get involved. Together we stand a better chance of maintaining our working environments at elite levels and continuing as a yardstick for other sports to follow”

Science & Football

he FMA are to work much closer with the Science & Football brand in the coming months, in order to nurture the growth of Sports Science as a discipline within the FMA. It has long been recognised that there is a need for scientists to demonstrate professional accountability by aligning with a representative organisation. Increasing prospects of litigation (claims against staff are already underway), coupled with the vulnerability of Sports Scientists involved in rehabilitation, put this group at a particularly high risk of claims. As a member of the FMA, scientists can find support from a peer group within the

association, who can give reasonable opinion in the event of litigation. This is vital. The alternative – facing a claim without any support at all – doesn’t bear thinking about.

Doctors club together

ollowing fresh impetus by Dr. Mike Stone and the FMA, we have seen a surge in membership of football club doctors, including those working in the Premier League. Of the 72 league clubs, we now have over 50 club doctors registered with the FMA and over half of the Premier League club doctors are currently members. Congratulations go to Mark Gillet who has been appointed Chair of the PLDG. Mark already sits on the FMA Committee, so is in a great position to see where everyone is heading and is in a pivotal role to generate further momentum.

ome clubs do, some clubs do by chance and many don’t do at all. We are talking of course about staff meeting their opposite numbers when they arrive at the ground on match days. To some extent this is policy in the Premier League in the aftermath of incidents/head injuries in recent years, but the majority of medical staff arrive at a ground and have little or no contact at all with the home staff, other than a quick nod or handshake before kick-off. Looking at the bigger picture, there are obviously dozens of issues that concern us and make our work that little more arduous than it needs to be. Many of these can be addressed without cost and facilitated by ourselves. It is up to us to implement change when and where we can. Thus a system whereby medical staff are met off the team bus by a member of the home team medical staff is easy to set in place and costs nothing. It is not just protocol that says this should happen, but such a policy could also prove extremely valuable. Introducing a point of contact, pointing out first aid facilities, explaining resus procedures etc, will make life that little bit easier for the visiting staff. Establishing this as the norm, therefore, is both professional and courteous, and in essence is part of what the FMA is about – cementing the network and community that is medicine and science in football. So, we at the FMA would like to ask all clubs to have someone present as the opposition team arrive. Extend a hand, a warm welcome and a professionalism that will not only be much appreciated but is likely to be reciprocated on your return visit.

FOOTBALL MEDIC & SCIENTIST | 5

NIGEL ADKINS ANNOUNCED AS FMA AMBASSADOR F ollowing his endorsement of the Football Medical Association in 2014, Nigel Adkins has agreed to become an Official Ambassador. Adkins, who enjoyed a playing career which included spells at Tranmere Rovers and Wigan Athletic, and a player/manager role at Bangor City, graduated from the University of Salford with a degree in Physiotherapy, before joining Scunthorpe United’s physiotherapy department. He then went on to great success as a manager at Scunthorpe United and Southampton, leading the Saints to back-to-back promotions and reaching the Premier League, before his most recent spell as manager of Reading. Speaking about his decision to formalise his support, Adkins said: “I was honoured when approached to support the Football Medical Association. As a physiotherapist for ten years at Scunthorpe United and now as a manager, it is my way of remembering where I’ve been and I am only too happy to share my experiences and offer back support to the medical profession in football.” Nigel joins former Newcastle United and England striker, Alan Shearer, who was named as an FMA Ambassador last year. FMA Chief Executive Officer, Eamonn Salmon, added: “We are delighted to be working with someone of Nigel’s

experience and stature within the game, and look forward to his involvement as the influence of the FMA continues to grow.” The next edition of the FMA’s members’ magazine, Football Medic & Scientist, issue 11, includes a feature-length interview with Nigel Adkins, discussing his

Parry Lands NWFA Award

Sakproject agree partnership

memories of being a physiotherapist and his hopes for the future of medicine and science in football. For more information on the FMA, please visit www.footballmedic.co.uk, and for more information follow @ footballmedical and @TheNigelAdkins on Twitter.

akproject have partnered with the FMA and will become a familiar name to members in the coming months. With an innovative concept and design for shin guards, Sakproject are keen to have an impact on injury prevention and hope to showcase their product at Clubs here in the UK. For more information on Sakproject, please visit www.sakproject.com

his year’s Northwest Football Award for Medicine and Sports Science Professional went to Les Parry. At a prestigious evening at The Point, Old Trafford, Les was presented with the award by Fabrice Muamba and in true Parry style, went on to bring the house down during his interview with host Dan Walker. Once again, this was a great platform for recognition of our members’ work within the game and Les is certainly a worthy winner.

PLEASE NOTE...

In order to maintain our 7 day a week availability please note that on occasion the mobile number we use for weekends is not within signal range. However we are always available via email info@footballmedic.co.uk so please use this out of office time and leave your phone number so we can get back to you. FMA Admin team

Touchline Rants! e by Pitchside Pet Not enough hours in the day

hen you’re working all hours of the week, how can you manage to keep up-to-date with your CPD responsibilities? Medical staff have to provide evidence of CPD as part of their registration, but how do you find time to do it? Last time I checked, there were no plans to get more than 24 hours in a day...and most of them are taken up with looking after the players! The change in recent times is not just to go on a course, but also write a reflective piece about how it may or may not impact your practice. How many times do you actually do this? Most courses are run at weekends,

so attendance can be difficult when each weekend you’re pitchside. The close season seems to get shorter each year as well. A good way of ensuring you meet the requirements of your registration is reflecting on some of the injuries you are dealing with on a daily basis. Get together with your medical and sports science team mates and review how you have done and what you can learn from each difficult injury. If you jot these down, then it’s all part of the reflective process...and not too much work. Maybe it’s a good idea to miss out the language you use about some of the awkward players though!

ON THE COUCH... FEATURE/Niam Mohammed Profession? Head Physiotherapist at Dundee Football Club.

Over the years I have been fortunate to meet many people with a vast and varied level of expertise within their own professions, such as Dr. Roger Oldham, Prof. Ernest Schilders, Prof. Gordon MacKay, Graham McKillop, Brian Bull, Nick Clark, Alan Hodson, Mark Leather, Chris Murphy (Physio UK) and Dr Alena Kobesova (DNS) and many others.

When and where did you train? Initially completed the FA Diploma in the Treatment and Management of Injuries in 1993, led by Alan Hodson at Lilleshall National Sports and Rehabilitation Centre. I then went on to complete BSc (Hons) Physiotherapy at Glasgow Caledonian University (2002-2006).

Long term plans for your career? A day off would be great! On a serious note I plan to help the manager and club in retaining their position in the SPFL and continue with my own educational development. I am currently undergoing various levels within Dynamic Neuromuscular Stabilization (DNS) Approach with the Rehabilitation Prague School.

How did you get into football? In 1994, Celtic Football Club were looking to recruit medical staff at youth level as they were implementing their own youth teams which are now the equivalent to Academies. I had an interview with then Head of Youth, Tony Taylor, and now over 20 years later I am still involved in professional football. I have worked throughout the years either on a full-time or part-time basis.

(RIP 1996). He was one of the most naturally gifted players I have seen in the last 20 years in professional sport.

Previous clubs/employment? Dundee Football Club Alloa Athletic Football Club East Stirling Football Club Celtic Football Club

In respect to managers and coaches, I have worked with many in my time and I would like to thank Tony Taylor, John McLaughlin, Jim McInally, George Adams and the late Tommy Burns for all their support.

Which player/manager/coach have you enjoyed working with? As anyone who knows me, I do not have any favourite players, but I would like to give a special mention in memory of the late Lawrence Haggart. Unfortunately, he was never given the opportunity to display his talent

I am currently reunited with Paul Hartley (Dundee Manager), and Tom Ritchie (Head of Fitness), having previously worked with them at Alloa Athletic. All parties have contributed to the current changes in the management and the maintenance of players at first team and youth team level.

The one size training program is not for everyone and I have found that the main key to performance is more on maintenance and management in training and on a match day. Continuous screening is fundamental in high level sport and it is important to know your athlete(s). Most memorable moment in football? Helping Alloa Athletic achieve back-to-back promotions from the old SFL Division 3 to Division 2, then from Division 2 to Division 1 via the play-offs, and then retaining their place in Division 1. Also, in my first year at Alloa Athletic (2011-2012), I helped Ross County to promotion to the old SPL from the SFL Division 1.

FOOTBALL MEDIC & SCIENTIST | 7

CSP to withdraw In d e m nity FOR Physiotherapists FEATURE/EAMONN SALMON The Chartered Society of Physiotherapy(CSP) announced recently that it is to withdraw Indemnity cover from Physiotherapists working in sections of Professional football.

Pictured: (Above) Southampton’s Toby Alderweireld receives treatment for an injury during the recent Premier League match against Manchester United. (Left, bottom) Charlton Athletic’s Andre Amougou receives treatment from physiotherapist Erol Umut.

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FootballRecovery

STRATEGIES Practical Aspects of Blending Science & Reality FEATURE/Grégory Dupont, Mathieu Nédélec, Alan McCall, Serge BerthoiNE (University Lille Nord de France, EA4488; and LOSC Lille) Nicola A. Maffiuletti (Neuromuscular Research Laboratory, Schulthess Clinic, Zurich) In elite soccer, the number of competitive matches per season, including domestic, continental and international matches, can be very high for successful teams. Some players can play up to 70 competitive matches per season.

n these conditions, the number of weeks with two matches per week is greater than the number of weeks with one match per week. A single match leads to an acute fatigue, characterised by a decline in maximal muscle strength (Magalhães et al., 2010), which requires several days to fully recover. When the schedule is congested (i.e. two matches per week over several weeks), the repetition of matches can lead to a chronic fatigue among the players who play regularly, as the recovery time between two successive matches may be too short. The Federation Internationale de Football Association recommends at least 2 days between two matches, but this is not a rule, it is solely a recommendation. Anecdotal interviews from managers and head coaches frequently reveal that the players are exhausted with the repetitions of the matches. Are these subjective statements justified by scientific evidence? In this instance, a congested schedule can be associated with a decrement of physical performance and with a higher injury rate. This aspect will be addressed in the first part of the article. The second question is how much time does a professional player need to fully recover? This aspect will be addressed in the second part of the article. The third part will deal with the actions performing during a match that may lead to fatigue and the potential mechanisms involved. The fourth question concerns the recovery strategies that are available to reduce the magnitude of fatigue and to accelerate the time to fully recover. This last aspect will be addressed in the fourth part of the article.

1.Effects of a congested schedule on physical performance and injury rate Soccer involves many activities such as sprints, changes in direction, jumps, shots, passes, tackles and physical

Pictured: (Above) Steven Gerrard trains alone with fitness coach, Gerard Nus, in a bid to regain fitness in time for a Champions League tie against Marseille in November, 2008.

contacts, which lead to fatigue, which is characterised by a decline in physical or muscle performance induced by exercise. During a match, fatigue occurs temporarily after short- term intense periods in both halves; towards the end of the match and after the match. Many non-contact injuries occur during the latter stages of each half (Hawkins RD et al., 2001; Ekstrand et al., 2011), suggesting that fatigue can be a risk factor of injury. However, fatigue can also come from the repetition of the matches. During periods where the schedule is particularly congested (i.e. two matches per week over several weeks), the recovery time between two successive matches can be between 2 and 4 days, which may be insufficient to restore normal homeostasis.

As a result, players may experience acute and chronic fatigue potentially leading to underperformance and/or injury. Ekstrand et al. (2004) investigated the relation between exposure of footballers in European clubs to match play in the months before the World Cup 2002 and their injuries and performance during that World Cup. They found that 60% of the players who had played more than 1 match a week before the World Cup incurred injuries or underperformed. Dupont et al. (2010) also studied match-related physical performance and injury rate playing either one or two matches per week during two seasons on 32 professional soccer players in a top-level team participating in the UEFA Champions league. Physical

FOOTBALL MEDIC & SCIENTIST | 11

Pictured: (Above) England fitness coach Massimo Neri (far right) gestures to England players Frank Lampard, Steven Gerrard and Wayne Rooney during a training session prior to a World Cup Qualifier against Belarus in 2008.

performance during official matches, characterised by total distance covered, high-intensity distance, sprint distance and number of sprints, was not significantly affected by the number of matches per week (1 versus 2), while the injury rate was more than 6 times higher (p<0.001) when players played 2 matches per week (25.6 injuries per 1000 hours of exposure) compared to 1 match per week (4.1 injuries per 1000 hours of exposure). Bengtsson et al. (2013) confirmed these results with a study involving 27 professional teams over 11 seasons. Total injury rates and muscle injury rates were increased in league matches when the recovery time was lower or equal to 4 days compared with matches where the recovery time was higher or equal to 6 days. The present data highlight the need for improved recovery strategies to maintain a low injury rate during periods with congested match fixtures. 2.Time course of recovery

After a soccer match, physical performance is impaired and requires several days to fully recover. Sprint performance over 20 m is impaired immediately after a

match by -3 (Andersson et al., 2008) to -9% (Magalhães et al., 2010). Thereafter, the recovery of sprint performance differs largely between studies with complete recovery occurring between 5 hours (Andersson et al., 2008) and 96 hours (Ispirlidis et al., 2008). When tested immediately after a match, jump performance decrements range from no decrement (Krustrup et al., 2010) to -12% (Magalhães et al., 2010). The time for jump performance to completely recover is between 48 hours (Ispirlidis et al., 2008) to more than 72 hours after the match (Andersson et al., 2008; Magalhães et al., 2010). The post-match decline in knee flexors maximal voluntary strength ranges from -7% (Thorlund et al., 2009) to -15% (Ascensão et al., 2008; Magalhães et al., 2010) and requires 51 hours (Andersson et al., 2008) to more than 72 hours (Ascensão et al., 2008; Magalhães et al., 2010) to fully recover. Although the validity of biochemical markers for muscle damage is questionable (Warren et al., 1999), creatine kinase concentrations are frequently used to investigate the underlying physiology of the recovery process. Immediately after a match, rises in creatine kinase

concentration range from +75% (Ascensão et al., 2008) to +250% (Magalhães et al., 2010). Creatine kinase concentrations peak at 24–48 hours after the match and return to baseline between 69 (Andersson et al., 2008) and 120 hours (Ispirlidis et al., 2008) following the match. In summary, soccer related-physical performance is impaired immediately after the match and recovers gradually to pre-match levels. Several studies failed to observe a normalisation of physical performance within the 3 days consecutive to a soccer match (Andersson et al., 2008; Ascensão et al., 2008; Fatouros et al., 2009; Magalhães et al., 2010) suggesting that performance can be impaired for 72 hours and more. When playing two matches per week, the 3-day recovery time between two successive matches may consequently be insufficient to fully recover. 3.Fatigue mechanisms The decrement in performance characterizes post soccer match fatigue. Long-lasting fatigue may be caused by both impaired excitation–contraction

coupling and structural damage (Allen, 2001). According to Rampinini et al. (2011), fatigue in soccer is determined by a combination of central and peripheral factors both immediately after the match and within hours of recovery. Central fatigue seems to be the main cause of the decline in maximal voluntary contraction and sprinting ability, whereas peripheral fatigue seems to be more related to increased muscle soreness and therefore may be linked with muscle damage and inflammation

Fatigue occurring in the last quarter of a match is characterised by a decline in the amount of high-intensity running and may be induced by the depletion of glycogen stores (Mohr et al., 2003). Although this fatigue occurs toward the end of the match, it can also affect the post-match fatigue, as muscle glycogen repletion after a high-level soccer match requires between 2 and 3 days when a specific nutrition plan is provided. Dehydration and thirst could be additional factors involved in the fatigue observed in the last quarter of the match. After a match played in a hot environment (31.2 to 31.6 °C), Mohr et al. (2010) reported a net fluid loss of more than 2% of the initial body mass. They found a significant correlation (r=0.73; p < 0.05) between the net fluid loss during the match and the fatigue index in a post-match sprint test. However, it is likely that dehydration plays a limited role in post soccer match fatigue, as the time to rehydrate is relatively short (6 hours) when guidelines are respected (Shirreffs et al., 1996). Muscle damage is likely a major factor to consider in an attempt to explain post soccer match fatigue. The repetition of changes of direction, accelerations and decelerations throughout a soccer match may induce muscle damage. Muscle damage is characterised by muscle soreness, increased passive muscle stiffness, muscle swelling, morphological changes such as disruption and disorganization of sarcomeres, sarcolemma and transverse tubular system and a prolonged reduction in maximal muscle force production (Davies and White 1981). Mental fatigue is an additional factor to consider in the attempt to explain post soccer match fatigue. When the competitive fixture list is congested, there may be insufficient time in between matches for players to recover their psychological resources potentially leading to lack of motivation and mental burnout. A congested schedule can be associated with a lot of traveling, which may lead to the disruption of circadian rhythms (jet lag or arrival during the night) and increase the level of stress induced by restricted motion, unfamiliar sleeping patterns and poorer quality of sleep. In summary, central fatigue seems to be the main cause of the decline in maximal voluntary contraction and sprinting ability, whereas peripheral fatigue seems to be more related to increased muscle soreness and therefore seems very likely linked to muscle damage and inflammation. Post soccer match fatigue may be associated

Pictured: (Above) Atletico Madrid’s Diego Costa is put through his paces by rehabilitation physiotherapist Oscar Pitillas in training before the 2014 Champions League Final. Costa was later forced off through injury just 9 minutes into the match.

with glycogen depletion, muscle damage and mental fatigue. 4.Recovery strategy

According to Bishop (2008), the general consensus is that the translation of sportscience research to practice is poor. In order to reduce the gap between sportscience research and practice, a survey on the recovery strategies currently used in professional soccer teams was performed (Nédélec et al., 2013). Thirty-two clubs responded that the aspects they took into account for the recovery of their players concerned nutrition and hydration (97% of the clubs) and sleep (95% of the clubs), while the recovery strategies used after the matches or during the following days were cold water immersion and contrast water therapy (88% of the clubs), active recovery (81%), massage (78%), stretching

(50%), compression garments (22%) and electrical stimulation (13%). Following this survey, the level of scientific evidence justifying these recovery strategies was reviewed. For this review, the level of scientific evidence focused on the effects of the recovery strategies on the change in the measured physical performance. Some recovery strategies such as hydration, diet, sleep, cold-water immersion and compression garments are effective to accelerate the recovery process. An example of a practical recovery protocol based on scientific evidence is proposed in Figure 1. Insert Figure 1 here please As described in the figure 1, the recovery protocol includes 6 steps and should start immediately after the match. The first step is hydration; the mass of the players

FOOTBALL MEDIC & SCIENTIST | 13

Pictured: Arsenal’s Jack Wilshere suffers an injury during a Premier League match at the Emirates Stadium against Mancheste United in November of last year. Wilshere was later ruled out for three months following surgery on the ligaments of his left ankle.

should be measured and compared to the pre-match body mass in order to propose the appropriate quantity of fluid to drink (150% of body mass lost). The fluid should contain a combination of water and a large amount of sodium (500 to 700 mg/L of water). The second step consists in drinking a tart cherry juice and chocolate milk in order to restore glycogen, to reduce oxidative stress and inflammation, to stimulate muscle repair and to promote quality and quantity of sleep. The third step is the cold bath. The players should immerse themselves up to the neck at a temperature between 12 and 15°C for 10 to 20 min to accelerate the recovery process. The fourth step is to wear a compression garment until bedtime. The fifth step is to eat a meal high in carbohydrate with a high-glycaemic index and protein within 1 h after the match (for example: soup, wellcooked white pasta or mashed potatoes, chicken or fish, yogurts or cake). The final step is to have a good nights’ sleep.

References Allen DG. Eccentric muscle damage: mechanisms of early reduction of force. Acta Physiol Scand. 2001 Mar;171(3):311-9. Andersson H, Raastad T, Nilsson J, et al. Neuromuscular fatigue and recovery in elite female soccer: effects of active recovery. Med Sci Sports Exerc 2008 Feb; 40 (2): 372-80 Ascensão A, Rebelo A, Oliveira E, et al. Biochemical impact of a soccer match - analysis of oxidative stress and muscle damage markers throughout recovery. Clin Biochem 2008 Jul; 41 (10-11): 841-51 Bengtsson H, Ekstrand J, Hägglund M. Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 2013 Aug;47(12):743-7. Bishop D. An applied research model for the sport sciences. Sports Med 2008; 38 (3): 253-63 Davies CT, White MJ. Muscle weakness following eccentric work in man. Pflugers Arch. 1981 Dec;392(2):16871. Dupont G, Nedelec M, McCall A, et al. Effect of 2 soccer matches in a week on physical performance and injury rate. Am J Sports Med 2010 Sep; 38 (9): 1752-8 Ekstrand J, Waldén M, Hägglund M. A congested football calendar and the wellbeing of players: correlation between match exposure of European footballers before the World Cup 2002 and their injuries and performances during that World Cup. Br J Sports Med 2004 Aug; 38 (4): 493-7 Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011 Jun;45(7):553-8.

Scientific evidence for the other strategies reviewed such as active recovery, stretching, massage and electrical stimulation is still lacking in the ability to accelerate the return to the initial level of performance. It does not mean that these strategies do not help to recover, but that the protocols implemented up until now were unable to accelerate the recovery of physical performance. In the survey on recovery administered to the professional soccer teams, practitioners revealed that recovery strategies are combined in recovery protocols. Although it remains important to isolate each strategy to determine its effects in the future research, it would also be interesting to analyse the interactions between the techniques. Longitudinal research protocols should also be led to take into account the chronic effects of cellular to molecular adaptations.

Ispirlidis I, Fatouros IG, Jamurtas AZ, et al. Time-course of changes in inflammatory and performance responses following a soccer game. Clin J Sport Med 2008 Sep; 18 (5): 423-31

Article reproduced with kind permission of ASPETAR Sports Medicine Journal

Warren GL, Lowe DA, Armstrong RB. Measurement tools used in the study of eccentric contraction-induced injury. Sports Med 1999 Jan; 27 (1): 43-59

Krustrup P, Zebis M, Jensen JM, et al. Game-induced fatigue patterns in elite female soccer. J Strength Cond Res 2010 Feb; 24 (2): 437-41 Magalhães J, Rebelo A, Oliveira E, et al. Impact of Loughborough Intermittent Shuttle Test versus soccer match on physiological, biochemical and neuromuscular parameters. Eur J Appl Physiol 2010 Jan; 108 (1): 39-48 Mohr M, Krustrup P, Bangsbo J. Match performance of high-standard soccer players with special reference to development of fatigue. J Sports Sci 2003 Jul; 21 (7): 519-28 Mohr M, Mujika I, Santisteban J, et al. Examination of fatigue development in elite soccer in a hot environment: a multi-experimental approach. Scand J Med Sci Sports 2010 Oct; 20 Suppl. 3: 125-32 Nédélec M, McCall A, Carling C, Legall F, Berthoin S, Dupont G. Recovery in soccer : part ii-recovery strategies. Sports Med. 2013 Jan;43(1):9-22 Rampinini E, Bosio A, Ferraresi I, et al. Match-related fatigue in soccer players. Med Sci Sports Exerc 2011 Nov; 43 (11): 2161-70 Shirreffs SM, Taylor AJ, Leiper JB, et al. Post-exercise rehydration in man: effects of volume consumed and drink sodium content. Med Sci Sports Exerc 1996 Oct; 28 (10): 1260-71 Thorlund JB, Aagaard P, Madsen K. Rapid muscle force capacity changes after soccer match play. Int J Sports Med 2009 Apr; 30 (4): 273-8

FOOTBALL MEDIC & SCIENTIST | 15

F M A C onference 2015

“Head over heels”

Practice based evidence

In association with Royal College of Surgeons Edinburgh

27-28 June 2015 Radisson Blue East Midland Airport Time to meet your colleagues before the big pre-season starts

ollowing on from the hugely successful inaugural event this year, the conference will see the programme again spread over two days, with international speakers as well as highly regarded colleagues from the world of football and sports medicine. The evening of Saturday 27 June will again host an Awards Dinner, and provide a great opportunity for everyone to network and meet up with colleagues in this superb setting. The date of this season’s event was chosen by the majority of members and is a great chance for you to gather the medical and science team together prior to the impending 2015/2016 season. This is a sample of what some of this year’s delegates had to say: “Thank you for arranging a fantastic weekend. All your hard work and effort I am sure was appreciated by so many people. It was great to meet old friends and talk about new techniques and methods. The course content was excellent, albeit that I missed a few to further my conversational skills! The evening I felt went really well and Les was superb. A big thank you too for the awards you gave out. It was really good to see that all the hard work a lot of people put in is being appreciated as you very rarely get a well done at a football club. I hope that was just the first of many.” Dave Galley

“I just wanted to forward my thanks for all your work behind an exceptional first conference at the weekend. The setting around and including the FA Cup Final and the ‘tone’ of the event and speakers was brilliant; relaxed but educational. The ‘boxing rounds’ on Sunday morning was again appropriate, informative and even entertaining. Please pass on thanks to Dave Fevre and those involved in planning the programme. It was relevant to whatever level of the football leagues we work in, and to whatever role we have in our clubs. We need the FMA to continue to lead this from our football ‘workplace’ perspective, and invite specialists to support us – not the other way round – as has been so in the past.” Joyce Watson

“Thank you so much for a fantastic evening and weekend. It was great to catch up with old friends. The format and organisation was absolutely top class.” Alan Sutton “Just a quick note to congratulate you on delivering an exceptional weekend at the Radisson Blu Hotel. It was great to see it well attended which demonstrated that there is a place for this conference every year.” Les Parry

p R O G R A M M E saturday INTRO 1230 Introduction Eamonn Salmon CEO of The FMA SESSION ONE - Chair: RCS Edinburgh Common problems. Managed well? We often assume that we manage common problems well. Maybe some of us do, however could we manage them better, quicker and with more safety? In football we sometimes work in isolation and therefore we wish to ask several of our colleagues how they manage problems that, at first glance, seems to be straight-forward... How to stop bleeding on the field of play. 12:50 Richard Higgins Sheffield Wednesday FC How to recognise and manage concussion on and off the field of play. 13:00 Mark Gillett West Bromwich Albion FC Committee member FMA Long term follow up of head injuries. How well is this done in football. 13:20 Anna Nordstrom Football Research Group, Sweden Data management. Deciding what is really relevant in professional football. 13:40 Mark Waller & Frankie Hunter Hull City FC Are we helping or harming academy players academic progress? What happens to ‘the reject’? 14:00 Grant Downie Manchester City FC Committee Member FMA Will I get support if I go beyond my area of expertise/job description? 14:20 Neil Redman of SEMPRIS Panel discussion - Questions and answers. 14:40 Chaired by RCSEd 15:10 Afternoon tea and visit sponsors. SESSION TWO - Chair: Bryan English, Medical Director FMA Ankle ligament injury. Common problem. Managed well? One of the most common problems we deal with and one where there is an issue that the player may be asked to continue but later has to leave the field of play. Do we assess this well on the pitch? Are we accurate in stopping the bleeding and swelling? If the ankle remains permanently “unstable”, is this a problem solved by thorough rehab or by surgery? If so, are the surgeons getting a little trigger-happy? With rehab is it guess-work or are we measuring our data in order to understand why we succeed or fail in our targets? Simple ankle sprain or not? 15:50 Adam Brett Brighton and Hove Albion FC 16:00 How to manage a ligament injury during mid stages of rehabilitation. Dave Galey Nottingham Forest FC 16:15

How to manage end stage return to training following ligament rupture. Chris Moseley & Adam Kerr Middleborough FC

16:30 When is the best time to operate on ankle ligament injury? Ioan Tudor Jones 16:45 17:00 17:30 18:30 19:00

Can end stage rehab be assessed “truly” scientifically. Jo Clubb Brighton and Hove Albion FC Debate: How to avoid surgery? Who makes the decision on player welfare? Off to the bar and visit sponsors Meal. Reception. Get together with sponsors FMA Annual Dinner & Award Ceremony plus late bar *Awards Categories Overleaf

FOOTBALL MEDIC & SCIENTIST | 17

p R O G R A M M E sunday TIME TRIAL 07:30

Measured one mile course outside the hotel. Age group awards.

07:30 07:35 07:40 07:45

U70s start U60s start U50s start U40s start

FMA 2015 Awards Categories Long Standing Service Award Outstanding Contribution to Football Member Award – Premiership Member Award – Championship Member Award – League one Member Award – League two Unsung Hero The 21 Club *

07:50

U30s start

*Please nominate any of the medical and science staff at your Club, Full or Part time who have given 21 years’ service or more

08:00 Breakfast SESSION THREE - Chair: Barry Drust Liverpool FC and FMA Committee TECHNOLOGY ISSUES

Has GPS and the plethora of science that is available in football (plus the manpower to drive it) added value to the sport, or is it just a luxury to impress enthusiastic owners? New technology appears every year, so how do you find out what is worthwhile and what will waste time and money? “Performance markers. High intensity. Return to training criteria. Methodology. Philosophy. Energy balance. Functional movement analysis.” Does this new football-speak have substance or is it just a job creation scheme? 08:40 The scientists opinion Barry Drust Liverpool FC 08:50 The physios opinion Chris Morgan Liverpool FC 09:00 The strength and conditioning opinion Tony Strudwick 09:10 The doctors opinion Steve McNally Manchester United FC 09:20 Debate amongst the membership of the conference. 10:00 Morning coffee and visit the sponsors SESSION FOUR - Chair: Steve Feldman Huddersfield Town and FMA Committee The team within a team Ekstrand has proven via the UEFA Injury Audit that good communication between performance teams and management and a happy atmosphere at the club results statistically in less injuries for the club. Why is this? How to get the most out of your team. My experiences. 10:30 The manager. TBA How to get the most out of your athlete physiologically. 10:50 My experiences. The physiologist. TBA How to get the best out of your team physically. 11:10 The trainer. Nick Allamby Bradford City FC How to get the most out of your athlete mentally. Do we need a psychologist? Panel discussion Chair: Steve Feldman Huddersfield Town FC 11:30 Committee Member FMA (Coach,Scientist, Physio , Scientist, Doctor, Psychologist) TBA 12:00 Conference finish and closing remarks by Eamonn Salmon 12:15 Light buffet lunch

FMA FOOTBALL MEDICAL ASSOCIATION

For more information visit www.footballmedic.co.uk

FOOTBALL MEDIC & SCIENTIST | 19

NIGEL ADKINS FEATURE/DEAN ELDREDGE

Dean Eldredge: Nigel, you are in a unique position, having worked on the medical

Pictured: Nigel celebrates with fans after Southampton’s promotion to the Premier League with a final-day win against Coventry City in 2012; Consequently securing an unprecedented two promotions in just two seasons.

availability to select a player is important, especially in the financial business world of football. “How far a body can be pushed to its maximum so that it is robust to deal with the demands of professional football is important, so communication between the player, physiotherapist, strength and conditioning coaches and the technical/ tactical coaches is paramount. We all need to appreciate each other’s roles so that we can maximise the precious time we have with the players, so that they can constantly train and play games.

NA: “I can’t speak for other managers; however, I’m sure they speak to the physiotherapist every day. At Reading we had an experienced physiotherapist in Luke Anthony. It’s beneficial being able to converse with technical language around an injury, and understanding what is going on. “I still have a genuine desire to keep up with the latest research and developments regarding diagnosis,

treatment and rehabilitation procedures so if I can, I like to drop into the regular CPD sessions we had at the club. The last one was on a systematic review of Shockwave Therapies. It’s a great way to have interaction as a department throughout the age groups at the club and also with other departments. If I can, I like to share experiences I had as a physiotherapist at Scunthorpe, and as a manager at Scunthorpe and Southampton. I’m a big rugby fan and

“Physiotherapists can form a very close bond with a player, and it’s fair to say that all players will come into contact with the physiotherapy department at some stage. Following ten years of hearing and dealing with player’s complaints and issues away from football has helped in the understanding of the demands placed upon the person that is a professional footballer. Performance = Potential – Interference is an excellent example of this. “There is a psychological element when dealing with players, especially those that are injured and unavailable to play, and those that are playing with injury, and those that are playing uninjured however highlight that a poor performance could be because of injury. “Being a physiotherapist has enabled me to care for a player and that’s something I have found invaluable as a manager, as I want all my players to be the best they can be as an individual, and as a part of the team.” DE: Do you feel that being a former physio means you work closer with your medical staff?

Pictured: Nigel lifts the League of Wales Championship Trophy for the second time as Player-Manager of Bangor City. He had previously won the title in his debut managerial season the year before.

FOOTBALL MEDIC & SCIENTIST | 21

Luke used to be the physiotherapist at Gloucester so it’s great to talk rugby, injuries and culture. We’ve been to a couple of London Irish games together as they play at the Madejski Stadium. “Whilst at Scunthorpe, I had an excellent relationship with Doctor Frank Baker, and I will always be grateful for his support both professionally and personally. “At Reading and Southampton, we also had daily morning and afternoon staff meetings, where the medical team would highlight the physical conditions of the players. This is very beneficial for the strength and conditioning and technical coaches to communicate how we can modify training for that or the next day. Physiotherapist Matt Radcliffe, who is now at Manchester United, was very good at this. The expertise of Doctor Mark Wotherspoon, who specialises as a sports physician, was fantastic. We would also talk on many occasions about cricket, which I also find fascinating. The Doc was, on many occasions, the England cricket doctor and dealing with being on tour for several months at a time is challenging to say the least.” DE: Since working as a manager, has your view of the medical side of the game changed? NA: “As the game has become quicker, and players need to be fitter and stronger, the demands placed on players are greater than ever. We now push the players to boundaries that could lead to them breaking down, therefore the demands and pressures placed on the medical departments, is greater than ever.

“The increasing transfer fees and financial contracts that players can now command require signing on medicals to be as detailed as possible. The demands for players to be available for selection, and perform, are more than ever and the pressures from owners, and therefore managers, on the medical department are greater than ever to get the players back to fitness as quickly as possible. The result is that the demand to have accurate injury diagnosis and return to play within a certain timeframe is immense.

see this expansion as a positive for the development of the game?

“Media coverage and social media is now 24/7 and the demands on the medical department to release information, is challenging to say the least, especially if you consider patient confidentiality.

“I say to my players ‘you are a selfemployed professional business, do the best you can to extract every ounce of potential you have, to look after and get the best out of your body for as long as possible.’

“I always believed the medical department was very important, however, working for 10 years in the position as physiotherapist didn’t believe that was the general consensus in football, from owners, managers, coaches and players. They are just the bucket and sponge man! “We must view a player as a Formula 1 racing car. If you look at the team that supports the car, and its driver, that is the level of detail, care and attention everyone connected must put in. Therefore, my view hasn’t changed, only confirmed how important the medical department is. The medical department must also realise how important other departments are as well.” DE: Medical and science teams have grown rapidly in recent years. Do you

NA: “Yes. The issues we have are changes in attitude. We have 168 hours in a week and every second of that week is precious. More knowledge and with that more teams to support the team. Departments obviously need to justify their position and thus need time to do that. The traditional working day of a professional footballer is now changing and that is a good thing if we are to maximise the true potential of a player.

“All departments need to understand their roles and responsibilities and how they work within the team dynamic. The Medical and science departments have progressed in profile and understanding, the need for access to the players, to have the time to physically develop and have a player in a condition, so that the technical coaches can do their jobs and develop the players effectively within the tactical dynamics of a team framework. “We all need to work together so the time spent on the grass with the technical coaches working closely with the SNC’s to develop movement and awareness and the intensities of the modern evolving game. “Whilst at Southampton as manager, we worked so well as a team, assistant

manager Andy Crosby, coach Dean Wilkins and strength and conditioning coach Nick Harvey would spend hours upon hours working on ways to maximise the time we had with the players.

my cheekbone. Our physio at the time was Les Helm, a top man in my eyes, no nonsense, down to earth and hard working. Les later went on to be the Everton physio for many years.

“At Reading with Andy, Dean and Nick, we worked tirelessly in our pursuit of excellence and the evolving nature of the game.”

“Les introduced me to the treatment of injuries and took me over to Liverpool for a first aid course. It then developed onto the Basic Treatment of Injuries course and then the Diploma in Treatment and Rehabilitation of Injuries course at Lilleshall National Sports Centre. The first year was under Graham Smith and then Alan Hodgson took over in the second year. I still remember those two-week residential courses with fond memories. Both Graham and Alan were inspirational figures; Alan headed up the FA medical department for many years, and I even joined Graham’s Association of Sports Therapists.

DE: Why did you endorse the Football Medical Association and what do you feel their role is within the game? NA: “I was honoured when approached to support the Football Medical Association. As a physiotherapist for ten years at Scunthorpe United and now as a manager, it is my way of remembering where I’ve been and I am only too happy to share my experiences and offer back support to the medical profession in football. “Being part of an association is important as it offers you support. There is nothing worse than feeling isolated and alone with nowhere to turn. As an association I’m sure a support network will grow and advice on the latest developments in medicine in football will be available. “The nature of football is one of change, of manager, and with that at times a change with other departments. Being part of the Football Medical Association, I’m sure, will offer support and advice on leaving and joining other clubs.” DE: Were there any medical staff in the past who inspired you, or continue to inspire you? NA: “Yes, whilst playing for Tranmere Rovers as a goalkeeper, I fractured

“Whilst I was a 17-year-old apprentice at Tranmere Rovers, we played Chelsea at Stamford Bridge in the League Cup. I was the ‘fizzio’ for the game as our regular ‘sponge man’ and long standing player, Ray Mathias was actually required to play in the game due to the lack of players available to play at the time. Maybe that unknowingly inspired me.” DE: What do you believe are the big challenges for the medical side of football and why? NA: “Litigation and blame are unfortunately the culture of the world now. Making sure we follow best practice and protocols are vitally important. So is being covered for the inevitable insurance claim. Are we putting players at risk, not just now, but also in their future lives? That will be under the microscope I’m sure.

“We are pushing the boundaries every day and with this the increased likelihood of injury. Communication is key from top to bottom; understanding everyone’s roles and responsibilities to be effective as a team, as everyone has a role to play in an organisation, is critical. Who has the final say on the fitness of a player will lean more and more on the advice and recommendations of the medical team. “There are now far many more options regarding treatment, consultations and opinions as to the care of a player. This is a challenge going forward as players are now more educated as to their care, as are the agents who surround them. The growing medical industry offers so many specialist options it is important to keep focused on doing the basics right to a World Class level first of all. “The psychological issues are increasing in football during and after a career. The support, awareness and advice, and understanding what is required, will only grow.” DE: If you could make any changes or improvements to the medical side of football what would they be and why would you make them? NA: “A full-time Doctor would, in my opinion, be advantageous at a club when you consider how many players and staff are now employed in the top two divisions in England. “From a business point of view, the importance of having players available for selection is paramount. The risk management strategies and the communication throughout the departments from top to bottom of an organisation will be focused upon more. “The awareness of time spent at work, and the physical and mental demands placed upon the physiotherapist need to be monitored with medical screening and wellness awareness to increase the longevity of a career. “Psychological support for physiotherapists, to help them and the players they are surrounded by, to be better equipped to deal with the mental issues that will increase in the future would be a valuable improvement.” NIGEL’S MANAGEMENT ACHIEVEMENTS Bangor City League of Wales Champions 1993/94 and 1994/95 Scunthorpe United Football League One Champions 2006/07 Football League One Play-Off Winners 2008/09

Pictured: (Left) Nigel shares a joke with Oliver Norwood and Simon Cox during a training session at Reading’s Hogwood Park training ground. (Above) A young fan wears a Nigel Adkins themed t-shirt following Scunthorpe’s League One title-winning season in 2007.

Southampton Football League One Runners-up 2010/11 Football League Championship Runners-up 2011/12

FOOTBALL MEDIC & SCIENTIST | 23

The F word! Jumping off the functional bandwagon FEATURE/ALEX MANOS - A preview from the forthcoming Science + Football Conference

unctional exercise’ seems to be the buzz word over the last 6-7 years. But what does ‘functional’ actually mean? Do exercises for rehab and strength always have to be performed in a position relevant to the sport? There are many ways to achieve a target and the most important thing is that it is relevant to the goal utilising different methods to achieve it. I would argue that we sometimes try to over complicate the the rehab of individuals when simple principles are still appropriate to follow. What is more important in my opinion is to have a progressive program which incorporates all aspects of training necessary, strength, endurance, power, function etc etc. Whilst it is important to incorporate function into rehab, this must be at the appropriate time and the individual must be able to cope with the demands of high-end exercises. Greater results can be achieved by simplifying exercises then increasing load, changing the plane, decreasing stability, with a view to achieving a higher degree of sports specificity. The purpose of the rehab

is to rehabilitate the injury first and foremost whilst also rehabilitating the athlete in preparation for training. There needs to be a smooth transition between gym based exercise and field

based work. ‘Function’ can only be achieved when basic principles of strength, stability, endurance, pain free loading are established. This presentation will look at some of the common disputed principles of rehab.

FOOTBALL MEDIC & SCIENTIST | 25

Monitoring

fatigue in youth team players & transitioning to first team FEATURE/Ross Herridge

onitoring of academy players within the English football system has developed greatly with the introduction of the elite player performance plan (EPPP). It had lead clubs to invest heavily in academy football in the form of high-tech equipment and an increase in sport science support staff to monitor player’s fatigue and performance levels. Player Profiling

With the latter in mind, generally clubs will develop a ‘player profile’ for all players comprising of their biological age, injury history, movement proficiency as well as other physical capacity characteristics. Sport scientists will collect data over the course of a season and build baseline measures for players; deviations away from these baselines will allow practitioners to assess levels of fatigue as well as susceptibility to injury and illness through daily monitoring. This is something that will be done for academy players right the way through to first team level and gives coaches a good indication on physical readiness to train and play. The monitoring provisions to assess this will vary from club to club with management philosophy on science and budget having an impact on the nature of assessment. The use of GPS systems in training is something that most, if not all top clubs will turn to and the data that can be extrapolated is endless. Ranging from distance covered, to the amount of sprints, the time spent in maximal heart rate zones and physical load being exerted on the body, GPS gives practitioners a holistic view on training loading. Other modalities of player monitoring include looking at subjective measures of fatigue though wellness questionnaires as well as more sophisticated methods such as sampling saliva to examine levels of antibodies, cortisol and testosterone in the body. These methods of monitoring player fatigue are of high importance to the sport scientist, as minimising non-contact injury risk is probably the number one aim for any practitioner, and gives the management a longer list of players to choose from on game day.

Young Player Management When a young player is being looked upon to play senior football it should be highlighted that they will be judged on a lot more than physical ability, but from a physical perspective they will have trained regularly with the first team squad leading up to breaking into the team. This will allow the senior management to judge the player against seasoned professionals day in, day out and should give them a clear indication of whether the

player is ready for the demands of first team football. Their needs in terms of tapering training load will be important to give them sufficient recovery, training will be more physical, and players will be stronger than fellow academy players, which can take its toll on a younger player. The staff may cycle when the player trains with the youth team and in the more physically challenging first team training sessions as well as deciding which parts to include them in. For example, for drill based

Pictured: (Above) Manchester City’s Tosin Adarabioyo battles with AS Roma’s Elio Capradossi (left) and Arturo Calabresi (centre) to get on the end of a corner during their UEFA Youth League match in November of last year.

Pictured: (Above) Everton’s bright young attacking talent, Ross Barkley, evades a series of challenges during a Premier League match against Queens Park Rangers in 2011.

training the young players may be included but taken out for the more physically demanding small-sided high intensity matches. This is just one example of how support staff and coaches may reduce the risk of fatigue, ‘burnout’ or injury of a young player stepping up to senior level.

Training Intensity & Recovery Players will need to increase their intensity of training load to meet the demands of senior level football; this will enhance their adaptation to training and make them more robust to the day-to-day rigors of

senior football. Recovery modalities are also important in assuring physical readiness of players, the recovery protocol can be tailored to an individual or based round whether the team has one game in a week or two. For example if a player has played his first 90 minutes in a senior game that was of a high intensity then they may be given a second day to recover or rested for a game. All clubs will have different way of monitoring training and game load to reduce the risk of fatigue of their players. There will also be strategies to enhance recovery including when players inevitably do become fatigued during the season. Reducing the risks associated with fatigue and ensuring optimal physical performance of players’ week in week out is key for sport scientists. Monitoring has developed significantly over recent years as players continue to be pushed to their limits, young players in particular need close attention to decrease the risk of fatigue and illness. This is part of a wider service delivered by support staff to ensure optimal development of young players moving into senior level football.

About Ross Herridge, BSc (Hons), MSc, ASCC

Pictured: (Left) Arsenal’s Jack Wilshere and Liverpool’s Thomas Ince collide whilst competing for the ball during the 2009 FA Youth Cup Final.

Ross was Lead Academy Strength & Conditioning Coach at Reading FC for two years with experience in Fencing and Tennis and is currently the Strength & Conditioning Coach at Nottinghamshire CCC.

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WHERE ARE THEY NOW? FEATURE/Dave Butler

Did you have a mentor or a fitness coach manager who you looked up to and inspired you? I have three people on the medical side who helped me tremendously. Pat Molley who was my physio when I joined Watford as a player and who I took over from when I finished playing. He stayed on as my assistant and looked after me and kept me right for the next two years.

List of previous clubs… As a professional footballer with Workington and Watford.

Dr. Vernon Edwards who was the Watford doctor and also the England doctor who believed in me more than I realized and without me knowing recommended me to Watford.

On the medical side In professional football. Watford, Crystal Palace, Queens Park Rangers, Tottenham Hotspur. England Confrence. England Under 18. England Under 21. England B team, and the England first team.

Professor Frank OGorman who Dr Vernon Edwards introduced me to and who I worked with for many years at international level and who in my eyes is one of the greatest men had I have ever had the privilege to meet.

On the scouting side of football . Middlesbrough, Leeds, Aston Villa, Portsmouth and Tottenham. What are you doing now? I’m still involved in the game on the scouting side with Tottenham Hotspur covering their opposition scouting reports.

Did you have any other duties other than your fitness coach role? At times I was asked to look at players the club were thinking of buying and to give my reccomendations on them.

What is your most memorable moment in the game? Euro 96.

How was your relationship with managers? There has to be a good relationship between the manager, physio and all the staff and no manager I worked for ever interfered with the medical sides decisions.

Your biggest disappointment? Losing the Euro 96 semi final. Do you have happy memories of your time in football? I have fabulous memories in football, obviously some disappointments but most of the people I worked with both players and staff helped give me those memories and I would recommend any one given the chance to be involved with professional football to take it.

the end of my final season Watford, the club I was with, the manager Mike Keen offered me the chance to join the medical side of his staff.

Pictured: Dave at an England training session during Euro ‘96

How did you get in to football? I became a professional footballer at 19 and got injured at 29 and had to give the game up, but during my professional football career I took my coaching and medical qualifications through the FA courses. At

Final thoughts on your time in the game at club level? I loved every moment of the day to day involvement as a player and on the medical side especially on the training ground, the game on Saturday when you lost was the only disappointment

How have things changed? Medically it has improved and the biggest change is probably the number of medical personnel involved in the team during the week and on match days. Another aspect that has improved is that it’s not just left to the physio and doctor to deal with all the players needs and other people are now around to provide help. When not in the game, did you miss being part of it on a day-to-day basis? You do miss the game, but I’ve been quite fortunate to have been out of it for fairly short periods.. Are you still in touch with people from the game? I am still in touch with most of the managers and staff I worked with and I also see quite a number of ex players and sports therapists on match days and at a number of functions.

Pictured: Dave and manager Terry Venables during their spell together at Crystal Palace in 1998.

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