Transitioning from club to national team

TRANSITIONING FROM CLUB TO NATIONAL

TEAM; CHALLENGES & SUGGESTIONS FOR PLAYER HEALTH & PERFORMANCE

FEATURE / ALAN McCALL1 , 2, GARY O’DRISCOLL1, GUILHERME PASSOS-RAMOS3, MARK JONES2 , FABIAN EHRMANN2, ROB DUFFIELD2 1 Arsenal Football Club, 2 Football Australia, 3 Confederação Brasileira de Futebol

Transitioning from club to national team (and back)

The transition from club to national team is an ongoing challenge for medical and science staff (referred to herein as ‘performance staff’) from both club and national team settings, to protect player health and optimise performance. The typical football calendar year includes several international periods where players can be called-up by their national teams to compete in training camps and matches, including friendlies, competitive qualifiers and/ or major international tournaments. During the competitive club seasons for both men’s and women’s senior top-level football, there are usually four to five international periods with around two to four matches over approximately 10 days. Coinciding with most leagues offseasons, there are also major international tournaments that rotate every couple of years, lasting up to approximately six weeks (e.g. FIFA World Cup UEFA European Championships, CONMEBOL Copa America, AFC Asia Cup, CAF African Cup of Nations and CONCACAF Gold Cup). These interruptions can require all or some of the following: short or extensive travel, exposure to different climatic conditions (cold, heat, altitude etc), unfamiliar environments and support (hotels, facilities, nutrition), varying types of training schedules and structures, increased match volume and demands with players potentially playing in different positions and in new team dynamics.

Thus, for those players selected to play international football, there are several periods during the year where their ‘normal’ routine of training and match-play with their club teams, as well as their day to day / week to week lifestyles (including family time, social circles etc) are interrupted. This may happen sometimes quite abruptly i.e. leaving from playing a club match directly to a national team and vice versa: aka, the ‘transition’. Therefore, it is clearly of interest for us as performance staff of both club and national teams to work together to optimise health and performance outcomes for individual players and collectively for our teams (Buchheit and Dupont, 2018).

What are the changes in training load and structure following the ‘transition’?

Alterations to the ‘normal’ weekly training structure is one of the biggest changes that players transitioning from club to national team (and back) face. This represents one change that is within our scope as performance staff to monitor (at least some aspects) and have some ability to act upon or at least provide some recommendations to players and to coaching staff. Changes can be seen in the training schedule (e.g. frequency, duration etc), training focus (e.g. switching focus from physical, technical/tactical etc) and the type of training performed (e.g. intensity, specific exercises, drills etc). While our own experience and data within our own teams helps guide us as to what changes we might expect, the football landscape is ever changing. With players, coaches and performance staff often moving to other teams coupled with the very limited scientific evidence that can give us any clear indications of what happens following these ‘transitions’, this proves to be quite a challenge.

Of the scarce scientific evidence that does exist describing these changes in training for transitioning players, the majority shows only the transition from club to national team and not when players return to their clubs after national duty. The existing research is also mainly from the same national federation and therefore, generalising this to all club to national team transitions is not possible. To give the reader an idea of what does exist, some of the current research group have followed the same men’s and women’s senior national team over multiple consecutive major international competitions (Noor et al., 2019 and unpublished

Pictured left: Gabriel Jesus training with Brasil National Team (Courtesy of Lucas Figueiredo, Confederação Brasileira de Futebol)

Pictured right: Gabriel Jesus training with Arsenal Football Club (Courtesy of Arsenal Football Club)

Pictured left: Steph Catley with Arsenal Football Club (Courtesy of Arsenal Football Club)

Pictured right: Steph Catley with Football Australia Matildas (Courtesy of Ann Odong and Football Australia)

data currently in review) found that players (both male and female) typically experienced an increase in internal training loads (measured using session-RPE; s-RPE) after transitioning from their club to the national team. Interestingly these increases in internal training load came from an increased number of sessions (i.e. session count – external load), rather than an increased (perceived) intensity of the sessions themselves. These trends represent one national federation only, and the reality is that in our practical experience with other national teams these scenarios can vary. Anecdotally the training prior to arriving at the national team can depend on the league the players are coming from, who they are coached by and the timing of the season.

While we mention above that (to our knowledge) there are no published studies describing training patterns when players transition back to their club teams following national team duties, preliminary investigations from some of our group have shown that senior women’s team players transitioning back to their clubs experienced a reduction in session count but similar overall s-RPE. This suggests that in these players from this one national team their total weekly training loads performed after transitioning to their club teams was similar to while with the national team. Again, this should be interpreted with caution as our practical experience also shows us that there can be various scenarios depending on many different factors. In other words, following individual players is key in the practical setting.

In football (and sports in general) we find ourselves in an age of ‘technology’. This information is useful to guide training within a team and GPS, in particular is widely used (i.e. for the club or for the national team while they have the players). However, using information from technologies such as GPS to inform the ‘transition’ is problematic due to different systems, methods of analysis, metrics used and reporting systems amongst others. For this reason, for most of our research in this transition period we have focused on simple and easy to collect measures such as training minutes, session counts (training and match), RPE and subjective wellness measures. We are working in this area to try and scientifically investigate the potential ‘utility’ of technologies (but this will be a story for another day).

Overall, while limited scientific evidence exists, the little that does exist, combined with our practical experience working in both national and club teams, highlight that the potential for an altered training structure (days, sessions, scheduling, etc) between club and national teams is extremely likely and individual players can be impacted in different ways. Hence, performance staff should ideally monitor and consider the training patterns (e.g. type, frequency, duration, intensity, etc) when planning training to integrate individual players into their ‘new’ (i.e. club or national) team environment.

Are there any consequences for injury following the ‘transition’?

As with changes to training, there is also very limited scientific evidence to glean insights into what to expect from an injury perspective when players transition in and out of teams. A study by Carling and colleagues (Carling et al., 2015) investigated the injury patterns of players from a single French Ligue 1 team when they returned from national team duty. Over five consecutive seasons, no training injuries occurred with national team players while on national team duty (injuries occurred in matches only) and overall the injuries occurring with national teams made up only a negligible part of the clubs’ total working days lost to injury. In the same study, the players who transitioned back to the club team were found to have a similar injury risk to those without national obligations (Carling et al., 2015). The authors of that study postulated that the clubs’ policy and buy-in from the head coach to player rotation and recovery protocols should be acknowledged and may have contributed to these findings. In other words, the team (from head coach throughout the team) had focused on and were invested in protecting players upon their return from national duty by adapting schedules and demands based on the player needs. Previous work on multiple club teams from UEFA (Ekstrand et al., 2004) showed that the risk of injury while playing for national team was comparable with reported figures in club teams. It is important to remember that scientific studies typically aggregate data and therefore do not necessarily apply to any one individual player.

While representing only a case study of one national football team, it was observed that players suffering a non-contact injury at the 2014 World Cup accumulated significantly less internal training load (s-RPE) in the two weeks prior to the national team camp and experienced a concomitant higher increase in internal training load during the initial period of the camp (McCall et al., 2018). Again, this increase in internal training load came from an increase in number of sessions and not the intensity within the session. Further supporting the potential for players transitioning into their national teams to be exposed to a different training microcycle structure compared to

their club team based on the specific needs of national team formation. We want to make it clear that we, in no way suggest that increases in training load (internal or external) cause an injury, and our findings are descriptive only and based on aggregated data, so to assume the change in training load is a cause of injury is spurious. On the individual level, the study by McCall et al. (2018) showed some players were exposed to high increases without and injury and on the contrary some saw no important increase yet still suffered an injury.

Following the 2014 FIFA World Cup (McCall et al., 2015) and in unpublished data from the subsequent Women’s and Junior male World Cups, some of the current authors surveyed national team practitioners to understand their perceived most important injury risk factors for players following transitions to and while with the national teams. Prior to the transition, previous injury, accumulated fatigue throughout the club season (e.g. from congested fixtures) and internal and external training loads prior to joining national teams, as well as physical fitness and attributes related to muscular performance were among the most commonly reported concerns for national team performance staff. Perceived risk factors for injury following transition and during the World Cups included reduced recovery time between matches, internal and external training loads, poor pitch quality and access to adequate recovery facilities. These findings mimic the concerns raised in surveys within UEFA club teams for injury risk perceptions (McCall et al., 2017), and highlight that both club and national team practitioners share similar concerns for player health and performance. There is insufficient scientific evidence to tell us what consequences the transition might have on injury and our experience shows us that this can be highly variable and often unpredictable. For us, our practices of trying to prevent injuries does not change. We need to be aware that there are some changes for the player(s), gather information about those changes we feel are important and help us build a picture of what has happened (e.g training and match exposure) and identify potential consequences of these changes (exposure to risk factors and even protective factors). With this information we can start to work on solutions. As most people reading this article, we probably all agree that there is a large variability for individuals injury risk that will be influenced by several factors including but not limited to, the player characteristics (anatomical, physical, psychological, behavioural etc), the team environment etc.

What information exchange exists & what do we want to know?

As alluded to earlier, the sharing of information between club and national teams relevant to their respective environments is particularly difficult and represents a key barrier to us as practitioners trying to optimise health and performance of players. A commentary piece by Buchheit and Dupont prior to the 2018 FIFA World Cup highlighted some anecdotal information that would likely be of mutual interest for club and national teams to share. This included; (i) players’ readiness to train and play (e.g. medical and fitness assessments), (ii) overall load management (e.g. types of training and loads players are accustomed to), (iii) specific programming information about injury prevention and/or injury management (e.g. preventive exercises, rehab programs, medications, radiological scans etc) and (iv) nutritional strategies (e.g. allergies, specific diets, preferences etc). Essentially, the goal of collecting this information is to attempt to maintain a similar level of care and service that players are accustomed to and avoid sudden changes in their programs, whether they are in normal, modified/restricted training or even currently returning from an injury or illness.

As part of a FIFA led project, following the cessation of the 2018 FIFA World Cup, some of the current author group implemented a Delphi Survey to national team performance practitioners. This was done to gather agreements on what information should ideally and can feasibly be exchanged between club and national teams, as well as to better understand the challenges faced. A Delphi survey is a scientific method to gain consensus/ agreement on a given topic which while still represents Level V evidence (expert opinion), attempts to minimise bias that is seen in an individual opinion. Further supporting the commentary by Buchheit and Dupont (Buchheit and Dupont 2018), the experts in our Delphi survey agreed that certain information sources should ideally be exchanged to optimise a seamless, continued care of transitioning players.

In the Delphi survey, medical staff within the performance departments agreed that information to collect should include straightforward epidemiological information, screening tests and current injury treatment. As explained by Weiler and colleagues (Wieler et al., 2021) including some from FIFA, the English Football Association and the world’s

Pictured left: Rafaelle Souza with Brasil National Team (Courtesy of Lucas Figueiredo, Confederação Brasileira de Futebol)

Pictured right: Rafaelle Souza training with Arsenal Football Club (Courtesy of Arsenal Football Club)

Figure 1: Medical and Science information to ‘ideally’ exchange between club, national team and/ or player. Based on McCall et al. (2022); Buchheit and Dupont (2018), Wieler et al., (2021).

Ongoing injury related treatments

• Manual therapies (anything ‘hands on’) • Electro therapies (anything that ‘plugs in’) • Excercise-based therapies (anything ‘gym-based’) >>>>>>> <<<<<<<

Training status

• Session count (training and matches) • Minutes trained and played • Rating of Perceived Exertion • Subjective wellness item(s) (eg. fatigue, muscle soreness) • GPS *if able to use calibration equations • Basic travel information (departure/arrival times)

Normal exercise / training

• Typical composition of preventive sessions (exercises, sets, reps etc) • Typical frequency and duration of preventive sessions

Medical screening

• Relevant radiological assessments (MRI, X-Ray etc) • Clinical screening (biomechanical and functional assessments IF methods are easily interchangeable)

Injury and illness (epidemiology)

• Injury type • Injury location • Number of injuries • Non-time loss injuries • Relevant previous / current illnesses • Current medication(s), allergies, supplementations

*urgent medical matters communicated immediately and relevant information shared as soon as possible

Restrictions to ‘normal’ training

• Exercises that should be avoided (on and off-pitch) • Restrictions to technical/tactical sessions

player union FIFPRO, urgent medical updates on injuries or illness during a national team training camp or international competition, should be actioned as soon as possible and in a suitable format e.g. by phone call, messaging, or confidential email, with written complete medical records being sent as soon as they are collated.

Science staff within the performance departments agreed that data pertaining to players internal and external training, match loads as well as an indication of their ‘fatigue’ status (in particular from subjective ratings and implied through GPS) and subjective wellness should be collated. While ‘fitness’ status was agreed to be important, the lack of appropriate tests and limited time after they transition to their national or club team was highlighted. The respondents agreed that it therefore should not be a priority. Other parameters were also discussed as potentially interesting information but were deemed too difficult to collect or interpret (eg neuromuscular force, biochemical assessments etc).

Essentially, the main message seems to be (and we, authors also agree) to focus efforts on exchanging simple yet potentially meaningful information about the transitioning players. We do not negate the importance of other measures where club and / or national teams may have historical, longitudinal data in their own players, and they have the ability to perform relevant, time efficient assessments of players when they arrive into their own teams. So, we remind the reader that we are focused on the exchange of information between club and national team and not each teams internal processes.

Challenges to health and performance information exchange

Now, this all sounds easy, right? Just share the data! After all, clubs and national teams readily collect and record these types of information and data. In reality, however, this is far from simple and there are several challenges to sharing information between club and national teams. This includes communication between teams, willingness to share information and then the quality of that information (McCall et al., 2022). Additional barriers like different languages, cultures (e.g. philosophies and approaches to football medicine and science), privacy and legal aspects of data transfer etc might also be present. Depending on the context of the match or tournament, teams can also have competing interests and therefore the accepted injury risk for a given player (and for the player themselves) can differ and should form part of collaborative discussions.

Quality and completeness of information Giving and receiving complete and high-quality information is one of the key challenges for both club and national team performance staff in successful information exchange (McCall et al., 2022). It is common sense to expect that consistent, accurate and high-quality sharing of medical and science information will ultimately have a positive impact on players’ injury risk and performance, as well as the teams collectively. However, as we alluded to earlier, it is no surprise that this is not straightforward. The methods and technologies are highly variable between club and national teams. The UEFA Football Research Group investigated the feasibility of a multi-club training load monitoring study (McCall et al., 2018), however, and hence why feasibility studies are vital before conducting larger multi-team studies, none of the teams included in the feasibility used all of the same approaches, subjective scales, technologies, or even if they used the same brand of technology. In fact, the interchangeability of information from different technologies is highly problematic. Using calibration equations to be able to interchange information from

Pictured left: Gabriel Jesus celebrating with Brasil National Team (Courtesy of Lucas Figueiredo, Confederação Brasileira de Futebol)

Pictured right: Gabriel Jesus celebrating with Arsenal Football (Courtesy of Arsenal Football Club)

different technologies and sources has been recommended and some guidance exists (Buchheit and Dupont, 2018), however this is also very difficult for clubs and particularly national teams to achieve.

Again, reiterating our message earlier, from our experience, simple measures (e.g. training minutes, session count, RPE and relevant but simple medical notes etc) are often the best in terms of ensuring quality and completeness of information. In line with the Japanese Seven Eleven franchise, our philosophy is ‘minimal data, big value’.

Communication and willingness to share information As with quality and completeness of information, communication and willingness to share information is one of the most significant challenges to teams (McCall et al., 2022). It is reasonable to expect that quality communication between club and national teams can improve the sharing and quality/ completeness of information. Buchheit and Dupont (2018) outlined some guidelines to facilitate the exchange of information of which we echo. These include:

- Discuss what the other side wants / needs (what information are they looking for and for how long e.g. prior 4 weeks, regularly throughout the season etc?) - Seek with the other side if there are any additional tests that you are willing and able to do - Discuss together what format(s) you would ideally receive the information (e.g. Excel, CSV, word etc). *In our experience one of the most frustrating formats is the dreaded ‘PDF’, which typically requires manual transferring of information into the preferred format.* - Understand when the other side would ideally want to receive the information, so you know when to send it. This is key to ensuring that information is exchanged with enough time that performance staff can ‘action’ on the information

Again, this all sounds great on paper, but language barriers, time-zone differences, managing communications between multiple people in teams all around the world and different modes of contact are all challenges that need to be overcome. This coupled with us doing our ‘normal’ jobs in our respective teams makes this extremely challenging. In our experience, building and maintaining strong (i.e. trusting) relationships with the performance staff in the various club and national teams are key to facilitating communication and the sharing of information. Although it is difficult and can be time consuming, maintaining consistent and open communication with other teams is essential if we want to optimise a two-way exchange that benefits both sides. Even a simple regular check in to say hello with our colleagues from other teams has demonstrated to us that it can go a long way. From our experience, we aim to create a shared vision between ourselves and the other team’s performance staff, we want to be genuine, and to make it clear (and with time we can demonstrate through our actions) that the players’ health and performance is our driver and that our relationship is both about giving and receiving. Scientific evidence about how to best build and maintain relationships in football (or sports) is lacking but we have learned from other areas that creating a shared vision motivates people to action, inspires them to go above and beyond and ultimately leads to sustained and desired change (Boyatzis et al., 2015).

Privacy and legal aspects of sharing player information While out of the scope of our article, when sharing player information, it is imperative that teams (and practitioners sharing the data) carefully consider data protection, legal and privacy aspects of data exchange (Buchheit and Dupont, 2018). It is of the utmost importance to recognise that we protect the rights and the privacy of our players. We therefore recommend that practitioners from clubs and national teams work closely with their legal and data protection departments to ensure that any information is shared in the proper manner and with full disclosure and agreement from the players themselves. A prerequisite to information sharing is the consent of players and documenting whether this is verbal or written (Weiler et al., 2021). Players must know that they can withdraw their consent to share their data at any time.

Don’t forget about us (the players)!

While we have been discussing the exchange of players’ information, we must not forget the players’ role themselves… remember, we are dealing with human beings who have their own beliefs, desires, motivations and fears. While information we collect about players can be valuable for club and national teams to share and drive individualisation of programs, we should not ignore the importance of the lived experience of the players themselves and their contribution to the decision-making process about their health and performance. As with the performance staff between teams, this relationship with the player is integral and should not be underestimated! We recommend that regular and open communication and actively involving the player in what information we want to share, why we want to share it and demonstrating meaningful impact, should form one of the main pillars of a strategy to protect their health and performance. Unfortunately, despite a lot of discussion and publications around shared decision making and player centred approaches (particularly in rehabilitation literature), the current trend in sports medicine and science seem to be favouring more and more just amassing masses of objective data

and avoiding engaging players to see how they actually feel (Montull et al., 2022). Even the concept of ‘invisible monitoring’ has been suggested with the (albeit well meaning) intention of lessening the monitoring burden on players/athletes (Delaney, 2018). Invisible monitoring has been described as gathering as much information about the player (athlete), their performance, and their current training status without them even knowing about it (Delaney, 2018). However, this means removing the player from the process and by doing so, we actually miss a crucial part of their real lived experiences, making us more susceptible to making ill-informed decisions about their full spectrum of health and performance capabilities (McCall et al., unpublished).

Some of the current author group have recently conducted phenomenological interviews (McCall et al., 2022 unpublished) with world-class team sport players (from both men’s and women’s team sports, including but not limited to winners of the men’s FIFA World Cup, women’s UEFA Champions League, NFL Superbowl, NBA World Championship, Olympic Gold medallists etc). We found that players want to be actively involved in health and performance strategies that will impact their sporting lives and they want to be treated as human-beings, not as just a “number” or “robots”. They need to know what we are doing with their information and to experience something meaningful based on the information they give us. By cultivating strong relationships through compassion i.e. empathising with the player, caring for the player, and acting in response to the player’s feelings (Boyatzis et al., 2013; Boyatzis et al., 2006) we are able to invoke positive emotions within them. This in turn, can encourage players to want to engage with us openly and honestly as performance staff. On the contrary, not demonstrating values to the players appears to invoke negative emotions where they become more guarded and less willing to share information.

Overall, establishing and maintaining regular communication with players to see how they

Pictured: Milos Degenek and Awer Mabil from Football Australia Socceroos (Courtesy of Kyoko Kurihara, Football Australia) are, what concerns they have, convincing them that we have their best interests at heart and ultimately building and maintaining a relationship appears to get player buy-in. Most importantly, they must be involved in decisions about their health and performance.

Recommendations to optimise player information exchange

There is limited scientific evidence to guide our management of the transitioning player, but based on what does exist and largely from our experience, the biggest tip we can give for successful and sustainable exchange of meaningful information is to strive to develop and maintain strong relationships with our colleagues from different teams and also with the players themselves. There is a tsunami of information that can be shared, but we should think carefully, ‘is it worth sharing?’, we are very aware that not all of it is useful. Our philosophy again is ‘minimal data, big value’.

Key points:

- Be aware of and monitor changes in the training structure for each individual player around transitions to and from club to national team - Focus on collecting simple measures and information that can be easily shared, understood/interpreted and instantly interchangeable - Actively involve the player in information exchange - Build trusting and cooperative relationships between teams, clubs and the players themselves, while not easy, it is most likely the best way to ensure quality communication, sharing of complete information and ultimately impact on player care - Work closely with data privacy and legal departments before sharing player information and ensure the player knows they can withdraw their consent at any time

Buchheit M and Dupont G. Elite clubs and national teams: sharing the same party?, Science and Medicine in Football. 2018 2:2, 83-85. Noor D, McCall A, Jones M, Duncan C, Ehrmann F, Meyer T, Duffield R. Transitioning from club to national teams: Training and match load profiles of international footballers. J Sci Med Sport. 2019 Aug;22(8):948-954. Carling C, McCall A, Le Gall F, Dupont G. The impact of in-season national team soccer play on injury and player availability in a professional club. J Sports Sci. 2015;33(17):1751-7. Ekstrand J, Waldén M, Hägglund M. Risk for injury when playing in a national football team. Scand J Med Sci Sports. 2004 Feb;14(1):34-8. McCall A, Davison M, Andersen TE, Beasley I, Bizzini M, Dupont G, Duffield R, Carling C, Dvorak J. Injury prevention strategies at the FIFA 2014 World Cup: perceptions and practices of the physicians from the 32 participating national teams. Br J Sports Med. 2015 May;49(9):603-8. McCall A, Jones M, Gelis L, Duncan C, Ehrmann F, Dupont G, Duffield R. Monitoring loads and non-contact injury during the transition from club to National team prior to an international football tournament: A case study of the 2014 FIFA World Cup and 2015 Asia Cup. J Sci Med Sport. 2018 Aug;21(8):800-804. McCall A, Dupont G, Ekstrand J. Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams’ head medical officers. Br J Sports Med. 2016 Jun;50(12):72530.

McCall A, Pruna R, Van der Horst N, Dupont G, Buchheit M, Coutts AJ, Impellizzeri FM, Fanchini M; EFP-Group. Exercise-Based Strategies to Prevent Muscle Injury in Male Elite Footballers: An Expert-Led Delphi Survey of 21 Practitioners Belonging to 18 Teams from the Big-5 European Leagues. Sports Med. 2020 Sep;50(9):1667-1681. Weiler R, Collinge R, Ewens J, Gouttebarge V, Massey A, Bennett P, Smith K, Ahmed OH. Club, country and clinicians united: ensuring collaborative care in elite sport medical handovers. Br J Sports Med. 2021 Dec;55(24):1383-1385. McCall A. Feasibility study for a multi-team training monitoring protocol. Football Research Group presentation in Madrid. 2019.

Boyatzis RE, Rochford K, Taylor SN. The role of the positive emotional attractor in vision and shared vision: toward effective leadership, relationships, and engagement. Front Psychol. 2015 May 21;6:670. Montull L, Slapšinskaitė-Dackevičienė A, Kiely J, Hristovski R, Balagué N. Integrative Proposals of Sports Monitoring: Subjective Outperforms Objective Monitoring. Sports Med Open. 2022 Mar 26;8(1):41. Delaney J. 2018. https://hiitscience.com/the-paradox-of-invisible-monitoring-the-less-you-do-the-more-you-do/ McCall A, Wolfberg A, Ivarsson A, Dupont G, Laroque A and Bilsborough J. A qualitative study of 11 WorldClass athletes’ experiences answering subjective questionnaires: The secret sauce for maximising health and performance monitoring? (In review). Boyatzis R, Smith L, and Blaize N. 2006. Developing sustainable leaders through coaching and compassion. Academy of Management Learning & Education. 5:8-24. Boyatzis R, Smith ML, and Beveridge AJ. 2013. Coaching with compassion: Inspiring health, well-being and development in organizations. https://doi.org/10.1177/0021886312462236