FOOTBALL MEDIC & SCIENTIST
The official magazine of the Football Medical Association
PERFECT PITCH
The role of the pitch in players injuries
BARRY DRUST Developing a Sports Science Strategy for your Club
2015 FMA CONFERENCE More Details Released
Issue 12: Spring 2015
FMA FOOTBALL MEDICAL ASSOCIATION
Contents
FMA FOOTBALL MEDICAL ASSOCIATION
Welcome 4 Members News 5 Indemnity Update 6 FMA/LMA Health Scheme 7 Touchline Rants 7 On the Couch Dr Gawain Davies
Editorials & Features 8 Focus On Womens Football Kat Wise 11 Perfect Pitch: The role of the pitch in players injuries Dave Rennie 15 2015 FMA Conference: An Update 20 Developing a Sports Science Strategy for your Club: Basic First Principles Barry Drust 23 Ten Great Years: A Thank You Fit4Sport
WELCOME/EAMONN SALMON At this time of year we begin to look forward to our conference event in the close season. The inaugural event last year was exceptional and we aim to repeat this success again this time round.
T
he programme is slightly different in that it is more of a pre-season conference than an end of season get together. This is reflected in the educational content which is geared to offer advice, tips and strategies for delegates to implement ahead of the 2015/2016 season. As you sit down in a couple of weeks’ time to plan next season, what better way to start than to have your ‘medical team’ all together at this event and for them to come away with best practice ideas to implement in the coming season. Needless to say the bar is also a great place for additional learning! The awards ceremony in the evening is a terrific way to recognise our members’ work and commitment to the game. In many ways this was the highlight of the event last year and is sure to be well received again this time round. We are still taking nominations for the award categories (see details in this edition) and I would ask you to send us a quick email nominating your candidates. After all, it is those working in the game that know best what we do and who in their opinion has made significant contributions over the past season. Which brings me nicely on to the theme of member participation within the FMA. The administration is established, the profile is being raised continually and the foundations are firmly set. It is up to you the member, however to play your part in driving us forward. I would ask that in your day to day work you mention the FMA wherever appropriate. Let the managers know we are here. Mention us to the players, to directors and administrators whenever you can. Everyone has heard or knows of the PFA and LMA, let’s make sure the same applies to the FMA. As a member, you are an ambassador for our association so talk about the FMA and the support network that we have established that underpins medicine and science provision in the game. Remember, everything we do that benefits our members, benefits the players, the Clubs and the leagues in turn. The FMA is giving much back to the game. Let’s make sure we are given official recognition.
Eamonn Salmon CEO Football Medical Association
25 Sports Psychology in Professional Football Prof. W. Stewart Hillis 28 A Summary of Recovery & Monitoring in Practice Alek Gross 30 Where are they Now? Stuart Walker
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Football Medic & Scientist Gisburn Road, Barrowford, Lancashire BB9 8PT Telephone 0333 456 7897 Email info@footballmedic.co.uk Web www.footballmedic.co.uk
Cover Image Millwall’s Sid Nelson is examined by physiotherapist Bobby Bacic after suffering a head injury Adam Davy/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.
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Eamonn Salmon
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Administrator
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IT
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Contributors
Gawain Davies, Dave Rennie, Kat Wise, Barry Drust, Fit4Sport, Stuart Walker, Nick Worth, Maggie McNerny, Chris Mortley, Prof. W. Stewart Hillis, Alek Gross
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FOOTBALL MEDIC & SCIENTIST | 3
MEMBERS’ NEWS FMA AUDIT TO GET UNDERWAY
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he FMA is to conduct it`s first medical audit through members concentrating on Medicines management, Infection control and minimum medical requirements. Accordingly the audit will primarily involve Club Dr`s and Sports Scientists and has been meticulously planned over the past 6 months. The audit has been formatted by Stephen Feldman and will be badged as an official FMA Audit. It also has the full support of
the FMA`s administration with confidential response systems set in place to collate, assess, and analyse the responses from members. Steve has enlisted the help of Dr Stefan Kluzek MRCP DipSEM M.Sc.(Oxon) Senior Specialist Registrar in Sport & Exercise Medicine Clinical Research Fellow in Sport and Osteoarthritis, University of Oxford who has already undertaken audit of facility in professional sport. In preparation for this project Steve has contacted all regulatory
bodies involved in medical regulations (CQC, MPS, SGSA, GMC and BASEM) asking them about any regulations or any recommendations regarding service provision including medications on the sports ground. He has also contacted numerous individuals who are involved in SEM at Elite level and across sporting disciplines. The Audit was ratified by the FMA committee at their meeting in January of this year.
England’s World Cup 1966 doctor Neil Phillips dies aged 83
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eil Phillips, the team doctor for England’s victorious 1966 World Cup campaign, has died at the age of 83. Manager Sir Alf Ramsey promoted Phillips from his role as Under 23 team doctor just before the ‘66 World Cup as seniors doctor Alan Bass had run out of holiday and could not join up with the squad for their preparation camp in Lilleshall. Phillips, who was born in Tredegar in South Wales, was England’s team doctor for the defence of the Jules Rimet trophy four years later in Mexico and he was present when Bobby Moore was arrested and mistakenly
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Pictured: Neil Phillips (centre) with jockey A.P McCoy and Horse Racing pundit Derek Thompson in Worcester, 2012.
accused of shoplifting in Bogota. He left the FA in 1974 following Ramsey’s departure. One of the most unusual trophies from his England days was a silver disc for the sales of ‘Back Home’, an English World Cup single that topped the charts for three weeks and lead to an appearance on Top of The Pops with the rest of the squad. Phillips was a former director at Middlesbrough FC and also used to have a surgery in Redcar. A service of thanksgiving took place on Wednesday April 8 in Dr Phillips’ home town of Malvern in Worcestershire.
THE LATEST NEWS ON IDEMNITY
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y the time this edition goes to press the issue of indemnity for physiotherapists will have reached its conclusion ahead of the July 1st deadline. The provision of a ‘Club’ policy for all named medical and healthcare staff will allow members to continue to work after this date with the knowledge that they have full and comprehensive cover in place to undertake their duties at their place of work. Final details will (or have) emerge(d) as official announcements are made and it is likely that the FMA will be party to the dissemination of much of this information to Members in due course. Our role thus far has been to act in an advisory capacity to the insurers, Sempris. As an association however, our duty is to Members and in this sense the FMA need to address one or two issues to ensure members are fully informed. While the “Club Policy” solution will cover members at their place or work, this cover will not extend to any form of practice outside of the Club environment. Nor, the FMA believe, will it cover Members for any disciplinary procedures
and associated legal costs involved in defending such cases. For these reasons, it is important for members to continue to have their own policy as well as the ‘Clubs’. At the moment, the FMA would advise that physiotherapists continue with their CSP policy in order to address these instances as currently there are no competitive alternative policies available. Sports scientists, sports therapists and sports
tissue therapists should also consider continuing with their own respective policies. Some members will be treating players from professional football in private practice or at foreign top two division clubs. It is important that they realise that after the 30th June they will not be insured to do so. The FMA expect an ‘individual’ policy will emerge shortly from Sempris and it is likely this will be hosted on the FMA website for affected individuals to subscribe to. This individual policy will in fact be fully comprehensive and as such would not require subscribers to continue with their CSP or other similar policies. This update merely presents an overview of the situation at the time of press and is not meant to be the definitive word on what has been a necessarily drawn out and confusing process for all involved. We are confident however that the solution that is now in place is the best we could have hoped for in the circumstances and expect full details of the policy and answers to many questions will be given in the coming weeks.
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FOOTBALL MEDIC & SCIENTIST | 5
SPIRE LEAD SPONSOR?
FMA launch Health Insurance partnership with the LMA Members now have direct access to the same healthcare policy as the managers Group policy means preferred rates for members and dependents Underwritten by AXA PPP Healthcare
FMA FOOTBALL MEDICAL ASSOCIATION
Benefits of the LMA/FMA Health Scheme • Competitive rates - cover for you and your spouse/partner/dependents • Choice – two levels of cover, with or without excess, keeping rates competitive • Wherever the job may take you - continuity of cover and protection in future years whilst you are a member of the LMA/FMA Group Health Scheme • Whether working or not - cover still continues whilst you are a member of the Group Health Scheme • 24 hour helpline
• Already have cover? You and your dependents may transfer into the LMA/FMA Group Health Scheme • No medicals required – either when you join or on transfer from an existing scheme • Seamless administration - policy procedures already tried and tested making it easy to join the scheme • Advice on medical conditions, travel vaccination and healthy living
• Member discounts on holidays, days out, retail and many more
You can join at any time by requesting an AXA PPP Healthcare 6 Enrolment Form from Nicola at the FMA on 0333 456 7897
Touchline Rants! e by Pitchside Pet IS THIS THE END?
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ith all the talk of the 39th game in the Premier League and end of season games being arranged, my feeling is how does this all impact upon the poor Medical and Sports Science staff? Several years ago, they looked forward to a few beers, a bit of sun and a couple of rounds of golf in Spain at the end of the season. Now, the holidays are getting shorter and shorter with added games being arranged for the teams when they would previously be sunning themselves. Interestingly this season, the Football League completes a couple of weeks ahead of the Premier League so that the end of the Premier
League coincides with the Play-Off finals. If you are working with a successful Play-Off team or one fortunate enough to have made the FA Cup final, then it all seems worthwhile…for the others it can be a long few weeks on top of an already tough season. And so to the end of the season – that can only mean one thing…pre-season planning. Making sure the pre-season strapping order is prepared and the long term injuries are catered for are essential before reacquainting yourself with your family for a few weeks! Then…and only then…can you reach for a welldeserved celebratory beer and get some sun on your back. You’ve earned it!
ON THE COUCH... FEATURE/DR GAWAIN DAVIES Profession? Academy Doctor at Sheffield Wednesday FC. Full time G.P in Birley, South East Sheffield.
The worst part of the job is having to explain to a player (and often their parents) that professional football is not going to be their career either because of injury or medical problems. I also get to know the players quite well and saying goodbye at the end of their two years at the academy is hard.
When and where did you train? I did my medical degree at the University of Sheffield and trained as G.P in both New Zealand and Doncaster (a bit of an unlikely mix!). I completed a Diploma in Sports Medicine at Bath University and became a founding member of the Faculty of Sports Medicine in 2007. How did you get into football? I grew up in Wales and lived for watching and playing rugby throughout my time in School, University and New Zealand. I was offered the job at Wednesday by the first team doctor who knew I was looking to work in Sports Medicine. Coincidentally my son started playing junior football around the same time and I became manager of his team. Both of the above despite never having played a competitive football match in my life! Previous clubs/employment? I am a one club man; just like fellow Welshman Ryan Giggs. Within Football I have only worked for Wednesday but I have worked as a Sports Doctor in Rugby, Cycling, Taekwondo and Squash. I have been Academy Doctor at Sheffield Wednesday since 2005 and U21
Long term plans for your career? My long term plans are to continue working at SWFC and to finish my Master’s degree – it’s taking longer than it took to build Wembley! Many years and several managers ago I was told I could work full–time when we got to the Premier League -so here’s hoping!
Doctor since 2012. I am also Doctor to a professional Ice Hockey team in Sheffield.
Any changes you’d like to see in the game? I think the change I really wanted to see was meaningful Football to fill the gap between academy and first team football. The advent of u21 teams has been excellent. I’d like to think that it was my idea but that would be a bit cheeky!
What is the best/worst part of your job? The best part of my job is match day and working with great colleagues at the academy. I don’t think it’s noticed how dedicated and hard-working the staff are at football academies. I enjoy the challenge of working with elite sportsmen and especially some of the rare and unusual medical conditions we see in the U18’s.
Most memorable moment in football? My most memorable moment in football... Probably the day I turned up for the academy team-photograph in the past season’s kit .There were about 150 people in blue tracksuits and I was in black. Luckily I was able to borrow new kit for the photo or my mistake would have been recorded forever!
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Pictured: (Above) Liverpool’s Captain Gemma Bonner holds aloft the FA Women’s Super League Trophy after their victory over Bristol Academy in 2013.
focu s ON
WOMENS FOOTBALL FEATURE/Kat WISE (Liverpool Ladies fc)
Kat Wise has already been there and done it - Working in the men`s game with Blackpool and now heading up the Medical and Science Department for Liverpool Ladies. So how did this all come about and how do the working environments compare?
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y football career started as soon as I qualified as a Physiotherapist. I worked for Manchester United Soccer Schools on residential camps and from there several of the coaches asked me to go and work for their other clubs. I started working for Leigh Genesis (formerly Leigh RMI) a non-league football team and Blackpool Football Club on a part-time basis whilst working full-time in the NHS. I was working 5 days a week in the NHS, two nights a week and a Saturday for one team and two nights a week and a Sunday for the other team! Obviously these were
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long days and long weeks but my love of football and my desire to take this career path kept me going. Football is my passion and as I had been brought up standing on the touchline every Saturday and Sunday morning watching my brother playing it was natural to spend all my spare time watching and working in the football environment. It was then that I was approached to work in a private Sports Injury Clinic in my “free time”! I only had one evening free, but accepted nonetheless as it gave me an opportunity to work with various athletes, but in particular runners and triathletes…another string to my
bow I thought, and why not work 7 days and 5 nights a week! Oh and complete an MSc! Working in men’s football was amazing! The lads were always fantastic with me and treated me like a sister! They were very protective and would come to confide in me with any problems they had. Despite the job being hard work, it was always good fun. The lads had a lot of good banter, and believe it or not I was rarely on the receiving end of it! Obviously there were challenges with lack of financial support often being the biggest issue together with the lack of personnel. This meant that I was very often a “lone” worker and lacked the multidisciplinary team of other physiotherapists, sports scientists, doctors, strength and conditioning coaches etc. Going to work in women’s football was a big change for me. I had a difficult decision to make as I was offered another job in a men’s football academy at the same time I was approached by Liverpool. I decided to take the job at Liverpool as it posed more of a challenge, working as the Head Physio of a team associated with a major Premier League club. The set up when I came in was very different to the set-up we have now. There was very little medical provision in place and the team trained part-time in an evening with most working other jobs during the day (including myself!).
Pictured: (Above) Liverpool’s Line Smorsgard takes a shot on goal during a recent FAWSL match against Sunderland Ladies.
The set up now is greatly improved and much more professional. The ladies are now fulltime as are the staff and we train on a daily basis. There are still steps to be made to continue to develop the structure but we are working hard to try and put these things in place.
same. The same issues I experienced in the past are still evident when it comes to lack of personnel. Again I work as a “lone” physiotherapist on a daily basis which obviously makes it a very busy job when you have a squad of 20 players to manage but that’s all part of the challenge!
The role is not too dissimilar to a role in the men’s team; all the fundamentals are the
The support through the rest of the club has been fantastic. The medical teams within the
first team and the academy are always on hand for advice and support when needed and the use of their facilities is a massive help also. To be part of a wider team of Physiotherapists and being able to share their knowledge and skills is something I’ve always wanted to be a part of, and what I hope for in the future, as my development as a Physiotherapist will come through learning from other’s experiences. I feel very privileged to be part of the in-service trainings that go on through the club and this has definitely helped my professional development. The FMA are focussed this year in ensuring medical and science staff from the women`s game play a key role in their Conference. This is the perfect opportunity for all of us to be a part of this flagship event and to integrate with colleagues from all disciplines and across the sport. As they rightly point out, the standards may vary in terms of football, but there is no reason at all why medical provision should be any different. In the end we are all doing the same job! There is no question the profile of women’s football has increased significantly over the last few years and it would be great to see this continue. There are still a lot of differences between the women’s and men’s leagues e.g. less games and less publicity but hopefully all these things will continue to build year upon year.
Pictured: (Above) Louise Fors (centre) celebrates after scoring the opening goal in the 2013 FAWSL Trophy Final.
It would also be nice to see more female professionals involved in the men’s game. I dream of being the Head Physiotherapist of a Premiership team but we will have to see what happens!
FOOTBALL MEDIC & SCIENTIST | 9
Pictured: (Above) The turf at Wigan Athletic’s DW stadium during a Premier League match against Tottenham Hotspur in February, 2010.
PERFECT PITCH ASSESSING THE ROLE OF THE PITCH iN PLAYERs INJURIES FEATURE/Dave Rennie (Leicester CITY F.C.) Frequently, managers, players, and football pundits comment on the possible effects that the pitch may have on both the performance of the team and on the likelihood that the pitch itself led to the injuries sustained by players.
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ne may therefore consider that the natural turf pitch may indeed be a risk factor in itself. However, within the literature its potential role within the injury paradigm remains unclear. Predominantly, knowledge has been inferred through indirect means, such as seasonal injuries biases associated with harder drier pitches 1-3 or through comparative studies on artificial pitches 4-12. Within football there are no studies which objectively assess the hardness of the natural turf
pitch and its affect upon the likelihood of injury. The literature therefore does not support the contention, that the natural turf pitch can be viewed as an injury risk factor. To a large extent this is attributable to the poor methodology adopted and the lack of objectivity regarding the testing of the natural turf pitch 13-14. This article aims to highlight two potential reasons why we should perhaps consider the pitch as a potential extrinsic risk factor for injury within football.
1. Perceptions of those working in the game: Establishing the perceptions of those working in the professional game regarding pitches and injury may provide the basis for further studies. A questionnaire based analysis of over 250 professional players and support staff, provides a brief insight into the perceptions regarding pitch hardness and its effect on injury.
FOOTBALL MEDIC & SCIENTIST | 11
Figure 1, clearly indicates that those working within football perceive the pitch to be a significant injury risk factor. Combining responses that ‘strongly agree with those who agree’ that the pitch can cause injury, illustrates that 80% of players, 99% of physiotherapists and 89% of sports scientists believe there is a link, views which are supported by other staff such as managers/coaches (95%) and referees (100%). Further responses by the players’ highlights some interesting findings with 57% reported having experienced an injury they attributed to the pitch. 73% of players believe pitches have changed over their time in the game, with 70% feeling they are getting harder. In an attempt to accommodate changes in the surface hardness the majority of players adapt their footwear to accommodate for surface hardness (86%). Interestingly, few players (29%) believed that injuries followed a seasonal trend as suggested in the literature 1-3. Of particular note was that the players’ perception of injury risk appeared dependent upon their perceptions of the relative hardness/softness any given pitch (Fig. 2 and 3). Hard pitches were perceived to cause more joint pain (92%) and lead to more abrasions (67%) than softer pitches. Perceptions of likely tendon (40%) injuries were also relatively high which is perhaps not surprising as joints and tendons are exposed to potentially excessive ground reaction forces on such surfaces. Concerns over muscle strains appear to be the highest perceived risk on the softer surface increasing from 38% to 50%. The perceived risk therefore appears non-uniform and as such insults to specific tissue types and resulting injuries may be dependent on the relative hardness or softness of the pitch. Players’ preferences appeared to be for pitches that felt neither too hard, nor too soft as this was perceived to aid their physical performance. It is therefore apparent both players and staff within football perceive pitches to be a risk factor in injury and a determining factor in the way they approach the game. Consequently, there is a need to provide objective pitch hardness data and for it to be correlated with prospective injury information in order to establish if such perceptions have grounds.
Figure 1. Perceptions of staff employed within professional football regarding pitch hardness and injury.
Figure 2. Players perceptions of injuries on hard pitches.
Figure 3. Players perceptions of injuries on soft pitches.
2.Variability in pitch hardness over a season Anecdotal evidence for the effects that grass football pitches have on injury has been reported but no studies have included objective measurement of grass pitches. The adoption of comparative studies, where the temporal grass pitch, is compared with its artificial counterpart, has limited research into the effects of the grass surface and its influence on injury 15. Such research masks the variation within and among such natural turf surfaces.
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This is highlighted well in Figure 4 and 5 where marked variability in both training and match pitch hardness is evident over a full season in the Football League. This brief, single season overview highlights the need for regular objective measures when addressing performance or injuries associated with natural turf pitches in both training and match settings.
Although biomechanical analysis of natural turf is difficult there are trends suggesting that researchers are realising the importance of such work and commencing studies to address the need for data on grass pitches 16-18. Perhaps most pertinently, the literature outlines a negative relationship between surface compliance and energy expenditure
suggesting that the pitch affects the physiological demands, and loading experienced, during any given training session or match 19-27. This may be one link in the chain between pitch hardness and the relative injury risk of each player. Indeed, it may be the foundation for the players’ concerns over pitch hardness. Further investigations examining pitch hardness, energy expenditure, loading, and recovery are required as their interaction will determine likelihood of injury.
Figure 4. Graph illustrating variability in training pitch hardness in a a full season in the Football League as measured by a 2.25kg Clegg Hammer (95 training sessions).
Conclusion It would therefore seem conceivable that the hardness of the playing surface may affect the way in which players approach, perceive, and thereby interact within any given training session or match. The surface hardness appears to effect psychological, physiological and biomechanical demands of the game and thereby the resulting risk of injury. Further studies are needed to collect longitudinal hardness data in a robust and reliable manner, correlating this with accurate injury monitoring. This new knowledge will enable a better understanding of how pitch hardness may affect injury risk. Furthermore, the knowledge gleaned particularly regarding energy expenditure and player load, will aid coaches, physiotherapists, sports scientists and players to maximise performance and minimise injury risk.
Figure 5. Graph illustrating variability in match pitch hardness in a a full season in the Football League as measured by a 2.25kg Clegg Hammer (55 Matches).
References 1. Hawkins RC, Fuller CW. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med 1999;33:196–203. 2. Ekstrand, J, Hagglund, M, Kristenson, K, Magnusson, H, Walden, M. Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: 11 year follow up of the UEFA Champions League injury study. Br J Sports Med, 2013:)0,:1-7. 3. Walden M, Hagglund M, Ekstrand J. UEFA Champions League study: a prospective study of injuries during the 2001-2002 season. Br J Sports Med 2005;39:542–546. 4. Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. BR J Sprts Med. 2011:45(7):553-558. 5. Williams S, Hume PA, Kara S. A Review of Football Injuries on Third and Fourth Generation Artificial Turfs Compared with Natural Turf. Sports Med 2011; 41 (11): 903-923. 6. Dragoo JL, Braun HJ. The effect of playing surface on injury rate a review of the current literature. Sport Med 2010;40 (11): 981-90 7. Ekstrand J, Timpka T, Hagglund M. Risk of injury in elite football played on artificial turf versus natural grass: a prospective two-cohort study. Br J Sports Med 2006; 40:975-80 8. Fuller CW, Dick RW, Corlette J, et al. Comparison of the incidence, nature and cause of injuries sustained on grass and new generation artificial turf by male and female football players. Part 1: match injuries. Br J Sports Med2007; 41 9. Fuller CW, Dick RW, Corlette J, et al. Comparison of the incidence, nature and cause of
injuries sustained on grass and new generation artificial turf by male and female football players. Part 2: training injuries. Br J Sports Med 2007; 10. Soligard T, Bahr R, Andersen TE. Injury risk on artificial turf and grass in youth football tournaments.2010. Scand J Med Sci Sports:6:1-6. 11. Almutawa M, Scott M, George KP, Drust B. The incidence and nature of injuries sustained on grass and 3rd generation artificial turf: A pilot study in elite Saudi National team footballers. Physical theraPy in sport 15 (2014) 47-51 12. Kristenson, K, Bjorneboe J, Walden M, Andersen TE et al. The Nordic football injury audit: higher injury rates for professional football clubs with 3rd generation artificial turf at their home venue. Br J Sports Med 2013, 47:775-781. 13. Petrass, L.A., Twomey, D.M., The relationship between ground conditions and injury: What level of experience do we have? J Sci and Med in Sport, 2013, 16:105-112. 14. Twomey DM, Otago L, Ullah S, Finch CF. Reliability of equipment for measuring the ground hardness and traction. ProceedingsInst Mech Eng. J Sports Engineering and Technology. 2011. Sept,225:131-137. 15. Stiles VH, James IT, Dixon, SJ, Guisasola IN. Natural Turf surfaces: The case for continued research. Sports Med 2009; 39: 65-84. 16. Stiles VH, Guisasola IN, James IT, Dixon SJ. Biomechancial responses to changes in natural turf in running and turning. J Appl Biomech. 2011 Feb;27(1):54-63. 17. Smith N, Dyson R, Janaway L. Ground reaction force measures when running in soccer boots and soccer training shoes on a natural turf surface. Sport Eng.(2004);7:159–67.
18. Kaila, R. Influence of modern studded and bladed soccer boots and sidestep cutting on knee loading during match play conditions. Am J Sports Med. 2007:35(9)1528-1536. 19. Geyer, H, Seyfarth A, Blickhan R. Positive force feedback in bouncing gaits? Proc.R.Soc. Lond.B.(2003);270:2173-2183. 20. Ferris DP, Liang K, Farley CT. Runners adjust leg stiffness for their first step on a new running surface. J Biomech. 1999;32:787–794. 21. Hardin EC, Van Dev Bogert AJ, Hamill J. Kinematic Adaptations during Running: Effects of Footwear, Surface, and Duration. Med Sci Sports Exerc.838-844. 22. Sassi A, Stefanescu A, Mensaspa P, et al. The cost of running on natural grass and artificial surfaces. J.Strength Cond.Res. 2011. 25(3)606–611. 23. Ferris DP, Louie M, Farley CT. Running in the real world: adjusting leg stiffness for different surfaces. Proc Biol Sci. 1998 June 7; 265(1400): 989–994. 24. Katkat D, Bulut Y, Demir M, Akar,S. Effects of different sports surfaces on muscle performance.Biol. sport. 2009:26:285-296. 25. Smith N, Dyson R, Janaway L. Ground reaction force measures when running in soccer boots and soccer training shoes on a natural turf surface. Sport Eng.(2004);7:159–67. 26. Kaila, R. Influence of modern studded and bladed soccer boots and sidestep cutting on knee loading during match play conditions. Am J Sports Med. 2007:35(9)1528-1536. 27. Pinnington, H C, & Dawson, B. (2001). The energy cost of running on grass compared to soft dry beach sand. Journal of Science and Medicine in Sport, 4, 416–430.
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Article reproduced with kind permission of ASPETAR Sports Medicine Journal
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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 Midlands Airport Time to meet your colleagues before the big pre-season starts
F
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
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p R O G R A M M E saturday INTRO 12:30 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 13:45 Trade Exhibition invited to Presentation Eamonn Salmon 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 Galley Nottingham Forest FC 16:15
How to manage end stage return to training following ligament rupture Chris Moseley & Adam Kerr Middlesbrough FC
16:30 When is the best time to operate on ankle ligament injury? Ioan Tudor Jones 16:45 Can end stage rehab be assessed “truly” scientifically. Jo Clubb Brighton and Hove Albion FC 17:00 Debate: How to avoid surgery? Who makes the decision on player welfare? 17:30 Off to the bar and visit sponsors 18:30 Champagne Reception. Get together with sponsors 19:00 FMA Annual Dinner & Award Ceremony plus late bar
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*Awards Categories on p. 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
07:50
U30s start
08:00 Breakfast SESSION THREE - Chair: Barry Drust, Liverpool FC, 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? 09:10
The scientists opinion - Barry Drust
09:20 The physios opinion - Steve Kemp 09:30 The strength and conditioning opinion - Tony Strudwick 09:40 The doctors opinion - Zaf Iqbal 09:50 Debate amongst the membership of the conference 10:30
Morning coffee and visit the sponsors
SESSION FOUR - Chair: Steve Feldman, Huddersfield Town, 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? 11:00 11:20
How to get most out of your team. My experiences The coach. TBA How to get the most out of your athlete physiologically. My experiences The physiologist. Paul Brice
How to get the best out of your team physically 11:40 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 / Committee Member FMA Coach -TBA 12:00 Physiologist - Paul Brice Physiotherapist - James Haycock Doctor - Zaf Iqbal Player - TBA 12:30 Conference finish and closing remarks Eamonn Salmon
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F M A C O N F E R E N C E 2015 FMA 2015 Awards Categories Long Standing Service Award Member Award – Premiership Member Award – Championship Member Award – League One Member Award – League Two Unsung Hero The 21 Club To put forward a fellow professional for one of the above awards please send nominations to Info@footballmedic.co.uk
the 21 club Members are invited to nominate anyone from their Club who has given 21 years’ service to the Medical department. This might include those who are part time and who work with the youth set-up as anyone who demonstrates such commitment is deserving of recognition. Please put colleagues forward by e-mailing us at the address below: Info@footballmedic.co.uk
Pictured: (Above) Last years recipients of the 21 Club.
FMA FOOTBALL MEDICAL ASSOCIATION
For more information visit www.footballmedic.co.uk 18
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Pictured: Manchester City’s David Silva takes part in a pre-match fitness test with Head of Sports Science, Sam Erith, before the FA Cup Fourth Round match against Watford in February, 2014.
DEVELOPING A SPORT SCIENCE
STRATEGY FOR YOUR CLUB
BASIC FIRST PRINCIPLES FEATURE/BARRY DRUST (Liverpool FC)
1.Introduction The top professional teams in the UK no longer rely on just the influence of the team manager, coaching staff and a limited number of medical personnel to influence the outcome of competitive matches. It is now far more common for clubs to operate with a more diverse range of support staff who fulfil specialist roles related to the development of both the individual and the team. Although these individuals can fulfil relatively diverse roles depending upon the club in question, they are frequently categorised broadly as “sport scientists”. The acceptance of sport scientists into football is partly related to the increased pressure to win. This desire for a competitive edge has led clubs to more frequently consider the role that scientific principles may play in the preparation and performance of players. This article will attempt to outline the role that sport science can play in elite football as well as provide some basic guiding principles for the development of a scientific support strategy.
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2.The role of sport science in football The substantial increase in the available research in the last 20-30 years provides the basis for the application of sport science into football. A focus on the preparation and organisation of training as well as pre-game, within-game and post-game strategies are all possible areas of a team’s activity that can be informed by sport science. The monitoring of players on a day to day has become one of the most important areas over recent years. This data is seen as useful as it may determine an individual’s readiness to train/play. This information is not only valued from a performance perspective but is also potentially crucial in the prevention of injuries. Sport science strategies can also help inform the approaches used to develop young players within the sport as well as recruit existing talent from other clubs and countries. This is exemplified by the large role that sport science plays within the development strategies advocated by the Premier League in its EPPP
documentation. It may also have a role to play in operationalising the organisational strategies and frameworks within which all the individuals involved in the club operate (e.g. management and executive practices). Successful sport science support also requires an understanding of the disciplines inherent limitations. While the scientific approach clearly has some advantages over other approaches (e.g. the generation of objective rather than subjective data) it is obvious that it is not capable of providing all the answers to the issues posed to the individuals who support elite footballers in today’s industry. The importance of contextual considerations with respect to the available research information (e.g. the populations on which research data is based, the translation of laboratory based protocols into “real world” settings) can provide real barriers to the development of effective interventions. Sport science can also be rendered ineffective when strategies from other organisations that
have been seen by practitioners are blindly integrated into environments for which they are not suitable. Like any strategy within elite football, sport science is only effective when it is a component of a holistic multi-disciplinary support system that is implemented across the whole club with the backing of key stakeholders (e.g. board, manager etc). It is clear therefore that all sport science strategies should be tailored individually to the players and organisation in question if the chances of its success are to be optimised. 3.Key stages in the development of a sport science programme The development of a sport science support programme requires progression through 3 key stages. These stages help to not only define the scope of the required activity but also ensure the successful revision of the focus of the work as the programme develops longitudinally. The following sections of this article outline the 3 keys areas: • Understanding performance • Identifying areas for consideration • Implementing and evaluating practice 3.1. Understanding performance The starting point for development of a sport science support strategy for any activity is an understanding of the factors that determine successful performance. Performance is especially complicated in football as a large number of factors related to both the individual player and a team’s performance can influence the outcome of matches. An individual’s performance in a game is related to technical and tactical competency, physical fitness and to some degree their psychological make-up. The technical and tactical competency of individuals is of obvious importance as the ability to carry out game specific actions (e.g., passing, tackling, shooting, heading) in relevant parts of the pitch is clearly crucial to match outcome. These technical/ tactical abilities are partly dependent on the physiological characteristics of each player. The physiological requirements that are important are also multi-factorial and include such elements as aerobic fitness, muscular strength, speed, power and flexibility. Such attributes enable players to perform the relevant movements and specific actions across the entire match as well as help to ensure that players can avoid the high incidences of injury that are common in the sport. A player’s psychological make-up completes the list of important performance determinants. Important attributes in this area include aspects of cognitive functioning such as decision making and individual
Pictured: Various resources available to professionals on display at St. George’s Park.
characteristics such as personality. It is very difficult to accurately determine the relative contribution of these three areas to an individual’s overall performance as the relative contribution from each factor will almost certainly very between individuals. It may also be different for a given player across a variety of games. Match outcome (the ultimate indicator of success) is also very rarely a function of a specific individual player’s performance, but rather a composite of the overall contribution of each individual player’s tactical, technical and physical input to the team effort. This may again may be highly variable depending upon the specific requirements of the match. When analysed together, these issues clearly demonstrate that performance in football is very complex. This will mean that sport science support programmes may need to be multi-factorial and aimed at both individual players and teams as a whole. 3.2.Identifying areas for consideration Effective sport science support programmes will frequently include a number of areas of specific focus in an attempt to improve performance (as discussed above). The three key areas that determine performance (technical and tactical skill, physical fitness and psychological attributes) can in turn be
Figure 1. Important areas for consideration in applied sport science support programmes in football
influenced by considerations such as the nutritional support of players. The role of effective strategies for injury management and prevention is also vital, as these can impact both individual player and team selection. Figure 1 provides a representation of the major areas that are frequently included in sport science support programmes within professional clubs. It is often difficult for a sport science support programme to address multiple areas of consideration in a lot of detail. It is therefore preferable to employ either a very broad “light touch” strategy across a number of areas or to select one specific area of focus to address initially. The choice of these approaches will be dependent on the organisation in question and/or the philosophy of the lead sport scientists. The individual practitioner’s characteristics (e.g., skill base, level of knowledge, personal philosophy) and the specific requirements of the individual players and the club will also play a role in this choice. For example, successful teams at the highest level that face large number of fixtures in short time scales may strategically target physiological and psychological recovery strategies while teams with fewer competitive fixtures and poor fitness levels may concentrate on physiological development. While it will be the ultimate aim of the sport science strategy to influence all of the different areas of performance that it is possible to do it must be accepted that the best strategies tend to build on the basis of progressing from initial “quick wins”. Such quick wins should be based around a selection of the area in which the biggest improvements can be made for the minimal individual and organisational input. The right initial starting point may not only provide a platform for future areas of action but create a fast route
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Pictured: Burnley’s Head of Sports Science Mark Howard oversees the warm up before their clash with Queens Park Rangers at Loftus Road in January, 2014.
to the acceptance of the benefits of sport science with key stakeholders. 3.3. Implementation and evaluation Once decided, interventions then become a product of the applied practitioner(s) ability to take relevant scientific information and apply it within the environmental constraints. Such constraints are a function of a large number of factors that include the culture of the club, the philosophy of the coaches, the attitude of the players and the available resource (as discussed previously). The most effective systems will integrate any individual areas of action into a multi-disciplinary programme of player support. This is done most effectively when there is communication and consultation with other key departments within the football club (such as the medical department or the performance analysis section). Anything that is implemented should be exposed to regular evaluation. Figure 2 shows a simple cycle of action that enables the effectiveness of any strategy to be assessed. Implementation must be accompanied by attempts to analyse the influence that the new practice has on key performance indicators/strategy. This analysis may take the form of regular discussions between key sports science
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staff and/or formal or informal feedback from significant others such as players and coaches. Ideally the implementation of any procedure should be accompanied by an applied study aimed at collecting objective data regarding both the impact of the new process and the nature of any important outcomes. This process should enable clear decisions to be made regarding the cost/ benefit analysis of the strategy that has been put in place. Clear outcomes from such
Figure 2. A simple action cycle for the evaluation of the effectiveness of a sport science strategy
projects provide the only real platform form the development of sport science strategy that has been implemented. It is also a beneficial way of providing proof of concept and records of action for the hierarchy of club. One aspect of the implementation strategy that is frequently over-looked is the importance of the management of the interpersonal aspects of the programme. Change, in any form is difficult for individuals to experience. This may be especially the case when new procedures are seemingly in conflict with the established dogma both organisational and individually. The management of the change process is therefore of the upmost importance in ensuring its success. Essential to this is the clear communication of ideas and practices amongst all interested stakeholders. These interpersonal skills are clearly not specifically related to the discipline of sport science. They obviously are more linked to an individual’s interpersonal skill base. This would suggest that sport scientists within professional sporting organisations need a broad generic skill base that includes things such as leadership, communication, delegation, negotiation, and conflict management as well as the relevant theoretical information.
Thank You for 10 Great Years FEATURE/FIT4SPORT Medical supplies play a key role in the life of a football medic and heaven help the Physio who doesn’t have a player’s favoured bandage or matching sock tape on match day. No-one knows that better than the team at Fit4Sport, who this year celebrate their 10th anniversary.
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he company, which has been a great supporter of the FMA since its launch, has made a major impact in the sports market, with professional football playing a key role in the Royton based business. Managing Director Shelley Wildbore and Sales Director Liz Armer have learned over the years the importance of putting the customer first. ‘Professional football is such a demanding business and we know there are huge pressures on the medical staff,’ said Shelley. ‘Our approach has always been that we will go the extra mile to help someone out, even if it means driving to a ground on match day or in the evening to get them out of a tight spot’. Such a philosophy has undoubtedly stood the test of time. Matt Radcliffe was Fit4Sport’s first customer. ‘He was at Crewe Alexandra when we started’, recalled Shelley ‘and as he became more experienced, moves followed to Preston and Southampton. Today, he is back in the North West with Manchester United and we are delighted to still be working with him’. Fit4Sport, like Manchester City, the first Premier Division Club on their books, has also experienced a meteoric rise and considerable expansion. Just as City outgrew their old stadium so Fit4Sport felt the need to expand. ‘The company was originally based in Oldham but the demand for bandages, tapes, oils, lotions and every medicine you can possibly think of soon outstripped the space we had available’ said Liz.
‘Clubs need a very quick turnaround, 24 hours or less, so we have to carry a large stock. Finding new premises in 2011 became a happy necessity’. Life in the professional game as we all know is not always a bed of roses. The sacking of managers can be a precarious time for backroom staff but some clearly have staying power. ‘Yes it’s always very tough when someone has to move on unexpectedly,’ said Shelley. A number do come to mind though who have been with the same club, they’ve worked with us over the last decade and have become great friends to the team- Chris Moseley at Middlesbrough, Dave Fevre, Blackburn, Phil Horner, Blackpool, Dave Moore, Grimsby, Andy Thorpe, Rochdale and of course Derek Wright at Newcastle’. ‘There are also several physios who have had a number of moves over the years but happily they have continued to work with us,’ added Liz. ‘Steve Kemp, Dave Galley, Rob Price, Nick Worth,
Ally Beattie, Lee Nobes, Neal Reynolds and Mark Leather to name but a few’. The medical football market is of course not just about the professional game as Shelley is quick to point out. ‘Our reputation with professional clubs has been a great help to us in non league football. In fact our first non league order was with FC United in 2005, which coincidentally was the year they were founded. Its to continue this working relationship and share this special 10th anniversary with them too.’ Behind every successful business there has to be a strong support team backed up by a quality range products. Fit4Sport seems to have this in spades. Both recognise this all too clearly. ‘Yes, we have a brilliant team of 10 staff and we do have a lot of fun,’ said Liz. ‘Our suppliers are also really important to us and many such as BSN, Mueller, Silipos and Donjoy have all stood the test of time, notching up their 10-year medal too’. So what do the next 10 years have in store? The charismatic pair laugh at the thought but for now it is all about 2015. ‘I think all we both want to say is a huge thank you to all our customers for their amazing loyalty and ten brilliant years’. Congratulations to Shelley, Liz and the Fit4Sport Team and see you all at the FMA Conference in June.
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Pictured: England Sports Psychologist, Bill Beswick, talks to Assistant Manager Terry Venables in 2006. The manager, Steve McLaren, previously worked with Beswick whilst at Middlesbrough.
SPORTS PSYCHOLOGY
in professional football FEATURE/Prof. W. Stewart Hillis (COURTESY OF UEFA MEDICINE MATTERS) The concept of a “team behind the team” in club and national team football has stimulated the integration of medical support groups working closely with coaching staff. Together they take care of the preparation and well-being of their players to produce optimal individual and team performances and the best possible results.
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he physical preparation of players has improved with medical advice and the integration and development of nutritional support, fluid balance and sports science. With the ever increasing speed of the game, managing acute injuries remains a challenge, but it has been greatly helped by appropriate imaging techniques and medical treatment allowing the development of playerspecific rehabilitation programmes. In club teams, day-to-day contact is made with the players, personal relationships are established, individual personalities and attitudes to injury are familiar, and there is ongoing daily interaction between the doctor, physiotherapist, player and coach. General support can be given to injured players by listening to their concerns, giving them reassurance and setting them early goals that are challenging but achievable. In addition, strategies can be developed to
counter setbacks and unrealistic expectations. Documentary evidence of successful treatment can be given and positive communication can be established with the coach, whose main interest is inevitably those players who are fit and available for team selection rather than with those with injuries. Other tangible support may be given by suggesting facilities and services available to help rehabilitation. Coping mechanisms may be developed with regard to a certain player’s performance, and support can be given in case there is a medical reason, such as injury or overtraining, for their not being selected or for their poor individual performance. Continuity of care and contact is maintained. The medical management of national team players poses different problems. When a player reports for international duty, the first step is to examine them for carry-over injuries and, if need be, decide whether they
should return to their club or remain with the national team for treatment. Early imaging can facilitate clinical decisions to the advantage of all. It is appreciated that players are on loan for international duty and the national team’s medical staff therefore keeps club medical staff up to date about the condition of their players. A player’s commitment to their national team is usually absolute and bolstered by the expectations and positive feedback of family, friends and club coaching staff. This may, however, be influenced by their attitude towards playing friendly matches within a very busy club season of competitive domestic and international matches. The club versus country issue may also be aggravated by pressure from their club coach about the risk of injury in a non-competitive match and the subsequent possibility of losing their place in the club’s starting lineup.
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Psychological management of athletes In light of these observations, physical assessments and clinical treatment need to be complemented by means of a holistic approach to players that includes psychological management. Sports psychology has an important role to play in the management of both individual and team athletes, although this medical specialism has been most widely applied to individual sports to date. The psychological management of footballers has thus far generally been assumed by motivational consultants whose training and background vary. The preparation of any athlete includes psychological elements such as concentration and goal setting, mental rehearsal, precompetition routines, rituals for managing anxiety and coping strategies for success, failure and potential injury. The specific application of these techniques varies greatly across sports, as does the level of support available from coaches and medical staff. Below are a few examples: •
In individual track and field athletics, athletes are able to compete on the basis of their own abilities on the day of the competition and their preparation and individual performance allow them to remain in control. They are also available most of the time for advice and support from their coach.
•
In elite tennis, particularly in singles competitions, a coach can give encouragement and advice to promote their player’s confidence between points. Players can develop their own rituals, for example the number of times they bounce the ball before serving, and they can use the time between serves to hurry or delay play. In doubles, each player can communicate verbally and non-verbally with their partner regarding the placement of serves, and after a winning point this can be complemented by high fives and fist bumping. Fluids and snacks can be
Pictured: Liverpool’s Daniel Sturridge has suffered several injuries whilst on England duty, prompting club versus country debate.
•
In golf, visualisation can be practised and utilised, particularly in putting, whereby the player conjures up a mental picture of their next strike, the potential line of the ball and its drop into the hole. In some team sports, the format of the game also lends itself to encouragement and support from other players and coaching staff. In cricket, discussions can be had
Pictured: Valencia’s Santiago Cañizares ‘makes himself big’ to offput Bayern Munich’s Mehmet Scholl in the 2001 Champions League Final. Cañizares faced 9 penalties, saving 4 (including this one in normal time), yet Valencia ultimately lost in a penalty shootout 5-4.
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and support can be given to a bowler by the captain and other players between balls and after a wicket has been taken. Discussions and encouragement among batsmen are also possible between shots.
given between points and interaction can be had with the coach to build or repair confidence.
•
In American football, the division of the teams into defence and offence means that mutual support can be given between each play. The stop-start nature of the game and the rotation of players also mean that there is a greater chance for players on the field to be encouraged from the sidelines and more opportunities for those not in the starting lineup to be introduced during the game.
The general principles and practices of sports psychology can also be applied in both club and national team football and the development of individual players can be supported by individual members of the “team behind the team”. The main psychological qualities required in football include sustained concentration, i.e. the ability to remain focused before, during and after each game. This is a special challenge in football, where players may face up to 60 competitive matches a year (compared with perhaps four or five competitions a year in track and field athletics). Players who are regulars within their club teams have the opportunity to build self-confidence, which promotes perseverance in difficult situations. They can also influence the team’s overall performance by showing enthusiasm, assuming responsibility and taking a positive approach. Selection for the national team, however, creates a new set of potential problems, not least as a result of the increased level of internal and external expectations.
Pictured: Uruguay’s Luis Suárez, who overcame knee surgery to score a brace against England in the 2014 World Cup. He was subsequently banned for biting Italy’s Giorgio Chiellini in the next match.
Psychological management on the national team Promising young players may be brought into their senior national teams to gain experience in that environment, knowing they are unlikely to play. Just being selected will be enough to satisfy their immediate ambitions. Better established players that are regular starters for their clubs will have different expectations. They are generally in control of their game, which, at club level, allows them to produce their best performances. When they are promoted to the national team and are challenged at a new level, different psychological problems are met. All elite players secretly feel they are the best in their position, otherwise they would not survive the pressures of the modern game. Each also has their own strategy for preparing for a game, all the while knowing that these individual preparations may feel like a waste of time if they are then not selected to play. This leads to a period of uncertainty leading up to kick-off which could be called the “worst three hours”. It is perhaps best illustrated by walking through the build-up to a national team match. As matchday approaches and the national team is preparing, the nation is buoyant with the natural excitement of international competition. The match is a sell-out and seats at a premium. Family, friends and acquaintances contact the players, coaches and backroom staff with requests for tickets; knowing one of the players is a great source of pride for family and friends looking forward to the big game. Within the squad, the mood is good. Training is going well, with the usual increase in focus among the players, many of whom are rivals at club level but, perhaps surprisingly, bond on the national team and enjoy the novelty of playing side by side. During training, it is very important for the coach to size up those likely to be in the
starting 11, but if this happens too soon it can send messages to the players regarding their chances of starting the game. This is particularly the case if the team’s preparation follows a regular pattern, and it may result in some players withdrawing or responding aggressively to a perceived rejection. The potential of not being selected can lead to anxiety or anger which may be focussed on the coach and backroom staff. Not only may these negative thoughts be evident while with the national team; they may also influence the player’s attitude when they return to their club. If they were not involved in the match at all, they may feel that the week of preparation could have been put to better use as a break, with minimal club training and increased family time. The players will know who is in the starting lineup the day before the match at the latest, as specific roles and positions must be determined. The squad as a whole, however, comprises 26 players (typically 3 goalkeepers and 23 outfield players). In addition to the starting 11, 7 will be selected for the substitutes’ bench. The other 8 will be in the stands and play no role in the game. Ideally these unselected players should remain upbeat and supportive of the team but it is often difficult to overcome the extreme disappointment of being left out. It is important for the coach to know how to deal with these players and how to tell them they have not been selected. Approaches vary but all rely on each player’s team spirit and commitment to the squad. Ideally the coach should have one-to-one discussions with the players to explain the decision and give them time to come to terms with it, so that the impact of the “worst three hours” can be minimised. In the immediate build-up to a game, however, this may not be possible. The substitutes may not be announced until the team’s last meeting before the game and
this meeting is often not attended by the medical staff, who are unaware of the chosen substitutes and therefore do not target the others with appropriate support. The substitutes may even be announced on arrival at the dressing room. The medical staff’s priority is to support the players involved in the match, but they must also think about how they can help the others. This can be difficult and their direct contact with the players may be limited as they prepare the medical equipment for the game, but small things can be considered. Below are just a few examples: •
Unselected players should stay in the dressing room until the others start their warm-up.
•
If the squad has numbered drinks bottles, those of the unselected players should be subtly removed and not noticeably discarded, so as not to emphasise the unselected players’ exclusion.
•
With the help of administrative staff, the unselected players should be guided to the appropriate area in the stands and have easy access to the dressing room at the end of the game. If possible they should sit with the members of the medical staff not on the bench, so that team cohesion is maintained.
In summary, the medical “team behind the team” cannot have a direct influence on the result of a match, as this depends on the coach’s tactics and the players’ performance. However, through preparation and foresight they can play an important part in maintaining the confidence and physical and psychological well-being of the squad as a whole.
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Pictured: Chelsea striker Diego Costa takes on fluid during a Premier League clash against Stoke City. Costa scored an incredible 7 goals in his first 4 Premier league appearances this season.
a summary of recovery
& monitoring in PRACTICE FEATURE/ALEK GROSS (SOUTHAMPTON FC)
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ny training or match bout has the potential to initiate performance related adaptation and fatigue effects. In order to ensure continued high levels of performance and continual positive training adaptation, the careful balance between training load and recovery needs to be achieved (Jeffreys, 2005). To allow players to achieve optimal performance, proactive planning of training loads, in addition to systematic planning and integration. Football involves a combination of physically demanding activities such as sprinting, high speed running, accelerations, and decelerations, changes of direction and high levels of overall volume in addition to technical factors that result in post-match fatigue. This post match and post training session fatigue is linked to a combination of muscle damage, dehydration, glycogen depletion, dampened neural drive and mental fatigue
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(Nedelec et al. 2012). The magnitude of the fatigue experienced by players is affected by extrinsic factors such as match results, quality of opposition and playing surface and intrinsic factors such as training status, age, maturational status and muscle fibre typology. It is also important to consider that non-football stressors such as exams, family life and travel can also increase both the subjective and objective fatigue felt by and player and this too needs to be acknowledged and considered within an individual’s overall training and recovery plan. Recovery and its practical application revolved around Seyle’s (1945) General Adaptation Syndrome (GAS). To prepare players for maximal performance, coaches and sports scientist must regularly challenge the boundaries of what the players can achieve and what their bodies can tolerate. Training loads or stress below the considered optimum thresholds are insufficient to
produce positive physiological adaptations. However, continued training loads above the optimum, with insufficient time for recovery may lead to overtraining, which is linked with poor performance and injury. The time for recovery needs to be correct within sessions, between sessions, within weeks across months and between seasons in order to maximise performance. Therefore, as a sports scientist we must be able to quantify training loads in order to prescribe the stress or load appropriately, monitor the players to assess how they have reacted to this load and prescribe appropriate recovery methods to ensure players have achieved normalization of function. Ultimately the aim is to calculate an individual’s dose response to training and stressors. This will allow the appropriate recovery methods to be utilised and allow us to prescribe training volumes, intensity and frequency at appropriate levels.
The main cornerstones of recovery are “train right, eat right, sleep right” with the other recovery methods available being supportive of these macro strategies. The correct prescription of training loads is based around sound periodization principles where players are allowed to tolerate a capacity for workload which automatically accelerates recovery and adaptation. Training load can be prescribed via frequency, duration and intensity at a very basic level with the integration of RPE, volume load (RPE X duration) and more advanced information via GPS data and HR data etc. allowing a more in-depth and prescriptive element to the planning of training. In order to ascertain how the players have reacted to the prescribed training stimulus it is important to use a battery of monitoring tools to access how they have reacted to the training. Over time we are able to develop a fingerprint of how player should react to certain stimulus and we can prescribe recovery methods as appropriate. We can also identify when players don’t react in their ‘usual’ way which in a positive way means we may be able to add additional training load, but could also be a negative response at which point training load would need to be reduced. We monitor players using a range of methods including daily well-being questionnaires, session RPE, volume load, GPS variables, hydration status, adductor squeeze test, body composition, neural fatigue tests and body load and HR response to pre-determined drills. This data is collected and individually correlated against training loads to develop a usual dose response as identified above. These are all simple methods of assessing preparedness to perform and levels of fatigue and are selected as they give meaningful data that can be used and integrated quickly. Whilst these numbers are databased, the numbers we gain through the monitoring system are often used to stimulate and inform conversation with players. It is important to remember that whilst numbers and figures give important objective information, we are coaching players and not spreadsheets, and discussion with a player is still an extremely important tool in monitoring.
Figure 1: Seyle (1945) General Adaptation Syndrome In addition to planning training we do educate players on appropriate recovery methods. If sleep is poor then the ongoing cycle of under recovery and elevated physical loads is likely to cause an imbalance linked to overreaching, overtraining and fatigue related injury. On a more acute phase, short term sleep deprivation is known to negatively affect cognitive function, decision making and neural function which are linked to injury risk and poor football performance. Sleep deprivation or disruption of over 64 hours has been linked with lover levels of power and strength which also cause performance concerns and heighten the risk of injury. Poor sleep has also been correlated with increased cortisol and decreased growth hormone levels and elevated risk of illness. Poor sleep also has a negative impact on nutrition which a further pillar of recovery. We assess sleep quality via a daily well-being questionnaire with persistent issues followed up with more precise sleep assessment via wrist actigraphy. Players are given education and instruction on sound sleep hygiene and sleep kits are provided to players when required. Nutrition is the third pillar of recovery. Complete restoration of fluid balance a match
is important as the loss of intracellular volume seen after intense exercise reduces the rates of glycogen and protein synthesis. Approximately 150% of the fluid lost during exercise needs to be consumed with the addition of sodium (500-700 mg/L of water) to rehydration drinks encouraged as this promotes fluid retention and thirst. An intake of protein is required immediately after exercise to ensure a positive protein balance is achievable to rebuild damaged muscles and carbohydrates with a high GI should be eaten as soon as possible after intense exercise to allow the resynthesis of blood glycogen stores. In addition to this we encourage nutrients high in tryptophan and melatonin to encourage sleep and also foods high in polyphenols and antioxidants to quicken the recovery of the body. In addition to already stated, we do also encourage micro recovery strategies including cold water immersion, contrast bathing, active recovery, compression garments, massage and stretching. However, the focus will always be on selecting the appropriate training stimulus at the appropriate time, managing sleep and eating correctly. Take home messages: • Performance is an outcome of the careful balance of stress and recovery. Be aware of all the stresses that may cause fatigue in your player. • Use a selection of monitoring tools to assess the fatigue of a player. Fatigue affects various systems; therefore the monitoring tools should reflect that. • Longitudinally track how your players response to training stimulus. Reacting differently to the same stimulus is the trigger to alter training load. • Collect data to inform your practice. However, remember the player behind the athlete, often speaking to the player exceeds any other monitoring option.
Pictured: Birmingham players warm-down on the pitch after a pre-season friendly against Inverness Caledonian Thistle in 2014.
IN ASSOCIATION WITH
FOOTBALL MEDIC & SCIENTIST | 29
WHERE ARE THEY NOW?
At Villa, I also worked with Brian Jones, Gordon Cowans, Kevin McDonald and Tony Mcandrew. We also had great young players there such as Boaz Myhill, Liam Ridgewell, Steven Davies and Gary Cahill; who all went on to great things and during this time we won the F.A. Youth Cup.
How did you get into the game? I came into football as an apprentice professional footballer in the junior team at Leeds unfortunately I left and moved onto Doncaster Rovers and finally York City, where I finished with an Injury which led me into a marvellous profession physiotherapy.
Finally Alan rang me to say Doug Ellis wanted to know what I was doing and if I wanted my job back and when he finally saw me his words were, ‘the grass isn’t always greener on the other side’, wise words indeed.
FEATURE/STUART WALKER
David O’Leary was then manager and he moved me to the first team. The sports scientist back then was Steve McGregor who now works with Lee Westwood and Rory McIllroy in the golfing world.
Where did your physio career start? My first job was with Barnsley Football Club where I worked along side the great Bobby Collins. Mick McCarthy was a player in those days; a great person and a proper Yorkshireman. During this time I was also doing the F.A treatment of injuries course at Lilleshall which allowed me to work in the sport. This was a fantastic course run by the late Paddy Armour, then Graham Smith, and finally Alan Hodgson. This course helped me and gave me a fantastic foundation in treating and managing sporting injuries. From there, where did it take you? I left football to go into Rugby League. At the time all I wanted to do was play football and unfortunately I couldn’t, so my interest in the game was waning. To get back on track, Rugby League felt like best road to travel down. I joined Castleford, who at the time were coached by Malcolm Reilly, a great player and coach not only in Great Britain, but also in Australia where he is still a legend. I was there for over 5 years and we won numerous trophies cumulating in us winning the Challenge Cup in 1986. I then moved onto Leeds RLFC. In those days rugby was a winter sport so in the summer I also helped out with Yorkshire County Cricket Club and was also asked to help out Dave Roberts, the England Cricket physiotherapist, during a test match against Australia. This was fantastic experience during my early days in sport. Any stories from your time in Rugby? At the time you were allowed to run onto the field of play during the game to treat injuries. Malcolm always told me to run in the oppositions line so if I ran in their line it would disrupt their play. It’s illegal now, but not in those days. Unfortunately it got me into many scrapes; I remember running on at Swinton and running into a centre called Danny Wilson and knocking him over. This same Danny Wilson is the great Ryan Giggs father!
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Eventually I left to go to Derby County with John Gregory, but it all went pear-shaped. It was a shame because Derby is a great club and they had good people working there at the time.
Finally Doug sold the club and Randy came in; a fantastic person. He brought in somebody who was an absolute inspiration to me, not only as a manager, but as a true friend; Martin O’Neill. He changed Villa from being a big club in name only, into genuine contenders. We went to the new Wembley twice; what a difference from the old regime. When he left, it was a sad day and leaving with him were top people such as John Robertson, Steve Walford, Seamus Mcdonaugh, and Ian Storey Moore. Pictured: Stuart pictured during his time at Chester City FC.
Where Next? Eventually I left for Chester City where I worked with Harry McNally, who gave me a good grounding in the new world of football and physiotherapy. I was a physio, a masseur, a kit man and a scout; a million miles from the premier league but non-the-less happy days! I then worked with a great football legend Kevin Ratcliffe who allowed me to continue my education at Salford University. When I finally got my degree, he said ‘now’s the time to move to the Premier’ and he got in touch with Peter Reid who took me to Sunderland. What a top man Reidy was, he took me under his wing and looked after me. Every day without fail he made me laugh. He was a brilliant person and a real character. There I also met Niall Quinn, Kevin Phillips, Steve Bould, Thomas Sørensen, Kevin Kilbane and Gavin McCann. Finally, I left due to family circumstaces and went to Shrewsbury with Kevin. How did you begin your association with Aston Villa? I got a phone call from an old pal Jim Walker, who asked me if I wanted to come to Villa and work at the Academy, and it changed my life forever. Thank you to Jim and also Alan Smith who I worked alongside; it was a magical moment in my life.
Then over time Gérard(Houllier), Alex(McLeish) and then myself all had to say goodbye to a wonderful club with such fantastic and lovely people. Don Revie always said ‘a club is like a family nobody is bigger than the tea lady, stick together through the good and the bad times.’ Sometimes, it feels like we forget that it’s togetherness that is often the key to success. What are you doing now? At present I work in a busy private practice in Chester two days a week and the rest of the week you can find me either volunteering to mow the grass in the local church yard or on the golf course. From tending to multi-million pound players to tending the church yard; I still get a kick from the manicured church grounds. Final thoughts on your time in the game? I can honestly say I have never had a bad time in sport. Lifes experiences have told me how to be caring treat others like you want to be treated yourself, something you always need as a physiotherapists not only in professional sport but in life in general. Thank you Football from the bottom of my heart for allowing me to see things I would never have seen, from being in this wonderful game.
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