Football Medicine & Performance by Football Medicine & Performance Association

football medicine & performance The official magazine of the Football Medicine & Performance Association

Issue 26 Autumn 2018

Exclusive: Are we squeezing the life out of adductor monitoring

In this issue: Cardiac Screening Life After Football

Legal

Contents Welcome 4

Members’ News

Features 5

The Barcelona Way Damian Hughes

Research and Development What you should know about R&D

Cardiac Screening Saves Footballers’ Lives – But We Can Do More David Oxborough

Are we Squeezing the Life out of Adductor Monitoring Gary Silk

CHIEF EXECUTIVE OFFICER The launch of the FMPA Register is the culmination of much endeavour by the FMPA team and we are delighted with the response to date and the momentum that is starting to build. The Register was largely designed as an initiative to support members who leave the game often at a time of real need, giving them a platform to showcase their experience, helping them to maintain a presence in the game and supporting their private practice ventures. The needs of these members are clearly different to members in full time posts, hence why the register was set up as a separate entity and viewed as a potential bolt- on to membership, to be used as required. Continued support for colleagues, whether currently in the game or not, is what the FMPA is all about. Our membership is hugely diverse, covering more than a dozen disciplines, with a variety of specific needs. While this can be challenging at times, our profound belief is that ALL disciplines providing health care services to players and Clubs have an important role to play and individuals therein are an invaluable part of our membership. The change of title to FMPA underpins this belief. It is in working together that we have strength as an organisation and a significant voice in the professional game.

What do sports medicine professionals working in football need to know about sport psychology? Dr Caroline Heaney

The Supply of Medicines to Sports Teams Roni Lennon Bsc

The FMPA Register

Life After Football – Rob Swire

A Commonly Misdiagnosed injury – Lisfranc Fracture Dislocation in a Professional Soccer Player Ashley Jones MSc Rodger Wylde BSc Richard Moss MSc

One of our main aims has always been to improve standards but there are many questions still to be addressed; areas such as governance, indemnity, safeguarding, fitness to practise and the increasing `brain drain` of skilled practitioners from the game, to name but a few. We should be very concerned that, in some areas, standards are actually falling Some of this is centred around cost saving measures at clubs who seem to think that as long as they have the minimum requirements in place, then everything is ok. Let me give one example for all to consider. If healthcare insurers determined long ago that their members (the public) can only be treated by practitioners who have a minimum of 5 years post graduate experience, why is it that `football` is happy for new graduates to treat professional players the day after graduation?

The (Return to Play) Times, They are a Changin’ Markus Waldén Clare Ardern

While the foundations of the FMPA are firmly in place, all Medical and Performance practitioners working in professional football should recognise the role that the FMPA is playing and grasp the opportunity, not only to take the organisation forward, but to be an even louder voice in the game, raising standards to the world class level that you all deserve.

Eamonn Salmon CEO Football Medicine & Performance Association Football Medicine & Performance Association 6A Cromwell Terrace, Gisburn Road, Barrowford, Lancashire, BB9 8PT T: 0333 456 7897 E: info@fmpa.co.uk W: www.fmpa.co.uk

Chief Executive Officer

Eamonn Salmon Eamonn.salmon@fmpa.co.uk

Executive Administrator Lindsay Butler Lindsay.butler@fmpa.co.uk

COVER IMAGE

Swansea City’s Martin Olsson on the ground after picking up an injury. Richard Sellers/EMPICS Sport/PA Images Football Medicine & Performance Association. All rights reserved. The views and opinions of contributors expressed in Football Medicine & Performance are their own and not necessarily of the FMPA Members, FMPA employees or of the association. No part of this publication may be reproduced or transmitted in any form or by any means, or stored in a retrieval system without prior permission except as permitted under the Copyright Designs Patents Act 1988. Application for permission for use of copyright material shall be made to FMPA. For permissions contact admin@fmpa.co.uk.

Project Manager

Angela Walton Angela.walton@fmpa.co.uk

Design

Oporto Sports - www.oportosports.com

Marketing/Advertising

Charles Whitney - 0845 004 1040

Photography

PA Images, FMPA.

Contributors

David Oxborough, Gary Silk, Dr Caroline Heaney, Roni Lennon Bsc, Ashley Jones MSc, Rodger Wylde BSc, Richard Moss MSc, Markus Waldén, Clare Ardern, Damian Hughes.

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FMPA PARTNER WITH KICK IT OUT –

The FMPA is delighted to support Kick It Out. For the last 25 years Kick It Out has been at the heart of the drive towards equality, inclusion and cohesion for everyone who plays, watches or participates in football. Having started as ‘Let’s Kick Racism Out of Football’ in 1993, it has evolved into an organisation which – working alongside its partners The FA, the Premier League, the English Football League, The Professional Footballers’ Association, the League Managers Association and the Football Supporters’ Federation, among others – fights all forms of discrimination in the game we love.

Since its inception, Kick It Out has provided a clear, independent voice within the game to challenge discrimination and exclusion, as well as education for professional players, clubs and staff, fans, grassroots organisations and beyond. The organisation also provides mentoring and guidance to help underrepresented groups participate in football and secure opportunities to develop a career in the game. Kick It Out has established an equality framework for professional clubs, supporting the development of equality practices and policies, and enabled more effective reporting and investigating

info@fmpa.co.uk

of complaints of discriminatory abuse through its pioneering reporting app. However, despite 25 years of progress, hatred, prejudice, abuse and discrimination are still evident in our society and in football. In the 2018/19 season and beyond we want everyone involved in football to continue to campaign for equality and challenge discrimination, while playing a part in shaping a fair and inclusive future for everyone who loves the game. Let’s kick racism and discrimination out of football – together.

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LIGHTFORCE® Wolverhampton Wanderers achieved promotion to the Premier League with one of the lowest injury rates in the Championship last season. fcbusiness speaks to 1st team physiotherapist Oliver Leaper, about his use of laser treatment within the medical department. How long have you been using your LightForce therapy laser and what ailments is it used to treat? We introduced the system to our medical department in November 2017 and all of our therapists were trained in its use when we purchased it. It’s primarily used to treat acute and chronic musculoskeletal problems but we also use it for pre-training and on the rehabilitation of players that we have in the department. Due to it being a Class 4 therapy laser, it’s very good for a range of deeper musculoskeletal problems or injuries because the infrared light can penetrate more deep tissue structures. We deal a lot with sub-acute muscle injuries, so in the initial acute stage, we use it to speed up the recovery of those problems. We found it very useful for managing tendinopathies - so the patella, achilles and perennial tendinopathies respond well to treatment with the system. Tendinopathy is a degenerative condition of the tendons – as a result of that it can become a more chronic problem and takes time to heal but we found using the LightForce system it reduces the stiffness and discomfort that the players would experience with these problems. Is that a common problem among footballers? Yes, especially at the start of the season and usually follows a change in training load. For instance players come back into pre-season after having a period off or they go from a hard pitch to a soft pitch – the change in load can create problems with tendons. We found those pathologies responded quite well to the LightForce treatment. What is your opinion of the LightForce system and the general opinion of those that use it? Within our department all of our therapists are trained to use the system and we’ve found that it’s been positively received. I find that it’s something that, depending upon the pathology, you use it in different ways. Even post-op it can be used to help with the recovery of scar tissue.

Are there any specific cases where you’ve used the treatment? We had a had a player who came to us during the transfer window last season who’d had a chronic problem with his foot and ankle for quite a while which he unfortunately injured further and required surgical intervention. Post-surgery other treatment options were limited but we were able to start fairly early with a low intensity laser treatment programme once the initial operating wound had healed.

How do you identify and monitor the damage of injuries and the progress being made during treatment? Primarily following injury or upon a complaint of an injury to our department, they would be assessed by a physiotherapist initially through a standard musculoskeletal assessment. But we’re very lucky to also have a very experienced doctor who is experienced in ultrasonography – so using an ultrasound machine and he can perform a scan in the treatment room which can give us more information and detail about a problem area and subsequently there could also be an MRI scan depending on whether the doctor requests it.

We were then able to adjust the power and the associated treatment during the rehabilitation process to assist with the healing of that area. We continued to use it once he was fit to help his body fully heal the area in which he’d had the injury and operation. He’s a player that comes to the treatment room and requests the LightForce treatment which is a good sign that the player is feeling it’s having a positive effect on them.

Are you planning to use the LightForce system in the new season ahead? Yes. It’s a very good system and its able to be used by a range of our therapists within the department as well as being very portable. As it has a battery pack, when we travel to away fixtures or to training camps it’s easy to take with us and means we can continue any treatment wherever we are - we’re not confined to the training ground. So it will travel with us to every game this season.

info@fmpa.co.uk

football medicine & performance

Medics are using laser therapy more often than ever before to help reduce pain and inflammation related to many common conditions. Thousands of medics and patients have experienced the benefits of laser therapy and are familiar with its therapeutic effects, but for those who aren’t, there are 5 key things to know. 1. It reduces pain and inflammation without side effects Laser therapy uses a process called photobiomodulation. Photons enter the tissue and interact with the cytochrome c complex within mitochondria. This interaction triggers a biological cascade of events that leads to an increase in cellular metabolism and a decrease in both pain and inflammation. Unlike medications, laser therapy reduces pain without undesirable side effects. It is also important to point out that patients report long-lasting pain relief. While the number of treatments required may vary depending on the acuity of the condition, many patients experience lasting relief after only a couple treatments. 2. Can be used for acute and chronic conditions When treating acute conditions with laser therapy, it is particularly effective when it is administered as soon as possible following injury (assuming there is no active hemorrhaging). The faster the inflammation is reduced and the healing process can begin, the better. In the case of acute injury, laser therapy helps restore the body to normal function quicker. With chronic conditions, laser therapy is used most often to help

combat persistent pain and inflammation. 3. Treatments can be customised for each situation Lasers that have larger power ranges offer versatile treatment options. A laser that can be set to operate from 0.5w all the way up to 25w allows the clinician flexibility to treat ‘low and slow’ or at maximum output. The availability of multiple treatment heads offers additional flexibility for the clinician. The LightForce Empower™ Delivery System, for example, features 5 different treatment heads, each designed to facilitate optimal delivery in different scenarios. It is important to have several delivery options to ensure the delivery method is appropriately matched to the situation. For instance, when treating over bony prominences, an off-contact treatment method is advisable. However, when treating deep-tissue structures, such as a hamstring muscle, an on-contact ‘massage ball’ attachment is best to reduce reflection and scattering, and also encourage deeper penetration by displacing excess fluids.

Depending on the laser, it can create little to no sensation or it can create a gentle, soothing warmth. Many patients receiving laser therapy treatments report enjoying the experience, especially when a massage-ball treatment head is used to deliver what is often referred to as a “laser massage.” Patients receiving treatments with higher-power lasers also frequently report a rapid decrease in pain. For someone suffering from chronic pain, this effect can be particularly pronounced. 5. Treatments Are Fast

With LightForce Class 4 lasers, treatments are quick, usually 5-10 minutes depending on the size, depth, and acuteness of the condition being treated. High-power lasers are able to deliver a lot of energy in a small amount of time, so therapeutic dosages are achieved quickly. For people with packed schedules, patients and clinicians alike, fast and effective treatments are a must. www.lightforcelasers.com

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One common question related to laser therapy is, “What does it feel like?”

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THE FMPA REGISTER “The FMPA Register highlights members as unique practitioners who have experience at the very top of the game within football. Accordingly the register is set to become a valuable and much sought after resource for both the Professional and grassroots game” As an elite register listing the FMPA Register is not open to any practitioner. Registrants must have worked in a professional capacity with players or a club in the top 5 tiers in English football, the top 2 tiers in Scotland or the FA WSL1. The Register is an additional option to membership and incurs a fee of just £10pcm. ARE YOU A Doctor Physiotherapist Sport Scientist Strength & Conditioning Coach Sports Therapist Consultant Surgeon Consultant Physician Sports Rehabilitator Optometrist

On other social media platforms there are certain features only accessible at an additional cost. The features available on the Register are entirely free to access and do not require an upgrade. If you are looking to get in touch with colleagues, professional clubs searching for consultants or grassroots players needing treatment or advice, practitioners listed on the Register can be easily accessed and direct messaged. Searches are unlimited and together with the filtered search option, practitioners can be quickly and easily sourced.

Nutritionist Dentist Soft Tissue Therapist Sports Psychologist Podiatrist Osteopath/Chiropractor Have you worked in a professional capacity with professional Football clubs /players in the top 5 tiers in English football, the top 2 tiers in Scotland or the FA WSL1.? If so you are eligible to join the FMPA Register of practitioners.. In order to promote and highlight our members, there are 3 categories to choose from. This allows you to stand out and be quickly sourced by your next employer, patient or client. It also helps us identify which audience you need promoting to.

PROFILE LISTING ONLY PRIVATE PRACTICE CONSULTATIONS & APPOINTMENTS PROFESSIONAL CONSULTANCY TO FOOTBALL CLUBS Note that the facility to contact and be contacted is inherent on the profile listing. In addition, practitioners can further promote their clinical specialty by submitting articles of interest for our quarterly magazine ‘Football Medicine & Performance’ or as a contribution to our CPD programme. Please send submissions to admin@fmpa.co.uk

Direct Messaging Contact anyone on the FMPA Register Unlimited People Browsing View unlimited profiles from search results Feature Coding Choose your own coding to stand out to your audience Geographical location feature Enables you to be located by customers/client Filtered search option Allows detailed/specific search by job title, location or practitioners name

info@fmpa.co.uk

football medicine & performance

This provides members with the opportunity to showcase their skills, experience and expertise working in professional football.

The Register offers a great opportunity for members already in private practice or those just starting out, to highlight their experience, services and professional profile to potential clients. There is a specific section on the listing to highlight your private practice, which pulls through a location map. The Register is a â&#x20AC;&#x2DC;bridgeâ&#x20AC;&#x2122; between professional and grassroots football and is a terrific platform from which amateur players can access world leading medical and scientific expertise from the professional game. Helping to keep people healthy and playing the game for longer is of national interest so our resource certainly has a place. Through a variety of marketing strategies, we will promote each practitioner to approximately 50 clubs with a reach of up to 3000 grassroots players, within a given radius of their private practice. These clubs will receive regular contact from the FMPA via injury updates, careers guidance and general information about the medicine and performance arena, thereby continually highlighting the FMPA Register and the practitioners within.

www.fmpa.co.uk

football medicine & performance

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Practitioners will be highlighted regularly to heads of departments who may wish to seek employment cover, temporary staff or consultancy within a particular speciality. We will also feature practitioners on the website and within our magazine and promote this category well into the semi-professional football arena. Please see listed below a selection of practitioners available for professional consultancy:

This is a brilliant project that will put us in touch personally with fans and grassroots football. Having been involved in private practice alongside football for many years, I am convinced that this will be a resounding success. This is a great initiative. Derek Wright Head Physiotherapist, Newcastle United FC

I work in the professional game and see patients in my Clinic as well. Fans who come to see me love to talk about the Club as itâ&#x20AC;&#x2122;s the life blood of our community. This register will open up the same opportunity for fans and practitioners across the country. Dave Tinker, Private Practitioner Podiatrist, Burnley Football Club

info@fmpa.co.uk

football medicine & performance

F M A R E G I S T E R

F M A R E G I S T E R CLICK HERE to search for elite practitioners

ü THE PLATFORM TO SHOWCASE YOUR EXPERTISE & EXPERIENCE AT THE VERY TOP OF THE GAME ü ACCESSED BY CLUBS AND COLLEAGUES TO SOURCE PRACTITIONERS ü PUTTING YOU & YOUR PRACTICE IN REACH OF FAN BASES AND GRASSROOTS FOOTBALL

Join the Register @ www.fmpa.co.uk The Register is an additional option to membership and incurs a fee of just £10pcm For further information contact FMPA Project Manager Angela Walton T: 0333 456 7897 M. 0743 236 0789 E: angela.walton@fmpa.co.uk

www.fmpa.co.uk

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Expert LEGAL representation in employment law, medicolegal and Regulatory law AND free contract appraisal Full support on any issue from the FMPA 7 days a week Confidential access to clinical experts to discuss issues within your discipline Annual FMPA Conference & Awards with Member discounts & priority Priority MEMBER ONLY access to job listings on FMPA website Regular e-news/updates Education/CPD via quarterly edition of ”football medicine & performance” magazine delivered to your door plus on-line resources Member discounts on car leasing, insurance & more Savings on courses and events for FMPA Members Eligibility to join the FMPA Register for members moving into private practice or offering consultancy to professional football clubs Plus much more…….

”Thank you for helping me through my recent exit from my club. Martin Price’s advice was exceptional. In a situation where an 'ordinary' person was in conflict with a large organisation Martin's knowledge and execution was empowering. Being represented by someone who clearly knew more than the opponents was really supportive. I would definitely recommend the FMPA legal team for Members going forward” Fitness Coach, Premier League Club

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HOW FAR HAVE WE COME?

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football medicine & performance football medicine & performance is a Member Only publication produced quarterly by the Football Medicine & Performance Association

football medicine & performance

football

The official magazine of the Football Medicine & Performance Association

Exclusive:

medicine & performance The official magazine of the Football Medicine & Performance Association

Issue 26 Autumn 2018

Are we squeezing the life out of adductor monitoring

Issue 25 Summer 2018

Exclusive:

In this issue: Cardiac Screening

How can we make it work in the elite football environment?

Life After Football

In this issue: 2018 FMPA Conference Review Long-Term Injury & Mental Health

Legal

TO READ THE FULL EDITION JOIN HERE

Legal