Why long-term injury to players is a mental health problem

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

Issue 25 Summer 2018

Exclusive:

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

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

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Football Medical Association, 6A Cromwell Terrace, Gisburn Road, Barrowford, Lancashire, BB9 8PT T: 0333 456 7897 E: info@footballmedic.co.uk W: www.footballmedic.co.uk

Chief Executive Officer

Eamonn Salmon Eamonn@footballmedic.co.uk

Executive Administrator Lindsay Butler Lindsay@footballmedic.co.uk Project Manager

Angela Walton Angela@footballmedic.co.uk

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Marketing/Advertising

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Photography

PA Images, Liverpool Football Club, Football Medical Association

Contributors

Jack D Ade, Jill Alexander, Andy Barker, Paul S Bradley, Georgie Bruinvels, Mark Evans, Andy Laws, Scott Pearce, Mayur Ranchordas, Damian Roden, Andrew Wiseman

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Contents Welcome 4

Members’ News

Features 8

5th Annual FMPA Conference & Awards 2018

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Hand Injuries in Goalkeepers Sam Haines, Raj Bhatia

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Great Toe Plantar Plate Injury Mr loan Tudur Jones

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Why long-term injury to players is a mental health problem Dr Misia Gervis

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Nordic hamstring exercise - how can we make it work in the elite football environment Adam Johnson

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Musculoskeletal ultrasound: a summary of its uses, limitations and training opportunities Stuart Wildman The 5th Asian Indoor and Martial Arts Games: Ashgabat, Turkmenistan (2017).

FMPA members’ experiences of working as part of the event medical team Richard Evans, Kevin Petersen, Alan Rankin

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Keeping your finger on the pulse!

Jim Moxon

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Lisfrang injuries in watersports Nick Savva

CHIEF EXECUTIVE OFFICER As we start the new campaign there is real sense of irony in that we are already collating figures for the number of members who have departed from Clubs in this 2018/19 season.

We gather these figures from the 1st June, and even as players and staff report back for training, we still see staff being released while the initials on their kit are still drying.

While we might all suspect there will be a lull in this regard, as the training programme gets underway, and that should indeed be the case, but this is football, and you never know.

You will notice that when talking about our members leaving clubs we refrain from using the word “sacked”. This is because in general the word infers that someone has done something wrong or has failed in their job and, while this might be appropriate for some industries to use this term, it rarely fits with the departure of our members from the game.

As the table in our article on page 4 suggests, the vast majority of our members (60%), exit a club when a new manager is appointed, as this is a time when they are likely to bring their own personnel with them. Notably, the number of backroom staff following their managers, particularly international ones is on the rise, as illustrated by Arsenal and other leading clubs in recent weeks.

While the introduction of overseas personnel can be an illuminating feature within the backroom team, we need to also recognise the disruption this can cause to the existing set up. Upheaval is never in the best interests of a Club or player and indeed players themselves value the stability of the medicine and performance teams when a new manager is appointed and there is uncertainty around the club and even their careers.

Clearly there is discussion to be had surrounding this situation but ultimately it is up to the clubs to value and protect their medicine and performance teams while still allowing a manager to bring in his own personnel, who might then act as a conduit between the incumbent and the established.

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

COVER IMAGE

Liverpool’s Mohamed Salah reacts after picking up an injury during the UEFA Champions League Final at the NSK Olimpiyskiy Stadium, Kiev.

Nick Potts/PA Wire/PA Images Football Medicine & Performance Association.

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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.

Eamonn Salmon Eamonn.salmon@fmpa.co.uk

Executive Administrator Lindsay Butler Lindsay.butler@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, Liverpool Football Club, FMPA, Ashgabat 2017 / LAUREL Photo services, Paul Hazlewood

Contributors

Sam Haines, Raj Bhatia, Mr Loan Tudur Jones, Misia Gervis, Adam Johnson, Stuart Wildman, Richard Evans, Kevin Petersen, Alan Rankin, Jim Moxon, Nick Savva

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feature

WHY LONG-TERM INJURY TO PLAYERS IS A MENTAL HEALTH PR0BLEM. FEATURE/ DR MISIA GERVIS

L

ong-term injury often poses a threat to a player’s mental health, as it is often the time of greatest psychological struggle. Watching from the side lines of the physio room, players can experience a whole range of psychological difficulties. However, the tried and tested method to support long-term injured players is through physiotherapy and physical rehabilitation. Rarely is an injury thought of as being both physically and psychologically traumatic and treated accordingly.

But there is now a wealth of evidence that demonstrates that the psychological responses to injury can trigger and/

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or undercover mental health issues such as depression, suicidal ideation, anxiety, disordered eating, and substance use/abuse. Furthermore, research has also discovered that after sustaining a long-term injury athletes often exhibit negative emotional reactions such as shock, anger, depression, fear, confusion, anxiety, uselessness and helplessness (Carson & Polman, 2008; Tracey, 2003). Thoughts about their inability to continue playing at their pre-injury level, concern about time missed from participation, and fear about their future careers are regularly reported.

These concerns impact on players’

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identity and self-belief, thus affecting their ability to perform at the highest level.

Although injured athletes may be physically ready to return to sport it does not necessarily mean they are psychologically ready (Podlog & Eklund, 2006). As athletes approach their first game back, reports of fear of re-injury are common (Clement et al., 2015).

This has been found to affect athletes’ rehabilitation process, increase fear of injury-provoking situations, cause longterm physical impairment, reducing their ability to perform and increasing the risk of re-injury whilst playing (Ardern, Taylor, Feller, & Webster, 2012; Johnston & Carroll, 1998; Lentz et al., 2014).

football medicine & performance Currently, physiotherapists, working under doctors, are usually responsible for the psychological assessment of long term injured athletes. (Podlog et al., 2014) But in practice, these professionals do not have psychological expertise. Injured athletes have reported that physiotherapists were focused solely on their physical recovery and were not in a position to provide appropriate emotional support (Arvinen – Barrow et al., 2014) So the question arises as to how psychological recovery should be considered within football for the rehabilitation of long term injury.

OUR RESEARCH Our research project, supported by the Professional Football Association (PFA) sought to investigate the psychological support mechanisms currently available for long –term injured players. Three studies were undertaken, each focusing on a different stakeholder perspective. These were medics, PFA counsellors and players. These three perspectives were essential in order to obtain an overall understanding of the main issues facing long term injured players.

appeared to be ignored. Our research found that players wanted improved psychological support during their rehabilitation. Indeed 60.6% of players reported needing more help coping with the mental aspect of injury when they returned to training and participation in games. Further our findings revealed, 99% of players reported experiencing some form 0f psychological distress during their injury. So this is not a minority issue, and we know that for some players this can spiral into severe mental health problems.

Cultural barriers make it difficult for psychological support to be implemented because medical departments are not routinely providing formal psychological support protocols for injured athletes.

Consequently, athletes do not feel able to seek psychological support for fear of being discriminated against by coaches, managers and other athletes.

The solution is to ensure that psychological support is an integral part of every player’s healthcare in order to reduce the incidences of long-term psychological trauma and stigma around mental health issues. Indeed in my practice at QPRI deliver a Psychological Treatment Plan (PTP) that is integrated into the physical rehabilitation programme of all long-term injured players and includes formal procedures of psychological screening. This requires cooperation of all staff working together, in order to ensure that psychological support is normal and generally accepted .Ideally this support needs to be provided by qualified personnel, who can work alongside physical recovery staff, but have the specific skills and knowledge and expertise to provide psychological support to injured players. Only then can we change the current accepted view that injury is simply a physical issue and acknowledge that injury is a mental health issue too.

Ardern, C. L., Taylor, N. F., Feller, J. A., & Webster, K. E. (2012). Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. Journal of Science and Medicine in Sport, 15, 488-495. doi: 10.1016/j.jsams.2012.03.015 Arvinen-Barrow, M., Massey, W. V., & Hemmings, B. (2014). Role of sport medicine professionals in addressing psychosocial aspects of sport-injury rehabilitation: Professional athletes’ views.

Journal of Athletic Training, 49, 764-772. doi: 10.4085/1062-6050-49.3.44 Carson, F., & Polman, R. C. (2008). ACL injury rehabilitation: A psychological case study of a professional rugby union player. Journal of Clinical Sport Psychology, 2, 71-90. Retrieved from http:// journals.humankinetics.com/jcsp Clement, D., Arvinen-Barrow, M., & Fetty, T. (2015). Psychosocial responses during different phases of sport-injury rehabilitation: A qualitative study. Journal of Athletic Training, 50, 95-104. doi: 10.4085/1062-6050-49.3.52 Johnston, L. H., & Carroll, D. (1998). The context of emotional responses to athletic injury: A qualitative analysis. Journal of Sport Rehabilitation, 7, 206-220. Retrieved from http:// journals.humankinetics.com/jsr Lentz, T. A., Zeppieri, G., George, S. Z., Tillman, S. M., Moser, M. W., Farmer, K. W., & Chmielewski, T. L. (2014). Comparison of physical impairment, functional, and psychosocial measures based on fear of reinjury/lack of confidence and return-to-sport status after ACL reconstruction. The American Journal of Sports Medicine, 43, 345-353. doi: 10.1177/0363546514559707 Podlog, L., Heil, J., & Schulte, S. (2014).

Psychosocial factors in sports injury rehabilitation and return to play. Physical Medicine and Rehabilitation Clinics of North America, 25, 915930. doi: 10.1016/j.pmr.2014.06.011 Tracey, J. (2003). The emotional response to the injury and rehabilitation process. Journal of Applied Sport Psychology, 15, 279-293. doi: 10.1080/714044197 Ruddock-Hudson, M., O’Halloran, P., & Murphy, G. (2014). The psychological impact of long-term injury on Australian Football League players.

Journal of Applied Sport Psychology, 26, 377-394. doi: 10.1080/10413200.2014.897269

We found that psychological support was not routinely available for long-term injured players. Indeed most clubs ‘never’ even screened for psychological issues.

Findings from both players and counsellors revealed that players were experiencing the detrimental psychological consequences of injury, including- isolation, depression, loss of identity, boredom, and fear of re-injury.

According to the counsellors these factors leave players vulnerable to mental health problems, such as addictions. Further, there is a risk of problematic rehabilitation, endangering future performance, and increased risk of injury.

Currently only the physical aspect of injury is treated. The psychological trauma generally

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For more information visit: www.bsnmedical.co.uk Call: 01482 670146 or email: commercialsales@bsnmedical.com

THERAPIES. HAND IN HAND. www.bsnmedical.co.uk

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