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FOOTBALL MEDIC & SCIENTIST

The official magazine of the Football Medical Association

REFEREES

Keeping an eye on us

WHAT’S IN A MEDICAL?

How to pass one, & why some players don’t

JET LAG

The effect on players & best practices to help prevent it

Issue 10: Autumn 2014

FMA FOOTBALL MEDICAL ASSOCIATION


Contents

FMA FOOTBALL MEDICAL ASSOCIATION

Welcome 4 Members News 6 Touchline Rants 7 On the Couch Matt Wignall

Editorials & Features 8 The Official View : Medical professionals & Referees Jeff Winter

WELCOME/EAMONN SALMON You will all be aware by now that the decision was taken in the summer to change our name from the League Medical Association (LMedA) to the Football Medical Association.

L

MedA served us well in the early days (if not proving a little difficult for some to pronounce!) but as we became more established, it became increasingly obvious that we needed a stronger brand identity on both the national and international stage. The Football Medical Association (FMA) quite simply says who we are and what we are about, making us instantly recognisable. It allows us to stand shoulder to shoulder with our other football counterparts i.e. the PFA, the LMA, the Premier League, the Football League and the FA, and provides a platform from which we will continue to grow.

10 Walking Football Mick Quinn

As a membership organisation, it is important that our focus always has our members at the heart of what we do. Educationally we are striving to raise standards and accessibility, and employment-wise, we are continually seeking to improve working conditions and legal protection for our members.

12 Jet Lag: Disruption of a Player’s Biological Clock Dr Juan Carlos Miralles

We live in a litigious society, and sport and professional football are no exception. The incidence of medical professionals being sued by players is on the increase, and this is at a time when there is huge focus on the value of our Indemnity cover. What is important is that our members know they have the right type of support from an Association that not only has expertise in what we do but most importantly is knowledgeable about football and the workings of the game.

16 2015 FMA Conference Announcement

The financial demands on clubs and desire for success have also seen a number of members become casualties of the ‘football manager merry-go-round’. Thankfully they had the FMA to support them from a legal standpoint and in negotiating their severance packages. While it is accepted that managers wish to surround themselves with their preferred staff, it is equally important that a club treats outgoing medical and sports science staff with respect and acts both professionally and within the law. Clubs now know we are here and expect us to be of assistance to their medical and science staff when a situation arises.

19 World-leading Hernia Surgeon Dr. Ulrike Muschaweck Joins Perform Birmingham 20 What’s in a Medical? How to Pass One & Why Some Don’t Rob Kemp

You as members can play a huge role in spreading this message and urging colleagues who are still to join, to do so, to give themselves that solid protection and also to help strengthen the standing of the medical and science professions in the game. It`s time everyone played their part!

Eamonn Salmon CEO Football Medical Association

JET LAG:

DISRUPTION OF A PLAYER’S BIOLOGICAL

26 Break the Rules & Face the Consequences Martin Price 28 Two Who Fell Foul of the Ref Chris Mortley 30 Where are they Now? Tim Exeter

Cover Image Manchester City’s Edin Dzeko winces in pain as he is treated by medical staff during the Barclays Premier League match against Liverpool on 25th August 2014. Martin Rickett/PA Wire/PA Images 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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Pictured: The England team at Heathrow Airport, before they flew to Belgium ahead of their first game of Euro 2000 at Eindhoven against Portugal.

CLOCK ON LONG-HAUL FLIGHTS

24 Visual Performance in Soccer Gerraint Griffiths

WHAT’S IN A MEDICAL?

HOW TO PASS ONE, & WHY

SOME PLAYERS DON’T

FEATURE/ROB KEMP COURTESY OF FOURFOURTWO MAGAZINE, IN PARTNERSHIP WITH THE FMA

FEATURE/Dr Juan Carlos Miralles, member of the UEFA Medical Committee

Most players glide through them but others, like Loic Remy (pictured, left) at Liverpool, see their dream moves shattered. FFT finds out why...

Many football teams use the aeroplane as the natural means of transport for the many journeys they have to make, whether during preseason, the league calendar or international competitions.

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atches are played in close succession, often in stadiums that are far away – even on different continents. In some cases, players may travel across more than five time zones to play a match, and may be required to compete soon after landing.

This would not be that serious were it not for the physiological changes that flying over more than five time zones can cause in aeroplane passengers. These changes are commonly known as “jet lag”, “desynchronosis” or “time zone change syndrome” and are effectively a disorder affecting the circadian rhythm in the human body. The circadian rhythm is the 24-hour cycle of biochemical, physiological and behavioural processes. The human biological clock is driven by external environmental factors such as light and dark. It regulates daily activities such as sleep, waking, body temperature, arterial tension and mealtimes. The inner clock that sets the rhythms of the human body is located in the suprachiasmatic nucleus of the anterior hypothalamus. It would run for longer than 24 hours were it not for the constant adjustments made owing to various external and environmental stimuli, which directly or indirectly modulate the inner clock. In some mammals, the light/dark cycle, the availability or not of food, activity/ inactivity and social influences can, individually or combined, modulate the biological clock. In humans, the light/ dark cycle is very important, as are social habits, and it would also appear that physical activity plays an important role. Light acts as an external stimulus, modulating the inner clock by stimulating the retinohypothalamic tract, especially the pineal gland, inhibiting the production of melatonin. With the advent of artificial

Pictured: Fulham’s Danny Murphy, Damien Duff and Chris Smalling step off a plane in Germany before their 2010 UEFA Europa League Quarter Final - Second Leg against Vfl Wolfsburg.

light, the importance of the light / dark cycle has changed. Until the advent of the aeroplane, only people working night shifts showed symptoms of what we now know as jet lag. These symptoms can include any of the following:

• • • • • • • • •

disturbed sleep patterns; tiredness during the day; loss of appetite; constipation, flatulence, bloated stomach; mood changes; headache; feelings of disorientation; impaired mental performance; impaired physical performance (mostly affecting athletes in endurance and precision sports).

All of these symptoms vary greatly and depend on the individual. Moreover, jet

lag is also influenced by factors such as age, the passenger’s physical condition, the amount of physical activity during the journey, and acceleration and deceleration during take-off, landing, ascent and descent. Another important factor is the dry air in the cabin and the cabin pressure, which can be equivalent to being around 3,000 metres above sea level. This causes a considerable drop in blood oxygen saturation and inhibits the supply of oxygen to the brain. Other factors also aggravate jet lag, such as heat, humidity, air pollution and the altitude of the destination. Thus, a player’s performance will be significantly affected after a long-haul flight crossing five or more time zones. It is important to recognise the effects of jet lag and know how to deal with them. If we ignore the phenomenon of jet lag, players may lose up to 10% of their sporting and physical performance, which is equivalent to them having only three hours of sleep or drinking a large quantity of alcohol. Some studies show that one day of adjustment is needed for each time zone change following a flight from west to east, so a passenger needs five to seven days to adjust after an intercontinental flight. Many authors state that psychomotor and mental activity stabilises within two to seven days, reaction speed within two days and core temperatures within four to six days. According to Panfilov (1986), after crossing seven or eight time zones, VO2 max values drop steeply over the two or three days following the flight and then recover gradually to reach the initial (or possibly even higher) levels between seven and 13 days, normalising completely after 18 to 20 days. Although any long-haul flight can cause

FOOTBALL MEDIC & SCIENTIST | 13

hink a medical is a foregone conclusion? Think again. As we’ve seen only this summer, a move isn’t done until a player has passed a club’s rigorous check-up with flying colours. To find out more, FourFourTwo got the lowdown from Blackburn’s Head of Sports Medicine Dave Fevre, formerly of Manchester United and Great Britain Rugby League, and a member of the Football Medical Association. “I liken it to when you go out and buy a second-hand car – you can take a risk on it being OK based on what you see, or if you’re wise you’ll invest after having an inspection from experts like the AA. When you look at the amount of money paid for players it’s really in the club’s benefit to ensure to the best of your ability that what you’re getting is in good working order. “But just as every footballer is different, so too is every football medical. The requirements of the club, the brief from the manager, the age, position, medical and injury history of the player – all of these variables will change every time. “There’s no standard medical as such – every club has its own way of doing things. Usually a player being transferred to our club will undergo a two-day medical, although when it comes to transfer deadline day, time isn’t always a luxury you can afford. But in both cases the role of the team physiotherapist, club doctor and fitness team is to provide as much information to the manager and the club’s executives in order for them to make the final call. “There are key elements that most medicals will feature. A health check to look for any cardio concerns is one of these; since Fabrice Muamba’s heart attack, clubs are even more diligent about checking any heart irregularities. Players up to the age of 24 will ideally have annual checks to detect any heart-related issues. “The timing of the transfer will influence things too. For the January

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window transfers, you’re usually looking at players who will need to hit the ground running – it’s rare that you’ll see a club sign a player with an existing injury at that time, although Arsenal did choose

to do so with the loan signing of Kim Kallstrom last season. It’s not often that happens, but there may be relevant information involved in the deal that people outside the club are not party to.

MEDICAL NON-MOVERS Demba Ba The Senegalese hitman failed a medical at Stoke in January 2011 (not for the first time), before joining West Ham for an undisclosed fee based on appearances. Leroy Fer Norwich’s Dutch powerhouse was supposed to pitch up at Everton in January 2013, only for his medical to reveal a long-term knee injury. Ruud van Nistelrooy (pictured,above) The free-scoring striker had his dream move to Manchester United twice put on hold after knee ligament damage in 2001. George Boyd The Hull winger should have joined Nottingham Forest last season, but for an “inconclusive eye test” to bizarrely scupper the move. John Hartson Rangers had the burly Welshman in their sights in 2000, but he failed his Ibrox check-up and later joined Celtic.

FOOTBALL MEDIC & SCIENTIST | 21

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

Eamonn Salmon

Senior Administrator

Lindsay McGlynn

Administrator

Nichola Holly

IT

Francis Joseph

Contributors

Mary O’Rourke QC, Martin Thomas, Matt Wignall, Dr. Juan Carlos Miralles, Rob Kemp, Dave Fevre, FourFourTwo Magazine, Tim Exeter, Gerraint Griffiths, Gavin Blackwell, Dr. Ulrike Muschaweck, Perform Birmingham

Editorial

Oporto Sports - www.oportosports.com

Design

Soar Media - www.soarmedia.co.uk

Marketing/Advertising

Charles Whitney - 0845 004 1040

Published by

Buxton Press Limited

Photography

Football Medical Association, PA Images

FOOTBALL MEDIC & SCIENTIST | 3


MEMBERS’ NEWS Call for Club Dr’s in Football League

Convention is

huge success

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NEW APPOINTMENTS FOR FMA T he FMA is delighted to announce that Dr. Bryan English has accepted the position of Medical Director with the FMA. Speaking about the appointment, FMA Chief Executive, Eamonn Salmon, said: “Bryan is without doubt one of the most recognised and highly respected clinicians in the game and will bring a wealth of experience and knowledge to the association. “Bryan is also known for being proactive and engaging in issues that

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concern medicine and football and we are delighted to have his commitment and support for the FMA. We have already discussed several ideas and areas where Bryan’s expertise will be crucial in pushing us forward, and we look forward to a working relationship that will see these ideas reach fruition.” Maggie McNerney has also accepted the position of Non-Executive Director and will continue to offer the much valued support and guidance that we

have come to rely on. The idea to create Director appointments is key to the FMA, allowing us to underpin the association and secure our future as an on-going entity for many years to come. Further appointments will be made in due course and will be announced via our website and eNewsletter.

he Global Soccerex Convention, which this year was held in Manchester in September, is of course one of the highlights in the football and business calendar. Guests, speakers and delegates from around the world attended the three day event and as a partner, the FMA was invited to hold a ‘Performance’ session involving guest panellists taking to the stage. Dr. Bryan English, Dave Fevre and Dr. Carl Wells, lead Sports Scientist at Perform, St George’s Park, fielded questions put to them by FMA Chief Executive, Eamonn Salmon and the audience. Topics covered included concussion, the Qatar World Cup, doping and fatigue, and recovery levels. The event was a resounding success with one ‘tweet’ saying this was the

best session they had seen at Soccerex this year. FMA CEO, Eamonn Salmon, said: “This was a great opportunity to put the FMA in to the spotlight at such a prestigious event. “Not only was the session we hosted exceptional, but we made many important contacts with colleagues and football administrators during the event. Events and partnerships of this magnitude further strengthen our standing within the game and are an ideal way in which to showcase the expertise we have in our association.”

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ome of you may recall that 18 months ago we sent emails to Club Dr’s regarding the setup of a Football League Doctors Group (FLDG). Although the response was favourable, there has now been fresh impetus on this led by Mike Stone and Bryan English. A meeting is planned for 3.00pm on Tuesday 25 November at St. Andrews, Birmingham, where the FMA will also be in attendance. There is no question that there is appetite for this group to form as an entity under the umbrella of the FMA, so please attend if possible. If you are able to come along please let Mike know via email mike.stone@bcfc-tg.com If you are unable to attend, but would like to send in your thoughts and ideas regarding the proposal please send to eamonn@footballmedic.co.uk

National Football Museum D o you have any memorabilia that has a story behind it? If so, it could be on permanent display at the National Football Museum in Manchester with your name credited! It can be anything related to football or medical and if it is deemed suitable, then you’ll

have your own piece of history immortalised. Please contact the office and let us know if you have anything of interest.

FOOTBALL MEDIC & SCIENTIST | 5


NOMINATIONS ANNOUNCED FOR MBNA NORTHWEST FOOTBALL AWARDS

Touchline Rants! e

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he MBNA Northwest Football Awards, which take place on Tuesday 18 November, at The Point, Emirates Old Trafford, will be the third year that the Football Medical Association are involved in the event. The nominations for the prestigious Fabrice Muamba Award for Medical & Sports Science Professional are:

by Pitchside Pet Ding Dong Merrily on High

I know it feels like an age away, but since the supermarkets are filling their shelves with seasonal offers, it’s time to think about the thorny subject of Christmas. Christmas for most of us is our busiest time of year – bumper crowds at matches and the games coming thick and fast. That doesn’t stop your family asking where you are when they’re getting tiddly and watching re-runs of Only Fools and Horses! I always find that when the fixtures come out, there are three keys ones to look for – the first, the last and the Boxing Day games. If you are at home, you may get very lucky and have a Gaffer

who allows the team to stay at home on Christmas night. If you’re away, then its turkey sandwiches and an overnight stay – usually in a near deserted hotel. The coach trip to a hotel on Christmas night is often ‘fragrant’...it’s the sprouts I think. So when it feels like you are the only team in the country staying away overnight on Christmas night – remember that we’ve all been there...and at least you can get the hold of the TV remote control for the evening so you can watch ‘Del Boy’ in peace! As a colleague of mine once said...’Christmas comes at the end of May’!

Dr Joyce Watson (Accrington Stanley) Matt Jackson (Preston North End) Les Parry (Manchester United) Simon Farnworth (Morecambe) Dr Ian Irving (Everton)

FMA Chief Executive, Eamonn Salmon, said: “All of this year’s candidates were nominated by their colleagues and they all thoroughly

deserve this acknowledgement of their undoubted talents and contributions in their field. “We all look forward to representing the FMA, continuing to raise our profile and influence within the game, whilst celebrating the achievements of the four nominees.” Last year’s winner was Rob Swire of Manchester United, with Joyce Watson (Accrington Stanley) and Rodger Wylde (Stockport County) receiving nominations. For more information on the event, please visit www.northwestfootballawards.com

ON THE COUCH... FEATURE/MATT WIGNALL

ADVERTISE IN THE

FOOTBALL MEDIC AND SCIENTIST...

And reach a targeted audience of medical and sports science professionals

For more information visit www.footballmedic.co.uk Call 03334 567897 Or email info@footballmedic.co.uk

Profession? Lead Soft Tissue Therapist at Wolverhampton Wanderers Football Club

Player – Marcus Hahnemann – Marcus or ‘Buddy’ as he was known, joined from Reading in 2009 and we hit it off straight away due to shared interests in adventure sports, rock climbing and heavy metal music!

Where did you train? With a company called Premier Global in Dudley who specialise in Sports Massage, Fitness Instruction and Personal Training. I did this aged 18 in 2001 after deciding I wanted to be involved in the sports industry and begin gaining vital work experience instead of going to university. As my career has progressed, so has the range of courses I have undertaken. I have been on a range of advanced sports massage courses over the country including course providers Naqi and Health Education Seminars. My most recent courses involved Instrument Assisted soft tissue therapy. In October 2012 I attended the Graston Technique at Bisham Abbey and have also attended the Kinnective Instrument assisted course at St.Georges Park. How did you get into football? After qualifying as a Sports Massage Therapist, I sent my CV to numerous professional football clubs outlining my qualifications and volunteering my services to see if any appropriate positions were available. As expected, most clubs replied with no positions available. However, Wolves wrote back to me offering a voluntary position on a part-time

basis. After several months of volunteering I was offered a paid part-time contract supporting the senior massage therapist and medical team. This then lead to a full-time position as a Soft Tissue Therapist in 2010. Previous jobs in the game... One club man so far! As my role has slowly evolved from voluntary to part-time and finally full-time my career has progressed solely at Wolves. Which manager/player/staff have you enjoyed working with most? Manager – Mick McCarthy – Mick came in as the gaffer in my first ever season, he joined two weeks after I did. We had some fabulous seasons under Mick’s reign including winning the championship in 2008/9 and staying in the Premier League for three further seasons.

Staff – Steve Kemp – As with my time under Mick McCarthy we had a very strong medical department under Steve Kemp in which I worked alongside Senior Masseur Mark James. The department has now continually developed under Phil Hayward where we have maintained a strong working relationship and team ethic. How’s the job going at the moment? At present, the Club is moving in the right direction under Kenny Jackett, where we won the League One title last season. We have a young squad which has brought a fresh impetus to our work and looking forward to a successful season in the Championship. Long-term career plans... My plan would be to help establish Wolves as a Premier League club, build on my experience with the England U20 squad with a view to potentially working with the senior squad in the future. What would be your dream job? I have always enjoyed travelling around Europe so working for a club in the Champions League would be a dream job combining two of my passions.

FOOTBALL MEDIC & SCIENTIST | 7


Pictured: Leeds United’s Lee Bowyer lies prone whilst Manchester United captain David Beckham makes a futile protest to Jeff during a heated Premier League tie at Elland Road in September2002. Pictured, opposite: Jeff and Manchester United’s Roy Keane, restrain Gary Neville following an incident with Manchester City’s Steve McManaman during an FA Cup 5th round match at Old Trafford in February 2004.

TheOFFICIALViEW FEATURE/JEFF WINTER  As featured earlier in this issue of Football Medic and Scientist, members of a club’s medical staff can also be sanctioned for unacceptable behaviour. Former Premier League referee, Jeff Winter, reveals what his relationship was like with medical professionals during his extensive career as a top-flight official, which also included the 2004 FA Cup Final…

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hat is a referee’s match day relationship like with medical teams; both pre-match and during the game? There is little or no contact with the medical teams, other than on a ‘needs must’ basis. Medical teams are aware that they can only enter the field of play when requested to do so by the referee.   What are the rules from the referee’s perspective regarding injuries? A referee initially assesses the injury and asks

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the player if he requires the services of the medical team. He is made aware that, if this happens, then he must then leave the field of play to receive any further treatment, with the exception of him being the goalkeeper. Should referees step in to shelter medics from outside influences (manager, coach, players etc.)? The medics must be allowed to assess the injured player and the referee should ensure that he is able to do that without interference.  

Can medical professionals be sent off? A referee can submit a report should he feel that the behaviour of a medic warranted it. It would be very unwise for a referee to dismiss someone who is there to treat the players, especially if there is no other qualified person to deal with the players. Have you ever cautioned or sent a member of the medical staff off? I have had words with members of the medical staff. On rare occasions, the medic has been passing his opinions about the

game, decisions etc., rather than doing what he is there to do. What were your thoughts on the rule change back in the 90s, which dictated that the physio could only assess players on the field of play and not treat them there? At times, it is annoying for everyone when a player is forced to leave the field of play. It is worth remembering why the rule change was introduced. Unfortunately, feigning injury was being used as a delaying tactic, especially in the latter stages of the game. A referee is not qualified to assess an injury and should not take chances, most definitely in the case of head injuries. But the rule does mean that players are aware that, should they choose to have a medic on the field, they will have to leave the field and reduce their team’s numbers. At times it can be farcical and unfair, especially if the player is injured as a result of a foul challenge on him. Until such time as players can be trusted, then this is unlikely to be changed. So never then!          Did you encounter any problems with physios during the early implementation of the new rule? There was dissent from a few medics and especially players, until it became accepted as something that was going to happen.   How has sports science influenced referees? The advent of sports scientists in football has not only helped players, but also referees. Specific training programmes and monitoring of training and match day physical activities is very beneficial. It is helpful in improving fitness and also monitoring performance which could prevent injuries.   Did you have good working relationships with some physios over others? Like with players, sometimes personalities clashed. In the main, I would like to think that I was aware of their importance and afforded them full respect and cooperation.

My medical experience was limited to a relationship with a nurse, so I bowed to their expertise! Do you think it would be helpful if medical staff introduced themselves to match officials before the game? I think that would be very helpful, just to confirm where the staff are situated and what signal they will be given to enter the field of play. We tend to see that, when a foul has been committed and a player has been injured, the physio at the touchline is waiting to be called on to the pitch. This usually happens after the caution to assess the injured player. Surely it would be ideal to get the physio on first, and then caution the player at the same time? I don’t disagree with this idea; however, it is difficult to be regimented. For example, the seriousness of the injury should be paramount then also the reaction of players.

However, if there is a confrontation situation, the referee might want to concentrate on that. It really is a common sense reaction that is required at the time of any incident.   Also have you encountered problems with medical staff in the technical area when you have been on fourth official duty? I had enough to worry about dealing with managers! Normally the medical staffs are excellent and supportive. Sometimes they are more forceful, especially when under the influence of instructions from managers. In the main, an overreaction by a member of the medical staff is a sign of concern that a player is seriously injured and should put the match officials on alert. With the communication system now deployed by match officials, any serious concerns from the medical staff can be immediately referred to the referee and entry to the field of play can be quickly sanctioned.

Pictured: Jeff watches as Liverpool’s Steven Gerrard leaps into a challenge on Southampton’s Claus Lundekvam during a Premier League match at Anfield in August 2003

FOOTBALL MEDIC & SCIENTIST | 9


VETERANS MAKE B IG STRIDES

FEATURE/MICK QUINN Football; the game that stirs our passions and breaks our hearts. We love the dressing room banter, the commitment and involvement that fills our playing days…but what do we do when that is all taken away from us?

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ost people stop playing due to physical limitations when our bodies decide that the running, twisting and turning are all becoming a bit too much to deal with. We could stay involved by coaching, managing or joining the backroom staff although nothing can fill the void that not playing leaves us

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with. Now there is a chance to keep the passion flowing and extend the playing career by playing ‘Walking Football’. ‘Walking Football’ is not as tame as it sounds, it is a newly developed version of the small sided 5 or 6 a side game with the adaptation of the rules to limit the

physical exertions. There is no running or slide tackling and one foot must always be in contact with the ground, it is a safe and controlled way of keeping fit and having the fun and camaraderie that retirement often denies us. Mick Quinn runs a Walking Football Club in Surrey via his Sports Injury

Clinic ‘Quinntessential Sports Therapy.’ A member of the Society of Sports therapists with previous Football League Medical experience at Brentford, Wycombe Wanderers and Crawley Town and with his playing days long behind him, Mick has dusted down his old training shoes and rekindled his desire to play. “I started my own wee club after reading about walking football on the internet and loved the idea of kicking the ball about again. My own fitness has deteriorated over the years through the various injuries obtained from my playing career and getting gradually fatter as the years progressed. I stopped playing at 38 when the pains were lasting 3 days after the matches and though that was that. This new sport has really captured my imagination. “My club boasts over forty players between the ages of 50 to the oldest member at 82 years old and includes one guy with a quadruple heart bypass. We play twice a week and we actually play ‘two touch’ football to reduce the amount of tackling. The fact there is no running and no showboating allowed, really levels the playing field, players of all skill and all levels of fitness can play an equal part in the game. “The lack of cutting movements and sharp turns means the body does not suffer so much and we play on a 4th generation Astroturf pitch which has rubber crumb and a bit of give, not like the old sandpaper plastic pitches of yesteryear. “The physical benefits for these older ‘athletes’ is amazing. I initially wanted to do a proper research study and obtain some empirical data but unfortunately the numbers would be too small to justify it. I have seen visual improvements in my group over the last seven months playing, with seven players reporting weight losses of over a stone in weight. The cardio vascular fitness, joint stability and proprioception are all very obvious and on average they are covering around 4-7k during the hour long session. I have contacted all the local Doctors surgeries, Hospitals and age related charities and I seem to be getting a great response. I even spoke with Gordon Smith the exChief executive of the Scottish Football Association about arranging a Scotland vs England old boy’s demonstration match at some future date. “I use my own club for rehabilitating ‘pre-discharge’ patients that are physically able to return to play but still have the psychological barrier with playing a contact sport. I also get a lot of feedback from my lads about the fact they now have something to look forward to every week, instead of trying to fill their long days during their retirement tending their allotments or watching TV. “I am sure this game will develop into a recognised FA affiliated sport and will be the biggest growth sport around over the next few years and I have been working

Pictured: Mick Quinn - runs his own walking football club in Surrey via his Sports Injury Clinic ‘Quinntessential Sports Therapy.’

very close with Hampshire FA to develop the rules and set up a local league as a sort of template. They have even started looking at training referees to officiate this version of the game. In the future I can see there being ‘fun’ leagues involving the ex-amateur players and fans of the game, but also a more competitive league structure for the ex-pro and semi-pro players. Could you imagine some of our older retired players pinging the ball around on a small pitch? It would be a joy to watch. “You may have seen the recent Barclays advert on television featuring my lads which is promoting both the bank and inadvertently, the walking football. The lads even got a few quid for starring in the advert and I have told them, I must be considered as the best new manager

around, when I have taken a group of useless players and turned them into professionals, after all they are getting paid to play? I don’t expect to see them out chasing WAGs or hitting the nightclubs as most of them will usually be tucked up in bed with some cocoa before 10pm most nights. If you want to find out where your nearest Walking Football club is, just contact your local FA for details and join in the fun. Remember 50 years old is just the start of your new 30 year playing career.”

The Barclays advert is available to view at www.barclays.co.uk/digitaleagles

FOOTBALL MEDIC & SCIENTIST | 11


JET LAG:

DISRUPTION OF A PLAYER’S BIOLOGICAL

CLOCK ON LONG-HAUL FLIGHTS FEATURE/Dr Juan Carlos Miralles, member of the UEFA Medical Committee

Pictured: The England team at Heathrow Airport, before they flew to Belgium ahead of their first game of Euro 2000 at Eindhoven against Portugal.

Many football teams use the aeroplane as the natural means of transport for the many journeys they have to make, whether during preseason, the league calendar or international competitions.

M

atches are played in close succession, often in stadiums that are far away – even on different continents. In some cases, players may travel across more than five time zones to play a match, and may be required to compete soon after landing.

This would not be that serious were it not for the physiological changes that flying over more than five time zones can cause in aeroplane passengers. These changes are commonly known as “jet lag”, “desynchronosis” or “time zone change syndrome” and are effectively a disorder affecting the circadian rhythm in the human body. The circadian rhythm is the 24-hour cycle of biochemical, physiological and behavioural processes. The human biological clock is driven by external environmental factors such as light and dark. It regulates daily activities such as sleep, waking, body temperature, arterial tension and mealtimes. The inner clock that sets the rhythms of the human body is located in the suprachiasmatic nucleus of the anterior hypothalamus. It would run for longer than 24 hours were it not for the constant adjustments made owing to various external and environmental stimuli, which directly or indirectly modulate the inner clock. In some mammals, the light/dark cycle, the availability or not of food, activity/ inactivity and social influences can, individually or combined, modulate the biological clock. In humans, the light/ dark cycle is very important, as are social habits, and it would also appear that physical activity plays an important role. Light acts as an external stimulus, modulating the inner clock by stimulating the retinohypothalamic tract, especially the pineal gland, inhibiting the production of melatonin. With the advent of artificial

Pictured: Fulham’s Danny Murphy, Damien Duff and Chris Smalling step off a plane in Germany before their 2010 UEFA Europa League Quarter Final - Second Leg against Vfl Wolfsburg.

light, the importance of the light / dark cycle has changed. Until the advent of the aeroplane, only people working night shifts showed symptoms of what we now know as jet lag. These symptoms can include any of the following:

• • • • • • • • •

disturbed sleep patterns; tiredness during the day; loss of appetite; constipation, flatulence, bloated stomach; mood changes; headache; feelings of disorientation; impaired mental performance; impaired physical performance (mostly affecting athletes in endurance and precision sports).

All of these symptoms vary greatly and depend on the individual. Moreover, jet

lag is also influenced by factors such as age, the passenger’s physical condition, the amount of physical activity during the journey, and acceleration and deceleration during take-off, landing, ascent and descent. Another important factor is the dry air in the cabin and the cabin pressure, which can be equivalent to being around 3,000 metres above sea level. This causes a considerable drop in blood oxygen saturation and inhibits the supply of oxygen to the brain. Other factors also aggravate jet lag, such as heat, humidity, air pollution and the altitude of the destination. Thus, a player’s performance will be significantly affected after a long-haul flight crossing five or more time zones. It is important to recognise the effects of jet lag and know how to deal with them. If we ignore the phenomenon of jet lag, players may lose up to 10% of their sporting and physical performance, which is equivalent to them having only three hours of sleep or drinking a large quantity of alcohol. Some studies show that one day of adjustment is needed for each time zone change following a flight from west to east, so a passenger needs five to seven days to adjust after an intercontinental flight. Many authors state that psychomotor and mental activity stabilises within two to seven days, reaction speed within two days and core temperatures within four to six days. According to Panfilov (1986), after crossing seven or eight time zones, VO2 max values drop steeply over the two or three days following the flight and then recover gradually to reach the initial (or possibly even higher) levels between seven and 13 days, normalising completely after 18 to 20 days. Although any long-haul flight can cause

FOOTBALL MEDIC & SCIENTIST | 13


jet lag, travelling from west to east is considered worse than east to west, as the day seems “longer”. Imagine flying from New York to Barcelona. When you land in Barcelona at 22.00, it is still 16.00 in New York. It is difficult to get to sleep, as your biological clock thinks it is 16.00. On the other hand, if you arrive in New York from Barcelona, it is easier to get to sleep. With flights heading west, adjustment is 30 to 50% faster than with flights heading east. It is interesting to note that long-haul flights going from north to south or vice versa have no effect on circadian rhythms. However, they still produce fatigue owing to intrinsic cabinrelated factors and the long period of physical inactivity.

How to reduce the effects of jet lag and adjust to the new time zone Before the journey Whenever possible, flights should be scheduled such that the team arrives in good time before the match. Departure, arrival and journey times should be taken into account as part of the pre-match planning process. In the week before the match, the player’s timetable for getting up and going to bed needs to be adjusted. In that week it will help to be in a well-lit environment for the two hours before bedtime. No afternoon nap should be taken on the days before departure and the

player should get up early and go to bed early. A diet rich in carbohydrates and low in proteins will help the brain to capture tryptophan and convert it into serotonin, making sleep easier and better. During the journey Players should wear comfortable clothes, wear progressive compression socks and use a small pillow during the flight. It is recommended that players always use their own pillow for journeys. Watches should be set to the destination time on entering the aeroplane. It is strongly recommended that players drink lots of liquids, as the cabin air is dry. Fizzy drinks are not recommended, as

Pictured: Members of the England team board the plane at Heathrow Airport en route to the 1970 World Cup in Mexico.

Pictured: Everton’s Sylvain Distin steps off a plane in Minsk as the team prepare to face FC BATE Borisov in a UEFA Europa League group match in 2009.

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they may cause gastric problems owing to the effect of air pressure changes on the imbibed gas. Coffee is not recommended because it encourages water loss and stimulates the central nervous system, making it difficult to sleep. The last meal before the time set for sleeping should be rich in carbohydrates and low in proteins in order to encourage sleep. Carbohydrates provide the basis for the production of serotonin, which is a neurotransmitter that regulates sleep. A breakfast that is high in proteins and low in carbohydrates will help to prevent sleepiness, as will drinking coffee. It is very important to do stretching exercises in the cabin aisle and static exercises while seated, stretching the lower extremities, trunk and cervical region. Using earplugs and a face mask encourages rest and improves the quality of sleep. During the flight, players should take off their shoes.

If arrival is at night, players should try not to sleep for the last few hours of the flight. If arrival is in the morning, players should sleep for the last part of the journey.

contain high levels of proteins and low levels of carbohydrates. Equally, the midday meal should contain plenty of carbohydrates and low levels of protein. Supper should be light.

On arrival at the destination Team and player training sessions at the destination should be conducted in daylight and should not be too intense, in order to avoid any injuries that might result from the physical fatigue caused by the journey. Long afternoon naps should not be taken, as if they are taken at the time when the player normally sleeps at home, they will make sleeping at night more difficult and delay the main biological clock’s adjustment to the new time zone. In this case, exposure to bright light, preferably natural light, is a useful antidote to sleepiness. For the first three days at the destination, breakfast should

Other means of fighting jet lag Melatonin is a hormone secreted by the pineal gland at night, in the absence of light, and may help the body to adjust faster to the new time zone. However, there is no scientific research proving that taking this hormone efficiently compensates for time zone changes. In fact, this product may even contain impurities that could give a positive result in an anti-doping test. If melatonin is taken, the dose should be 3mg before bedtime for the three days before the journey. This should then be taken while on the aeroplane at the time the player should be going to bed at the destination, and also at bedtime for the first three days at the destination.

FOOTBALL MEDIC & SCIENTIST | 15


PRELIMINARY PROGRAMME SATURDAY 27 JUNE 2015 Time 12.30 – 13.00 13.00 – 14.45 14.45 – 15.30 15.30 – 18.00 19.30 20.00

Activity Registration Opening lecture and speakers Break & Check-In Lectures Drinks Reception Dinner & Awards

SUNDAY 28 JUNE 2015 Time Activity 09.00 – 10.30 Lectures 11.00 – 12.30 Lectures CLOSE

2015 FMA Conference Announced

“In and Out of the Box” A football Medical & Science Confererence on practice based evidence

The second FMA Conference will be held at the Radisson Blu Hotel, East Midlands Airport, on Saturday June 27th & Sunday June 28th 2015.

Fees to include parking, tea/ coffee and all refreshments over 2 days, Champagne reception and Awards dinner. Members Early bird until 31st Jan 2015 Non- members

£165 £150 £190

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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

For more information visit www.footballmedic.co.uk

FMA FOOTBALL MEDICAL ASSOCIATION

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FOOTBALL MEDIC & SCIENTIST | 17


World-leading Hernia Surgeon Dr. Ulrike Muschaweck joins Perform Birmingham Team FEATURE/PERFORM BIRMINGHAM Cutting-edge sports medicine centre Perform Birmingham have recently added to their prominent sports medicine team with the recruitment of top global Hernia surgeon Dr. Ulrike Muschaweck.

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orld-renowned for her Minimal Repair Technique, which allows footballers return to light training within as little as 48 hours and full training within seven days. Dr. Muschaweck hosted her first surgery at Perform Birmingham in Little Aston in September with several top-flight football stars already visiting her for treatment.

The Minimal Repair Technique is a revolutionary treatment whereby only the localized defect in the inguinal area is repaired. Sound areas of tissue remain intact with only the weakness in the groin being treated. Hence the procedure is ideal for high performance athletes who in the past Dr. Muschaweck believes have been over treated with older established techniques. Traditional practices come with a five to six-week recovery period; time top professional football clubs and their players simply don’t have to waste. Previous patients at Dr. Muschaweck’s home base in Munich include England football star Michael Owen and thanks to the her new UK surgery at Little Aston, sports stars with hip and groin related injuries need now only travel to the

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Midlands for their treatment. Dr. Muschaweck joins an established specialist Hip and Groin team working at Perform Birmingham; including West Bromwich Albion’s Performance Director, Dr. Mark Gillett, Consultant Hip Surgeon Mr Callum McBride as well as the Baggies’ Lead Physiotherapist Steve Wright. Speaking at an educational evening hosted by Perform Birmingham for industry professionals in August, Dr. Muschaweck commented; “I am very excited to be joining Perform Birmingham; my new colleagues and the fantastic facilities there will enable me to

offer a service of the highest level to my patients.” “My key priorities is to provide a rapid treatment solution to those suffering from hernia-related injuries and a UKbase is a convenient option for my clients playing professionally in this country.” Dr Mark Gillett, Medicine and Exercise Consultant at Perform Birmingham added; “We’re absolutely delighted to welcome Dr. Muschaweck to our specialist Hip and Groin Team at Perform Birmingham. Her Minimal Repair Technique has huge appeal to professional clubs as it promotes a safe, but speedy recovery for their players. ” “She brings an immense wealth of experience and enables us to offer a unique service, available at no other UK facility, right here at Little Aston.” Dr. Muschaweck and the Hip and Groin team at Perform Birmingham offer a range of treatment options for players and work closely with their club’s to devise an effective recovery plan. For more information about treatment at Perform Birmingham, visit www.spireperform.com/birmingham or call 0121 580 7131.

FOOTBALL MEDIC & SCIENTIST | 19


What’s in a medical?

How to pass one, & why

some players don’t

FEATURE/Rob Kemp Courtesy of FourFourTwo Magazine, in partnership with the FMA  Most players glide through them but others, like Loic Remy (pictured, left) at Liverpool, see their dream moves shattered. FFT finds out why...

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hink a medical is a foregone conclusion? Think again. As we’ve seen only this summer, a move isn’t done until a player has passed a club’s rigorous check-up with flying colours. To find out more, FourFourTwo got the lowdown from Blackburn’s Head of Sports Medicine Dave Fevre, formerly of Manchester United and Great Britain Rugby League, and a member of the Football Medical Association. “I liken it to when you go out and buy a second-hand car – you can take a risk on it being OK based on what you see, or if you’re wise you’ll invest after having an inspection from experts like the AA. When you look at the amount of money paid for players it’s really in the club’s benefit to ensure to the best of your ability that what you’re getting is in good working order. “But just as every footballer is different, so too is every football medical. The requirements of the club, the brief from the manager, the age, position, medical and injury history of the player – all of these variables will change every time. “There’s no standard medical as such – every club has its own way of doing things. Usually a player being transferred to our club will undergo a two-day medical, although when it comes to transfer deadline day, time isn’t always a luxury you can afford. But in both cases the role of the team physiotherapist, club doctor and fitness team is to provide as much information to the manager and the club’s executives in order for them to make the final call. “There are key elements that most medicals will feature. A health check to look for any cardio concerns is one of these; since Fabrice Muamba’s heart attack, clubs are even more diligent about checking any heart irregularities. Players up to the age of 24 will ideally have annual checks to detect any heart-related issues. “The timing of the transfer will influence things too. For the January

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window transfers, you’re usually looking at players who will need to hit the ground running – it’s rare that you’ll see a club sign a player with an existing injury at that time, although Arsenal did choose

to do so with the loan signing of Kim Kallstrom last season. It’s not often that happens, but there may be relevant information involved in the deal that people outside the club are not party to.

MEDICAL NON-MOVERS Demba Ba The Senegalese hitman failed a medical at Stoke in January 2011 (not for the first time), before joining West Ham for an undisclosed fee based on appearances. Leroy Fer Norwich’s Dutch powerhouse was supposed to pitch up at Everton in January 2013, only for his medical to reveal a long-term knee injury. Ruud van Nistelrooy (pictured,above) The free-scoring striker had his dream move to Manchester United twice put on hold after knee ligament damage in 2001. George Boyd The Hull winger should have joined Nottingham Forest last season, but for an “inconclusive eye test” to bizarrely scupper the move. John Hartson Rangers had the burly Welshman in their sights in 2000, but he failed his Ibrox check-up and later joined Celtic.

FOOTBALL MEDIC & SCIENTIST | 21


“You’ll look to sign players who have consistently played, and it is then up to you to provide the manager with an assessment of where they are physically and what additional work may be needed to get them up to full fitness. The club will use their own fitness checks for this; everything from body fat percentages to maximum VO2 testing to gauge where the player is at and how far away they are from starting. “Some clubs will include vision, hearing and dental checks during the medical. For example, during my time at Manchester United we worked with Professor Gail Stephenson (vision scientist at Liverpool University) in looking at many aspects of sport, exercise and vision. We also send players off to the dentist for check-ups to try to prevent any problems that can happen throughout the season, and the knock-on bio-mechanical effects that such issues can create. “The player’s skeletal range of movement – that’s joints, key muscles, fitness and any possible weak spots – will be assessed. I’m especially keen on checking the pelvis as it’s such a key area for both upper and lower-body mobility, strength and injury prevention. The player’s position will influence the medical too – goalkeepers, for example, will have a check on shoulders, elbows, wrists and, of course, hands. If anything needs further investigation we’ll book a scan and get a more thorough assessment. Real Madrid’s medicals are now iconic “It’s not just players we sign who undergo medicals, too. Our academy players will have one when they move up to the senior squad to assess their development against first-team markers. Loan signings will also have a medical, which can work in several ways for the player and the club. Some loan signings will make permanent moves and often cite the care shown by the club that signs them as an influencing factor. So a thorough, professional check-up of a loan player not only ensures the club is getting a fully fit player but it also can impress a player to the point where they join for good.  “Players can fail a medical for any number of reasons – sometimes we’ll look at the assessment results and think, ‘we’re not sure they can go through 40odd games in the Championship at the moment – we don’t want to take a risk on them’. “That’s not the end of the story, and we’ll still work with the player and their representatives so we can help them. Ultimately, the needs of the club, the strength of the squad, the time the player has to get up to full fitness or overcome an injury will dictate things. So while they may not sign for one club, they could pass for another.”

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Pictured: Arsenal physiotherapist (and later, manager) Bertie Mee using revolutionary new treatment techniques in 1961.

Playing the Passing Game: the key elements of a football medical Test 1: Heart and health A club medical includes cardiac screening with an ECG, echo monitor and heart health history questionnaire; these may also feature blood tests and a fitness check. The club doctor may include a urine test to detect proteins or ketones that indicate health issues such as diabetes.   Test 2:  Musculoskeletal stability  The physio team’s in-depth look at possible weak spots like the lower lumbar (back) and pelvic region – areas where hamstring and adductor problems can originate from. They may also check for any defects in function or muscle tightness when performing straightforward moves by using drills such as squats, hop tests and lunges.   Test 3:  Isokinetic issues Focusing on muscles and movements (like the quads and hamstrings, for example), the physios can work out the ratios between the two muscle groups as they work together and identify weaknesses which may predispose injury or have developed post-injury. Knee flexion and extension drills are among those used to check the player’s movement.   Test 4: Deep scanning In the event of a history of problems, the medical team will have a hospital on standby for a magnetic resonance or ultrasound scan. Scanning units can be used to assess the majority of muscles and joints in the human skeleton.   Test 5: Body fat score Clubs may use Bioelectrical Impedance technology – a body fat monitor that sends an electrical signal through the body to measure lean tissue and fat. Most professional players are expected to be around the 10% body fat mark. Fat callipers are still used in many instances for reliability, as long as the same examiner is involved in any re-testing.   Test 6: Ergometric sprint test Does what it says on the tin – measures a player’s speed over a set distance. A result of sub-three seconds for the 20m sprint test would be expected for outfield players in the Championship.

FOOTBALL MEDIC & SCIENTIST | 23


VIS UA L

performance

in Soccer FEATURE/Geraint Griffiths

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eague goalkeeper John was missing high crosses and getting caught off his line, his manager could see this from the stand and asked for a visual assessment. He was short sighted with very strong focusing. Unfortunately the harder he focused the more short-sighted he became. His dominant eye was also losing its aim. As a result he was misjudging the position and distance of the high crosses. The stability of eye dominance and hence the need to measure it is key to understanding the problem. The incidence of Type 1 dominance (right eye, right hand, right foot) and Type 2 (any left tendency in

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eye, hand or foot) varies from sport to sport1 A low power contact lens solved the problem and the club was able to sell the player later for three times his original transfer value. The manager with one eye on the balance sheet in a respected feeder club was delighted with the outcome, seeing a first class keeper progress in his career. John’s problem is common in Soccer and focusing is very often associated with difficulty coordinating the eyes at the reading distance. It is important to maintain players’ vision off the pitch to make sure they perform well on it, as well as optimising distance vision Problems with aiming and depth

perception are often over looked even in elite players. The following data from a squad of 32 national league players illustrates this. Demographics The squad included 9 strikers /forwards, 11 midfield players, 9 defence and 3 keepers. Their average age was 22 with around 14 years playing experience each. 50% of the squad were Type 1 dominant, 50% Type 2. A mixture of dominance types is likely in Soccer because of the need to defend and attack down the left side. Deciding a players position could start by knowing his or her dominance type.

Vision The importance of eye dominance becomes apparent when players at risk of sporting deficit related to visual deficiency are compared. Out of 10 players with significant visual deficit 80% are Type 2. The importance of Type 2 players to the defence of the left wing against attacking Type 1 players is critical to overall team performance. From the data it is clear that many teams could transform results by supporting the vision of their type 2 players with regular visual assessments Reported difficulties 15 for the players (47%) volunteered that they had issues with their vision. Taking into account all risk factors this number rises even further. This includes 47% of the squad who had significant light sensitivity and 14 (44%) who are predisposed to reading difficulties (dyslexia). In fact only 6 (19%) could be said to have no difficulties related to vision. Many of the players were unaware that the difficulties they were experiencing on the pitch could be related to their eye-sight. Eye strain can restrict peripheral awareness which is a critical skill in soccer Short sight reduces the time a player has to decide what to do with the ball; players can be preoccupied by judging its distance and position and forget to read the pattern of the play off the ball or the threat of an on coming tackle. Light sensitivity can be very debilitating and yet easily solved with tinted contact lenses. Long sight can provoke frustration and inappropriate aggression as players fatigue and position and distance judgement are lost2. Muscle physiology All the rules of physiology, diet and hydration apply directly to visual system. It may be that their effects on vision in soccer are even more important than their effect on the major skeletal muscles. It is often forgotten that the

striated muscles that control eye movement have the same physiological characteristics as leg and arm muscles. Their function has to be precise and repeatable otherwise the fittest athlete will be misdirecting their energy3. Sport vision is now a growing speciality in Optometry. There is a clear indication that all professional players should be screened at least once a year for visual deficit. There is a probability that team performance could be transformed very cost effectively by a simple visual correction The Association of Sport and Schoolvision Practitioners (ASvP) maintains a register of qualified sport vision practitioners (go to www. sportvision.co.uk/finda practitioner). The screening programme is well established and grounded in fundamental optical principles. All the visual problems highlighted in this league club are amenable to correction with contact lenses or spectacles. This depends on whether the need is on the pitch or to support eye-strain due to reading difficulties, which could have a secondary effect on playing performance.

Conclusion In soccer confidence is all. All athletes have an innate feeling of when they have given their best. When the team or individual players make inexplicable errors confidence can spiral down out of control. Vision is the most important consideration in the preparation for competitive sport. It is so important that most athletes take it for granted, especially when the mechanism between visual deficiency and poor performance on the pitch is not understood. Team performance relies on everyone playing their best. Even one player who is underperforming will sap the confidence of the team. The data suggests that in this particular squad over 50% are at risk of visual problems, which will have a direct effect on their playing ability. All league players from the Premier League to League Two belong to an elite group already marked by their innate physiological talent. It is possible that the main difference between the very top and the lower leagues is vision. If half a team is under performing because of easily correctable visual problems, the collective effect of remedying this could be remarkable. Players can only develop if they and the team are confident and performing at their best. When the ball is seen clearly and comfortably and distributed accurately, when tackles can be timed well and the flow of the game off the ball is read clearly, excitement and adrenaline flow. This is when muscle performance and skills optimally improve. No amount of training and preparation can substitute for the power of successful competition in achieving excellence. Vision is critical to this success. 1. Griffiths GW 2003 Eye Dominance in sport – a comparative study Optometry Today Vol 43:16 15.8.03 2. Griffiths GW 2001. Colour preference – a comparative study. Optometry Today October Vol 41:20 3. Griffiths GW 2002 Eye speed, motility and athletic potential. Optometry Today Vol 42:12 14.6.02

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Break the

Rules &

SUFFER

THE CONSEQUENCES LEGAL/MARTIN PRICE

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e are all aware of players and managers getting into trouble for unacceptable behaviour during a football game, but did you know that the club’s medical team could also suffer harsh penalties if their behaviour falls below the required standard? All players and ‘participants’ fall within the scope of the FA’s rules and regulations. The meaning of ‘participants’ is as follows: ‘An Affiliated Association, Authorised Agent, Competition, Club, Club Official, Licensed Agent, Player, Official, Match Official, Management Committee Member, Member or Employee of an affiliated Club and all such persons who are from time to time participating in an activity sanctioned either directly or indirectly by The Association.’ This broad definition of ‘participants’ brings a club’s medical team within the jurisdiction of the FA’s rules. How does this impact upon you? It is important that you are aware of the FIFA Laws of the Game 2013-14 and, in particular, that you are aware of the

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Standard Penalty 1 – Standard Penalty Charge admitted and 2 – Charge Denied and standard penalty accepted subsequently found proved by a regulatory commission Including Abusive/Insulting Including Abusive/Insulting language language

rules in relation to the ‘technical area’. The technical area is the designated area for the club’s playing and coaching staff, including physiotherapists and the club doctor. There are various rules governing the layout of this area. However, some of the most important rules that you should be aware of are: 1. only one person at a time is authorised to convey tactical instructions from the technical area; 2. you must remain within the confines of the technical area except in special circumstances, for example, a physiotherapist or doctor needs to enter the field of play, with the referee’s permission, to assess an injured player; and 3. the coach and other occupants of the technical area must behave in a responsible manner. These rules are to ensure that all staff and players accept and respect the decisions of match officials at all times. Should you not follow these rules, for example, by entering the pitch without permission or acting in an aggressive or threatening manner towards the referee then disciplinary action may be taken.

Pictured: FIFA World Cup Italia 90 - Bobby Robson gets animated during England’s group match with Ireland, along with Physio Fred Street (in tracksuit left) and coach Don Howe (in glasses, centre).

Sanctions There are two standard sanctions in relation to misconduct within the technical area that can be imposed by the FA, depending on whether a charge has been admitted or not. In deciding whether disciplinary action should be brought the FA will take into account a number of factors, such as the nature of the misconduct, adverse publicity and the duration of the incident. It is felt that in the majority of cases the following standard sanctions will be imposed:

Either 1 match touch line ban for non-players or 1 match ban for player.

Either 2 match touch line ban for non-players or 2 match ban for player.

-AND-

-AND-

Fine:

Fine:

Premier League

£8,000

Premier League

£12,000

Championship £2,000

Championship

£3,000

League 1

£1,000

League 1

£1,500

League 2

£500

League 2

£750

Conference (National) £250

Conference (National) £375

Should the Regulatory Commission feel that an incident is more serious and the punishment would not be reflected through a standard sanction they would, on a case-by-case basis, have to determine what further penalty would be appropriate to reflect the seriousness of the misconduct. Within the heat of a football match it is important that all participants and players respect the rules of the game and accept the decisions made by officials. No matter what role or functions each member of staff carries out, it is essential that they are aware of the boundaries within which they must operate, as should they breach the rules, they can bring their club into disrepute and suffer consequences on a personal level. If you are charged with an offence it is important to consider your position carefully before responding – denying a charge where your position lacks substance or because feelings are still “raw” could well result in a more severe penalty which might rub a little salt in the wound. It seems that this Premier League season has presented a whole set of new challenges for the Regulatory Commission to rule on, from managers headbutting players, interpretation of political gestures, to the Hazards of being a ballboy against Chelsea!

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TWO WHO FELL

FOUL REF

OF THE

FEATURE/CHRIS MORTLEY

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s featured within this edition of Football Medic & Scientist, match officials can have as much of a say in the conduct of physios and medical professionals, as they do the team’s players and coaches. Although cases of any cautions issued to medics by match officials have been few and far between, they are not entirely unheard of, as two first-team physiotherapists in particular can testify…

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EREK FRENCH enjoyed an illustrious career as a first-team physiotherapist, with clubs including Sheffield United, Watford, Barnsley, Wimbledon and Nottingham Forest. On New Year’s Day, Derek was part of Watford’s staff when the Hornets took on Tottenham Hotspur. A passionate member of the club’s set-up, confusion led to Derek being dismissed from the dugout, as he explains. “We had just had a player sent off for dissent and I was remonstrating with the player for getting sent off,” said Derek. “The assistant referee thought my tirade was aimed at the ref and the referee sent me off! “I would not criticise match officials, as I do believe that they have a very difficult job. I wasn’t proud of the way I spoke to the player in front of officials – and certainly don’t condone that sort of behaviour, but it does go to show that medics and physiotherapists are just as likely to be reprimanded by the officials as players, managers and coaches.”

Pictured: Tim Sheppard (centre) flanked by Celtic and Norwich City players during his testimonial in 2001.

was given a testimonial fixture against Celtic for his service. During his time with the Norfolk side, Tim experienced nights of European competition for the Canaries, including a famous two-legged UEFA Cup tie against German giants Bayern Munich in 1993, which Norwich ended up winning 3-2 on aggregate. Whilst Tim worked for the first leg against Bayern at the Olympic Stadium, he would miss the return leg at Carrow Road – after being served with a one-match suspension by the match official in Germany. “I ended up going on the pitch and Ruel Fox, who was on the other side of the pitch to me,

had an injury,” remembered Tim. “So I had gone across to check something and then I had crouched down (on the opposite side of the pitch to the team dugouts) because if he went down again or there was a problem with him again very soon after, what was the point of my going all the way round the pitch? “So I crouched down there, which was never a problem in English football, but this linesman drew the attention to the referee that I was still crouching there and should have been on the bench. “Nothing was said during the game other than go and sit back down,” he continued. “Then we got a letter at Carrow Road the week after saying that I had contravened this ‘time’ thing within the game, and that I would be subjected to a one-match ban for the return leg. “So I wasn’t to be in the dressing room for an hour before or after the game. When you look at what a player could get a ban for in the match, for an indiscretion or foul play, you think, ‘yeah, you deserve a one-match ban’, but how pathetic was that? It was just bizarre.” Many thanks to David Freezer of the Eastern Daily Press for his assistance with this feature.

­SPORTS MEDICINE REGISTER

Free sign up for Members Many of you may have noticed the Sports Medicine Register on the website, designed to promote practitioners in private practice. It’s an exciting new development that has four main objectives: • The FMA is seeking to establish a comprehensive register of practitioners who have worked or are working in professional sport with teams or individuals at club, national and international levels. • The register will also create a vehicle to support members who are working in private practice and/or who have their own businesses. In doing so it will provide an opportunity to showcase your skills, expertise and experience in elite level sport. • It is hoped that that register will become an invaluable directory for colleagues to source skilled practitioners who have worked at the highest level in various disciplines and across the sporting spectrum. • The directory is being made available to the public. Should you decide to enrol, your skills will be recognised as part of an elite register and will hopefully provide an additional revenue stream for your business. Once established we will also seek to promote our register to fan engagement groups so that members of the public can also find practitioners who have worked for “their team”. Currently no such register exists in this format and the FMA already has many members who fit the criteria. We are kick starting the project by offering members who have involvement in private practice the opportunity to place your practice details on the site for FREE and as part of your membership. If you are involved in private practice, register by contacting the office for full details - Info@footballmedic.co.uk

Representing and promoting medical, science and BERSHIPS exercise personnel in professional league football FMREMOM JUST

Pictured:Left to Right - Vinnie jones, Dave Bassett, Derek French and Bob Booker during their Sheffield United days.

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IM SHEPPARD was Norwich City’s longserving physiotherapist, working for the Carrow Road outfit until 2001 when he

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Pictured: Ruel fox is on the recieving end of a bad challenge by Bayern Munich’s Thomas Helmer in the match that led to Tim’s suspension.

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WHERE ARE THEY NOW? FEATURE/TIM EXETER

List of previous clubs… WBA, Coventry City, Gillingham, Portsmouth, Stoke City, plus Welsh National Team in the Giggs, Hughes, Southall, Saunders and Rush era. What are you doing now? Athletic Performance training, everything to improve performance and reduce injury risk. I am based in France where I have set up a private centre, working with amateurs and pros in football, rugby, cricket plus others. Looking to offer my specialist expertise in speed and movement efficiency on a visiting basis, UK and abroad. I have helped two Indian test cricket, IPL and World Cup winners – Yuvraj Singh and Zaheer Khan to get back in to the national squad. Best and worst part of working in football? The team environment is great, coming from a rugby background you need that interaction and the hardest part was changing traditional ways and certain coaches. It was a great challenge to try and improve players in many aspects of their physical performance. Nowadays it’s the norm what I tried to put in place. Players were in the main open to finding an edge; certainly the best have this thirst to improve. What was your biggest disappointment in the game? With hindsight, probably turning down Chelsea in 1996. Rugby had just turned pro, I had shook hands on a deal with Richmond in London and Chelsea interviewed me as Mark Hughes recommended me from our time together in the Wales set up. I don’t think he ever forgave me for turning it down, even my dad who is a rugby man through and through was saying go for Chelsea, but I am a man of my word and I couldn’t backtrack. How have things changed? Visiting clubs over the last few years, the facilities are second to none and the staffing resources at the bigger clubs are more comprehensive. The players are the assets and the managers need them available to train and play as often as possible. For too many years there was not an understanding of the importance of support structures. Are you still in touch with people from the game? Yes Tony Pulis and I see each other when we can, I had Jonny Williams over for a spell at the end of the season, I caught up with Neville Southall recently and I visited Tony Strudwick at Manchester United a couple of years ago where I briefly caught up with Ryan Giggs and impressed Patrice Evra with my French!

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Did you have any other duties other than your fitness coach role? A little on nutrition and sports massage but now that is rightly left to the specialists in those fields. How was your relationship with managers? Ok, just football was quite insular so I was an outsider, however I think it helped having played another sport at high level. Also, being taken by the manager to another club, which again showed the value of good working relationships including Bobby Gould, one of the game’s great characters at both Albion and Coventry. For sure, Gouldy was marmite, but he was forward thinking, he let me have my head and we had great results particularly during our time at Coventry City. Did you feel you contributed to the overall success of your team? I hope so. I always got involved with the Youth teams too as the potential positive impact you can have there is huge. It also means the youngsters come into the pros better prepared. Sir Alex Ferguson saw that a long time ago and put things in place at Manchester United. It takes a stable club with a real long-term vision that is prepared to back the manager to do that.

Pictured: Tim during his time with Northampton Saints.

How did you get in to football? I had to retire from top class rugby at 24 after fracturing vertebrae C1. I spent a year in the USA where I had spent time training in my off seasons and on returning contacted all the clubs. Bobby Gould was ahead of his time in looking outside the game and he got in touch. At no stage had I ever worked full-time as that was really rare. It was only the offer at Chelsea which would have been the first full-time position. Once I got into Rugby then I was full-time at Richmond followed by seven years at Northampton Saints and then CA Brive here in France. Do you have happy memories of your time in football? Absolutely, it was fun, full of great characters. I like to feel it made a difference and opened eyes to what is possible. I would love to get involved again as I’m still relatively young and feel there is room for external complimentary expertise where the staff are still overloaded running the squads on a day-to-day basis and individual attention is sometimes hard to give. Did you have a mentor or a fitness coach manager who you looked up to and inspired you? Not really, the injury was a life changing thing. My dreams of playing International Rugby for Scotland were gone, I had the idea to go for the commonwealth games and trained for the 100m, but although I was fast it would have taken a long time to get down to 10.2 seconds which would have been ok at that stage.

The importance of good relationships with players is no better emphasised than your role… Ultimately, you have to keep the line between player and coach. However, it is a strong two-way relationship if you are to get the results that you and the player want. They have to be engaged and see you are there to help them be the very best they can be. Any funny stories? Yes plenty, too many to mention and I’d probably get a lawsuit if I did! Final thoughts on your time in the game at club level? I was in at the start of the Premier League. It has evolved massively, however, I still see good young players coming through with fundamental movement issues. There is still a huge amount of work to get the youth development right from the athletic point of view. Clubs have some bright newly-qualified, young fitness trainers but with little hands on experience. Ultimately coaching whether it is football or fitness is teaching and communication.

Pictured: Tim working with the Welsh national football team in Riccioni, Italy - June, 1996.


Football Medic & Scientist  

Autumn 2014 Issue 10

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