Issue 13 - Summer 2015

FOOTBALL MEDIC & SCIENTIST The official magazine of the Football Medical Association

Lead SPONSORSHIP ANNOUNCED

with Spire Healthcare

2015 FMA

Conference

Pictures, awards & retrospective on Jim Headridge

FMA: Defining Our Position

& the “pillars” of our Association

FMA FOOTBALL MEDICAL ASSOCIATION

Issue 13: Summer 2015

SPONSORED BY

Contents

FMA FOOTBALL MEDICAL ASSOCIATION SPONSORED BY

Welcome 4 Members News 7 Touchline Rants

WELCOME/EAMONN SALMON

7 On the Couch Paul Atkinson

This, the summer edition has just about made it – the summer that is. The delay comes on the back of a late Conference this year which in turn was because of a late FA Cup Final, and a late end to the season.

Editorials & Features 8 Spire Announcement

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he Conference event this time around was nonetheless spectacular once again, not just in its educational programme but also in its format, its organisation, the awards dinner, the trade exhibitions and sponsors, the venue and of course the delegates themselves who actively engaged in the whole event and throughout the weekend. No doubt our feature in this edition will give you an insight into why this is now the must attend event in the football medicine calendar.

Looking back through past editions it seems this “welcome” section is primarily an opportunity to flag up the successes of the FMA. Well I hope this is a tradition that long continues, as once again there is so much to shout about:

11 The Women’s Game 12 FMA Conference 2015: Jim Headridge 14 FMA Conference 2015: Picture Special 16 FMA Conference 2015: Awards Winners 18 Defining the FMA’s Position 20 Antidepressants in Professional Football Wilfried Kindermann

22 BSN Announcement 24 Diagnostic Approach to Head Injuries in Footballers Dr Ioannis Economides 26 Screening: Who’s Responsiblity Is It? Johnny Wilson 30 Where are they Now? Chris Smith

• • • • • • •

A 2 year Lead sponsor announcement with Spire Healthcare.

Business Partnership agreed with BSN Medical.

An Educational partnership with the Royal College of Surgeons of Edinburgh.

Announcement of ambassador appointment and establishment of advisory panel in women’s football.

An expansion of our Educational provision for members.

Our first audit set to be delivered. & the appointment of two more members of FMA staff.

This edition also provides an opportunity to deliver a strategic plan of our membership and the remit for the FMA moving forwards. In straightforward terms we have determined who our member disciplines are and set out the “pillars” of our association so that there is no ambiguity as to who we represent and what we are about. With a clear pathway now ahead of us it is our intention to embrace all practitioners of these disciplines as members and excel in our delivery of these essential support services to each and every member.

Finally, I know from personal experience that during the season, we work very much aware that there are issues and pressures lurking behind us. We know these should be dealt with but instead we chose to ignore them and concentrate on the immediate tasks hoping to get through the season without these issues raising their ugly heads.

FMA members can rest assured that since we are dealing with many of these same issues for them they can feel free to concentrate on those immediate tasks and enjoy what the season brings. It’s all about peace of mind.

Eamonn Salmon CEO Football Medical Association

Football Medic & Scientist Gisburn Road, Barrowford, Lancashire BB9 8PT Telephone 0333 456 7897 Email info@footballmedic.co.uk Web www.footballmedic.co.uk

Cover Image Physiotherapist, Jim Headrige, features in the 1978-79 Bolton Wanderers team photo.

S&G/S&G and Barratts/EMPICS Sport Football Medical Association. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, or stored in a retreval system without prior permission except as permitted under the Copyright Designs Patents Act 1988. Application for permission for use of copyright material shall be made to FMA.

Chief Executive Officer

Eamonn Salmon

Senior Administrator

Lindsay McGlynn

Administrator

Nichola Holly

IT

Francis Joseph

Contributors

Johnny Wilson, Chris Smith, Paul Atkinson, Wilfried Kindermann, Dr Ioannis Economides, Spire Healthcare, BSN Medical

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

FMA FOOTBALL MEDICAL ASSOCIATION SPONSORED BY

FMA announces landmark partnership with Spire Healthcare

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he Football Medical Association (FMA) is delighted to announce a two year ‘Lead Sponsor’ partnership with Spire Healthcare. The agreement will run to the end of the 2016/17 professional football season and marks a significant development for the UK’s lead body representing both medics and scientists working in the professional game.

The Spire agreement incorporates Perform’s flagship facility at St Georges Park National Football Centre. Phil Horton, National Perform Director, commented: ‘This is a significant partnership agreement for Spire Healthcare and we are looking forward to partnering with the FMA and its members. The presence of medical and science personnel in professional football has

Bear Grylls – The Island

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he FMA have been approached by the makers of the channel 4 programme “The Island” who though it would be interesting to have a former Football Medic or Therapist as one of their contestants. Since this entails a 6 week filming programme it is unlikely that this will appeal to members currently working in the game but for those who are currently available and able to get the time, this might be an interesting experience.

“In previous series, volunteers were stripped of all the comforts of civilisation, and cast away on a remote deserted island. They filmed themselves, and shared their raw

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and exhilarating story of survival in a ground breaking series.

We are looking for fit and able men and women of all ages (18+) each with their unique skillset, who are confident in their ability to thrive. But they do not need any experience in adventure or survival pursuits to participate.

We will also cover reasonable pre-agreed loss of earnings for everyone who participates.”

If any member wishes to express an interest, please contact the office and full details will be forwarded. It would be great to see one of our colleagues taking up the challenge !!

grown enormously over the past 15 years and reflects the increasing importance of their work and contribution to the modern game.

Spire currently provides medical services to footballers, managers and referees and we are keen to welcome football medics and scientists to our football family.’

BSN Medical on board

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SN Medical, best known perhaps for their Leukotape brand have signed a Business Partnership with the FMA for the coming season.

The launch of this partnership was in fact heralded at the recent Conference

Conference date announced

which was sponsored by BSN Medical.

The 2015/16 season will see arrange of initiatives between BSN and the FMA as part of the agreement and a much higher profile for the company in the world of football.

FMA to have increased presence at Soccerex

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The 2015/16 season FMA Conference will be held on the 21st and 22nd May 2016 which is FA cup final weekend.

A board discussion and opinion of delegate at the recent event strongly suggested that this was the preferred date fo many reasons – staff from only 2 teams will be unable to attend ( unfortunately for them) No end of season tours are likely to have been planned and staff are unlikely to have planned a holiday in case they reach the final!

With everybody around we can ensure a huge turnout for what is a fantastic way to end the season.

The FMA Conference will now take place on every FA cup final weekend.

New staff at the office

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s well as hosting a panel session at this years event, the FMA is to have a stand over the 3 days.

This will give all delegates and exhibitors who attend the opportunity to come along and discuss with staff

the growing presence of the FMA in professional football.

There will be the usual offer to FMA members of a complimentary pass.

Full details of the event are featured overleaf on page 6.

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he FMA is currently busy recruiting 2 new members of staff to ease the pressure on Lindsay and Nicola.

This means there is much more opportunity for us to engage and meet up with members this coming season, and will also allow us to tackle the volume of work that besets us much more effectively.

FOOTBALL MEDIC & SCIENTIST | 5

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Touchline Rants! e

by Pitchside Pet CUP FEVER

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s the FA and League Cup rounds come thick and fast at this time of the season, it got me thinking about extra time and penalties.

Why is it always an Away game, been a traumatic journey getting there and raining cats and dogs when the match goes to penalties? It always seems as though the footballing Gods have been conspiring against you…

These type of matches are the ones where you run low on Deep Heat and Vicks – usually to keep the toes of the players and staff warm.

The tubes are normally empty by the time you think about applying some welcome warmth to your own tootsies!

It’s that slight moment of panic as you ask someone in the 85th minute of normal time to

grab some extra gels bars and energy drinks for extra time – not earlier than that to tempt fate – you wouldn’t want to be seen to be settling for extra time and the opposition score a late winner!

As every team does at the start of the Cup competitions, you always feel that it is ‘your year’ – however big a club you work for. Either you plan on winning it – or at least having a decent run…with the odd giant-killing for good measure.

It’s that feeling of excitement and dread when the draw for the next rounds are made……Will you get a home game, play one of the moneyspinning teams or will it be another endless journey on a wet Wednesday evening?

I’d pack a couple of extra tubes of Deep Heat for that match if I were you…

ON THE COUCH...

FEATURE/PAUL ATKINSON including 5 in the last 5 years at Plymouth Argyle. Each manager is different in his approach to the game and style of management. By a strange twist of fate the new Assistant Manager, Craig Brewster, was a player at Dunfermline Athletic whilst I was physio for the club 13 years ago. We kept in touch and now find ourselves working together at the opposite end of the UK.

Profession?

Chartered Physiotherapist Where and when did you train?

Trained at Wolverhampton University between 1990 – 1993 whilst serving in the Royal Navy.

Completed a Post Graduate Diploma in Sport & Exercise Medicine in 2010 at Cardiff University.

Previous clubs/employment?

I left the Royal Navy in 1996 and worked for 4 years in an Out Patient Department of a Private Hospital. I have worked in Professional Football since 1999 starting at Plymouth Argyle before moving to Scotland and working for Dunfermline Athletic and Heart of Midlothian in the Scottish Premier League. I returned to Plymouth Argyle in 2010 as Head of the Medical Department.

How did you get into football?

I got involved in football during my time as a physiotherapist in the Royal Navy, I was running a rehabilitation gymnasium in the old Naval Hospital in Plymouth and used to see several players who had undergone A.C.L. reconstructions for the then Club Physiotherapist, ex England Physiotherapist, Norman Medhurst. When Norman moved to Torquay Athletic he put me forward for the vacancy.

How’s it going at the moment?

After what can only be described as a turbulent start to my return to Plymouth Argyle in 2010 which saw the club suffer successive relegations from the Championship to League 2 and a 9 month period in administration, during which time the club staff went unpaid, I am happy to say that hopefully we seem to have at last turned a corner with the club just missing out on promotion last season. We have a new management team this season and are currently undergoing the hectic Pre Season Training period and looking forward to a successful season.

Which Manager / Player / Staff have you most enjoyed working with?

During my 16 years working in Professional football I have worked under lots of managers

Next Step/career path?

Id like to say that my next step would be to retire when Plymouth Argyle make it to the Premier League but the period in administration has seriously affected any retirement plans that I may have had so for now Ill keep doing the job that I enjoy doing to the best of my ability.

Dream job?

I always thought that my dream job would be as Physio for Manchester City, the team I supported as a kid growing up in Oldham, however the longer I work in football the more I think that this would be one of the hardest jobs for a physio.

Whilst it would be nice not to have to worry about budgets etc I can imagine that everybody would be wanting to get involved with your department and to a certain extent you are there to be shot at by every individual who may think they can do a better job than you.

FOOTBALL MEDIC & SCIENTIST | 7

FMA FOOTBALL MEDICAL ASSOCIATION SPONSORED BY

SPIRE HEALTHCARE

ANNOUNCEMENT

The Football Medical Association (FMA) are delighted to have signed a two year lead sponsorship deal with Spire Healthcare. The partnership looks to unite an organisation who caters for the football medics – The FMA, and Spire Healthcare who provide medical services to the whole football family including footballers, managers and referees.

Spire Healthcare has 39 private hospitals, 13 clinics and 11 Perform centres around the UK. Spire offers a diagnostic pathway, imaging, pathology and inpatient treatment as well as connecting patients to leading physiotherapists and consultants. Teams/players and patients can access treatment through medical insurance or by paying for their own treatment.

Perform is as a world-class sports medicine, health and human performance brand. Its network of 11 centres encompasses physiotherapy, sports and exercise science, clinical services and corporate wellness to help people of all abilities to perform beyond their expectations. Its flagship facility is based at The FA’s National football Centre, St. George’s Park.

The presence of medical and science personnel in professional football has grown enormously over the past 15 years, both in number and in significance, recognising the importance of their work and contribution to the modern game.

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Eamonn Salmon, CEO of the FMA, said: “Spire Healthcare is an internationally recognised brand and we are delighted to have reached agreement to partner for the next 2 seasons. It was always important for the FMA to align itself to a brand that fits our profile and SPIRE does exactly that. We are looking forwards to developing the partnership and feel certain this is a relationship for the long term” Phil Horton, National Perform Director, commented: “The Spire Healthcare network supports footballers, managers and referees throughout the UK with rehabilitation, cardiac screening, health screening, imaging, pathology and rapid access to further medical services and consultants. Our leading interdisciplinary team approach delivers results and helps people get reach optimum health & fitness.”

“We’re proud to be partnering with The Football Medical Association whose members can access Perform’s Gold standard of care facilitated through Spire

Healthcare’s all-encompassing medical network and infrastructure. Committed to football, Perform not only look after the team but also, the team behind the team.”

The partnership follows on from an already existing relationship that Perform has with The FA at the National Football Centre St. George’s Park, the League Managers Association (LMA), the Professional Footballers Association (PFA) and the Professional Game Match Officials Limited (PGMOL). Perform is committed to football and everyone who works in and around the sport. They provide high quality medical services to the whole football family whether they are in or out of work; including rehabilitation for all members of the PFA, LMA and PGMOL, cardiac screening for members of the PFA and PGMOL and health screening for LMA members.

To find out more, please visit www.spireperform.com/st-georges-park or contact the Perform team on 01283 576 333 or email stgeorgespark@spireperform.com

SPIRE ANNOUNCEMENT

FOOTBALL MEDIC & SCIENTIST | 9

Pictured: England women’s team photograph prior to their FIFA Women’s World Cup Quarter-final against Canada. England beat the hosts 2-1, eventually finishing third in the tournament.

THEWOMEN’sGAME FEATURE/FMA SPOTLIGHT ON WOMEN’s FOOTBALL There is no question that women’s football is undergoing huge changes as it emerges from the shadow of the men’s game.

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ith the recent advent of a full time professional league, the opportunity for many medical and science staff to take up full time employment at clubs and on the back of a successful world cup for the national side, all is looking prosperous for our colleagues in women’s football.

The FMA is in turn keeping pace with these developments and has already set in place several projects to ensure colleagues throughout the women’s game feel very much a part of our evolving association: • The FMA recently announced the appointment of former England goalkeeper Rachel Brown-Finnis as ambassador. A science graduate herself, Rachel has always had a keen interest in medicine and science in football, it is hoped her appointment will act as a catalyst for staff in these professions to become members of and engage fully with the FMA. • An advisory panel has recently been established to promote medicine and science in women’s football on behalf of the FMA. Physiotherapists Kathrine Wise, of Liverpool and Lorna Collins of Chelsea, Dr Liam West of Birmingham City and Ellena Turner, Head of Sports Science at Manchester City Ladies are to guide and shape the process of integration

Pictured: (Clockwise, top left) England Women’s Jill Scott ghosts through Canada’s midfield at the World Cup; Glasgow FC face PSG in a 2015 Champions League Quarter-Final; Last years’s FA cup victors Arsenal Ladies; England Women battle France in the World Cup.

that we believe is key to the success of practitioners in women’s football.

• Women’s football will also have a dedicated page in each addition of Football Medical and

Scientist helping to raise their profile and cement their involvement within the FMA. This will be used for news and views or articles specific to the women’s game, across the disciplines and leagues.

FOOTBALL MEDIC & SCIENTIST | 11

F M A C O N F E R E N C E 2015

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F M A C O N F E R E N C E 2015

Outstanding event capped by

award for Jimmy Headrige The award for Outstanding Contribution to Professional Football this year went posthumously to Jimmy Headrige. The former Middlesbrough, Bolton and Manchester United physiotherapist who plied his trade in the 70’s and 80’s was every bit a pioneer of the profession in the days when “trainer” was making the transition to the more recognised and formidable title of physiotherapist.

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t was no co-incidence that this change of title coincided with a dramatic step up in terms of standards and provision of care to players and Jim was certainly pivotal in driving this change.

Born in Glasgow in 1959, Jim played for Clydebank before taking up the reigns as physiotherapist in the late 60’s working with Stan Anderson at Middlesbrough.

The youngest man in football to hold

this position at age 28. After 11 years on Teesside, Jim took up an appointment in the United Arab Emirates, where he stayed just 12 months before returning to England to a job with Bolton Wanderers in 1978. In 1981, very soon after joining United, Ron Atkinson made one of his first appointments when he persuaded Jim to come to Manchester United. Sadly, only a few weeks in to the

job, Jim collapsed at the Cliff training ground and died of a heart attack.

Such was the esteem that the players, staff and club had for Jim, a MEMORIAL match was arranged against Bolton Wanderers the following season, Tuesday 24th August 1982.

The following is taken from the match programme.

JIM HEADRIGE - “THE BEST IN THE BUSINESS” RON ATKINSON

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nited fans will know that first and foremost I am a football fan and usually I am ready with a very warm welcome as a new season commences. Unfortunately, circumstances dictate that this is a sad occasion as we and Bolton Wanderers meet to honour the memory of Jim Headrige.

Jim died suddenly, exactly 12 months ago whilst training at the Cliff with a group of our injured players. He had only been with us for a few short weeks, but in all my years in the game, I cannot recall a man, at any level, who so quickly won the respect and admiration of his colleagues. Make no mistake, Jim was the best physio in the game – and I mean no disrespect whatsoever, to the man he replaced, or indeed, the man who succeeded him.

The award for Jim at our Conference naturally came as a surprise to all but a few of the 150 dinner guests.

Understandably, some had not heard of their erstwhile “colleague” though many had a recollection of the tragedy that unfolded in 1981. However, by the time delegates had witnessed details of Jims career; watched a moving video compilation, listened to tributes from former Boro’ manager Stan Anderson

When I first arrived at Old Trafford, I asked for, and was granted, my own staff around me. Jim was at the top of my shopping list, I’m proud to say he accepted the invitation , and achieved for just a few short weeks what was, in the words of his wife Margaret, “the fulfilment of a lifetimes ambition”.

I had, once before, tried to get Jim join me, that was during my time at the Hawthorns. On that occasion he turned me down. In the short time we worked together here at the Old Trafford I saw more than enough to confirm what I already knew. He was the best and he is still sadly missed.

Since his untimely death, I’ve been asked on more than one occasion, just what was it about the man that made him so good? Obviously, as a I said earlier, he was for me, the best in the game, but more than that, he had this tremendous ability to get on with people. Soon after he arrived here, we were off on a pre-season tour of Norway, and to see experienced international players in such awe of the man was remarkable.

I am hoping that Jim’s wife and children, Karen, Lynn and Gary, will be able to join us this evening and I can assure you, the fans, that it is our aim to give you value for your money. On behalf of the family, I thank you for your support, and I extend a very warm welcome to Bolton Wanderers and their new manager, John McGovern. I hope they do as well as ourselves this season, and we aim to win the League!

and Captain Stuart Boam, and heard heartfelt memories given from Alan Smith and Ron Atkinson, it was as though everyone there knew him.

poignant moment for all.The fact that the entire room rose to give a standing ovation as the award was presented said it all”.

Eamonn Salmon said: “We knew this particular award would be a moving and humbling occasion, and inviting Jim’s wife Margaret and children, Lynne, Karen and Gary on to the stage to receive the award from Ron Atkinson was a

There is no question that for many, not least Jim’s family, this was the highlight of the conference awards evening. It is a fitting tribute as well that the FMA recognised a colleague that is “gone but not forgotten”

FOOTBALL MEDIC & SCIENTIST | 13

F M A C O N F E R E N C E 2015

PICTURESPECIAL

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F M A C O N F E R E N C E 2015

FOOTBALL MEDIC & SCIENTIST | 15

FMA CONFERENCE 2015 AWARDS WinnerS

Sponsored by

Member Award - Premiership - Sponsored by Fit4Sport Ltd

Jon Fearn

Member Award - Championship - Sponsored by Fit4Sport Ltd

James Haycock

Member Award - Division 1 - Sponsored by Fit4Sport Ltd

Jon Whitney

Member Award - Division 2 - Sponsored by Fit4Sport Ltd

Chris Skitt

Exceptional Contribution Award - Sponsored by Game Ready

Nathan Winder

Longstanding Service Award - Sponsored by Skin Matrix

Andrew Dent

Outstanding Contribution Award - Sponsored by PhysioLab Technologies

Jimmy Headrige

Lifetime Achievement Award - Sponsored by The Gilmore Groin & Hernia Clinic

Alan Smith

21 Club - Sponsored by Health Partners

Alan Smith Andrew Dent Derek French Grant Downie Mark Waller Neil Dalton Rodger Wylde Steve Redmond Tony Denton Matt Brown Joe Miller Bob Ward Mike Ashworth Stephen Feldman

The FMA would like to thank our sponsors and exhibitors for their terrific support at our conference.

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SPIRE LEAD SPONSOR?

FMA launch Health Insurance partnership with the LMA Members now have direct access to the same healthcare policy as the managers Group policy means preferred rates for members and dependents Underwritten by AXA PPP Healthcare

FMA FOOTBALL MEDICAL ASSOCIATION

Benefits of the LMA/FMA Health Scheme • Competitive rates - cover for you and your spouse/partner/dependents • Choice – two levels of cover, with or without excess, keeping rates competitive • Wherever the job may take you - continuity of cover and protection in future years whilst you are a member of the LMA/FMA Group Health Scheme • Whether working or not - cover still continues whilst you are a member of the Group Health Scheme • 24 hour helpline

• Already have cover?

You and your dependents may transfer into the LMA/FMA Group Health Scheme • No medicals required – either when you join or on transfer from an existing scheme • Seamless administration - policy procedures already tried and tested making it easy to join the scheme • Advice on medical conditions, travel vaccination and healthy living

• Member discounts on holidays, days out, retail and many more

You can join at any time by requesting an AXA PPP Healthcare FOOTBALL MEDIC & SCIENTIST | 17 Enrolment Form from Nicola at the FMA on 0333 456 7897

Pictured above: Burnley's Ashley Barnes is treated by head physiotherapist, Alisdair Beattie, after picking up a knee injury in the final premier league game of the 2015 season.

THE FOOTBALL MEDICAL ASSOCIATION

DEFINING OUR POSITION FEATURE/FOOTBALL MEDICAL ASSOCIATION Since the emergence of the Football Medical Association (FMA) 5 years ago the Association has clearly gone from strength to strength and can now be seen as an established entity in Professional Football alongside organisations such as the PFA and the LMA.

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clear mandate has been set by members for the FMA to represent their interests both personally and professionally and in so doing it is important that the FMA now sets out its exact purpose and strategy for the future.

Developing an association and taking it from a concept to reality is an exciting yet daunting prospect. Along the way

ideas flourish about what could and could not, should and should not form part of the service provision to members and the industry as a whole. In effect an organisation can become a notice board for dozens and dozens of post-its, all overlapping each other and with the inevitable danger that some of the better ideas become buried in the process.

The fact that ideas come pouring in is welcome affirmation and support for the Association. But, when it comes down to it, it is important to sift through the deluge of projects that naturally develop over the initial few years and define exactly what the FMA is about.

In that respect the FMA has 4 “pillars” within its framework:

Legal. Education. Recruitment. Wellbeing.

LEGAL

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ur legal support for Members is second to none. We have at our disposal the best lawyers in the industry when it comes to football, in particular when settling compromise agreements following loss of post/dismissal. Interspersing their work for the managers one week and our Members the next, means our lawyers remain at the

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very top of their game and certainly know the industry inside out. Remembering the maxim “football is no ordinary business”, it is easy to see why experience is so vital and our members can rest assured that when needed, they have the very best in the business.

Contract appraisal also forms part of our legal service. Current or new contracts can

be evaluated for Members – AT NO COST – making sure loopholes are closed and the terms of the contract are fair and legally tight. As an ongoing service for the past 5 years, we have never seen a contract that has not required amendments or adjustments to protect our members.

EDUCATION

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ducation is set to play an increasing role for the FMA. Plans are being made to:

• Re-shape the online delivery of our CPD reading material.

• Establish the provision of webinars to clubs and/or individual members • Set up 3 one day courses per season for doctors, therapists and sports scientists with content set to complement CPD and webinars.

Formal links with the Royal College of Surgeons Edinburgh (RCSEd) are now in place. Further discussions are likely to result in exciting developments regarding educational provision for FMA members.

standards of practice, and the value of your educational portfolio to demonstrate evidence of appropriate learning, becomes insurmountable.

FMA members have the benefit of a portfolio which is being created for them. In short, if members engage with our monthly

CPD reading material, attend courses advertised on our site, participate in one of our forthcoming day programmes and attend our end of season Conference, they will be giving real substance to their portfolio which is automatically built on their member profile.

When you need it, the FMA is there.

the LMA with regard to alerting managers to our recruitment facility and this will be revisited again this season, as we establish ourselves as the industry leader for medical and science jobs in football. By making sure managers can trust our membership database as a recruitment source, we are ensuring that our members are best placed to secure positions within the game.

Career guidance is also a feature of our

recruitment schedule. In this respect, content will be added to our website highlighting the many disciplines that make up our membership and their pathway into Professional football.

Validated undergraduate and post graduate courses at recognised Universities will be hosted as well as guidance on specific requirements needed to land that all important post in Professional football.

We also have a team of experienced practitioners from all disciplines and across the divisions who are on hand to offer impartial assistance to colleagues whether it is a career issue or simply a need for advice.

Members can be put in touch with someone from this team on a confidential basis by

contacting the office.

Eamonn Salmon is of course always available to discuss any matter confidentially and can be contacted directly by members at any time on 0794 795 5488.

Portfolio

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aintaining a portfolio is a mandatory requirement of professional practice irrespective of the specific discipline. It is also vital in ensuring your Professional Indemnity is valid. Couple these with the need to show accountability for your own professional conduct and

RECRUITMENT

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he FMA probably has the “best database in the world” from which to source former, current and future medical and science staff in professional football. Having posted over 50 jobs in the 2014/2015 season alone, our website is now recognised as the place to advertise positions within the game.

But we don’t intend to stop there.

Discussions have already taken place with

WELLBEING

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he personal and professional wellbeing of our members also plays a key part in the FMA service. Whether it is by giving members access to a Health Insurance policy, operating a seven day support facility, sourcing best deals for car hire or financial services, the FMA is there to help its members.

FMA MEMBERSHIP

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he FMA is an umbrella organisation representing member practitioners in Medicine, Physical Therapies and Sports Science.* These 3 core groups are inextricably linked by common working conditions, practices,beliefs and goals. Nowhere outside of professional sport do the 3 disciplines work so closely together, each one complementing the other in terms of injury diagnosis, treatment, rehab and prevention.

There is no question that cohesion,understanding and co-operation between these practitioners and a “team” approach leads to better outcomes for all involved. Each “group” of course has its own specific issues and the FMA, whilst representing these disciplines as an entity, is also in place to assist and support the particular needs and professional development of each discipline.

For example: 1. The doctors have had particular concerns regarding minimal medical requirements, infection control and medicines management. The FMA is supporting, coordinating and delivering an audit specific to these issues and is gathering information that might be useful to appropriate governing bodies.

2. Physiotherapists have recently had the issue of indemnity to deal with and the FMA played a pivotal role in working with Health Partners Europe and guiding and defining the policy that has emerged.

3. Sports Scientists are now a firmly established entity within professional football yet still have issues regarding lack of an official representative body.

The FMA is now set on a course to concentrate specifically on each of the “pillars” outlined.

Though there will always be other projects to undertake, we intend to excel in these key areas in order to give real support and substance to our members in their day to day roles in professional football.

*For ease of reference our Affiliate members such as Podiatrists, Acupuncturists, Dentists, Sports Psychologists and other health care providers all fall within the 3 main titles outlined.

FOOTBALL MEDIC & SCIENTIST | 19

Pictured: Ivory Coast players wear a t-shirt in memorium of goalkeeper Robert Enke before their friendly match against Germany in 2009, Vincent Angban (far right) is a fellow goalkeeper.

Antidepressants

in professional football FEATURE/Wilfried Kindermann - UEFA MEDICINE MATTERS Mental (psychiatric) illness and competitive sport are not mutually exclusive. Athletes can perform at a high level despite some form of mental illness. In fact, it is thought to be as common among athletes as anyone else. Almost all mental illnesses can also occur among athletes.

Depression Depression is one of the most common of mental illnesses. Its prevalence among recreational athletes seems to be below the general average, but there is no data available in elite sport.

However, the suicide of the German international footballer Robert Enke in November 2009 sparked public debate about depression in elite sport, especially professional football. The German Football Association’s scientific working group consequently commissioned the institute of biochemistry at the German Sport University to analyse the findings of doping controls (urine tests) conducted

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between 1999 and 2008, looking specifically at the use of antidepressants in football.

Methodology Over a period of 10 years, almost 83,000 urine samples from athletes in various sports were analysed for antidepressants.

The results have already been published elsewhere, albeit with no specific focus on football. Over a third of the samples were those of German athletes. Almost all sports were included, with 32% of the samples from footballers. All of the major antidepressants were picked up by the analysis.

Fewer antidepressants in football Only 0.31% of almost 83,000 urine samples tested positive for antidepressants. The percentage among footballers was almost half that (0.14%).

No difference was found between professional football in Germany and internationally.

Antidepressants in other sports The number of urine samples which tested positive for antidepressants was relatively high in endurance and strength sports.

Compared with football, antidepressants were found to be up to ten times more

common in some sports. The overall percentage of elite athletes who tested positive for antidepressants (0.31%) was well below the percentage of ordinary Germans of a similar demographic prescribed with antidepressants (approx.

2.25% of 15 to 34-year-olds).

Which antidepressants?

The majority of antidepressants found in the urine samples were selective serotonin reuptake inhibitors (SSRIs).

This was the case across all sports and in football specifically (74%). SSRIs were followed, albeit in much fewer cases, by trycyclic antidepressants (13%), the side effects of which include weight gain. SSRIs (e.g. fluoxetine) increase the concentration of serotonin in the brain, which has various effects. Among other things, it is a transfer agent in the central nervous system and can effect a person’s mood, for example, hence being known by some as a happy hormone. There have been a few scientific studies into the effects of SSRIs on performance, but as yet no correlation has been proven.

Are footballers less affected by depression?

Compared with the general population, but also the majority of other sports, the number of footballers who tested positive for antidepressants was below average. Only 6 in 4,400 urine samples in German football tested positive for antidepressants over the 10-year period.

It is tempting to conclude from this that depression in elite sport, and especially in football, is less common than in the general population. To draw such a conclusion, however, systematic studies into the use of these substances would be needed and, as yet, no such studies have been conducted. It is likely that the data available underestimates the real proportion of depression in elite

Pictured: (Above) Former footballer Clarke Carlisle at the launch of The Mental Health Charter for Sport and Recreation - a project to tackle mental health discrimination in sport. Clarke has publicly struggled with his own mental health issues.

sport. An obvious assumption is that professional athletes who suffer from depression or other psychiatric problems and illnesses avoid medication because of the possible side effects or negative impact on performance. It must also be borne in mind that some athletes deny or ignore the symptoms because of the personal stigma

they attach to mental problems requiring psychiatric treatment.

On the other hand, the data available suggests that abuse, for example taking antidepressants as neuroenhancers, is not a problem in professional football. Known by some as brain doping, this means using psychotropic drugs such as SSRIs to sustainably enhance mental capacities such as alertness, concentration, learning and memory. It should be noted, in this regard, that there is currently no knowing whether these high expectations can even be met, bearing in mind the possible risks of such drugs. Antidepressants belong in the hands of doctors and should not be used – or rather abused – as neuroenhancers. That said, antidepressants can help athletes with depression to successfully continue their careers in sport.

This article is based on the following study: Machnik M, Sigmund G, Koch A, Thevis M, Schänzer W; Prevalence of antidepressants and biosimilars in elite sports, Drug Testing and Analysis 2009, 1: 286-291. The following footballspecific analysis was commissioned and supported by the German Football Association’s scientific working group via the institute of biochemistry at the German Sport University, Cologne.

Pictured: (Above)A 31 year-old Paul Gascoigne with his then (Middlesbrough) manager Bryan Robson in 1998. Gascoigne was making his first press appearance following hospital treatment for stress, depression and alcohol-related problems.

Published by kind permission of UEFA Medicine Matters.

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Pictured: Athletico Madrid’s Mario Mandzukic appeals to the referee with a bloodied head during last year’s ill-tempered UEFA Champions League Quarter Final - First Leg versus Real Madrid.

DIAGNOSTIC APPROACH TO

HEAD INJURIES IN FOOTBALLERS FEATURE/Dr Ioannis Economides - UEFA MEDICINE MATTERS Football is a contact sport. The forces that occur during a match, the speed of the game and stress relating to the result of the match all cause increases in both arterial blood pressure and heart rate.

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head injury may cause a variety of symptoms, such as bleeding from a skin laceration trauma, a nose bleed, bleeding from the ear, diplopia (double vision), concussion or loss of consciousness.

Concussion is a complex pathophysiological process affecting the brain which is induced by traumatic biomechanical forces. Concussion can be caused either by a direct blow to the head or by a blow to the neck or another part of the body which results in an ‘impulsive’ force being transmitted to the head.

An assessment of the various tackle mechanisms has identified that a deliberate or accidental clash of heads has the highest probability of causing an injury to one or both players (Fuller et al., 2004). This often occurs when players jump to challenge for the ball in the penalty area following a cross or a corner, or in the centre of the pitch following a clearance by a goalkeeper or a defender. In the

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penalty area, a clash of heads is more likely to involve face-to-face contact, while a clash of heads in the middle of the pitch is more likely to involve contact between the face and the back of the head. The second most common cause of head/neck injuries involves contact between the arm or hand of one player and the head of another.

Skin lacerations can be sutured immediately – even on the pitch. In the case of a simple nosebleed which is not accompanied by nasal pyramid deviation, the nasal cavity should be well cleaned of mucous discharge and bloody secretions and an anterior tamponade should be put in place (either a gauze or a Merocel). The player can return to the pitch if he/she does not have symptoms such as dizziness, tinnitus or vertigo. However, if the player has a nasal pyramid deviation, that should be reduced by the physician in the stadium or transferred to a hospital for

further treatment. In the event of bleeding from the ear due to trauma, there may well be a fracture to the temporal bone, so the player has to be withdrawn from play and sent to the nearest hospital for a CT scan. Likewise, in the event of persistent diplopia, the player must be withdrawn and sent to the nearest hospital for more detailed evaluation. The same applies if the player shows symptoms of concussion or any loss of consciousness.

Concussion results in functional changes to the way that the brain works, but no structural damage can be seen using standard imaging tests such as a CT scan. It is well known that concussion follows a blow to the skull or an action that generates abrupt acceleration and deceleration of the brain within the skull. The acceleration/deceleration forces may lead to linear and/or rotational movement of the brain, whereby brain tissue is compressed inside the skull, increasing the

risk of neurocognitive and neurobehavioural deficits (Barth et al., 2001).

The most common symptoms include headaches, dizziness, confusion, nausea, memory problems, ‘mental fogginess’, fatigue, balance problems, attention and concentration problems, feeling ‘dinged’, stunned or dazed, seeing stars or flashing lights, and ringing in the ears. There may also be delayed symptoms such as sleepiness, sleep disturbance, ‘nervousness’ and a subjective feeling of slowness or fatigue (Erlanger et al., 2003; Iverson et al., 2004).

According to the Centers for Disease Control and Prevention (CDC) in the United States, symptoms observed by coaching staff that may be a sign of concussion include the following: • Appears dazed or stunned • Is confused about his/her role or position • Forgets an instruction • Is unsure of the game, score or opponent • Moves clumsily • Answers questions slowly • Loses consciousness (even briefly) • Shows mood, behaviour or personality changes • Cannot recall events prior to the incident • Cannot recall events after the incident The following symptoms are reported by players: • Headache or ‘pressure’ in head • Nausea or vomiting • Balance problems or dizziness • Double or blurred vision • Sensitivity to light • Sensitivity to noise • Feeling sluggish, hazy, foggy or groggy • Concentration or memory problems • Confusion • ‘Does not feel right’ or ‘feels down’ The following physical signs may be observed when examining a player: • Slow to answer questions or follow instructions • Poor concentration or easily distracted • Loss of consciousness • Poor coordination or balance • Decreased playing ability • Nausea and vomiting • Slurred speech It is essential that the team physician or a paramedic undertakes a physical examination on the pitch and conducts a thorough neuropsychological evaluation (e.g. attention and memory function tests), looking for weakness, paralysis or changes in sensation in the body. To maximise the clinical utility of such neuropsychological assessments, baseline tests are recommended.

Examples include: • Which team are we playing today?

• Who are you marking?

• Which team did we play last week?

• Did we win last week?

• Which half is it?

• Which side scored the last goal?

Pictured: Southend United’s Michael Timlin is left bleeding following a clash of heads during this year’s League Two Playoff Second Leg versus Stevenage. Southend went on to win this match and the subsequent final to gain promotion to League One.

Balance and coordination should be evaluated.

Vision and hearing could also be checked.

The head will be examined, looking for signs of injury, including potential skull or facial bone fractures. (For example, a clear liquid discharge from the nose may be a sign of a skull base fracture.) The neck may also be evaluated, since neck injuries can be associated with head traumas.

The Sport Concussion Assessment Tool (SCAT) was developed as part of the summary and agreement statement of the second International Conference on Concussion in Sport, which took place in 2004 in Prague (McCrory et al., 2005). This tool represents a standardised method of evaluating people who have suffered a concussion while playing sport.

There are no clear rules or guidelines when deciding whether a player should return to the pitch. The team physician or paramedic has to deal with each suspected concussion on a case by case basis. If the player shows any symptoms or signs of concussion, he/she should not be allowed to return to the match in question. More generally, players should never return to the pitch while displaying any symptoms, hence the maxim: ‘If in doubt, sit them out.’

In conclusion, where a player has the above symptomatology, the physician should immediately withdraw that player from the game and send him/her to the nearest hospital for more detailed evaluation and surveillance.

Published by kind permission of UEFA Medicine Matters.

Bibliography 1. Fuller, C., et al., ‘The influence of tackle parameters on the propensity for injury in international football’, The American Journal of Sports Medicine 32 (supplement), 2004, S43-53.

2. Kors, E.E., et al., ‘Delayed cerebral edema and fatal coma after minor head trauma’, Annals of Neurology 49(6), 2001, pp.

1391-1396.

3. McCrory, P., et al., ‘Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004’, British Journal of Sports Medicine 39(4), 2005, pp. 196-204.

4. Moser, R.S., et al., ‘Neuropsychological evaluation in the diagnosis and management of sports-related concussion’, Archives of Clinical Neuropsychology 22, 2007, pp. 909-916.

5. Stiell, I.G., et al., ‘The Canadian CT Head Rule for patients with minor head injury’, The Lancet 357(9266), 2001, pp. 13911396.

6. Barth, J.T., et al., ‘Acceleration-Deceleration Sport-Related Concussion: The Gravity of It All’, Journal of Athletic Training 36(3), September 2001, pp. 253256.

7. Erlanger, D., et al., ‘Symptom-based assessment of the severity of a concussion’, Journal of Neurosurgery 98(3), March 2003, pp.

477-484.

8. Iverson, G.L., et al., ‘Relation between subjective fogginess and neuropsychological testing following concussion’, Journal of the International Neuropsychological Society 10(6), October 2004, pp. 904-906.

9. Iverson, G.L., et al., ‘Cumulative effects of concussion in amateur athletes’, Brain Injury 18(5), May 2004, pp. 433-443.

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Pictured: Notts County goalkeeper Roy Carroll writhes in agony after a collision with Coventry City’s Aaron Phillips during their match at the Ricoh Arena in November, 2014.

Screening Who’s responsibility is it?

FEATURE/Johnny Wilson - Head of Sports Medicine, Notts COunty This is a brief overview of musculoskeletal screening from the perspective of a first team physiotherapist working in the real world of professional football at League 2 where resources are limited.

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his is certainly not an in depth academic review. Instead, the aim is to stimulate debate and challenge the true purpose of screening our athletes.

Musculoskeletal screening in football is a very contentious subject possibly due to its inability to predict injury (McCall et al 2015). In addition to this, there is an evergrowing body of empirical literature that reports there has been no decrease in the incidence of injuries over the past decade

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in professional football despite the introduction of musculoskeletal screening (Ekstrand et al 2011). However, this is in contrast to a Premier League club who recently reported at an international conference in London that they have significantly reduced soft tissue injuries as a result of their screening methods.

So why is there a discrepancy between the science of screening and screening in practice? Where does screening originate?

What is the most effective screening

method? Who should take responsibility for reducing injury incidence?

Screening: - A historical perspective Medical screening has been undertaken for many years; for psychiatric disorders, syphilis and other diseases. Half a century ago, it was used primarily to keep unsuitable people from joining military service. Screening within professional football takes its cues from the principles of medical screening although the focus is

on sporting injuries rather than idiopathic disease.

Screening Models: Wilson & Jungner (1968) proposed a criteria that is widely considered as the benchmark for disease screening (Figure 1). These authors are often credited as pioneers for developing the modern principles of screening. Most of the points identified remain relevant to screening in football.

1. The natural history of the condition should be well understood 2. There should be a detectable early stage 3. Treatment at an early stage should be of more benefit than at a later stage 4. A suitable test should be devised for the early stage 5. The test should be acceptable 6. Intervals for repeating the test should be determined 7. Adequate health service provision should be made for the extra clinical workload resulting from screening 8. The risks, both physical and psychological, should be less than the benefits 9. The costs should be balanced against the benefits

Figure 2: Four step sequence of injury prevention research

Figure 1: Wilson & Younger (1968) Application to Musculoskeletal Screening Van Mechelen et al (1992) adapted Wilson and Junger’s approach and proposed a simple model to help “prevent injury”. This model emphasized that an understanding of the aetiology of injury and the risk factors were essential, prior to implementation of corrective strategies. Following this, the Translating Research into Injury Prevention Practice (TRIPP) (figure 3) framework was developed. In addition to Van Mechelen’s model it included athlete compliance and the assessment of risk taking behavior, which may predispose a footballer to injury (Finch, 2006).

Risk Management and screening: Musculoskeletal screening in football falls under the remits of risk management.

This is the overall process of assessing and controlling risks and should be implemented as part of a best practice management system by critiquing one’s own current practice and using epidemiological studies (enable you to make evidence-based decisions) to assess a player’s ability to safely participate in training and games (Fuller & Drawer, 2004). The primary aim of screening is to identify risk factors (a condition, object or situation that may be a potential source of harm), estimate and evaluate the amount of risk associated with that factor as illustrated in Fuller & Drawer’s model, right (Figure 4). A very good example of this would be the ongoing work by the FA and other sports governing bodies on

Figure 3: Modified TRIPP Framework (Finch, 2006) cardiac screening of athletes to prevent sudden cardiac death.

Musculoskeletal Screening in Football Musculoskeletal screening is very mechanical in nature and effectively is simplified into a set of numbers on an excel sheet at the end of the process.

In contrast, injuries are complex, multi dimensional, and despite significant

Figure 4: Risk Management (Fuller & Drawer, 2004)

advancement in research and clinical screening tests capable of predicting future injury, the causative factors and pathophysiological processes of soft tissue injuries remain largely unclear.

Although screening methods are being continuously scrutinised in order to establish a more extensive range of clinical indicators to predict injury, some clinicians might argue that it is currently of little value to screen players prior to participation due to the lack of clinical utility. In essence, this is because screening tests are very poor at predicting injury. For example, those who score badly may remain injury-free whilst those who score well may still suffer injury.

In reality, we as clinicians are continuously screening our players at every patient contact, which includes “corridor consultations”. If you were to only screen players according to the models discussed in this review, it is this author’s opinion that you may be missing out on valuable information, which may affect decisions on readiness to train and play. Soft skills, the ability to interpret subtle cues when interacting with a patient, although very difficult to quantify, play a vital role when assessing risk. It could be argued that going with your “gut feeling” has as much evidence behind it as any single clinical predictive test, just a thought!!! Of course I am not

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suggesting that we throw the baby out with the bath water, but maybe a more sensible approach would be to marry the science (objective data) with the art (experiential experience), in other words integrating an evidence-based approach into practice. It would take a very brave clinician to knock on the manager’s door and request that a player be removed from training on his GPS or heart rate data alone. A more holistic view when analyzing this data may increase its accuracy on assessing readiness to train and play.

We need to accept that there will always be a risk of injury involved in football, and unless we remove the player completely from training and playing we will not be able to eliminate the risk. It is a contact sport, which places extreme physiological and psychological demands on the player.

Therefore, it would be unreasonable to think that we can mitigate for all the risks involved and that we can successfully prevent any injuries through screening. Consequently, it might be a better strategy when screening players to identify what the risk is and if it is an acceptable level of risk? To put it simply we need to think more in terms of utilizing a risk reduction approach rather than an injury prevention strategy. Preventing injury and reducing risks are not the same. Effective screening to identify the risks may impact on injury rates but this is not a certainty.

In my opinion this paradigm shift is long over due. As frontline clinicians working in professional football we need to educate all those involved about risk management rather than injury prevention. We need to

Pictured: England’s Raheem Sterling lies injured during the recent European Championship Qualifying match against Slovenia.

involve players, managers, coaching staff and stakeholders in the process of risk management. Risk management needs to be a shared concept within your club rather than being your sole responsibility. “Framing” the risks involved in a positive manner to the players, managers, stakeholders and supporters in an open and honest fashion and educating them about their role in

Pictured: Manchester United’s Phil Jones trains on his own at United’s Carrington Training Ground as he recovers from an injury prior to a Champions League tie against Bayer Leverkusen in 2013.

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injury reduction is an extremely challenging communication skill, which should not be underestimated. How we communicate the risks involved can have an enormous impact the views/concerns of the recipients of the information. We need to educate players and coaches that we are “risk aware” rather than “risk averse” as medical practitioners are sometimes portrayed.

In conclusion, there are various methods for screening players and many authors have acknowledged that there is no particular musculoskeletal screening method, which is better than another for predicting injury.

How you choose to screen your players will reflect your current playing squad, resources, facilities, manpower etc. In principle, the choice of screening method should be evidence based, reliable, specific and repeatable. Ideally objective-screening methods should form part of a wider holistic process, which takes into account the player as a person rather than being used in isolation to mechanically evaluate risk.

There is no right or wrong way to screen, however, it might be prudent to critique your own screening philosophy to ensure it is fit for purpose to assess the risks involved at your club. This is not an easy process and even with the best risk management system there is no guarantee that you will reduce your injury rates, but at the very least you should be able to successfully determine what your risk factors are, who is affected by them and if the risks involved are acceptable.

Reducing the injury burden should be a shared responsibility between all the parties involved in the club and should not lie only at the feet of the clinician. Players, managers and other stakeholders all have a role to play in managing risk. In essence, as long as you communicate the limitations of screening as a predictor of injury and are not naïve enough to think you can prevent injury, you shouldn’t go too far wrong.

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WHERE ARE THEY NOW? FEATURE/CHRIS SMITH

What are you doing now?

I am still working as a physio, but now in private practice; I co-own and run a business called Physiocentric in Wimbledon Village.

Best and worst part working in football?

There were loads of great moments! I love football, and working in it was ‘living the dream’, so to speak. The buzz of the crowd roar as you walk on to a pitch pre match, the team spirit, the banter with the lads, visiting so many top grounds- it was all great, and winning 3 promotions capped it. The worst part was definitely the time spent travelling and being away from the family so muchthat’s ultimately why I left to spend more time with my children. Training on Christmas day and working seven days a week for months on end leaves a lot to be desired.

Do you have happy memories of your time in football?

Definitely. There were so many great moments that they outweighed the negatives that come with any job.

Did you have a mentor or a physio who you looked up to and inspired you to work in football?

The aforementioned Glenn and Kevin helped me understand what the job was all about, and the 18 months working with them was invaluable.

What’s your most memorable moment?

The promotion season of 2000-01 was fantastic, where we dominated so much, but the start of the Fulham resurgence with Micky Adams in 1996-97 certainly equalled it....good times!

What was your biggest disappointment in the game?

Certainly being relegated to the lowest division in 1993-94 was a low point. We then sat 91st in the league the following season, and even lost away to Torquay who were 92nd and bottom of the league at the time.

That lead to questions over the club’s future existence.....low moments.

How have things changed?

Without doubt the budget and staff numbers have massively increased, allowing the set up of a huge multidisciplinary medical teams. That now ensures players have access to the highest possible standards of care, rivalling any sport in the world.

Are you still in touch with players/ managers/physios?

Yes, quite a few of each. Some from the early days, and some from the latter times. I still work closely with members of the medical team that were together in 2001, and have also provided specialist testing to some members of the Fulham team over the last few years.

How did you get in to football?

When I was studying, I wrote my final year dissertation on Football injuries. Part of this involved spending time at both Fulham and Crystal Palace, where I met physios Glenn Hunter and Kevin Thomas, and they offered me the chance to gain some experience outside of my NHS work. I used nearly all of my annual leave working voluntarily at Fulham, and 18 months later was offered the job full time when Kevin left. I knew the chance of a career in football might not come again, so I said yes!

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Pictured: Chris pictured during his days at Craven Cottage.

The manager and his medical team partnership; how was that relationship?

Having a good relationship with the manager was vital for the team to succeed, and over my 10+ years at Fulham I worked with 13 managers in total. Trust between us was at the heart of the success- I had to trust that the manager would back my medical decisions, and he had to trust that my judgements were accurate. I am lucky to say this was almost always the case, and no player ever played unless I had okayed it.

With so many different managers there was a massive range of personalities and styles to adapt to, and there was always a learning process when a new one took over. By that I mean for both sides, but you very quickly become a close knit unit that demands respect from each other, and of course, the players.

Some managers would check on an injured player’s fitness every day, ask them how they were, make them feel valued. Others would completely ignore them until they were back on the pitch. As the physio you had a very important psychotherapeutic role too!

As you might imagine, the banter and mickey taking was also a massive part of the daily routine, and was a vital part of the team

spirit. Everyone had a role to play at times, and it kept the mood up when things on the pitch weren’t doing so well.

Did you feel you contributed to the overall success of the team ?

Without doubt. The physio’s role is integrally related to the team’s success, both medically and psychologically. You are working to ensure the players are prepared as well as possible to play both mentally and physically, and your decisions can hugely influence their performance. You are generally privy to all sorts of info from players that the manager isn’t, and you have to filter what he needs to know from what he doesn’t, without losing the trust of the player. Making sure players could focus on playing with no other concerns was always the main aim, and you facilitated that process in whatever way it was appropriate.

Any funny stories?

Wow, there are so many, and probably loads I shouldn’t put in print! There are plenty of moments that ‘you had to be there’ for, and I’m laughing now thinking about them, but they don’t translate well I suspect.

Alan ‘Corky’ Cork was always the butt of plentiful abuse when he was around, and he deserved most of what he got one day when he coordinated a ‘bleep’ test to measure the players fitness. Mickey Adams and I were stunned when every player smashed their own PB, and some players actually completed every level. It quickly became clear that the set distance needed for the test should be measured in metres and not the yards Corky used, and everyone was in fits as the batteries in the stereo gradually ran out of power and the tape speed slowed to Corky’s jogging pace. The players certainly let him know his error....

There was also the time in the 2001 season when we were away to Palace, and travelled on the day only to hit shocking traffic a mile away that brought the coach to a standstill. After going nowhere for a few minutes, it was clear we had missed the cut-off for submitting the team sheet and were in danger of missing the kick-off. The decision was made that we would all get off the coach and run to the ground. Whilst the players only had themselves to carry, I had a huge medical bag and all my kit, and the poor kitman was pushing a huge metal container.

You can imagine the abuse and looks we got from the Palace fans!

By the time we got to the ground, we were totally knackered, and looked up to see the coach pull in 10 seconds after us! We only had time for a 5 minute warm up and I was breaking record times for putting strappings on, but the lads went out and played brilliantly to win 2-0. So much for proper preparation!

Final thoughts on your time in the game?

It was a fantastic time of life, and I was able to be involved with a sport I had lived for when I was younger. I had some amazing experiences, worked with some of the best players in the game, and even got to have a ‘kick about’ at Wembley and Old Trafford over the years, as well as visiting almost every ground in the country. I think in total I sat on the bench covering between 800 and a 1000 games of all types, saw just about every injury that football throws up, and travelled to numerous countries around the world. I have so many memories, and have made so many friends and contacts that are still important to me today that I look back on my time in the game with great affection.