Football Medic & Scientist - Spring Edition 2016

FOOTBALL medic & scientist Issue 16 Spring 2016

The official magazine of the Football Medical Association

Dr Ian Beasley & Gary LEWIN On Their England Careers, 2016 Euros and Beyond

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Contents

FMA FOOTBALL MEDICAL ASSOCIATION

Welcome

SPONSORED BY

4 Members News

Features 6 Have we Finally Started to Take Concussion Seriously?

Dave Fevre 11

BEYOND FOOTBALL: The Fragile Athlete Prof. Cathy Speed & Fortius Clinic

14 Euros & Beyond Dr. Ian Beasley & Gary Lewin 18 2016 FMA Conference 21 AHEAD OF THE EUROS: The Hands that Rocked a Nation Mick Byrne with Liam Mackey 23 WOMEN IN FOOTBALL: Supply & Demand Jennifer Lace

CHIEF EXECUTIVE OFFICER

“More than just a conference”

T

hose few words sum up perfectly the upcoming FMA Conference in May. We are of course, back at the Radisson Blu East Midlands hotel and we have restored the date to its rightful place over the FA Cup Final Weekend.

Our event is unique amongst the plethora of conferences and courses that clutter the calendar each year. Not only do we have excellent, relevant and insightful speakers who understand our roles in the game, this is a networking and community building event allowing us all to meet, discuss and engage with colleagues on an informal basis.

The Awards dinner is also a great way to recognise those who have excelled amongst us and this has to be best way possible for a Club and for Heads of Department to reward their staff and show their appreciation for the season’s endeavours.

Of course this also means that the season end is upon us and I hope members can find some time to be away from their Clubs, spend some time with their families and take a well earned break.

The close season does however remain a time for Clubs to reorganise. The FMA will no doubt be busy in the jobs market, with dismissals and appointments, severance packages and contract evaluations and, most importantly, in continuing to give advice and guidance whenever needed, to our members.

Eamonn Salmon CEO Football Medical Association

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29 Heat Stress & Football Prof. Gülfem Ersöz, Prof. Sadi Kurdak & Prof. Mehmet S. Binnet 32 Where are they Now? Brian Morris

Advertorials 13 MLS Star at Spire Perform for pre-season training Spire/Perform Group 34 Car News for Members Keyfleet

Pictured: Uruguay’s Alvaro Pereira lies unconscious on the pitch after a coming together with England’s Raheem Sterling during their 2014 World Cup group stage match in Sao Paulo, Brazil.

HAVE WE FINALLY STARTED

TO TAKE

CONCUSSION

INFOOTBALL

MORE SERIOUSLY? FEATURE/DAVID FEVRE MSC MCSP SRP - HEAD OF SPORTS MEDICINE BLACKBURN ROVERS FC

February 2016 saw the release of the film ‘Concussion’, starring Will Smith, in the UK. The film is based on the 2009 GQ exposé Game Brain by Jeanne Marie Laskas starring Will Smith as Dr. Bennet Omalu, a Nigerian forensic pathologist who fought against efforts by the National Football League (NFL) to suppress his research on Chronic Traumatic Encephalopathy (CTE) brain damage suffered by professional American football players.

H

is interest in the subject was initiated after he performed an autopsy on a former NFL player, who committed suicide and was found to have severe brain damage. This led to him publishing a research paper on his findings as a co-author and which then encouraged him to look into the deaths of several other deceased former NFL players.

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As the Head of Sports Medicine in a professional football club in England, there is obviously going to be some ‘treatment room’ discussion between medical staff and players on this subject over the next few months and this in the main will be due to the film release.

So in football have we started to take a medical subject such as concussion more seriously? In the 2014 World Cup,

not that long ago, two serious incidents led to criticism of the sport. Uruguay’s Alvaro Pereira was knocked out in and Germany’s Christoph Kramer sustained a head injury in the final against Argentina.

Both players were allowed to continue playing despite appearing to have concussion. That was followed a couple of months later by the apparent failure to implement the Football Association’s

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Pictured: Ian and Gary tend to Theo Walcott in England’s 5-0 World Cup Qualifier win over San Marino in 2012. Walcott suffered a bruised lung following a challenge from keeper Aldo Simonici.

EUROS & BEYOND

Representing your country in any form is one of the proudest things you can do. The hairs still stand on the back of my neck when singing the National Anthem

Ian says “I have enjoyed the experience immensely. It is a real privileged to sit on the bench at world cups, the Macarana in Rio and at venues like Wembley.I have met some fantastic people both within and outside of the FA and have many fond memories.”

For Gary it will be the end of a 20 year association with the England set up. His “debut” was in 1996 against Moldova. A certain David Beckham also made his England debut in the same game ! Gary adds “Representing your country in any form is one of the proudest things you can do. The hairs still stand on the back of my neck when singing the National Anthem. There have been some disappointments along the way of course such as losing 4 quarter finals and missing the euros 2008 but there have been memorable moments too such as beating Germany 5-1 in Munich and the last minute draw with Greece that ensured qualification for the World Cup in Japan”.

Pictured: Gary talks with England Manager Roy Hodgson during a training session before a Norway friendly match in 2012.

Ironically Gary`s first tournament was in France in 1998 and this is set to be his last venue as well. While naturally disappointed at leaving the job he loves he enthuses about the prospects for the FA at Saint Georges Park. “I expect there to be exciting developments at the FA as they bring in many changes in structure but more importantly they are investing in more medical staff, and are creating a fantastic performance unit. Although I will not be part of

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FEATURE/DR IAN BEASLEY & GARY LEWIN

The upcoming 2016 Euros will hopefully stir the nations of our home countries into a passionate frenzy of support for their respective teams, especially if they make it towards the final! And, while the focus will rightly be on the players and the results, behind the scenes the myriad of back room staff will no doubt be doing their utmost to ensure they play their part in their team’s success.

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or some players and staff, this will be their first taste of an international competition and while others may have sampled an event like this before, it is likely that the most ‘experienced’ member of the England squad at least will be Head Physiotherapist, Gary Lewin.

Gary has clocked up 5 World Cups, 3 Euros and 2 under 20 World Cups in his time with England as well as acting as Physio for the GB team at the Olympics. Alongside him will be England Doctor Ian Beasley who has also played his part in 2 World Cups, 2 European Championships and 2 under 20 World Cups. Quite a formidable achievement for the pair and unquestionably,

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with that level of experience, a very real asset to have in the squad.

We caught up with the “duo” to gather their thoughts on what has changed over the years, their preparations for the Euros and life beyond.

“There is more administration now than in past years since all injuries and illnesses are now recorded and cardiac screening is undertaken for all the players” says Ian. Gary added “There is a “club environment” about the medical and science staff and we are very much a team where communication is an absolute key element of all we do together. As a unit living and working together we become very close.

Indeed, the “come down” after a tournament is one of the hardest things to deal with”.

Preparations are now well underway as one would expect and both Ian and Gary have already visited the base camp in Chantilly and the three venues for the group matches.

Further visits are planned prior to the competition after which thorough discussions will take place with the coaching staff to finalise plans.

Since this will be their last competition the duo will be involved in as England staff, there will be poignant moments to reflect on past games and their time with the national team.

Pictured: England forward, Wayne Rooney, has a discussion with Ian during preparations for a friendly against Scotland in 2013.

We are very much a team where communication is an absolute key element of all we do together

it my heart will always be there as I have many friends still working at SGP and I cant wait to eventually be a spectator watching England win another World Cup !

There is no question that their full focus will be on the competition in June but understandably there maybe a moment to reflect also on what the future holds.

Gary intends to stay in the game in some capacity whether with a Club, managing a medical and performance department, working with development teams or giving his vast experience to an academy set up. Ian meanwhile has similar designs and has no intention of giving up work “I still want to do, rather than be” he says.

While there will inevitably be some sadness at leaving their roles what better way to bow out than with an international competition such as the Euros, and who knows, maybe a cup final to boot!

FOOTBALL MEDIC & SCIENTIST | 15

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

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Chris Smalling is treated by Dr. Ian Beasley and Gary Lewin after clashing heads with Netherlands’ Klaas-Jan Huntelaar during friendly match in 2012.

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Contributors

Dave Fevre, Prof. Cathy Speed, Dr. Ian Beasley, Gary Lewin, Liam Mackey, Mick Byrne, Jennifer Lace, Prof. Gülfem Ersöz, Prof. Sadi Kurdak, Prof. Mehmet S. Binnet, UEFA Medicine Matters, fcbusiness magazine

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FOOTBALL MEDIC & SCIENTIST | 3

MEMBERS’ NEWS New appointments at the FA

Pictured: John was physio to the Northern Ireland squad that qualified for the World Cup in Mexico ‘86. Pictured above is the team that faced Spain in the Group Stage of that tournament.

John McVey 1931-2015 In the words of Alan Bennett - former Secretary of Leicester City FC

I

first met John when I joined Leicester City as General Secretary in April 1979.

John was the in situ Club Physiotherapist having joined Leicester in 1977 from Northampton Saints Rugby Union club and had the great advantage, being a true Scot, in being able to understand our Manager of the time, the legendary Jock Wallace! Those of you who may have met Jock will understand exactly what I mean!

Forty years ago the Club Physio was just that – responsible for the injury treatment and wellbeing of ALL the Club players from sixteen year old Trainees to the seniors squad. Now at least a four man job, John coped admirably with the task and earned the respect of both the players and also the Management.

I got to know him on the Leicester preSeason tour of Finland and Sweden in July 1979 and realised quickly that in addition to his medical expertise John, as with Physios then at many Clubs, was the person that players with problems, not necessarily football related, felt that they could confide in and receive advice, with John balancing nicely the need for confidentiality and sometimes to pass on information to the Manager and perhaps myself.

I also discovered at first hand John was an excellent singer, although he did take some persuading on the odd evening on that tour to sing for us. But if we did succeed in that persuasion, he would sing Sinatra / Crosby type songs with no accompaniment for quite some time. It was no surprise to learn that he

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was a leading member of his Church choir.

But the most important thing about John was that primarily he was very good at his job. That isn’t always as easy as it may sound at a Football Club, where a Manager may often lean on his Physio to declare an important player fit to play in a vital match.

But John would have none of that – if the player was not quite right he would tell the Manager so and that opinion was invariably respected. Equally he recognised the player who was happy to be recovering slowly from injury – and on occasions that did happen – and it was amazing the improvement that occurred following a few McVey inspired extra training sessions.

That expertise was recognised in 1982 when the Northern Ireland International squad required a Physio and wisely asked for John. He enjoyed seven years with the Irish boys – who, I am sure, got him singing more than once – including a trip to the World Cup Finals of 1986.

A year after that John decided his loyal wife Flo deserved to see a bit more of him - Football Club Physios certainly do NOT work just a forty hour week - and he left Leicester City to take up a private practice in Leicester. This proved very successful with John’s skill and friendly manner building up a large practice which he continued to serve, maybe on a lesser scale in recent years, until that fall last Autumn that brought about his death.

A top Physio and a fine man that those who knew him were proud to call our friend.

F

ormer Wolves Physiotherapist Steve Kemp is to take up the position of England Mens Lead Physiotherapist following the Euros this summer.

Steve, who has been a member of the England`s Physiotherapy team for the past 4 years is to step up to the role on the departure of Gary Lewin who will leave the post after 20 years.

Many of the new positions at the FA are now filled and it is expected that the FA will make a statement announcing all new personnel around the time of this issue.

Blatchford Clinic Team Up With The FMA As A Club Member

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he FMA are delighted to welcome on board Blatchford Clinic as a Club Member. Blatchford is an established British company with a global reputation as a developer, innovator and provider of prosthetic and orthotic devices, special seating and clinical rehabilitation services. They have a team of clinical experts who are able to tailor individual rehabilitation plans to treat a wide range of conditions and injuries. Blatchford will also attending the FMA Conference in May with the Momentum exoskeletal carbon fibre orthosis brace - a bespoke off-loading brace for complex lower-limb injuries.

Here are the Clubs Jeff will be visiting:

Jeff Stelling’s Walk

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he FMA are delighted to be supporting Jeff Stelling’s Men United March.

At the time of going to press Sky Sports Presenter Jeff Stelling is about to walk 10 marathons in 10 days from Hartlepool United to Wembley Stadium to help beat prostate cancer. He is walking through the heartlands of England to raise money to beat a disease killing one man every hour. CEO Eamonn Salmon will be joining Jeff for part of the walk.

Jeff is visiting over 30 football clubs across 10 days from Monday 21 March to Wednesday 30 March 2016 and will be joined in spells by Men United supporters including Matt Le Tissier, Chris Kamara, Paul Merson, Charlie Nicholas and FMA Ambassador Nigel Adkins.

The medical and science teams at each of the Clubs have got behind Jeff by offering to be on hand to advise and treat any injuries, and we would like to offer a HUGE thank you to you all for your support.

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Hartlepool United Middlesbrough United Marske United York City FC Leeds United Doncaster Rovers Scunthorpe United Rotherham United Sheffield United Chesterfield FC Derby County Burton Albion Notts County Nottingham Forest Wolverhampton Wanderers Walsall West Bromwich Albion Aston Villa Birmingham City Coventry City Leicester City Northampton Town MK Dons Luton Town St Albans City Watford AFC Wimbledon Brentford Fulham Queens Park Rangers Chelsea FC Wembley Stadium

A BIG thank you to all the FMA Medical and Science members who offered their support for Prostate Cancer UK!

FOOTBALL TO AMSTERDAM

T

he biggest ride in football which takes place on 3 June 2016 will see FMA Members join Terry Butcher, Viv Anderson, Luther Blissett and Titus Bramble challenging themselves to 145 miles of cycling over two days.

There is still time to join us! Check out the details on www.prostatecanceruk.org and if you are interested contact Lindsay@footballmedic.co.uk as soon as possible!

TEAM FMA Our riders will be starting at London or Hull and this will be a great opportunity to get together with other FMA members and head to Amsterdam – the FMA will even pay your registration fee (£149)! You can then enjoy a night out in Dam Square with your fellow comrades and feel great that you have helped Men United to raise over £500,000 while you enjoyed an epic weekend!

We can’t wait for this event and for TEAM FMA Members getting involved we wish you lots of luck!

FOOTBALL MEDIC & SCIENTIST | 5

Pictured: Uruguay’s Álvaro Pereira lies unconscious on the pitch after a coming together with England’s Raheem Sterling during their 2014 World Cup group stage match in Sao Paulo, Brazil.

Have We Finally Started

to Take

Concussion

inFootball more Seriously?

FEATURE/David Fevre MSc MCSP SRP - head of sports medicine blackburn rovers fc

February 2016 saw the release of the film ‘Concussion’, starring Will Smith, in the UK. The film is based on the 2009 GQ exposé Game Brain by Jeanne Marie Laskas starring Will Smith as Dr. Bennet Omalu, a Nigerian forensic pathologist who fought against efforts by the National Football League (NFL) to suppress his research on Chronic Traumatic Encephalopathy (CTE) brain damage suffered by professional American football players.

H

is interest in the subject was initiated after he performed an autopsy on a former NFL player, who committed suicide and was found to have severe brain damage. This led to him publishing a research paper on his findings as a co-author and which then encouraged him to look into the deaths

6

of several other deceased former NFL players.

As the Head of Sports Medicine in a professional football club in England, there is obviously going to be some ‘treatment room’ discussion between medical staff and players on this subject over the next few months and this in

the main will be due to the film release.

So in football have we started to take a medical subject such as concussion more seriously? In the 2014 World Cup, not that long ago, two serious incidents led to criticism of the sport. Uruguay’s Álvaro Pereira was knocked out in and Germany’s Christoph Kramer sustained a

Pictured: Former Stoke City defender Andy Wilkinson makes an emotional farewell to fans. He retired as a player in February due to a number of complications linked to a concussion suffered a year earlier.

head injury in the final against Argentina.

Both players were allowed to continue playing despite appearing to have concussion. That was followed a couple of months later by the apparent failure to implement the Football Association’s strengthened concussion guidelines when Chelsea goalkeeper Thibaut Courtois was injured in a collision with Arsenal’s Alexis Sanchez. At the time, two leading brain injury experts strongly criticised football for not taking head injuries and associated concussion seriously. Dr Willie Stewart, neuropathologist and a rugby union advisor on concussion based in Scotland stated ‘I don’t see much progress happening in football. It could learn a lot from how other sports have changed their protocols to better look after their players’. Dr Robert Cantu, a leading head injury expert also said at the time FIFA was ‘light years behind’ rugby union with its handling of the issue.

According to Cantu and Stewart, further impetus for change should come from the campaign led by Jeff Astle’s family for more research into CTE and footballers.

The former England and West Bromwich Albion forward died of CTE in 2002, aged just 59.

Shortly afterwards the Football Association introduced new rules for the 2014-15 Premier League season which involved pitch-side assessments of head injuries being doubled in diagnostic time to give team and independent doctors longer to spot any relevant symptoms, players were to be educated more on the risks of ignoring the related symptoms and all potential concussion victims were

to be assessed after the game and on subsequent days. Also all Premier League players were to have baseline neurological assessments as part of an annual medical check-up to help doctors measure their recovery time if they suffered a subsequent concussion. This was followed up in September 2014 by UEFA introducing new rules for concussion as well. It may be co-incidence that these changes occurred at this time, or it may be related to over 4500 lawsuits issued in the USA by former NFL players in July 2013. In response the NFL contributed Figure 1.

$765 million to provide medical help to more than 18 000 former players who suffered neurological problems during and after their playing careers. This ‘settlement’ stated that such a payment should not be interpreted as a statement of legal liability on the part of the NFL. Following on from this the Football Association introduced concussion guidelines for all levels of the sport in November 2015 under the slogan ‘If in doubt sit them out’. This 17 page document covers diagnosis, recognition and a graduated Return to Play (RTP) protocol for all levels of the game.

Australian Rules football and World Rugby have a similar document which they introduced at the beginning of 2012 and 2014 respectively. In Scotland (May 2015) a single, shared set of guidelines were introduced across all grassroots and amateur sports, the first country in the world to do so.

So as individual professional football clubs what are our aims in screening prior to possible concussion injury? As a club our aim is baseline measurements for all the first team and U-21 squad, approximately 56 players. This includes an individual Sports Concussion Assessment Tool (SCAT 3) test and a Clinical Test of Sensory Interaction and Balance (CTSIB) test using the Biodex Balance System SD (Figure 1) or the portable Biosway (Biodex). The SCAT 3 is a standardized assessment tool which incorporates the Glasgow Coma scale, Maddocks score and symptom, cognitive and physical evaluation of the individual. There is no direct financial

FOOTBALL MEDIC & SCIENTIST | 7

cost to the club but to get baseline data on all squad players, 56 in our case, does require a big time commitment from the assessor. The physical CTSIB only takes 10 minutes maximum per player but does have a financial cost of approximately £11k for the balance system, software and supplementary equipment such as the cushion/head torch which are needed for several of the tests. There is a training element to ensure the assessor standardises the testing procedure and ensure reproducibility which is important in any baseline testing.

So what of other sports? The man on the street usually presumes that the high contact sports such as Australian Rules football, American football and rugby have the greatest percentage of concussions. However concussion rates in amateur race riding are 500 times greater than in American football, with statistics of 95 concussions per 1000 rides and 0.2 per 1000 riding (playing) hours.

Jockeys are the athletes at greatest risk of developing a concussion. In professional racing a jockey falls off a horse in 1 out of 16 rides, compared to amateur racing where jockeys fall off once every 8 rides.

The difference relates to skill level. One jockey dies every 250,000 rides. In order to obtain a license to ride, each jockey has to undergo baseline neuro-psychological screening. Following a concussive incident, the jockey stands down for a minimum of 6 days and is then retested against the baseline information.

Each screen costs approximately £3000 per individual, a far greater expense than spent in professional soccer but a far more detailed approach due to the

Pictured: Jockey Ken Whelan falls from horse Royal County Star during a Steeple Chase at Cheltenham Racecourse in December,2009. Jockeys are the athletes most at risk of developing a concussion.

injury incidence of head injury. Horse racing introduced ‘pitch side’ concussion protocols in 2003 (Dr Michael Turner) and at the start of 2016 the British Horseracing Authority (BHA) began a review of these sports’ concussion management and education protocols to ensure horse racing remains at the forefront of concussion management in

Pictured: Swansea City’s Ki Sung-Yeung is treated for a head injury against West Brom in February, he later developed concussion.

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sport. Racing has an advantage in that the injury event is far clearer (i.e. a fall) than in other contact sports. To this end the NFL and World Rugby have introduced concussion spotters pitch side who relay relevant information to the respective medical teams or even the referee to stop the game if necessary so the ‘concussed’ player can be assessed away from the field of play.

To date, it would appear that the sports with the highest incidence of head injury/concussion recognise the need for a detailed approach screening, diagnosis and subsequent injury management. This in time has led them to apportion greater time and finance than in professional soccer. However in a sport that receives a large percentage of its income from television and the worldwide coverage the broadcasting companies get in return, it is essential that the game gets the right balance between care of the concussed player and ‘screening for screening’s sake’. The important message to get across to the players is that it is the number and grade of concussions which are important and the potential risk percentage of CTE developing, rather than the isolated low grade concussion injury a player may suffer. Medical science is not definitive in the causes of CTE at this point and international research institutions in Australia and Qatar are heavily involved in collecting data related to head injury as well as genetic and environmental components. Their initial aim is to be able to give an early indication of the onset of CTE. At present, we can only tell after death.

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BEYOND FOOTBALL

Pictured: Following a injury filled campaign the then reigning Olympic Marathon champion, Paula Radcliffe (far left), struggles to stay in touch with the pack during the 2008 Beijing Olympic Marathon.

TFRAGILE

H

EATHLETE

FEATURE/ Professor Cathy Speed - Consultant in Rheumatology and Sports & Exercise Medicine

In a medical context, the term fragile athlete can be used to describe an athlete, of any age, who is more susceptible than normal to injury or illness. The term is also often used in the context of coaching, when the individual is considered to be psychologically vulnerable under pressure.

I

n a medical context, the term fragile athlete can be used to describe an athlete, of any age, who is more susceptible than normal to injury or illness. The term is also often used in the context of coaching, when the individual is considered to be psychologically vulnerable under pressure.

In this lecture, I will discuss the adult fragile athlete in the context of musculoskeletal issues, defining fragility, exploring methods of detection and reviewing briefly some appropriate interventions.

Recognising fragility in patients can be

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difficult, but all patients who present with an injury should be assessed for the possibility that the injury is a fragility injury: one that under the circumstances of the injury should not have happened. Whether a bone stress fracture, joint or soft tissue injury, it is important to question why the injury happened, should it have happened and could there be an undiagnosed underlying medical condition which caused it?

Fragile athletes include those who sustain a fragility injury, those who present with recurrent or multiple sequential injuries, those who are slow to return to play, or

who suffer so many illnesses that they have prolonged periods of time out of sport (due to their vulnerability when they try to return), those with mental illnesses or psychological issues and those with body weight extremes, underlying diseases or nutritional issues.

Whether an athlete is fragile or not is influenced not only by their physical, physiological and psychological make-up (intrinsic factors), but also their particular sport and the specific skills and techniques needed to excel, as well as their regular coaching environment.

Predisposing intrinsic fragility factors include: female gender, hypermobility, proprioceptive deficits, deficiencies in movement, landing patterns and trunk control. Also, those who are too heavy for their sport or their injury, or too light, as well as those with a history of previous injuries or low back pain, those with nutritional deficiencies and/or diseases and those on certain medications such as glucocorticoids.

Females are at much higher risk of fragility injuries, ligament issues in particular (especially cruciate ligament damage) due to a combination of factors that include proprioceptive impairment and deficits in landing pattern and trunk control. Also, their rehabilitation tends to be slower.

Hypermobile individuals are considered to be fragile, for some of the same reasons. But hypermobility is only the start of a diagnosis, as there are many hypermobile athletes who function extremely well with stable health.

Research on hypermobile athletes and injury risk is scant, but a small study of footballers showed an injury risk of 22 injuries per 1000 hours played in hypermobile players, compared with 6 injuries per 1000 hours in non-hypermobile players. The risk of knee injuries was increased 5-6 fold, whereas no significant relationship with ankle injuries was demonstrated (Pacey et al al, ajsm2010). Ankle restriction is far more likely to make the athlete vulnerable to injury.

Issues related to low body weight are a common cause of fragility. The female athlete triad is a complex syndrome of low body mass, reduced bone mass, menstrual dysfunction and problems with reproductive function. The energy intake threshold for negative effects is likely to vary between individuals, but it is considered that most athletes who have an energy intake of less than 30 kilocalories per kg of fat-free mass per day, will fall into the more severe end of the spectrum. Changes are still likely in those who have energy intakes higher than this value if there is a deficit.

Subtle hypothalamic changes, a slowing of metabolism and broad hormonal dysfunction are considered very common. One result is poor bone and soft tissue health, including bone stress fractures, plus delayed healing.

So if you see an athlete with bone or softtissue injuries which are slow to heal, do screen for eating habits to check the balance between calorific intake and exercise levels.

This syndrome is not unique to females.

Lightweight males can also be fragile, with reduced hormone levels and a slower return to sport. They are also susceptible.

Although the archetypal fragile athlete is a lightweight female, it is worth noting that a very heavy athlete may also be fragile. Excessive body weight, in the form of adiposity or muscle, is a risk for fragility.

Adiposity is pro-inflammatory, which drives the injury and slows tissue repair. The effects of increased mechanical load on, for example, a knee injury, may make an athlete fragile - but reducing weight may make them more vulnerable in their particular sport. The ideal body weight for someone presenting intra-articular injuries or lower patellar tendinopathy is often less than their usual weight, but this in turn may mean that they are too light to perform at a high level

Pictured: Despite winning 14 Grand Slam titles, Rafael Nadal’s career has been beset a number of high profile injuries.

in their sport, in rugby for example.

So what is the best way to detect the fragile athlete and screen for fragility? A detailed history is necessary to identify the potentially fragile athlete, as is a physical examination to look for underlying intrinsic factors, patterns of injury or a slowness to heal or return to form. Some medical conditions can cause athletic fragility and impair soft tissue healing, so screening for conditions like vitamin D or iron deficiencies or hormone abnormalities is advisable.

In addition, consider the sport and the athlete’s training environment, as well as their support structures, both physical and social.

Different screening protocols suit different sports and there is much debate as to how sensitive or accurate these tests are. The Star Balance Excursion Test - one single test of balance and proprioception - has been shown to be a more sensitive predictor of injury than some other generic screening tools. It is also important to consider psychological screening for factors including anxiety, fear, lack of motivation in rehabilitation and the absence of social support, which can all lead both to injury and to a slow return, just as fear of a recurrence can delay recovery.

The important thing is to use all of the information gleaned from a very thorough history, examination and screening tools to clarify the situation. Getting to know your patient by seeing them regularly will enable you to judge when they are presenting with unexpected symptoms. If you suspect that an athlete is sustaining injuries too easily, but can’t pinpoint the reason, this is the

time to refer the patient for a specialist opinion and further investigations. Similarly, those athletes who do not respond to standard treatments for their particular vulnerabilities should be referred.

One crucial factor which affects an athlete’s prognosis is their self-efficacy.

Confidence, insight and engagement with the rehabilitation process will all positively influence the pace of recovery. Ensuring physical and psychological support and motivation is important. Resilience is a strong determining factor in outcome - both psychological resilience to cope with the stress and management of an injury and physical resilience to prevent a recurrence.

Learning to cope with injury should be part of every young athlete’s training – there are huge demands placed on their bodies.

Psychological and physical resilience training can both prevent fragile injuries and support fragile athletes.

Professor Cathy Speed Consultant in Rheumatology and Sports & Exercise Medicine Professor Speed specialises in the management of elite athletes and patients of all ages with arthritis and complex pain, bone and soft tissue conditions.

FOOTBALL MEDIC & SCIENTIST | 11

FOOTBALL MEDIC & SCIENTIST | 12

MLS Star at Spire Perform

for pre-season conditioning ADVERTORIAL/PERFORM It’s that time of year again; the madness of the January transfer window is upon us and medical teams across the country will be stretched far and wide assessing the condition of potential new signings.

C

olorado Rapids defender, and Republic of Ireland international Sean St Ledger, spent much of his MLS offseason back in the UK and decided to book in a couple of days conditioning work at Spire Perform at St George’s Park. This gave Sean the opportunity to get a head start in preparation for pre-season, and ultimately the start of the season on 6th March. “Having previously worked with Steve Kemp (Perform Elite Physiotherapist) at Preston, I knew I was going to receive first class treatment” Sean remarks.

Upon arrival, Sean was seen by our Elite Physiotherapist, Steve Kemp. The information obtained from this assessment would then determine both the content and intensities of the sessions that he would partake in. This was then followed up by a running mechanics development session led by Ben Mackenzie, one of Perform’s leading Sports Scientists.

“The first thing I did was to discuss with Sean his training history and perform a needs analysis. This enabled me to design a short, but bespoke, high-intensity training program.” Mackenzie recalls. Ben set Sean up in the Altitude Chamber in Perform’s BASES accredited Human Performance Lab on a Watt-bike, and set the environmental conditions to 40°C and 2229m altitude (16% oxygen content). The entire session in the chamber lasted around 40 minutes, with

Pictured: Sean (pictured, right) training in the pool at Perform, St. George’s Park.

a 5-minute incremental cycle at a wattage relative to bodyweight for a warm up, followed by 4x4 minutes continuous cycling with 2 minutes passive recovery between sets, and finishing with a 5-minute recovery cycle at a wattage below body weight.

“This type of training in those conditions has a very good effect on cardiorespiratory fitness whilst helping reduce mechanical load, and given the location of Sean’s team in America, will certainly stand him in good stead for continued work at altitude.”

After substantial recovery, the afternoon sessions began with a strength and conditioning session in the gym. Sean completed three key, lower limb exercises aimed at developing mobility and capacity both anteriorly and posteriorly, as well as a core/abs session. The final part of the day

was spent In the hydrotherapy suite, with 20 minutes of both dynamic and static stretching at a depth of 120 cm to help recover from the day’s activities. In addition to this, Sean also performed 10 minutes of cold water submersion (10°C) to help reduce muscle damage and swelling.

Day 2 followed a similar format but progressed by increasing mechanical load, and moved to a pitch-based, high-intensity, position specific session that had been designed with Sean’s individual needs in mind. This involved sprinting to intercept passes, clearing crosses, and engaging an attacking opponent. Further strength and conditioning work and a hydrotherapy recovery session rounded off Sean’s two day programme. Sean left the centre feeling very satisfied with his programme commenting; “The facilities at Perform St George’s Park are unbelievable, and when I heard I was going to work with Ben (Mackenzie), I knew I was in capable hands as his reputation in Football is second to none. I fully enjoyed the work I’ve done here to prepare me for the season!”

For more information on Perform’s bespoke Player Conditioning Programmes please call 01283 576 333 or email ben.mackenzie@spireperform.com

FOOTBALL MEDIC & SCIENTIST | 13

Pictured: Ian and Gary tend to Theo Walcott in England’s 5-0 World Cup Qualifier win over San Marino in 2012. Walcott suffered a bruised lung following a challenge from keeper Aldo Simonici.

EUROS & BEYOND FEATURE/DR IAN BEASLEY & GARY LEWIN

The upcoming 2016 Euros will hopefully stir the nations of our home countries into a passionate frenzy of support for their respective teams, especially if they make it towards the final! And, while the focus will rightly be on the players and the results, behind the scenes the myriad of back room staff will no doubt be doing their utmost to ensure they play their part in their team’s success.

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or some players and staff, this will be their first taste of an international competition and while others may have sampled an event like this before, it is likely that the most ‘experienced’ member of the England squad at least will be Head Physiotherapist, Gary Lewin.

Gary has clocked up 5 World Cups, 3 Euros and 2 under 20 World Cups in his time with England as well as acting as Physio for the GB team at the Olympics. Alongside him will be England Doctor Ian Beasley who has also played his part in 2 World Cups, 2 European Championships and 2 under 20 World Cups. Quite a formidable achievement for the pair and unquestionably,

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with that level of experience, a very real asset to have in the squad.

We caught up with the “duo” to gather their thoughts on what has changed over the years, their preparations for the Euros and life beyond.

“There is more administration now than in past years since all injuries and illnesses are now recorded and cardiac screening is undertaken for all the players” says Ian. Gary added “There is a “club environment” about the medical and science staff and we are very much a team where communication is an absolute key element of all we do together. As a unit living and working together we become very close.

Indeed, the “come down” after a tournament is one of the hardest things to deal with”.

Preparations are now well underway as one would expect and both Ian and Gary have already visited the base camp in Chantilly and the three venues for the group matches.

Further visits are planned prior to the competition after which thorough discussions will take place with the coaching staff to finalise plans.

Since this will be their last competition the duo will be involved in as England staff, there will be poignant moments to reflect on past games and their time with the national team.

“

Representing your country in any form is one of the proudest things you can do. The hairs still stand on the back of my neck when singing the National Anthem

Ian says “I have enjoyed the experience immensely. It is a real privileged to sit on the bench at world cups, the Macarana in Rio and at venues like Wembley.I have met some fantastic people both within and outside of the FA and have many fond memories.”

For Gary it will be the end of a 20 year association with the England set up. His “debut” was in 1996 against Moldova. A certain David Beckham also made his England debut in the same game ! Gary adds “Representing your country in any form is one of the proudest things you can do. The hairs still stand on the back of my neck when singing the National Anthem. There have been some disappointments along the way of course such as losing 4 quarter finals and missing the euros 2008 but there have been memorable moments too such as beating Germany 5-1 in Munich and the last minute draw with Greece that ensured qualification for the World Cup in Japan”.

Pictured: Gary talks with England Manager Roy Hodgson during a training session before a Norway friendly match in 2012.

Ironically Gary`s first tournament was in France in 1998 and this is set to be his last venue as well. While naturally disappointed at leaving the job he loves he enthuses about the prospects for the FA at Saint Georges Park. “I expect there to be exciting developments at the FA as they bring in many changes in structure but more importantly they are investing in more medical staff, and are creating a fantastic performance unit. Although I will not be part of

Pictured: England forward, Wayne Rooney, has a discussion with Ian during preparations for a friendly against Scotland in 2013.

“

We are very much a team where communication is an absolute key element of all we do together

it my heart will always be there as I have many friends still working at SGP and I cant wait to eventually be a spectator watching England win another World Cup !

There is no question that their full focus will be on the competition in June but understandably there maybe a moment to reflect also on what the future holds.

Gary intends to stay in the game in some capacity whether with a Club, managing a medical and performance department, working with development teams or giving his vast experience to an academy set up. Ian meanwhile has similar designs and has no intention of giving up work “I still want to do, rather than be” he says.

While there will inevitably be some sadness at leaving their roles what better way to bow out than with an international competition such as the Euros, and who knows, maybe a cup final to boot!

FOOTBALL MEDIC & SCIENTIST | 15

F M A C onference P R O G R A M M E 2 0 1 6 Tackling the HIP & GROIN 21 - 22 May 2016 Radisson Blu East Midlands Airport PROGRAMME Saturday IntRoduction 12.30

Introduction: Eamonn Salmon CEO of the Football Medical Association

SESSION ONE - Chair: Professor Graham Smith, Chairman of The Society of Sports Therapists INVESTIGATIONS, ASSESSMENT & REHABILITATION OF COMMON HIP & GROIN PROBLEMS IN PROFESSIONAL FOOTBALL 12:45

Imaging in Femero - Acetabular Impingement Emma Rowbotham, Musculoskeletal Radiology Consultant, Leeds Teaching Hospitals

13:00

Hip dysplasia: Pathology, physical assessment and treatment options Alan Rankin, Physiotherapist, Hamilton Academicals FC

13:15

Hip dysplasia: Rehabilitation and functional return to sport Andy Boles, Sports Scientist, Motherwell FC

13:30

Panel Discussion

13:45

Keynote: Taxonomy diagnosis and treatment of groin injuries in football Professor Per Hölmich, MD, DMSc is Head of and Chief Surgeon (orthopaedic) at the Arthroscopic Centre Amager, Associate Professor at University of Copenhagen, and Head of Sports Groin Pain Centre, at Aspetar Orthopaedic Hospital in Qatar. Per Hölmich is a specialist in sports-orthopaedics, and has contributed to numerous articles on the treatment and prevention of sports-injuries.

14:05

Q+A

14:15

Trade Exhibition & extended coffee break for check-in

SESSION TWO – Chair: Chris Barnes, Consultant Sports Scientist AN INTERDISCIPLINARY TEAM APPROACH TO THE HIP AND GROIN 15:00

Screening of the hip and groin Steve Wright, Senior First Team Physiotherapist, Southampton FC

15:15

Gym based strength and conditioning interventions Nick Grantham, Strength and Conditioning Coach, West Bromwich Albion FC

15:30

Field based strength and conditioning interventions Matt Reeves, First Team Sports Scientist, Leicester City FC

15:45

Panel Discussion

16:00

KEYNOTE: Rehabilitation strategies in tackling the hip & groin in field sports: from theory to practice James Allen, National Team Physiotherapist, IRFU, former Senior Team Physiotherapist with Leinster Rugby from 2006 to 2012 and Senior Physiotherapist to the Dublin Gaelic football team winning the All-Ireland Football Championship. In 2012, he was appointed to his current position with the Irish National Rugby Team; Six Nations trophy winners in 2014 and 2015. One of James’ main clinical interests is the rehabilitation of chronic groin pain and he has lectured nationally and internationally on the topic.

16:30

FA CUP FINAL Viewing in Conference Suite or Hotel Bar

19.30

Drinks reception Sponsored by Health Partners Europe Conference Lobby

20.00

AWARDS DINNER Conference Suite

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In association with the Royal College of Surgeons Edinburgh Plus day 2 keynote speakers on the Mental Health of Players PROGRAMME SUNDAY SESSION THREE – Chair: Stephen Feldman, Club Doctor, Huddersfield Town FC Influences, Prevention & Diagnosis revisited 9:15

Biomechanics in Relations to Hip & Groin - A Modern Solution for The Modern Game Jonathan Draper, Podiatrist

9:30

Hip injury prevention strategies from the weight room to the pitch Jon Cree, Lecturer in Sport & Exercise Science, London Sport Institute at Middlesex University

9:45

Examining differential diagnosis in the hip and groin region Charlotte Cowie, Sports Physician, Perform SGP

10:00

Panel Discussion

10:15

KEYNOTE: Mental Health: On The Look Out for Mental Health Issues Affecting Players, Sporting Chance Clinic, Presentation by clinical staff and former players referencing the early signs and indicators of mental health issues in the professional footballer

10:35

Q&A

10:45

Trade Exhibition & break

SESSION FOUR - Chair: Dave Fevre, Head of Sports Medicine, Blackburn Rovers FC Golden nuggets from the groin 11.15

A Medical Perspective Professor Per Hölmich, MD, DMSc, Head of Research, Consultant, Sports Orthopaedic Research Centre– Copenhagen

11.30

An Alternative Perspective Professor Graham Smith, Society of Sports Therapists

11.45

A Physiotherapy Perspective James Allen, National Team Physiotherapist, IRFU

12.00

Panel Discussion

12.15

KEYNOTE: Mental Health: A Players experience Informal discussion and open forum with former professional footballers on their experience and how they see you as clinical practitioners as key in understanding and mentoring

12.35

Q&A

12.45

Conference Finish & Closing Address Eamonn Salmon (CEO) Football Medical Association

Conference Opportunities: Trade Exhibition, Award Sponsorship and Inserts for delegate packs Our annual conference promises exposure to over 200 medical and science professionals interested in new techniques and technologies. This two-day event is a great way to showcase your company directly to purchasers and decision makers in our industry. Introduce your products and services directly to a knowledgeable audience and have face-to-face talks with existing and future customers.

FOOTBALL MEDIC & SCIENTIST | 19

FMA FOOTBALL MEDICAL ASSOCIATION SPONSORED BY

FOOTBALL MEDIC & SCIENTIST | 20

AHEAD OF THE EUROS

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Pictured: Ireland’s Ray Houghton (right) celebrates with trainer Charlie O’Leary (c) after his goal gave Ireland victory over England. Mick celebrates on the left of the picture with defender Kevin Moran.

THEHANDS

THAT ROCKED

NATION FEATURE/Mick Byrne - IN conversation with Liam mackey

Officially he was the team physio but he was much more than that. Mick Byrne tells Liam Mackey about the fun and games of a golden era.

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TUTTGART, June 12, 1988. Ray Houghton’s goal. Packie Bonner defying Gary Lineker and everything else England could throw at him. The full-time scoreboard reading ‘England 0 Rep of Ireland 1. And, beneath it, the Green Army going positively bonkers.

To those indelible images from one of the greatest days in Irish sport, must be added two more. And they both revolve around the same man: silver-haired physio Mick Byrne. Before the game, it was Mick who was seen by millions of television viewers stepping off the team bus outside

the Neckarstadion and, in broad Dublinese accentuated by a clenched fist, shouting to some nearby Irish supporters: “We’ll do them for yiz today, lads.” And after the game, it was Mick who was photographed down on his knees in prayer on the pitch, another shot which went around the world.

Or, as veteran reporter Peter Byrne so memorably put it at the time: “I could visualise Ireland beating England and I could even visualise Ireland winning the Championship. But in my wildest dreams I could never have pictured Mick Byrne following The Pope, General De Gaulle and

Ronald Reagan onto the front page of The Daily Telegraph.”

Twenty-four years on, and on the eve of Ireland’s long-awaited return to the Euros, Mick contemplates those golden memories from a position of comfortable retirement at his home is Ashbourne.

“We’ll do them for yiz lads,” he says again. “Yeah, there were Irish supporters hanging over the railings above us when we were going into the stadium and I was feeling the emotion of it all, seeing everyone with the flags. But I believed it too. I really did. I believed that with the players we had, we could beat England.”

FOOTBALL MEDIC & SCIENTIST | 21

But not before having to endure 84 minutes of heart-stopping tension after Houghton had put the ball in the English net.

“After scoring so early, we had to go through torture,” Mick remembers. “Packie was brilliant that day because Lineker was all over the place. But looking back, we had such big players at the time, players who took charge when they went out — Kevin Moran, Mick McCarthy, Ronnie Whelan, Paul McGrath, Frank Stapleton. It wasn’t just through luck that we got to those finals. We had a great team. Jack Charlton had a great saying: ‘when they cross the line, they’re on their own’. It was up to the players then. But Jack was also a brilliant coach. He knew how the opposition tied their laces. I don’t think he gets the credit for being the great coach he was. And the other thing I’d stress is that, even though people talk a lot about the craic we had, I can tell you that we couldn’t have been better prepared professionally for that tournament.”

It was in the moments of happy bedlam after the final whistle in the Neckarstadion that Byrne fell to his knees on the turf, a very private moment in a very public place.

“You know, I’m an Irish Catholic and I have my faith and that was just me giving thanks,” he says now. “I saw grown men roaring crying everywhere, there were fellas sobbing on my shoulder. It was that kind of a day.”

And the celebrations were only getting under way. After the game, dope tests for Chris Hughton and Tony Galvin meant that the exhausted squad were left sitting on the team coach outside the stadium awaiting their comrades.

“We’d never leave without all the lads, we’d never leave anyone behind,” says Mick.

“So there we all were, sitting on the coach

Pictured: England’s Gary Lineker looks certain to score but his shot is saved by Ireland goalkeeper Pat Bonner. Kevin Moran (left) stretches to try and keep out Lineker’s shot.

and it was steaming hot. And Jack said to me, ‘Is there any way we could have a drink?’ I got off to go and see and I spotted these two fellows in blazers going back into the stadium. So I followed them up in a lift two floors, down a corridor and into this big room — and there was a magnificent bar in it. So, straight away, I race back out onto the coach and I say to Jack and the lads:

Pictured: England’s Chris Waddle is marshalled by future Ireland manager, Mick McCarthy (left), in a key battle during the game.

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‘C’mon, I’ve found a spot’. We all went up and then the singing started. The players could look down on the fans outside the stadium and the fans could see them up there — and they were singing songs to each other. Unbelievable times.”

Byrne was the physio to Irish squads under a succession of managers including John Giles, Eoin Hand, Jack Charlton and Mick McCarthy. And when Steve Staunton took over from Brian Kerr, one of his first moves was to bring Byrne back into the fold, something which came as a happy surprise to the players. As Damien Duff revealed at the time: “The first I knew he was back was when he sneaked into my room, jumped onto my bed and started kissing me. It was a nice way to wake up.

He is a special man and you can’t help but love him.”

But Byrne wasn’t just held in affection; along the way, he also earned the trust and respect of some of the game’s most demanding characters, including Alex Ferguson, Kenny Dalglish and Roy Keane.

Andy Townsend tells a great story from the build-up to the World Cup quarterfinal against Italy in 1990. On a slow day at the team’s small family-run team hotel in Rome, some bored players were lounging around when Byrne took it upon himself to cheer everyone up. Especially for the benefit of the London-Irish boys, Townsend and Tony Cascarino, he began singing ‘The Lambeth Walk’, complete with dance movements, and was so caught up in his performance that he failed to notice he was moving perilously close to the magnificent model ship which held pride of place on a plinth in the middle of the small lobby.

Helplessly, the players watched the inevitable catastrophe unfold as Mick

accidentally brushed against the ship causing it to tilt and although, with one despairing lunge, he managed to get his finger-tips to it, the precious heirloom eluded his grasp and smashed into a thousand tiny pieces on the marble floor.

At the terrible sound, the hotel owner rushed in and, when he saw his beloved model ship reduced to smithereens, promptly went into hysterics. As a redfaced Mick pleaded in pidgin English, “I so sorry, I no mean it,” the owner was joined by his wife, and she too proceeded to lose the plot, the screeching decibel level of the pair now entirely drowning out the mortified physio’s repeated apologies.

In his more avuncular moods, Mick might always have been the one in the Irish camp to dish out hugs and kisses and an arm around the shoulder but the Dublin docker’s son has a vein of toughened steel running through him too.

And after five minutes of Italian operatics, he finally snapped. “Look,” he said, now white in the face, “I said I sorry. I no sorry any more. F*** you – and f*** your boat.”

And with that he stormed out, leaving Townsend and Cascarino, as Andy later put it, “rolling around, gasping for air and trying not to wet ourselves — he couldn’t have done any better to break the monotony.”

As well as tending to aches and pains and knocks and strains - “Kev’s tweaked a hammer,” he once typically confided, after Moran had pulled up suddenly in training - Byrne combined the roles of Mr Fix-It, Minister For Morale and Court Jester in the Irish camp, his responsibilities extending far beyond the treatment room.

He gave me one example when I interviewed him for Hot Press in the run-up to Italia ’90. It was his job, he told me, to select the movie the squad would go to see on their regular outings to the cinema when they were in Dublin. And, he further revealed, the players would give him ratings

Pictured: Ireland players and fans celebrate following their 1-0 victory over England.

for his efforts. I asked him how the most recent one had gone.

“Ah, that would have been ‘Red October’ and I didn’t do too bad actually,” he replied.

“I got a few nines for that. But they were the intellectuals - the rough and tumble gave it three.”

Pictured: Republic of Ireland’s John O’Shea receives congratulations from physio Mick Byrne (left) during the Euro 2008 qualifying match against San Marino at Lansdowne Road.

But he was also visibly moved in the same interview as he tried to describe his feelings on the return to Dublin following the heroics of Euro ’88.

“Something else,” he said. “I’d never witnessed anything like it. I mean, I broke down a couple of times because it was so overwhelming. I remember when we passed O’Connell Street, I looked down the quays, where I used to play in my bare feet, and here we were, coming back as national heroes after putting on tremendous displays for the country.”

Byrne says he’d love to be able to turn back the clock and travel to Poland with Ireland this month.

“Ah, don’t you know that,” he says. “I loved every minute of it. I loved the players.

They’re the ones for me. And I have no fear for them going to Poland now. I think we can handle Croatia. And we’ve always given Spain a hard time.

“But, this time, I’ll be watching at home with the grandkids. I’ll cheer with the grandkids, I’ll cry with the grandkids and I’ll run out onto the street when we score. You know what? When I was in the dug-out, I used to be singing all the songs along with the fans. Singing ‘The Fields Of Athenry’ in the dug-out! And Jack would be looking at me, laughing. I know I had a job to do and I did that job but, in my heart, I was a fan.

And I still am.”

Published with kind permission of the Irish Examiner and Liam Mackey.

FOOTBALL MEDIC & SCIENTIST | 23

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FOOTBALL MEDIC & SCIENTIST | 25

WOMEN IN FOOTBALL

Pictured: Burnley First Team Coach Tony Loughlan (right) with Burnley’s Tendayi Darikwa (left) during the warm up before a match against Wolverhampton Wanderers in November, 2015.

SUPPLY & DEMAND FEATURE/JENNIFER LACE ACADEMY SPORT PSYCHOLOGIST, BURNLEY FC

With the increasingly urgent need for clubs to produce the stars of the future the perceived pressure heaped on the shoulders of young players is ever greater. We speak to Jennifer Lace, Academy Sport Psychologist at Burnley FC, who helps their developing starlets deal with the demands and expectations of becoming a modern day footballer.

What is your role and how long have you worked for Burnley FC? My role at Burnley football club is ‘Academy Sport Psychologist’ and I have been involved with the club for four seasons now. I was originally brought in in January 2010 where I was brought in to support development squad players on a 1-21 basis. I then introduced academy workshops, gathering together groups of players to enhance their awareness and understanding of psychological topics. Since then the role

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has grown to an organisational psychologist type role, so that I am now fully embedded within the club from the pre- academy phase players (under 8s) right through the academy to the development squad.

I work with players, staff and parents covering all aspects such as: enhancing self-awareness, coping with stressful situations and failure, creating and identifying resilience, behaviours for performance, best practice for feedback, decision-making, and creating good habits to improve performance.

Tell us a little about yourself, your experience and qualifications needed for the role you are in?

I am a sporty person myself. Being an ex-national gymnast I have lived a highly competitive life. It helps me understand and relate to the environment I am working in and adds to my professional efficacy.

The academic qualifications needed for a Sport Psychology role are an undergraduate degree in Psychology and a master’s degree in Sport Psychology. After a master’s degree, aspiring psychological practitioners are encouraged to undergo a further two years of professional supervision, to ensure their standard and quality of practice.

There are two main routes to becoming an accredited Sport Psychologist: become a British Psychological accredited practitioner, or a British Association of Sport and Exercise

Scientist (BASES). I chose the BASES accreditation because in football the sport psychologist is on the sport science team and I feel it is important for me have a good understanding of working in a multi-disciplinary team.

You split your work across three groups, how do you work with each sector?

It’s a big responsibility to reach all three areas. With the parents I aim to have regular workshops across the season, to educate and upskill the social support network of the players at the club. This looks at how they praise their youngster, how they can avoid putting perceived pressure on them, and understanding the psychological demands becoming a footballer puts on the academy players. Having contact with parents also allows opportunity for them to impart any important events or information they feel necessary which could have an influence on the player’s performance or psychological development.

Working with the players, my role is to deliver 1-2-1 confidential meetings based on trust to review their current mental skills and see what needs refreshing, but ultimately, enhancing self-awareness and practices orientated at the long term development of the individual. The types of issues faced by players in an academy are: de-selection from the starting line-up, culture change, problems relating to motivation, knowing/dealing with expectations and understanding their roles and responsibilities on the field of play. These are experiences and challenges faced by academy footballers on a daily, weekly and seasonal basis.

With the staff, I aim to educate them on how psychology is embedded in their practices. I try to help staff gain knowledge on psychological topics and how they manifest in players’ behaviours and performance. I try to equip coaches with a psychological awareness of their players to help individualise learning objectives and develop youth players to cope with the demands of the first team environment. The second part of my role with our backroom staff is focussed more on organisational psychology, where I seek to work with each of them on designing and implementing a system of personal and professional development and support.

Finally, the task of organising the processes associated with good communication between different departments is a major challenge for me.

Do you feel psychology is often misunderstood or under-used in football?

Yes, it is heavily misunderstood but I believe that support from the academy manager can change and/or control this perception.

Without support from the academy manager or performance director a sport psychologist may be seen as ‘ineffective’. It is naivety or personal short-comings that are cause for the under-use of psychology. In an environment open to learning and trying new ideas, where staff value each others expertise, psychology can really be utilised, implemented and to be effective.

People’s notion of psychology, especially in football, is one traditionally associated with alcohol, drugs, gambling, mental illness and low motivation but it is fundamental to

Pictured: Jason Gilchrist, one of a number of players to break through from Burnley’s academy side in recent years.

performance in training and on the pitch. It is about staff and players becoming self-aware and focusing on the ‘controllable’ to combat unhelpful thoughts that may impair their attention, decision-making or focus pre or midperformance in training or on game day.

The perception of psychology at Burnley FC has changed during my four years. Originally, an ‘old school’ view saw it as a negative or purely ‘problem-related’ support mechanism rather than a performance-enhancing set of skills. But now staff and players I work with understand that equipping athletes with the correct set of psychological skills helps them cope with increasing performance levels, manage the pressure of big games and ultimately deal with their playing contract decision/outcome.

Psychology is now a proactive process to enhance players rather than a reactive process to ‘fix’ players.

One of the most interesting aspects of your role is the work you do with the Academy Manager, What does this involve?

I support the academy manager in his work and aim to increase his self-knowledge.

The manager of a high level or professional sports organisation is someone who may find they have to make difficult decisions alone. Although this can be an attractive and enjoyable aspect of the role, it does place considerable demands upon the individual concerned. My operation as the sport psychologist is to be able to establish

a series of regular and frequent individual meetings with the academy manager where the aim is to provide support for them to maximize their performance in the job and develop their knowledge of the importance of psychological factors in high performance environments. I aim to support the academy manager (through discussions) in dealing with their own professional/personal goals and ambitions, as well as potentially dealing with anxiety, stress and maintaining focus. I further try to help them in the area of leadership and associated skills and qualities too. Lastly, we work together to help develop his level of self- awareness, identity and understanding the deeper levels of meaning they attach to important events in their lives.

What advice do you have for anyone wanting to take on a similar role?

Be persistent in the academic route of gaining the qualifications, even if it seems long and often irrelevant to what it would actually be like in a real sports setting. Do as much reading and research as possible, but don’t get lost in the research. Your methods of practice have to be grounded in research but creative in your own practices and ideas to help athletes, and adapted to each person you work with individually. You will never stop learning.

Most crucially, you have to be genuine, you have to care about the people you work with and ultimately care about performance and development.

FOOTBALL MEDIC & SCIENTIST | 27

Pictured: Belgium’s Marouane Fellaini and Kevin de Bruyne (behind) try to cool themeselves down during an official water break in their game against the USA at the 2014 World Cup.

hEat StrESS and football FEATURE/Prof. Gülfem Ersöz, Prof. Sadi Kurdak and Prof. Mehmet S. Binnet

Football is the most popular sport in the world and is played by all kinds of people, regardless of their age, gender or physical condition.

T

he physical aspects of football have been studied most intensively in adult male players, and a substantial body of information is available for this section of the population. In a typical football match, elite players cover a total distance of 9–12km, with an average aerobic load of 75 % of their maximum oxygen uptake (VO 2 max) and a heart rate of about 80–90 % of its maximum.

It is clear that performance levels, and thus the outcome of matches, may be determined by the ability to perform repeated short bursts of high- intensity work in an endurance context, and the effects of heat stress or dehydration, either separately or in combination, may contribute to a decline in performance levels during a match.

Stressful environmental conditions can pose numerous problems for athletes.

Exertional heat-stroke (EHS) is often associated with physical activity in a hot and humid environment, with incidence of EHS

being correlated with rises in ambient air temperatures and humidity.

1. Extreme environmental heat places significant stress on the body’s ability to perform, while thermoregulatory responses occur in various internal organs.

2. These responses include mobilising nutrients and electrolytes and maintaining an appropriate equilibrium within the body in terms of fluids, body temperature, pH and blood pressure. If the organs’ internal systems do not respond appropriately, the athlete may develop a serious and potentially catastrophic medical condition.

To guard against EHS during athletic events, the American College of Sports Medicine (ACSM) has studied the effects of heat stress and made specific recommendations regarding participa- tion in sport in stressful

environments. Those recommendations consist of guidelines that measure and define the severity of heat stress using a wet bulb globe temperature (WBGT) index. On the basis of the WBGT at the time of the event, the ACSM also makes recommendations regarding the type, duration and frequency of exercise sessions on that particular day, the frequency of hydration and rest breaks, and whether or not the activity should be moved to a different time of day or cancelled altogether. Football is played in many different environments, and in some parts of the world competitive matches are played in challenging conditions, with temperatures exceeding 30C and a high degree of relative humidity.

Hyperthermia imposes extra thermal stress on the player in addition to the usual physical stress. The core temperature of the player’s body rises, the sweat rate increases as physiological defence mechanisms are used to dissipate the heat and reduce thermal stress,

FOOTBALL MEDIC & SCIENTIST | 29

and fatigue ensues. The combination of an increase in the body’s core temperature and progressive dehydration causes the player to become increasingly exhausted, leading to fatigue and, more importantly, the potential for adverse effects on the player’s health.

3 Testing of players at the end of a recent Australian rules football game that was played at an ambient temperature of 38C revealed a mean core temperature of 39.9C, so some individual values would have been well in excess of 40C. The thermal stress that players face during a match has typically been estimated by simulating match conditions in a laboratory or a controlled indoor environment. However, football involves frequent fluctuations between high and low- intensity exercise, with a change of activity every four to six seconds, so the physical activity pat- tern of a football match may be quite different from the activities typically performed in laboratories. In addition, measurements made after a game may not truly reflect the changes in core temperature that occurred during the game.

To reduce the number of heat-related illnesses, the National Collegiate Athletic Association recently introduced a mandatory five-day acclimatisation period. However, some research indicates that even longer acclimatisation may be needed. Several authors have suggested that an athlete requires approximately 10 to 14 days to fully acclimatise to environmental conditions and that the specific WBGT may not play a significant role in the incidence rate of heat cramps. Increasing the mandatory acclimatisation period in hot environments may reduce the incidence of exertional heat illnesses (EHIs). Based on the data collected, results indicate that most reported EHIs occur during the first three weeks of training in August, with a dramatic decline in

incdence rates thereafter. This coincides with the beginning of football training and double training sessions. It appears that once double training sessions have ended, the incidence rate falls. The majority of the reported EHIs were heat cramps, which are typically associated with a lack of acclimatisation or conditioning.

Dehydration reduces endurance exercise performance, decreases time to exhaustion and increases heat storage 5 . EHS is characterised by rectal temperatures in excess of 40C at collapse and changes to the central nervous system. The following factors increase the risk of EHS or exertional heat exhaustion:

• • • • • • • • • • •

Obesity; Low level of physical fitness; Lack of acclimatisation to heat; Dehydration; Previous history of EHS; Sleep deprivation; Sweat gland dysfunction; Sunburn; Viral illness; Diarrhoea; Certain medication.

Physical training and cardiorespiratory fitness reduce the risk of EHS. In the event of EHS, immersion in cold water is the fastest way to cool the whole body down and produces the lowest morbidity and mortality rates. When immersion in water is not possible, placing ice packs and towels or sheets soaked in freezing cold water on the head, trunk and extremities results in effective – but slower – cooling of the body.

Dehydration and a high body mass index both increase the risk of exertional heat exhaustion, while 10–14 days of exercise training in the heat will improve acclimatisation to the heat and reduce the risk. EHS casualties

may return to training and competitive matches when they have re-established their tolerance of heat. Aural, oral, skin, temporal and axillary temperature measurements should not be used to diagnose EHS or distinguish it from exertional heat exhaustion.

Early symptoms of EHS include clumsiness, stumbling, headaches, nausea, dizziness, apathy, confusion and impairment of consciousness. Training and competitive matches should be altered on the basis of air temperature, relative humidity, exposure to the sun, degree of acclimatisation to the heat, age and equipment requirements, by reducing the duration and intensity of exercise and by altering the kit worn.

Educating athletes, coaches, administrators and medical staff (especially on-site personnel and local emergency response teams) can help with the reduction, recognition and treatment of heat-related illness. Athletes should be advised about the importance of being well-hydrated, well-fed, well-rested and acclimatised to the heat. Athletes should also be told to monitor each other for signs of subtle changes in their performance or behaviour, making them responsible for monitoring each other’s well-being.

REFERENCES 1. Bangsbo J., Mohr M., Krustrup P., Physical and metabolic demands of training and match-play in the elite football player, J Sports Sci, 2006, Volume 24, 665-674.

2. American College of Sports Medicine position stand: Exertional heat illness during training and competition, Medicine & Science in Sports & Exercise, March 2007, Volume 39, Issue 3, 556572.

3. Kurdak S.S., Shirreffs S.M., Maughan R.J., Ozgünen K.T., Zeren C., Korkmaz S., Yazici Z., Ersöz G., Binnet M.S., Dvorak J., Hydration and sweating responses to hot-weather football competition, Scand J Med Sci Sports, October 2010, Volume 20, Suppl. 3, 133-139.

4. Ozgünen K.T., Kurdak S.S., Maughan R.J., Zeren C., Korkmaz S., Yazici Z., Ersöz G., Shirreffs S.M., Binnet M.S., Dvorak J., Effect of hot environmental conditions on physical activity patterns and temperature response of football players, Scand J Med Sci Sports, October 2010, Volume 20, Suppl. 3, 140-147.

5. Maughan R.J., Shirreffs S.M., Ozgünen K.T., Kurdak S.S., Ersöz G., Binnet M.S., Dvorak J., Living, training and playing in the heat: challenges to the football player and strategies for coping with environmental extremes, Scand J Med Sci Sports, October 2010, Volume 20, Suppl. 3, 117-124.

6. Shirreffs S.M., Sawka M.N., Stone M., Water and electrolyte needs for football training and match-play, J Sports Sci, 2006, Volume 24, 699-707

Pictured: Stoke City midfielder Charlie Adam struggles with the heat during their August 2015 match against Norwich.

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team since I first saw them in 1950 and for which I now have a season ticket!

Are you still in touch with people from the game?

I am still in touch with players on Facebook but it is a tenuous connection and they are all family guys now and bound up with their own busy lives.

How have things changed?

Things have changed immensely. I was the sole therapist at Rangers looking after both the professional staff of 36 players and over 20 YTS recruits. I now follow my boyhood team Leyton Orient and wait with my daughter who comes with me and wants team autographs and I am amazed at the back room staff that even the League 2 clubs have . They can number up to 6 or 7 and all travel!

Pictured: Brian treating Queens Park Rangers’ Les Ferdinand on the pitch during a match against Crystal Palace.

WHERE ARE THEY NOW? FEATURE/BRIAN MORRIS

Why did you decide to leave the game?

I finished at QPR in June 2001 having spent 11 seasons there. The reason for my departure was threefold - the club was in administration and 20+ players were no longer going to be retained, my knee had completely given out and I could no longer run on the pitch and lastly all this coincided with the imminent birth of a daughter to whom I had decided to be prime carer full-time.

What is your most memorable moment?

Beating Manchester United away from home on New Year’s Day 1992 with goals from Dennis Bailey (3) and Andy Sinton. Bailey became an overnight legend and the game a YouTube favourite. We could have scored 6!

Do you have happy memories of your time in football?

I have innumerable happy memories of my time in the pro game particularly the banter and the characters you find in all clubs, there were some real comedians at large 20 odd years ago.

Your biggest disappointment?

The biggest disappointment was two relegations and never winning a trophy or league title! Another was never serving Leyton Orient in the capacity of physio; my

Did you have a mentor or a coach that you looked up to and inspired you?

I would have to count Gary Lewin as the greatest influence in my life when I started at the Gunners and I am so pleased he

What are you doing now?

In 2006 I studied complementary medicine at the University of Westminster and was awarded a post-graduate diploma in Bodyworks under Leon Chaitow. I am now at the London Metropolitan University on a BSc programme in classical guitar construction and repair.

What are the best/worst aspects of working in the game?

The best part of working in football was the complete immersion in elite sport and I must also confess it was quite a glamorous occupation. The worst part was the long hours spent in the treatment room, the continual phone calls to and from managers and coaches, club doctor and consultants etc. I invariably worked seven days a week, had no real Christmas or New Year for 11 years and spent untold hours travelling to and from away games with stays in solitary confinement at numerous hotels.

32

How did you get in to football?

I played the game myself in the Southern league for a short while and in the old Athenian League but had a rupture of my (right)ACL and medial collateral ligament in 1965 which cut short a possible illustrious career as a long jumper (Essex schools and Junior AAA champ 1963- 65 and in the ranks of the young potentials for Mexico 1968).So I had a real interest in injuries as a result and in 1978 followed a course run by the FA in the treatment of Injury and thereafter joined Finchley, then Enfield, Barking, Dagenham and Leytonstone and Ilford before being asked by Gary Lewin to assist him at Arsenal in 1988.

Pictured: Brian with Gerry Francis in the QPR dugout.

went on to reach the pinnacle in the game. I also learnt from other gifted and knowledgeable people like our club doctor Neil Fraser, Mark Bender and in the latter time at Rangers from Prav Methana our academy physio who is now with the Welsh RFU and the British Lions.

Who else did you work wiht a Queens Park Rangers?

It was just me and Dr Fraser until the academy got their own staff after 1997.I was grateful for the help I got from Bob Oteng our kit manager, who took the full FA licence In the treatment of injury and was a great help when in my final season I could not run on to the pitch for the last 6 games (Bob is still in the game and has been at a number of London clubs).

Did you have any other duties other than your physiotherapy role?

When Gerry Francis was manager I had the duty of filling in the team sheet, which he dictated to me. I quite enjoyed it, but I never got to sign it!

How was your relationship with managers?

I remember all our coaches with affection Roger Cross, Frank Sibley, Billy Bonds, John Hollins Des Bulpin and Ian Dowie and had good working relationships with Gerry Francis, Ray Wilkins and Ray Harford. I must mention Don Howe, my first manager, a special man of great dignity who was held in universal respect.

He unfortunately died very recently. I was also saddened by the untimely death of our long time skipper Alan MacDonald a couple of years ago.

In general, how did you prepare for matches?

I always packed the medical skip on Thursday night before away games or occasionally early on Friday morning because we didn’t leave until the afternoon. I had a real routine for checking everything particularly the blow up splints, various strappings, under wrap vinyl gloves etc. and then the paraphernalia of

Pictured: Brian in the dugout in the 1990-91 season QPR Vs Wimbledon tie. Derek French is on the away team bench.

Vaseline, Vicks, scissors, nail clippers etc. which players use before the game. For most players there is a clear pre-match ritual and if it includes the use of rubs etc. you cannot afford not to have packed them, players will use any excuse for a bad performance. At Rangers I would be strapping ankles of more than half the team and some for both ankles. Any delay in arriving at the ground meant a real and stressful hasty preparation. When the players went out to warm up I would sit quietly and visualise a possible bad injury and run through how I would cope with it- I found this most useful!

Can you talk about your preparations for matches away from home?

I invariably had to treat players on the night before a game. Because there was no-one available back at the training ground we would often take 3 or 4 players who had no chance of playing yet could have therapy and use the pool, bikes etc.

in the ubiquitous leisure centres. The biggest problem was that we did not often leave on Fridays until 1.30 or 2 pm because we always had a full training session on that day as a result our journeys were plagued by hold ups. I remember one trip to Bolton and another to Blackburn when we arrived after 8.30pm!! It just entailed more hands of Kalookie on the staff table but thankfully I never ventured into the player’s school where fortunes were lost and won on such trips.

What was your routine on a match day?

For most of my years spent at QPR Gerry Francis conducted a “small sided” game on the morning of every match and everyone played including the kit man, me and even the coach driver! It would be Old versus Young or North versus South etc. and we would start at 10 AM; the end generally came when the side Gerry was on scored the winning goal - which he adjudicated. It was not unknown to still be playing beyond 11 am with our pre match meal at 12! If the secretary at the club did her research we would use a booked school field, if not, a park would have to suffice or even, and not infrequently, the hotel grounds. There was no holding back and everyone steamed in. Of course we did have injuries - before a game against Middlesbrough in January 1993 Ray Wilkins sustained a spiral fracture of his right fibula in the hotel grounds!

Final thoughts on your time in the game at club level?

I’ve mentioned my time in non-league football and one of the finest moments I had was to win the FA trophy at Wembley in 1982 with the great Enfield side, also memorable was the replay against Barnsley in the FA cup 4th round in front of 35,000 fans at White Hart Lane in 1981.

I have great memories and a lot for which to be thankful!

Pictured: Brian with former Queens Park Rangers striker Dennis Bailey Sweden in July, 1994.

FOOTBALL MEDIC & SCIENTIST | 33

CAR NEWS FOR MEMBERS

IN ASSOCIATION WITH

‘Baby’ Jaguar flexes its muscles…

N

o one puts baby in a corner, and that’s certainly true of the new Jaguar XE now available to order in the UK and providing a very attractive alternative to the usual suspects.

Jaguar is looking to double its UK sales this year to 36,000 with XE making up around 50% of that so expectations are high. But they were under no illusions that to make an impact in this sector they really needed to up the ante in terms of looks, design, efficiency, technology and be competitive on whole life costs – certainly as around 60% of XE sales are expected in

the fleet sector.

In fact, when it comes to efficiency, a 70 mpg figure being achieved internally by staff at Jaguar exceeds the already impressive 67.3 official figure for the 163 bhp model and makes it a market leader in this regard. Also, the standard specification includes a number of safety technologies, including ‘autonomous braking’, leaving Jaguar executives confident of a 5 star EuroNCAP rating.

Together with a front-end design, which reduces the chance of headlamps smashing in a collision, the safety package

Top 10 bad driving habits Over 50% of drivers on the road are taking unacceptable risks with those under 34 years old the biggest culprits.

A survey conducted on behalf of Halifax Can Insurance showed that 34% of drivers eat and drank whilst at the wheel, 19% took a hands-free phone call and 15% have driven whilst heavily fatigued.

Worse still 13% admitted to sending a text whilst at the wheel and 12% said they checked a smartphone map on the move. 1% even confessed to driving without insurance or a valid MOT certificate.

The figures also reveal that risky behaviour is considerably more likely with younger drivers, as 25% of 18-24-year-olds admitted texting

on the move while just 5% of over 55s doing the same. A quarter of 25-34-year-olds have checked a smartphone map on the move compared to 3% of over 55s.

Quite sobering statistics when you consider how many of these drivers are at driving for work.

1. Eating/drinking- 34% 2. Making a hands-free call – 19% 3. Driving while tired – 15% 4. Sending texts – 13% 5. Checking map app – 12% 6. Checking Facebook – 8% 7. Driving after alcohol – 6% 8. Phone call using handset – 7% 9. Check work emails – 5% 10. Sending Tweets – 3%

is sufficient for the car to receive an insurance rating of 22E (163hp version), well below its rivals. It could reduce insurance premiums by several hundred pounds.

Jaguar is well known for its ‘as standard’ inclusions and the XE is no exception. For example you get navigation, DAB radio, 17” wheels and cruise control with the SE model whilst the R Sport add’s a spoiler, sports suspension, bi-xenons and an wheel upgrade to 18”.

The interior design has had its fair share of attention too – and using the F type as the template isn’t a bad place to start as the cockpit and seating feels every inch a premium vehicle rather than a downgrade from the XF model.

The XE is Jaguar’s most connected car yet, with smartphone apps and wi-fi via its touchscreen In-Control infotainment system and for the driver there’s plenty of power available whilst ensuring a refined and sharp drive on your journey.

The ride is no doubt firm but don’t be fooled, your teeth will all remain in their rightful place as the suspension makes the experience effortless with its blend of sporty and comfort accommodation.

There isn’t much room in the back though so if you have a family of rugby players its maybe not the car for you. That is unless you are planning on getting at least one of them in the more than ample boot space.

For the executive upgrading from a Passat or Mondeo or considering a change from the normal 3 Series, C Class or A4 then there’s a new sheriff in town. And his name is XE.

Expert Advice: Is your business getting the best value contract hire pricing Or “Competitive Tendering”?

If you always use dealer funding or deal directly with one of the FN50 leasing companies then the answer could be no. The great thing about using an independent broker, just as with insurance, is the market knowledge

34 34

advice and ‘competitive tendering’ service they can offer which means you can be guaranteed of a best in market price for each and every vehicle you order. An ideal match is an independent broker that can offer you the pricing advantage

but also that consistency of delivery and aftersales that you might enjoy with a leasing company directly. Oh and keep an eye out for the ICFM and BVRLA logo to ensure you are dealing with a reputable company.

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