Football Medic & Scientist summer 2017

football medic & scientist The official magazine of the Football Medical Association

Issue 21 Summer 2017

In this issue: Art of Treating Clearly Sports Psychology Everton Doc Retires Developing Elite Performance

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Contents

FMA FOOTBALL MEDICAL ASSOCIATION SPONSORED BY

Welcome 4

Members’ News

Features 7

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Developing an Elite Performance Department Neil Sullivan The Five Steps to a Winning Mindset Damian Hughes

14 The Art of Treating Clearly Boris Gojanovic & François Fourchet 18 Conference Review 20 Conference Gallery 22 Award Winners 25 The Team Behind the Team Bill Beswick 28 What Football Can Borrow from the Gymnastics World Nick Ruddock 29 FMA Register

CHIEF EXECUTIVE OFFICER Our FMA Annual Conference and Awards evening rounded off the 2016/2017 season in terrific style as once again the event was hailed a huge success on all fronts.

Like our members, our close season gets ever shorter and no sooner had we all taken a deep breath after organising such a huge event than we were preparing this edition and next year’s conference.

Working in football, in whatever capacity, is a 12 month, 7 days a week commitment.

The past four weeks have highlighted once again why we are here, with many of our members losing their posts and thankful that we are in place to support, advise and guide them through what is a stressful experience. As always, we have stepped up to the mark and ensured that each and every member has attained the best outcome possible in reaching a separation agreement with their club. But our support doesn’t end there. We are always on hand to discuss and advise on future posts and the prospect of private work which is now underpinned by the FMA through the FMA Register - the ideal network to promote any new venture.

As the 2017/2018 season unfolds we are raring to go and have several projects underway that will not only be of real benefit to members but will engage us with football administrators and put us at the forefront of impending changes within the football arena.

While parties discuss the medical and science framework within the game it is vital that the FMA is there to give an independent voice and representation on behalf of its members; one that is realistic and pragmatic and truly representative of practitioners working at the clubs. Indeed, we at the FMA would consider it is the voice of our members that matters most of all.

Eamonn Salmon CEO Football Medical Association

30 Injury in Academy Football - A Nine Seasons Study at a Single Club Dr Gawain Davies 34 Soccer Match-Play Represents an Important Component of the Power Training Stimulus in Premier League Players Ryland Morgans, Rocco Di Michele & Barry Drust 38 Tales from a Healthy Career Rob Urbani 42 Where are they Now? Barry Statham

COVER IMAGE Zlatan Ibrahimovic makes his way off the pitch Martin Rickett/PA Wire/PA Images Football Medical Association. All rights reserved.

The views and opinions of contributors expressed in Football Medic & Scientist are their own and not necessarily of the FMA Members, FMA employees or of the association. No part of this publication may be reproduced or transmitted in any form or by any means, or stored in a retrieval system without prior permission except as permitted under the Copyright Designs Patents Act 1988. Application for permission for use of copyright material shall be made to FMA. For permissions contact admin@footballmedic.co.uk.

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football medic & scientist

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“I

t was a great honour and privilege to receive the Championship Medical & Science Team Award for the 2016-17 season at the recent Football Medical Association Conference and Dinner. This is always a very tough category, as there are some fantastic medical departments and staff throughout the Championship League. Thank you to the FMA for the award, for hosting a fantastic weekend and for all the hard-work they do for medical professionals in the game. The FMA conference weekend offers a great chance to have informal chats, network and discuss medical advances in football with colleagues, sponsors and external specialists in the game!

Adam Brett, Head of Medical Services, Brighton & Hove Albion

“T

he FMA conference once again exceeded expectations. The knowledge, expertise and experience delivered by the speakers has positively impacted my clinical practice. I look forward to next years event which I am sure will continue to grow and attract and influence many more practitioners from all levels of professional football Dr Matt Brown, Manchester City FC Doctor

Pictured: Middlesbrough’s Marten de Roon receives treatment for an injury during the Premier League match Bournemouth in April.

THE ART OF TREATING CLEARLY FEATURE/BORIS GOJANOVIC AND FRANÇOIS FOURCHET, SWITZERLAND Who has fallen for that therapeutic modality, you know, the one for which you know there is no real evidence of effectiveness? There may even be some pretty good evidence that it is ineffective (although most probably harmless). Most of us, of course.

S

ports and exercise medicine (SEM) practitioners try to apply rigorous science as often as possible in clinical practice, even when facing extreme demands from our patient-athletes. But sticking to evidence-based treatments is not always easy.

Authors’ disclaimer: we have applied and suggested therapies, for which we are pretty convinced that the available evidence is either non-existent or non-supportive.

Rolf Dobelli is a novelist, thinker and entrepreneur. In his book The Art of Thinking Clearly1, he pinpoints the assumptions, biases and illusions that shape the way we think and make decisions. We all fall for these cognitive biases as we make decisions, whether for ourselves or when working with our patientathletes. The further you delve into his 99 short chapters, each describing one of these phenomena, as a healthcare provider you start connecting the dots between what our patient-athletes search for, do and expect, and what we are willing to try, offer, recommend or advise. Sports medicine is an area where borders are ill-defined, lines

14

blurred. Science can be extremely specific, but also looks like a big piece of Swiss cheese in the practical setting: looks and tastes yummy, but can be hard to digest, and is filled with holes that we happily ignore and mix with the good bits. This leaves the door open to many biases known to behavioural psychologists for a long time.

In this article, we will look at some of the cognitive and systematic flaws that can cloud our judgment, raise the public’s and the athlete’s expectations to irrational levels and ultimately obscure the art of treating clearly.

Throughout the paper, we will refer to the terms used in Dobelli’s treatise, succumbing in the process to the mother of all biases, confirmation bias.

TO SHAZAM If you work with athletes, you work with superheroes. They achieve what was deemed impossible years ago. They keep pushing the limits (and your limits) and they defy business as usual as we know it. In the 1940s, Bill Batson’s alter ego, Shazam (Captain Marvel), summoned extraordinary powers to

fight against evil (Figure 1).

As SEM professionals we often feel compelled, or are expected to produce shazam-like effects, to restore physical performance capacity as quickly as possible (if not immediately). Sometimes these demands extend to chasing ‘marginal gains’ to make the difference between yesterday’s loss and tomorrow’s win. This would constitute a ‘shazam act’. Although it may be possible on very rare occasions (think benign symptomatic tachycardia that is converted through the Valsalva manoeuvre), most often it leads to disappointment and frustration for both the SEM professional and the patientathlete.

People who shazam have much in common with those who excel in the art of quackery, charlatanism or snake-oil sales, relying on similar mechanisms: they are full of scientific terms and will quote references, putting on a mask of benevolence and camouflaging under a cloak of science. But maybe the flipside is that these people are not being disingenuous.

Perhaps they are deeply convinced that they are providing an outstanding service

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CONFERENCE REVIEW Radison Blu Hotel, East Midlands Airport - 27th and 28th of June 2017 The FMA annual conference and awards evening returned to the Radisson Blu Hotel, East Midlands Airport this year, with numbers of attendees exceeding all previous years.

O

nce again the event was hailed a huge success and delivered across all areas that the event is now renowned for:

Education: Presenters were of an exceptionally high quality again this year and a healthy mixture of speakers from within and beyond football ensured there was much to learn for everyone. All presentations were entertaining, informative and professionally delivered in an informal and engaging manner and proved a real hit with delegates.

Network: This aspect of the event continues to grow in significance each year as numbers of delegates increases and expands the platform through which to forge new connections and meet colleagues in a relaxed and informal setting. Many contacts are made and there is no question that as a body of practitioners we are now much more coherent, engaged and “together” as group than we have ever been these past 20 years. This in itself is every reason to nurture and grow the event year upon year and this is the aim for 2018.

Awards: In many ways the awards evening was once again the highlight of the weekend.

Over 180 guests were in attendance this year and saw an expanded list of awards that

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included medical and science `teams` and individual winners from both the men’s and the women’s game. The event also heard poignant words from Mansfield Town’s Lee Taylor who sadly reported the passing of one of his colleagues Matt Salmon (pictured below). Matt was the academy physiotherapist at the club who had risen to undertake first team duties in his time there. Aged only 25, Matt was certainly one for the future.

Notably, on receiving the team award for Division 2, Notts County FC Head

Physiotherapist Johnny Wilson accepted but then gave the award to “a team of people at a club more deserving.” Referencing Matt, (who had spent some time at Notts County as a student), Johnny gave the award to Lee Taylor and Mansfield Town in an emotional and selfless gesture.

The evening also had a surprise in store for Plymouth Argyle’s Paul Atkinson. Ahead of their cup game against Liverpool last season, Paul was called upon to assist a fan who had collapsed at the ground. Paul and a colleague, sports therapist Victoria Hanniford, duly administered CPR and managed to revive Ray Pomfret before paramedics arrived to take him to hospital.

Ray kindly sent a video to us in which he thanked Paul and said he “would not be here now had it not been for his help”.

The evening was rounded off by former Premier League referee Jeff Winter who gave us a unique and hilarious insight in to his career in the game and related many stories and incidents that we could all relate to.

Plans are already underway for next year`s event and remember to book early – it is certainly not one to be missed!

“A

nother excellent and well organised event put on by the FMA. A great networking event with fellow professionals learning from a diverse group of speakers. Looking forward to next years event!

Tony Tompos, Head Physiotherapist, St Johnstone FC

“I

have exhibited for Catapult at a number of national conferences but I look forward to attending the annual FMA conference not only because of the high calibre of speakers but because of the engaging and open attendees. I am always amazed at how many people are open to sharing their ideas and practices at the FMA conference and for that reason, I think it is one of the best around Rob Pacey, Catapult Sports

“I

just wanted to say what a fantastic event it was this year that cultivated an integrated learning experience through collaborating with Science in football. The awards dinner was a great opportunity to network with new faces and catch up with old with some outstanding contributions to football by all the winners.

Andy Stanbury, Swansea City FC

“I

’d like to congratulate the FMA for creating a relaxed learning environment where peers can interact freely around the great speakers that were presenting. This years conference further highlighted the progress and development of our community within the industry Nathan Winder, Head of Club Sport Science, Barnsley Football Club

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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

Eamonn Salmon Eamonn@footballmedic.co.uk

Executive Administrator

Lindsay McGlynn Lindsay@footballmedic.co.uk

Project Manager

Angela Walton Angela@footballmedic.co.uk

Design

Oporto Sports - www.oportosports.com

Marketing/Advertising

Charles Whitney - 0845 004 1040

Photography

PA Images, Francis Joseph, Football Medical Association

Contributors

Neil Sullivan, Damian Hughes, Boris Gojanovic, François Fourchet, Bill Beswick, Nick Ruddock, Dr Gawain Davies, Ryland Morgans, Rocco Di Michele, Barry Drust, Rob Urbani, Barry Statham

Publisher

Academy Print & Design www.academy-print.co.uk

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members’ news

MEMBERS’ NEWS NORMAN MEDHURST

F MATT SALMON

T

he FMA was saddened to hear of the passing of Matt Salmon on the 24th May.

Matt who was the academy Physiotherapist at Mansfield Town was one of the younger generation of Physiotherapists in the game and was destined for a bright future.

Head of Science at the club, Lee Taylor, who knew Matt well paid a moving tribute to his “friend and colleague” at the recent FMA Conference event saying he was “a fantastic young man to have around the Club, always eager to learn, willing to help in every way he could and always enthusiastic and so likeable. He was popular with players and staff alike and all at the club were devastated by the news of his illness and tragically his recent passing”.

FMA CEO Eamonn Salmon added “I first met Matt at our Conference a couple of years ago.

It was unusual to have the same surname but we were not related. On chatting to him I was taken by his drive, his endearing personality and his keenness to help in any way he could. There and then I knew we had to get him on board and asked if he would be happy to take up the role of Student Liaison. He jumped at the chance and we worked together to produce a brochure to distribute to students across the disciplines involved in football.

Only 2 days before his passing he tweeted `Thanks to Nottingham University, the FMA and Mansfield Town for making me the Therapist I am today’ – generous praise indeed and typical of Matt that he was thinking of others at a difficult time. Our condolences go to his family and many friends.”

FMA BUSINESS

T

he FMA are delighted to announce that BSN Medical, Bacoban, Renew Health, Knights and PCUK are all on board as Business partners for the 2017/18 season. We look forward to working with them and ensuring they are firmly in our members sights this season.

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Liteforce, Physiolab, Promote Medical, Fit4Sport and Game Ready are all lined up as Business Club members and full details of all our partners are available in detail on the FMA website.

ormer Chelsea and England Physiotherapist Norman Medhurst has passed away aged 73 while at his home in France. Norman who also worked for Plymouth Argyle and Torquay United before retiring in 2005 was a well known figure in the game during a 30-year spell as Physiotherapist.

Normans career began as assistant to his father who was the goalkeeper at Stamford Bridge before converting to the role of Physio at the club after retiring from the playing side of the game. He left in 1998 and moved to the West Country for a “quieter life”.

Plymouth Argyle stalwart Kevin Hodges said “Norman would always go out of his way to help you; he was very professional and will be sadly missed.”

Fred Street, who brought Norman into the frame with the England set up added “All of us who work at football clubs, big and small, need a Norman.

Norman was one of those many people who work away behind the scenes in our football clubs, looking after the nuts and bolts of keeping the show on the road.

On the international scene he gave me tremendous support as my assistant with England over 20 years.

He was reliable and loyal and if I forgot something, he would remember for me, before I knew I had forgotten it.

One anecdote. When flying, Norman would collect all the boots in a kit bag, which had its own seat on the plane, next to him.

A true belt and braces man. RIP”

football medic & scientist

FMA TEAM RAISE OVER £3000 FOR PROSTATE CANCER UK

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n June this year two of our fantastic Members set out on an impressive feat to ride 145 miles to Amsterdam over 2 days.

Bobby Childs, Sports Therapist at Sutton United, set off from London on Friday 9th June whilst his comrade Ben McGlynn from the FMA began at Barnsley Football Club on the same day. They joined 380 football fans and legends of the game who embarked on this two-day pedal-pilgrimage to the Dutch

capital on the “Football to Amsterdam” bike ride raising over £450,000 so far.

new friends and I will definitely be taking part next year.”

Bobby said “It was a great experience, everyone mucked in and helped each other and it certainly restores your faith in others when you take part in something like this.”

The FMA Team raised a whopping £3030 (so far) for Prostate Cancer UK. Unfortunately FMA Member, Anthony Colman, had to pull out at the last hurdle but still managed to raise £710 during his training. Well done to each one of our “team” and we hope more of you will join next year’s event.

Ben added “I had an absolutely fantastic weekend from start to finish. Made some

FMA MEMBERS SUPPORT WALL JEFF STELLINGS’ PLANNER MARCH FOR MEN AT 40 O FOOTBALL CLUBS

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huge thank you to our Members within the medical and science teams at the 40 Clubs in the UK who supported Sky Sports Presenter Jeff Stelling. Jeff walked 400 miles from St James’ Park in Exeter to St James’ Park in Newcastle to raise money to beat a disease that kills one man every hour.

FMA Members were on hand at the clubs to provide support in the form of dressings, strappings and moral support along the way.

Chris Royston (pictured below left) at Bradford City FC said : ‘It was a pleasure to try and get some life back into Jeff’s legs after the Barnsley to Bradford leg of his March for Men! Fantastic cause and achievement for everyone involved.’

Keith Graham, Bristol Rovers FC, (pictured below right) said “It was really good to meet Jeff and some of his walking team. Some of their stories were truly inspirational. Luke Almond (First Team Sports Therapist) and myself were happy to be able to help!”

ur wall Planner is set for delivery early July to all departments. Hosting the full timetable of fixtures throughout the season (and a list of useful numbers) the planner will help you to plan events/ meetings within your club according to the football schedule.

If by the start of the season you have not received your copy or you would like an additional copy please contact admin@ footballmedic.co.uk

REMINDER FROM THE FMA

W

ith all the changes that have been made during a busy close season, please can members make sure they update their profile via the website. This is important in case we need to contact you and to ensure you get all emails and delivery of the magazine. www.footballmedic.co.uk

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football medic & scientist

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Pictured: England’s Kyle Walker and Marcus Rashford during the training session staged before the international friendly against France in March.

DEVELOPING AN ELITE PERFORMANCE DEPARTMENT FEATURE/NEIL SULLIVAN Football has changed – a lot - and so too have the needs of the players and the expectations of the clubs. As sports science has increased our understanding of performance, football clubs need to have the staff and the capability to help players cope with the physical demands of the modern game. But what do clubs need to consider when developing their medical and performance departments? Neil Sullivan talks about what a club should consider.

Is there an ideal structure or does it depend on the size/level of the club?

The important part of the process is identifying what the structure should look like in your environment. The squad size often dictates the minimum number of staff required to function effectively. Most importantly however, is the size and playing level of the club will often dictate the budget available. Being creative with the budget is a talent, ensure that it is not just volume of bodies within the department, but also that there is enough experience and expertise available too.

What types of roles are required within an Elite Performance Department and is there a hierarchy of command?

There are always certain roles that have to be fulfilled from a legal stand point,

and following this there are also essential roles to enable the team to perform. physiotherapists often take centre stage in a medical department, based on the minimum standard requirements, and their history within the game.

With all things being equal, an Elite Performance Department should strive to provide excellence in all areas. In essence you need a team of individuals who collectively provide an elite service in-house and have the best network of external providers to fulfil the goal. The professionals required to provide this elite service would include physiotherapists, sports medicine physicians, strength & conditioning coaches, sports scientists, general practitioners, sports therapists, rehabilitators, soft tissue therapists, nutritionists, podiatrists, chiropractic or osteopathy specialists. Many

of the above professions are similar and will overlap. As such it is not essential to have all of these roles in-house, and it is not always a case of recruiting just one type of professional. For example, to fulfil a rehabilitation role within the department, a sports therapist, sports rehabilitator or physiotherapist would all be relevant professions.

The hierarchy of command within the department should be designed with the department lead communicating on behalf of the department. This role isn’t necessarily dependant on professional title, and a number of professionals can, and have, fulfilled this role. This should be someone who is experienced in their field and who is an inspiration to the whole department with their educational, clinical and professional skill set.

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Pictured: Liverpool’s Philippe Coutinho is led off the pitch with an injury during the Premier League match against Watford in May.

Where would an Elite Performance Department fit within the overall structure of the club and who would they report directly to – team management/ directors/ CEO? The Elite Performance Department should be the hub of the football club. Data and information collected from training, matches, testing and medical updates will in turn aid the coaching staff to make informed decisions on training schedules, training loads, player availability, and team selection.

There has to be reporting at multiple levels to enable a smooth flow of information to the key stakeholders. Short-term planning and long-term strategies for squads, recruitment, contracts and performance can be reliant upon regular, honest and accurate updates from the Elite Performance Department.

As understanding of performance and sports science develops has it become even more critical that clubs have a highly skilled team working within the Elite Performance Department?

There is more and more demand being placed on the sports science and medicine departments to provide the individual players, and therefore the team, with that extra edge to perform at the highest level possible. To achieve this successfully, the Elite Performance Department needs to be high performing itself with a desire for continuous improvement and this can only be achieved fully by investing in the

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individuals and the department. Individual projects, higher degree education, research projects and CPD will all provide a sense of responsibility and belonging and will allow the individuals to grow within their roles.

By sharing findings, collectively everyone within the department will improve. This will therefore lead to productive team building and ensure that you have a high performing department by striving for continuous improvement.

As well as human capital, is it also important that clubs invest in technology?

Most definitely. Keeping up to date with the latest innovations is very important.

But it’s not just about having the latest new gadget on the market, or that the other team doing well down the road are using it, it’s because you have done your homework and understand the value it will bring to the department and the club as a whole. There is always a new product on the market, and due-diligence is essential.

What three points should a club consider when establishing a medical/performance team?

It is easy to see why medical and science departments are often under scrutiny from coaches, management and the executive board. When players are injured and results don’t go so well the pressure to return players to training earlier or increase the physical performance levels of those

currently in the squad are great.

The Elite Performance Department should have an agreed ‘blueprint’ on how to strive for success. Every member of the department should be aware of how this ‘blueprint’ fits into their own roles.

Having this in place ensures buy in from the department and shows the rest of the business that there is a clear vision on how to continuously move the department forwards.

Analyse what the department does well, and where there are any potential short falls. Ask questions of the staff within the department, find out their thoughts about what works well and where they have frustrations with their day to day roles.

It may be simple things such as the gym equipment is in need of a service, but also it could be that they do not have enough time or the budget to attend a course.

Develop the staff within the department.

Engage staff in developing themselves with clearly identified pathways for future learning based upon not only the individual’s strengths, weaknesses and interests, but also the department’s and club’s needs as a whole. Striving for this continuous improvement ensures that the department develops into a high performing environment.

Published with kind permission of FCbusiness magazine

football medic & scientist

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Pictured: Great Britain rowers (left to right) Steve Redgrave, Tim Foster, James Cracknell and Matthew Pinsent celebrate winning the Gold Medal in the Men’s Coxless Four Final at the 2000 Olympics.

THE FIVE STEPS TO A WINNING MINDSET FEATURE/DAMIEN HUGHES In my work, as an adviser to sporting and business leaders, I have pored over the thousands of notes and observations from the great coaches I have seen and studied - including rowing’s Jurgen Grobler, cycling’s Shane Sutton and Dave Brailsford and numerous elite coaches.

I

have recognised, over and over, the same principles at work. They all deliver their message using five principles:

Simplicity of ideas, Thinking skills, Emotional Intelligence, Practical language, Story telling ability.

An astute observer will note that these can be compacted into the acronym STEPS. Ultimately, all leaders, in any field of endeavour or in any context where individuals lead other individuals in the pursuit of success, are charged with the same mission: can you get people to start behaving to their potential.

These ideas will help you do precisely that.

Here’s our STEPS checklist for creating a winning mindset: 1. SIMPLICITY Great sporting leaders strive for the ultimate model of simplicity: a one-sentence

statement of their intentions.

When Jurgen Grobler arrived from East Germany, with a brief to deliver a culture of professionalism to the amateur-run sport, he spoke, in his sparing, heavily-accented English. He said, “I asked every rower to summarise whatever they were doing against the question: ‘Will it make the boat go faster?’”

Early on in his illustrious career, Steve Redgrave was openly dismissive of the idea that he needed to incorporate weight training into his regime. “If I wanted to lift weights, I would have chosen to be a weightlifter,” he scoffed.

When Grobler attempted to convince him to adopt these new sessions into his training, Grobler posed his golden – will it make the boat go faster? - question along with some statistics to help guide Redgrave’s response.

Soon after, Redgrave began to see the difference increased power developed within the weight room could make to his speed

in the boat. He became one of the most committed trainers in the gym.

2. THINKING Psychologically it’s much more satisfying and validating to find the solution to a problem yourself than have someone else solve it for you. British Cycling - a gold medal factory - does this by appointing each athlete as a Monarch.

Sir Dave Brailsford explains, “Each athlete is appointed as king or queen of their discipline, with the performance support staff being there as “aides and advisers” to help and guide them.”

The kings or queens are able to pick and choose where they get their help from – but ultimately, if they do not meet their agreed performance targets they can be overthrown and replaced.

Brailsford explains, “We put the riders in the middle; they have the ownership and responsibility for thinking about what they’re

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Pictured: Shane Sutton (fifth right) and David Brailsford (centre with Union Flag) celebrate with the British cycling coaches after their gold medal haul on day eleven of the 2012 Olympics.

doing whilst we’re just the minions around them giving them expert advice. It seems to work,” he adds with some understatement.

3. EMOTIONS When we come under pressure, our emotional brain engages in a contest with the rational, “human” part. The emotional brain is five times stronger and unless it is controlled, it takes over. The consequence of this is clear: We become erratic and unpredictable, forgetting the best laid plans.

Great coaches manage this neurological conflict to the best effect. The USA boxing coach, Emanuel Steward, explained to me that to help people perform under pressure, he adopts a two-step approach, which reinforces this two-brains-in-one model: “To engage you have to contain and then explain. It doesn’t work in any other order.”

To do this requires what you may call ‘soft skills’ but they are anything but ‘soft’ in their application.

4. PRACTICAL The former US secretary of state, Colin Powell once asserted that, “If you can’t explain what you are doing to your mother, maybe you don’t really understand it.”

Great leaders are able to explain themselves in clear, understandable language. In 1980, Peter Coe once advised his son, Sebastian that he had to maintain contact with the athletes at the front of the 1500 metres final. He told him, “You sit so tight into that action you can smell Steve Ovett’s armpits.”

He knew that speaking in practical terms is the only way to ensure that our ideas will mean the same thing to everyone listening.

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5. STORIES In July 2005, Sebastian Coe delivered an emotional story to the International Olympic Committee members about the powerful inspiration which the Olympic Games had on him - and on future generations. At the end of his presentation, he declared, “On behalf of the youth of today, the athletes of tomorrow, and the Olympians of the future,” said Coe, “We humbly submit the bid of London 2012.”

Paris’s presentation had ended with an

entirely different story.

Paris needs the Games. Paris wants the Games. Paris loves the Games.

Paris’s presentation was not about appealing to the positive emotions of the Olympic Committee. It was simply about Paris.

SUMMARY Whilst the thinking that inspired this book is taken from the practices of those coaches operating within their chosen sport at an elite level, that doesn’t mean you have to work in sport to apply it – far from it. The approach is both broader and simpler than that. It relies on an understanding of human beings and their ways of thinking and learning.

You don’t need to be a coaching genius to use the STEPS process to create a winning mindset within your own field of endeavour.

There is nothing magical about this way of thinking. It usually traffics in the obvious and places a huge premium on common sense.

We all have the ability to apply the STEPS checklist as an ideal tool to make a difference and start creating a winning mindset within your own world.

You might just surprise yourself.

Professor Damian Hughes is an international speaker and best selling author who combines his practical and academic background within sport, organisational development and change psychology, to help organisations and teams to create a high performing culture.

Damian@liquidthinker.com

feature

Pictured: Middlesbrough’s Marten de Roon receives treatment for an injury during the Premier League match Bournemouth in April.

THE ART OF TREATING CLEARLY FEATURE/BORIS GOJANOVIC AND FRANÇOIS FOURCHET, SWITZERLAND Who has fallen for that therapeutic modality, you know, the one for which you know there is no real evidence of effectiveness? There may even be some pretty good evidence that it is ineffective (although most probably harmless). Most of us, of course.

S

ports and exercise medicine (SEM) practitioners try to apply rigorous science as often as possible in clinical practice, even when facing extreme demands from our patient-athletes. But sticking to evidence-based treatments is not always easy.

Authors’ disclaimer: we have applied and suggested therapies, for which we are pretty convinced that the available evidence is either non-existent or non-supportive.

Rolf Dobelli is a novelist, thinker and entrepreneur. In his book The Art of Thinking Clearly1, he pinpoints the assumptions, biases and illusions that shape the way we think and make decisions. We all fall for these cognitive biases as we make decisions, whether for ourselves or when working with our patientathletes. The further you delve into his 99 short chapters, each describing one of these phenomena, as a healthcare provider you start connecting the dots between what our patient-athletes search for, do and expect, and what we are willing to try, offer, recommend or advise. Sports medicine is an area where borders are ill-defined, lines

14

blurred. Science can be extremely specific, but also looks like a big piece of Swiss cheese in the practical setting: looks and tastes yummy, but can be hard to digest, and is filled with holes that we happily ignore and mix with the good bits. This leaves the door open to many biases known to behavioural psychologists for a long time.

In this article, we will look at some of the cognitive and systematic flaws that can cloud our judgment, raise the public’s and the athlete’s expectations to irrational levels and ultimately obscure the art of treating clearly.

Throughout the paper, we will refer to the terms used in Dobelli’s treatise, succumbing in the process to the mother of all biases, confirmation bias.

TO SHAZAM If you work with athletes, you work with superheroes. They achieve what was deemed impossible years ago. They keep pushing the limits (and your limits) and they defy business as usual as we know it. In the 1940s, Bill Batson’s alter ego, Shazam (Captain Marvel), summoned extraordinary powers to

fight against evil (Figure 1).

As SEM professionals we often feel compelled, or are expected to produce shazam-like effects, to restore physical performance capacity as quickly as possible (if not immediately). Sometimes these demands extend to chasing ‘marginal gains’ to make the difference between yesterday’s loss and tomorrow’s win. This would constitute a ‘shazam act’. Although it may be possible on very rare occasions (think benign symptomatic tachycardia that is converted through the Valsalva manoeuvre), most often it leads to disappointment and frustration for both the SEM professional and the patientathlete.

People who shazam have much in common with those who excel in the art of quackery, charlatanism or snake-oil sales, relying on similar mechanisms: they are full of scientific terms and will quote references, putting on a mask of benevolence and camouflaging under a cloak of science. But maybe the flipside is that these people are not being disingenuous.

Perhaps they are deeply convinced that they are providing an outstanding service

football medic & scientist by treading the waters others are too timid to approach. Maybe they interpret science differently? Perhaps the science was delivered in an unclear way, fuelling enthusiasm to develop new health and performance theories and therapies.

In our SEM shazam plot, there are three main characters: The Good, the Bad and the Ugly (Figure 2). Each part can be played alternatively by three protagonists: the SEM professional, the demanding patient-athlete and ‘Big Media’.

HOW SEM PRACTITIONERS TRY TO STAY AFLOAT The bedrock of SEM is passion. Most professionals have some form of personal connection to the sporting world. We tend to be involved in sports we are closer to and relationships with sporting organisations and athletes may have personal components beyond the professional ones. SEM has developed from a field-based discipline into a scientific domain in its own right, although often the rules of the field take precedent for many arguable reasons. Concussion management provides many examples for this2.

How can we navigate the troubled waters between fast, field-guided action and reasoned evidence-based therapy to avoid the many traps? Most agree that SEM’s role is to protect athlete health, restore optimal performance capacity and help athletes achieve their full potential in a safe, fair and legal way. For that purpose, SEM practitioners are ready to dedicate extra time, be extremely available and act faster than medically necessary. Working in sports requires adaptability, reactivity, innovation and creativity. One can argue that science does too, except the time frames are very different. Science takes a longer path full of codes, whereas the sporting setting needs all of this here and now3.

Take an athlete with worsening, symptomatic Achilles tendinopathy.

Figure 1

Figure 2

Major competitions are coming up. Load management is a priority, but it is a ‘boring’ course of action. The practitioner feels compelled to do more for the athlete. This is called action bias (another example of action bias is the football goalkeeper defending a penalty kick. He or she will usually always jump to one side, even though he or she could stay in the middle of the goal – the likelihood of stopping the kick is the same.

But if the ‘keeper did not move one way or the other, he or she would be perceived as lazy). Coming back to the athlete with Achilles tendinopathy; your institution has recently acquired a shockwave therapy machine (availability bias) and your head of department has successfully treated Achilles tendon pain with it (authority bias).

Not everyone has the device at hand, so a

form of scarcity error will be at play (the rarity of the device makes it appear more effective than it is). When or if the athlete recovers and performs well, the clinician will gain satisfaction and maybe fame along the way (self-serving bias). Sometimes we have spent time, effort and money learning new therapeutic techniques that may not be validated by rigorous science. Yet we apply them nonetheless, falling prey to effort justification and sunk-cost fallacy.

On the other hand, the strict application of evidence-based principles or guidelines can also lead to problems. Single case studies may not be valid for the situation at hand.

Meta-analyses may be misleading if they pool data from biased sources4. Applying evidence can be difficult. Example: a new study shows positive effects of a supplement to reduce the severity of upper respiratory tract infections (publication bias always present), so the practitioner starts prescribing it to athletes. A few years later, the same supplement is debunked and shown to be detrimental as it negatively impacts muscle adaptation to training. Science was applied in the decision making process, but the athlete probably did not benefit from the science.

Applying new scientific findings ahead of the field or simply making the latest reported advances available to athletes seems obvious.

After all, it is about those marginal gains, and provided we respect the 'primum non nocere' principle, this course of action might seem appropriate. But the problem is, when we do this, we contribute to the hype and raise expectations with limited room for backpedalling.

TIPS FOR SEM PRACTITIONERS 1.Don’t overstate the effect of a single treatment (single-cause fallacy).

2.Make sure you have your bases covered with the most likely beneficial course of action before using sparingly (if at all) the

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Pictured: MK Dons Lee Nicholls receives treatment during the Sky Bet League One match against Charlton Athletic in April.

slight added effect of the latest novelty.

3.Follow Warren Buffet’s advice5: find your circle of competence and stick to it. The rest belongs to your network that completes the expertise you need to treat clearly.

PATIENTS, ATHLETES AND EXPECTATIONS We mentioned athletes are superheroes.

They are trained to believe they can overcome all obstacles and prevail through the sheer power of their determination. Of course history teaches us that most athletes will not reach the pinnacle of their sport, however hard they try. They must, however, obliterate this reality to adopt an optimistic faith in success. Managing expectations at all levels is crucial. From this flows the necessity of an egocentric attitude, literally: centred on themselves, in praise of their individuality. This will open the door to many quacks. It becomes easy to develop a rhetoric of invincibility through cure-all remedies or specially-developed formulas that address the specific needs of the individual. There are many potential cognitive errors here: It’ll-get-worse-before-it-gets-better fallacy – predicated in this way, the quack cannot lose (consultants make their living on this one), scarcity error, fundamental attribution error, and one which should not be underestimated, affect heuristics (deliver the advice with empathy and compliments to get most bang for your snake oil buck).

Patients may also adopt similar thinking.

Recent developments in medicine, from genetics to personalised medicine reinforce the expectation of ‘anything’s possible’.

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Fuelled by media hype, the demand for novel therapies is fast-growing. Platelet-rich plasma becomes a must-have commodity (Figure 3) and the more expensive it is, the greater the belief (placebo effect?) it will work. Hyperbolic discounting is at play (‘I want it now, no matter what’). If the treatment fails, cognitive dissonance comes to the rescue (reinterpreting negative outcomes positively).

When treatments are combined, often the salience effect will surface: an overreached athlete takes a couple of weeks of rest and starts to take spirulina supplements.

He recovers his energy and performance level 2 weeks later; is it the rest or the fancy trending supplement that made all the difference? It may be harmless at first sight, but salience is also at play when more dramatic therapeutic choices are made. For example, in the presence of subacromial pain syndrome or medial meniscopathy, surgery has been advocated for a long time, despite the fact that conservative treatment is most often effective, cheaper and obviously less invasive. The only thing is, the scalpel is attractive6. Salience effect again.

Medicine has entered the age of shared decision-making, where practitioners are compelled to disclose, explain, share and discuss. This is where patients can be susceptible to information bias. Too much information kills information and decision fatigue ensues, potentially turning patients over to people who have simpler (or simplistic) explanations and therapeutic options. These solutions will entail some

level of fallacy of single cause (e.g. the correction of foot pronation as the cure for all lower limb – and more – maladies) (see Breakout box 1).

TIPS FOR SEM PRACTITIONERS 1.Sharing information is good, but cut to the chase – understand what the patient expects and work from there.

2.Make the good treatment sound just as appealing as the shazam therapy.

3.Empathise and don’t make the mistake of the conjunction fallacy (too many details in a story make it less likely to be true).

READ WITH A CRITICAL EYE. DON’T BELIEVE THE HYPE! First of all, take any headline that ends with a question mark (e.g. can X cure cancer? or can Y heal muscle tears faster?). Now answer systematically, no. You will find this to be correct most of the time. Betteridge’s law of headlines can help us identify an oversold story: characterised by weak to non-existent facts, an oversold story is built on tenuous hypotheses. This is sensationalism. But it does sell well, since we are all likely to continue reading – searching for the magic bullet. Oversold stories are an increasingly common problem, as readers of any media tend to spend less and less time on a piece, usually reading on a mobile device. Catching the eye and capturing the ever shorter attention span requires sensationalism.

In oversold stories, the halo effect will be at play: if it glitters, it must be gold! Key giveaways are often innovation, technology,

football medic & scientist ancient roots and celebrity endorsement, among others – the whole package used by advertising professionals. If you dig into the claims, you will find that they are usually unsubstantiated, but the damage has been done. The distorted message sticks as we all hope that the headline carries some truth. Unfortunately, the stories behind the headlines tend to die quickly, losing relevance as soon as the next issue of the media outlet arrives, due to the necessity to continually report ‘new’ news. This is the news illusion.

Second, we have seen in recent years the emergence of new conditions that seem pushed into the headlines. Diseases that were non-existent or rarely present before now seem to be at the front of everyone’s mind. Take lactose or gluten intolerance, for example. All of a sudden, we are confronted with an epidemic of digestive issues, which make for beautiful stories by mixing the best elements in any health saga: demonisation of food processing (and ‘Big Food’), the nostalgia of a lost paradise past where food was ‘natural’ and therefore ‘healthy for the gut’ and anecdotes of extreme longevity or stamina. Social proof becomes a problem, as more and more people embrace these theories and apply the (most likely) unnecessary dietary restrictions. Athletes are not immune to this7. And of course, the media may be influenced by the development of a vast, profitable (and ever-increasing) industry behind special-requirements food products.

According to Caulfield, an author and health law expert, the “rhetoric of revolution is everywhere, […] stem cell, microbiome, nanotech, genomic, personalised medicine revolution”8. We highly recommend reading his books on the topic of health messages.

Science and sports are popular topics in the media and the combination makes for a good sell. It also comes as no surprise that scientists can fall prey to the appeal of widespread and instantaneous (although often short-lived) fame, by reporting small findings in a hyperbolic way. They may be encouraged to do so by their institution’s media department and editing/distortion might happen along the way.

TIPS FOR SEM PRACTITIONERS 1.Don’t read the news. But if you do, before you make up your own mind, assume the answer to headlines is NO. 2.Don’t use hyperbole to overstate your research findings, even when media experts nudge you in that direction.

A CALL TO BE CONSCIOUS OF THE POTENTIAL FOR THINKING ERRORS We have tried to illustrate some of the major cognitive errors that cloud human reasoning, leading to suboptimal decisions and erroneous conclusions. When foul play is involved, the Bad and the Ugly show up and quackery takes over. Joint cracking, vitamin popping, snake oil, hair analysis, immune boosters, detoxification and balance restoration are on the menu. A large industry and the media contribute to spreading the beliefs of treatment benefits and social

networks magnify the message using powerful storytelling. The promoters of these treatments use all the cognitive mechanisms in their bag of tricks, but now you know how to spot them.

However, it is often more difficult to spot our own cognitive errors as SEM clinicians when we apply some therapeutic modalities (vitamin D, extracorpeal shockwave therapy, platelet-rich plasma, various supplements, to name but a few). Figure 3 describes the recipe for Shazam therapies.

Awareness of these cognitive mechanisms allows the SEM practitioner to thoughtfully reflect on the optimal course of action, while avoiding decision paralysis. Some can then be put to good use, like the illusion of control – the false belief that we can influence the course of something over which we have no clear sway or affect heuristics. We can do this by making sure the athlete benefits from all established therapeutic techniques, while being aware of the power hidden in communication skills. For most practitioners, this is second nature. Although we may not be fully aware of all mechanisms, we apply some ‘remedies’ in the best interest of our patient-athletes, in an effort to incarnate 'The Good' practitioner.

With regard to science and the urge to stick to it, it may be worth recognising a few pitfalls. First, orthopaedics and sports medicine sometimes suffers from a lack of sound and valid science to base everyday decisions on. As Lohmander and Roos point out, “clinical impressions can be deceiving”, and we need to start recognising the major reasoning flaws and interpret the available science correctly, applying it when applicable9.

How then, do we deal with Ioannidis’ statement that “most published research findings are false10”? One way is to remember that the absence of evidence is not evidence of absence11. Case reports give ideas, which become small observational studies, which, in turn, may become stateof-the-art intention-to-treat valid clinical trials. While research is important, the fast-paced action of the sporting world continues and success will be achieved regardless of the results of fancy scientific trials. The SEM field thrives on the passionate dedication of its actors, who go well beyond sports medicine staff, to include coaches, psychologists, trainers and athletes themselves. They all come up with innovative and creative solutions. These solutions may not all be scientifically supported, but they certainly tend to get a pass in the real athletic world and contribute to the art of treating.

To conclude, we leave the last word to a great philosopher of science, Karl Popper, who theorised about what differentiates science from pseudo-science: “the criterion of the scientific status of a theory is its falsifiability, or refutability, or testability”.

Good science can be tried and proved wrong by better science, whereas any pre-emptory decree (Shazam!) cannot be considered scientifically true.

Boris Gojanovic M.D. Health and Performance Medical Director Hôpital de La Tour La Tour Sports Medicine Swiss Olympic Medical Center Meyrin, Switzerland Attending Associate Physician Sports Medicine Lausanne University and Hospital Lausanne, Switzerland François Fourchet P.T., Ph.D. Hôpital de La Tour La Tour Sports Medicine Swiss Olympic Medical Center Meyrin, Switzerland Contact: boris.gojanovic@latour.ch References 1. Dobelli R. The Art of Thinking Clearly.New York: Harper 2013. p. 384 .

2. Jenkins G. Smith 'snake dance' prompts change to concussion trial. ESPN Sportsmedia Ltd 2013. Available from: http://en.espn. co.uk/scrum/rugby/story/196939.html [Accessed August 2016].

3. McCall A, Davison M, Carling C, Buckthorpe M, Coutts AJ, Dupont G. Can off-field 'brains' provide a competitive advantage in professional football? Br J Sports Med 2016; 50:710-712.

4. Weir A, Rabia S, Ardern C. Trusting systematic reviews and meta-analyses: all that glitters is not gold! Br J Sports Med 2016; 50:1100-1101.

5. Buffett WE. 1996 Chairman's letter.

Berkshire Hathaway Inc 1997. Available from: www.berkshirehathaway.com/letters/1996. html. [Accessed August 2016].

6. Jevne J. The sexy scalpel: unnecessary shoulder surgery on the rise. Br J Sports Med 2015; 49:1031-1032.

7. Lis DM, Fell JW, Ahuja KD, Kitic CM, Stellingwerff T. Commercial hype versus reality: our current scientific understanding of gluten and athletic performance. Curr Sports Med Rep 2016; 15:262-268.

8. Caulfield T. When we hype our science, discoveries are diminished. The Globe and Mail Inc 2016. Available from: www. theglobeandmail.com/opinion/when-wehype-our-science-discoveries-are-diminished/ article29984407/ [Accessed July 2016].

9. Lohmander LS, Roos EM. The evidence base for orthopaedics and sports medicine. BMJ 2015; 350:g7835.

10. Ioannidis JP. Why most published research findings are false. PLoS Med 2005; 2:e124.

11. Altman DG, Bland JM. Absence of evidence is not evidence of absence. BMJ 1995; 311:485.

12. Krabak BJ, Hoffman MD, Millet GY, Chimes GP. Barefoot running. PM R 2011; 3:11421149.

13. Gunderman RB, Sistrom C. Avoiding errors in reasoning: an introduction to logical fallacies. AJR Am J Roentgenol 2006; 187:W469-W471.

Published with kind permission of Aspetar magazine

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CONFERENCE REVIEW Radisson Blu Hotel, East Midlands Airport - 27th and 28th of May 2017 The FMA annual conference and awards evening returned to the Radisson Blu Hotel, East Midlands Airport this year, with numbers of attendees exceeding all previous years.

O

nce again the event was hailed a huge success and delivered across all areas that the event is now renowned for:

Education: Presenters were of an exceptionally high quality again this year and a healthy mixture of speakers from within and beyond football ensured there was much to learn for everyone. All presentations were entertaining, informative and professionally delivered in an informal and engaging manner and proved a real hit with delegates.

Network: This aspect of the event continues to grow in significance each year as numbers of delegates increases and expands the platform through which to forge new connections and meet colleagues in a relaxed and informal setting. Many contacts are made and there is no question that as a body of practitioners we are now much more coherent, engaged and “together” as a group than we have ever been these past 20 years. This in itself is every reason to nurture and grow the event year upon year and this is the aim for 2018.

Awards: In many ways the awards evening was once again the highlight of the weekend.

Over 180 guests were in attendance this year and saw an expanded list of awards that

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included medical and science `teams` and individual winners from both the men’s and the women’s game. The event also heard poignant words from Mansfield Town’s Lee Taylor who sadly reported the passing of one of his colleagues Matt Salmon (pictured below). Matt was the academy physiotherapist at the club who had risen to undertake first team duties in his time there. Aged only 25, Matt was certainly one for the future.

Notably, on receiving the team award for Division 2, Notts County FC Head

Physiotherapist Johnny Wilson accepted but then gave the award to “a team of people at a club more deserving.” Referencing Matt, (who had spent some time at Notts County as a student), Johnny gave the award to Lee Taylor and Mansfield Town in an emotional and selfless gesture.

The evening also had a surprise in store for Plymouth Argyle’s Paul Atkinson. Ahead of their cup game against Liverpool last season, Paul was called upon to assist a fan who had collapsed at the ground. Paul and a colleague, sports therapist Victoria Hanniford, duly administered CPR and managed to revive Ray Pomfret before paramedics arrived to take him to hospital.

Ray kindly sent a video to us in which he thanked Paul and said he “would not be here now had it not been for his help”.

The evening was rounded off by former Premier League referee Jeff Winter who gave us a unique and hilarious insight in to his career in the game and recalled many stories and incidents that we could all relate to.

Plans are already underway for next year`s event and remember to book early – it is certainly not one to be missed!

football medic & scientist

“I

t was a great honour and privilege to receive the Championship Medical & Science Team Award for the 2016-17 season at the recent Football Medical Association Conference and Dinner. This is always a very tough category, as there are some fantastic medical departments and staff throughout the Championship League. Thank you to the FMA for the award, for hosting a fantastic weekend and for all the hard-work they do for medical professionals in the game. The FMA conference weekend offers a great chance to have informal chats, network and discuss medical advances in football with colleagues, sponsors and external specialists in the game!

Adam Brett, Head of Medical Services, Brighton & Hove Albion

“T

he FMA conference once again exceeded expectations. The knowledge, expertise and experience delivered by the speakers has positively impacted my clinical practice. I look forward to next years event which I am sure will continue to grow and attract and influence many more practitioners from all levels of professional football.

Dr Matt Brown, Manchester City FC Doctor

“A

nother excellent and well organised event put on by the FMA. A great networking event with fellow professionals learning from a diverse group of speakers. Looking forward to next years event!

Tony Tompos, Head Physiotherapist, St Johnstone FC

“I

have exhibited for Catapult at a number of national conferences but I look forward to attending the annual FMA conference not only because of the high calibre of speakers but because of the engaging and open attendees. I am always amazed at how many people are open to sharing their ideas and practices at the FMA conference and for that reason, I think it is one of the best around.

Rob Pacey, Catapult Sports

“I

just wanted to say what a fantastic event it was this year that cultivated an integrated learning experience through collaborating with Science in football. The awards dinner was a great opportunity to network with new faces and catch up with old with some outstanding contributions to football by all the winners.

Andy Stanbury, Swansea City FC

“I

’d like to congratulate the FMA for creating a relaxed learning environment where peers can interact freely around the great speakers that were presenting. This years conference further highlighted the progress and development of our community within the industry.

Nathan Winder, Head of Club Sport Science, Barnsley Football Club

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CONFERENCE GALLERY

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football medic & scientist

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AWARD WINNERS 2017 Premier League Medical & Science Team Award 2016/2017

Sponsored by

West Bromwich Albion FC

Championship Medical & Science Team Award 2016/2017

Sponsored by

Brighton & Hove Albion FC

League One Medical & Science Team Award 2016/2017

Sponsored by

Scunthorpe United FC

League Two Medical & Science Team Award 2016/2017

Sponsored by

Notts County FC

National League Medical & Science Team Award 2016/2017

Sponsored by

Lincoln City FC

Scottish League Medical & Science Team Award 2016/2017

Sponsored by

Celtic Ladies FC

Scottish League Award 2016/2017 Tony Tompos

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Sponsored by

football medic & scientist

Women’s Game Award 2016/2017

Sponsored by

Manchester City Ladies FC

Exceptional Achievement Award

Sponsored by

Wales Senior Mens Medical & Science Team

Exceptional Achievement Award

Sponsored by

Northern Ireland Senior Mens Medical & Science Team

Exceptional Service Award

Sponsored by

Rob Price & Alan Peacham

Outstanding Contribution to Football Medicine & Science

Sponsored by

Dr David Muckle

Longstanding Service Award

Sponsored by

Steve Allen

21 Club Chris Moseley Steve Redmond Nigel Cox Stuart Collie

Sponsored by

Dave Lawson Paul Smith Lee Taylor Kevin Hornsby

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With thanks to all our sponsors and exhibitors for making the Conference a huge success

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football medic & scientist

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Pictured: Bill Beswick stands alongside Steve McClaren during their time together at Middlesbrough.

THE TEAM BEHIND THE TEAM

THE ROLE OF THE SPORTS PSYCHOLOGIST FEATURE/BILL BESWICK Every sports psychologist adopts a particular style and mine has been very much influenced by my experience as a teacher/lecturer and as a coach at club and national level.

T

he ideas shared here reflect this background, plus my involvement with a number of high performance teams, at youth and senior levels, both men and women, in a range of sports including football. These experiences have increasingly confirmed my view that success in elite sport is driven by a winning mindset underpinned by physical, technical and tactical capacity. A high performance culture is based on a collective mindset – a way of thinking and feeling that drives winning behaviour. Such a culture: ~ ~ ~ ~

embodies the understanding that people make successful programmes balances challenge with support considers ‘human beings’ as well as ‘human doings’ ensures everybody involved feels needed, cared for, listened to and appreciated.

This was recognised in the winter 2016 edition of this magazine, when Tony Strudwick commented: ‘Even though we will have sophisticated protocols, technology and analytics, there has to be an appreciation that professional football participation is a human pursuit.

Something between the magic sponge and sports science lies common sense and solid practice’ The role of the sports psychologist is to champion this ‘human’ dimension and contribute to winning by helping shape the collective mindset positively on a daily basis and across multiple circumstances.

The sports psychologist has to build relationships with the players and, most importantly, with the Head Coach, (who has the most significant influence on

the collective mindset), plus with the coaching and the performance support teams. This multi-relationship role means the sports psychologist often functions as a key guardian of the culture. He or she reinforces and renews the cultural ‘glue’ that binds everyone together, often acting as a mediator between different perspectives in order to keep the collective mindset on the right track.

As part of a daily routine, as well as seeing players individually, the lead psychologist is in the ideal position to keep a close watch on the: ~ ~ ~ ~ ~ ~

impact of the Head Coach and coaches influence of the performance team attitude of the player leadership group effects of the training and playing environment general climate of positivity likely ‘red flags.’

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Apart from external pressures these elements generally shape the daily mood and morale of the club or camp.

When mentoring or acting as a ‘thinking partner’ to a Head Coach I have always stressed the importance of selecting performance staff to achieve best-fit with the club or team culture; people who will consistently perform brilliantly and add that little bit extra, especially at critical moments. The aim is to appoint support staff that have the expertise to improve players physically, technically and mentally together with the personality and disposition to support the everyday shaping of positive individual and the collective mindset.

It’s not unusual for Performance Team members to fail to recognise the importance of their role beyond their primary functional expertise. If a player has, say, eight meaningful interactions in a working day then two or three are likely to be with members of the Performance Team. This kind of interaction is often when a player feels vulnerable, (could be in or out of the team or in rehabilitation, for instance), and takes place in an environment where the player may let their guard down or be receptive to help, thus it is an important opportunity to shape mindset. There is a constant battle between positive and negative player and team mood in the football season (and the higher the level and challenge of competition, the more mood and morale can be threatened at any moment). Rosabeth Moss Kanter in her book ‘Confidence’ underlines the importance of having positive, stable staff around the team: ‘Good moods are both causes and effects. Winning puts people in a good mood and being in a good mood makes it easier to win. The contagion of positive emotions can help improve co-operation, decrease conflict and underscore more positive perceptions of everyone’s task performance. Negative emotions have the reverse effect.

Moods are catching, especially among people who know they can depend on one another. Moods spread from person to person in surprisingly subtle ways’ An important element of my role is building relationships with the Performance Team that contributes towards strengthening player and staff interaction in a positive way. This can also be a way of allowing staff to share information, (without of course, compromising professional integrity) and combining on an agreed course of supportive action to optimise player and team benefits.

When Steve McClaren began managing the England Senior Men the Performance Team were already in place and Steve wanted to stress their importance in his plans so the first meeting we held was with them. As a basis for further discussion we asked Performance Team members to create an ‘In/Out Wish List,’

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i.e. to use their experience to identify what processes and behaviours benefited the team and thus should remain (In) and what should go (Out). The information gained was invaluable. A great proportion of the marginal gains that a high performing sports team strives to achieve comes from the combined knowledge of experienced Performance Team practitioners who are aware that their contributions are valued and enjoy working together for the common cause.

This role of the sports psychologist as a ‘corporate coach’ also worked well with the England Rugby Performance Team, especially when facing a demanding preparation schedule for the World Cup campaign; fifty days together, a twenty-eight day stretch at high altitude camp, three days off in thirty-five. The Performance Director, Matt Parker and I discussed issues such as: ~ ~ ~ ~ ~ ~ ~ ~

staying realistic but always positive developing a questioning mentality relaxing pressure on the players not increasing it avoiding speculation and staying in the present keeping everything as simple as possible pacing themselves and avoiding burning out keeping their work as fresh and interesting as possible managing mistakes and setbacks

Preparing Performance Team members for likely conversations they might have with players and thus helping to ensure a positive response is also a useful strategy. For example when a player showed failing self-belief we discussed their role as ‘belief partners,’ assisting in reinforcing confidence and refusing to allow the player to succumb to ‘victim’ mentality. If players claimed it was ‘non stop’ work they would be reminded of the carefully devised plan for work/rest/ recovery/relaxation. Similarly the claim of ‘too much hotel time’ would be met by the encouragement to organise a stimulating downtime and create more opportunities for social interaction.

British Swimming worked hard to create a very significant turnaround in four years from a miserable London Olympics in 2012 to a best ever performance in Rio 2016. Under the leadership of Performance Director Chris Spice, an emphasis was laid on the development of a ‘super’ performance team to match the ‘super’ coaches and ‘super’ athletes needed for Olympic success. Psychological services were integrated into the performance team and contributed towards delivering the aims of: ~ ~

constantly creating and updating a world class pathway understanding the needs of the ‘super’ athlete and ‘super’ coach

~ ~ ~

being comfortable with leading-edge technology being able to fine-tune athlete coaching, recovery and ‘peaking’ contributing formally and informally towards making British Swimming a good place to be

An essential role for the sports psychologist is agreeing with the Performance Team the best ways to support the team (and each other) after a defeat. Discussions focus on issues such as these below and consensus can help to minimise negative effects post defeat. ~ ~ ~ ~ ~ ~ ~ ~ ~

Being at your best in the tough times Recognising a defeat is only one lost opportunity Being prepared to listen rather than speak Asking good questions Avoiding blaming Recognising there were positive aspects of the performance Helping direct thoughts and feelings towards recovery Setting a forward agenda of hope Refusing to discuss the game beyond a ‘twenty four hour’ post-game limit

The sports psychologist should also play a part in working closely with the medical and sports science staff in the treatment and recovery from injuries.

For elite athletes injury can be traumatic and the mind suffers as much, if not more than the body. Whilst the Team Doctor leads, the psychologist is an important component of the support team, advising the player on dealing with negative thoughts and emotions, avoiding depression, staying motivated and building resilience. He or she also monitors the player’s mental and emotional state through what might be a long-term rehabilitation process, rebuilding confidence and preventing them from becoming too isolated and detached from the energising activities of the team.

On the very few occasions I have encountered a failing performance team member (and intervention has not been successful) it has rarely been a problem with professional competence but rather trustworthiness. The first rule of being part of an elite sports team is ‘leave your ego at the door’ and be willing to be invisible yet available. For some, the glamour proves too much and an excess of self-interest, (an inability to move from ‘me’ to ‘we’), can lead to inappropriate behaviour, decline in player relationships and thus the loss of trust.

Such situations, though, are rare.

As lead psychologist with many ‘Teams behind the Team.’ I have been privileged to work with staff who knew their jobs, took responsibility, understood the working context, communicated well and put the team first. Good people to be around!

football medic & scientist

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WHAT FOOTBALL CAN BORROW FROM THE GYMNASTICS WORLD FEATURE/NICK RUDDOCK

U

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~ ~

It’s often said that gymnastics is the foundation of all sports. Perhaps we’re bias within the gymnastics world, but it can’t be argued that gymnastics provides a great foundation for several, if not all sports, and that’s what I want to talk about … foundations. ndeniably, gymnastics is an early specialisation sport. It’s not through choice but through necessity that see’s 10 year old gymnasts juggling 20 hours a week of training plus a standard school education. A young child’s ability to learn, adapt and tolerate large amounts of physical and mental loading is incredible, and is non comparable to their older teenage peers. We simply must take advantage of it. The sport has reached incredible levels of complexity which brings with it an inevitable demand for harder and of course smarter training.

Without wishing to reinforce the 10,000 hour principle, for us gymnastics coaches it bears some truth, with the majority of our female athletes being talent ID’d as young as 5/6 years old (to the extent to which it is possible so young) with the potential opportunity of representing Team GB at an Olympic Games ten years later.

So why are gymnasts such impressive athletes? Well quite simply, you get good at whatever you spend your time on.

If a 9 year old spends 8 hours a week solely dedicated to physical preparation alone then you would expect them to build a solid foundation of movement, and that’s exactly what we do. By the time they have

objection - ‘football first.’ And there are of course the ‘unicorn’ athletes who contradict this thought process, having become gods of the football world without these kind of interventions.

But we’re looking at the masses, not the unicorns.

Depositing a few quid into a savings account each day would accumulate to a nice sum within a few years, as it accumulates over time. You’d see this as a long term investment strategy, looking to reap the rewards of these deposits in the future and not the present. It might be more enjoyable to spend the money here and now, but that would sabotage a goal of creating wealth.

Look after the pennies and the pounds will look after themselves right?

Sport and time is no different. In fact it is even more prevalent with time as it is our only non renewable resource.

The winning team is the one that spends their time most wisely, and we all are on a level playing field when it comes to that (excuse the pun.)

So what are the easiest ways of increasing volume of time on physical preparation without impeding on the critical pitch time?

For me, I’d say warm up and cool down’s. A typical gymnastics session of mine would look something like this :

reached their teenage years they have already accumulated significant hours in just about every aspect of movement you would expect from a high performing athlete, and that’s before we even look at the technical training also.

With such complex movements and forces being tolerated in training, an athletes’ physical preparation level is often the deciding factor with their potential to survive and achieve in the sport. Without it, you’re limited to a cartwheel and a few rolls on the floor.

Give a child a ball and they can play all day long. Give them a set of uneven bars and you’re a bit limited as to what can be done.

So physical comes first, no compromise. It underpins the entire skill acquisition model.

I’m curious to know what would happen if a football academy adopted a similar model for their young players. What if the ratio of physical to technical training was flipped around the other way, and physical competencies became more of a priority than pitch time?

Surely we would see less injuries, better movement, better body control and awareness?

When the athletes do step up to the squat rack, there would be years of conditioning already underpinning their movements.

I understand the dilemma, and the common

~ ~ ~ ~ ~

General Warm Up (Could include speed / power / plyometric activities) General full body conditioning and muscle activation Active/dynamic flexibility Apparatus time (Vault, bars, beam, floor) Core conditioning & Prehab Passive flexibility Session ends

By incorporating basic conditioning, jumping and landing, plyometric and movement competency work into daily warm up’s you can accumulate significant volume over a week. The same can be said by finishing the day off with a 15 minute core set. Yet the impact on the pitch time is minimal.

The frequency of these sessions is as important as the total volume. I’d rather spend 10 minutes each day on basic movement competency, then hit the athlete with a full 60mins session only once a week. Short, daily interventions allows the coaches to remind, reinforce, regulate and remedy technique and movement.

This article is not to be critical of the football industry, which is light years ahead of gymnastics in many departments, with lots we can learn. The intention however, is to inspire a paradigm shift towards the ratio of physical and technical training, capitalising on a tremendous opportunity for optimising the physical abilities of their youth athletes.

Nick Ruddock Performance Gymnastics Coach, Consultant and Speaker Twitter.com/nickruddock Facebook.com/nickruddock Email - nick@nickruddock.com

football medic & scientist

feature

FMA REGISTER GIVING SOMETHING BACK TO THE GAME

A

s we all know the close season is a volatile and precarious time in the football medical and science arena.

This year was no exception with over 20 members having been relieved of duties during this period.

For members, their first port of call of course has been the FMA who then arrange specialist legal support for representation in reaching a compromise agreement. But that’s not where the support ends. In fact, it is just the start.

As well as supporting that member during what is a difficult time, we also discuss options for the future. Firstly, remaining a member is vital in order to access jobs as soon as they become available. We also advise on updating of their CV and can put them in touch with an emerging recruitment agency that will assist in their search for new positions. The vast majority of members however turn to private practice and this is where the FMA Register comes in to its own.

The Register offers a great opportunity for members already in private practice or those just starting out, to highlight their experience, services and professional profile in promoting their skills to potential clients.

Joining the Register will highlight members as a unique individual who has experience at the very top within football and this is something that needs to be promoted to a wider audience.

The FMA Register is the perfect recruitment platform for members to promote their skills and expertise to colleagues within the game, fan bases and grassroots football.

Colleagues working within the game are already using this register as a resource to find practitioners either with specialisms they are in need of, for consultancy work or to cover absence or address staffing levels while appointments are pending.

The FMA Register is a `bridge’ between professional and grassroots football and is a terrific platform from which amateur players can access world leading medical and scientific expertise from the professional game.

As an elite register listing the FMA Register is not open to any practitioner. Registrants must have worked in a professional capacity with players or a club in the top 5 tiers in English football, the top 2 tiers in Scotland or the FA WSL1.

Eligible practitioners include: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Doctor Physiotherapist Sports Therapist Consultant Surgeon Consultant Physician Sports Rehabilitator Sports Scientist Strength & Conditioning Coach Optometrist Nutritionist Dentist Soft Tissue Therapist Sports Psychologist Podiatrist Osteopath/Chiropractor

Registrants also receive the full spectrum of benefits offered as members of the association.

Join the FMA Register today at www.footballmedic.co.uk/fma-register Or by contacting Angela Walton, Project Manager 07432 360789 or 0333 4567897

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feature

Pictured: Coventry City’s Billy Steadman (Left) is tackled by Sheffield Wednesday’s Fraser Preston during the Premier Development League Semi-Final in April.

INJURY IN ACADEMY FOOTBALL A NINE SEASONS STUDY AT A SINGLE CLUB FEATURE/DR GAWAIN DAVIES MFSEM, SHEFFIELD WEDNESDAY F.C. Introduction The academy programme started in English professional football in 1998 with the aim of progressing a select group of young players into full time elite football.

Research from 2004 (Price et al. 2004) suggested injury rates in youth footballers were similar to adult players (Nielsen 1989) but the effect of injury was not clear (Steffen and Engebretsen 2010).

There was an acknowledged lack of data on both epidemiology (Emery et al. 2005) and preventative strategies (Olsen et al.

2004) for football injury in adolescents.

Football has increased in intensity and tactical demands over the last two decades (Wallace and Norton 2014) and it has become increasingly competitive to make a career in professional football (Cardona 2011).

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This paper looks at the injury rates over nine seasons at the academy of a championship club.

Under -18 players join the academy for pre season training in early July. The new players undergo a full medical assessment completed by the club doctor. . The match load is around 40 competitive matches per season and the players receive a minimum of 12 hours per week of direct football coaching.

METHODS Injury data analysed was gathered over the nine seasons from 2006-7 to 2014-15.

The doctor was present at all home matches and held a weekly clinic at the training ground. The physiotherapist was present at all matches and training sessions, enabling an accurate diagnosis

and progress review for all injured players.

For the purposes of this study, an injury was defined as: Any physical complaint sustained by a player resulting from a football match or football training, irrespective of the need for medical attention, that resulted in a player being unable to take a full part in future football training or match play.

The time loss from an individual injury is the number of days elapsed from the date of injury to the date of the player returning to full participation in team training.

RESULTS For Under-18 players at this academy in comparison with adult professional football: 1. The rate of injury was less.

2. The time loss through injury was greater.

football medic & scientist 3. The frequency of injury by site was different.

102 individual players were studied over the 9 seasons 2006-07 to 2014-15.

The mean squad size was 20 players (range 17-24) per season.

Their mean age was 17yrs and 3 months at the end of their first season.

The total number of injuries recorded in the study was 294 (mean 32.6 injuries/season).

67 (25%) injuries were classed severe with a time loss of greater than 28 days.

The mean time loss per injury was 25 days (median 10 days).

A mean of 17.8 (range 20-14, 87% of average squad) players sustained at least one time loss injury in a season.

The total number of days missed from training and match availability was 7407 days at a mean of 823 days/season.

The mean number of days missed from training and match play for an individual player was 40 days (Range 0-300) per season and a total of 80 days missed over the two seasons.

DISCUSSION 1. Injury rate and site.

The mean number of injuries per player (1.58) per season in this study is lower but the mean time loss per injury (25.19 days) is higher in comparison with the UEFA study of professional adult footballers( 2 injuries , time loss 21 days ) (Ekstrand et al. 2011). The percentage time injured in this study was 14% in comparison to 6% in the 2004 Football Association study of academy injuries (Price et al. 2004).

The frequency of injury by site in this group differs from the 2004 study and adult football. The most frequent sites of injury are the ankle (24% of all injuries), knee (18%) and hip (13%). The studies cited earlier of academy football found near equal proportions of injury at the ankle (19%), thigh (19%) and knee (18%).

The frequency of injury by site in the UEFA study was thigh 17%, Adductor 9%, Ankle 7% and Knee (MCL) 5% (Ekstrand et al.

2011).

A total of 74 ankle injuries occurred over nine seasons, an incidence of 0.4 injuries

Figure 2

Figure 1

per player per season and a mean of 13.9 days per player were missed due to ankle injury over their two seasons. 24% of these injuries were classed as severe.

Risk factors cited for ankle injury include young age and instability (Fousekis et al. 2010) but a study of adult footballers showed only previous injury was a significant predictor of risk of re –injury of the ankle (Engebretsen et al 2010). The academy players receive regular training on balance exercise and injury prevention exercises with regard to ankle sprain and several players play all matches and training with supportive tape. The research questions the effectiveness of this approach. In general ankle injuries have a positive outcome but injury can affect growth (Schneider and Linhart 2013) and predispose to osteoarthritis in later life (Mafulli et al. 2011).

Knee injury was the cause of the greatest time loss at 1984 days. Five anterior cruciate ligament (ACL) rupture knee injuries occurred over nine seasons. All were treated with interval surgical repair around six weeks post -injury. Three players suffered re–tear within 2 years. The mean return to play time was 274 days (range 185-468). The mean return to play time in ACL injury in adult football is 207 days with

a 4% risk of re-tear before return to play).

High levels of activity and young age are risk factors for re-rupture and contralateral ACL tears (Keading 2015).

Right ankle injury was 2.21 times more frequent than left ankle injury. Rightsided injury was also more frequent for thigh (2.22:1), foot (2.13:1) and hip/ groin (1.49:1).

The occurrence of knee injury was approximately equal between right and left sides (0.92:1).

The mean number of left footed players in the squad per season was 3.4 (17%) This indicates a two-fold increased risk of injury to non-dominant lower limb and four times increased risk of injury to nondominant knee. This pattern is also found in adult footballers (Krajnc et al 2010).

The factor that increase rate and severity of injury in youth football players include: injury history (Brito et al.2012, Le Gall 2006), high rates of match exposure (Zarei et al.2010), age/size discrepancy (Le Gall et al. 2007), increasing age (Dahlstrom et al. 2012), increased workload (Bowen et al. 2016), lower skill levels (Schwebel et al. 2007) and artificial playing surfaces (Soligard et al. 2012). Professional players in their first season have a lower injury rate than older players and academy players (Kristenson et al.2013) despite the perceived increased intensity and match exposure in the adult game. A complex interplay of factors and relative immaturity appears to make academy footballers more vulnerable to injury.

2. Return to Play Times The mean return to play times are longer than in adult football.

The cohort examined had a higher proportion of “serious“ injuries (taking over 28 days to return to play) 25% compared with 16% in the UEFA survey (Ekstrand et al. 2011).

Factors that increase return to play times in youth football include ankle injury, hamstring injury, contact mechanism (Merrion et al. 2006) and increase in age

31

Pictured: Coventry City’s Lewis Green (Left) and Sheffield Wednesday’s George Hirst battle for the ball during the Premier Development League Semi-Final in April.

(Cloke et al. 2009). The coaching and medical staff may be more cautious with returning a young player to sport – the perception of the player’s career potential and a higher risk of re-injury. The decision to return to play is complex and should be shared between athlete, coach and medical staff (Dijkstra et al. 2016). Financial and team pressures influence return to play times in adult football (Burgess 2011) and these are probably less in academy football.

Time-based models to judge return to play may be inappropriate; criteria based models are more effective in ACL injury (Delvaux et al. 2013). Coaching strategies have a strong influence on the psychological factors in return to play (Podlog and Eklund 2010) and can lower the risk of re-injury (Haglund et al. 2007). Governing bodies have influence on return to play times, notably for head injury where increased caution is recommended in young athletes (Harmon et al. 2013). A consensus on

Goalkeeper Defender Midfield Striker Figure 3

32

return to play strategies and strategic assessment of risk has been suggested (Arden et al. 2016) but there exists a large variation in opinion in return to play decisions (Shultz et al. 2013) 3. Injury trends per season .

The mean number of days lost to injury shows a large variation during the study period. The rate of injury in adult professional football has remained stable over the last 15 years (Ekstrand et al. 2013, Dauty and Collon 2011) but falling trends are reported in youth football (Chandran et al.2016) .In this study the three seasons since the introduction of the Elite Performance plan show no change in the mean days injured per player per season (39 days) however the mean number of injuries per season has fallen to 20.00 compared with mean 32.66 for the whole study period.

The focus on injury prevention in football worldwide is high and the efficacy of

Mean number per season in squad

Squad composition (%)

Total number of injuries/ position

2 6.3 7.4 4.3

10 31 37 21

18 68 98 85

Mean number injuries/ player / season by position 1 1.19 1.47 2.19

Ratio

Significance

0.6 0.81 1.00 1.52

P< 0.05

P<0.05

programmes including the FIFA 11 is now established (Zein et al. 2014, SilversGranelli et al. 2015). The falling trend in the number of injuries may reflect a greater emphasis within the club on injury prevention by better qualified coaching / strength and conditioning staff. In the pre –season, time is spent on screening and functional testing, but the effect of this as an injury prevention strategy is not clear (Frisch et al. 2011). The mismatch between the fall in injury rate and stability in time missed indicates a possible increase in individual injury severity.

4. In season variation of injury rate There was a significantly (p<0.05) lower rate of injury for goalkeepers and a higher rate for forwards. In adult football there is no difference in injury rate by position (Daughty and Collon 2011). Factors to explain the higher injury rate in forward players in this cohort are the lower numbers in the squad resulting in greater exposure to “risky “match play (Emery et al. 2005), forwards run greater distances during matches (Andrzejewski et al. 2015) and run at higher intensity (Di Mascio and Bradley 2011, Al Haddad et al. 2015 5. Summary The under -18 academy footballers at this club miss 13.3% of their training period through injury with a mean time loss of 25 days per injury. This is over twice the time loss in previous studies (Price et al. 2004).

The illness absence rates in employment for

football medic & scientist similar age groups in the United Kingdom are 1.2% overall (HSE 2015) with a mean time loss from a work injury of 6.7 days (RIDDOR. 2013).

The long-term consequences and prognosis of injury are of concern (McCormack and Hutchinson 2016). Risk factors for injury are known but are these being addressed ? Injury itself is the major risk factor for re–injury (Haglund et al.

2013, Kucera et al. 2005)and the risk of further ACL knee injury is six times greater in players under age 25 years who return to sport (Paterno et al. 2014).

Injury may have long-term adverse effects on joint health with increased risk of early osteoarthritis following ACL injury of the knee in young athletes (Thompson et al.

2015). It may be appropriate to restrict the return to a lower level of sport (Arden and Khan 2016) thus ending the prospects of playing professional football. Psychological consequences of injury include depression, anxiety and stress (Covassin et al. 2015, Dessoki et al. 2012).

The success rate of the academy system in progressing players to the offer of a professional contract is low (Williams 2009).

The time loss through injury may be a denial of opportunity to the player and high injury rate has a negative effect on team performance (Hagglund et al. 2013, Eirale et al. 2013).

There do not appear to be any studies on the impact of injury on academy player progression. Future research into the length and content of the football academy programme should evaluate the impact of injury and time lost from the programme.

Acknowledgements Mr. Ash Fickling. Head Physiotherapist, SWFC Academy.

Mr. D Ramsdale. Director, SWFC Academy.

Players and Parents of Sheffield Wednesday Football Club.

Key points The rate of injury in this cohort of Under 18 academy footballers over nine seasons is comparable to that in the UEFA injury survey but return to play times are longer.

The Ankle is the most common site of injury in Under 18 footballers.

The mean time missed through injury is 40 days a season -14 % of the two seasons academy programme.

It is not known what impact injury has on the progression to adult professional football but time loss is likely to be a negative factor.

Ardern,C., Khan, Karim. 2016. The Old Knee in the Young Athlete. British Journal of Sports Medicine. 50 (9), pp. 505-506.

Ardern, C., Bizzini, M., Bahr, R. 2016. It is time for consensus on return to play after injury: five key questions. British Journal of Sports Medicine, 50 (9), pp. 506-508.

Bengtsson, H., Ekstrand, J., Hägglund, M.2013. Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study.

British Journal of Sports Medicine, 47(12), p.743.

Bowen, L., Gross, A., Gimpel, M., Li, F.2016. Accumulated workloads and the acute: chronic workload ratio relate to injury risk in elite youth football players. British Journal of Sports Medicine, doi:10. 1136/bjsports-2015-095820 Brito , J., Malina R.,Seabra A .,Massanda J.,Krustup P.,Rebelo A. ,2012. Injuries in Portuguese Youth Soccer Players During Training and Match Play: Journal of Athletic Training, 47(2), pp.191-198.

Burgess, Theresa L., 2011. Ethical Issues in Return to Sport Decisions:Commentary.

South African Journal of Sports Medicine, 23(4), pp.138-139.

Cardona, P., Lleo, B. 2011 The case study: Barcelona Football Club’s Youth Academy.

Financial Times, Jan 13, p.14.

Carling, C., Orhant, E., Le Gall F., 2010. Match Injuries in Professional Soccer: Inter –Seasonal Variation and Effects of Competition type, Match Congestion and Positional Role.

International Journal of Sports Medicine, 31(4), pp. 271-276.

Chandran A., Barron M., Westerman B., DiPietro L., 2016. Time Trends in Incidence and Severity Among American Collegiate Soccer Players in the United States. Medicine & Science in Sports & Exercise, 48(5S Supp 1), pp.869-869.

Cloke D., Spenser S., Hodson A., Deehan D., 2009. The epidemiology of ankle injuries occurring in English Football Association academies. British Journal of Sports Medicine. 43 (14), pp.1119-1126.

Cloke, D., Ansell, P. Avery, P., Deehan, D. , 2011. Ankle injuries in football academies: a three-centre prospective study. British Journal of Sports Medicine, 45(9), p.702.

Covassin, T., Beidler, E., Ostrowski, J., Wallace, J., 2015.

Psychosocial Aspects of Rehabilitation in Sports. Clinics in Sports Medicine, 34(2), pp.199-212.

Dahlström, Ö.,Backe, S., Ekberg , J., Janson, S.,Timpka, T. 2012.

Injuries are common in youth soccer. Is “Football for All” Safe for All? Cross-Sectional Study of Disparities as Determinants of 1-Year Injury Prevalence in Youth Football Programs . Public Health And Epidemiology ; Non-clinical Medicine. 7(8), p437.

Dauty, M., Collon, S., 2011. Incidence of Injuries in French Professional Soccer Players. International Journal of Sports Medicine, 32(12), pp.965-969.

Delvaux, F., Croisier, P., Rochcongar, O. , Bruyère, C. , Reginster, J.-Y. , Daniel, J.-L.,2015. Return-to-play criteria after anterior cruciate ligament reconstruction: Actual medicine practice in professional soccer teams. Science and Sports Medicine, 30(1), pp.33-40.

Dessoki, H., El-Kalupy, H., Hefnawy, T. ,2012.Psychological Effect of Lower Limb Injuries among Football Players. European Psychiatry, 27, pp.1.

Dijkstra H, Pollock N, Chakraverty R,Ardern C., 2016. Return to play in elite sport: a shared decision-making process. British Journal of Sports Medicine, DOI: 10.1136/bjsports-2016-096209; PMID: 27474390 .

Di Mascio, M., Bradley, P. , 2011. The most intense running periods in English FA Premier League soccer matches. British Journal of Sports Medicine, 45(15), p. A13.

Eirale, C.,Tol, J., Farooq, A., Smiley, F., Chalabi, H., 2013.Low Injury Rate Strongly Correlate with Team Success in Quatari Football. British Journal of Sports Medicine, 47 (12), p.807.

Hägglund, M., Waldén, M., Magnusson, H., Kristenson, K., Bengtsson, H., Ekstrand,J., 2013. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study. British Journal of Sports Medicine, 47(12), pp.738-743.

Harmon,K., Drezner, J., Gammons, M., Guskiewicz, K., Halstead, M.,Herring, S., Kutcher, J., Pana, A., Putukian, M., Roberts, W., 2013. American Medical Society for Sports Medicine position statement: concussion in sport. British Journal of Sports Medicine, 47(1), pp.15-26.

Health and Safety Executive: Working Days Lost 2015. www. hse.gov.uk Kaeding C., 2015. Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction. American Journal of Sports Medicine 43(7), pp1583-1590.

Krajnc, Z., Vogrin, M., Rečnik, G., Crnjac, A., Drobnič, M., Antolič, V., 2010.

Increase Risk of Knee Injuries and Osteoarthritis in the Nondominant Leg of Former Professional Footballer Players.- Wiener Klinische Wochenschrift. 122, pp. 40-43.

Kristenson, K., Waldén, M., Ekstrand, J., Hägglund, M.,2013.

Lower Injury Rates in Newcomers to Professional Soccer.

American Journal of Sports Medicine, 41(6 )pp1419-25.

Kucera K.,Marshall S.,Kirkendall D., Marchak P., Garrett W.,2005.

Injury history as a risk factor for incident injury in youth soccer.

British journal of sports medicine. 39:pp 462.

Le Gall, F. , Carling, C. Reilly, T. ,2007.Biological maturity and injury in elite youth football. Scandinavian Journal of Medicine and Science in Sports, 17(5), pp. 564-577.

Maffulli, N., Longo, U., Gougoulias, N., Caine.D, Denaro, V., 2011.

Sport injuries: a review of outcomes. British Medical Bulletin, 97 (1), pp.47-80.

McCormack, R., Hutchinson, M., 2016. Time to be honest regarding outcomes of ACL reconstructions: should we be quoting 55–65% success rates for high-level athletes?

British Journal of Sports Medicine, 50, pp 1167-1168.

Merron, R., Selfe, J., Swire, R., Rolf, C., 2006.

Injuries among professional soccer players of different age groups: A prospective four-year study in an English Premier League Football Club. International Sport Med Journal, 7 (4), pp.266-277.

Moore O. , Cloke D., Avery P., Beasley I.,Deehan D.,2011. English Premiership Academy Knee Injuries: Lessons from a Five year Study Journal of Sports Sciences , 29. (14) Nielsen A., 1989. Epidemiology and traumatology of injuries in Soccer.American Journal of Sports Medicine, 17(60) pp. 803-807.

Noya, S., Gomez-Carmona, P.,Gracio-Marco, L., Moliner-Urdiles, D., Sillero-Qiuintana,M., 2014. Epidemiology of Injuries in Spanish First Division Football, Journal of Sports Sciences, 32(13) pp1263-1270.

Olsen, M., Scanlan, A., Mackay, M., Babul, S., Reid, D., Clark, M., Raina, P., 2004. Strategies for Prevention of soccer related injuries: a systematic review: British Journal of Sports Medicine, 38(1), p.8.

Paterno, M., Rauh, M., Schmitt, L., Ford, K., Hewett, T., 2014.

Incidence of Second ACL Injuries Two Years after Primary ACL Reconstruction and Return to Sport. The American Journal of Sports Medicine, 42(7), pp.1567-73.

Podlog, L., Eklund, R., 2010. Returning to competition after a serious injury: The role of self-determination. Journal of Sports Sciences, 28(8), pp.819-832.

Price, R., Hawkins, R., Hulse, M., Hodson, A., 2004. The Football Association medical research programme: an audit of injuries in academy youth football. British Journal of Sports Medicine.

38(4), pp.466.

RIDDOR Reporting of injuries, Diseases and Dangerous Occurrences, 2013. www.hse.gov.uk/riddor.

Ekstrand, J., Hägglund, M., Waldén, M.,2011. Injury Incidence and Injury patterns in professional football - the UEFA Injury study: British journal of Sports Medicine, 45(7), pp. 553-558.

Schneider, F., Linhart, W., 2013. Posttraumatic Complications after Paediatric Ankle Injuries. Der Orthopäde, 42(8), pp. 665678.

Ekstrand, J., Hägglund, M, Kristenson, K., Magnusson, H., Waldén, M.,2013. Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year followup of the UEFA Champions League Injury study. British Journal of Sports Medicine, 47(12), pp.732-737.

Schwebel, D., Banaszek, M. , Mcdaniel, M., 2007. Behavioural Risk Factors for Youth Soccer (Football) Injury. Journal of Pediatric Psychology, 32(4), pp.411-416.

Emery C.,Meeuwise W.,Hartmann S.,2005. Evaluation of Risk Factors for Injury in Adolescent Soccer: American Journal of Sports Medicine, 33(12) pp.1882-1891.

Engebretsen, A. H. ; Myklebust, G. ; Holme, I. ; Engebretsen, L. ; Bahr, R., 2010. Intrinsic risk Factors for Acute Ankle Injuries among male soccer players: a prospective cohort study. Scandinavian Journal of Medicine & Science in Sports, 20 (3), pp.403-407.

References:

Fousekis,K., Tsepis, E., Vagenas, G.,2010. Lower limb strength in professional soccer players: profile, asymmetry, and training age.

Journal of Sports Science and Medicine, 9(3), pp.364-73.

Al Haddad, H., Simpson, B.,Buchheldt, M.,DiSalvo V., and Mendez-Villaneuva J,2015. Peak Match Speed and Maximal Sprinting Speed in Young Soccer Players: Effect of Age and Position. International Journal of Sports Physiology and Performance.10 (7), pp.888-896.

Frisch, A.,Urhausen, A., Seil, R., Croisier, J., Windal, T. , Theisen, D., 2011.

Association between preseason functional tests and injuries in Youth Football: A prospective follow-up. Scandinavian Journal of Medicine & Science in Sports, 21(6), pp468.

Andrzejewski, M., Chmura, J. , Pluta, B. , Konarski, J.2015 Sprinting Activities and Distance Covered by Top Level Europa League Soccer Players.

International Journal of Sports Science and Coaching, 10(1).

Hagglund, M., Waldén, M., Ekstrand, J., 2013. Risk Factors for Lower Extremity Muscle Injury In professional Soccer: The American Journal of Sports Medicine, 41(2), pp.327.

Shultz, R.,Bido, J., Shrier, I., ; Meeuwisse, W., Garza, D., Matheson, G.,2013. Team clinician variability in return- to –play decisions. Clinical Journal of Sports Medicine, 23(6), pp.456-61.

Silvers-Granelli, H., Mandelbaum, B., Adeniji, O., Insler, S., Bizzini, M., Pohlig, R., Junge, A., Snyder-Mackler, L., Dvorak, J., 2015. Efficacy of the FIFA 11+ Injury Prevention Program in the Collegiate Male Soccer Player. The American Journal of Sports Medicine, 43(11), pp.2628-2637.

Soligard, T., Bahr, R., Andersen, T. E., 2012. Injury risk on artificial turf and grass in youth tournament football.

Scandinavian Journal of Medicine & Science in Sports, 22(3), pp.356-361.

Wallace J., Norton K., 2014., Evolution of World Cup soccer final games 1966–2010: Game structure, speed and play patterns.

Journal of Science and Medicine in Sport. 17, Issue 2, pp.

223–228.

Williams S., 2009. Football Academies: Kicking and Screaming.

The Daily Telegraph 4th March.

Zein, M., Kurniarobbi, J., Agung, N., 2014. The effect of FIFA 11+ as an injury prevention program in youth futsal players.

British Journal of Sports Medicine, 48(7), p.673.

33

feature

Pictured: Tottenham Hotspur’s Dele Alli scores his side’s third goal of the game during the Premier League match against Everton in March.

SOCCER MATCH-PLAY REPRESENTS AN IMPORTANT COMPONENT OF THE POWER TRAINING STIMULUS IN PREMIER LEAGUE PLAYERS FEATURE/RYLAND MORGANS, ROCCO DI MICHELE AND BARRY DRUST Abstract Purpose: Competitive match-play is a dominant component of the physical load completed by soccer players within a training micro-cycle.

Characterising the temporal disruption in homeostasis that follows exercise may provide some insight into the potential for matchplay to elicit an adaptive response. Methods: Countermovement jump (CMJ) performance was characterised 3 days post-match for 15 outfield players from an English Premier League soccer team (age: 25.8 ± 4.1 yrs; stature: 1.78 ± 0.08 m; mass: 71.7 ± 9.1 kg) across a season.

These players were classified as either starters (n=9), or non-starters (n=6), according to the average individual playing time (higher/lower than 60 min/match). Linear mixed models were used to investigate the influence of

34

indicators of match-activity (total distance covered (TD), and high-intensity running distance (HI)) on CMJ height and peak power (PP) values. Results: Starting players covered largely greater TD (ES=1.5) and HI (ES=1.4) than non-starters. Furthermore, there was a possible positive effect of HI on CMJ height and PP. This relationship suggests that an additional 0.6 km high-intensity distance covered would increase CMJ height and PP by slightly more than the smallest worthwhile change values of 0.6 cm and 1.0 W/kg, respectively. This small yet practically relevant increase in performance may suggest that match-play, more specifically the intense activities that are associated with the match, provides a physiological stimulus for neuromuscular adaptation. Conclusions: This data may have implications for the

management of preparation of soccer squads, especially the training requirements of starting and non-starting players.

Introduction Evidence of the systematic manipulation of training load in the build up to a competitive fixture illustrate the importance of the match to the overall planning and preparation strategies used within soccer.1 The dominant role of the match in the weekly cycle of activity is also typified by it being associated with the highest physical load (both in terms of volume and intensity).2 Longitudinal studies carried out on professional teams suggest that longer individual match playing time completed across the season favours the improvement and/or maintenance of the physical capacities relevant

football medic & scientist to soccer performance.3 While playing time is an important contributor to the stimulus that may be presented by matches, other factors such as the match status4 and the team’s playing formation5 will also impact the physical performance within matches. As a consequence the extent that match-play may lead to changes in fitness may not be identical for all players in all situations. Characterising the temporal disruption in homeostasis that follows an exercise bout can provide some insight into the potential for that stimulus to elicit an adaptive response. Improvements in jump performance may be indicative of the super-compensation that follows an exercise stimulus.6 The quantification of jump performance at relevant time periods following matches may therefore provide a way to evidence the potential for match-play to act as a training stimulus for muscle power in soccer players.

Methods Fifteen male professional outfield soccer players from an English Premier League (EPL) team were included in the study (age: 25.8 ± 4.1 yrs; stature: 1.78 ± 0.08 m; mass: 71.7 ± 9.1 kg).

Written informed consent was obtained from all participants. The study was approved by the University Human Research Ethics Committee and the EPL club from which the participants volunteered. Data was collected and analysed for 12 domestic home matches for the team across an EPL season using a multi-camera computerised tracking system (Amisco Pro®, Sport-Universal Process, Nice, France). Physical parameters included the total distance covered

(TD) (km) and the total distance covered at highintensity (> 19.8 km/h) (HI) (km). Missing TD and HI data was attributed to players for non-played matches. According to the individual total playing time in the 12 matches (higher/lower than 720 min or, on average, 60 min/match) the players were classified as starters (n=9), or non-starters (n=6).

Countermovement jump without arm swing (CMJ) data were collected for all participants between 0900 and 1000, 3 days post-match.

All participants were familiar with the jumping protocols, after completing jumps regularly as part of warm-up routines and participating in several practice testing sessions. All jump tests were conducted at an indoor facility to avoid any external variations in surface affecting results. In an attempt to standardise jump tests, participants were instructed to perform all attempts in accordance with the protocols outlined by Cormack et al.7 Before each jump test, participants performed a two minute warm-up consisting of a variety of running patterns (e.g. jogging, high knees, and skipping). Participants then performed three practice jumps before the measurement trial.

Participants were informed to self-select the jumping depth and to jump as high as possible.

An Accupower force plate (AMTI; Watertown, MA; USA) was used for data collection. The CMJ height and peak power (PP) were taken as the outcomes of the CMJ test.

Linear mixed models were used for data analysis, with random intercepts for individual players. First, for all examined variables, the mean values (as measured across all examined

matches) were compared for starters vs. nonstarters. The standardised estimated difference between groups was used as the effect size (ES). The ES magnitude was evaluated as trivial (>0.2), small (>0.2 to 0.6), moderate (>0.6 to 1.2), large (>1.2 to 2.0), and very large (>2.0).8 Subsequently, the effects of match TD and HI (fixed factors) on post-match CMJ height and PP (dependent variables) were evaluated in the whole sample of players (n=15). Since the average CMJ height and PP showed a curvilinear trend over time across the 12 matches, a thirddegree polynomial effect of time (days) was also included among fixed effects. The effects of match physical performance variables on CMJ outcomes were assessed as the effects of two within-player standard deviations changes in the fixed factor.8 Magnitude-based inferences were made on the true effects and evaluated with respect to the smallest worthwhile change (SWC) of dependent variables. 0.6 cm and 1.0 W/kg were used as SWC values for CMJ height and PP, respectively.7 The following scale of qualitative probabilistic terms was used to make inference on the effects: 25-75%, possible; 7595%, likely, 95-99%, very likely; > 99%, almost certain.8 The analyses were performed using the software R, version 3.0.3.

Results Starting players covered greater TD and HI than non-starters, with differences (90% CI) of, respectively, 3.192 (1.613 to 4.770) and 0.317 (0.119 to 0.515) km. The differences showed large effect sizes (1.5 and 1.4, respectively).

Conversely, CMJ height and CMJ PP showed trivial differences (0.4 (-2.3 to 3.2) cm, ES = 0.16; 0.6 (-3.2 to 4.5) W/kg, ES = 0.13) between the two groups.

The within-player standard deviations, calculated from the residual variance of linear mixed models with random intercepts on individual players, were 2.442 and 0.291 km for TD and HI, respectively.

Linear mixed models revealed a possible trivial effect of TD on both CMJ height and PP measured 3-days post match. Conversely, there was a possible positive effect of HI on CMJ height and PP (Figure 1). This relationship suggests that an around 0.6 km additional distance covered would increase CMJ height and PP by slightly more than the SWCs of 0.6 cm and 1.0 W/kg. A previous study9 showed that the average HI for different playing position ranged from 0.459 km (central defenders) to 0.856 km (wide midfielders). These HI values would respectively imply CMJ height and PP increases from 0.5 to 1.0 cm, and from 0.9 to 1.6 W/kg, as compared to a condition of not playing the match (HI = 0 km). Therefore, matchplay may be regarded as having a practically meaningful impact on CMJ performance.

Discussion The aim of this investigation was to evaluate the potential for match-play to act as a physiological stimulus for adaptation in professional soccer players. The analysis of our data demonstrated a short-term improvement in CMJ height and PP 3 days post-match.

The improvements were proportional to the amount of HI completed in the match. Such relationships were slightly less evident between

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References 1. Malone JJ, Di Michele R, Morgans R, Burgess D, Morton JP, Drust B. Seasonal training-load quantification in elite English premier league soccer players. Int J Sports Physiol Perform.

2015;10:489-497.

2. Anderson L, Orme P, Di Michele R, Close GL, Morgans R, Drust B, Morton JP. Quantification of training load in one, two and three-game week schedules in professional soccer players from the English Premier League: Implications for carbohydrate periodization. J Sports Sci. 2016;34:1250-1259.

Pictured: Chelsea’s Pedro and Liverpool’s Jordan Henderson battle for the ball at the Anfield in January.

the TD covered and CMJ performance. This data suggests that the intensity of activity that is associated with an EPL match may act as an important stimulus for the neuromuscular system. It is not surprising that we have observed this relationship as the importance of exercise intensity for the adaptative process is well documented.10 Moreover, these observations are not dissimilar to the data of Meister et al.11 that illustrated trends for CMJ to increase in periods when fixtures were congested.

The small yet practically relevant increase in jump performance observed as a consequence of greater HI may represent evidence to support the notion that match-play, more specifically the intense activities that are associated with elite soccer competition, may provide a physiological stimulus for muscle power. As such it would seem that the match-play itself may represent an important component of the neuromuscular load completed by players during the week. This data may have implications for the management of appropriate training methods of elite soccer players. This could include a better understanding of the different training requirements for starting and nonstarting players. The training needs for starting players can be adapted according to the HI distance they actually covered in the previous match as compared to trying to influence the training completed through the use of a team’s or player’s typical values. Indeed, the physical load during match-play can’t be pre-arranged as that associated with training sessions, as this physical demand is a consequence of factors such as the teams and opponent tactics, match status, actual individual playing time (e.g. 75 vs.

95 minutes), playing position (e.g. in a match a player could play in a position different than his usual position), and other factors. Specifically, it would seem advisable to ensure some additional training to starting players who for any reason (e.g. low match intensity) have not reached the amount of HI deemed to provide an appropriate neuromuscular stimulus during match play. In this case, it seems logical to set the additional training proportionally to the difference between the actual and target match

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HI. Also, according to the present findings, a practical recommendation for coaches is to ensure additional high-intensity training to nonstarting players. This training strategy was used in the management of the present team. This may explain why the overall CMJ performance was not lower in non-starters, despite them completing less amounts of total and highintensity distance during matches.

Some limitations of the present study are to be acknowledged. First, the assessment was focused on muscle power as a physical performance capacity, although match-play may also act as a stimulus for endurance or other soccer-specific physical capacities.

Furthermore, the potential effects of power training performed by the team during the study period on CMJ performance was not examined. Finally, the study was carried out over approximately a 3-month long period in the middle of the season. Further studies need to address these points by examining, over an entire season, the interactive effects of training and match physical load stimuli on a wider set of physical performance variables. Furthermore, the impact of specifically designed additional training programs for non-starters deserves particular attention.

Match-play is typically associated with the highest amount of HI running experienced by players within a training micro-cycle.12 It is therefore un-surprising that this activity may then act as a stimulus for adaptation for individual players. Periodising the physical load so the competition represents the highest physiological requirement during a micro-cycle is logical in one sense (i.e. players may not be over-reached going into matches and are protected from the risk of injury). It could also be suggested that the failure to adequately recreate the intensity associated with match play in training may also have the potential to be maladaptive, making difficult the improvement or maintenance of muscle power across the season. The limited data that is available to scientifically support these approaches would indicate a need for more comprehensive training studies at an elite professional level.

3. Silva JR, Magalhães JF, Ascensão AA, Oliveira EM, Seabra AF, Rebelo AN. Individual match playing time during the season affects fitnessrelated parameters of male professional soccer players. J Strength Cond Res. 2011;25:27292739.

4. Lago-Peñas C, Rey E, Lago-Ballesteros J, Casáis L, Domínguez E. The influence of a congested calendar on physical performance in elite soccer. J Strength Cond Res. 2011;25:21112117.

5. Bradley PS, Carling C, Archer D, Roberts J, Dodds A, Di Mascio M, Paul D, Diaz AG, Peart D, Krustrup P. The effect of playing formation on high-intensity running and technical profiles in English FA Premier League soccer matches. J Sports Sci. 2011;29:821-830.

6. Coutts AJ, Slattery KM, Wallace, LK. Practical tests for monitoring performance, fatigue and recovery in triathletes. J Sci Med Sport.

2007;10:372-381.

7. Cormack SJ, Newton RU, McGuigan MR, Doyle TL. Reliability of measures obtained during single and repeated countermovement jumps.

Int J Sports Physiol Perform. 2008;3:131-144.

8. Hopkins WG, Marshall SW, Batterham AM, Hanin J. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc. 2009;41:3-12.

9. Gregson W, Drust B, Atkinson G, Salvo VD. Match-to-match variability of high-speed activities in premier league soccer. Int J Sports Med. 2010;31:237-242.

10. Dudley GA, Abraham WM, Terjung RL. Influence of exercise intensity and duration on the biochemical adaptions in skeletal muscle. J Appl Physiol. 1982;53:844-850.

11. Meister S, Faude O, Ammann T, Schnittker R, Meyer T. Indicators for high physical strain and overload in elite football players. Scand J Med Sci Sports. 2013;23:156-163.

12. Anderson L, Orme P, Di Michele R, Close GL, Milsom J, Morgans R, Drust B, Morton, JP. Quantification of seasonal long physical load in soccer players with different starting status from the English Premier League: implications for maintaining squad physical fitness. Int J Sports Physiol Perform. 2016;11:1038-1046.

feature

Pictured: Jose Baxter with Doctor Ian Irving in 2010.

TALES FROM A HEALTHY CAREER FEATURE/ROB URBANI Following the announcement of his decision to retirement at the end of the season Rob Urbani caught up with Everton Club Doctor, Ian Irving, to discuss his future plans and memories from a remarkable 39 years’ service

A

n embarrassing experience en route to Wembley in 1984 left Everton Club Doctor Ian Irving reluctant to step into the media limelight again.

“I was speaking to Bob Wilson once on the team coach on the way to the FA Cup final. It was live on television and all the players were stood behind dropping their trousers to try to make me laugh. Since then I’ve steered clear of interviews.”

Decades later and Dr Irving has finally agreed to break his silence. And with very good reason, too. After 39 years with Everton, the likeable, long-standing, well-respected pillar of the Club’s backroom team will be waving farewell at the end of the season and stepping into his hard-earned retirement.

His memories and anecdotes stretch, amazingly, across nine different Everton managers – and beyond. “My father, who came from Russia, was the team doctor for 25 years before me,” he recalls. “I remember as a kid, Alex Young would come round to our house for fitness tests in the back garden. Mick Meagan, too. I used to peer out of the window because I couldn’t believe they were at our house.

“I remember in 1966 watching my father walk out at Wembley with the team and I

38

never thought I’d do that. I ended up walking out at Wembley seven or eight times. I couldn’t believe that I became part of Everton.

I qualified as a doctor at about the age of 30 or 31, which was late. I did a year at Broadgreen Hospital and went straight into general practice. Between qualifying as a doctor and joining Everton, I think it must have only been two or three years.

“I don’t know exactly what happened behind the scenes but I got a letter from Club Secretary

“

Jim Greenwood asking me to join the Club. My father had some ill health at the time and had made it clear that he didn’t want to continue.

“I was the youngest doctor in the League because they were all old fellas who used to sit and smoke cigars with a bottle of whisky in the stands. It was slightly different in those days!

“Gordon Lee was the Everton manager, so it was a long time ago. I’m very proud to do nearly 40 years here – it’s the people I’ve met that’s

I’ve worked with The Doc for over 15 years and he has been a great influence on me. There isn’t much he hasn’t seen in his career so his advice on potential pitfalls has been invaluable.

He’ll be very fondly remembered too. We’ve had some good times over the years, have travelled together on many tours and there have been plenty of funny stories.

Between Ian and his father, they’ve contributed greatly to the success of Everton Football Club.

Matt Connery - Head of Medical Services

football medic & scientist

Pictured: Ian checks the head of Tim Cahill after he picks up an injury against Wolverhampton Wanderers in 2011.

“

He’s a great guy and a great Evertonian. He has been here longer than all of us and, obviously, 39 years of service to the Club is a magnificent achievement.

“I remember him from when I was a schoolboy here and I class him as a trusted friend now. We’re all a bit sad his time with us is coming to an end, but he can go and enjoy his boat now!

“He was an excellent member of the medical staff when I was a player, too. He was always approachable and you could trust him with anything – he’s everything you would want in a doctor.

“He’s an avid sportsman – he sails, he plays golf, squash and football – he thinks he is the best at all of those things but he is actually the worst! But you can’t fault the man for effort, there is not a bad bone in his body – he is just a terrific guy.

“I’ll never forget the time I bundled him over in a staff game when we were back at Bellefield. He always used to look forward to these games they had every Friday afternoon. They were a body short this one afternoon so they called me, as a YTS, to join in. Early on, the Doc ran into me and I ended up bouncing him into a wall.

He’s never let me forget about it! We carried it on when we moved to Finch Farm, playing on a Thursday and I remember he was always last pick, every single week!

“He’s as enthusiastic now as he was the first day I met him. He is the ultimate professional, great at his job and we will all miss him. With that said, I’m sure like all Evertonians, he won’t stay away from the place.

David Unsworth

been the greatest privilege.

“Mick Lyons and Bob Latchford were in the squad when I joined. I remember going on the first away tour to Israel… they were even playing tricks on me then!”

Ask around USM Finch Farm, from players to kit men to medical staff, and there are stories aplenty of Dr Irving, understandably so for a man who has been part of the Club’s fabric since 1978.

“I’ve made some marvellous friends along the way,” says the 69-year-old. “I’ve got on well with everybody. I honestly can’t think of anyone who I have had problems with.

“The people who have influenced me the most, my teachers if you like, were Howard Kendall, Colin Harvey, Joe Royle and the old physio, Les Helm.

“Colin and Howard, they were my heroes. I could never have imagined that I would work with them – it was like a dream come true.

“That period with Howard, we won so much with that team. I remember everything about that era but the game that I recall the most in terms of the expectation was the FA Cup semi-final in 1984. We beat Southampton at Highbury 1-0.

“Arriving at the ground, seeing the crowds and the passion of the fans, then there was the joy of getting through to Wembley. You could really sense at that time that the team was on the brink of achieving the success which it went on to do in the coming years. They are special memories of working at the Club I supported – and still do.”

Science, medicine and research have progressed extensively since Dr Irving became an Everton employee, but how has the remit of a club doctor at the top level of

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Pictured: Dr Ian Irving before an FA Cup tie against West Ham United in 2015.

English football evolved since 1978?

“I think it’s changed massively, from having a role in the background and not really being involved, apart from treating a few illnesses, to being very involved in the modern concept of sports medicine,” he explains.

“The biggest change, I believe, has been the refinement of orthopaedic surgery from what was vulgar hammer and chisel work, to now precise, fine technical work.

That’s evolved massively and has had a big impact on the restoration of players’ careers.

Orthopaedics has become a very sophisticated discipline.

“Curiously enough, though, I don’t think healing times have changed, despite all the modern techniques. In my view, muscle takes just as long to heal as it ever did and the risks of it re-tearing are just the same.

“The introduction of more discipline in terms of sports science is another area of improvement but a lot of the coaches were doing the right things in any event during the old days.

“The department here at Everton has kept itself on one track throughout that time.Matt (Connery) and Richie (Porter) have been here a long time, and before that we had Danny (Donachie) and prior to that Mike Rathbone.

Mike was the most amazing character, possibly the most amazing character that I’ve ever met in football. Just his personality, he was fantastic and really great fun to work with.”

Dr Irving is a hugely interesting character and his plans for retirement are unusual as much as they are fascinating.

He looks forward to spending time with his family and playing golf on the courses around Cheshire – but he also has intentions to sail the seas around Europe.

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“

First of all, what a guy. A top guy. He’s a really nice fella and it’s been good to work with him all these years. It’s sad to see him leave the Club and I wish him all the best for the future.

“One thing I would say about the Doc, he loved to be seen on the TV. “Later in his career, there were two or three doctors working at the Club, but he always made sure his name was on the list to work the games on the telly. He never missed a match when it was a Super Sunday or Monday Night Football!

“I was watching TV the other week and there were short highlights of a classic Everton match, back in the 1980s sometime. It cut away to Howard Kendall and there was the Doc sat next to him. He looked no different, just a bit more hair around the side of his head.

“My good memories of the Doc are playing golf with him. Most of the time I wanted him to go out in the fourball before me because I liked to try and hit him with my tee shot!

“There was a time in Portugal when the Doc, Steve Simonsen and Dave Billows were playing together in front of us. There was me, Hibbo and Tim Cahill in our group… I’ve never hit such perfect shots in my life as I did that day! Putting the Doc in the middle of the fairway I was accurate every time.

“We’ve spent a lot of time together and I wish him all the best in his retirement.”

Leon Osman

football medic & scientist

Pictured: Everton Kit Manager Jimmy Martin, Tony Sage and Club Doctor Ian Irving.

“I used to do a lot of underwater photography in the Red Sea and one day years ago whilst I was there I went for a trip on a three-mast sailing boat. I’d never been on a sailing boat before and when I stepped onboard I just said, ‘wow’. They turned the engines off and I fell in love with the experience.

“After that I messed about with small boats.

I’ve got a little solo boat in north Wales and another in France, and I’ve just bought a proper sailing boat with a friend in Sardinia, it’s 45 foot.

“That’s serious sailing – I sailed it to Malta and back last summer. You can travel on it across seas and oceans. You need help as it’s too big to sail on your own, so I’ve invited a few of the people here to come out and visit.

“On the golf course, Jags and Gareth will still be taking money off me. I took up the sport about 10 years ago and my handicap is 23. I’m a member of Prestbury, which is near Alderley where I live. I took the manager (Ronald Koeman) on there not too long ago. He’s a very good golfer so I set him playing with some better golfers – I didn’t want to embarrass myself.

“Of course, I will also find time to come to Goodison. I’ve watched a few games this season from the stands and I’ve noticed how slow the game seems from up there compared to the dugout.

“Not working here will be a loss, personally, but you have got to move on at some time and make way for younger people. Every dog has his day!”

This feature first appeared in Everton Magazine issue 45, and is shared here with the permission of Everton Football Club

“

The lads have been speaking about the Doc and how much we’ll miss him. I’ll miss him, not just as the Doctor but as a mate, too. He’s someone I call a friend.

“I’ve had so many conversations with him when we are travelling or are away at hotels. He’s someone who I would tend to gravitate towards because of his experiences and stories. We have had so many conversations about so many different things.

“Some of the lads spend time away with him socially.

We play golf with him – he’ll bore you to death with his golf stories. He’s not improved much in about 40 years.

But he loves it and now, hopefully, he’ll spend a bit more time on the course and will start to improve.

“He’ll be a big miss around the place.

Leighton Baines

“

I’ve known him for almost 35 years since I became the coach driver. What a great man, who I’m sorry to see go.

He never bought me a drink in all that time, though!

“He’s one of those people who is funny without realising it. He’s really, really bright but has got no common sense.

That’s what I like about him.

“I’ve been around the world with him. He helped to save my life when I had my heart attack. He was one of the first there and he came to the hospital to see me every day.

They are the kind of friends you want in football.

Jimmy Martin - Kitman

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football medic & scientist

feature

Pictured: Mansfield Town 2002/2003 team photo. Barry is on the bottom left.

WHERE ARE THEY NOW? FEATURE/BARRY STATHAM

W

hile I was in the Army I was at Harrogate working at the Army Apprentices College. Both Doncaster Rovers and Leeds United came as part of their Pre-Season training to use the facilities and while they were there I helped treat some of the injuries. Word must have got around somehow as on leaving the services I was offered jobs at Preston North End, Doncaster Rovers and Mansfield Town.

In the end, I accepted the job at Mansfield Town.

Currently I run a private practice in Mansfield which keeps me busy. To some extent I would say I miss the day to day banter and match days in particular. The best part of the job was always in getting a player back on the pitch from a potential career threatening injury. The worst was the limited budget you were expected to work with in the lower leagues. In all I started and finished my time in football during an 8-year spell at Mansfield Town and there were some great moments to reflect on.

Getting promotion to League One was the best moment and getting relegated back to League Two after just one season the worst.

My saddest time was when Graham North died of a heart attack when refereeing the game between Southend against Mansfield.

Each of the managers I worked under at

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Mansfield Town were great guys in different ways. My biggest disappointment was seeing each one of them lose their jobs especially as they each worked so hard for success.

I do keep in touch with players, physio’s and some of the previous managers I worked with on a professional and social basis. I would find it difficult to divorce myself from the game that gave me so much enjoyment.

I couldn’t imagine ever working in the game again but if I did it would have to be on a consultancy basis which would need to be part time as the full-time work is far too many hours and you’re always on call. I think I would notice some changes from a medical perspective however as I think the health and safety regime and the qualifications to work in professional football have definitely improved over the years.

I have always been involved in football in one way or another. From being an apprentice at Tranmere Rovers in the late 60s to playing for the British Army between 74 to 86. During this period, I did all my football coaching qualifications up to what was called your Full Badge and I believe is now called the Advanced Coaching License.

I did some work for the FA running coaching courses up to Full Badge level as well.

I have some very happy memories working

in a sport that I love and one particularly funny incident that stands out is when we were playing away at Chester. You have to picture the scene, the dugouts at Chester have a step down so your head is about level with the pitch, also these seats spring up if you are not sat on them. Anyone of average height must be careful when standing due to the roof height above the seats. We are now into the final 15 minutes of the game, have made 3 substitutions due to injury, the score somehow is 1-1 and we are under real pressure. The Manager at the time is Andy King, now if you want to meet somebody who is demonstrative and passionate about the game you need to meet Andy. At this time, our left sided midfield player Kevin Noteman goes down with cramp right near the dugout, I jump out of the dugout to treat the player and pull my calf, fortunately I have a short distance to limp and I am still in earshot of the Manager as he shouts everybody is injured even the physio. I turn around to face him as he jumps up bangs his head on the roof of the dugout and misses the seat on the way down which has now flipped up. Talk about “you’ve been framed”.

My relationship with all the managers I worked with was very professional and I was left to get on with my job and expected to keep the Manager up to date on a daily basis regarding any changes on an injured player’s fitness. It also helped that I had good football knowledge and this coupled with me being an ex Army Physical Corps Instructor often involved me in writing the pre-season training programme.

Through my background, I was included in most aspects of the club so I would like to think that I offered more than treating injuries.

My main role at the club was to get players fit by using the best tools available at the time. If I was not to busy with the injured players I would help out in any way I could, we all used to pull together.

In the time, I was in the game all the physiotherapists and staff I met were always helpful to each other. You could ring each other, swap ideas or ask advice on an injury you may be dealing with. I found this to be very helpful and a good way of improving your knowledge and I still do it now to some extent.

All in all, it was an experience I thoroughly enjoyed. It has its ups and downs as any job does but the highs far exceed the lows. Its very sad that there is such a divide between the premiership and football league in the finances. I sometimes think that it must be easier to do your job in the premier league rather than the lower leagues due to the financial restraints. On the other side of the coin though do you have that closeness, kinship and sense of pulling together at lower leagues.

I would never deter anyone from wanting to work in football but would suggest they be prepared to put the hours in for relatively limited pay. The plus side is that you will gain lots of knowledge and learn to work under pressure with limited resources and of course get to be a part of the beautiful game.