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

Issue 29 Summer 2019


Position Specific & Positional Play Training in Elite Football: Context Matters In this issue FMPA Conference Award Winners 2019 Maximising player availability whilst respecting the fundamental ethics of healthcare in sport Pre-Season – When Foundations Are Laid

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CEO MESSAGE The success of the recent Conference cannot be overestimated in terms of organisation, programme content and the outstanding Awards evening. Much has already been said to confirm this and certainly the event is a reflection on the success and status of the FMPA as an organisation. The theme of this years’ programme focussed on a wide range of topics and delivered yet again something for everyone. Sports Scientists, Therapists, Medics and colleagues from allied professions all found content that was relevant to their discipline and as practitioners. I am sure delegates were able to take much away with them that they would find useful within their roles in the game. But the concept that really united everyone was that regardless of profession we must all work together for the betterment of our industry. It would be easy to assemble here all the quotes that extol the virtues of working together but I am sure we are all too aware of them and their message. While it is no easy task of course to ensure the FMPA as an organisation delivers across the disciplines, we make sure that in our endeavours to do so, all members are treated in an equal manner. This is important in maintaining the cohesive nature of our organisation – one that continues to bring the medicine and performance teams together as a single entity. Working together, moving forwards and facing challenges together. It is worth reminding everyone that as a not for profit organisation the FMPA is not owned by any one individual or the board of directors or the advisory committee. It belongs to you the member and as we now face challenges head on we need to do so together for the common interest of everyone in the game. Finally can I take this opportunity to welcome Dr Sean Carmody to the role of Editor for our magazine. Dr Carmody has experience in this arena having initiated and produced the highly successful USEMS online journal. I am sure he will bring a fresh and dare I say more youthful vision to the publication as we look to develop the magazine beyond its current format.

Chief Executive Officer Football Medicine & Performance Association





9  The “Football Creditors Rule” What Does it Mean for You? Marin Price FMPA Lawyer


25 A Balancing Act: Maximising Player Availability Whilst Respecting the Fundamental Ethics of Healthcare in Sport Dr Rob Tatham

10  Can Modern Football Match Demands be Translated Into Novel Training and Testing Modes? Paul S Bradley, Michele Di Mascio, Magni Mohr, Dan Fransson, Carl Wells, Alexandre Moreira, Julen Castellano, Antonio Gomez Diaz & Jack D Ade 15 The Importance of a Uniform Club Philosophy for Enhancing Athlete Health and Performance Adam Brett & Will Abbott - Brighton & Hove Albion FC

20 FMPA Conference Award Winners 2019


29  How to Thrive With a Little Help From Your Friends 31  Position Specific & Positional Play Training in Elite Football: Context Matters Paul S Bradley, Andres Martin-Garcia, Jack D Ade, Antonio Gomez Diaz 36  Pre-season – When Foundations Are Laid UEFA 40 FMPA Register

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Contributors Paul S. Bradley, Michele Di Mascio, Magni Mohr, Dan Fransson, Carl Wells, Alexandre Moreira, Julen Castellano, Antonio Gomez, Jack D. Ade, Gary Souter, Professor Laura Serrant OBE, Dr Robin Lewis, UEFA Direct, Dr Rob Tatham, Andres MartinGarcia, Antonio Gomez Diaz

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COVER IMAGE Derby County v West Bromwich Albion - Sky Bet Championship Pride Park Stadium. Derby County’s Martyn Waghorn leaves the pitch after incurring an injury. Darren Staples / EMPICS Sport / PA Images Football Medicine & Performance Association. All rights reserved. The views and opinions of contributors expressed in Football Medicine & Performance are their own and not necessarily of the FMPA Members, FMPA employees or of the association. No part of this publication may be reproduced or transmitted in any form or by any means, or stored in a retrieval system without prior permission except as permitted under the Copyright Designs Patents Act 1988. Application for permission for use of copyright material shall be made to FMPA. For permissions contact








football medicine & performance

FMPA UPDATES BUSINESS CLUB PARTNERS Fit4Sport, The Foam Company, ESP Enercial and Swimex are all on board supporting the FMPA and our members for the coming season. We are delighted to be working with each and every one of our Business Club partners who recognise the value of engaging with our members via the FMPA and who are in return valued by our members for their support. Business suppliers 2019/20 season include Vivomed, Game Ready, Renew Health, Toropro, and Lightforce Lasers, while discussions are still taking place with several companies who wish to work with the FMPA this coming season.

ESSITY ON BOARD FOR NEW SEASON We are delighted to announce an extension to our partnership with Essity heading into the 2019/20 season. A spokesperson for Essity said: “Essity is pleased to extend the long-standing relationship with continued support for the FMPA for the coming season. Eager to start the 2019/20 season off successfully, Essity will strive to demonstrate that this partnership and your performance are central to our activities.” Eamonn Salmon, CEO of FMPA, added: “We are delighted to have the continued support of Essity as we head into the 2019/20 season and look forward to working closely with them in a range of areas that will serve to benefit our members.”

FMPA MAGAZINE APPOINTS NEW EDITOR FMPA is delighted to announce that Dr Sean Carmody is to become the new editor of FMPA Magazine. “I’m delighted to accept the position as Editor of Football Medicine and Performance,” said Sean. “Football, despite the long hours and relentless pressures, remains a wonderful environment to work in. While the game has changed, our remit as health and performance practitioners stays the same; to deliver exceptional care and support to the players. Andy Massey, Head of Medical Services at Liverpool FC, summed it up well recently when he spoke about a coach’s expectations of his performance team: ‘… to try to [help the players to] run further, faster and more often than every other team

because if we do that the obvious skill of the players will take over’. “I hope that the editions we create will reflect this; that the players are at the centre of everything we do. Our aim is to truly captivate the whole interdisciplinary team, not just medical and sport science staff, but coaches, performance analysts, psychologists and every other profession engaged in supporting player performance. We hope that in doing this, we will make a small contribution to improving the care and support for players throughout the UK and beyond. “Finally, thank you to Eamonn for the great work he has done on this publication over the past few years. It is without doubt an excellent resource for the football practitioner.”

SURGE IN MEMBERSHIP New members to the Association have been flooding in this close season as practitioners prepare themselves for the coming campaign. The number of contract appraisals has soared and there is clear recognition that having the support of specialist, experienced and knowledgeable solicitors is invaluable should members find themselves in difficulty. The FMPA cannot emphasise enough just how important such knowledge is and members can rest assured that when in need of negotiating a settlement they have the very best in their corner. “I sent my contract direct to the FMPA Lawyers and was sent a reply the same day. The points that were highlighted were really quite important and I managed to get them into my amended contract at the club. I am confident I have a solid contract behind me should I need to refer to it.” Championship Sports Scientist “Excellent service and advice from FMPA lawyers regarding my contract.” Division 1 Sports Therapist

This [contract evaluation] is a great service and really valuable. As a member it is exactly the kind of support we need. I couldn’t believe how poor my contract actually was.” Lead Physiotherapist Championship



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football medicine & performance

THE “FOOTBALL CREDITORS RULE” – WHAT DOES IT MEAN FOR YOU? FMPA LAWYER MARTIN PRICE EXPLAINS... Unfortunately, the recent financial issues at Bolton and at Bury have brought the issue of insolvency within football clubs into sharp focus once more. On the face of it a football club is no different to any other limited company and therefore an employee’s employment law rights should the club become insolvent are limited. These rights depend upon which legal form of insolvency the club enters into, the most common one being administration and less common but more terminal, liquidation. In an administration the employer becomes XYZ Football Club Limited (in administration). The administrators do not become your employer, they act as agents for the company in administration with a view to selling the club as a going concern or realising the value of assets for the benefit of the creditors. If no sale can be achieved it is almost inevitable that the club would enter liquidation, which spells the end of the road for the club. If the administrators continue to employ you for 14 days or more after their appointment they will “adopt” your contract of employment. This means that wages and salaries (including holiday pay) which accrue after the 14-day period will have to be paid ahead of the administrator’s fees and any payments to other unsecured creditors. For this reason, unless there is a strong possibility of a sale, administrators will be very reluctant to adopt the employment contracts of all but the most crucial employees. In a football context this might be a player still under contract who has a significant transfer value. In an administration arrears of salary are limited to maximum of £800 as “preferential debts” which are payable in full after anyone who has a secured debt and the costs of the administration. In practice, it is unusual for there to be enough money left over for the payment of preferential debts. Assuming that your contract is not “adopted” then debts owed by the club to you under your contract of employment will be unsecured debts and therefore it is very unlikely that you would get any more than a few pence in the pound should the club exit administration by way of a negotiated deal with the creditors. In addition, whether or not your contracts have been adopted, certain further payments can

be claimed from the government’s national insurance fund. These are:• Arrears of a maximum of 8 weeks’ pay (capped at a maximum of £525 per week) • Notice pay of one week (capped at a maximum of £525) for every complete year of service up to a maximum of 12 weeks • A maximum of 6 weeks accrued but untaken holiday pay, again subject to a maximum of £525 for each week. So, if your club goes into administration and your contract is not adopted then your entitlements are very limited if the administrator does not find a buyer and the club goes into liquidation. If your contract is adopted, then the position becomes slightly better but in reality not much better should a buyer not be found and liquidation follows. Looking at things more positively, what if the administrator finds a buyer? This happens in the majority of cases. If you are still employed by the club at the time it is sold, then your contract automatically transfers to the buyer and continues with that buyer e.g. XYZ (2019) Football Club Limited. The new company will also be liable for your arrears of salary over and above the amount that can be claimed from the national insurance fund. If you have been dismissed by the administrator prior to the purchase, then generally unfortunately you are limited to the amounts you can claim from the national insurance fund as set out above. So where does the football creditors rule come in and how does it help? In order to compete in the English Football League (“EFL”) or Premier League, all clubs must hold a share in the EFL or Premier League – the so-called “Golden Share”. The Golden Share can only be transferred from XYZ Football Club Limited in administration to XYZ (2019) Football Club Limited with the permission of the EFL or Premier League. The EFL or Premier League will only ratify the transfer of the Golden Share if football creditors are paid in full by the purchaser. As, in effect the club is worthless without the ability to play in the EFL or Premier League, the purchaser’s hands are tied – they must satisfy football creditors in full if they want to play in the EFL or Premier League. Football creditors are defined as the League, other clubs and full-time employees of the club. This includes

not only players and managers but all full-time backroom staff. If you are a football creditor, your arrears of pay must be paid in full before the Golden Share will be transferred. If you have left the club, your arrears must still be met in full i.e. you will not be subject to the £800 cap and you are in a much better position. If you are still employed by the club in administration at the point of transfer, not only do your arrears of pay have to be paid in full but also your contract will transfer to the new owner on the same terms thus preserving your future rights too. This is a technical and complicated area and so I have tried to summarise it in the diagram below. As always if you are worried contact Eamonn and his team and you will be signposted to the necessary advice.










Written by Paul S Bradley*, Michele Di Mascio, Magni Mohr, Dan Fransson, Carl Wells, Alexandre Moreira, Julen Castellano, Antonio Gomez Diaz & Jack D Ade *Corresponding author. Email Address: Association football is a complex sport with unpredictable activity patterns during matches1. Players regularly transition between short multi-directional high-intensity efforts and longer periods of low-intensity activity2. Time– motion analysis has been the data-collection technique of choice to quantify the physical match performance of elite footballers3. In the last four decades this technique has quantified the relative or absolute distance covered and time spent along a motion continuum of walking through to sprinting 4-6. This is accomplished with the aid of validated manual/computerized tracking or global/local positioning technology7. Technological advancements in wearables such as tri-axial accelerometers have enabled inertial indices to be progressively introduced alongside traditional time-motion techniques to provide more insight into metabolically taxing activities8. This has surely progressed the fields understanding of the physiological, metabolic and mechanical demands of elite football match play. Although more validation work should be conducted that compares inertial indices with physiological and metabolic measures. The first in-depth match analysis study was published more than 40 years ago by the pioneer Professor Tom Reilly4 and since then researchers have quantified the physical


match performances across a multitude of competitions. These include the English Premier League9 10, Italian Serie A2,11, Danish League5, Spanish La Liga12, French Ligue 113, German Bundesliga14, in addition to the European Champions League15,16 and International tournaments17,18. The match demands of different populations have also been examined such as male19, female20, youth21 and amputee players22. Moreover, this body of literature has been able to reveal the demands of various positions9,10, competitive standards2,23,24, formations25 and the associated match related fatigue patterns26, 27. Although the use of different speed thresholds, technologies and dwell times for selected movement categories in these studies has limited the ability to generalise and compare between studies28. Another fundamental issue very present within the majority of these studies is the lack of contextualisation of the physical data. For instance, authors simply reporting the distances covered and frequency of occurrence of selected physical metrics without any consideration for important performance determinants in football like tactical and technical factors9, 29. This ultimately leads to one-dimensional view into fluctuations in running performances and a lack of insight to the players and coaches30. Another issue experienced by practitioners reading such research is its lack of application into practices such as training and testing. Thus, this brief review will explore the literature published on the longitudinal trends in match running performance to inform the reader on the current demands of elite football matchplay. Moreover, illustrate how data on modern match performance can be applied into everyday

practices within the elite environment such as training and testing. EVOLUTIONARY TRENDS IN FOOTBALL MATCH PERFORMANCE Sports such as running, team handball and Australian Rules football have evolved significantly in recent years, potentially due to advances in physical and/or tactical preparation31-34. In football there is also a commonly held belief amongst the media, coaches and players that the game has evolved exponentially in the last decade. However, despite the popularity of the game, limited reports have been published on this area. The earliest paper published on this subject compared the intensity of English League matches played in the 1991–92 versus the 1997– 98 season35. The authors concluded that the tempo of the game had increased as evidenced by more dribbling, passing, crossing and running with the ball in the latter season. More recently, Wallace and Norton36 analysed match performance data from World Cup Final matches across a 44-year period. The data demonstrated that passing rates increased by 40% with concomitant elevation in ball speed. A main limitation of this research was it only provided insight into technical evolution with very limited consideration for the physical performance of players. Football is a multifaceted sport with the physical, tactical and technical factors amalgamating to influence performance with each factor not mutually exclusive of another30. Thus, research quantifying the evolution of football match-play should consider multiple factors. A series of studies exploring the evolution of the English Premier League have recently been published using a duel technical-physical approach 9,37,38. These studies examined the largest sample of elite players published to date

football medicine & performance (14700 player observations) across 7 seasons (2006-07 to 2012-13) whilst equalising the number of players analysed across each year, seasonal period, position and game location. The first study37 analysed the data in its entirety and demonstrated that total distance covered by players did not differ between the 2006-07 and 2012-13 seasons but high-intensity running and sprinting distances increased by 30-50% (Figure 1). Whilst sprints in the 2012-13 season were much more frequent than that found for the 2006-07 season, they were also shorter and more explosive. From a technical perspective, players performed more passes and successful passes in 2012–13 compared to 2006–07 season. This increase was mainly due to an increase in short and medium distance passes. The data clearly indicate that elite leagues like the English Premier League have evolved substantially. This first study only examined longitudinal trends in physical and technical match performances in their entirety, so a second study quantified the evolution of playing position to gain an insight into tactical changes38. Fullbacks demonstrated the most pronounced increase in high-intensity running and sprinting distances with attackers the least pronounced in the 2006-07 versus 2012-13 seasons. While wide players illustrated markedly more physical evolution than other positions, it was the central players like central defenders and midfielders that evolved more in terms of passing metrics. These trends could indicate tactical changes in the English Premier League with teams utilising traditional tactical systems in 2006-07 like 4-4-2, 4-3-3 and 4-5-1 and then moving towards more modern systems such as 4-2-3-1 and 4-14-1 formations38. These latter tactical systems are extremely compact in the central regions of the pitch (hence central players passing more) and allow wide players (full-backs) to utilise the flanks to add an offensive threat39. The third study examined if this physical and technical evolution was partly due to the English Premier League becoming more competitive9. Thus, the data was split into four groups based on the final placing (A=1st-4th, B=5th8th, C=9th-14th, D=15th-20th). Although all groups physical and technical performances increased, it was group B that illustrated the most pronounced elevations in high-intensity running distance and the number of passes from 2006-07 versus 2012-13. The demarcation line between 4th (bottom of group A) and 5th place (top of group B) in the 2006–07 season was 8 points, but this decreased to just a single point in the 2012–13 season. The data demonstrate that physical and technical performances have evolved more in group B than any other group in the EPL and could indicate a narrowing of the performance gap between the top two groups. A consistent finding from all studies in the literature is that the game is becoming more demanding. Thus, fitness coaches should aim to condition players to cope with multiple intense bouts with minimal recovery while maintain technical and tactical proficiency. A major limitation with the majority of match demands studies is the lack of application into practice40. Few studies have translated discrete actions into useable metrics such as angles of

Figure 1. Longitudinal changes in high-intensity running distance in the English Premier League (2006-07 versus 2012-13). WP = with possession, BOP = ball out of play, WOP = without possession. Data modified from Barnes et al.37.

turns, technical sequences and tactical actions associated with physical data that could be used within the club setting40,41. Thus, the next section will detail how match demands data can be applied to design testing and training modalities that have a high degree of specificity. APPLICATION OF MATCH ANALYSIS INTO TRAINING AND TESTING MODALITIES A recent study has revealed unique positionspecific trends with special reference to movement patterns, pitch location, technical skills, tactical actions and combination play40. All of the categorises above were coded using a novel ‘High Intensity Movement Programme’ Categories Movement Pattern Turn 0-90º Turn 90-180º Swerve Arc Run Technical Skill Long Pass Trick Cross third of the pitch Shot Header Tackle Tactical Outcome (In Possession) Break into the opposition penalty box Run with the ball touches Overlapping Run Push up the pitch Drive through the middle of the pitch Drive inside the pitch Run the channel of the pitch Run in behind the opposition defence Tactical Outcome (Out of Possession) Close down opposition player Interception of opposition pass Covering Track runner Ball passed over the top of player Ball passed down the side of pitch Recovery run

which synchronised physical match metrics such as high-intensity running with video recording of each intense action (Table 1). The study was designed to provide additional information for practitioners wishing to design general and position-specific drills. The study demonstrated that high-intensity running distances were greatest for wide midfielders and lowest for centre backs with full-backs, central midfielders and centre forwards falling somewhere in-between. However, as the data was contextualised it provided more insight into purposeful tactical efforts in and out of possession. For instance, in possession, centre forwards carried out more high-intensity efforts in the offensive third of the pitch, whilst driving through the middle, running in behind, and

Description Player turns ≤ ¼ circle Player turns ≥ ¼ circle but ≤ ½ circle Player changes direction at speed without rotating the body Player (often leaning to one side) moving in a semi-circular direction Player attempts to pass the ball to a team mate over a distance greater than 30 yards Player performs ball skill before, during or after dribbling / running with the ball Player attempts to cross the ball into the opposition penalty box from either flank in the attacking Player attempts to kick the ball into the opposition goal Player makes contact with the soccer ball using the head Player dispossess the soccer ball from the opponent Player enters the opposition penalty box Player moves with the ball either dribbling with small touches or running with the ball with bigger On the external channel, player runs from behind to in front of, or parallel to the player on the ball Player moves up the pitch to support the play or play offside (defensive and middle third of the pitch only) Player runs with or without the ball through the middle of the pitch Player runs from external flank with or without the ball into the central area Player runs with or without the ball down one of the external areas of the pitch Player aims to beat the opposition offside trap to run through onto the opposition goal Player runs directly towards opposition player on the ball Player cuts out pass from opposition player Player moves to cover space or a player on the pitch whilst remaining goal side Player runs alongside opposition player with or without the ball Opposition plays a long pass over the defence through the center of the pitch Opposition plays a ball over the top or down the side of the flank Player runs back towards own goal when out of position to be goal side

Table 1. ‘High Intensity Movement Programme’. Adapted from Ade et al.40


feature breaking into the box. Whilst wide players like full backs and wide midfielders produced more high-intensity efforts overlapping and running the channel than other positions40. They also performed more crosses after these runs than other positions due to more efforts finishing in wide attacking pitch areas. Out of possession, positions with a major defensive role in the team like centre backs, full backs and central midfielders produced more high-intensity efforts covering space or team-mates and recovery running whilst all positions performed frequent high-intensity efforts closing down the opposition. The frequency, duration, distance, angle of turns of these contextualised efforts across positions are valuable prescription metrics when constructing combination or isolated drills, particularly when considered relative to one another40. In order for a movement pattern, technical skill, combination play or tactical action to be included in the design of a position specific drill they adhered to one of the following criteria: (1) It occurs in >33% of efforts, (2) There is at least a small effect size difference compared to a minimum of two other positions, (3) In categories with a large number of variables (>3), there is a moderate standardised difference compared to the mean of the other variables. The third criteria allows for actions that may not occur in a high percentage of efforts, but relative to the other variables are the most prominent and should therefore be included (e.g. heading for a centre back). Ade et al. 40 reported the majority of high-intensity efforts do not include any ball contact (~60-75%), however for player enjoyment, technical skill development under fatigue and compliance such actions should be included. The first drill designed used an appropriate blend of science gathered from the ‘High Intensity Movement Programme’ and the art of coaching as evidenced by consultation with a UEFA Pro License football coach. This was a combination drill in which all positions are worked in unison with game- and position-specific ball work present. For effective drill design on a full-sized pitch, the start and end location of efforts were replicated to enhance the ecological validity of this drill, thus duplicating position-specific in and out of possession scenarios but with over-load. As speed endurance production and maintenance training typically induces sufficient metabolic overload42 for aerobic and anaerobic adaptations in players43, this was the training mode used. The drill started with the full-back producing an effort in the defensive third before overlapping the wide midfielder, to receive a pass in the wide attacking third to perform a cross. Simultaneously, the centre forward breaks into the box to score while being tracked by the centre back both having started in the middle third of the pitch. The central midfielder drives through the middle of the pitch performing an arc run to support the attack ending with a possible shot on goal. At the end, all positions produce a recovery run to individual pitch locations based on match data44. Using a speed endurance production work to rest ratio (1:6), all five positions (n=10; English Premier League academy U17-18’s) produced 8 repetitions of ~30s with 180s recovery. This elicited an average


and peak heart rate response of ~77 and 88% of maximal heart rate and produced blood lactate concentrations following the final repetition of ~5-6 mmol∙L-1.44 This training response is substantially lower than that reported in previous research assessing isolated running drills or 1vs1 small-sided games in football players (~82-84 and 89-90% of maximal heart rate and 10-13 mmol∙L-1) albeit using a lower work to rest ratio of 1:442. Using a speed endurance maintenance work to rest ratio (1:2), all five positions (n=10; English Premier League academy U17-18’s) produced 8 repetitions of ~30s with 60s recovery. This elicited an average and peak heart rate response of ~80 and 93% of maximal heart rate and produced blood lactate concentrations following the final repetition of ~6-16 mmol∙L-1.44 Video footage revealed the intensity of the drill drops should one player perform a technical skill poorly (pass / touch) as the simultaneous flow of the drill becomes disjointed resulting in some positions having to slow down and alter their runs. Large intra-player variation in time-motion characteristics between repetitions was also evident, especially sprint distance covered (>40%)44. This particularly impacted the metabolic responses of the speed endurance production drill. Consequently, the

position-specific speed endurance drills were amended to be administered in isolation in the absence of a coach led session during end stage rehabilitation or when additional conditioning is required due to lack of match exposure or poor fitness. Testing data (n=6; English Premier League academy U17-21’s) of the isolated speed endurance production and maintenance drills physiological response has revealed average and peak heart rate response of ~76, 85% and ~84, 90% of maximal heart rate with post drill blood lactate concentrations of >13 mmol∙L-1.44 Please see Figure 2 for an example of an isolated positional drill for a full back based on the ‘High Intensity Movement Programme’. Alongside daily training, players are also required to complete physiological testing batteries to monitor physical qualities that are vital for the game6. The ability to repeatedly produce intense actions with minimal recovery is an important attribute for elite players to possess5. A recent study has revealed a unique Reactive RepeatedSprint Test that was developed using key variables from the most intense 5-min period in elite football matches6, 26. The test consists of 8 repetitions of 30 m sprints, with accelerations, decelerations, multi-directional movements

Figure 2. Isolated positional drill for a full back based on the ‘High Intensity Movement Programme’. Please note the yellow figures represent mannequins. SEM = speed endurance maintenance, SEP = speed endurance production. Drill configuration from Ade & Bradley44.
















Figure 3. Layout of the reactive repeated sprint test. Test configuration from Di Mascio et al. 6. All short sprints are 6 m (5 x 6 m = 30 m). Players start at point A, and sprint to the poles at point C. They turn at point C, sprint through to point E via point D, turn and sprint to point F via a curved run to the outside of point E then through the finishing gate shown at point G via a curved run to the inside of the cone. A visual signal at point H determines whether they go right or left, and is initiated when the player runs through the second set of timing gates. Timing starts at the first set of timing gates and is complete at point G. O timing gate

football medicine & performance and a reactive element included in the 5 sets of 6 m sprints within the 30 m (Figure 3). The turns during the test were based on those found by Bloomfield et al.45 where the most frequent at high-intensity were directly forward, forward diagonal and arc forward; these were included in this order. Results included total (for 8 repetitions) and best time (fastest repetition), and has so far excluded a fatigue index due to its high variability46. English Premier League youth players performing the test on two separate occasions interspersed by 1 week, produce a coefficient of variation of <1%, highlighting excellent reliability. As the test is based on measurements from the most intense 5-min period during competitive matches (logical validity), the validity of the test was assessed by evaluating match running performance (concurrent validity). Large to very large correlations were found between test performance vs high-intensity running in the most intense period (r = -0.55-0.74) and during a match (r = -0.55-0.67) for elite and sub elite youth squads. It was also compared to other tests of a relevant nature (criterion validity) and sensitivity to performance levels (construct validity). An excellent relationship was found between the Arrowhead agility test and the fastest repetition of the test for elite youth players. Test performance differed markedly between levels with elite U18 players outperforming elite U16 and sub-elite players. Furthermore, elite senior female players were outperformed by all male counterparts. The test is similar to intense periods during a match due to its heart rate and blood lactate concentrations throughout. This test elicited peak heart rate responses of ~92-95% of maximal heart rate and produced blood lactate concentrations following the final repetition of ~9-15 mmol∙L-1 in sub-elite youth players.6 This was similar to values after intense periods of match-play 47. CONCLUSIONS This review details the longitudinal trends in match demands and clearly indicates that elite leagues such as the English Premier League are now more physically and technically demanding than a decade ago. Thus, the need to optimise a player’s physical capacity using running and football-based drills is more important than ever to enable players to perform optimally but also make them robust enough to maintain this throughout the season. Moreover, the monitoring and evaluation of elite players needs to use the most reliable, valid and sensitive tests possible. As a result, this review has explored how match performance data can be used to design testing and training modalities that have a high degree of specificity. PRACTICAL IMPLICATIONS • Elite football competition has evolved substantially, with large increases in physical and technical demands that are often interrelated. The use of traditional performance metrics that report gross physical output therefore lack the contextual information necessary to fully explain and enhance player performance during training and games. • The synergy of physical and technical performance metrics allows for the creation of player/position-specific drills and tests,

challenging the individual’s physical capabilities in relation to their tactical role within the team, in and out of possession. • Tactical conditioning drills appear to provide the greatest physical and technical challenge when isolated to specific positional demands rather than when incorporated into a multi-positional drill. Such a position-specific approach to conditioning is highly effective in allowing close replication of the most challenging periods of math play, which is a crucial when conditioning players to meet the demands of the modern game.

1. Reilly T, Williams AM (eds). Science and Soccer. 2nd ed. 2003, London; New York: Routledge. 2. Mohr M, Krustrup P, Bangsbo J. Match performance of highstandard soccer players with special reference to development of fatigue. J Sports Sci 2003; 21:519-528. 3. Bradley PS, Sheldon W, Wooster B, Olsen P, Boanas P et al. Highintensity running in English FA Premier League soccer matches. J Sports Sci 2009; 27:159-168. 4. Reilly T, Thomas V. A motion-analysis of work-rate in different positional roles in professional football match-play. J Hum Mov Stud 1976; 2: 87–97. 5. Bangsbo J, Norregaard L, Thorso F. Activity profile of competition soccer. Can J Sport Sci 1991; 16:110-116. 6. Di Mascio M, Ade J, Bradley PS. The reliability, validity and sensitivity of a novel soccer-specific reactive repeated-sprint test (RRST). Eur J Appl Physiol 2015; 115: 2531-2542. 7. Buchheit M, Allen A, Poon TK, Modonutti M, Gregson W et al. Integrating different tracking systems in football: multiple camera semi-automatic system, local position measurement and GPS technologies. J Sports Sci 2014; 32: 1844-1857. 8. Osgnach C, Poser S, Bernardini R, Rinaldo R, di Prampero PE. Energy cost and metabolic power in elite soccer: a new match analysis approach. Med Sci Sports Exerc. 2010;42:170–178. 9. Bradley PS, Archer DT, Hogg B, Schuth G, Bush M et al. Tier-specific evolution of match performance characteristics in the English Premier League: it’s getting tougher at the top. J Sports Sci 2016; 34:980-987. 10. Di Salvo V, Gregson W, Atkinson G, Tordoff P, Drust B. Analysis of high intensity activity in Premier League soccer. Int J Sports Med 2009; 30:205-212. 11. Vigne G, Gaudino C, Rogowski I, Alloatti G., Hautier C. Activity profile in elite Italian soccer team. Int J Sports Med 2010; 31: 304-310. 12. Castellano J, Blanco-Villasenor A, Alvarez D. Contextual variables and time-motion analysis in soccer. Int J Sports Med 2011; 32: 415-421. 13. Carling C, Dupont G. Are declines in physical performance associated with a reduction in skill-related performance during professional soccer match-play? J Sports Sci 2011; 29: 63-71. 14.Hoppe MW, Slomka M, Baumgart C, Weber H, Freiwald J. Match Running Performance and Success Across a Season in German Bundesliga Soccer Teams. Int J Sports Med 2015; 36: 563-566. 15.Bradley PS, Dellal A, Mohr M, Castellano J, Wilkie A. Gender differences in match performance characteristics of soccer players competing in the UEFA Champions League. Hum Mov Sci 2014; 33:159-171. 16. Di Salvo V, Baron R, González-Haro C, Gormasz C, Pigozzi F et al. Sprinting analysis of elite soccer players during European Champions League and UEFA Cup matches. J Sports Sci 2010; 28:1489-1494. 17. da Mota GR, Thiengo CR, Gimenes SV, Bradley PS. The effects of ball possession status on physical and technical indicators during the 2014 FIFA World Cup Finals. J Sports Sci 2016; 34: 493-500. 18.Schimpchen J, Skorski S, Nopp S, Meyer T. Are “classical” tests of repeated-sprint ability in football externally valid? A new approach to determine in-game sprinting behaviour in elite football players. J Sports Sci 2016; 34: 519-526. 19.Bradley PS, Lago-Peñas C, Rey E, Gomez Diaz A. et al. The effect of high and low percentage ball possession on physical and technical profiles in English FA Premier League soccer matches. J Sports Sci 2013; 31: 1261-1270. 20.Krustrup P, Mohr M, Ellingsgaard H, Bangsbo J. Physical demands during an elite female soccer game: importance of training status. Med Sci Sports Exerc 2005; 37: 1242-1248. 21.Bellistri G, Marzorati M, Sodero L, Chiarella S, Bradley PS, Simone P. Match running performance and physical capacity profiles of U8 and U10 soccer player. Sport Sci Health 2017; 13: 273–280. 22.Simim MA, Mota GR, Marocolo M, Bradley PS. The demands of amputee soccer impair muscular endurance and power indices but not match physical performance. Adapt Phys Activ Q 2017; Epub ahead of print. 23.Bradley PS, Carling C, Gomez Diaz A, Hood P, Barnes C. Match performance and physical capacity of players in the top three competitive standards of English professional soccer. Hum Mov Sci 2013; 32: 808-821. 24.Di Salvo V, Pigozzi F, González-Haro C, Laughlin MS, De Witt JK.

• Please note that combination drills could still be used other isolated drills especially if the emphasis is on a global performance stimulus rather than just a physical stimulus. Future research should examine acceleration indices to provide a deeper context to this translation. This was taken from the following paper with permission from the journal. ‘Bradley PS, Di Mascio M, Mohr M, Fransson D, Wells C, Moreira A, Castellano J, Gomez Diaz A, & Ade J. Can Modern Football Match Demands Be Translated into Novel Training and Testing Modes? Aspetar Sports Med J. 2018; 7, 46-52.’ Match performance comparison in top English soccer leagues. Int J Sports Med 2013; 34: 526-532. 25.Bradley PS, Carling C, Archer D, Roberts J, Dodds A. 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. 26.Di Mascio M, Bradley PS. Evaluation of the most intense high-intensity running period in English FA premier league soccer matches. J Strength Cond Res 2013; 27: 909-915. 27.Fransson D, Krustrup P, Mohr M. Running intensity fluctuations indicate temporary performance decrement in top-class football. Science and Medicine in Football 2017; 1: 10-17. 28.Varley MC, Jaspers A, Helsen WF, Malone JJ. Methodological Considerations When Quantifying High-Intensity Efforts in Team Sport Using Global Positioning System Technology. Int J Sports Physiol Perform 2017: 1-25. 29.Collet C. The possession game? A comparative analysis of ball retention and team success in European and international football, 2007-2010. J Sports Sci 2013; 31: 123-136. 30.Paul DJ, Bradley PS, Nassis GP. Factors affecting match running performance of elite soccer players: shedding some light on the complexity. Int J Sports Physiol Perform 2015; 10: 516-519. 31. Bilge M. Game analysis of Olympic, World and European Championships in Men’s Handball . J Hum Kinet 2012: 35: 109 – 118. 32. Haake SJ, Foster LI, James DM. An Improvement index to quantify the evolution of performance in running. J Sports Sci 2014; 32: 610-622. 33.Norton KI, Craig NP, Olds TS. The Evolution of Australian Football. J Sci Med Sport 1999; 2:389 – 404 34.Woods CT, Robertson S, Collier NF, Swinbourne AL, Leicht AS. Transferring an Analytical Technique from Ecology to the Sport Sciences. Sports Med 2017: August: Epub ahead of print. 35.Williams AM, Lee D, Reilly T. A quantitative analysis of matches played in the 1991–92 and 1997–98 Seasons. 1999, London: The Football Association. 36.Wallace JL, Norton KI. Evolution of World Cup soccer final games 1966– 2010: Game structure, speed and play patterns. J Sci Med Sport 2014; 17:223-228. 37.Barnes C, Archer DT, Hogg B, Bush M, Bradley PS. The evolution of physical and technical performance parameters in the English Premier League. Int J Sports Med 2014; 35: 1095-1100. 38.Bush M, Barnes C, Archer DT, Hogg B, Bradley PS. Evolution of match performance parameters for various playing positions in the English Premier League. Hum Mov Sci 2015; 39: 1-11. 39.Bangsbo J, Peitersen B. Offensive soccer tactics. 2004, Champaign, IL: Human Kinetics. 40.Ade J, Fitzpatrick J, Bradley PS. High-intensity efforts in elite soccer matches and associated movement patterns, technical skills and tactical actions. Information for position-specific training drills. J Sports Sci 2016; 34: 2205-2214. 41.Bloomfield J, Polman RCJ, O’Donoghue PG. The ‘Bloomfield movementlassification’: Motion Analysis of Individual Players in Dynamic Movement Sports. International Journal of Performance Analysis in Sport 2004; 4:20-31. 42.Ade JD, Harley JA, Bradley PS. Physiological response, time-motion characteristics, and reproducibility of various speed-endurance drills in elite youth soccer players: small-sided games versus generic running. Int J Sports Physiol Perform 2014; 9: 471-479. 43.Iaia FM, Fiorenza M, Perri E, Alberti G, Millet GP, Bangsbo J. The Effect of Two Speed Endurance Training Regimes on Performance of Soccer Players. PLoS One 2015; 10 (9):e0138096. 44.Ade JD, Bradley PS. Position-Specific Speed Endurance Training Drills for Elite Youth Players. Unpublished data. 45.Bloomfield J, Polman RCJ, O’Donoghue PG. Physical demands of different positions in FA Premier League soccer. J Sports Sci Med 2007; 6: 63-70. 46.Oliver JL. Is a fatigue index a worthwhile measure of repeated sprint ability? J Sci Med Sport 2009; 12:20–23. 47. Krustrup P, Mohr M, Steensberg A, Bencke J, Kjaer M, Bangsbo J.Muscle and blood metabolities dueing a soccer game: implications for sprint performance. Med Sci Sports Exerc 2006; 38: 1165-1674.


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football medicine & performance

THE IMPORTANCE OF A UNIFORM CLUB PHILOSOPHY FOR ENHANCING ATHLETE HEALTH AND PERFORMANCE FEATURE / ADAM BRETT & WILL ABBOTT - BRIGHTON & HOVE ALBION FC Professional football clubs are huge organisms, with numerous contributing parts. To achieve success it is vital the individual parts, for example the science and medical department, are aligned and working towards a common goal. Considering science and medical departments are comprised of physiotherapy, sport science, strength and conditioning, psychology and nutrition disciplines, this can equate to a large number staff. To increase collaboration between sub-disciplines, and avoid working within individual ‘silos’, a collective philosophy for the department must be formulated. A departmental philosophy, that each staff member and sub-discipline has contributed towards, allows for a collective vision and direction to be established. This ensures staff member’s efforts are streamlined towards the overall aim, and ensures accountability within the department. From an academy perspective, it is vital the academy aims and philosophy feeds into the 1st Team’s. The academy aim is to produce players for the 1st Team, with a higher likelihood of success if

the 1st Team’s aims, philosophy, and athlete expectations are considered. At Brighton and Hove Albion FC (BHAFC), the science and medical department’s philosophy centres around four key performance pillars that run throughout the academy and 1st Team (Figure 1). These are: •

Enhance & Educate - enhancing physical qualities, and educating athletes surrounding their lives inside and outside the club.

Prevent & Protect - preventing and protecting against illness and injury.

Motivate & Inspire - motivating and inspiring a long-term love for what the athletes do.

Produce & Perform - the closer the proximity to 1st Team, the larger the emphasis placed upon producing and performing.



PRODUCE & PERFORM Figure 1. BHAFC key performance pillars


feature Whilst sharing a science and medical philosophy between academy and 1st Team, it’s vital to acknowledge the implementation of the philosophy will differ significantly at each of the developmental stages. Academy athletes are not mini adults and therefore cannot be trained like them! The BHAFC academy’s physical development framework is heavily linked to Lloyd and Oliver’s Youth Physical Development Model (2012). A high emphasis is placed upon developing strength at all development stages, regardless of age. Strength is a vital building block for physical preparation, allowing for subsequent physical qualities to be developed at a later stage. From a movement skill perspective, fundamental movement skills are targeted at younger age groups. As with strength, the aim is to ensure the ‘building blocks’ are in place first, before focusing on sport specific skills at later developmental stages. Within BHAFC, the Foundation Phase (U9U12) is our earliest contact with academy athletes, and our physical preparation work is pitch-based. A high priority at this stage is placed upon engaging the athlete and having fun. The last thing we want is for the U9s to dread S&C already, otherwise what hope have we got by the time they get to U23s! At this age, the kids within the academy are not footballers, they are kids that happen to play football, and the programme reflects that. The aim within this phase is to expose athletes to a wide breadth of movements, and to increase the quality of basic, fundamental

Multi-Sport Physical Aim

Paired Multi-Sport

Linear Speed & Plyometrics



Tag Games



Change of Direction

Tag Rugby

Lateral Movement


Figure 2. Example multi-sport curriculum

movement skills. We believe exposure to a wide breadth of movements can be achieved through sports other than football, an aspect we address using our multi-sport programme. The programme pairs the physical aim for the cycle with a sport eliciting similar movement patterns, an example of which is shown in Figure 2. Within the Youth Development Phase (U13-U16) the complexity and specificity of the pitch-based curriculum progresses. At U13, athletes begin the gym-based S&C programme, the primary aim of which is technical mastery of basic lifts. By U15/16 age groups, the aim is that athletes are technically


• • •

Joined club as 9 y/o Gym based training age = 7 years Competent with core lifts and Olympic Lifts

A significant aspect of working within an academy setting, specifically the Youth Development Phase, are differences in growth and maturation. A huge role of sport science practitioners is to educate coaches, scouts and key decision makers surrounding where athletes are within their maturation journey. To ensure later developing athletes are not prematurely released due to their inability to ‘affect the game’, and that we challenge early developing athletes relying upon their temporary superior physical attributes. One way to increase consideration for individual athletes’ maturation status is via bio-banding, and grouping athletes based upon maturation. Recent research, most notably by Sean Cumming and colleagues (2018), supports the use of bio-banding in academy football. Following some very positive experiences at BHAFC with biobanded competition, we have recently trialled training in bio-banded groups for a six week period. Training and competing in bio-banded groups has allowed relevant decision makers at the club to see some athletes in a different light, and make more informed decision regarding retains or releases. Within the Professional Development Phase (U18 to U23) our programme is highly individualised, due to the large variation in training age between athletes. An example of the variability is demonstrated in Figure 3.


• • •

Joined club as 16 y/o Gym based training age = 3 years Competent with core lifts not Olympic Lifts

Figure 3. Typical variations in gym-based training age within Professional Development Phase.


competent with a variety of lifts, and at a level where intensity can be progressed.


• • •

Joined club as 19 y/o Gym based training age = 0 years First time in gym environment

football medicine & performance

Three athletes within the U23 squad, all 19 years of age, but with varying gym-based training histories. Consequently, the aim and content of each individual’s programme differs significantly to cater for their individual needs, and respective stage of development. The Professional Development Phase is characterised by a large increase in technical and tactical training, due to training full time. Athletes are therefore exposed to a large volume of physical stimuli through the footballing aspect of the programme. Rather than pile on more of the same stimulus through our pitch-based work, a more efficient use of time is to identify important physical stimuli not currently present, and focus upon eliciting these. With the volume of training sessions being conducted within this phase, the periodisation of training load becomes increasingly important, ensuring a good balance of drills and physical exposures throughout the week. An athlete’s transition to the 1st Team typically involves experiencing 1st Team football on loan first. This exposes athletes to high volumes of matches, fixture congestion, the physical challenge of playing against men, but is also a huge learning curve surrounding the level of professionalism required to remain available to train and play over a long season. During a loan spell away from

BHAFC, athletes may experience different facilities, environments, and levels of support. Consequently, we have a role in providing them with the necessary tools, education and support to equip them for these situations. This is achieved through our loan education programme, which encompasses the following areas: •




Physical Preparation

Mental Wellbeing

The successful transition of an academy athlete to the 1st Team squad is a difficult task. The fluidity of this transition is increased by a shared club philosophy. If physical benchmarks are set for athletes graduating into the 1st Team, academy staff can focus their efforts towards achieving these. Achievement of physical benchmarks or key transition criteria results in a smoother transition for academy athletes, and a higher likelihood of tolerating the 1st Team environment. Identification of benchmarks, alongside open and honest communication regarding academy athlete’s development, is a vital aspect of a science and medical department.

Cumming, S. P., Brown, D. J., Mitchell, S., Bunce, J., Hunt, D., Hedges, C., Crane, G., Gross, A., Scott, S., Franklin, E., Breakspear, D., Dennison, L., White, P., Cain, A., Eisenmann, J. C., & Malina, R. M. (2018). Premier league academy soccer players’ experiences of competing in a tournament bio-banded for biological maturation. Journal of Sports Sciences, 36(7), 757-765. Lloyd, R. S. & Oliver, J. L. (2012). The youth physical development model: A new approach to long-term athletic development. Strength and Conditioning Journal 34(3), 61-72.

Adam Brett Head of Medical Services, Brighton & Hove Albion FC Dr. Will Abbott Head of Academy S&C & Sports Science, Brighton & Hove Albion FC


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“The FMPA continues to deliver a fantastic line-up of speakers working in vastly different roles across the football landscape. The 2019 conference was a fantastic opportunity to learn, as well as catching up with old friends, and meeting new ones.”

BBC Sports Presenter Hugh Ferris hosts the 2019 Awards

“It was great to see such a variety of practitioners, old and young and from different disciplines all congregating to share knowledge and discuss improving athlete health and performance. Improving the links between medical and Strength & Conditioning staff is vital for the holistic development of the athlete and it was great to see a commitment from all to understanding the need for accredited and proven competency in delivering athletic development training to all”

“An extremely well run couple of days with some fantastic takeaways!”

FMPA CEO Eamonn Salmon addresses conference delegates

“I enjoyed the event immensely, this was my first time and I will definitely attend again”


& AWARDS “End of season showcase keeps on getting better and better”

“Candid and interesting talks, thought provoking presentations”



“Thank you for another great conference and awards event”

“The event really does go from strength to strength every year”

“Great to receive peer recognition”




This first category emphasises the part played by the medical and performance teams in their clubs’ successes. As an association it is vital that we recognise and promote the work of our members in Professional Football. It is incumbent on us therefore to make sure that colleagues in the game recognise too that our members endeavours are synonymous with a teams success, and that they collectively make a significant contribution to the overall “team “effort that results in that success. PREMIER LEAGUE MANCHESTER CITY / LIVERPOOL FC








“Picking up the award for Medicine & Performance Team is a personal moment.”



FMPA MEMBERSâ&#x20AC;&#x2122; AWARD WINNERS 2018/2019 This award is designed to recognise the exceptional contribution of a medical and performance team within a Club. Where they have worked as a unit, pulled together as a team, achieved great results, worked under extenuating circumstances, been innovative or worked beyond the call of duty then they deserve recognition. That this comes from fellow colleagues in the game makes this is a particularly rewarding accolade. PREMIER LEAGUE SOUTHAMPTON FC






FMPA INDIVIDUAL AWARD WINNERS 2018/2019 The FMPA specialist awards look at individuals whose overall contribution to football, impact on their club and colleagues or the exceptional nature of their contribution within their field of practice. Award winners may have worked beyond the call of duty, excelled within a particular aspect of their practice or been called upon to push the boundaries of their discipline to the highest level. LONGSTANDING SERVICE DR STEPHEN FELDMAN




t have stood the test of , with long-term product herapists alike. Taping st® are used in daily red players. Essity miumFMPA brandEXCEPTIONAL of






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WHAT OUR MEMBERS THOUGHT “The 2019 FMPA Conference was, without question, the best conference I have attended in the last 10 years: the organisers should be congratulated on developing such a wide-ranging and engaging programme. Throughout the two-day conference, knowledgeable and experienced speakers presented high quality lectures on topics of current importance: I am certain that everyone attending the Conference learnt something of value from every presentation. The dates for the 2020 FMPA Conference have already been added to my calendar - it is definitely an event I will not want to miss.” Dr Colin Fuller BSc, PhD, FRSC

“As always, a great few days with FMPA members at their annual Conference .The event really does go from strength to strength every year! Thanks to everyone who helped to organise and shared their knowledge.” Craig Smith, Head of Fitness & Conditioning, Peterborough United FC

“It was a pleasure to present on our academy philosophy at the recent FMPA conference. An extremely well run couple of days, with some fantastic takeaways!” Will Abbott, Head Academy Strength and Conditioning Coach, Brighton & Hove Albion FC

“It was great to see such a variety of practitioners, old and young and from different disciplines all congregating to share knowledge and discuss improving athlete health and performance. Improving the links between medical and Strength & Conditioning staff is vital for the holistic development of the athlete and it was great to see a commitment from all to understanding the need for accredited and proven competency in delivering athletic development training to all.” Kevin Paxton, Head of Academy Sports Science, Leicester City FC

“The FMPA continues to deliver a fantastic line-up of speakers working in vastly different roles across the football landscape. The 2019 conference was a fantastic opportunity to learn, as well as catching up with old friends, and meeting new ones.” Callum Repper, Women’s Team Physiotherapist, Women’s Professional Development Phase, The FA





football medicine & performance

A BALANCING ACT: MAXIMISING PLAYER AVAILABILITY WHILST RESPECTING THE FUNDAMENTAL ETHICS OF HEALTHCARE IN SPORT FEATURE / DR ROB TATHAM, SPORTS PHYSICIAN Ethical and medico-legal considerations regarding healthcare provision in sport A sports clinician’s role may be summarised as “assisting athletes to achieve optimal performance, enhancing resilience to injury, and maximising availability for training and competition”. To achieve this a multidisciplinary approach is required to address the many challenges that an athlete may face (Figure 1).

Enhancing athleticism Illness prevention & acute management

Acute injury management & rehabilitation

Optimal performance, resilience & availability Chronic injury managment



Figure 1. The key facets of sports medicine

The provision of healthcare in sport is a unique employment environment. A clinician’s overarching duty is to the welfare of the athletes that they are employed to care for. Their employer (usually the football club) similarly has a vested interest in the long-term welfare of their ‘assets’. Occasionally however, a clinician may feel pressured to declare an athlete available for selection for short-term football-related gains despite the risk of exacerbating a condition. The decision-making dilemmas of sports medicine are further confounded by the medical uncertainties of diagnosis and rehabilitation progression (Figure 2).

‘targets’ are also quoted within football medicine. ‘Player availability’ and ‘return to training time’ are two common examples. However, such indicators do not necessarily give a direct insight into the preventative strategies in place (reduction in injury, illness and secondary complications). Preventative medicine is arguably the most important work that sports clinicians do, but possibly one of the most difficult to measure. Medical KPI’s may only tell part of the story and should always be placed in context. When faced with difficult decisions it may be helpful to refer back to the fundamental ethical principles of healthcare provision. In 2015 Baroness Tanni Grey-Thompson conducted an independent review for the government regarding the Duty of Care sport has towards its participants. The result of this review (Grey-Thompson, 2017) identifies the fundamental obligations that sporting organisations and care providers should deliver (and may be judged against). In particular; i) whatever the level of facilities and resources, taking steps to ensure the safety of people playing, supporting, officiating and watching sport is fundamental, ii) sports have a duty to respect the advice and guidance of medical experts, and put safety and athlete welfare above all other concerns. Determining availability to train & play is an opportunity to identify those individuals who may be at increased risk of harm if they are allowed

to be exposed to the occupational hazards presented by football and football training. Unfortunately the incidence of medical negligence cases within sport is increasing, with the majority being filed against clubs on the basis of failure of Duty of Care for a player (SEMPRIS, 2019). As is the case for healthcare providers in sport, a Club’s Duty of Care for players overrides everything else. So, whilst our employers (the Club) expect (quite reasonably) that a well-functioning Medicine & Science Department should maximise availability for athletes to train and play, this should never be at the expense of the player’s welfare. It is worth noting that such medical negligence claims are usually passed on from The Club to the Head of Medical Services to answer. Individuals appointed to the role of Head of Medical Services (and who therefore carry ultimate accountability) need to ensure they have adequate indemnity to cover them in the event of such claims. Indemnity providers may not cover certain professions to take up a role as Head of Medical Services, and this type of cover is not usually provided by the Club’s umbrella medical indemnity policy.

Club asset (long term)

Figure 2. The dual-role dilemma of working in sports medicine

Medical uncertainty


Coach asset (short term)

Patient welfare

‘Key performance indicators’ (KPI’s) are used ubiquitously across industry as markers of productivity and effectiveness. Such



Figure 3. Common infections encountered amongst athletes (Scharhag and Meyer, 2014).

Upper respiratory tract infection (common cold)

Acute pharyngitis

Acute tonsillitis

Acute sinusitis

Infectious mononucleosis (glandular fever)


Acute gastroenteritis (viral or bacterial)

Injury & illness affecting the ability to train The majority of training days are ‘lost’ due to: i) acute injury ii) illness (usually infection) iii) exacerbation of a pre-existing pathology iv) aberrant neuromuscular activation. The following section discusses pertinent aspects regarding the latter three in relation to fitness to train. •


Common infections encountered are illustrated in Figure 3. It is important to distinguish those illnesses that may place an athlete at risk of increased harm if they exercise. In general terms athletes should NOT train in the presence of: • Systemic symptoms (eg. arthralgia, myalgia) • Elevated resting heart rate • Evidence of dehydration • Fever • Suspicion of glandular fever As a general rule of thumb do not train if there are infectious symptoms below the neck (Metz, 2003; Eichner, 1993; Primos, 1996). Training during an infectious illness in the presence of these red flag symptom(s) may (2007; Eichner, 1993; Primos, 1996) : 1. Exacerbate symptoms and prolong illness duration 2. Increase the risk of heat-related illness and dehydration 3. Reduce muscle strength & endurance 4. Increase fatigue & reduce exercise tolerance 5. Increase the risk of acute viral myocarditis


Glandular fever is of particular significance in athletes because of the risk of splenomegaly and the increased risk of acute splenic rupture. All suspected cases of glandular fever should be excluded from training pending further investigation. Key points regarding glandular fever are illustrated in Figure 4 below.

90% Ebstein Barr Virus (EBV)

<10% Cytomegalovirus (CMV)

4-8 weeks incubation period

Classic triad: i) fever + ii) sore throat + iii) lymphadenopathy

May have signifcant malaise

Up to 60% have splenomegaly (sensitivty of palpation only approx 20%)

Acute bronchitis

Athletes with glandular fever should be excluded from training during this period of increased risk (Figure 5). •

Exacerbation of pre-existing pathology (eg. tendinopathy, chondral lesion)

It is easy to forget about the pre-existing conditions that athletes may have if they are fully ‘fit’ and training. One example is that of a knee chondral lesion. This may be quiescent when the cumulative training load is tolerable, but beyond a certain threshold the knee reacts and forms an effusion. Note that the effusion is a symptom of the underlying pathology but is itself also a risk factor for further injury due to its effect on quadriceps muscle inhibition, proprioception, co-ordination and biomechanics (Arthrogenic Muscle Inhibition) (Rice and McNair, 2010). Key points 99 Aggravation of pre-existing pathology may produce symptoms that negatively affect the kinetic chain. This in itself may be a risk factor for further injury.

Adults more likely to have hepatomegaly +/- jaundice

Risk of splenic rupture 0.5% - highest risk in first 21 days

99 Establish a system to identify background pathology within a squad and monitor for key symptoms.

Assume splenomegaly is present (use ultrasound to confirm)

99 Ensure appropriate maintenance work is not neglected (eg. tendinopathy).

Figure 4. Key points regarding glandular fever (Dommerby et al., 1986; Kinderknecht, 2002; Macknight, 2002)

99 Early coach communication may help facilitate a system of load-management to a level that is tolerable.

football medicine & performance

Minimum 3 week sport exclusion for acute infectious mononucleosis

Inflammatory markers and LFT’s normalised

Resolution of symptoms

Departmental functioning is critical to safely optimising player availability Addressing all potential issues that may lead to player unavailability requires a truly multidisciplinary approach (Figure 6). No one practitioner has all the answers, but collectively a systematic and structured approach can be created. Provide a clear structure of line management, expectations and accountability. Fundamentally, regardless of the demands made for player availability, clinicians should always strive to adhere to the ethical principle “primum non nocere” (first, do no harm).

Resolution of splenomegaly (ultrasound ideally)

Adequate preparation time Optimise fitness & athleticism

1 week graduated return to train period

Figure 5. Suggested return to train criteria following an episode of glandular fever (Kinderknecht, 2002; Macknight, 2002) .

Maximise recovery (including sleep)

Player reporting systems Availability

Aberrant neuromuscular activation

This is not necessarily a pathology in itself but is a failure of the neural and muscular systems to effectively communicate and may result in suboptimal muscular recruitment. This can occur at a spinal level (eg. disc pathology) or at a peripheral level. One such peripheral example is tibialis posterior dysfunction in the lower leg. The muscle ‘switches off’ and fails to resist pronation of the foot following heel strike (Ling and Lui, 2017) . Consequently, the mid-foot remains unlocked leading to aberrant biomechanics and load distribution. Unsurprisingly this is a risk factor for subsequent injury.

Player education & buy-in

Department integration

Early wound management

99 Test the muscle throughout its full range and into fatigue. 99 Identify athletes who may be at risk (eg. tibialis posterior is very common following ankle injury). 99 Establish individual activation programmes for athletes (self-led) to ensure readiness for training.


Figure 6. Factors in optimising player availability.

Key points 99 Aberrant neuromuscular activation can be picked up through simple movement screening (eg. single leg squat) or isolated muscle testing (eg. tibialis posterior – assessing resisted inversion of the foot).

Case managment of chronic pathology

Macknight JM. (2002) Infectious mononucleosis: ensuring a safe return to sport. Phys Sportsmed 30: 27-41. Metz JP. (2003) Upper respiratory tract infections: who plays, who sits? Curr Sports Med Rep 2: 84-90. Primos WA, Jr. (1996) Sports and exercise during acute illness: recommending the right course for patients. Phys Sportsmed 24: 44-52.

(2007) Exercise and febrile illnesses. Paediatr Child Health 12: 885-892. Dommerby H, Stangerup SE, Stangerup M, et al. (1986) Hepatosplenomegaly in infectious mononucleosis, assessed by ultrasonic scanning. J Laryngol Otol 100: 573-579. Eichner ER. (1993) Infection, Immunity, and Exercise. Phys Sportsmed 21: 125-135.

Rice DA and McNair PJ. (2010) Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum 40: 250-266.

Grey-Thompson B. (2017) Duty of Care in Sport. Available at: publications/duty-of-care-in-sport-review.

Scharhag J and Meyer T. (2014) Return to play after acute infectious disease in football players. J Sports Sci 32: 1237-1242.

Kinderknecht JJ. (2002) Infectious mononucleosis and the spleen. Curr Sports Med Rep 1: 116-120.

SEMPRIS. (2019) Personal communication regarding the rise of medical negligence cases within sport.

Ling SK and Lui TH. (2017) Posterior Tibial Tendon Dysfunction: An Overview. Open Orthop J 11: 714-723.

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football medicine & performance

HOW TO THRIVE WITH A LITTLE HELP FROM YOUR FRIENDS Songs often tell us that a friend will get you through difficult times. True. In fact research often shows social support to be the most important thing that helps us buffer against and cope with many of life’s difficult situations. Now however, research also tells us that, in both difficult and normal times, social support is important in helping us pursue opportunities to develop and grow, and therefore to thrive. A quick reminder that wellbeing includes feeling; competent, autonomous, valued, supported and part of a community, gives some indication as to why social support can be so beneficial to our mental and social health, and in turn, physical health. But how often and how strategically do we seek and engage the support of others? My guess is that few of us use it enough. We give it low priority. Our immediate environment gives us limited opportunity. We are embarrassed to ask for support or don’t want to bother others. But are we missing out on a simple way of coping, moving on, improving and thriving? Almost everyone can benefit from receiving (and giving) social support, but the more strategic you are, the more you can gain. So how do you use it effectively? Give the following some honest consideration, and start to plan how you can use social support to help you cope and thrive more effectively.

Prepare to Take the Opportunity: Encourage and help you develop attainable goals and to recognise or develop skills, space and resources. Also to provide feedback, information or tangible support to attain resources. Start and Optimise the Opportunity: Help provide a secure launch pad, providing appropriate support and encouragement, without interfering or becoming too involved. This includes celebrating your accomplishments, encouraging reflection and learning, and helping to fine-tune perceptions, skills and strategies. Also to respond sensitively to setbacks and to ensure that you maintain a healthy balance across important life areas. Support for Difficult Times: To help you buffer against stress and promote your ability to cope and thrive, engage with individuals who can enable you to: Have a safe haven: Allow you to talk, be honest and show emotion, someone who will listen to, understand, accept and reassure you. Also possibly someone who can provide tangible assistance that reduces or shields you from the difficult situation. Fortify: Help you to recognise or develop your existing coping strengths and talents, or to identity and help you to attain new coping skills.

EXTRA SOCIAL SUPPORT TIPS 5. Support the Supporter: If they can, people are often willing to give support, but let them know their efforts have been worthwhile. Be receptive and grateful, and check you’re not asking for too much. 6. Maintain a healthy balance of dependence and independence: You can’t thrive through competence and autonomy if you become too dependent. Likewise, beware of any support person who encourages dependency.

1 . Don’t Wait: Ask people if they would support you if needed: Just knowing that support is available is an important predictor of health and wellbeing.

Reframe: Help you think differently; to see the situation as less threatening or difficult, or as possible to overcome or of potential benefit.

7. Give Support: With caution, if you already feel that you give too much, but the feeling of giving successful support can have a more profound effect on wellbeing than receiving it. Use the above to give support more effectively. If you work in a team, maybe discuss how you can implement the above together. Remember even small acts of care, e.g., a few encouraging words, recognising skills, are of benefit to you both.

2. Engage with social support regularly: Plan to use it as a matter of course, not a last resort.

Support for All Times: To help you thrive, your network should include individuals who can help you:

Remember: Others are important to our wellbeing. Don’t wait. Plan and ask others to help you thrive.

Nurture a desire to create or seize opportunities to grow: To encourage you to take initiative, to challenge or extend yourself to take opportunities however big or small. Also, to support your goals and aspirations. See Life’s Opportunities: Help you recognise opportunities that you might otherwise not see or dismiss as too difficult, threatening or as likely to fail. To help you see potential benefits and visualise future possibilities, and to recognise that even if unsuccessful, the experience can lead to growth and further opportunities.

Dr Caroline Marlow, C.Psychol., AFBPsS. HCPC Registered. Specialist in performance and wellbeing psychology. Director of L&M Consulting Ltd. Contact: Website:


3. Build a wide and varied support network: Seek people with different support skills, but ensure that they; are trustworthy, will do what you ask, and treat you as you see your ideal self. Face-to-face support is best, i.e., family, friends, fellow professionals, peer-support groups, charities, or professional support, but with care, social media can be helpful too. 4. Match your needs: Research tells us that the support you seek should depend on a) whether you are experiencing difficult or normal times, and b) your specific needs. Further, that when asking for support, be clear about what you need and why. So again prepare…

Reconstruct: Help you get back on your feet, to use your strengths, to problem-solve. To take positive actions that promote your control, coping and change.





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football medicine & performance

POSITION SPECIFIC & POSITIONAL PLAY TRAINING IN ELITE FOOTBALL: CONTEXT MATTERS FEATURE / PAUL S BRADLEY, ANDRES MARTIN-GARCIA, JACK D ADE & ANTONIO GOMEZ DIAZ Introduction Those who have watched elite football across the last decade, realise that the game is more demanding than ever1. This places more emphasis on training methods to prepare players for the rigors of the game2. If we use the mantra of ‘train like you play’ it might be wise to complement existing practices with conditioning drills related to a players’ tactical role3 (e.g. position specific) and even elements of the club’s playing style/ energetic profile4 (e.g. positional play). Thus, this piece will explore how such a stimulus can be incorporated into two areas of football conditioning: (1) team training and (2) individual end stage rehabilitation. Examples are presented from two European clubs. 1. Positional Approaches to Team Training: Using Examples from FC Barcelona FC Barcelona employ a unique training model, incorporating a general and positional stimulus4. The distinct playing style adopted informs training. Emphasis is placed on passing and combination play while loading players physically5 Adding an extra layer of detail to training, staff examine match physical performances of each position/player to prepare game scenarios5. For example,

during FC Barcelona matches centre backs and midfielders (~300-400 m) cover less high speed running (>19.8 km.h-1) than forwards and fullbacks (~600-800 m) with the number of intense accelerations (>3m.s-2) also highest for fullbacks and forwards (n=57-60) compared to centre backs and midfielders (n=50-52). This is combined with football specific context to create conditioning practices for the collective but also positions and individuals. Conditioning modes used at the club include simulated situations in the form of team circuits, small sided games and positional play drills. Simulated Situations: Position Specific Team Circuits Circuits were developed to physically load players in relation to position specific activities while adhering to the teams playing style and individual player traits (Figure 1). For instance, players occupy common pitch areas for their respective positions. One version of the circuit commences with a defensive midfielder heading a ball at the halfway line, before dribbling and passing the ball wide to a fullback (Sequence 1). The fullback then passes to a supporting midfielder so he can overlap at high intensity before turning rapidly

to recover to a defensive position (Sequence 2). Three midfielders then switch the play (Sequence 3). The opposite fullback runs down the channel while one forward drives inside. The fullback receives the ball from a midfielder and dribbles along the flank before crossing into the box (Sequence 4). All forwards break into the box while the centre backs defend the cross (Sequence 5). This circuit can end after this or be extended by including a recovery run or additional actions such as a shot on goal (Sequence 6). This can be varied to challenge players with different scenarios with load controlled by manipulating rules/drill configuration, work/rest, reps etc. Average load metrics for this circuit are not presented as FC Barcelona alter these situations regularly to optimise the demands on each player in relation to their specific role and the team tactics for the next game. However, a similar drill has been used by English Premier League U17-18 Academy players whereby all positions are worked together (Figure 2A-C). All tactical-physical actions are based on integrated match data.9 The drill starts with the fullback producing an effort in the defensive third (first sequence) before overlapping the wide midfielder, to

Figure 1. Position Specific Team Circuit from FC Barcelona. (1) coach throws the ball to a defensive midfielder to head before he passes to a fullback, (2) fullback passes inside to overlap before recovering, (3) midfielders switch the play, (4) ball is passed into the channel for the fullback to run onto, while a forward drives inside, (5) selected forwards/midfielders break into the box to attack the cross (options A-C) while the centre backs defend. (6) a forward moves to the edge of the box to receive a coaches pass before performing a shot on goal.

B C 5 A 4


3 2 1


feature receive a pass in the wide attacking third to perform a cross (second sequence). Simultaneously, the centre forward breaks into the box to score while being tracked by the centre back, both having started in the middle third of the pitch (first sequence). The central midfielder drives through the middle of the pitch performing an arc run to support the attack ending with a possible shot on goal (second sequence). At the end, all positions produce a recovery run to individual pitch locations (final sequence). Using a speed endurance maintenance work to rest ratio of 1:2, all five positions produced 8 repetitions of ~30 seconds with 60 seconds recovery. This elicited an average and peak heart rate response of ~80 and 93% of maximal heart rate and produced a wide range of blood lactate concentrations following the final repetition of 6-16 mmolâ&#x2C6;&#x2122;L-1. Drills in which all positions are worked in unison with specific ball work adds variety to training while loading physical qualities alongside some tactical elements. More variation per rep is present in these circuits as the intensity can drop should one player perform a technical skill poorly (pass/touch) resulting in some positions having to slow down and alter their runs. Another limitation is the lack of unpredictable scenarios whereby individual and collective positioning needs to adapt and react accordingly, hence the complemented use of position play drills (see below).

Figure 2. Position-Specific Speed Endurance Team Drill. This drill has been employed by a English Premier League Academy and has similarities to FC Barcelonaâ&#x20AC;&#x2122;s circuit. (A) first sequence of drill: Coach plays ball inside FB to recover and play back to GK, at the same time the CM plays a bounce pass with CF before playing a ball over the top for the CF and CB to run on to contest. At the same time the WM drops to support the play but then pushes up and wide for an outlet for the GK. The FB then moves wide to receive the ball from the GK, CM drops to support the FB. The FB plays to the CM, the WM drops and moves inside the pitch to support the play. The CM passes to the WM whilst the FB performs an overlapping run. At the same time the CF and CB challenge for the ball over the top in a 1v1 situation resulting in the either the CF shooting on goal or the CB performing a clearance. (B) second sequence of drill: FB continues to perform overlapping run, CB pushes up the pitch whilst the CF performs a recovery run. The WM performs a trick upon receiving the ball from the CM, runs with the ball inside the pitch before playing a reverse pass out wide to the FB. The CM performs an arced run before driving through the middle of the pitch. The WM continues to run through the middle of the pitch. The CB and CF turn around the mannequin and start to accelerate into the box. The CM continues to drive through the middle of the pitch performing a swerve inside the mannequin. The FB runs with the ball and crosses into the box. The CF and CB run into the box to attack the ball whilst the CM and WM attack the front of the box and back post, respectively. (C) final sequence of drill: All players perform recovery runs back to set positions. See text above for description of drill.





football medicine & performance

Figure 3. Game Formats of the Positional Play Drills. Black circle is team A, White circle is team B and Grey circle with ‘J’ is the ‘joker’ or

sometimes known as ‘floating’ players.6

Simulated Situations: Team Positional Play and Overload in Attack/Defensive Transition Drills Other simulated situations used by FC Barcelona that have a subtler positional stimulus but align with their playing style are adapted small sided and positional games. These games are more dynamic than the circuits above as players have priority areas in which space is tailored to the player’s customary context in competition but without any rules restricting the players’ space during the task.6 Some games adhere to the principle of ‘positional play’ whereby players collectively work with a high tempo to pass the ball to each other in close spaces to draw in pressing players so they can pass to a wide open player to exploit space (e.g. Paco Seirul•lo methodology). Although these drills are certainly not position specific they require selected roles to position themselves intelligently (e.g. fullbacks are wide and can move up and down the line while central players can move between the lines in highly dense middle areas) and the team works dynamically and collectively in synergy. These positional play games do place different physical demands on selected roles. For example, using ‘joker’ players (also known as ‘floating’ players) encourages ball retention and generates numerical superiority for the team in possession.6 Thus, ‘joker’ players only experience an offensive role, in possession, thus this can be tailored towards distinct players. The physical demands placed on the ‘joker’ players in Figure 3 are lower than that imposed on others in the game (particularly for 8v8+3 versus 4v4+3 formats)6. GPS data highlights the demands on ‘joker’ players vs others for total distance (TD), the number of intense accelerations/decelerations (>3m.s2 ; ACC/DEC) and average metabolic power (AMP). These drills use a work to rest ratio of 2:1, whereby players produced 4 repetitions of 180 seconds with 90 seconds recovery. In 4v4+3: TD: 78 vs 69 m·min-1; ACC: 5 vs 4 n·min-1: DEC: 5 vs 4 n·min-1 and AMP: 8 vs 7 W·kg-1. In 8v8+3: TD: 106 vs 77 m·min-1; ACC: 4 vs 3 n·min-1: DEC: 4 v 3 n·min-1 and AMP:

11 v 7 W·kg-1. Additionally, game scenarios in 3v2+2v1 also physically load players in their offensive/defensive roles but are not necessarily position specific but mimic common dynamic positional scenarios while conditioning players (TD: 110 m·min-1; ACC: 3 n·min-1; DEC: 3 n·min-1; AMP: 14 W·kg-1). Rules, player numbers, area, work/rest can all be adjusted based on the conditioning aim. Thus, football context is absolutely key for training prescription7. For instance, factors such as the style of play of the team in addition to the position of each player can be accounted for. These are important pieces of the jigsaw in order to prepare training tasks so players can perform effectively. Using this approach, some of FC Barcelona’s conditioning has a distinct positional element to it (e.g. position-specific and/or positional play). 2. Positional Approaches to End Stage Rehabilitation: Using an Example from Liverpool Football Club Academy Throughout the rehabilitation process, elite players are exposed to various conditioning methods to enable a return to training and games8. Once players enter end stage rehabilitation and are medically cleared to perform maximal running and changes of direction, there is a need to prescribe drills based on the demands of training. Such drills not only prepare players for the physical demands of training but also the unique movements, skills and tactical actions required for their distinct position9. Players continue developing their aerobic fitness during end stage rehabilitation, therefore position specific drills can supplement on-going endurance training. In addition to providing a training stimulus, position specific drills that include sprinting, jumping, kicking and changing direction also place extra demands on the neuromuscular system ensuring players are robust and able to cope with training10. Position Specific Speed Endurance Drills: Individual End Stage Rehabilitation Drills using intervals enable practitioners to target certain physical qualities to ensure

players adapt and thus return successfully. An effective mode for this stage of rehabilitation is speed endurance training, as it improves football endurance and sprinting abilities11. This requires a player to perform intense football activity for 20-30 seconds using recovery periods between 40-180 seconds, which is repeated 8-10 times dependent on the aim of the drill (production training has a work to rest ratio of ~1:5-1:6 and maintenance training has a work to rest ratio of ~1:1-1.3). This taxes players aerobically and anaerobically whilst involving the ball, so is ideal preparation before a return to team training (complementing drills emphasizing other qualities)12. Liverpool FC Academy fitness/conditioning staff use an appropriate blend of science gathered from match analysis and the art of coaching to design position specific speed endurance drills. Match analysis demonstrates the number of high intensity efforts (>21 km.h-1) during games is greatest for wide midfielders (n=39) and lowest for centre backs (n=20), with fullbacks (n=31), central midfielders (n=29) and centre forwards (n=34) falling somewhere inbetween9. Contextualised match data provides insight into purposeful efforts in and out of possession and not just ‘blind’ distances and frequencies9. For example, in possession, centre forwards perform more efforts in the offensive third, whilst driving through the middle, running in behind, and breaking into the box. Whilst fullbacks and wide midfielders produced more efforts running the channel with fullbacks completing a greater number of overlapping runs9. They also perform more crosses after these runs than other positions due to efforts finishing in wide attacking areas. Out of possession, positions with a major defensive role in the team like centre backs, fullbacks and central midfielders produce more intense efforts covering space or team-mates and recovery running, whilst all positions perform frequent efforts closing down the opposition9. Thus, these patterns were translated into isolated position specific conditioning drills for players during end-stage rehabilitation. An example for a wide midfielder and fullback can be seen in Figures 4A-B,


feature Figure 4. (A) End Stage Rehabilitation Drill for a Wide Midfielder. (1) play bounce pass with coach A and make a run down the channel. (2) receive pass from coach A, run with the ball, perform a trick in front of mannequin. (3) execute in-swinging cross into mini goal, then perform recovery run. (4) receive another pass from coach A, perform a trick and run with the ball driving inside the pitch before passing the ball wide to coach B. (5) break into the box to receive a cross from coach B and finish into mini goal. (6) perform recovery run back to original start position on half way line. Please note: players are given freedom for some decision making while the coach will vary the type of pass and cross e.g. players have option to perform trick and beat mannequin during phase (2) to perform out-swinging cross into mini goal.(12) (B). End Stage Rehabilitation Drill for a Fullback. (1) Coach and FB play a one-two on either side of mannequin, moving FB side-to-side. (2) Coach plays ball down the inside for the FB to recover, FB sprints to recover the ball, turns and passes to coach inside the pitch. (3) FB overlaps coach around pole and receives pass in final third. (4) FB runs with ball and dribbles through mannequins. (5) FB delivers cross into mini goal. (6). Recovery run to the halfway line. Please note: players are given freedom for some decision making while the coach will vary the type of pass e.g. players have option to play off bounce board during phase (4) and cut back to play in swinging cross during phase (5).12 Individual player traits in terms of movements, tactical/technical events in training/games can also be added to conditioning drills for ecological validity purposes. Given the complexity involved in returning a player to training after injury, this drill is only one example from the players detailed end-stage rehabilitation plan

with some movements adapted to the teams tactical requirements for each position. GPS data captured during a speed endurance maintenance session (work to rest ratio of 1:2) completed by Liverpool FC Academy players returning from injury revealed that for selected speed thresholds (>14.4 and >19.8 km.h-1) wide midfielders (120 & 56 m) and fullbacks (104 & 60 m) covered greater distances per repetition across these drills than centre backs (68 & 16 m), central midfielders (93 & 28 m) and centre forwards (80 & 30 m), which is consistent with match trends13. Furthermore, centre backs and forwards covered the lowest overall distance per repetition (215 & 233 m.min-1, respectively) but performed greater total accelerations and decelerations (n=14 & 15) than full backs (n=11) and wide midfielders (n=9) though similar to central midfielders (n=13). High intensity accelerations and decelerations were more frequent for full backs (n=6), centre backs (n=6) and forwards (n=4) than central midfielders (n=3) and wide midfielders (n=3)12. This also elicited an




average and peak heart rate response of ~85 and 91% of maximal heart rate and produced blood lactate concentrations following the final repetition of >14 mmol∙L-1. This format can also be useful for ‘top up’ sessions when players are not getting game time or working multiple positions in unison to add a dynamic scenario. The conditioning coach not only prepares players for the demands necessary for training but also familiarizes them with ball striking, discrete positional movements, orientation of space on the pitch, whilst providing a reactive stimulus so players are exposed to uncontrolled movements when training with additional players. Elite clubs should use their analysis department to study player movements to create bespoke drills that are not only position specific but ideally individual specific (moving away from ‘blind’ distances/frequencies). This may enable practitioners to identify movement dysfunction and improve mechanics such as turning off a particular shoulder or body position when decelerating to press an opponent.

Summary Elite football training requires a blend of science and the art of coaching to design appropriate team and individual drills7. The approaches presented (positionspecific and/or positional play) illustrate that context really does matter when implementing personalized conditioning practices. It might be advantageous to supplement training with a stimulus related to a players’ tactical role in the team and even elements of the club’s playing style/energetic profile. It’s important to stress that there are many effective ways to accomplish this type of work and we have only provided a few examples for the interested reader (e.g. many approaches can be used that are specific to the methodological and cultural aspects of each club). Ideally, future work would use integrated match analysis systems to detail football specific context when providing conditioning guidelines.7,9,12,14,15.

football medicine & performance

1.Bradley PS, Archer DT, Hogg B, Schuth G, Bush M, Carling C, & Barnes C. Tier-specific evolution of match performance characteristics in the English Premier League: it’s getting tougher at the top. J Sports Sci. 2016;34(10):980–987.

AUTHORS Paul S Bradley Reader in Sports Performance at Liverpool John Moores University & FC Barcelona Consultant Andres Martin-Garcia Fitness Coach at FC Barcelona Jack D Ade U23’s Fitness Coach at Liverpool Football Club & PhD Researcher at Liverpool John Moores University Antonio Gomez Diaz Fitness Coach at FC Barcelona

Please note: This article is based on information previously published on the Barca Innovation Hub.

2.Ade JD, Harley JA, Bradley PS. Physiological response, time-motion characteristics, and reproducibility of various speed-endurance drills in elite youth soccer players: small-sided games versus generic running. Int J Sports Physiol Perform. 2014;9(3):471–479. 3.Bush M, Barnes C, Archer DT, Hogg B, Bradley PS. Evolution of match performance parameters for various playing positions in the English Premier League. Hum Mov Sci. 2015;39:1–11. 4.Martín-García A, Gómez AD, Bradley PS, Morera F, & Casamichana D. Quantification of a Professional Football Team's External Load Using a Microcycle Structure. J Strength & Cond Res. 2018; 32(12):35113518. 5.Martín-García A, Casamichana D, Díaz AG, Cos F, & Gabbett TJ. Positional Differences in the Most Demanding Passages of Play in Football Competition. J Sports Sci & Med. 2018; 17(4), 563-570. 6.Casamichana D, Díaz AG, Morera FC, & Martin-García A. Jugadores comodines durante diferentes juegos de posición [Wildcard Players during Positional Games]. Apunts. Educación física y deportes. 2018; 3(133), 85-97. 7.Bradley PS, Di Mascio M, Mohr M, Fransson D, Wells C, Moreira A, Castellano J, Gomez Diaz A, & Ade J. Can Modern Football Match Demands Be Translated into Novel Training and Testing Modes? Aspetar Sports Med J. 2018; 7, 46-52. 8.Morrison S, Ward P, & duManoir GR. Energy system development and load management through the

rehabilitation and return to play process. Int J Sports Phys Therapy. 2017; 2 (4) 697-710. 9.Ade JD, Fitzpatrick J, & Bradley PS. High-intensity efforts in elite soccer matches and associated movement patterns, technical skills and tactical actions. Information for position-specific training drills. J Sports Sci. 2017; 34 (24), 2205-2214. 10.Vanrenterghem J, Nedergaard NJ, Robinson MA, & Drust B. Training Load Monitoring in Team Sports: A Novel Framework Separating Physiological and Biomechanical Load-Adaptation Pathways. Sports Med. 2017 47, (11) 2135-2142. 11.Bangsbo J. Performance in sports – with specific emphasis on the effect of intensified training. Scand J Med & Sci Sports. 2015; 25 (Suppl. 4), 88-99. 12.Ade JD, Drust B, Morgan O, & Bradley PS. Physiological Characteristics and Acute Fatigue Associated with Position Specific Speed Endurance Soccer Drills: Production vs Maintenance Training. BASES Conference, Free Communication – Sport & Performance. 2018. 13.Bradley PS, Sheldon W, Wooster B, Olsen P, Boanas P, & Krustrup P. High-intensity running in English Premier League soccer matches. J Sports Sci. 2009; 27, (2), 159-168. 14.Bradley PS, Evans M, Laws A, Ade JD. ‘Context is King’ when interpreting match physical performances. Football Medic & Scientist Magazine. 2018; 24:42–45. 15.Bradley PS, Ade JD. Are current physical match performance metrics in elite soccer fit for purpose or is the adoption of an integrated approach needed? Int J Sports Physiol Perform. 2018; 13: 656–664



PRE-SEASON – WHEN FOUNDATIONS ARE LAID So you’ve coached, guided and nurtured your team through the season, with its vast catalogue of highs and lows. Perhaps you’ve won a title, captured domestic or international trophies, or clinched a hard-earned promotion to a higher division. Maybe you’ve masterminded recovery and survival from a seemingly hopeless position, and avoided relegation against all the odds. You’ve coped with myriad internal and external pressures, and come through the other side. Well-earned rest and recreation beckons – but the next campaign is already looming on the horizon… and preparations for the new season lie in wait around the corner.


football medicine & performance The ‘pre-season’ period of several weeks is crucial for coaches and their squads in the search for success. The coaches strive to create a team spirit and cohesion that will prove its worth through the months to come. They plan, organise, improve and define objectives, and ensure that the players are in tune with the coach’s overall vision for the campaign. Coaches can, among other things, try out tactical variations, or blood youngsters to help them gather vital experience for the future. It might also be a ‘getting to know you’ period for a coach as he – or she – sets out on a job with a new club. As for the players, they are coming back after their own much-needed break. Working together with the coach and his staff, players sweat and graft to reach maximum fitness and attain ideal match sharpness levels – to be ready and present for the battles ahead. Taking a break Before then, at the previous season’s conclusion, coaches need a ‘timeout’, a welcome holiday, to replenish energy levels. Each of them has their preferred ways of refuelling the engine – be it relaxation on a beach, cherished family time or walks in countryside calm. However, with fresh challenges just a short distance away, how easy is it for the coach to recuperate between seasons? Thomas Schaaf, a veteran of countless Bundesliga campaigns with Werder Bremen and Eintracht Frankfurt, highlights a particular dilemma: “As a coach, I’m thinking that the season is at an end, but I’m asking myself how my

squad is set up – the squad isn’t complete yet, and there’s work to do during the break. I have to look at which results I can achieve in the preparation, and when.”

says Paatelainen, “introduce everybody and do everything within your powers to help them settle into a new environment, a new country, a new culture.

Constant success for a coach also has an impact that needs addressing in terms of taking a rest. “The ends of the season were always exhausting, because we were always involved in something,” says Sir Alex Ferguson, who, as a winner of honours galore with Manchester United FC and Aberdeen FC, is in a perfect position to make an assessment. “It always went to the last game or so, or you were in a final. I only used to take two weeks’ holiday when I was a young manager. It was not until about 18 years ago that I started taking three or four weeks’ holiday. That is a matter of needing it.”

Obviously, you have private discussions with the player regarding tactics and weekly routines – you make sure the player feels at home.” The pre-season period is an essential moment for careful team-building on and off the field, with new players looking to fit in seamlessly and quickly with their new team-mates, and make a good overall impression on coaches and colleagues. Team training camps are seen as an excellent way of bonding a squad together and getting away from daily routines. “When you’re training at your own training ground,” says Paatelainen, “the players go home – but at a training camp, you meet together, you have activities in the evening, social things with the players. That’s where the players get to know each other really well – there’s possibly one or two jokes going about, and maybe new nicknames that might stick! It’s very important – that really gels the team together, because you are 24 hours together.”

“You do think about the next season, even well before the break,” reflects Mixu Paatelainen, who has coached extensively in Scotland, as well as managing the national team in his native Finland. “It is important to be able to switch off, and to do activities such as fishing or golf, where you can engage your mind totally, instead of dwelling on your work. But it is very difficult, because there are so many things to think about.” Team-bonding Player transfers are a dominant part of every summer, with each club welcoming newcomers, sometimes in considerable numbers. Alongside the key involvement in deciding which players come in, the coach’s task is to help the recruits bed in to their new surroundings. “You want to make the new players as comfortable as possible,”

“Team-bonding has an important role,” adds Sir Alex. “In the last 15 years, we went abroad all the time, for commercial reasons, going to the Far East or the United States. The new players would have a dinner, and they would have to sing a song, make a statement or make a bit of poetry. It was just a way of light initiation. The players are pretty good at that … they enjoy that part.” Most clubs carefully plan their pre-season match programme, with games against lowerlevel opposition followed by more testing outings that

As a coach, I’m thinking that the season is at an end, but I’m asking myself how my squad is set up - the squad isn’t complete yet, and there’s work to do during the break.” Thomas Schaaf German football coach



might include a tournament featuring topnotch international outfits. “Today, there may be six, seven or eight closeseason transfers, or perhaps even more,” says Schaaf. “This means that a team has to become attuned to each other as quickly as possible. Of course, everyone wants to prove themselves against strong teams. But you need to be able to analyse, adapt and apply certain things, so you need the gradual increase in intensity to then be able to produce optimum performance against strong opponents.” Schaaf stresses that the diligent pre-season fine-tuning and experimenting process should ideally mean that actual results at this stage ought not to be viewed by the public or media as being of fundamental importance. Observing the changes David Moyes, a coach at the highest levels with Everton, Manchester United, Real Sociedad de Fútbol and now Sunderland, says he has seen various changes in pre-season preparations from when he was a player up to the start of the new millennium. “When you came back for pre-season preparation,” he explains, “you were never in great shape. The breaks were bigger for the players, and you did have to work very hard in pre-season to keep yourself in shape. Training was much harder, less with the ball at that time, much more running-orientated, and I think that, over the years, that has changed. I would say that even in my own work as a coach, most of the work would be done now with the ball.” “What I have just seen a little bit of recently is going back to where it was before,” Moyes adds, however. “I think, without doubt, that people want their players to be fit. Coaches want to do most things with the ball, but you want your players to feel fit as well. So there is a balance in getting that right.” It’s July/August for a club playing an autumn-winter-spring season. The grass is green, the sun is shining, the coach is proudly watching over his charges. A time for natural optimism, because, as Sir Alex rightly points out: “You can’t lose a game then.” Every coach is united by the firm hope that the hard yards of planning, training and dedication put in by everyone under those summer skies will lead to the feeling of losing becoming an absolute rarity, once the serious business of getting results kicks off in earnest…

GETTING INTO GEAR Even if they may find the work gruelling, players recognise the importance and benefit of pre-season training, for themselves and the team as a whole. It’s the time to gradually run through the gears and attain fitness and sharpness to embark on the serious rigours of the months ahead. Gareth Southgate, manager of the England Under-21 team, played over 500 club games at England’s highest levels, and made 57 appearances for England’s national team, including EURO and World Cup final rounds. He looks at his pre-season experiences:

it was very different to having a six-week pre-season, where you are starting from almost nothing, to coming in later with some sort of match play within a couple of days.

“I think there were two phases for me – one when I was a young player, where you were looking at gaining strength for the season, and making sure that you were in good condition when you went back to training to impress the manager. So you wanted to be in a good place before the start of pre-season.

“I think, generally, it’s very hard to go into the first competitive game completely fit and where you want to be. But you’re also conscious that this just takes time. The matches in pre-season are never quite the same as the matches at the beginning of the season. I think everybody suffers a little bit in the first few weeks.

“Then, once I was a little bit older, I was always coming back from having played international matches, so you had a smaller period, maybe normally three weeks – so then it was just a question of getting match sharpness. Your basic fitness was there, so

“I was always happy and ready to go. As long as there was long enough to switch off from the last season to think about your objectives and your goals for the next season, three weeks was always enough for me.”

Reproduced by kind permission of UEFA


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REGISTER It is always great to see our Register members assisting lower league clubs at times of need. Their expertise and knowledge is invaluable when dealing with a host of challenging injuries or when in need of sports science input to monitor or improve performance. Dorking Wanderers FC for example, recently sought the services of Physio Steve Allen, who is listed on the FMPA Register, and who was tasked with alleviating a crippling injury list. Dorking went on to win the title and promotion to the National league South division last season which may not be a co-incidence! With this in mind I have recently made contact with over 140 semiprofessional league football clubs to highlight the fact that they too can access experienced practitioners on the FMPA Register and I will continue to liaise with them on a regular basis extolling the virtues of accessing our site in the coming season. Tiers 6 and below most certainly have a need to improve medicine and performance provision at their Clubs and we will make sure we direct them all to our Register accordingly.

Angela Walton Angela Walton Project Manager


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football medicine & performance  

Issue 29 - Summer 2019

football medicine & performance  

Issue 29 - Summer 2019

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