The official magazine of the Issue 24 Football Medical Association Spring 2018

In this issue: Anxiety & Getting Injured Cryotherapy Exposure Durations Antioxidant Supplements Context is King; Interpreting Match Performance

Exclusive: Football Rehabilitation How to safely reintegrate, avoid re-injury and prepare players for the demands of the Premier League FMA FOOTBALL MEDICAL ASSOCIATION www.footballmedic.co.uk Contents Welcome

4 Members’ News Features 6 Football rehabilitation: How to safely CHIEF EXECUTIVE OFFICER reintegrate, avoid re-injury and prepare players for the demands of the Premier League s an educational platform we once again look to our colleagues working in the Damian Roden sporting arena to relate their own experiences within the scope of the Conference Atitle, which this year is ‘Development and Innovation in Sports Performance and 13 Women’s football and the menstrual cycle... Medicine’. The title deliberately allows scope for a wide variety of discussion points and how we can further individualise? ideas and what can be better than learning and identifying with fellow practitioners. Andrew Wiseman & Georgie Bruinvels As a networking experience the event is second to none, as this piece of feedback 15 FMA Conference & Awards 2018 received last year from Lincoln City Football Club’s Head of Sports Science, Mike Hine, testifies: 30 Grass to game Scott Pearce “The conference was fantastic for our department last summer. We spent the Saturday night on a table with Middlesbrough’s staff discussing all things medical and sports 32 Why screening ‘mental health’ might be the science. Where else could you bring together two groups that in the previous season had missing link in reducing injury been working in the top tier and the fifth tier? Andy Barker “The networking element that we took from the event was brilliant. Several offers from 34 Don’t waste your time taking antioxidant superior club staff to visit their training grounds and get an insight into their work was supplements after exercise remarkable. I personally have contacted a number of the people I met that weekend in Mayur Ranchordas order to seek advice or guidance on certain things this season.”

38 The effect of three different (-135°C) whole With the Conference also serving as an awards event, we continue to recognise the body cryotherapy exposure durations on tireless endeavours of our members. We have already had four-times more nominations elite rugby league players sent through than last year for various categories within the awards programme; a clear Jill Alexander indication of the value in which these awards are now held.

42 ‘Context is king’ when interpreting match With an exceptional event management team now in place, state-of-the-art AV system physical performances and a well-known host conducting the awards, the entire event now demonstrates Paul S Bradley, Mark Evans, Andy Laws exactly where we are. & Jack D Ade Enjoy this issue of Football Medic and Scientist. I look forward to seeing you at this year’s Conference.

Eamonn Salmon CEO Football Medical Association

Football Medical Association, 6A Cromwell Terrace, Gisburn Road, Barrowford, Lancashire, BB9 8PT T: 0333 456 7897 E: [email protected] W: www.footballmedic.co.uk Chief Executive Officer Eamonn Salmon [email protected] Executive Administrator Lindsay Butler [email protected] Project Manager Angela Walton Cover Image [email protected] Southampton’s Charlie Austin limps off injured Design Oporto Sports - www.oportosports.com during the Premier League match at St Mary’s. Marketing/Advertising Charles Whitney - 0845 004 1040 Adam Davy/PA Images Photography PA Images, Liverpool Football Club, Football Medical Association Football Medical Association. All rights reserved. Contributors Jack D Ade, Jill Alexander, Andy Barker, Paul S Bradley, Georgie The views and opinions of contributors expressed in Football Bruinvels, Mark Evans, Andy Laws, Scott Pearce, Mayur Medic & Scientist are their own and not necessarily of the Ranchordas, Damian Roden, Andrew Wiseman FMA Members, FMA employees or of the association. No part of this publication may be reproduced or transmitted in any Print Media Village form or by any means, or stored in a retrieval system without www.media-village.co.uk prior permission except as permitted under the Copyright Designs Patents Act 1988. Application for permission for use of copyright material shall be made to FMA. For permissions contact [email protected]. 3 members’ news football medic & scientist Scottish Football Association Meeting

meeting was held at Hampden Park MEMBERS’ NEWS in January attended by Eamonn ASalmon and Alan Rankin from the FMA and Graeme Jones, Head of Football Science and Medicine at the Scottish FA. Discussions revolved around the role of the FMA in supporting members and how COLCHESTER UNITED’S FIRST TEAM their reach into Scottish football could be TH facilitated by the Scottish FA. PHYSIO CELEBRATES 1000 MATCH Eamonn Salmon said “This was a very positive and beneficial meeting with Graeme and there was much agreement on the way forward in terms of addressing ongratulations to Tony Flynn on reaching back on his feet after an injury it is really nice. It colleague’s needs in Scottish football. his 1000th match and who amazingly is great to see them back out there doing their Chas only missed 3 matches in his 23 year stuff.” “We are delighted to be working with career! As an FMA Member Tony was presented such a positive and forward thinking with his “21 Club Award” at the FMA Conference Tony said he didn’t realise his 1,000th match organisation and will look to consolidate & Awards in 2016. Team mates from Colchester was approaching and only found out shortly our presence in Scottish football with the United also attended the event to congratulate before the match. Scottish FA’s support.” Tony on this fantastic achievement. He has some good advice for those looking to Graeme Jones added “I’d like to thank Tony, who has been at his current club for 12 get into football physiotherapy – to get into a Eamonn and Alan for taking the time to years, made his 1,000th appearance on Saturday club as soon as you can. meet with me and discuss the benefits as The U’s beat Newport County 2-0 at the the FMA can provide sports science community stadium. “It is all very well working with your local gym but and medicine staff in Scottish Football team manager. Now we have lots of people who there is a difference between that and the high through its membership. I am sure this He started his career as a physio at Leyton back us up. intensity of professional football. will be well received and look forward to Orient in 1996 before moving in 2003 to join the relationship between the Scottish Wimbledon, which later became the MK Dons. “We have sports scientists who help out in “I don’t think people often understand how very FA and FMA improving the practice and He joined Colchester in 2006, just after the club terms of telling us if the balance of training and intensive it is which leads to more injuries. support of colleagues within Scottish were promoted to the championship. treatment is good. “I would advise they get into a football club as Football.” soon as soon as they can and get in at the sharp Tony said a lot had changed over the years in the “The surgical procedures are also much more end. way physiotherapists treat injured players – but advanced now, particularly with ACL (anterior that the trusty ‘magic sponge’ was still a key cruciate ligament) injuries. “Write to the football clubs and offer your part of his kit. services. “But if you look, a lot of us still carry water and “The game has got quicker and more intense,” a sponge. I always carry a bag of ice too in case “You may not be doing very much hands-on but he said. someone gets a knock. you will pick up, learn and absorb knowledge.” Lawyers to speak Board “When I started there was me, the kit man, the “Some of the old things physios have been doing To read more about the 21 club visit manager, the assistant manager and the youth for many years still work. When you see a player www.footballmedic.co.uk/21-club/ at FMA Conference Appointment

his year’s FMA Conference, ollowing our recent board meeting titled ‘Development and we are pleased to announce TInnovation is Sports Fthe appointment of Dr Edmund Performance and Medicine’, will see Morris as a Non-Executive Director. RYAN MASON THANKS HULL CITY MEDICAL TEAM us introduce the FMA’s lawyers into Dr Morris is a practising consultant the schedule. In true FMA tradition, anaesthetist and also brings a he 26-year-old fractured his skull in a have helped me to recover from what was a life- we like to throw something different huge amount of experience to the Premier League clash with Chelsea in threatening injury in January 2017. in to the mix to provide a tangent to board in management, negotiation, TJanuary 2017. the main theme; something that gets teaching and training, organisational “I would like to thank everyone at Hull City, delegates thinking and talking. development and regulatory matters. Emergency surgery last January is credited with especially The Doc Mark Waller and all of the saving Mason’s life but the reluctant decision medical team for helping me to recover More importantly this introduction Dr Morris is an associate member has now been taken for the midfielder to hang comes as a result of there still being of the General Medical Council and up his boots after a recent consultation with a “I’m retiring from the game with my head held issues at large for members that tribunal member for the Medical leading neurosurgeon. high having done everything in my power over have potential risks. These should be Practitioners’ Tribunal Service. He is these past 13 months to have given myself every highlighted and addressed accordingly therefore well positioned to advise “I can confirm that following specialist opportunity to return to the pitch. and the Conference provides a perfect the board on current trends including medical advice I am having to retire from occasion to do so. It is why each and disciplinary procedures, appraisal playing professional football,” Mason said in a “I feel content knowing that I dedicated my life every club should have representation and revalidation which are relevant statement. to be able to play football at the highest level, at the Conference, in order to keep- to all professions involved in football hard work really does pay off! I love the game, up-to-date and informed on matters medicine and performance. “I am and always will be eternally grateful for I always will and I am excited to see where that are very important issues. the incredible network of people around me who football will take me next.”

4 [email protected] www.footballmedic.co.uk 5 feature feature football medic & scientist

Of course, there will potentially be a range of different exercises that the practitioner responsible for rehabilitation will want to perform, but the key is Football rehabilitation: to always improve the ‘quality’ of each action in order to progress so the number of exercises similar to the number of sets and repetitions should be kept to a how to safely reintegrate, avoid minimum.

Similarly, because the ‘quality’ training sessions re-injury and prepare players for precede the ‘quantity’ training sessions it is important that there is no fatigue going into the the demands of the premier league more demanding ‘quantity’ sessions. ‘Quantity’ training

As soon as players can put weight through the FEATURE/D amian Roden injured joint or muscle group, the ‘quantity’ element (jogging) they stay within safe boundaries in relation that there are more accelerations in the same period of of training can also commence. The term ‘quantity’ to their injury but they perform multiple accelerations time. An example of which can be seen in diagram 2. refers to the number of actions performed per each set where every time they increase the intensity Injuries in professional football are commonplace and whilst numerous strategies that are training session that in comparison to the ‘quality’ from a walk to a jog they stimulate their immediate As you can see in diagram 2 players repeat the same training sessions is greater to enable players to energy system (phosphate system) which is process as rehabilitation interval run 1, but instead of supported by science are put in place to prevent injuries from occurring many practitioners improve their physical condition. important as that is what happens in a game each jogging then walking at each line, they progress from time a player performs an explosive action. jogging to accelerating at 55-60% at each line. suggest that injuries are unavoidable. Interval Runs Progression In comparison to interval run 1 by replacing walking Regardless of how severe the injury is players with accelerating, players perform a greater quantity n a well structured and balanced training Football Rehabilitation : Weekly Structure greater intensity, maybe 55% of what they should be encouraged to perform interval training Using this example in the context of the training of accelerations in the same period of time. Over programme however almost every injury is normally perform when they are injury free, as soon as possible for a specified number of sets week, the next time the player performs a ‘quantity’ a short period of time you will therefore notice a Monday ‘Quality’ Training Iavoidable and when an injury does occur, more a significant improvement from the first and repetitions. This does not mean that players training session they should perform the same vast improvement in both quality and quantity of often than not whenever you look back along the Tuesday ‘Quantity’ Training ‘quality’ training session. are placed at risk by performing exercises that they interval run but instead of performing 3 x 5 minutes actions specific to the game of football and players timeline leading to an injury there is a glitch or an cannot possibly cope with, it simply means that with 2 minutes rest in between they should perform will quickly progress towards the ability to perform oversight in the planning, prevention, conditioning, or Wednesday ‘Recovery’ Training Rest between actions they perform exercises that mirror the intermittent 3 x 6 minutes with 2 minutes rest in between. By actions at 100% of maximal intensity. regeneration process particularly on an individual level. Thursday ‘Quality’ Training demands of football. increasing the duration of each set, players will perform a greater ‘quantity’ of accelerations at 50% Given the number of actions per minute, Interval runs Friday ‘Quantity’ Training To maintain the desired execution of each When an injury does occur and the cause of the Using the same example as before, even if the player than before therefore placing an overload on the 1 and 2 replicate the demands of large sided games. injury has been investigated it is important to focus Saturday ‘Recovery’ Training ‘quality’ action it is important that players with a hamstring injury is only capable of running at player to achieve a training effect. (8v8/11v11). on safely rehabilitating the player and reintegrating Sunday ‘Rest’ have maximum rest between each action to 50% of their normal maximum intensity they can them back into training effectively in order to prevent ensure full recovery of the immediate energy still perform interval runs. A hypothetical example of Similarly, because the player will have performed Progression re-injury. system (the phosphate system) and also which can be seen in diagram 1. another ‘quality’ training session prior to the second full recovery of the neuromuscular system. ‘quantity’ training session it is likely that the intensity As the player progresses and is able to perform The key here, however, is that the team training ‘Quality’ Training (Messages from the brain to the muscles) As you can see in diagram 1, the player starts at of each action will be greater than 50% (perhaps more intense actions, for example 70% of maximal should be used as the reference point that determines the touch line and slowly accelerates at 50% of 55-60%). intensity, it is important to expose them to a greater the content of the players’ rehabilitation programme. As soon as a player is able to put weight As a general rule if the practitioner maximum intensity (jogging) to the 18 yard line, frequency of actions specific to the number of actions To ensure players continue to safely make progress, that they will experience when they return to training. through the injured joint or muscle group, responsible for rehabilitation allows for 12-18 walks to the half way line, slowly accelerates at 50% The reason for this is that by the time the player is the ‘quality’ element of their rehabilitation of maximum intensity (jogging) to the opposite 18 each ‘quantity’ training session thereafter should ready to return to full training with the team, if there times the duration of each action before can commence. The term ‘quality’ refers to yard line, walks to the opposite touch line, turns be given careful consideration in relation to how the This can be done simply by following the same is a progressive training structure in place and it has performing the next action ‘quality’ will be the intensity of each action, the rest period and repeats the process. In this example the player interval runs are progressed. process as interval runs 1 and 2 but by using the been implemented properly it is likely that the team maintained and each action will be at 100%. width of the pitch instead of the length of the pitch in between each action and the number of hypothetically performs 3 x 5 minute sets with 2 will be performing a greater volume than before the So if a player recovering from a hamstring minutes rest in between. This can be done in a number of ways by simply as illustrated in diagram 3. player received the injury. So not only does the player actions. injury performs a lunge for example that increasing the duration from 3x6 minutes to 3x7 have to get over the injury, they have to be prepared takes 2 seconds, they should be given 24-36 Because the player is only accelerating at 50% minutes to 3x8 minutes or by structuring the runs so As you can see in diagram 3 Players start at the for an increased volume of training. Intensity of actions seconds recovery time before performing another lunge. The rehabilitation period will ultimately be dependent Regardless of how severe the injury is, 1. 2. 3. upon the severity of the injury, but no matter what each weight-baring exercise should be at Number of actions the injury is the rehabilitation should follow a simple 100%. That does not mean that players put and logical structure that dovetails Into the team unrealistic force through the injured site, it training structure. Although there is not a game at Because the objective is to maintain the the end of the training week, the same principles simply means that the action they perform is ‘quality’ of each action, performing endless of training that apply to the team also apply to the at 100% intensity of what they can manage amounts of actions will undoubtedly affect injured player. Of course the injury itself determines to perform at that particular time pain free. the ability to perform at 100%. The number what can and can’t be done each day but regardless Such actions may only be 50% of what they of actions each ‘quality’ training session of the injury the focus of the training week should be can normally perform when they are injury should therefore be kept to a minimum. consistent. free but the objective of ‘quality’ training is Using the same example, a player performing to go from 100% to 101% so there is always lunges following a hamstring injury should The following football rehabilitation weekly structure an improvement. therefore uses a simple cycle that is repeated twice perform a small amount of sets and each week to help the injury improve in the form repetitions, hypothetically speaking 2-3 sets Using this example, if each action performed of ‘quality’ training, improve the players physical of 4-6 repetitions. condition in the form of ‘quantity’ training and during the first ‘quality’ training session is at to allow for super-compensation and ultimately 100% then the next time the player performs By progressing in this manner the players’ a training effect to occur in the form of ‘recovery’ a ‘quality’ training session the player capability to perform greater intensity of actions training and ‘rest’. should be able to perform each action at a will improve fairly rapidly.

6 [email protected] www.footballmedic.co.uk 7 feature football medic & scientist touch line and jog to 18 yard line, accelerate at 70% opposite 18 yard line, turn and sprint at 95-100% to to penalty spot, Jog to opposite 18 yard line, walk to the 18 yard line for the full duration. opposite touch line, turn and repeat the process. Given the intensity and the number of actions Not only are the intensity of accelerations greater per minute, Interval runs 5 and 6 replicate the because of the stage of rehabilitation reached but demands of small sided games. (3v3/4v4) the length of the accelerations are shorter and more realistic to the average length of sprints in ‘Recovery’ training a game, and more frequent than the number of accelerations in interval runs 1 and 2. In a well balanced and structured rehabilitation programme ‘recovery’ training is as important as Because of the increase in intensity and number of both the ‘quality’ and ‘quantity’ training sessions accelerations per minute in comparison to interval to enable the body to heal, adapt and improve. runs 1 and 2 however, it is not realistic for players to perform interval run 3 for the same duration. Even though the intensity and duration of the early Hypothetically therefore players should perform stage rehabilitation sessions are not as demanding more blocks of shorter duration. For example 4 x 3 as the later end stage rehabilitation sessions the minutes with 2 minutes rest in between. demand on the body is the same because it is working at 100% of its capacity for that particular To ensure players continue to improve at period of time given the restrictions of the injury. each stage of their rehabilitation there should be a progression for each interval run all the Recovery following both the ‘quality’ and ‘quantity’ way through to when they are re-integrated training sessions each training week similar to into training. This can be done by progressing can be done using a similar approach to interval recovery following team conditioning sessions and rehabilitation interval run 3 by increasing the runs 1-4 but because the players are able to games should aim to encourage blood flow to help duration from 4x3 minutes to 4x3.5 minutes to perform near maximal accelerations they should remove build up of waste in addition to careful 4x4 minutes etc. Alternatively, it can be done by perform a greater amount of blocks but for shorter considerations regarding nutrition. increasing the number of accelerations within the duration, for example 2x6x1minutes, with 2 same time period, an example of which can be minutes rest between repetitions and 4 minutes Movement within a swimming pool ensures there seen in diagram 4. rest between sets as illustrated in diagram 5. is no weight going through the injured joint or As you can see in diagram 5 Players start at touch muscle group whilst the pressure of the water Case Study The player in question began this process following The table above illustrates the players’ response As you can see in diagram 4 Players start at the line and jog to 18 yard line, accelerate at 80-90% helps to encourage blood flow back to the heart for an extremely poorly executed rehabilitation to training in relation to their season average for touch line and jog to 18 yard line, accelerate at 70% to penalty spot, jog to opposite 18 yard line, turn removal and should form the basis of recovery for The following information provides an example of programme from a broken leg that also consisted of the parameters listed. As you can see each ‘quality’ to penalty spot, Jog to opposite 18 yard line, turn and accelerate at 80-90% to penalty spot and jog early stage rehabilitation in particular. Similarly a how football rehabilitation was implemented with several muscle injuries. training session (green) remained fairly consistent in and accelerate to penalty spot, jog to 18 yard line to touch line. change of environment always helps to maintain a premier league midfield player. It consists of daily terms of duration and level of difficulty, whilst the and walk to touch line. fresh thoughts particularly with longer term explosivity preparation exercises, football specific Following 3 weeks of the ‘football rehabilitation’ ‘quantity’ training sessions (red) gradually increased This should be done until players are able to sprint injuries. ‘quality’ training sessions (in and out of possession), approach the player was re-introduced into training in intensity towards the end of the rehabilitation Given the number of actions per minute, Interval maximally each time they accelerate so that the and ‘quantity’ training sessions using the afore- and competitive games and remained available for programme closely mirroring the demands of a runs 3 and 4 replicate the demands of medium intensity and frequency of accelerations mimic the ‘Rest’ mentioned interval runs progressively. selection and injury free for the complete season. match. sided games (5v5/7v7). demands of football. The final progression prior to returning to training and more specifically games Whilst the aim is to safely reintegrate players back Intensity is to make the interval runs more demanding. into training and games and prevent re-injury, the faster this can be done the better. Rest following This approach should be followed by gradually This can be done by reducing the rest period a ‘recovery’ training session and prior to the next increasing the intensity of accelerations each between each repetition from 2 minutes to 1.5 ‘quality’ training session enables the practitioner ‘quantity’ training session until players are able minutes to 1 minute between each repetition or to increase the intensity of each second ‘quantity’ to accelerate at 80-90%. Once the players have by increasing the number of accelerations within training session as there is an increased period for performed the necessary ‘volume’ of work it is the same time period as illustrated in diagram 6. the body to adapt. Greater adaptation will lead to time to progress to the end stage of rehabilitation As you can see in diagram 6 Players start at the 18 a faster rehabilitation period whilst also improving to prepare them for safe return to training. This yard line, sprint at 95-100% to penalty spot, Jog to their physical condition.

4. 5. 6.

Pictured: Manchester City’s Ilkay Gundogan has been available most of the season after suffering a cruciate ligament injury and was out for nine months

8 [email protected] www.footballmedic.co.uk 9 feature football medic & scientist

Explosivity Preparation Exercises Position Specific ‘Quality’ Exercises

Explosivity Preparation Exercises were used progressively each training day to prepare the hamstrings Position Specific Exercises were used from Day 1 of the football rehabilitation programme albeit by reducing for accelerating and decelerating and also help the player deal with the build up of lactic acid. the intensity of each action and the distances of the servers and target goals. Each ‘quality’ session however consisted of 2 blocks of 4-6 repetitions with maximum rest in between each repetition.

‘Quality’ Training Day 1 each week consisted of position specific exercises in possession.

Damian Roden is a highly regarded and well respected performance coaches in the Premier League and beyond.

With a resume that includes Manchester City and Australia, Damian ‘Quality’ Training Day 2 each week consisted of position specific exercises out of possession. was influential in Wales meteoric rise up the world rankings and more recently helped Stoke City record their highest league position in the club’s history over 3 consecutive seasons.

Damian was one of the youngest coaches to gain the UEFA Pro Licence in the U.K. and is now about to embark on a new post as Director of High Performance with the most successful team in Major League Soccer, the Seattle Sounders.

‘Quantity’ Training Sessions began with interval run 1 and progressed all the way through to Interval run 6.

10 [email protected] www.footballmedic.co.uk 11 feature football medic & scientist Women’s football & the menstrual cycle... how we can further individualise? FEATURE/A ndrew Wiseman & Georgie Bruinvels

Female athletes are two to eight times more likely to rupture their anterior cruciate ligament (ACL) than men when using the same rules and equipment.1

Crucially however, risk is enhanced further While it may be difficult to modify joint laxity, 1.Boden BP, Sheehan FT, Torg JS, Hewett TE. at certain times in the menstrual cycle in a solid programme to increase muscular Noncontact anterior cruciate ligament injuries: line with the changes in ovarian hormones strength and heighten neuromuscular control mechanisms and risk factors. J Am Acad Orthop 2. Specific injury prevention programmes should become an integral part of the female Surg. 2010;18(9):520-527. incorporating individualised neuromuscular players individual training programme. Further, 2.Balachandar V, Marciniak J-L, Wall O, Balachandar C. Effects of the menstrual cycle on training are already being implemented to specific strategies can be implemented lower-limb biomechanics, neuromuscular control, support female athletes, however it is now on a player-by-player basis depending on and anterior cruciate ligament injury risk: a important to consider incorporating menstrual where they are in their cycle and based on systematic review. Muscles Ligaments Tendons J. cycle tracking to enhance awareness and their individual risk profile. For example, an 2017;7(1):136-146. doi:10.11138/mltj/2017.7.1.136. mitigate risk. enhanced warm up, that is steadily progressive 3. Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation After Anterior and increasingly dynamic, could be used at, Cruciate Ligament Reconstruction: Criteria- Statistically the general injury pattern is and a greater focus can be placed on post- Based Progression Through the Return-to-Sport similar for male and female players, however exercise recovery, enhancing tissue repair at Phase. Journal of Orthopaedic & Sports Physical the female player is likely to suffer greater certain times in the cycle. Evidently, we accept Therapy. 2006;36(6):385-402. doi:10.2519/ jospt.2006.2222. knee and head injuries than male counterparts it can be challenging to individualise players 4. Hewett TE, Ford KR, Myer GD. Anterior with the ankle sprain being the most common programmes, especially when players are not Cruciate Ligament Injuries in Female Athletes. joint injury in female players (FIFA F-Marc). full time. Am J Sports Med. 2017;34(3):490-498. doi:10.1177/0363546505282619. The time just prior to ovulation in the While there is a paucity of research on the 5. Oosthuyse T, Bosch AN. The effect of the menstrual cycle on exercise metabolism: menstrual cycle, when oestradiol levels reach a effect of the menstrual cycle on performance implications for exercise performance peak has been associated with increased knee in female soccer, as practitioners we need in eumenorrhoeic women. Sports Med. joint laxity 2. This is thought due to activation to be aware of the potential performance 2010;40(3):207-227. doi:10.2165/11317090- of specific receptors located to connective decrements that may occur especially when 000000000-00000. 6. Sung E, Han A, Hinrichs T, Vorgerd M, tissue. Evidently it is therefore possible that fatigue may be a limiting factor, particularly Manchado C, Platen P. Effects of follicular this is a causative factor in the post-pubertal just before and during menstruation. versus luteal phase-based strength training increase in ACL injury rate in women 3,4. Simple modifications to nutrition should be in young women. SpringerPlus. 2014;3(1):668. considered, accounting for blood loss and the doi:10.1186/2193-1801-3-668. potential for changes in substrate utilisaiton 7. Julian R, Hecksteden A, Fullagar HHK, Meyer T. 5 The effects of menstrual cycle phase on physical as hormone levels change . Research in other performance in female soccer players. Lucía A, sports has demonstrated increases in strength ed. PLoS ONE. 2017;12(3):e0173951. doi:10.1371/ within the follicular phase of the cycle 6, and journal.pone.0173951. this may give us scope to more effectively plan training for performance gains within this period. One recent study by Julian et al., Georgie Bruinvels (2017)7 demonstrated a reduction in maximal Exercise Physiologist and Research endurance performance (Yo-Yo IET) in the mid- Scientist, Orreco Ltd. luteal phase of the menstrual cycle. However, Twitter: @gbruinvels, this study was hampered by a small sample Email: [email protected], size (n=9). Further research is clearly required. Co-founder of FitrWoman. www.fitrwoman.com To conclude, by integrating individual menstrual cycle data there is a clear rationale Andrew Wiseman for tailoring training methods to reflect this Sports Scientist & Physical Preparation in a relatively simple way within a team Coach, Celtic FC (Women) environment. This could be considered Twitter: @mrwiseyman alongside subjective data to optimise physical Email: [email protected] performance.

www.footballmedic.co.uk 13 Moving Forwards Development & Innovation in Sports Performance & Medicine

FMA FOOTBALL MEDICAL ASSOCIATION FRI 18th / SAT 19th MAY CONFERENCE RADISSON BLU HOTEL & AWARDS EAST MIDLANDS DE74 2TZ For more details Tel: 0333 4567897 2018 E-mail: [email protected] Sponsored by: Twitter: @FMA_LATEST Facebook: @THEFMA Instagram: FMALATEST

WWW.FOOTBALLMEDIC.CO.UK football medic & scientist INTRODUCING THE SPEAKERS

NICK WORTH DARREN BURGESS ANDREA JAMES Event Co-ordinator Director of High Performance Lawyer Arsenal FC Knights 1759

Nick has been working within Darren is currently the Director of High Andrea James is an English and Professional Football for over 23 Performance at Arsenal Football Club. Irish qualified solicitor and an years. He is a highly experienced Prior to this appointment Darren was expert in professional discipline and Physiotherapist who has spent most of High Performance Manager at Port healthcare regulatory law. The main his career with Premier League teams. Adelaide Football (AFL) Club for just focus of Andrea’s work is defending He was the England Under 21 Team short of 5 years, and Head of Fitness and professionals at fitness to practise Physiotherapist between 2000-2003. Conditioning at Liverpool Football Club proceedings before their regulatory Nick was a key member of the Medical for 2.5 years bodies, particularly doctors before the team that helped Al Jazira, from Abu General Medical Council. Over the years, Dhabi, win the league and cup double for From 2008 till 2010 Darren was she has represented doctors facing every the first time in their history in 2011. He employed as Head of Sports Science for kind of allegation, ranging from deficient has also worked for Bolton Wanderers, Football Federation Australia as well as performance to sexual misconduct. West Bromwich Albion, Manchester the Australian Soccer Team’s Fitness City Academy, Wigan Athletic, Fulham, Coach. This included the 2010 World Cup Andrea also spent three years of her Burnley, Sheffield Wednesday and the in South Africa. Darren has previously career as in-house solicitor to the Thailand National Team. worked as Head of High Performance General Medical Council itself, giving her at Port Adelaide Football Club (2004- a unique insight into the workings of He is an experienced lecturer and 2007) and Assistant Fitness Coach with this high-profile organisation. Module Lead of the MSc programme at Sydney Swans in the AFL (1997-2000), Salford University. As a Fellow of the as well as Head Fitness Coach with the Society of Orthopaedic Medicine, Nick Parramatta Power in the Australian teaches Physiotherapists and GP’s about National Soccer League (2002-2004). manual therapy skills, manipulations and injections. Nick also lectures Darren worked as a lecturer in Exercise internationally on sports injuries and Science at Australian Catholic University musculoskeletal assessment, diagnosis in Sydney between 1997 and 2005 and and treatment of injuries. completed his PhD in movement analysis of AFL and Soccer in 2012. Darren has had multiple papers published in peer review journals and has spoken at many international conferences.

www.footballmedic.co.uk 17 feature football medic & scientist CONFERENCE FMA & AWARDS INTRODUCING THE SPEAKERS FOOTBALL MEDICAL ASSOCIATION 2018

JAMIE HARLEY ANDY RENSHAW NICK LITTLEHALES MARTIN PRICE DAVE RENNIE DAVE ORTON Head of Sports Science Consultant MSK Elite Sport Sleep Coach Lawyer Head Physiotherapist Head Physiotherapist Newcastle United FC Physiotherapist Knights 1759 Leicester City FC Leicester Tigers Rugby Club

Jamie has worked in professional Andy has worked in full-time Premier A former PGA Professional Golfer, An employment lawyer focused on the Dave Rennie has over 18 years’ Dave moved from Cornwall to study football for the past 10 years, originally League football for over 15 years International Sales & Marketing Director sports sector. experience working within professional BSc Physiotherapy at University of with Middlesbrough FC and moving onto and was most recently the Head of of a major sleep product manufacturer football. After initially obtaining Hertfordshire and has since completed Newcastle United FC in 2010, where Physiotherapy for Liverpool FC. Prior and Chairman of the UK Sleep Council. Martin advises employers, senior a degree in Sports Science for the his MSc in Sport & Exercise specialising he is currently Head of Sports Science. to this he worked as the club’s Head Nick has been at the forefront of executives and sports personalities University of Surrey, Dave retrained in Sports Injuries through Manchester He completed his MSc in Exercise of Academy Physiotherapy and was projecting sleep recovery into the world on all aspects of employment law. in Physiotherapy and graduated Metropolitan University. Physiology whilst conducting research previously with Bolton Wanderers as of Elite Sport. Instigating conversation He specialises in the sports industry from the University of Nottingham with the Leeds Rhinos during their their Head of Academy Physiotherapy amongst leading sport and business advising clubs, players, managers, in 1994. Prior to life at Leicester City Dave started work within the NHS, title-winning 2007 season, before going and then the First Team Physiotherapist. professionals since 1998, he is an coaches, administrators and medical Dave worked within the NHS at both progressed into football with Watford FC on to work as a Research Assistant at Andy holds bachelors degrees in Sport advocate of using recovery to advance professionals on a range of issues the Leicester Royal Infirmary and the academy and 1st Team, consulted with Teesside University, with a particular and Exercise Science, Physiotherapy, performance. A passionate speaker, his relating to the hiring and firing of sports Derby Gait Analysis Laboratory. During Red Bull Racing F1 before moving North focus on the use of tracking devices in and an MSc in Musculoskeletal internationally acclaimed seminars and professionals. his time at both institutions he was to Leicester Tigers. football. He holds High Performance Physiotherapy. appearances, redefine peoples attitudes able to explore his interest in sports Sport Accreditation for Football towards sleep constantly, making him He has acted for The Football League, medicine working within the Leicester He is now in his 8th season at Tigers, Science with BASES, and is considered He has a special interest in the field regarded as the world’s leading Elite The League Managers Association, Tigers Rugby, and the English Schools in a Head Physiotherapist position, one of the leading practitioners in his of Injury Auditing and published the Sport Sleep Coach. The Football Medical Association, Badminton Association. He joined Dave continues to be innovative in field. world’s first Injury Audit in elite youth Nottingham Forest Football Club and Leicester City FC in 1999 becoming their his treatment and rehabilitation football during his time at Liverpool FC Salford City Reds Rugby League. head physiotherapist, responsible for all approach alongside managing pitch side Academy. Martin assists his clients with medical service at the club. emergency care and injuries on match contractual negotiations, disciplinary days. proceedings, handling employment He is currently involved in a number of disputes and settlement agreements for research areas and is currently studying departing players and executives. a PhD ‘Investigating the effect that pitch hardness may have upon players, injury and performance’. Dave has presented his research at National and International meetings with a number of articles being published.

18 [email protected] www.footballmedic.co.uk 19 feature football medic & scientist CONFERENCE FMA & AWARDS INTRODUCING THE SPEAKERS FOOTBALL MEDICAL ASSOCIATION 2018

DR MATT BROWN JOHNNY WILSON LES PARRY TOM JOEL AIDAN O’CONNELL STEVE JONES Academy Doctor & Man City Head of Medical Services Academy Elite Performance First Team Sports Scientist Senior S & C Coach Academy S & C Coach Women’s FC Doctor Chesterfield FC Manager, Man Utd FC Leicester City FC Munster Rugby Bolton Wanderers FC

Dr Matt Brown qualified in 2007 and Johnny has completed undergraduate Les is currently employed by Manchester Tom has spent the past six seasons Aidan O’Connell is from Cork in Ireland Steven Jones is a UKSCA accredited worked in Emergency Medicine for degrees in Sports Science and United as Academy Elite Performance at Leicester City. Initially gaining and holds a Degree in Sport Science from and currently employed at Bolton 10 years, while working part-time for Physiotherapy as well as a PGCE in Manager. He has been at the club experience during an internship in 2011, the University of Limerick and a Masters Wanderers academy, but previous clubs Manchester City. During this time, Primary Education and a Masters in for 5 years having previously been he proceeded to develop his skillset Degree in Coaching Studies from the have included Al Ain (UAE) and FC Zenit he became experienced in expedition Sports & Exercise Medicine. Johnny has employed at Tranmere Rovers for over working with the U23 Development University of Edinburgh. St Petersburg (Russia). medicine and pre-hospital care including also completed a Post-grad in Manual 20 years as Head of Sports Science and Squad before joining up with the trips to Brazil, Peru and the Sahara Therapy with MACP accreditation. Medicine. He has the interesting record 1st Team upon promotion to the Aidan has been coaching, leading, and Over 12 years experience working with Desert. Now full-time at Manchester Formerly Head of Sports Medicine for of performing as both physiotherapist Premier League. innovating in professional Rugby both youth players and now pursuing an PhD City, Dr Brown is committed to a career Notts County FC for the past 8 years, and Manager roles at the same time as provincially and nationally for the last focusing on injury risk within academy in football medicine and is responsible Johnny is currently Head of Medical writing up his PhD. He completed his As 1st Team Sport Scientist, one of two decades. football. for the care of over 400 athletes Services at Chesterfield FC. PhD in “The effects of injury induced Tom’s responsibilities is to manage, at Manchester City academy and detraining in professional football” later monitor & analyse the range of data In his 14 years at Munster Rugby he Manchester City Women’s FC. He also As well as all of this he is currently an that season and continued to manage streams being collected on a daily has managing all aspects of physical provides medical care pitch side for the associate Lecturer for the University of the division one club for two and a half basis at the club. Working closely with performance from academy level to the first team players and assists the first Nottingham on their Masters course years before poor team form resulted in other members of the Medical & Sport professional game level. He is currently team doctor. in Sport and Exercise Medicine and is him losing his job and being snapped up Science Department he aims to utilize Senior Strength and Conditioning currently chief editor for an international by Manchester Utd via a short stay at this data in an effective manner to help Coach and Lead Strength Coach at the Sports Medicine book with Elsevier due Accrington Stanley. make more informed decisions with Province. for publication later this year. Johnny regard to training, performance and regularly speaks at International Les’s breadth of experiences give him return to play. Whilst at Munster he has also been conference and was very grateful for a unique view of the demands of each Assistant Strength and Conditioning the amazing opportunity to present department within a football club. This Coach to the Irish National Rugby team at Barcelona FC in the Camp Nou insight results in an empathy for the for the 6 nation series in 2003, 2004 and on “Engaging the athlete in Functional inherent problems across the multi- 2012. Aidan has also been Head Strength Rehabilitation”. disciplinary spectrum at a football club and Conditioning Coach for the Irish A and a different and effective approach team in 2006 and 2013. to solving those problems. Previously he was Head of Fitness at Leinster Rugby 2001-2003.

20 [email protected] www.footballmedic.co.uk 21 feature football medic & scientist CONFERENCE & AWARDS Moving Forwards Sponsored by: FRI 18th / SAT 19th MAY Development & Innovation in FMA RADISSON BLU HOTEL FOOTBALL MEDICAL ASSOCIATION 2018 EAST MIDLANDS Sports Performance & Medicine

FRIDAY 18th MAY FRIDAY 18th MAY

10.00 Registration Opens Hotel Lobby 2.45 Return to play - Should it be data driven? Les Parry Tom Joel Academy Performance First Team Sports Scientist 11.15 Opening Address Eamonn Salmon Manager, Man Utd FC Leicester City CEO Is the decision making process of returning an injured player back to competitive action a science, an art, or both? Is 11.30 Innovation in performance – Where are we now? Darren Burgess PhD science a synergistic contributory factor or is it a hindrance? Is load data the tenpin bowling bumper lane that prevents us from causing further harm or is it a tourniquet around our necks that strangles our desire to maximise the physical Currently, there is a wealth of technology available to the sports science and sports medicine practitioner claiming and physiological adaptations in preparation from the demands to come? The questions are many. to improve all aspects of performance. Although on the surface some of these technologies may offer significant improvements in performance, their practical use in elite football is often limited. This presentation will provide an 3.15 Q & A overview of some of these technologies and how they may be implemented in a high performance football environment. 3.30 Coffee Break, Trade Exhibition & Networking 12.00 Programming through the fog of war – The in-season strength program: Aidan O’Connell A professional rugby perspective Senior Strength & Conditioning Coach 4.00 Panel Session Andy Renshaw Steve Jones Dr Matt Brown Munster Rubgy Talent ID and screening Consultant MSK Academy S & C Academy Doctor/ ‘an open panel session discussing Screening and Physiotherapist Coach, Bolton Women’s Professional Rugby is a pressurised, high stakes environment where optimisation of strength, power and speed can give Talent ID within professional football’ Wanderers Man City FC you a definitive performance edge. Developing and sustaining these qualities across the pre-season can be can be quite uniform and straightforward. However, the unpredictability and volatility inherent in a forty game in-season, combined The session will be an open panel discussion session debating the use and methods of Sports Science, Performance and with transient non-linear individual responses to this environment, creates one of coaching’s greatest challenges. This Medicine in the identification of talent in professional football. Does Sports Science and Medicine have a place within presentation will examine how we tackle this obstacle at Munster Rugby. Talent ID? Are physical, mental and developmental aspects of a player taken into consideration when considering the ‘3 R’s -Recruitment, Release and Retention? Which screening or assessment methods for talent ID have the panel 12.30 Employment and fitness to practise legal update Martin Price & Andrea James members experienced throughout their careers? What information would be useful to know in the future to make more What you really need to know! informed decisions?

Martin Price and Andrea James of Knights 1759 Solicitors will discuss the latest trends and risks in both employment and 5.00 Moving forwards or treading water: Dave Rennie fitness to practise matters a 5000/1 outsider Head Physiotherapist Leicester City FC 1.15 Lunch Break, Trade Exhibition & Networking This presentation will discuss and challenge the role of developments and innovation in sports medicine and science Session Sponsor which may have contributed to this. Can such factors help us identify where we need to develop and innovate in the future to ensure continued improvement or are we simply treading water?

5.30 Close

2.15 Moving Forwards: Development & innovation in scientific athlete Johnny Wilson rehabilitation Clinical Director, Notts Physio

Athlete rehabilitation has changed dramatically over the past 20 years. In this presentation Johnny Wilson will detail the BOOK N O W purpose of athletic rehabilitation and discuss the scientific principles underpinning its mechanism. Johnny will also share examples of how we can apply science in practice to help improve specificity and progression of athletic rehabilitation and document the areas for development. www.footballmedic.co.uk/fma-conference-booking/ Or call 0333 4567897 FMA Member discount applies

22 [email protected] www.footballmedic.co.uk 23 feature football medic & scientist football medic & scientist CONFERENCE & AWARDS Sponsored by: AWARDS FMA th th FRI 18 / SAT 19 MAY FOOTBALL MEDICAL ASSOCIATION RADISSON BLU HOTEL 2018 EAST MIDLANDS RECOGNISING MEDICAL, & PERFORMANCE PRACTITIONERS’ CONTRIBUTION TO THE Saturday 19th May 2018 PROFESSIONAL GAME

9.30 Cervical injuries in rugby – How we return players to the pitch for a crazy Dave Orton game? Physiotherapist Leicester Tigers Rugby Club SUPPORTED BY Road3 Events Rugby union is increasing in intensity with more impacts and collisions year on year. Players have to be robust enough to manage this week in week out and we as sports medicine professionals have to manage this. We will look at how we have innovated our methods to manage cervical spine injuries, rehabilitation and return to play for club and international NOMINATIONS: games using the most up to date approach. The categories are: 10.00 Redefining sleep in elite sport Nick Littlehales • Premiership Team Award Championship Team Elite Sport Sleep Coach • Division 1 Team Award • Division 2 Team Award Sleep is overlooked as a performance factor and taken for granted. To maximize your personal best performance during NOMINATE: training and matches, you need to understand how to optimise what you are doing off the pitch. Mental and physical • National League Team Award WWW.FOOTBALLMEDIC.CO.UK/NOMINATE recovery has never been so important and I’m here to redefine what you think you know about sleep and it’s impact on • Scottish League Team Award your life both in and out of sport. • Women’s Game Team Award OR CALL • Exceptional Achievement Award 10.30 A data informed approach to end-stage rehabilitation Jamie Harley • Longstanding Service Award Head of Sports Science 0333 4567897 • Outstanding Contribution to Football Medicine Newcastle United FC Radisson Blu, OR EMAIL • 21 Club Award - For those who have been in the game for over 21 years How can we use data to inform the rehabilitation and return to play process? The development of tracking technology [email protected] East Midlands Airport has enabled us as practitioners to quantify the movement profiles of the players when fully fit and training, and subsequently when they are in the rehabilitation phase. But how do we currently use data to inform the process? In this talk we will preset two case studies - one rehabilitation case from a hamstring injury, following the physical progression to return-to-play, and another case following an ACL reconstruction, where we look beyond traditional distance and “It was a great honour and privilege to receive the speed values to consider the finer movement patterns of the player. Championship Medical & Science Team Award for the 2016-17 11.00 Coffee Break, Trade Exhibition & Networking season at the recent Football Medical Association Conference and Dinner. Thank you to the FMA for the award, for hosting Session Sponsor a fantastic weekend and for all the hard-work they do for medical professionals in the game.” Adam Brett, Head of Medical Services, Brighton & Hove Albion 11.30 English Premier League & The Football Association Combined Session

12.30 Development and innovation discussion panel An open discussion forum to share ideas ‘How can we Move Forwards? and thoughts from the Conference.

1.00 Closing Address Eamonn Salmon Pro Football AMAT Logo White.pdf 1 16/02/2018 12:55 CEO

®

24 [email protected] www.footballmedic.co.uk 25

FMA REGISTER WORKING FOR OUR MEMBERS

F M A R E G I S T E R

F M A R E G I S T E R CLICK HERE to search for elite practitioners

ü THE PLATFORM TO SHOWCASE YOUR EXPERTISE & EXPERIENCE AT THE VERY TOP OF THE GAME

ü ACCESSED BY CLUBS AND COLLEAGUES TO SOURCE PRACTITIONERS

ü PUTTING YOU & YOUR PRACTICE IN REACH OF FAN BASES AND GRASSROOTS FOOTBALL

For further information contact FMA Project Manager Angela Walton on T: 0333 456 7897 M. 0743 236 0789 E: [email protected] join the Register @ www.footballmedic.co.uk feature football medic & scientist

multidirectional activities will commence, RETURN TO TRAINING (non-contact to TAKE HOME MESSAGES conditioning the players ability to contact) accelerate, decelerate, change direction, • Utilise linear stages to develop produce force and accept force. With the use Prior to presenting the player available appropriate energy systems and build of GPS, you will begin to see an increased to train it is important that you have tolerance to work load number of accelerations, decelerations and the player physically prepared for • Be patient with multidirectional changes of direction during this period, the demands of training as well as development this needs to be carefully programmed psychologically ready. Utilising all the • Be progressive with work loads and monitored to prevent acute spikes in information captured during rehab to • Introduce the technical coach to football mechanical workload and increasing the make an informed decision on player specific conditioning risk of injury. From experience this can be a readiness. This decision-making process is • Use all subjective/objective data to challenging period in rehab and will inform the responsibility of the whole backroom inform return to training you of the players confidence in the injured team and the player. Ensuring the player • Squad training is an integral part of limb. It is important that you are patient is confident in the work done and is ready rehabilitation with the player and allow him to progress at to return. • Ensure physical, technical and mental their pace whilst reassuring them. preparedness prior to return to match The initial introduction to training is play FOOTBALL SPECIFIC CONDITIONING non-contact allowing the player to • Progress players match load in develop their perceptual skills in a squad preparation for return to competitive Progressing from multidirectional activities setting. Providing a more realistic tactic match play the player can now begin ball based to training this is a critical part of the conditioning drills, increasing neuromuscular rehabilitation process and not an end. This Conclusion demands further, whilst challenging can be achieved in technical training such confidence and competence in the injured as passing and ball mastery activities, I hope that I have a provided a small insight limb in a football specific setting. This stage unopposed phases of play or as a ‘floater’ into my experiences in rehab from long is the most enjoyable for the player as it in possession and or small sided games. term injury. I believe that my contribution increases motivation due to the specific to rehab has improved me immensely as a nature. From experience head coaches may not practitioner whilst building strong rapports adhere to this approach as it may interfere with members of the medical, coaching and Implement the ball as soon as possible with their training objectives, therefore playing staff. Allowing me to implement with simple ball skills and progress to more consider the player training with another trial training models with individuals that GRASS TO GAME complex skills that require decision making squad at this point such as the U23s. I have then utilised with the squad. It has for skill acquisition and refinement. If you Continue to prescribe appropriate load and given me a wide skill set in areas such do not feel competent to deliver ball-based monitor and adjust accordingly allowing as S&C, on field conditioning, recovery, FEATURE/S cott Pearce drills work with the player to devise their the player time for adaption and recovery. nutrition, monitoring, technical based own technical programme whilst ensuring When the player becomes competent/ training and most importantly my ability to exposure to the appropriate stimulus is confident in a non-contact environment connect with playing, coaching and medical achieved to create the desired adaptation. progress them to full contact training. staff. I strongly encourage sports scientist, The role of a sports scientist in the end stages of long term rehabilitation of an injured player. strength and conditioning and physical Although competent myself with ball-based RETURN TO GAME PLAY (friendly to performance coaches to become involved n winter’s edition I discussed the role of reduce injury risk, providing a safe pathway a percentage of their pre-injury workloads drills I also employ the use of the technical competitive) with rehab as it has been highly rewarding the sports scientist in the mid stages to return to squad training and competitive before progressing to increased loads to coach during this phase. Providing a new experience for myself and provides Iof rehab with the focus on progressing match play. provide appropriate overload for adaptation. face/voice for the player and allowing the When is the player ready to play? A opportunity for self-development. the player from the gym to the grass A strategy I’ve used with players returning coaching team access to the player for question that is asked when the player whilst developing workload tolerance and BASE CONDITIONING/BUILD TOLERANCE to field-based conditioning is 1 day on grass technical and skill development can further has returned to training from the head robustness. It is widely accepted that the followed by 1 day off the grass. Alternating increase player motivation in preparation coach. My response to this is ‘we have to further the player progresses through It is important to note that the sports days of running drills with gym/strength- for squad training demands. This supports be confident that the player is prepared rehabilitation the more of a direct and scientist can be granted access to the player based conditioning progressing into a my statement in my first article on the and ready’. Tim Gabbett has done some significant influence the sports scientist to develop aerobic/anaerobic condition with structure a 2 on and 1 off. importance of the whole backroom team in fantastic work on the importance of plays. In this edition I would like to discuss a restriction of linear running activities only. the rehabilitation of the player. Typically, 1-1 physical preparedness and its relationship my personal experiences of end stage This provides a good opportunity to build a An effective method I have implemented technical coaching involves many intensive with injury. Also pay caution to the fact rehabilitation. At this stage the player baseline condition and build a tolerance to at this stage of rehab is the use of maximal actions in small areas. It is therefore useful that players will always think they’re will now engage in linear based running general workload. aerobic speed grids (MAS) as it allows you to alternate this work with extensive ready, have a strong understanding of activities on the grass following exposure to to measure aerobic performance, training running-based activities to add volume into your player. The multi-disciplinary team the Anti-gravity treadmill. As a consistent As previously mentioned the desired prescription and monitor loads as well as the session. Repeated sprint training is a are working in harmony at this phase message throughout my articles I again training prescription to achieve such goals stimulating tolerance to high intensity training strategy that I would implement to prepare the player for competitive emphasise the importance of the support will be a personal preference of the sports workloads. (see Dan Baker, UKSCA, Issue at this point. Exposing the player to short match play. Confident that the player team (medical/coaching) to monitor the scientist, remembering there is ‘more than 22) duration high intensity efforts improves is physically, technically and mentally players development and responses to any one way to skin a cat’. However, I do advise their ability to repeat high speed efforts and prepared expose the player to friendly unaccustomed workload. that whatever training stimuli is selected Undulating alongside this will be the develop a robust player. Strength training is games or u23 games depending on level that is should be prescribed in a progressive development of linear maximal velocity often and easy to neglect during this phase if possible, building up their match loads The objectives throughout this phase are to manner, taking into consideration the beginning with basic acceleration (force when a player is back on the grass yet still over a period of games from 45 minutes build base conditioning, progress tolerance nature of the injury, chronic load issues and production) working towards maximal fundamental to rehab process. Appropriate to full games. to linear and multidirectional workload, positional demands when programming. velocity drills. programming of field and gym-based football specific conditioning/activities Use of performance data can aid your training is essential to continue driving the Another integral part of the rehab process to develop fitness, build robustness and training prescription by loading a player to When clinically cleared the onset of player forward. and arguably the most important.

30 [email protected] www.footballmedic.co.uk 31 feature football medic & scientist Why Screening ‘Mental Health’ Might Be The Missing Link In Reducing Injury

FEATURE/A ndy Barker MSc BSc MCSP

The prevalence of mental health issues is increasing within modern day sport. The most common are depression and anxiety, but poor mental health can manifest itself in many ways. Andy Barker Consultant Sports Physiotherapist rom the outset high profile sportsmen developed a ‘mental health screen’ allowing What was interesting however, was that and women seem to have it all. For us to identify such issues earlier and intervene athletes that reported an illness symptom Pictured: Manchester City’s Benjamin Mendy (right) celebrates with fans whilst recovering from a ACL injury Andy is a consultant sports Fmost, they are playing a sport they love, accordingly. causing anxiety were fivefold more likely physiotherapists and current Head of being paid handsomely for doing so and thus, (OR, 5.56; 95% CI 1.34 to 23.15; p=0.018) Physiotherapy and Rehabilitation for can lead a lavish lifestyle. But, that doesn’t But going back to heightened physical injury to sustain an in-championship injury than the Leeds Rhinos Rugby League side, mean they are immune to mental health risk and poor mental health, is this new and those that didn’t. manifest itself in a muscle tear, tendonopathy Rather than a reactive system, wouldn’t we pattern, bone fracture, ligament tear or any be better at trying to screen and observe having been involved with the club for issues. Quite the opposite in many respects. unexpected? the past ten seasons. The pressure to perform consistently at the This undoubtfully shows an evidenced another type of injury. these stressors frequently, to pick up any highest level, dealing with injuries, contractual The answer is no. Previous academia in link between heightened injury risk and possible issues that might predispose What we often don’t consider is other injury, to try prevent injury before it He graduated in Physiotherapy from issues and off-field stressors are just a few athletics has also shown similar themes psychosocial issues within an athletic sample the University of Bradford with a first examples that can result in players struggling (Timpka et al., 2017). In short, the study looked and backs up the early research we are putting stressors, non-physical stressors that happens. A more proactive approach seems contribute towards an athletes overall ‘stress’ reasonable rather than reacting to injuries class honours degree which followed psychologically. to determine preparticipation predictors of together within elite rugby. on from a previous Bachelor of Science injury and illness before the 2015 International level. Ultimately the more our athletes are after they have occurred. ‘stressed’ via physical and non-physical degree from Leeds Metropolitan Over the last few seasons within my role Association of Athletics Federations World Whilst increased injury risk might be expected University in Sports Performance consultancy role as Head of Physiotherapy Championships in Beijing. A total of 307 given what we know about the what happens parameters then the more likely they might Like I say, as simple as this sounds, it be to break down. doesn’t happen. Coaching. He recently graduated and Rehabilitation at the Leeds Rhinos Rugby athletes completed a preparticipation health to the nervous system when we suffer illness with an MSc in Sport and Exercise Club we have started to gather information screen, whilst new injuries and illnesses i.e. viral infection, the notion that mental Biomechanics from Leeds Beckett that our players are at a much greater risk of that occurred at the championships were health issues can increase physical injury Obviously, recovery strategies or for a better Considering the findings, we have observed term ‘de-stressing activities’ play a big in elite rugby players and increased injury University. injury; both contact and non-contact following prospectively recorded. incidence is a relatively new notion. mental health issues. part in this process, given what we know risk with illness we have made and active about physical stressors, recovery and the effort to monitor ‘psychological health’ as Alongside professional rugby he has This study found links between increased But, is this surprising? also consulted within professional Whilst we only have a small sample size injury risk during the championships if athletes principle of supercompensation. In short, if part of our athlete monitoring system. we progressively load, we adapt, assuming basketball, football and golf in his and our data only includes athletes from a had suffered other pre-competition injuries Injury of any type is the result of our bodies capacity as director of Perform Ready single sport the results have been greatly or illness. Again, this is not new, given what being unable to tolerate stress. When we adequate recovery is observed. By being able to monitor an athlete’s physical and mental wellbeing status as Clinic, a physiotherapy and exercise advantageous to us as a performance we already know about previous injury being a reach failure point, any tissue, be it bone, medicine clinic in Leeds; department. Off the back of this data we have major risk factor for future injury. ligament, muscle, fascia, will break. This could But, how often do we really observe and part of their pre-training testing, is our acknowledge the non-physical stressors that first line of defence to identify issues early, www.performreadyclinic.com may have contributed towards an athletes allowing us to act accordingly and quickly. injury? Article Reference: Timpka et al Without such a system by the time we (2017) Preparticipation predictors for In most professional sports environments, find out about these other off-field issues championship injury and illness: cohort this happens very infrequently if ever!!! athletes may have, its often too late, study at the Beijing 2015 International as often they have already contributed Association of Athletics Federations If it does it’s usually reactive i.e. an athlete is towards injury and/or reductions in World Championships. British Journal of injured, then we review why it has happened, performance. Sports Medicine, 51 (4), 271-276. then we discover some of these non-physical stressors have potentially contributed towards But why is this important and is it just that athletes injury. about injury prevention? back to the equation above would result For an athlete these non-physical stressors Performance for me is the product of in a detriment in performance. So not only could be financial worries, issues around their fitness minus fatigue. are de-stressing activities injury prevention current of future playing contract, include based but they are also performance based. player selection, bereavement and/or issues Performance = Fitness – Fatigue with family or friends. Could identifying and acting on these mental The non-physical or ‘mental’ stressors health issues be the missing link in reducing We often forget about athletes lives discussed above ultimately affect fatigue, injury risk in professional sport? away from the training and match-day in not allowing our nervous system to environment. down-regulate. If we are always in ‘fight or The more data we collect should hopefully flight’ and never in a ‘rest and digest’ state shed more light on such a question but early We often forget or fail to acknowledge the how can we expect to relax and recovery indications suggest that by failing to look out effect these stressors have on physical from physical exercise. As such our level for stressors, not just the physical stressors, preparation and injury risk. of fatigue will be much greater and linking we are missing a big trick!

32 [email protected] www.footballmedic.co.uk 33 feature football medic & scientist Don’t waste your time taking antioxidant supplements after exercise

FEATURE/M ayur Ranchordas Senior Lecturer & Sport Nutrition Consultant, Sheffield Hallam University

The antioxidant market is big business and millions of pounds are spent every year on antioxidant supplements – such as vitamin A, C and E – as well as fruit and vegetable extracts and juices.

ntioxidants are so popular – particularly inflammation and muscle soreness. The belief of the normal recommended daily dose for among people who do a lot of exercise is this will allow the players to recover more antioxidants – does not appear to reduce A– because it is believed they help quickly in preparation for the next match. muscle soreness after exercise. to reduce muscle soreness after exercise. It is thought that by taking antioxidant Similarly, in professional cycling, a Tour de More harm than good? supplements in doses much higher than the France rider may take antioxidant supplements recommended amounts, muscles recover to accelerate recovery after each stage. The Of the studies we looked at, only nine reported quicker by reducing some of the harmful belief is this will help them to recover more on adverse effects. Two of these found some effects of exercise. And this is why so many quickly for the following day’s riding. people who took antioxidants experienced people swear by antioxidants – such as cherry gastrointestinal distress – such as diarrhoea, juice or pomegranate juice – after a workout. Antioxidants debunked indigestion and bloating. On top of our findings, more recently, there has been an Some people also take antioxidant Our recent review compared high-dose emergence of studies showing that chronic supplements to improve their general health antioxidant supplementation with a placebo antioxidant supplementation may actually be or protect against certain cancers but the (a dummy pill or drink with no antioxidant). counterproductive. For instance, it has been scientific evidence for this is poor. And Various antioxidants were used in the studies shown that antioxidant supplements may similarly, our recent analysis of the existing ranging from single vitamins to extracts delay healing and recovery from exercise, hinder scientific literature found similar results. and juices. These included cherry juice, adaptations to training, and may even increase pomegranate juice, vitamins C and E, black tea mortality. We recently published a Cochrane review which extract and others in various doses. included 50 studies looking at the link between Taking all of this into consideration, the antioxidant use and reduced muscle soreness. The review included 1,089 participants, nearly main take home message is to steer clear And we discovered that there is no solid nine out of ten of these were male and most of antioxidants supplements and save your evidence that antioxidants works. participants were recreationally active or money. Instead, just try and move more, moderately trained. The age range of the exercise regularly, and eat a balanced diet Aching muscles participants varied from 16 to 55 years. that includes at least five or more portions of rainbow coloured fruits and vegetables. Muscle soreness typically occurs following Although we found antioxidant Because for now at least, there is no quick fix to unaccustomed or intense exercise and usually supplementation may very slightly reduce easing muscle soreness after exercise. peaks two days afterwards. This can obviously muscle soreness in the first three days after impair future athletic performance, so it’s not exercise, these reductions were so small, it was In fact, it seems muscle soreness is an surprising that various interventions have been unlikely they made any difference at all. important part of the recovery process and can put forward to reduce exercise related muscle help to make your muscles stronger and bigger aches and pains. So ultimately, we found that high dose over time. And that will ultimately help to antioxidant supplementation – in excess make you fitter and stronger in the long run. These range from a number of different techniques, including whole body cryotherapy – which involves getting exposure to extremely cold temperatures for several minutes in a special chamber where temperatures can range from -110 to -140°C. Then there is also the use of compression garments and massage, as well as antioxidant supplementation.

Some athletes also strategically take antioxidant supplements to accelerate recovery during periods of intense competition rather than taking them every day. In professional football for example, when there can often be periods of fixture congestion (a team may play three matches in an eight day period), dietary antioxidants are used to reduce *Originally published on The Conversation

www.footballmedic.co.uk 35

feature football medic & scientist

The Effect of Three Different (-135°C) Table 1. Comparison of parameters between time points, pre, immediately post, +5, +10, +15 and +20 minutes post WBC exposures for all exposures. Time to Time Core Temp Sig. Tsk Sig. Blood Sig. NIRO G Sig. NIRO G Sig. NIRO G Sig. NIRO VL Sig. NIRO VL Sig. NIRO VL Sig. Point* Point °C** °C*** IL-6 O2HB HHB TOI O2HB HHB TOI Whole Body Cryotherapy Exposure 0 1 -0.5 0.21 8.85 0 4.28 0.31 12.79 0.03 2.36 0.11 -1.7 0.6 6.85 0.04 3.81 0.03 0 2 3.4 0 -2.15 0.61 -3.05 0.6 1.78 0.23 -3.74 0.25 -0.43 0.9 2.2 0.21 Durations on Elite Rugby LeaguE PLAYERS 0 3 2.59 0 -1.62 0.7 -7.83 0.18 1.19 0.42 -1.8 0.58 -2.59 0.44 2.44 0.16 0 4 2.19 0 2.33 0.58 -6.52 0.27 0.95 0.52 -1.18 0.71 1.24 0.71 1.54 0.38 0 5 -0.38 0.35 2.01 0 0.15 0.91 FEATURE/J ill Alexander 1 2 -5.45 0 -6.43 0.13 -15.85 0.01 -0.58 0.69 -2.04 0.53 -7.28 0.03 -1.61 0.35 1 3 -6.26 0 -5.9 0.16 -20.62 0 -1.17 0.43 -0.1 0.98 -9.44 0.01 -1.38 0.43 The aim of the study was to explore whether the length of whole body cryotherapy (WBC) exposures affect 1 4 -6.66 0 -1.95 0.64 -19.31 0 -1.41 0.34 0.52 0.87 -5.61 0.1 -2.28 0.19 1 5 0.12 0.76 -6.84 0 changes in inflammatory blood markers, tissue oxygenation, core and skin surface temperature alongside 2 3 -0.81 0 0.53 0.9 -4.77 0.41 -0.59 0.69 1.95 0.55 -2.16 0.52 0.24 0.89 thermal comfort and sensation. The application of extreme cold air for short periods known as WBC presents 2 4 -1.21 0 4.49 0.29 -3.46 0.55 -0.83 0.57 2.56 0.43 1.67 0.62 -0.66 0.7 anecdotal evidence for its use in elite sport, with minimal evidence to identify optimal exposure protocols. 2 5 -1.39 0 3 4 -0.4 0.09 3.96 0.35 1.31 0.82 -0.24 0.87 0.61 0.85 3.83 0.26 -0.9 0.6 Methods: Fourteen elite male rugby the acceleration of exercise induced muscle (Starstedt)), muscle oxygenation levels 3 5 -0.58 0.02 super league players exposed to 1, 2 and 3 damage (EIMD) following multiple WBC (Near-infrared spectrometer (NIRO-200 4 5 -0.18 0.46 minutes of WBC at -135°C. The study was a exposures, although Costello and colleagues Oxygenation Monitor, Hamamatsu, Japan)), randomised cross over design, participants (2012) reported poor results in trying to skin surface temperature (ThermoVision, acted as their own control with testing for alleviate EIMD and soreness with WBC. It is A40M Thermal imaging Camera (Flir Table 2. Comparison between WBC exposure times for all testing parameters and significant values each exposure separated by seven days, difficult to compare physiological changes Systems, Danderyd, Sweden)), core taking place the day following a competitive across available studies due to differences temperature (CorTemp® Wireless Ingestible Measurement WBC Exposure Time Compared to WBC Mean Difference Sig. league fixture. in methodologies and inconsistencies that temperature Sensor-Product No. HT150002. (minutes) exposure time (minutes) may occur across sporting populations. HQInc. Florida. USA) and thermal comfort/ Results: Significant reductions in skin WBC research reports commonly in rugby sensation (Chloewka et al, 2012). Following Interleukin Six (IL-6) (pg/mL) 1 2 0.37 0.81 surface temperature, thermal comfort and populations, due to the physical demands of exposure, the same data were collected 1 3 0.14 0.93 thermal sensation were noted (P=<.05) but the sport, anecdotally WBC is regularly used immediately and up to 20 minutes post WBC no significant change in core temperature in elite football, although limited research exposure over 5 minute increments. 2 3 -0.23 0.89 (P>.05). No significant changes recorded for is available to support optimum protocols in Tissue Oxygenation Gastrocnemius HHB (μmol•L-1) 1 2 -2.5 0.58 inflammatory blood markers (IL-6). Results that specific athletic population. Statistical Analysis: A mixed methods model further reported significant reductions in (SPSS version 19.0, SPSS Inc, Chicago, IL, 1 3 -0.41 0.93 deoxyhaemoglobin for gastrocnemius and Methods USA) analysed continuous data using pre- vastus lateralis. Significant reductions in exposure data as a covariate, this determined 2 3 2.09 0.64 oxyhaemoglobin and tissue oxygenation Participants changes between pre and all other Tissue Oxygenation Gastrocnemius TOI (μmol•L-1) 1 2 -0.87 0.45 index were also demonstrated (P=<.05). A single group randomised cross over design timepoints. Fixed factors were time points included fourteen volunteer professional and exposure. The data were assessed and 1 3 -1.98 0.08 Conclusion: A 2-minute WBC exposure rugby super league players (24 years; height found to be suitable for parametric statistical 2 3 -1.11 0.33 was the optimum exposure length 183.2cm; weight 77.6 kg) from a professional testing. To explore differences between the at temperatures of -135°C, however super rugby league club. Data was collected three exposures, nominal questionnaire data Tissue Oxygenation VL O2HB (μmol•L-1) 1 2 2.24 0.37 physiological changes in Il-6 or core mid-competitive season, all participants were analysed using a Friedman Test, with a temperature were unaffected following were uninjured, training fully and took part in Wilcoxon sign rank test used as a post-hoc 1 3 5.93 0.02 three brief exposures of WBC separated by a competitive fixture the day prior to testing. analysis to compare exposure and time point 2 3 3.7 0.14 1 week. Although significant changes in skin All participants completed health-screening differences. surface temperature, thermal sensation, checks and provided written informed Tissue Oxygenation VL HHB (μmol•L-1) 1 2 -3.82 0.14 deoxyhaemoglobin, oxyhaemoglobin, and consent to take part in the study. Results: Comparison of all parameters 1 3 -2.53 0.33 tissue oxygenation index occurred. between time points, pre, immediately Testing Procedure post, +5, +10, +15 and +20 minutes post 2 3 1.29 0.62 Introduction: Prevalent for its use amongst Separated by seven days, three different WBC exposures, for each exposure (1, 2, and the elite sporting populations, reportedly WBC exposures followed a competitive 3 minutes) are demonstrated in table 1. A Tissue Oxygenation VL TOI (μmol•L-1) 1 2 -0.28 0.84 WBC promotes recovery and prevention of fixture the previous evening. Each participant comparison between WBC exposure times for 1 3 1.78 0.19 injury via therapeutic application of extreme acted as their own control and randomly all testing parameters and significant values cold air (-110°C-140°C). Physiological effects allocated to exposure lengths of 1, 2, or 3 are representable in Table 2. Significant 2 3 2.06 0.13 of WBC discussed in current literature, fail to minutes. The exposure protocol consisted reductions in skin surface temperature, Tsk (°C)** 1 2 1.21 0 present optimal protocols specifically around of 30 second precooling at -60°C, followed thermal comfort and thermal sensation exposure duration, with typical exposures by the random exposure (1, 2 or 3 minutes) were noted (P=<.05) but no significant 1 3 1.7 0 varying between 2-3 minutes. Therefore, it at -135°C in a liquid nitrogen cryochamber change in core temperature (P>.05) is ambiguous as to what WBC protocol is (JUKA, Poland), owned and operated by BOC following WBC exposures. No significant 2 3 0.5 0 required to initiate beneficial physiological Linde. changes recorded for inflammatory blood Core Temperature (°C)* 1 2 0.51 0.2 changes to support recovery or for the markers (IL-6). Results further reported prevention of injury. A common change Baseline testing included venous blood significant reductions in deoxyhaemoglobin 1 3 0.72 0.08 reported following WBC exposures is the samples (three days prior to the first WBC for gastrocnemius and vastus lateralis. reduction in inflammatory markers (Banfi et exposure) with pre-cooling measurements Significant reductions in oxyhaemoglobin 2 3 0.2 0.62 al, 2010; Lubrowska et al, 2010; Wozniak et taken for venous blood samples and tissue oxygenation index were also al, 2007). Hausswirth et al (2011) identified (S-Monovette blood collection system demonstrated (P=<.05).

38 [email protected] www.footballmedic.co.uk 39 feature football medic & scientist

Full paper reference:

Selfe, J., Alexander, J., Costello, JT., May, K., Garratt, N., Atkins, S., Dillon, S., Hurst, H., Davison, M., Przybyla, D., Coley, A., Bitcon, M., Littler, G., Richards, J. (2014). The Effect of Three Different (-135°C) Whole Body Cryotherapy Exposure Durations on Elite Rugby League Players. PLoS ONE 9(1); 1-9.

References

Costello JT, Algar L and Donnelly A. (2012) Effects of whole-body cryotherapy (-110C) on proprioception and indices of muscle damage. Scand J Med Sci Sports, 22:190-198.

Cholewka, A., Drzazga, Z., and Sieron, A. (2012). Thermography study of skin response due to whole-body cryotherapy. Skin Res Technol, 18:180- 187.

Banfi G, Lombardi G, Columbini A, et al. (2010) Whole-body cryotherapy in athletes. Sports Med, 7:1-9.

Fonda, B and Sarabon, N. (2013). Effects of whole-body cryotherapy on recovery after hamstring damaging exercise: A crossover study. Scand J Med Sci Sports, 23:270-278.

Lubkowska A, Banfi G, Dolegowska B, et al. (2010) Changes in lipid profile in response to three different protocols of whole-body cryostimulation treatments. Cryobiology, 61:22-25.

Hausswirth C, Louis J, Bieuzen F, et al. (2011) Effects of whole-body cryotherapy vs. far-infrared vs. passive modalities on recovery from exercise- induced muscle damage in highly-trained runners. PLoS ONE, 12:1-7.

Pedersen BK and Febbraio MA. (2008). Muscle as an endocrine organ: focus on muscle-derived interleukin-6. Physiol. Rev, 88:1379-1406.

Discussion: The results of the study reports the antecubital fossa. Vascular shunting took WBC exposure demonstrated effective Pournot H, Bieuzen F, Louis J, et al. (2011). Time-course of changes in inflammatory responses after whole-body cryotherapy multi exposures 30 seconds at -60°C followed by 2 minutes place from upper to lower limbs following reductions is skin surface temperature in following severe exercise. PLos ONE, 6:1-6. WBC at around -135°C appear to be an a 3-minute WBC exposure. In summary, agreement with previous studies (Cholewka optimum WBC exposure time. A 2-minute although venepuncture was successful, et al, 2012). Although core temperature Reynolds, J.D., Ahearn, G.S., Angelo, M., Zhang, J., Cobb, F., et al. (2007). S-nitrosohemoglobin deficiency: A mechanism for loss of physiological WBC exposure produces physiological the level of blood flow often appeared did not present any significant changes activity in banked blood. PNAS, 104:17058-17062. changes in core and skin temperature, compromised, and more commonly, this this supports the predictable relationship tissue oxygenation in vastus lateralis occurred following the 3-minute WBC with skin surface temperature cooling. Stocks JM, Taylor NAS, Tipton MJ, et al. (2004). Human physiological responses to cold exposure. Aviation Space Environ Med, 75:444-457. and gastrocnemius muscles and thermal exposure. Where the lowest post WBC reduction sensation responses. To the authors in skin temperature occurred, core Wozniak A, Wozniak B, Drewa G, et al. (2007). The effect of whole-body cryostimulation on lysosomal enzyme activity in kayakers during training, knowledge no other study has examined Tissue oxygenation significantly differed temperature demonstrated a rise. Observed 100:137-142. duration of WBC exposure time and the after a 3-minute WBC exposure compared to across all exposure times this supports effects on the multiple observation of tissue 1 or 2 minute exposures. The results suggest the observation of vascular shunting to oxygenation, core temperature, skin surface localised tissue hypoxia in the vastus maintain normal functions of vital organs temperature, inflammatory marker (IL-6), lateralis muscle. A decrease in blood volume during exposure to extreme cold. Recordings thermal comfort or sensation in elite athletic in the gastrocnemius muscle also reported of thermal sensation and comfort from populations at 0-5 minutes post WBC. Indicative of participants demonstrated no differences venous pooling, oxyhaemoglobin and in 2-3 minutes of WBC exposure, but The current study revealed increases in deoxyhaemoglobin both increased to above significant differences in sensation were Il-6, 10-16 hours post-competitive fixture, pre-WBC measures over the remaining reported when comparing 1-2 minute in line with previous research (Pedersen, 15 minute time-period. Perhaps due to a exposures. Perceptions in temperature 2011). Variance in IL-6 levels were noticed weaker vasoconstriction response rather sensation suggest that 1-minute WBC by the high standard deviations reported, than active vasodilation, results suggest exposures may not be long enough to note but thought to be due to the variance in gastrocnemius compared to vastus changes in sensation of cold. playing positions causing differences in lateralis is more susceptible to pooling. It player movement/loading during play. is common to observe vasoconstriction of Practical Implications: Professions working Future studies should consider the positional peripheral blood vessels under moderately within elite sport may advise that applying differences and consider that this may cold temperatures in order to maintain an optimal WBC exposure time of 2 minutes occur across other sports, such as football. core temperature (Stocks et al, 2004). The at around -135°C physiological changes Irrespective of WBC duration, the current present study demonstrates physiological may occur; however, it would be useful to study reports that a single bout of WBC does responses, but under extreme cold apply this protocol in different sports such not alter IL-6 levels, supporting a previous exposure, the body aims to protect the as football. Clinicians should utilise the study by Pournot et al (2011) observing 3 extremities, with cold-induced vasodilation protocol from this study to compare future minute exposures at -110°C. Compared to (CIVD) occurring (Reynolds et al, 2007). research that will help now determine the other studies (Fonda, 2013; Hausswirth et al, Deeper musculature loses heat to the number of required WBC exposure sessions 2011; Lubkowska et al, 2011), our collection surface initiating CIVD response. Although to initiate larger physiological responses. of blood samples at 20 minutes post WBC exact mechanisms are not fully understood, The findings from future studies may be exposure was the shortest time period in line with previous research we note welcomed to direct optimum protocols for reported, therefore it may have been too that core temperature rose above 36°C use in elite football populations in order early to detect changes in inflammatory immediately post 3-minute WBC exposure, to aid recovery or as a preventative injury markers. The collection of venous blood along with peripheral blood volume/flow measure. Research investigating WBC on samples following a 3-minute WBC exposure increases and pooling; in response to these other elite athletes and women would be posed challenges in the partial ‘shut down’ of processes, therefore the concept of CIVD advantageous to broaden the knowledge on peripheral vasculature of the median vein of may be supported. WBC across a variety of sports and gender.

40 [email protected] www.footballmedic.co.uk 41 feature football medic & scientist

ball is out of play.1, 4, 5 It is debatable as to the benefits for each position (e.g. overlapping for a full back) and Example of the ‘Integrated’ Approach Using Current of this information in isolation as it simply reflects collectively for the team (e.g. closing down opposition Match Analysis Technology ball possession status. Therefore, this approach does players). Practitioners tend to use a ‘one size fits all’ approach not seem to be the solution as it provides negligible when measuring the work rate profiles of various insight regarding physical efforts with a tactical Figure 1 depicts the generalised model using a Venn positions, as the same categories are uniformly purpose (e.g. recovery running). The application of format. Three performance factors are represented used.1,3-6 To make sense of this information, some this data into practice is limited as most simply in isolation and combination as circles. The regions advocate individualized rather than arbitrary speed report game or half by half averages for general in which factors overlap are the intersections. The thresholds that are founded on player’s physical categories such as sprinting. Few studies have area whereby all factors overlay is called the union fitness indices.8 This is based on the premise that translated discrete actions into useable metrics such (black dot) and denotes innovation in match analysis positional variation has consistently been found as angles of turns, technical sequences and tactical as full integration occurs (considered beyond the for fitness attributes.3,8,9 This provides a more actions associated with physical data that could be realms of technology and expertise at present). This representative indicator of a player’s physical match used within the club setting.6 To progress this field article will focus on the intersection of the Venn exertion rather than the use of arbitrary thresholds and to advance the application of physical match between physical-tactical factors. The variables that are likely to over or underestimate demands.8 data, it’s imperative that scientists examine updated listed within this intersection were adapted from Irrespective of speed thresholds, players in selected methodologies that develop our understanding of a recently developed High Intensity Movement positions will only be able to exert themselves based contextualising game demands or at the very least Programme.6 This data set was used in the example on match scenarios as a result of tactical, contextual generate constructive dialogue within the literature. below and comprised of a single team tracked across and physical factors.6 Accordingly, some suggest three consecutive English Premier League seasons that ‘in game’ running performance should be used The ‘Integrated’ Approach using a computerized tracking system (Amisco Pro, to assign such thresholds.10 This is a particularly Football is a multi-facetted sport with the physical, Sport-Universal Process, Nice, France). High-intensity pertinent point given the games submaximal nature, tactical and technical factors amalgamating to efforts were activities reaching speeds ≥21 km∙h-1 which results in some positions working well within influence performance with each factor not mutually for a minimal dwell time of 1 s. To synchronize data, their physical capabilities, particularly if constrained exclusive of another.7 Hence, this piece proposes the tactical actions associated with each effort were by tactical rather than physical factors. As such, a novel ‘integrated’ approach that focuses on a manually coded from video recordings viewed using the tactical role of a player seems to be a powerful sensitive metric such as high-intensity running6 but computerised tracking software. determinant of their match physical performance. contextualises this in relation to key tactical activities Thus, a ‘one size fits all’ approach even with optimal ‘Context is King’ when Interpreting Match Physical Performances FEATURE/P aul S Bradley, Mark Evans, Andy Laws & Jack D Ade

‘I was blind, now I can see’. Thus, is it time to retire the ‘blind’ distance covered model that’s been used in football for decades and replace it with an integrated model that contextualises physical efforts during matches.

Football incorporates unpredictable movements specifies the advantages of such an integrative aspects of the game are a challenge to quantify at during matches where players transition between model by demonstrating the concept using current present. Despite shortcomings, the demands using multi-directional high-intensity efforts and low- computerized tracking technology. An example this approach are well understood and have been intensity activity. High-intensity running during will demonstrate an alternative or complimentary for some time now. So is it wise to keep going over matches has increased by a third in the English way of analysing and interpreting physical match ‘old ground’ or produce similar research questions Premier League across the last decade, thus players performances. with slight permutations! The question that begs an must be robust enough to cope with such demands1. answer is: will this approach progress this field from The ‘traditional’ approach to quantifying demands Defining the Approaches to Quantifying Match both a fundamental or applied perspective? Well with in the absence of physiological and mechanical Physical Performance a saturated research area that boasts hundreds of measures during match play is to determine the The ‘Traditional’ Approach papers that have varying degrees of originality and distance covered at different speeds. Whilst not In the last four decades the ‘traditional’ approach has application, the inconvenient and uncomfortable accounting for metabolically taxing accelerations quantified the relative or absolute distance covered answer to this question is probably ‘No’. Studies and directional changes,2 it still crudely provides an and time spent along a motion continuum of walking have attempted to expand on this reductionism by indirect energetics measure. Despite hundreds of through to sprinting. Studies using this ‘traditional’ incorporating technical, tactical and physical metrics publications on the physical match demands, little approach are reductionist, whereby the physical within their methodology.1,5 However, data are still progress has been made regarding optimising the metrics are explored without consideration for the reported separately within the results with limited array of metrics used by applied staff within clubs. technical and tactical indices.2, 3, 4, One could argue synthesis and consequently our understanding of the However, at present a new ‘integrated’ approach that this enables an in-depth physical analysis, with global game demands still remains superficial. Figure 1. A Venn diagram depicting a generalized ‘integrated’ approach to quantifying and interpreting the physical match that contextualises match physical performance the inclusion of other factors diluting this, especially performance of players. This piece will focus on high-intensity running efforts across the game but contextualises these would surely progress the fields understanding of if the study aims do not include a technical-tactical Some tracking systems do provide a basic physical- actions in relation to key technical and tactical activities (the intersection between physical and tactical). the global demands and assimilate the physical and element. Moreover, it’s difficult for researchers to tactical perspective by categorizing high-intensity tactical data more effectively. Therefore, this piece gain access to technical analyses and the tactical running with/without ball possession and when the

42 [email protected] www.footballmedic.co.uk 43 feature football medic & scientist speed thresholds could provide tactically constrained Figure 2. High-intensity system. To enable this to happen, we are taking the of one or more of the innovative techniques available Conclusions data for selected positions that is challenging to distance covered using (A) concept a step further and collaborating on a new from these highly active research areas. The scanned The ‘traditional’ approach has been used for four interpret given the lack contextualisation. the Traditional Approach project between the Sports Science and Computing match data can be resolved to identify the activities decades to quantify match physical performances. or ‘blind’ distance covered Departments of Liverpool John Moores University. of particular players performing specific roles in their However, the ‘integrated’ approach contextualises A more customized approach that is derived from versus (B) the Integrated The plan is to create a cutting edge product that elite respective team. Moreover, it is implicit within those match demands by assimilating physical and tactical physical actions with a tactical purpose could be Approach or ‘purposeful’ teams can use to monitor players. It will combine roles that the player spatial dynamics will vary in data effectively. In the example presented, the advantageous. Even if tactics or context are the main distance covered. Please techniques from artificial intelligence and machine their characteristics depending on the overarching contemporary model unveiled the unique high- physical modulators then practitioners could still note in Figure 2B: The learning to facilitate the rapid pattern matching state of game play at the point their data readings intensity profile that exists due to distinct tactical establish if crucial roles were fulfilled or not using bottom of each stack needed to contextualise tactical activities. Such were taken. Accordingly, by directly associating a roles, rather than the one-dimensional ‘blind’ this new model. Figure 2B presents the ‘integrated’ includes out of possession techniques generally rely on the availability of large player’s spatial data to a contextual match activity distance covered produced by existing models. approach specialized to the position of each player variables while the top amounts of data from a specific domain of interest. coding scheme, the real prospect exists of being Evidence of the merits and application of this new (data derived from Ade et al.6). Ten individual variables includes in possession Consequently, employing highly sophisticated able to provide a series of activity data patterns to concept are needed before the scientific community are presented, with six occurring in possession and variables for each position. computerised scanning systems in football matches an artificial neural network12 so that it can learn to accepts it as it may well add complexity to an area four out of possession. Defensive positions have a represents an excellent candidate for the application automatically classify them appropriately. that conceivably needs simplicity. lower ratio of in/out of possession variables (centre backs: 1/5) whilst offensive positions are assigned a higher ratio (centre forwards: 4/5). Covering and recovery running are common for all positions except Table 1. Definitions used to characterise physical-tactical actions (Adapted from Ade et al 6). centre forwards, whilst closing down/intercepting is the only collective variable. The inclusion of specialist Physical-Tactical Variable Description variables enables key actions to be contextualised (e.g In Possession running in behind for centre forwards). The diversity of actions makes its challenging to catalogue each Break into box Player enters the opposition penalty box players unique physical-tactical profile using five Overlap Player runs from behind to in front of, or parallel to the player on the ball variables, thus a sixth entitled ‘other’ was created to amass additional activities. Push up pitch Player moves up the pitch to support the play (defensive and middle third of the pitch only) Run the channel Player runs with or without the ball down one of the external areas of the pitch Match physical performance data for each position Run in behind Player aims to beat the opposition offside trap to run through onto the opposition goal are displayed in Figures 2A and 2B using both models. Central midfielders, full backs and centre forwards Drive inside/through the middle Player runs with/without ball through the middle of the pitch or from external flank into the central area covered similar high-intensity distances (~600 m), Out of Possession so using the ‘traditional’ approach one could argue that these performances are comparable (Figure 2A). Closing down/Interception Player runs directly towards opposition player on the ball or cuts out pass from opposition player The ‘integrated’ method compartmentalizes data Covering Player moves to cover space or a player on the pitch whilst remaining goal side more clearly by unveiling the unique high-intensity profile that exists due to distinct tactical roles (Figure Recovery run Player runs back towards own goal when out of position to be goal side 2B), rather than one-dimensional ‘blind’ distances Ball over the top/down side Opposition plays a pass over the defence through the centre or down the side of pitch produced by existing models. This purposeful distance could be valuable to practitioners, as they do not Other All other variables that could not be categorized by the above necessarily want to determine which positions are the most demanding or cover the most distance. But rather how each performs their duties in relation a 90–180° turn as they transition from offensive channel than other positions (20-24%). They perform The information is a summary of the research article from: Bradley, P.S. & Ade, J.D. (2018). Are Current Physical to a specific opponent and team philosophy. The into defensive roles, executing more tackles post more crosses after these runs than other positions Dr Paul S Bradley 6 Match Performance Metrics in Elite Soccer Fit for Purpose or is the Adoption of an Integrated Approach Needed? ‘traditional’ model cannot provide this insight and effort than other positions. Ball over the top/down due to more efforts finishing in wide attacking pitch Integrative football specialist at Liverpool John 6 International Journal of Sports Physiology and Performance. DOI: https://doi.org/10.1123/ijspp.2017-0433. thus the subsequent section will detail the sensitivity side contributed to 20% of the total high-intensity areas. Strategies that employ offensive wide players Moores University. I conduct translational work of this integrative methodology. distance covered by centre backs. This position means that specialist variables within this model References within an elite football setting that bridges performed more 0-90° turns compared to other could provide confirmation that players are abiding to 1.Barnes C, Archer DT, Hogg B, et al. The evolution of physical and technical performance parameters in the the gap between cutting edge research and Out of possession, positions with a major defensive defensive players with most efforts anticipated with the tactical philosophy. Such as full backs, who cover English Premier League. Int J Sports Med. 2014; 35(13): 1095-100. professional practice. role in the team like centre backs, full backs and players already on a half turn as sudden directional 9% of their total high-intensity distance overlapping 2.Akenhead R, Hayes PR, Thompson KG, et al. Diminutions of acceleration and deceleration output during Contact: [email protected]. central midfielders (26-31%) cover a greater proportion changes are necessary to react to opposition players to deliver a cross.6 High-intensity running by professional football match play. J Sci Med Sport. 2013; 16(6): 556-61. of their distance at high-intensity covering space or movement.6 Obtaining true match demands should full back has increased by ~40% in the English Premier 3.Mohr M, Krustrup P, Bangsbo J. Match performance of high-standard soccer players with special reference Dr Mark Evans team-mates compared to wide midfielders (13%). incorporate accelerations but such data has yet to League in the last decades as a duel role requires to development of fatigue. J Sports Sci. 2003; 21(7): 519-28. Liverpool John Moores University Computer This innovative approach provides defensive insight be robustly validated using optical tracking systems. them to be defensive out of possession but conduct 4.Bradley PS, Sheldon W, Wooster B, et al. High-intensity running in English FA Premier League soccer Science alumnus and consultant specialising to practitioners on how players cover one another at Although including accelerometer indices is more offensive in possession actions such as overlapping matches. J Sports Sci. 2009; 27(2): 159-68. in the application of Managerial Cybernetics high-intensity and their propensity to remain compact representative of current practices, it must be noted to cross. The aforementioned actions are meaningful 5.Bush M, Barnes C, Archer DT, et al. Evolution of match performance parameters for various playing and data science to the structure, operation, to limit space for the opposition during defensive that these are typically presented ‘blind’ and without offensive attributes for the relevant positions positions in the English Premier League. Hum Mov Sci. 2015; 39: 1-11. performance and success levels of football teams. phases of play.6 The proportion of high-intensity context. Thus, this new approach is now being used to within the literature11 highlighting the importance of 6.Ade J, Fitzpatrick J, Bradley PS. High-intensity efforts in elite soccer matches and associated movement distance covered in defensive activities such as closing contextualise accelerations. As the aforementioned amalgamating physical-tactical actions. patterns, technical skills and tactical actions. Information for position-specific training drills. J Sports Sci. Andy Laws down/intercepting were similar for central (16-19%) variables are considered notable defensive attributes 2016; 34(24): 2205-2214. Academic and researcher in the Department and wide positions (14-16%) but greatest for the most in the literature,11 this approach could add real 7.Paul DJ, Bradley PS, Nassis GP. Factors affecting match running performance of elite soccer players: of Computer Science Faculty of Engineering & offensive position in the team (centre forwards: 23%). world value by detailing the physical-tactical match Could Artificial Intelligence (AI) be the answer? shedding some light on the complexity. Int J Sports Physiol Perform. 2015; 10(4): 516-9. Technology Liverpool John Moores University Centre forwards frequently perform arc runs out of behaviour across position. The ‘integrated’ approach is manually coded within 8. Abt G, Lovell R. The use of individualized speed and intensity thresholds for determining the distance run specialising in the application of cybernetics possession6 to channel an opponent with the ball one computerized tracking software by time stamping at high-intensity in professional soccer. J Sports Sci. 2009; 27(9): 893-8. and artificial intelligence to the development of way while closing them down in order to delay their In possession, centre forwards covered more high- each high-intensity effort before then observing 9.Di Mascio M, Ade J, Bradley PS. The reliability, validity and sensitivity of a novel soccer-specific reactive cognitive software systems. attack and enable team-mates to support the press. intensity distance in the offensive third of the pitch,6 associated video footage to derive its tactical repeated-sprint test (RRST). Eur J Appl Physiol. 2015; 115(12): 2531-42. This assimilated information could conceivably verify whilst driving inside/through the middle (32%), purpose. Although time consuming at present, 10.Schimpchen J, Skorski S, Nopp S, et al. Are “classical” tests of repeated-sprint ability in football externally Jack D Ade if players are adhering to tactical directives during running in behind (12%), breaking into the box (10%) algorithms could be incorporated within such valid? A new approach to determine in-game sprinting behaviour in elite football players. J Sports Sci. 2016; Head of Academy Fitness & Conditioning and the phases of play that require high-intensity efforts. The and running the channel (11%). These tactics exploit technologies so this becomes part of the normal 34(6): 519-26. U23’s Fitness Coach at Liverpool FC. Currently position covering the greatest relative high-intensity space in order to score and create opportunities for coding process. This manual technique limits the 11. Hughes M, Caudrelier T, James N, et al. Moneyball and Soccer - an analysis of the key performance undertaking a part-time PhD at Liverpool John distance in the category of recovery running was teammates, so they provide data to practitioners proposed model and at this moment in time its more indicators of elite male soccer players by position. J of Hum Sport and Exerc. 2012; 7(2): 402-412. Moores University investigating speed endurance centre backs (20%) with full backs, centre midfielders, concerning purposeful offensive running. Wide players applicable to the research setting. It may be possible 12. Russell S & Norvig P. Artificial Intelligence – A Modern Approach. 2nd ed. New Jersey: Pearson Education. training in elite youth soccer players. wide midfielders producing similar proportions like full backs and wide midfielders covered a greater in future through supervised machine learning and 2003L 736-752 (15-17%). Full backs typically preceded efforts with proportion of high-intensity distance running the artificial intelligence to have a more automated

44 [email protected] www.footballmedic.co.uk 45 feature football medic & scientist

46 [email protected]