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Is there an increased injury risk to football players during the busy Christmas schedule?

Is there an increased injury risk to football players during the busy Christmas schedule?

Dec 12, 2023

It’s that time of year again where the managers at the top premier league clubs resent the hectic fixture list that’s thrown at them. Less time to prepare and to recover and as a result, a risk of a reduction in the quality of performance. However, is there also an added risk to the player’s well being? With a forced significant change in their pre and post match routines, are they at higher risk of injury?

If we take a look at one of those clubs affected in this manner, West Ham (European Champions and Premier League heavyweights), their fixture list over the next month consists of 10 games. A mix of league, Carabao cup, FA Cup and Europa League games make for an incredibly intense festive period. As a club that doesn’t have the same luxury, as say Man City, when it comes to squad size, and therefore the ability to rotate playing staff, there is a good chance you will see a very similar starting 11 in most of these games. The intensity of each of these games, the colder weather, the travel up and down the country and into Europe are all factors that can impact how a player feels and therefore performs on the pitch.

Julian, Page and Harper, 1, (2020) conducted a systematic review on the effects of fixture congestion on performance during male professional football matches and found that performance variables such as low and moderate intensity distances covered during the 90 mins reduces. They also suggest a possible reduction in tactical performance, with decreased synchronisation between the players.

Page et. al, 2, (2022) have then gone on to take a look at a direct correlation between fixture congestion and injury in professional male soccer. They state that overall injury risk is increased during matches completed within fixture-congested periods. This is further supported by findings from a substantial European competition review which shows an increase in hamstring and quadricep muscular injuries during periods of fixture congestion. 3. (Bengtsson et. al 2014)

This leads to a very valid point of discussion, that these findings could help provide a source of scientific evidence for governing bodies to elicit change  to support player welfare and develop a more sustainable match calendar that promotes a player’s career longevity.

In the meantime however, it will continue to be a period of time where coaching and medical staff will have to regularly review and adapt their training, pre and post match plans in order to keep injury risk at a minimum and performance levels as high as possible. Players may be required to take on a role of being more active in their own recovery away from the training ground. Nutrition plans being altered to suit the increased regularity of match days. The use of alternative therapies such as heat, ice and compression when at home and ensuring plenty of sleep and rest when the opportunity arises.

Reference List

 

  • Julian, R., Page, R.M. and Harper, L.D. (2020). The Effect of Fixture Congestion on Performance During Professional Male Soccer Match-Play: A Systematic Critical Review with Meta-Analysis. Sports Medicine, 51. doi:https://doi.org/10.1007/s40279-020-01359-9.

  • Page, R.M., Field, A., Langley, B., Harper, L.D. and Julian, R. (2022). The Effects of Fixture Congestion on Injury in Professional Male Soccer: A Systematic Review. Sports Medicine. doi:https://doi.org/10.1007/s40279-022-01799-5.

  • Bengtsson, H., Ekstrand, J., Waldén, M. and Hägglund, M. (2014). MUSCLE INJURY RATES IN PROFESSIONAL FOOTBALL INCREASE WITH FIXTURE CONGESTION: AN 11-YEAR FOLLOW-UP OF THE UEFA CHAMPIONS LEAGUE INJURY STUDY. British Journal of Sports Medicine, 48(7), pp.566.2-567. doi:https://doi.org/10.1136/bjsports-2014-093494.19.

Is there an increased injury risk to football players during the busy Christmas schedule?

Lower back pain in Golf

Nov 23, 2023

Lower back pain (LBP) is the most common injury for golfers as 34.5 % of all golfing injuries involve the lumbar spine. It is important to understand the golf swing in order to identify the cause of injury and provide optimum treatment. Most injuries occur due to the impact of the golf club and the follow-through phase. Follow-through phase promotes lumber extension and eccentric contraction of abdominals in order to generate force and rotation; this places increased pressure on the spine and intervertebral discs (Finn et. Al 2013). Hosea et. al found that the compressive load during a golf swing was considerably higher in professionals than amateur golfers, with a difference of 7584 N versus 6100 N. The compressive load in a professional golf swing is equivalent to 8 times body weight (Dale and Brumitt, 2015). It is important to compare this to cadaveric studies which have shown disc prolapses to occur at 5,500 N; this highlights that the golf swing (in both amateur and professional golfers) is able to generate enough force to injure the lumbar spine (Lindsay and Vandervoot,2014).

The golf swing is repetitive, asymmetric in nature and dependent on the dominant hand; this can determine the location and severity of LBP. For example, in a right-handed golfer, the right- sided external obliques, paraspinal muscles and abdominals take the most impact and therefore the right lumbar region is most commonly injured. Also, the end position of the golf swing is called reverse C position which promotes lumbar extension and increases the risk of facet irritation. In more severe cases, spondylosis and discogenic back pain can occur from poor technique and severe muscle imbalances. (Finn et. Al 2013)

It is important to focus on muscle imbalances, thoracic and lumbar mobility and technique to prevent and recover from LBP. From analysing the swing mechanics, core stability exercises are essential in LBP rehabilitation (Evans and Oldreive,2013). Horton et al. found a delay in muscle activation in abdominal muscle for golfers with LBP, especially the lead external oblique during back swings; this further highlights the importance of core strength and endurance in protecting lumbar spine. (Horton et. Al 2001). Hip stabilisation and mobility is equally important to aid trunk rotation and lumbar stability. Vad et. al demonstrated that reduced lead hip rotation (internal and external) and lumbar spinae extension were found in golfers with LBP; this may be due to decreased hip rotation in the leading lower limb causing more force to be directed into the spine (Vad et. al 2004). Therefore, ensuring glute strengthening exercises in rehabilitation are key to provide a base of support for trunk rotation. (Finn et. Al 2013)

Reference List

 

  • Dale, R.B. and Brumitt, J. (2016). Spine biomechanics associated with the shortened, modern one-plane golf swing. Sports Biomechanics, 15(2), pp.198–206. doi:https://doi.org/10.1080/14763141.2016.1159723.

  • Evans, C. and Oldreive, W. (2000). A Study to Investigate Whether Golfers with a History of Low Back Pain Show a Reduced Endurance of Transversus Abdominis. Journal of Manual & Manipulative Therapy, 8(4), pp.162–174. doi:https://doi.org/10.1179/jmt.2000.8.4.162.

  • Finn, C. (2013). Rehabilitation of Low Back Pain in Golfers. Sports Health: A Multidisciplinary Approach, 5(4), pp.313–319. doi:https://doi.org/10.1177/1941738113479893.

  • HORTON, J.F., LINDSAY, D.M. and MACINTOSH, B.R. (2001). Abdominal muscle activation of elite male golfers with chronic low back pain. Medicine & Science in Sports & Exercise, 33(10), pp.1647–1654. doi:https://doi.org/10.1097/00005768-200110000-00006.

  • Lindsay, D. and A. Vandervoort, A. (2014). Golf-Related Low Back Pain: A Review of Causative Factors and Prevention Strategies. Asian Journal of Sports Medicine, 5(4). doi:https://doi.org/10.5812/asjsm.24289.

  • Vad, V.B., Bhat, A.L., Basrai, D., Gebeh, A., Aspergren, D.D. and Andrews, J.R. (2004). Low Back Pain in Professional Golfers. The American Journal of Sports Medicine, 32(2), pp.494–497. doi:https://doi.org/10.1177/0363546503261729.

Is there an increased injury risk to football players during the busy Christmas schedule?

Are we finally seeing the necessary consistent respect towards reducing the risk of head injuries in Elite sport?

Nov 14, 2023

What a game. What a Rugby World cup. What a final performance from both the Springboks and Kiwis. But, as always when there is any form of controversy in a big match, we will ask the question. If New Zealand captain Sam Cane didn’t have his yellow card upgraded to a red card so early on in the contest would it have been the same outcome? The rugby fan in me would love to have seen 15 vs 15 for a full 80 mins of course. However, to witness the sense taken by the officials in making an example of what is a direct shoulder to head shot, on the biggest stage there is, was a great decision. We need to protect contact sport athletes around head and spinal injuries and I personally hope this particular event will help to amplify this.

Some fantastic research was done into the frequency and type of head injuries experienced at the 2019 rugby world cup. Across 45 matches, 68 head injuries occurred with just over half of these players being removed from the field of play (Cooke et al 2023). 1. It’s going to be fascinating to see if with the recent changes in approach to the treatment and discipline of head injury related incidents in this year’s tournament correlates to a significant statistical shift compared to 2019.

Thankfully there has been much change In recent years in both the medical management of head injuries in rugby union and also the disciplinary approach to offending players.

A huge contributing factor to the progression of management and increase in discipline towards head injuries has been driven by the recent cases of ex players receiving a diagnosis of dementia with probable chronic traumatic encephalopathy. A recent paper on ‘Football’s Influence on Lifelong health and Dementia risk (FIELD)’ found that ex-professional international rugby players had twice the risk of developing dementia in later life than compared to the general population (Russell et. al 2019)2.

From the medical side, there’s been much clearer guidelines set out on the in play decision making on concussion and also on the return to play protocol. The emphasis on both the ‘recognise and remove’ principle and ‘Graduated return to Activity and Sport (GRAS) programme’ are highlighted in the HEADCASE extended guidelines posted by the RFU. 3.

Hopefully, the sensible refereeing decision made in last weekend’s final will have had a suitable impact on all those involved in the coaching and playing of rugby union. Understanding the importance of trying to abide by the safe tackling laws of the game, should correlate to us seeing less cases of longer term head injury consequences in competitors of the sport.

Is there an increased injury risk to football players during the busy Christmas schedule?

The Importance of Pilates in Physiotherapy

Oct 20, 2023

Pilates is a form of resistance training that focuses on improving muscular strength, mobility, posture retraining and balance. Pilates incorporates more of a dynamic approach to exercise and can be adapted using various equipment. The mind-body connection is the foundation of Pilates which promotes isolated muscle activation and joint mobility.

Pilates has been modified to be used as an adjunct to physiotherapy, especially to aid women’s health and chronic lower back pain (CLBP) due to its focus on transverse abdominus, multifidus, diaphragmatic breathing and lumbo-pelvic control (Wells et. Al 2014). Pilates also incorporates a holistic approach to strength training, which is achieved by mind-body connection and breathing. Focusing on a muscle, breath or movement helps to redirect thoughts away from stress and create a meditative practice (Memmedove,2015).

There are various types of Pilates equipment which include reformer, chair, cadillac and mat. The equipment enables the exercises to be modified to the patient’s needs; for example, the springs and ropes on the reformer can provide more stability compared to a mat based Pilates exercise. Luz Jr et. Al found that equipment based Pilates reduced patient specific disability and kinesiophobia  (Luz Jr et. al,2014) and therefore aids recovery from injury.

Pilates exercises can be adapted for all age groups and can promote independence for elderly patients. The combination of strength and balance training enables an increase of activities of daily living (ADLs) and prevention of falls (Ferandez-Rodriguez et.al 2021). In addition to preventing injury, more recent studies have shown Pilates to lower the severity of temporomandibular dysfunction, fasting blood glucose and HbA1c level in type 2 diabetes in women (Parveen et. al 2023).

Pilates has been proven to progress both physiological and psychosocial aspects of patients’ well-being. However, there is evidence to suggest that there is no difference between Pilates and other forms of strength training in improving “dynamic strength, isometric strength, resistance strength, balance and flexibility” (Pinto et. Al 2022). It is crucial to understand that there is no optimum form of rehabilitation, and this highlights the importance of patient specific care.

Reference List

da Luz, M.A., Costa, L.O.P., Fuhro, F.F., Manzoni, A.C.T., Oliveira, N.T.B. and Cabral, C.M.N. (2014). Effectiveness of Mat Pilates or Equipment-Based Pilates Exercises in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. Physical Therapy, 94(5), pp.623–631. doi:https://doi.org/10.2522/ptj.20130277.

Fernández-Rodríguez, R., Álvarez-Bueno, C., Ferri-Morales, A., Torres-Costoso, A., Pozuelo-Carrascosa, D.P. and Martínez-Vizcaíno, V. (2021). Pilates improves physical performance and decreases risk of falls in older adults: a systematic review and meta-analysis. Physiotherapy. doi:https://doi.org/10.1016/j.physio.2021.05.008.

Memmedova, K. (2015). Impact of Pilates on Anxiety Attention, Motivation, Cognitive function and Achievement of Students: Structural Modeling. Procedia – Social and Behavioral Sciences, 186, pp.544–548. doi:https://doi.org/10.1016/j.sbspro.2015.04.009.

Parveen, A., Kalra, S. and Jain, S. (2023). Effects of Pilates on health and well-being of women: a systematic review. Bulletin of Faculty of Physical Therapy volume , 28(1). doi:https://doi.org/10.1186/s43161-023-00128-9.

Pinto, J.R., Santos, C.S., Souza Soares, W.J., Silveira Ramos, A.P., Scoz, R.D., Teixeira de Júdice, A.F., Alves Ferreira, L.M., Baltazar Mendes, J.J. and Amorim, C.F. (2022). Is pilates better than other exercises at increasing muscle strength? A systematic review. Heliyon, [online] 8(11), p.e11564. doi:https://doi.org/10.1016/j.heliyon.2022.e11564.

Wells, C., Kolt, G.S., Marshall, P., Hill, B. and Bialocerkowski, A. (2014). The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review. PLoS ONE, 9(7), p.e100402. doi:https://doi.org/10.1371/journal.pone.0100402.

Is there an increased injury risk to football players during the busy Christmas schedule?

Multidisciplinary Teams in Private Practice: Lessons from the NHS

Apr 14, 2023

As a healthcare professional, I have had the privilege of working in both the National Health Service (NHS) and private practice settings. One aspect that has stood out to me is the power of multidisciplinary teams (MDTs) in delivering high-quality care to patients. MDTs, consisting of professionals from different disciplines working together, have long been an integral part of the NHS model of care.

In the NHS, MDTs are formed by bringing together healthcare professionals from various disciplines, such as physicians, nurses, pharmacists, physiotherapists, occupational therapists, social workers, and others, to collaborate in the assessment, planning, and delivery of care for patients with complex health conditions. MDTs utilise their diverse expertise and perspectives to provide holistic and patient-centered care, considering not only the medical condition but also the social, emotional, and psychological aspects of patients’ well-being. This collaborative approach has been shown to improve patient outcomes, reduce hospital readmissions, enhance patient satisfaction, and optimise the utilisation of healthcare resources.

Emulating MDTs in private practice can be equally beneficial. In private practice, healthcare providers often work independently, focusing on their specific area of expertise. However, incorporating a multidisciplinary approach can significantly enhance the quality and effectiveness of care delivered to patients. Here are some key reasons why emulating MDTs in private practice can be advantageous:

  • Comprehensive and Holistic Care: Incorporating professionals from various disciplines in private practice can enable a more comprehensive and holistic approach to patient care. By considering not only the medical condition but also the broader context of patients’ lives, including their social, emotional, and psychological well-being, healthcare providers can develop more effective treatment plans that address the whole person, leading to improved patient outcomes.
  • Collaborative Decision-Making: MDTs foster collaborative decision-making, where healthcare providers with different perspectives and expertise come together to develop and implement patient care plans. This collaborative approach can lead to more informed and evidence-based decision-making, reducing the risk of medical errors and improving patient safety.
  • Improved Patient Experience: Patients often appreciate the convenience of receiving care from a variety of healthcare professionals in one location, rather than having to visit multiple providers in different locations. A multidisciplinary approach can enhance the patient experience by providing streamlined and coordinated care, resulting in increased patient satisfaction.
  • Enhanced Professional Development: Working in a multidisciplinary team can also provide opportunities for professional development and learning. Collaborating with colleagues from different disciplines can expand healthcare providers’ knowledge and skills, fostering a culture of continuous learning and professional growth.
  • Efficient Resource Utilisation: MDTs in private practice can also optimise the utilisation of healthcare resources. By pooling the expertise of different professionals, redundant or unnecessary tests or procedures can be minimised, resulting in cost-effective and efficient care delivery.

Emulating MDTs in private practice can be highly beneficial for patients and healthcare providers alike. By fostering collaboration, comprehensive care, patient-centeredness, and efficient resource utilisation, MDTs can enhance the quality and effectiveness of care delivered in private practice settings. As healthcare professionals, let us learn from the successful model of MDTs in the NHS and strive to incorporate multidisciplinary approaches in private practice to optimise patient care and outcomes.