First Meeting: The Gaffer Effect

Friday, April 3 2020

 

So you think you've got a hernia?! In proud association with 108 Harley Street 

Chapter Three

Co-authors: Johnny Wilson, Ben Dinnery and Stel Stylianou

Photo: Dimitri Houtteman on Unsplash


Be careful what you wish for…

Pepper paused before knocking on the Gaffer's door, her heart was racing and palms sweaty. She recalled her meeting with Jock McTopdog during her interview three months earlier. Jock had complemented Pepper on an excellent presentation; he was forthright and brutally honest about the role and the difficulties of transitioning from a hospital environment to working at the coalface of professional football. She remembered, impressing upon him, that she was ready and this is all she ever wanted to do. She told Jock: "I'm sure with time, you will agree that I will become an invaluable member of the staff and an integral part of the team." Jock nodded his head and gave her a knowing smile.

Jock had a fearsome reputation, no quarter was ever asked from him, and indeed, none were given by him either. McTopdog was a man who wanted things done his way. No one was safe. Only last month, three of Town's best players had been sold due to a lack of commitment; they were more interested in self-fulfilment, self-gain than being footballers. No one was bigger than the team. Stories of Jock's ruthless discipline had gained almost mythical status under his tenure. Four years ago, he stormed the DJ booth at a local nightclub when the Under-18s decided to enjoy some post-match celebrations following a hard-fought 5-4 victory: "Defences win titles," he lambasted his players over the mic. "Your defending this afternoon was dogsh*t! Get your arses home now, and I expect to see you in training at 9am tomorrow – sharpish!" A character, who found his vocation in life: a love for football that never once left his heart. A heart, strewn across a battle-hardened no excuse sleeve, for all to see.


And down the rabbit hole she went!

Pepper took a deep breath and rapped on the door… "Come in," boomed a loud voice.

The first thing Pepper noticed when she opened the door was a wall adorned with framed images. A collection of photographs featuring Jock standing next to some of football's biggest names - a who's who from the past and present - former players and world-renowned coaches; Sir Alex Ferguson, Arsène Wenger, Sir Bobby Robson, George Best, Pele, Franz Beckenbauer, Johan Cruyff… Pepper's eyes darted around the room. She had heard rumours of the infamous "Wall of Fame" but hadn't believed the hyperbole. Standing in awe, Pepper felt as though she had ingested a shrinking potion and was heading down the rabbit hole. The coaching staff said it was intimidating. Now she knew exactly what they meant!

"Sit down love," Jock said as he took off his glasses and gave them a quick clean. "Hmmm, no eye contact, this must be bad," thought Pepper. Her mind quickly teleported Pepper back to being a child, feelings of vulnerability came flooding back, she held onto her notepad, for comfort, as if it were a teddy and proceeded to take a pew. Pepper felt as Jock was studying her, reading her body language, analysing her from top to toe, until finally, he made eye contact: "How did the boys do today?"


The Handover

Pepper fumbled with the pages of her notebook. She began by regaling the GPS data and commented that there was a lot of high intensity running in the session. Jock seemed happy to hear this.

Pepper went on to say that a couple of the players were reporting DOMS like symptoms in their legs but nothing serious. Jock didn't believe in DOMS and gave her a scornful glance. Pepper had enough emotional intelligence to remember not to mention DOMS again from the glare he gave her.


Pipe Down Jock

She then mentioned Francie's name. Jock leaned back on his chair and muttered: "What's wrong with him now?" Pepper did her best to explain the mechanism of injury, describe his pain and the uncertainty that lay around his diagnosis and prognosis. Jock seemed all too unimpressed with the situation. He started grilling her with questions, some she had already answered: "When will he be back playing? Why did it happen? What were his bodyfat measurements? Did he carry out his off-season conditioning program?" With each question, he became more animated. Pepper thought that he might simply just combust in front of her, such was his increasing rage. Pepper did little to temper his emotions with her replies, and Jock ended the conversation abruptly: "I want him to be the first player through the door, and the last out. I want him on double sessions every day, and I want him in on Sunday too. Pepper nervously nodded in agreement, now was not the time to start discussing "load management" or the importance of psychological rest and recovery. Jock looked at her, shook his head with disappointment and then turned to the tactics board on the wall behind his desk. Pepper sat on the chair, trembling and dejected. She didn't know if the meeting was finished or not; she didn't know if she should just leave. After a few moments, she decided to rise from the chair and make a run for the door, but as soon as her bum lifted, Jock turned around and roared at her: "Get Francie for me now, tell him I want to see him in my office right now!"

Pepper could see the veins in his forehead pulse with electric anger, they sort of glowed ruby red with a tint of purple. Pepper was distraught as she had to tell Jock that she let him go home at the same time as the other players. Jock was apoplectic at this stage. He sighed, and with a raised eyebrow, replied: "In the quiet words of the Virgin Mary – come again? What do you mean Francie has gone home?" He then roared at her to get out of his office and order Francie to come back to the club immediately. As she tried to escape McTopdog's bollocking continued: "I don't care how you do it, but you get on the blower to Francie and tell him to get his arse back here, and you do your bloody job. Am I clear? "Crystal," replied Pepper. "Good. Now take your My Little Pony notebook and get out of my office."


Dreams never come cheap Pepper

Photo: Ian Espinosa on Unsplash

Pepper limped out of his office down the corridor to the medical room. She was trembling on the verge of tears and felt very lonely. She very gingerly went to get Francie's medical file, to find his number, and advise him to return to the club. However, when she finally did access his notes, she realised that in all the panic, she never even asked him where he lived. What was his date of birth? Did he have an email address? And, most fatally of all: What was his telephone number? "What a sh*t show," she thought. "The first day on the job and I'm probably going to get sacked," she ruminated. Her mind was racing from one catastrophic thought to another. She was unable to control her feelings and burst into tears.


The Greatest Kitman of them All

On his daily rounds, Kev the greatest self-proclaimed "kitman" was on his way, begrudgingly, to the medical room to collect the dirty towels. He wouldn't usually ever "fetch" the kit or the dirty towels after training, that was the duty of the scholars. However, he was still adjusting to the new guidelines from the FA, which stated that scholars were no longer required to carry out such tasks as cleaning boots or collecting laundry from around the club. Anyway, Kev had an ulterior motive for collecting the dirty linen today… He burst into the medical room, in his usual, over-the-top boisterous manner, keen to know everything and anything he could about the new physio in the club.

@StanleyParkSG on Twitter


Be patient: YOU WILL be Fine Pepper

He startled Pepper, who tried to collect herself. Kev was a lovely soul. He could see that she had been crying. He introduced himself and sat down. Kev spoke, and Pepper listened. It was like medicine for Pepper, just to hear a friendly voice talking to her. After five minutes, Kev finally asked Pepper: "What's the matter?" She relayed the events of the day with the Gaffer. Kev smiled, took out his mobile, scrolled through his phonebook and scribbled Francie's number on her notepad. He looked at her, collected the towels and said: "I'll be in the kit room if you need a cuppa and a friendly ear." Pepper mustered a wry smile.


A word from the wise

In that very moment, when Pepper felt she was going to lose everything, a friend appeared unannounced with the one thing she needed most. "The universe is a wonderfully magical place, Pepper, and it is when we are in the midst of our toughest of times, that we must believe that there is a way forward. For if we believe, we can make it happen."


Back to the story

Pepper composed herself, she had a glimmer of hope now, her journey, her dream was still alive. In her mind, she smiled. She made the call…


To find out what happens next, make sure you tune in for next month's chapter. To follow the story from the beginning click here


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FPL Bargain Bucket: Eleven players who cost under £5m

Thursday, March 5 2020

 

The business end of the Premier League season is approaching much quicker than you would think. With some managers having European priorities when selecting their line-ups, it’s time to think carefully about which players to have in your team. Budgeting is always the key when it comes to FPL, so here is a team of players all under £5m, which will leave you with a pocket full of cash to help you load up on premium picks.


Alex McCarthy (Southampton) – Current value £4.4m

McCarthy has been Southampton’s No.1 since November after Angus Gunn lost his place following the 9-0 mauling by Leicester. McCarthy is a competent shot-stopper, and with a decent run of fixtures, Southampton players have some appeal. The Saints next ‘big’ game isn’t until April when City arrive at St Mary’s, but before that, they play Newcastle, Norwich and Watford. There is clean sheet potential here for the 30-year-old, as well as bonus points for saves made.


Joel Ward (Crystal Palace) – Current value £4.3m

Despite some solid performances by Martin Kelly, Ward is Roy Hodgson’s preferred option at right-back when both of them are fit. With Palace’s pragmatic and dogged style, they are never easy to break down, which means they’re not likely to concede many. Ward could be an excellent addition to your squad. The Eagles have some favourable fixtures remaining – Watford and Bournemouth next up - and they may grab some clean sheets.


Chris Basham (Sheffield United) – Current value £4.5m

Any of the Blades’ central defenders are viable selections with John Egan (£4.6m) and Jack O’Connell (£4.7m) representing excellent value. Basham is singled out though, as he is the cheapest starting defender United have at £4.5m and is currently second in the Premier League for headed clearances (72), and these tangible nuances can make the difference when considering the FPL bonus points system. Basham is the least owned United defender at just 1.3% while Chris Wilder’s men will also have a double gameweek coming up.


Jack Stephens (Southampton) – Current value £4.5m

Stephens only started one league match in the first three months of the season, but like teammate Alex McCarthy, he has been a permanent fixture since November. Despite his slow start to the campaign, he has still amassed 62 points, which is joint fourth within the Saints squad. Stephens has one goal and three assists this season, and with Southampton having already played Liverpool, Leicester and Tottenham twice, he will be looking to add to his points tally.


Japhet Tanganga (Tottenham) - Current value £4.1m

Unless you are a Spurs fan, it was highly likely that you had no idea who Tanganga was before Christmas, but Jose Mourinho has spotted something in the 20-year-old. Tanganga is energetic, loves a tackle, is capable in the air, and his versatility across the backline means he will get minutes. Mourinho is known for his tactical nous, and although Tottenham are struggling to keep clean sheets, they did have two shutouts in February which offers a glimmer of hope.


Douglas Luiz (Aston Villa) – Current value £4.4m

Considering he has been introduced from the bench on eight occasions, Luiz has contributed quite well for Villa in his first season with the club. He has three goals and two assists and has rather quietly mustered up 69 FPL points. As Villa continue their fight to beat the drop, expect him to be getting forward and shooting more in the absence of John McGinn.


Todd Cantwell (Norwich) - Current value £4.8m

Cantwell is already owned by 20.5% of FPL managers, but as Norwich’s secondary goal threat, expect more heroics from him despite the Canaries looking destined for relegation. Daniel Farke would do well to hang on to the tough-tackling 22-year old this summer who has six goals and two assists. If he avoids injury, there should be a minimum of three more goal contributions this season, regardless of how many points Norwich pick up.


Bukayo Saka (Arsenal) – Current value 4.5m

Due to fitness concerns over Sead Kolasinac and Kieran Tierney, the winger has had to deputise at left-back on occasions, but this has not halted his output, Mikel Arteta has shown confidence in him and allowed him to express himself. He has already amassed four assists with limited game time. With Arsenal out of the Europa League, he will continue to get more minutes and should leave his owners satisfied.


Mason Greenwood (Manchester United) – Current value £4.3m

Ole Gunnar Solskjaer is already waxing lyrical over his teenager, saying that at his young age he is already one of the best natural finishers that he has seen, comparing him to the likes of Robin van Persie. Solskjaer thus far has been careful in the way he has used Greenwood, but with Marcus Rashford out for the rest of the season his playing time will increase. After playing Manchester City and Spurs back-to-back in March (two teams they have already beaten), United then have a nice run of fixtures.


Gabriel Martinelli (Arsenal) – Current value £4.6m

The 18-year old Brazilian told Unai Emery when he was in charge of the Gunners that he prefers to play out wide than in the centre. However, he has the instincts of a man who was born to play centrally, and he looks a goal threat whenever he’s on the pitch. His goal against Chelsea at Stamford Bridge shows that he has maturity beyond his years, and the more he plays, the better his movement will become. Martinelli should see some starts during the season run-in.


Eddie Nketiah (Arsenal) – Current value 4.3m

Some were surprised when Nketiah was called back from his loan spell at Leeds in January. It was not known whether or not he would be loaned out again or sold permanently, but now we know Mikel Arteta has brought him back to North London to use him. Nketiah has started Arsenal’s last two league games and scored against Everton. Still only 20, he could grow into a very good frontman, and a killer when in the penalty box.


Daniel Dwamena

@DubulDee

 

 


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Heung-Min Son speared by “The Spanish Archer”

Wednesday, February 19 2020

 

Heung-Min Son speared by “The Spanish Archer”

 

On form, on Son…..

Six in his last 5, the Champions League quarter-finals just around the corner, Kane hamstrung and no centre-forward signing during the January window, then all of a sudden, Spurs UNDROPPABLE man has been speared by the deadly “Spanish Archer” and given the “El-bow”.


The Perfect Storm:

  • 32 games already this season
  • Previous Elbow Injury
  • Contact with an opponent
  • Fall on an outstretched hand

Surely this is a schoolboy error by Mourinho???

They said he had it all: speed, power, technical attributes and an unerring ability to be in the right place at the right time. And they were right: he is an exceptional player, some would say one of the best in the world. But he’s not Superman. With Kane injured, Jose Mourinho placed all his eggs in one South Korean basket, and under his tutelage, he started every game when not suspended. So there you go, high game load, previous injury and the correct mechanism to inflict a proximal radial fracture. I’m surprised your surprised he got injured!!! Why not plan for the worst and hope for the best? Why did Mourinho not sign a proven goalscorer in the January window? Is this amateurish? I’ll cover this in The Late Fitness Test Podcast with my cohosts Ben and Stel.


How bad is this injury?

Radial fractures are the most common fracture at the elbow. This type of injury was first reported over 80 years ago in the New England Journal of Medicine; it is still a topic for debate on how to best manage this injury. The radius is an extremely important bone of the forearm. If injured it pretty much renders the rest of the arm useless. It provides vital stability and movement at the elbow and governs function at the wrist and hand. Suffice to say, an injury to it can be quite debilitating. An important note to also bear in mind is that radial fractures are often associated with other injuries including ligament and cartilage damage as well as damage to the other bones around the elbow joint. More trauma may lead to a delay in return to play is what I am getting at.


The Surgeon

Mr Alun Yewlett, a recognised expert in the field of shoulder and elbow surgery, reports that an operation is usually required if the bone has been displaced. In an interesting conversation around this type of injury and the need to go under the knife, Alun believes that the key to a successful surgery is to “restore stability at the joint”. Alun also forecasts that “when surgery is involved” and depending on which repair option was chosen, these cases are more likely to need “between 10-12 weeks before returning to play”.

https://www.108harleystreet.co.uk/consultant-list/the-london-sports-orthopaedic-clinic/alun-yewlett/


Where is the proximal radius?

The proximal (closest to the head) part of the radius can be found at the elbow. The radial bone runs the length of the forearm down to the wrist on the side of the thumb and forms two joints at the elbow and one further down at the wrist. The other bone of the forearm is the ulna.


When will he return to play?

Six weeks might be a best-case scenario while some people can take up to three months to recover from such an injury. Obviously, a lot depends on how severe the initial trauma was. The more trauma, the more likely it will take longer to recover.

According to injury analyst Ben Dinnery, Heung-min Son suffered a similar injury (same arm) in the summer of 2017. He returned to play nine weeks later (61 days exactly). Further interrogation of the data by Ben reveals that he is the only attacker to have suffered this injury in the Premier League in the last ten years. Over 63% of players to incur this type of injury or similar were goalkeepers and defenders. And of note his teammate Hugo Lloris recently spent 109 days on the sidelines due to an elbow dislocation.


Premier Injuries

If like me, you love your injury stats, then check this out for size:

  • Arm/Elbow account for Five of the Top Six time-loss injuries for the Upper Body
  • On average Goalkeepers spend 75% longer (vs Outfield) on the sidelines after suffering an Upper Body injury.
  • Overall Upper Body injuries count for 12% of those reported by Premier Injuries.


Rehab Like A Pro:

The key to quick and safe recovery is to get the arm moving as soon as possible to limit stiffness, reduce stiffness and minimise muscle loss. The rehab around the elbow itself will focus on:

  • Minimise infection risk
  • Protect the surgical site from re-injury
  • Optimise Bone remodelling
  • Pain reduction
  • Range of Motion - https://youtu.be/CYQmLzEp9ik
  • Grip strength
  • Functional strength

If the fracture site is deemed stable, and surgery is relatively unremarkable, the likelihood is that Son’s elbow will not be placed in a cast, and instead, be placed in a removable splint which will enable early gentle movement to begin as soon as possible. When he returns to train and play, the medical team will need to come up with an innovative solution to not only protect the elbow from future injury but to also ensure that it will not endanger the safety of the other players.

Over the coming few weeks, I will detail the type of rehab that he will undertake in our Rehab Pro Series and you can check out all the exercises he is likely going to do on our YouTube Page: https://www.youtube.com/channel/UCB1DrMOViNEvMATXnUDfBpw


Hope you enjoyed the piece guys. Love to hear your feedback.

Best wishes

 

Johnny Wilson

Clinical Director

108 Harley Street

www.108sem.co.uk


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Ben Dinnery

Ben Dinnery

@BenDinnery

Ben is football’s leading injury specialist. The ‘go-to’ guru for big hitters like Sky Sports, ESPN and NBC Sports when they need data. Or the BBC, talkSPORT and the broadsheets when a quote is required. His unique insight has helped provide a better understanding of what is really happening in the treatment rooms.


Johnny Wilson

Johnny Wilson

@johnny_wilson5

Johnny is a respected physiotherapist and sports scientist, specialising in football injuries and rehab. Johnny has headed up the medical departments at Chesterfield, Scunthorpe and Notts County. Overseeing everything from player-specific training loads to pre-signing medicals. He has a proven record working with elite athletes in Private Practice and is regularly called upon throughout Europe to deliver presentations on the latest rehab innovations.


Matt Nesbitt

Matt Nesbitt On TipTV

@MattNesbitt16

Matt's short, unremarkable football career was ended by his own bad driving. His long, distinguished career as a football tipster was ended by his own good advice. Because bookmakers don’t like a winner. First, they closed his accounts. Then his members’ accounts. Then his tipping service. And now they employ him as a consultant. Funny old game.


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