How to pass a football medical...

Monday, September 30 2019

 

Matt Nesbitt pulls back the strapping on what really goes on in a football medical

If you think that the football medical is merely a sideshow of Transfer Deadline Day. A formality to be rattled through in a few minutes, while the player’s agent is getting the last couple of critical contract terms over the line - usually his percentage and the sell-on fee (for the more-than-likely already arranged transfer). You’d be wrong. It’s crucial, often as a get-out-this-deal-free card for the player and/or the club.

John Beresford tells a great – and revealing - story about his proposed move to Liverpool from Portsmouth. Moments after his dream move was derailed by the medical team at Anfield, he passed a medical for Newcastle United – over the phone.

 

An Englishman’s fish is a Frenchman’s poisson

C’mon, you remember John Beresford… He was the diminutive blond left-back that played behind David Ginola for Kevin Keegan’s mid-nineties nearly men.

He was the one blamed for about half of the goals they conceded. Grossly unfair because he spent most of his time being double-teamed by the opposition winger and right-back, while the immaculately coiffured Frenchman in front of him strolled about on the halfway line clicking his fingers above his head.

“Garcon… Garcon. Le ballon, s’il vous plait.”

The story goes that John was on his way to join Graeme Souness’ Liverpool having impressed for Pompey in a cup tie (despite missing the all-important penalty in the shoot-out). But during the medical, an x-ray revealed a problem with his ankle. Apparently, it hadn’t set correctly following a fracture playing for Barnsley – four years and 150-odd games previous.

No-fault of the club, of course. They sent all their injuries to accident and emergency in Barnsley General hospital during that period.

But Liverpool were (and remain) bastions of the highest possible standards. And at the time were only a few seasons past an unmatched period of domestic and European domination. If they’d started taking chances on half-fit full-backs in 1992, it could’ve been decades before they began to challenging for the major prizes once again.

(Yes, I know that actually did turn out to be the case. But it wasn’t due to their medical team playing fast and loose with floating cartilage).

Anyway, the deal was off, and a gutted Beresford was marched off the premises.

 

As one gate slams, another one opens

Enter Kevin Keegan.

With the clang of the Anfield gate slamming behind him still ringing in his ears. John’s phone rings.

*NOTE FROM THE AUTHOR*

I know what you’re thinking.

‘There were no mobile phones in 1992! The credibility of this story has been compromised. ABORT! ABORT!’

I thought the same. But that’s how John tells it, and I’m not calling him a liar – he’s got an MBE now, y’know. Plus, there is no way of checking, and it is key to success of his story and this article.

So how about we say his agent had a car phone. Happy with that…? Great.

AS YOU WERE…

With the clang of the Anfield gate slamming behind him still ringing in his ears. John’s agent’s car phone begins to ring.

John is still disconsolate in the passenger seat. Head bowed. Eyes filled with tears.

The agent pulls his BMW 5 series (probably) to the curb and answers. It’s Kevin Keegan.

 

‘Hello Mr Keegan. Let me hand you over to my client John sat next to me, disconsolate in the passenger seat. Head bowed. Eyes filled with tears.’

‘John, Kevin here. Come and sign for me. I’d love it.’

 

John Beresford MBE spots an emergency parachute when he sees one but is a professional. Immediately ‘fessing up what has just happened in the Anfield treatment room, explaining to KK about the badly set ankle.

He needn’t have worried.

‘Oh, don’t worry about that. We’ve just signed Paul Bracewell – his ankle is f#@ked!’

And that was that.

 

Trust me; I’m a football manager

Later that day, Beresford was ushered through the medical department at Newcastle United with Keegan cajoling and heckling the physios throughout. And the deal was done.

He went on to play 179 games for Toon over six seasons, during the most exciting period in their history. So, this is no criticism of Keegan or Souness. It merely highlights the grey area around the football medical.

(Paul Bracewell also managed over 70 games for Toon. Training once a week and being packed in ice and pumped full of pain-killers the rest of the time).        

Harry Redknapp has spoken openly about using a failed medical as an excuse to put the kybosh on transfers. Usually to make way for a late Peter Crouch or Niko Kranjcar deal.

So don’t make the mistake of thinking that football medicals are black and white. Or that medical teams or a latent injury carries more weight than the people running the club.

Football is a game of opinions. And so is match fitness, my friends.

 

Matt Nesbitt swapped his short, unspectacular but joyous football career for a much longer, successful one as a football tipster.


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The Late Fitness Test podcast | Episode Seven

Monday, September 23 2019

 

On episode seven of the Late Fitness Test podcast - in association with Shoot the Defence – myself, Johnny Wilson (@johnny_wilson5) and Stel Stylianou (@UncleStel) analyse the injury data from the opening weeks’ of the new Premier League season and explore why the number of reported incidences has increased in recent years.

  • We discuss Callum Hudson-Odoi’s impending first-team return (⏱️ 12:00m). The winger underwent surgery in April after rupturing his Achilles at Watford in the Premier League five months ago.

“Generally, they repair pretty well, and then it comes down to how rigorous the rehab is after that. The tendon doesn’t like rest, it’s probably the worst thing you can do, so tendons they respond to load.”

  • Newcastle United defender Florian Lejeune is closing in on a comeback after suffering a second serious knee injury within the space of 12 months. We look at the research carried out by a Scandinavian group led by Hege Grindem in 2016 and why his setback came as no surprise.

The nine-month rule. (⏱️ 16:00m)

“Athletes who return to their level of sport before nine-months are nearly five times more likely to re-injure the knee or suffer an injury to the other knee. And every month that you wait after nine months, your risk of recurrence goes down by 51 per cent each month.”

  • Lejeune made a remarkable return-to-play for the Under-23s after only 140 days but ruptured the ACL in his opposite knee less than five months later.

“I’d be surprised if he didn’t have a recurrence, for a number of reasons……... We are rushing these players back because there’s a huge amount at stake.”

 

Debunking the Miracle Doctor myth (⏱️ 25:00m)

  • Following the news that Manchester United full-back Diogo Dalot spent 10-days in China with Super League side Shanghai SIPG and Head of Medical - Eduardo Santos – we look at what, if anything, is so special about these go-to clinicians.

“All you need is one very high-profile player in the dressing room saying to the guy beside him, ‘You need to go-to X, he’s the Miracle Guy’. And then, two players go there; three players go there, four players go there and all of a sudden you have this reputation of being in the right place at the right time and being known as the Miracle Guy.”

There is absolutely nothing out there that is going to speed up recovery. You must:

  1. Protect from re-injury.
  2. Give it the right environment to grow and heal properly.
  3. Time. There are no miracles. There is no magic pill. You’ve got to do the work.

 

And finally.

The FIFA Technical Report from 2018/19 Champions League tournament. (⏱️ 33:00m)

  • Premier League players have recorded the Top Three fastest speeds in the competition for two years running while the number of sprints overall more than doubled in 2018/19.

Are increases in injury incidence rates indicative of players reaching their ceiling point?

We talk:

  • Recruitment – and how the genotype of a player - has changed over the previous decade as the game continues to evolve.
  • Are we conditioning players with enough speed work to help them tolerate this new game?
  • Responsibility and ownership. 
  • Does football need to become more ruthless at an early age?

“It comes down to a little bit like gymnastics where they weed out the weak very, very early. You either can cope with gymnastics, or you get injured, and if you get injured, you get thrown away. And in a lot of ways, football has to become a bit more ruthless because of the amount of money that’s there…”

 

Have a listen; we would love to hear your thoughts!

 

🍏Apple https://podcasts.apple.com/gb/podcast/the-late-fitness-test-season-2019-2020-episode-7/id633108165?i=1000449475694

 

🎙Audioboom https://audioboom.com/posts/7365759-the-late-fitness-test-season-2019-2020-episode-7

 

🗣Spotify https://open.spotify.com/episode/01NNYc6IJLQIKmPZbIR51Q


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The Late Fitness Test podcast | Episode Six

Tuesday, September 10 2019

 

On this weeks’ Late Fitness Test podcast - in association with Shoot the Defence - myself, Johnny Wilson (@johnny_wilson5) and Stel Stylianou (@UncleStel) were joined by former Head of Sports Science at Bury FC – Matt Wood – to discuss the tragic demise of this small northern club.

“100 per cent, I thought right up until the end that we were going to be saved by someone.”

Heart-wrenching stuff from Matt who tells us what it was like during those final weeks and days. He talks us through his time as a volunteer and how he finished as an unpaid head of department. A club left in turmoil, but for Matt, he will always be grateful for the opportunity handed to him by Bury.

 

Aymeric Laporte

  • Johnny outlines the task-based rehabilitation programme the Frenchman will undertake as he targets a return-to-play in early 2020.

“This guy is going to have to learn to walk again, and the knee is going to have to learn to function with part of its shock absorber gone.”

 

The International Break

  • Is the social media circus justified given the high number of players who will withdraw from their respective national teams, but return when the domestic fixtures resume?
  • The Fergie fingerprint. Do big clubs influence high-profile player omissions? We look at Aaron Wan-Bissaka/Paul Pogba and the FIFA guidelines around releasing players for games.

 

Ben Foster

Dietary habits and the ‘Four Pillars of Performance’….

  • Mindset – positive outlook, practice with intensity
  • Type of Exercise – training with precision, periodisation
  • Sleep – more, and better!
  • And diet…… *spoiler* Johnny loses us for a bit when he touches upon metabolic flexibility.

 

And, finally, Stel is full of praise for Watford head coach Javi Gracia, just two days before his sacking!

 

🍏 Apple https://podcasts.apple.com/gb/podcast/shoot-the-defence/id633108165?i=1000448736920

🗣️ Spotify https://open.spotify.com/episode/4bKrwoF1zFvgy5egctqr2I

🎙️ Audioboom https://audioboom.com/posts/7360776-the-late-fitness-test-season-2019-2020-episode-6-special-guest-matt-wood


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The Modern Day Footballer

Thursday, September 5 2019

 

Strength Training

In the powder keg arena of Sport Science and it’s mission to improve the athletic prowess of footballers and reduce their risk of injury, this highly political performance pendulum seems to have swung towards an emphasis on training the muscles of the lower limb in an isolated approach to run faster, jump higher and resist injury.

Source social media sport science theorists. That is to say that there is a lot of importance put on gym-based exercises such as nordics, squatting, deadlifting, lunging, calf raises etc. Now, while I am not for one moment arguing against this type of conditioning, as it is also a common theme in my own practice, I do believe that more of a nuance could be placed on a systems approach to improving sport-specific strength. From reading the contrasting and often hotly debated theories on social media, my concern is that we are becoming too granular in the gym with soccer players and that the sports science community are more interested in isolated tissue mechanics; is the muscle eccentrically contracting et cetera, et cetera, rather than what is demanded by the sport.

Let’s get straight into it.

 

What is a footballer?

In effect, he/she is an endurance athlete and therefore needs to be able to cover roughly 10-to-12km of high-speed running and intermittent sprinting over a 90(ish) minute period.

Therefore, maybe more of an emphasis needs to be placed on strengthening and conditioning the cardiovascular and cardiorespiratory systems in the gym or on the pitch rather than developing lower limb strength in isolation to run faster for longer, jump higher and be more resistant to injury - just a thought (I know a provoking thought).

However, let me be clear, I am not saying that we should not strengthen leg muscles, just bias a bit more towards strengthening them at speed or at a threshold heart rate (THR) (maximum number of beats your heart can beat to supply oxygenated blood to the working muscles usually longer than 10 minutes and less than an hour). And again I am not saying that we need to increase the volume of training or time on the training ground, just possibly tweak the type, intensity and speed of exercise that we choose.

For example, we might select short distance, high-intensity sprints with incomplete recovery between sprints at the end of a training session on a Tuesday rather than three sets of Nordics to help inoculate against hamstring injuries. Here, we are incorporating a high heart rate at or above their THR, improving oxygen turnover efficiency, practising the skill of running at speed (also needs to be trained), replicating the demands of the game and improving the hamstrings ability to tolerate repeated eccentric (lengthening of the muscles) explosive efforts: Better still get the player to execute a motor skill at the end of each sprint (shooting crossing dribbling et cetera, and you have “Soccer Specific Strength Training” which is physiologically demanding, fun and engaging - a systems rather than isolated muscle approach. This is just a redirection on the mindset of strength training for soccer players rather than being opposed to it.

I am in fact a huge advocate of strength training but more from the perspective as a multi-joint, multiplanar activity which requires control, movement of many body parts, rotation and the ability (strength) to move/stop/change direction/vary pace in response to an external stimulus (cone/pole/whistle/opponent). And in my own humble opinion, the ability to lift heavy in the gym doesn’t always translate to fewer injuries on the playing field. I have worked with plenty of players in the past who were incredibly strong in the gym but kept getting injured on the training pitch and also vice versa. The controversy of that statement hasn’t gone amiss on me either, and I’m sure I’ll receive some fire on that one, shields up, fire away.

To summarise, including a systems approach planned around the demands of the game in conjunction with a more traditional granular tissue (muscle) mechanics system (which by the way we still don’t know very much about) may improve our ability to positively affect players’ in-season aerobic and anaerobic fitness levels while also reducing their injury risk and engaging them with fun and demanding sessions with the ball.

Johnny Wilson (🐦@johnny_wilson5)


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Why players will [always] choose to play...

Thursday, September 5 2019

 

Mo’ matches, mo’ money, no problem.

 

In the last couple of posts I’ve had a pop at FIFPro’s At The Limit report.

 

It outlines their proposal for reducing the workload of elite footballers. Suggesting mandatory pre and mid-season breaks, caps on the number of matches per season and enforced rest periods between games.

 

Bless.

 

It’s at best naive. At worst, nonsense. Not because it doesn’t make valid points. It does. But it completely overlooks two critical factors: Money. And football’s relentless pursuit of it.

 

And I’m not just talking about the TV companies, governing bodies and boardroom fat cats. All of whom would swallow their collective tongues at the prospect of less product to flog to the masses.

 

(Sorry, that last line should end: ‘…at the prospect of less of the beautiful game to share with the worldwide football family.’ Pesky predictive text.)

 

Players are also guilty.

 

Because fewer matches means less appearance money. Less exposure to bigger clubs, better contracts and more lucrative image rights.

 

  1. every match you miss means one of the perhaps half dozen squad members battling for the same shirt is out there strutting his stuff. And no-one wants that.

 

So if it means overplaying, you’ll do it. If it means playing at 75% fit, you’ll do it. If it means having a pre-match injection to block out the 25% that’s broken, torn or strained, you’ll do it.

 

And if it means lying to your manager… Pfft! What do you think…?!

 

Spoiler alert: there is no such thing as a magic sponge

 

I regularly played with cortisone injections. Not so I wouldn’t miss a Champions League final… or to get me through a World Cup… no, no, no.

 

I did it to collect fifty quid appearance money on a wet, windy Friday night at Rochdale. It doesn’t always have to be a Tuesday night at Stoke, y’know!

 

Okay, we are talking late 80s, early 90s in Division Three and Four – that’s League One and Two for any millennials or iGens* reading this – so the numbers might’ve changed, but I guarantee the attitudes haven’t.

 

*Note: Of course, no actual millennials or iGens will be reading this. They’ll be race-trolling a footballer on Twitterstagram, or doing a knife crime.

 

The difference between a teammate and a mate

 

I didn’t even know what cortisone was. But I did know I wanted my £50 appearance bonus. I also knew I didn’t want some other - quicker, fitter, better – player taking my place. And quite possibly keeping it.

 

So I had to play. And that meant a pre-match jab. Which sounds harmless. Quaint even. Certainly no indicator of the bone-grinding agony to come in your late 40s every time you drive, climb stairs or spend more than four minutes on an aeroplane.

 

But professional football is a cut-throat business. Most people will understand that. What might surprise some is the extent and proximity of the throat-cutting. And how far beyond the 90+3 minutes on the pitch it goes.

 

That, brothers and sisters, is playtime. All you have to worry about during the match is the other team.

 

There is not a player playing who hasn’t been ‘done’ by a team-mate. Typically one who plays in your position. Often on a Friday. Occasionally on the morning of a game.

 

The late (tackle) fitness test

 

In this next bit, the names have been left out to protect the guilty, but the events are actual.

 

The year is the late 1980s. The setting is the English lower divisions. It’s the morning of a non-event match between two non-descript teams. A senior player is giving a fitness test to a first-year professional who’s had a spell out injured.

 

The younger player – who we’ll call… erm… Natt Mesbitt - has missed the last six weeks with a broken foot (now called a metatarsal injury). The senior player – who we’ll call, er… Blive Caker – had been out of the first-team picture for a while and reached that pitiful stage where he is helping out the coaching staff on match days.

 

Anyway, the foot in question feels fine. No discomfort from running, jumping, or ball-striking — all good.

 

Young Natt is thinking that £50 appearance money has got his name all over it. He’ll be out on the town tonight!

 

“How’s it feel?”

 

“Great. 100%.”

 

“Right, let’s do a couple of block tackles.”

 

“No problem.”

 

Couple of gentle 50/50s. Side-foot, stationary ball. Nice and steady. Feels fine.

 

Now a bit firmer. Up the resistance. Rolling ball. But nothing silly – after all, we’re in ankle socks. No strapping or shin pads or anything. Not a twinge. All good.

 

Young Natt’s thinking he might even wear the club blazer out tonight. See if he can get a bit of VIP action in Ritzy's nightclub…

 

“Okay, one more and we’re done…”

 

BANG!

 

High. Late. Studs up. Six weeks out.

 

“…well, you’re gonna get them in the game son…” Said the smirking senior player as he walked towards the dressing rooms.

 

Guess who started the match. And pocketed my £50 appearance money. And guess who stayed in that night.

 

 

Matt Nesbitt swapped his short, unspectacular but joyous football career for a much longer, successful one as a football tipster.


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Late Fitness Test podcast | Episode Five

Tuesday, September 3 2019

 

In Episode Five of the 'Late Fitness Test' podcast, we welcome former Manchester United and Northern Ireland international goalkeeper Roy Carroll to the show. The veteran stopper discusses his time in Greece and how his return to England - the weather and the style of play at Notts County – contributed to an increase in back and groin injuries. He gives us a players’ perspective of the game and an insight into the mental toughness required when working towards a return to training and playing. Roy provides an update on his recovery from reconstructive (ACL) knee surgery and tells us more about his RC 1 Coaching programme for aspiring young goalkeepers. Also, we discuss:

  • Warm-ups - Following on from Pedro’s withdrawal prior to kick-off at Norwich City (GW3) due to a hamstring problem. Why players are injured pre-match. Johnny talks us through GPS data and how increased anxiety levels cause "huge chemical changes in the body” and why some players struggle to manage the emotions of game day.
  • Until the final whistle - Everyone remembers ‘Fergie Time’. Norwich also had a knack of scoring late during their promotion campaign. Is it luck? Conditioning? Or are there other influencing factors which come into play – mental fatigue, switching off and poor decision making — mental capacity and the players' ability to cope with the scenarios in front of you.
  • Are we giving players enough ownership? - Are we asking them enough questions? Are we putting enough out there for them to mentally make a decision? “For me, that’s probably the biggest excuse why they lost on Saturday because we didn’t ask enough questions. These guys are not going to be great decision makers because we haven’t put the problems out there.”
  • Rotation - Carabao Cup - Players can decide on these types of games; it’s not always entirely down to the manager. Blood emerging talent…. Resting players for psychological or physiological reasons – this is not their priority - there are other environmental factors which they are fulfilling.
  • Strategising - Integrating and involving a player returning from a long-term injury. We discuss Winston Reid and his imminent comeback after more than 18 months on the sidelines. 
  • Bournemouth and knee injuries…. Troy Deeney…. and why surgery is not the be-all and end-all…... Danny Welbeck on his return. Johnny’s “delight” at seeing the former Arsenal attacker starting his first game for Watford.

 

We would love to hear your thoughts. Have a listen. 

🍏 https://podcasts.apple.com/gw/podcast/shoot-the-defence/id633108165?mt=2

🗣️ https://open.spotify.com/show/0IhypURW1JiiI7rGU354aV?nd=1

 

 


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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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