Medics not always at fault in blame game
When I left my previous job running a medical department for many years, I was surprised to hear some supporters bring up the fact that it was the medical team, particularly me, that was responsible for some of the long-term injuries. Not only does it amaze me how good fans’ memories are but it also surprised me how little they know about the causative factors of injury and injury management.
The causes of injury are either intrinsic (player specific) or extrinsic (external factors). Intrinsically, the main causes of injury are age and previous injury. Older players get injured more and if you have had an injury before, you are at a greater risk of reinjuring that area again. Both of which you can’t do anything about except not signing the injury prone, old player in the first place!
Yes, you can work at preventing injury but this is the Holy Grail of sports medicine with many theories, mostly unproven, to deal with preventing injury. These include strength training, stretching, yoga, pilates, functional movement screening, balance exercises … I can go on and on.
Essentially, injury prevention is specific to the player and a prevention strategy is different from one player to another as their needs are different. There is, however, really only one influential factor that extrinsically causes players to get injured. That is training.
Training influences a player’s fitness level and their ability to be “football fit”. If they are not fit enough, they will break in games as their system has not been conditioned for the matches. If training is too excessive, they will break due to overstressing the system.
The specific aspects of training have to be balanced. In training, you want to improve technique but not too much to cause fatigue and injury. A common issue is when the team practise crossing and shooting. In a game, this crossing or shooting happens about ten times by the wide players and strikers but, in training, ALL players in all positions tend to be involved and as many as 50 crosses can be carried out in one session. This results in many players complaining of tight groins.
One area that is potentially preventable is when a player returns from injury. It is essential that no stone is left unturned to ensure that the player is physically fit, anatomically fit and mentally fit to train or play in a competitive fixture. However, in reality, this rarely occurs. It is common practice to have to accelerate a player’s return, particularly with essential players. This, therefore, comes with an element of risk.
It is naive to think that, within a professional football club, it is the sole responsibility of the medical team to decide when a player is fit to return. At times, the manager, coaching staff, fitness coach, sport scientist, board members, the player himself and even his agent can all get involved in the decision-making process.
It is about managing risk and this has to be a team decision, even if we, the medical team, don’t like it!
I don’t disagree with the message, but with one point. In terms of a player who has been injured, I understand that that player is more likely to be injured again. However, I disagree that there is nothing that one can do. I see players who tear their ACL and go through rehab and are cleared to play, but nobody examines their movement to see if it affected their non-contact injury. Or, take the example of Stephen Curry from the Golden State Warriors. He twisted his ankle dozens of times and missed many, many games before there was an apparent effort this summer to change his stride from one that landed on the extreme lateral border of his foot to a more neutral stride. Strengthening exercises and rehab were insufficient to prevent a subsequent injury because of his running biomechanics, but that does not mean that something could not be done. Whether it is the phsyio, a biomechanist, a strength coach, etc., these instances require movement re-education to prevent further injury rather than just waiting with an ice pack for the next one to occur.
I’m grateful for the work that physios do to help the players regain their fitness and come back from injury, I don’t think a lot of fans blame physios, a lot just blame the players for doing it in the first place and the manager if he has brought a player back too quickly.