Report from Arsenal’s Sport and Exercise Medicine Conference

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This week Arsenal hosted their annual Sport and Exercise Medicine Conference at the Emirates, reports Tom Goom.

Attending as both a physio specialising in sports injury and a lifelong Arsenal fan was an illuminating experience. It shed a little light on the ongoing question of why do we get so many injuries?

Our medical team took centre stage as Dr Gary O’Driscoll, Colin Lewin and Shad Forsythe all spoke expertly about various topics. Shad was especially impressive, giving one the best presentations of the day. Bearing in mind who else was on the bill this was quite some achievement. He was on a par with Karim Khan, arguably the biggest name in sports medicine, and Dr Nigel Jones, the England Rugby Team Head Doctor.

The talks from the Arsenal medical staff highlighted just how knowledgable they are. The theme of the conference was marginal gains in sport and I’m sure our medical team are fully aware of how to get that extra 1-2% from our players. Specifically, Shad’s discussion of strength and conditioning was really impressive, showing they are fully aware of the key role of strength and how to vary and structure exercise to suit the individual and stage of the season.

My impression from the day is that the medical team are doing everything they can to prevent injuries and provide the highest level of treatment. It’s clear they monitor training and game loads intensively, provide training targeting to both individual and team need, fully understand the demands of the game and carefully plan return to play after injury. In a nutshell they are striving to make our players physically and psychologically tough enough to cope with the rigours of the game. The problem is they can’t do this alone.

Relying solely on a great medical team is like driving a car with one wheel. It won’t get you very far. Injury prevention is very much a 4 wheeled-drive (though not one of those Chelsea tractors that yummy mummies drive). The remaining 3 tyres are the player, the manager and the fixture schedule (plus maybe a spare in the boot – luck.)

The player is vital and a host of factors affect resilience and injury risk including history of previous injury, strength, flexibility, agility, movement control, role within the team, psychology and communication skills. Thierry Henry spoke at the start of conference (more on that here) and said he was, “on a mission” to do everything he could to perform for the team. Are all our players that committed? Do they do their rehab? Are they consistent with their strength and conditioning?

Shad Forsythe showed a picture of Aaron Ramsey in the gym in jeans and a dodgy tank-top cardigan, making sure he got his strength work in! Medical advice is useless if a player won’t listen to it and equally useless if a player doesn’t honestly communicate how they are feeling. Was Alexis honest about his hamstring before he injured it in the Norwich game? Did he tell the medical team if it hurt during testing, or decide to just push on through?

Throughout the conference we heard examples of managers making decisions that had big medical consequences. It was, unsurprisingly, fairly mute when it came to stories of Arsene Wenger though. Much of injury prevention comes down to managing risk and weighing up risk v reward. Ramsey’s recent injury is a good example of this; Arsenal were 1-0 up against Hull and playing their 6th game in 18 days. Was it worth the risk of introducing Ramsey without a proper warm-up when he has a history of muscle injuries? Him leaving the field just 16 minutes later with yet another thigh strain suggests not. Le Boss is not alone though in this and other managers take even bigger risks. It wouldn’t be dramatic to say that when AVB allowed Hugo Lloris to play on with concussion he gambled with his life.

The final ‘wheel’ is one we have little control over – the fixture schedule. Coaching and medical staff work hard to monitor and modify training workload but there’s far less they can do about game time. If you overload muscles, tendons, joints etc with too much football eventually they are going to hurt. When we compare Arsenal’s injury troubles with other clubs we have to compare like with like.

How are other clubs managing that play 38 league games and at least 8 Champions League games (actually, sadly it’s usually just 8), as well as UK cup competitions? 4 out of 5 of the teams currently topping the physiorooms.com injury league have been juggling European and domestic commitments.

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We have to take into account our player’s considerable international commitments too and sheer volume of games is not the only factor – frequency and intensity are also key. Our recent run of ‘crucial’ games against Watford, Barcelona and then Everton demonstrated a perfect storm of high frequency, intensity and volume at a stage where the manager is forced to take risks in order to perform.

When I think back to what I’ll take from this week’s conference (apart from a bright pink lanyard and a selection of free pens) it’s a new level of respect for our medical team. While medical professionals are always learning and developing I’m sure they are at the cutting edge of sports medicine and doing everything they can to prepare our players for the demands of one of the toughest leagues in the world.

For more from Tom following him on Twitter via @TomGoom and check out his website: running-physio.com

Check out this week’s Interlull Arsecast Extra

28 COMMENTS

    • First of all, that was initial diagnosis. Second of all, that is what Arsenal told the media. Does not mean it is true.

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      • Pitches. I want to know about our pitches.
        And about our physio looking quite concerned and animated after Ospina ‘s run-in with Lukaku and Gabriel, and Wenger nodding and patting him on the chest and making no change.

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  1. Interesting stuff, thanks. Good to know our medical staff are impressive.

    Everything seemed to be well until Cazorla, Coquelin and Alexis were injured, both in injuries and league position. Since then not so hot.

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    • Losing Cazorla and Coquelin really has fucked us over. Since little Santi’s been missing, we’ve lost all our rhythm and smoothness in buildup and transition.

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      • The loss of Cazorla and co may have had an impact, but the injuries have not stopped Arsenal from creating a plethora of chances. If we had efficient centre forwards there would be none of this angst and disharmony amongst the fans, as we would be winning more games and would be Champions. How many extra points would we have with a player like Aguero, Higuain or dare I say it Kane leading the line for us? Certainly enough to be ahead of Spurs and Leicester. Injuries yeah, but lets not ignore the fact that our lack of activity last summer is the true cause of our poor form.

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  2. Great post, good to have some fact based opinions on these matters as the usual discussion of our teams fitness problems usually descends into blanket statements about the medical team’s incompetence or Wenger’s penchant for overplaying certain players (which according to the Ramsey anecdote, may have some basis). But interesting to note the culpability of players by not heeding advice.

    Interested to know if there’s any video of the talks? Would be interested to hear Shad’s preso. Cheers.

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  3. 1. Good that we are on the cutting edge when it comes to sports medicine. But when there are no critical questions asked, the medical team will look like super heroes.

    2. There are two sides to a players physical state. First it’s the body he’s born with. Second it is, like it’s pointed out in this article, how the players deal with physical training and restitution. Both are the responsibility of the manager. He consistantly signs small-framed players with a physical condition that are not able to cope with the PL, and when the finger is pointed at their lack of profesional attitude in training, isn’t it also the manager that coaches and continues to sign the same players?

    3. The manager is also the man who decides which team to pick, when to rotate and the total sum of physical strenght, speed and agility of the starting line up as a whole. If you play 4 Mertesackers at the back, the defence will be pushed on speed and injuries will come because of lack of it. If you play a bunch of midgit Cazorlas in the middle of the park, chances are that they will be kicked about. We’ve got one Santi. He is brilliant, but he needs protection. If the manager plays Jack Wilshere behind the striker, running at defenders, his weak ankles will be snapped at by snarring studs. When you choose to have only one option up front, no matter how strong he is and how hard he fights he will tire and get injured. When you bang your head against the same wall for ten years, chances are it’s gonna get bloody and you will pass out before the end of the show. These are the managers responsibility.

    4. Like it is said here noone within the club can change the fixture list, but one man can see to it so that the club has a squad can handle the schedule. He is the manager.

    Other than that. Thanks for a good read.

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  4. When the fans and the media talk about our injury woes it is the classic case of speaking without knowledge and also apportioning blame based on the wish to continue a narrative – the narrative being that Wenger is an old man who is out of touch with modern sports medicine.

    The facts are that we can’t attribute all our injuries to one source. There is not one thing to blame. We want there to be. Those who want regime change want there to be – they believe a change at the top will change our injury fortunes.

    They clamoured for Klopp. But Klopp presided over an injury ravaged final season at Dortmund and since he joined LFC if anything they have suffered more injuries than before.

    They tell us Mourinho would not keep a player like Wilshere or Diaby in his squad- he would be ruthless. Well he bought Costa who had a history of hamstring problems and played him half fit when he was desperate for results. He signed Falcao who has not been right for 2 years and nothing about his previous season suggested he was injury free.

    Van Gaal’s entire reign at United has been hampered by injury problems especially to defenders.

    I think the spare tyre of luck is more than an issue. Managers will admit many times over that they take a risk with players health because players are rarely 100% fit – there’s always one niggle or another. If the team wins and the player lasts the game the manager is a genius if not he is a buffoon.

    Or so say the experts in the press and in the stands who all know better

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  5. Great read, Tom.
    As a Sports Scientist who worked with another London-based PL club, I’m glad Arsenal have finally stepped their game up the last few years. For so long, they were behind the major clubs in this regard.

    Quick point, but you touched on a critical factor for our injuries; and that is Wenger himself. I always get irked when fans criticise the medical team, when a lot of the decisions are down to Wenger. Is it a coincidence that every year come christmas time, it is usually the platyers the manager plays the most that end up with a chronic injury either that same season, or after a previous season of playing many games (Vermalean came to arsenal with no serious history of injuries. He plays virtually an entire season of almost all available games. He’s then broken the next season. Jack breaks into the first team, Wenger talks about the importance of not overplaying a young player. Proceeds to play him in as many games as possible that season, gets broken next season. Ozil and Ramsey last 2 seasons play in almost every game till christmas. Gets borked. Wenger warns us that Sanchez is in red zone. Keeps playing him in every game, gets muscle strain. I could go on and on).

    I understand it boils down to the risk/reward of the manager, and I have no doubt the medical team warn him before hand, but he has to either make the squad deep enough quality wise to not put pressure on constantly playing particular players. This has gone on for years.

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    • I remember a couple of times when Henry was still playing for Arsenal, he stated he needed rest and Wenger replied he wasn’t exhausted. Hope Henry brings that up as a pundit one day because it will then get visibility at the club.

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      • Over playing players seems to happen to Arsenal Players, If you look at Messi he plays more games on average than Arsenal players but no one ever complain that Messi is being over played or state that Messi needs a rest. People were saying Alexis did not rest in summer but people forget that Messi also played up to the final of COPA.

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        • One anomaly does not a rule make.
          It’s like when someone points to that one guy in the gym who always eats junk yet is always ripped as evidence for why they don’t need to eat that healthy to be ripped.

          Also, I’ve seen most of the games Barca play in the league. The spanish team is no where near as physically as intense.

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  6. Very interesting. I wonder what role doping has in the injury and recovery time for various clubs. I’m fairly confident Arsenal don’t “enhance” their medical efforts in that way, but I’m less confident other clubs are as ethical. It particularly seems odd that Arsenal have so many “setbacks” with extended recovery times from various injuries.

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    • Doping in football in the UK is greatly exaggerated.
      I’ve noted this is an agenda that was mentioned by Wenger and it seems areas of the fans have decided to run away with it, and seemingly claiming everyone else is cheating but us, making us feel superior again. Lest we forget Wenger is the same man that deemed creatine like steroids just within the last 5 years.

      I can’t speak for Spain and Italy especially, but doping doesn’t just come our of nowhere; there has to be a culture of doping. And in a sport in particular whereby players are generally scared of diet pills let alone needles, this is heavily exaggerated in the UK. Besides, the main doping choice wouldn’t be steroids, as everyone is thinking, it would likely be EPO. And this isn’t cycling, no way players wouldn’t talk if EPO was heavily abused.

      Like I said, I can’t speak for Spain or Italy, but this persistent talk of doping in UK football is heavily exaggerated, and has been caused by Wenger’s comments. Like I said, he once called creatine a steroid, and that ran and ran for months in the media, so professor or not, he does has a history of saying things that aren’t true and letting the media and fanbase run wild with it.

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      • Wenger said quite clearly that he didn’t think the PL had a problem with it.
        He was making reference to eastern European teams where teams have been caught but not punished appropriately.

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  7. In addition, Tom touched on flexibility and motor control, and I think it would be great to get an insight into technical and physical development program used at Arsenal.

    There’s always been a long debate in regards to specialization (starting kids early to specialise in learning football from an early age) in comparison a multi-sport approach. I know Wenger has always been a support for early-specialization, which is used commonly in football, but research for years now has always support multi-sport for overall motor cortex and motor development. My initial Master’s Thesis was on this, and looked into a model of the potential motor cortex development based on early specialization compared to a multi-sport model based on using football, tennis (to improve hand to eye co-ordination and lateral movement reaction), ballet (studies have shown they have the highest foot control and sensitivity – outside of barefoot farmers), taekwondo (hip and leg control) and gymnastics.

    My study hit a readblock as I couldn’t get certain ethical clearances, let alone the cost of doing it (would require years of study and constant brain scanning), but the idea was that multi-sport improved cerebral motor-cortex and neural plasticity. Essentially, those with a multi-sport background are more able to better learn new skills or better “problem solve” football situations with their bodies than others.

    Case in point, the Ajax model use a multi-sport model that very few are aware about. Most of the Ajax academy guys must also do Judo and gymnastics at their academy. It can’t be a coincidence that they constantly develop highly technical players.
    Equally, it’s commonly referred that in football, the smaller players can be technical, and the big boys can’t. Yet one of the most technical players in the world is Zlatan Ibra. What isn’t commonly known about him is that he’s a blackbelt in taekwondo. Equally, it’s no coincidence that many “flair” players come from very impoverished areas, where they play a lot of football, but in a very “rich proprioceptive” environment rather than just football on a pitch.

    Sorry to go off tangent there guys, but just some topics for some to ponder if you don’t know about it. Basically, developing players isn’t straight forward as we all think.

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    • Your spot on I’m from a military background and played many sports in football, rugby, field hockey and not being the biggest of build (6′ 1″ but only 10 stone). I coped very well over the period from 1970 to 1990 when these sports was physically harder than they are today and I believe I coped by doing judo, basketball, cricket & volleyball also when training for football, rugby etc we done yoga, ballet movement and mixed other sports whuch helped me physically and mentally.

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  8. The best way to manage game time must be to make maximum use of squad positions. We simply cannot afford to carry liabilities and must be more ruthless with injury prone players and those who a simply not the required standard.

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  9. Could players also be held accountable for a lack of a proper warm up? There has to be some accountability on their behalf. We cannot sit here and encourage them to put their careers on the line, esspecially with football being a short career. I wonder why this warm up issues have only come about now rather than consistently throughout previous seasons, because it seems to be these players fault rather than the manager or medical staff.

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    • You see it season after season getting injuries due to bad warming up which came to light more recently at Sheffield was it 3 injures due to not warming up properly but was it’s really that or just our fitness & training not being good enough.

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  10. Like Lone Star above ….I too have questions about drugs and injuries

    Last year it was Chelsea , this year Leicester

    How can 24 average players ( abet three very very good ones ) can sustain no injuries throughout a full EPL season with the loss of 3 games , playing high intensive football without the help of drugs

    Just a question, not an acquisition …..don’t want trouble

    I’m liking that Forsythe is respected in the same manner as Khan and Jones.
    They are extradorinary smart men

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    • You can do it for a season when you aren’t playing European football too. It also helps that they play counterattacking football and therefore are on all the ball less and therefore less likely to pick up impact injuries.

      If the team stays the same next season you can expect to see a lot of them start breaking down much more often.

      If Leicester goes through next season playing the game group of people the same amount of games with no injuries…yes, that will start to look odd. Right now there’s nothing to particularly raise the eyebrows though.

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      • Basically this.
        This idea that Leicester are doping is getting ridiculous and a tad bitter.
        People make it seem like it’s some kind of special condition, but many research has shown a strong correlation between number of games and injuries. The more games you play, the less the injuries. The converse is equally true.

        There’s nothing surprising about a team who play once a week, particularly as it’s well known that Ranieri gives them 2 days off after every game.

        It was the same thing when Liverpool almost won the league too, playing a game a week.
        People need to cut this out. Doping was barely ever mentioned here till Wenger (irresponsibly imo) mentioned it. Now everyone is a doping detective.

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  11. All of this is useless when we make bonehead decisions like sending players on without warm ups. The Sheffield Wednesday and Hull games still stick in the mind.

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