Behind the scenes

Test of endurance

With matches coming thick and fast after a truncated pre-season, the science and techniques of injury prevention have never been in greater demand

WORDS Simon Hart

“Pre-season was very untypical,” begins Diego Martínez, coach of Spain’s first-time Europa League participants Granada. “We’d finished the previous season with a really high density of competition, had very little preparation time and have begun with three games each week.”

“Untypical” might be something of an understatement, given the difficulties posed by Covid-19’s distortion of the football calendar. Indeed, Martínez and his players are far from alone, with one Champions League club left with just four full days of pre-season training together before the new campaign began – instead of the usual minimum of 24. Such are the strains that Manchester City manager Pep Guardiola spoke about a reported rise of over 40% in muscle injuries among English top-flight sides when recently pressing for the return of the five-substitute rule in the Premier League, a rule retained in UEFA’s club competitions.

The challenge is considerable, and it means the demands on club medical departments are greater than ever. Fortunately, injury-prevention methods have become increasingly sophisticated according to Andy Renshaw, a former head of physiotherapy at Liverpool. “Nowadays injury prevention is much more player-specific,” he says. “It’s built around both an individual’s injury history, their own training week, and used in conjunction with concise injury-audit methodologies.”

Drawing on 18 years’ experience as a physio with Premier League clubs, Renshaw believes a “united approach” is vital, with medical and fitness staff “monitoring training load in close conjunction with coaches”. He elaborates: “Players spend the majority of time out on a pitch so injury prevention has to start out there. Regardless of how much work we as medical staff do with players, they will still sustain injuries if there’s no monitoring system in place regarding the training and playing load.”

For John Hartley, an injury-prevention specialist at former European Cup winners Aston Villa, this means, for example, keeping count of how many sprints are done on the training pitch weekly. “We aim at trying to get six to eight sprints a week into them through the training week,” he says, noting that if a player had “three sprints in a little game they were playing”, this would be logged and the player instructed to do his other sprints (running above 90% his maximum speed) in a separate running session.

Fabinho receives treatment during Liverpool’s win against Midtjylland (above); training-ground fluids at Mönchengladbach (above right); Chelsea gear up for Champions League action (right)

More generally, Hartley has shifted from “injury prevention” to “performance-enhancing work” in order to achieve a “better buy-in from players”. He starts the process in pre-season with a series of exercises to strengthen the hamstring and adductor muscles. Once the season has begun, players will focus on one of these exercises each week.

Hartley went into the current campaign “trying to make the players as robust as possible” – but found that the abbreviated summer break meant his players had had “no time to detrain at all." The tighter schedule has also necessitated a shift in the frequency of monitoring player fitness tests. “In the past,” he explains, “we’ve done testing on matchday plus two to see how guys are recovering, but if matchday plus two is the day before the next game, there’s no use in telling someone he’s tired. Psychologically, we’d be taking away from their performance from the off, so we’ve shifted to monitoring them a little wider apart and each month getting that information.”

Eduardo Camavinga and his Rennes team-mates in training

Hartley likewise advises his players on recovery sessions, which can include workouts on an exercise bike, sessions in the training ground’s hot and cold spas, and foam rolling to massage the muscles. “We can guide them with all these strategies, but sometimes the best things for recovery are good nutrition and sleep.”

The significance of rest cannot be overstated according to Andy Renshaw. “We’re seeing more research now being performed on the importance of rest and sleep in maximising injury-prevention programmes,” he says. This tallies with the latest findings of UEFA’s Elite Club Injury Study (ECIS) group, which analysed 21 clubs across Europe from the post-lockdown period until the end of the season and found, contrary to expectations, that there had been 10% fewer muscle injuries and 20% fewer ligament injuries. Professor Jan Ekstrand, who heads the group, suggests this was because players, for once, had had a proper period of rest during lockdown.

Fatigue affects the body as well as the brain. Ole Gunnar Solskjær spoke in November of the “strain” of playing in the current circumstances for Manchester United. A Granada player told us after a recent Europa League fixture that “we have to play with the tiredness," and this is not just physical according to his coach. “The more tired you are, it affects your attention,” says Martínez. “When you’ve been driving ten hours, clearly your attention diminishes, so the demands on our attention are proving a challenge for our coaching team and the players, and [it’s about] giving them information in a much more concrete way.”

“PLAYERS SPEND THE MAJORITY OF TIME OUT ON A PITCH SO INJURY PREVENTION HAS TO START OUT THERE”

Andy Renshaw

In the current context, nutrition is more important than ever. James Collins is a project leader for UEFA’s team of experts who delivered fresh guidelines on Nutrition for Elite Football in October. As Collins explains, this included a reminder to players that their carbohydrate intake on a matchday – as well as the day before and the day after– should be between six and eight grams per kilo of their body weight in order “to sustain both physical and cognitive performance during matches”. Keeping players well means eating well, and Collins adds: “The first thing is fuelling and making sure there’s enough fuel, then the second is that there’s enough protein for the muscles to recover, and also fruit and vegetables – the extracts of which help support immune function. We also recommend food over supplements where possible.” One specific recommendation is that players take on carbohydrate, for example a drink or gel both before kick-off and at half-time. “There’s some evidence,” says Collins, “that carbs can be sensed by the brain. When you take in a carb gel or a drink and it’s rinsed around the mouth, it can activate the brain and help support cognitive function – it can help players fuel the brain and the muscles.”

As for the future of injury prevention, it may already be here if you speak to Tal Brown, a co-founder of Zone7, an Artificial Intelligence tool that reads player data to help predict and thereby prevent injuries. The California-based Brown offers an example from this year’s ‘NBA Bubble’ – which enabled the US basketball season to finish – where each player wore an Oura ring that uses sensors to record variations in body temperature and respiration rates. “It has a camera and takes very high-definition images of your skin to measure variations in heartbeat, temperature,” he explains.

“THE WEAK PLAYERS DON’T REALLY GET TO THE ELITE LEVEL. YOU GET PLAYERS LIKE IBRAHIMOVIĆ AND OTHERS WHO SURVIVE BECAUSE THEY’RE TOUGH”

In football, Zone7 has partnered with 40 clubs around the world, including in England, Spain, Italy and Germany as well as Rangers in Scotland. What they provide is an objective data-driven analysis of players’ physical levels. “It allows you to tap into all this data in real time and run some pretty complex comparisons,” says Brown. “If you can compare player X to 100,000 other players, you can understand their performances, the injuries they sustain and then draw some pretty unique insights.”

The support systems for elite footballers have never been better – evidenced, for example, by reinjury rates among Champions League teams dropping from 15% to around 8%. Yet as Professor Jan Ekstrand notes, in a sport that remains “the survival of the fittest”, we should never underestimate the need for mental toughness. “The weak players don’t really get to the elite level. You get players like [Zlatan] Ibrahimović and others who survive because they’re tough.”

Back in Spain, where, because of Covid-19, Getafe played Real Sociedad on 8 November with just seven first-team squad members available, Diego Martínez makes a similar point: “I often say to the players it’s better not to think too much. You have to adapt and that’s all.”

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Fabinho receives treatment during Liverpool’s win against Midtjylland (above); training-ground fluids at Mönchengladbach (above right); Chelsea gear up for Champions League action (right)

“PLAYERS SPEND THE MAJORITY OF TIME OUT ON A PITCH SO INJURY PREVENTION HAS TO START OUT THERE”

Andy Renshaw

“THE WEAK PLAYERS DON’T REALLY GET TO THE ELITE LEVEL. YOU GET PLAYERS LIKE IBRAHIMOVIĆ AND OTHERS WHO SURVIVE BECAUSE THEY’RE TOUGH”

Fabinho receives treatment during Liverpool’s win against Midtjylland (above); training-ground fluids at Mönchengladbach (above right); Chelsea gear up for Champions League action (right)

“PLAYERS SPEND THE MAJORITY OF TIME OUT ON A PITCH SO INJURY PREVENTION HAS TO START OUT THERE”

Andy Renshaw

“THE WEAK PLAYERS DON’T REALLY GET TO THE ELITE LEVEL. YOU GET PLAYERS LIKE IBRAHIMOVIĆ AND OTHERS WHO SURVIVE BECAUSE THEY’RE TOUGH”

Training

Sliding leg curl

Got a game for the first time in while? Physio John Hartley offers a bit of advice for your pre-match routine to avoid some common injuries.

“If you’ve not played football for ages, you are either going to pull your hamstring, you are going to pull your calf or you will lunge for something and stretch your groin, so the main things are the Nordic hamstring and the sliding leg curl for the hamstring. For the sliding leg curl, lie flat on your back with your feet on the floor and bring your knees up so they are at 90 degrees to the floor. Bridge up, so you lift your bum and hips off the floor, then slowly let your legs straighten out. You need a slippery floor and a good pair of socks and then you just let your legs slide away from you. Keep those hips up to work your glutes and stretch the hamstring.”

Training

Sliding leg curl

Got a game for the first time in while? Physio John Hartley offers a bit of advice for your pre-match routine to avoid some common injuries.

Training

Sliding leg curl

Got a game for the first time in while? Physio John Hartley offers a bit of advice for your pre-match routine to avoid some common injuries.