An Impossible Boxing Day: Why European Football Stops at Christmas
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On the 8th of October, the first edition of the “Barça Sports Physiotherapy Conference” took place, which was part of the “Sport Science week”. Within an innovative format, where theory and practice were combined, FC Barcelona physiotherapists and worldwide-recognized experts exposed the latest research and trends about treatment and prevention of injuries. Also, practical workshops were held which allowed assistants to see how these professionals and researchers apply the latest advances to their patients and athletes.
The director of research and education physiotherapy at Aspetar, Dr. Erik Witvrouw, made the opening speech of the event and explained the process by which athletes can learn a movement. In this sense, he specified that coaches should create exercise protocols with “clear objectives” where athletes “should search, explore and adapt themselves by combining different movement patrons until finding a successful solution”.
The first part of the day was related to tendon injuries. The researcher and physiotherapist Igor Sancho, gave a masterclass on rehabilitation for runners with Achilles tendon pain, exposing preliminary results showcasing how they better function as well as feeling less pain. Furthermore, he analyzed the most common mistakes committed by doctors and health practitioners, such as, “treating the pathology and not the person”, “not educating the patient during the treatment process”, “not applying the appropriate loads”, and, especially, “relying on quick solutions, healing potions and passive treatments”.
Silvia Ortega, physiotherapist at FC Barcelona medical services, explained that for the club players, speed and power are key for the rehabilitation process and not the use of heavy loads because as she mentioned, “what we really want are fast players”.
She also highlighted the importance of controlling the pain as a principal marker during the healing process and the necessity to maintain an open mind for new approaches or techniques. Applying this approach, she revealed that they are now starting to use the Blood Flow Restriction as a new recovery protocol. In regard to this new protocol she said that “despite the lack of evidence, we see a pain-reducing effect in the tendon that allows players to make the movement”.
Jesús María López Alfonso, who is a physiotherapist at Athletic Bilbao, shared his opinion on the tendon’s rehabilitation process. He explained an assessment algorithm that takes into account both the structure of the tissue and the biomechanic function.
The second part of the agenda focused on chronic ankle instability (CAI), and it began with a masterclass of Dr. Chris Bleakley, researcher and physiotherapist at Ulster University, stated that CAI is a “common, complex and difficult injury to predict”, “even though there are some indicators” like having suffered an injury before. While showing some graphics to visualize the difference, he explained that major movement variability is associated with chronic ankle instability.
Carles Martín, physiotherapist and osteopath of the first basketball team at FC Barcelona, specified that it is necessary to include strategies to prevent muscle injuries during the ankle rehabilitation process. He also stated that “manual therapy should not focus solely on the ankle”. Furthermore, Liverpool’s physiotherapist Jim Moxon, exposed the use of an echography in the first stages of lateral ligament injury in order “to guide treatment decisions and player/trainer expectations”. Similarly, he summarized the key stages and possible progressions when starting a rehabilitation treatment.
Dr. Rodney Whiteley, physiotherapist at Aspetar Sports Medicine Hospital, performed a masterclass which related to rehabilitation techniques for hamstring injuries. He explained that the length of the fascicles of the long femoral bicep’s head and age, influence the risk of injury, meaning that having short fascicles and being older is associated with the risk of getting injured. Referring to the recovery process he insisted on the importance of load management. It is key for the patient to do “all the exercise that he can do during the rehabilitation process, as well as good communication so that he or she can understand the process”. He stated that the rehabilitation process must begin “ as soon as possible but not aggressively”. Furthermore, he made some live demonstrations on how to measure eccentric force and flexibility as well as how to feel the ischiosural area.
Marta Saula, a physiotherapist at FC Barcelona, insisted on the necessity to “prepare the athlete for the stress required during the season by explaining what will take place to achieve this goal”. “Load control, exercise variability, and doing an integral and individual rehabilitation”. She also mentioned “the importance of training the injury’s mechanism during the rehabilitation process”.
To conclude this topic, Telmo Firmino, Benfica physiotherapist, explained how despite the lack of agreement on the return to play criteria, “fatigue and resistance capacity seem to play an important role for a new injury to take place”, stating that “a secondary prevention plan is necessary, at least one year after the injury”.
Lastly, prevention and rehabilitation models of the groin zone were presented. Dr. Andreas Serner, physiotherapist and researcher at Aspetar, gave a masterclass where he explained that the groin injury normally occurs following a diagonal patron. Also, Dr Serner emphasized that “when we plan the selection and progression of exercises, we should think on how painful movements could possibly affect athletes”. Besides, he advised that during rehabilitation, apart from the necessary controls of load, it is important to value different aspects such as nutrition and psychological factors.
Xavier Linde, FC Barcelona physiotherapist, specified that in the last 10 years, there has only been one case where the patient needed surgery. In this sense, he remarked the importance of monitoring load during the treatment and the necessity of working the CORE.
To finish the day, Gwenaëlle Pelé, Paris-Saint-Germain physiotherapist, analyzed the incidence of groin pain on professional athletes, stating, “Hip and groin injuries represent between 11% and 17% of all injuries, which makes them the second most common injury followed by ischiosural injuries”. As a result, she insisted on “the importance of good evaluation of athletes during pre-season to identify imbalances and possible risk factors” as well as “to establish an individual prevention program taking into account if it is a first-time injury or a relapse”.
The Barça Innovation Hub team