BIHUB PATH

18 November, 2020

Sports Tomorrow – Day 7

Events

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“Before investing in a healthcare technology, it is essential to see if it can be applied to everyone, not just elite athletes”

Gil Rodas, medical manager of the Barça Innovation Hub, Guy Paul Nohra, of Alta Life Sciences, and Daniel Medina, Chief of Athlete Care & Performance of Monumental Basketball, have had a discussion chaired by Lluis Quintana on the concept of biotechnology in sport, its most important advances and the possibilities for development in the near future.

Medina, after his experience in the NBA, believes that biotechnology should be viewed as a technology for human improvement. It must be an application in which techniques such as nanotechnology, biotechnology and cognitive science converge. In sport there would be three fundamental fields in which it could develop: in the treatment of injuries, in player performance and for boosting skills.

The case of injuries would be the most urgent. Medina says it is no secret that they are becoming more and more common. In these months of pandemic, there has also been an increase. In the Premier League, to cite one case, there were 42% more muscle injuries than in the previous season. Biotechnology would provide tools for better prevention and rehabilitation, especially in competitions like the NBA, where recovery times are very short.

He mentioned, for example, the case of a hydrogel based on algae, vegetables and fruits that aids absorption of carbohydrates in recovery periods. He also mentioned the appearance of patches that serve as biomarkers to detect fatigue levels. Similarly, there are shirts that can detect body heat and be automatically modulated to generate more or less heat.

He also explained that a tripod, an iPhone and an app with which to record yourself while taking shots to help to correct shooting issues should also be considered a case of biotechnology. The same goes for developments in sports shoes. He described Rapid Liquid Printer, which can be used to make custom designed shoes as well as injury bandages.

Rodas says that it is in the field of regenerative medicine where he expects the most advances. Especially in the field of biomarkers so that, with due follow-up, the possibility of injury due to load accumulation or fatigue can be calculated. It should be borne in mind that UEFA itself is concerned that the injury rate is going to go up, probably because the intensity of the game is increasing. This is something that cannot be controlled, but other factors can. Tendons and muscles are the priority focus of the 70 research projects that he is involved in because that is where most injuries occur. He feels regenerative medicine with biological treatment is going to be the next challenge for sports injuries.

Meanwhile, the key, he says, is to be able to monitor everything around an athlete: grass, nutrition, hydration, analytics, sleep, fatigue, stress, weather conditions, pollution, and so on. It is useful to have everything on record because it can influence performance. In addition, in the case of women’s teams, gynaecology and hormone control also matter. He understands that women’s sport requires more work and a different approach because there are obviously different indicators to measure.

Quintana signalled tendinopathy and osteoarthritis as the two most serious problems. He presented a project on the Achilles tendon and restorative treatments with collagen and other products that can serve as implants. This project is being funded by the European Union and involves the participation of the Barça innovation Hub. The advantage would be to be able to design a suitable product for each type of injury, rather than using the same therapy for all problems with that tendon. The goal once again is to make recovery rates more effective and to reduce the times.

Finally, Nohra offered his point of view as an investor in this type of research. What he claims matters most to him is the legal regulation of new treatments and their scope. It is very important for them to target the entire population and not just a market niche of elite athletes because they are processes that require a lot of time and money.

“Before investing in a healthcare technology, it is essential to see if it can be applied to everyone, not just elite athletes”

Gil Rodas, medical manager of the Barça Innovation Hub, Guy Paul Nohra, of Alta Life Sciences, and Daniel Medina, Chief of Athlete Care & Performance of Monumental Basketball, have had a discussion chaired by Lluis Quintana on the concept of biotechnology in sport, its most important advances and the possibilities for development in the near future.

Medina, after his experience in the NBA, believes that biotechnology should be viewed as a technology for human improvement. It must be an application in which techniques such as nanotechnology, biotechnology and cognitive science converge. In sport there would be three fundamental fields in which it could develop: in the treatment of injuries, in player performance and for boosting skills.

The case of injuries would be the most urgent. Medina says it is no secret that they are becoming more and more common. In these months of pandemic, there has also been an increase. In the Premier League, to cite one case, there were 42% more muscle injuries than in the previous season. Biotechnology would provide tools for better prevention and rehabilitation, especially in competitions like the NBA, where recovery times are very short.

He mentioned, for example, the case of a hydrogel based on algae, vegetables and fruits that aids absorption of carbohydrates in recovery periods. He also mentioned the appearance of patches that serve as biomarkers to detect fatigue levels. Similarly, there are shirts that can detect body heat and be automatically modulated to generate more or less heat.

He also explained that a tripod, an iPhone and an app with which to record yourself while taking shots to help to correct shooting issues should also be considered a case of biotechnology. The same goes for developments in sports shoes. He described Rapid Liquid Printer, which can be used to make custom designed shoes as well as injury bandages.

Rodas says that it is in the field of regenerative medicine where he expects the most advances. Especially in the field of biomarkers so that, with due follow-up, the possibility of injury due to load accumulation or fatigue can be calculated. It should be borne in mind that UEFA itself is concerned that the injury rate is going to go up, probably because the intensity of the game is increasing. This is something that cannot be controlled, but other factors can. Tendons and muscles are the priority focus of the 70 research projects that he is involved in because that is where most injuries occur. He feels regenerative medicine with biological treatment is going to be the next challenge for sports injuries.

Meanwhile, the key, he says, is to be able to monitor everything around an athlete: grass, nutrition, hydration, analytics, sleep, fatigue, stress, weather conditions, pollution, and so on. It is useful to have everything on record because it can influence performance. In addition, in the case of women’s teams, gynaecology and hormone control also matter. He understands that women’s sport requires more work and a different approach because there are obviously different indicators to measure.

Quintana signalled tendinopathy and osteoarthritis as the two most serious problems. He presented a project on the Achilles tendon and restorative treatments with collagen and other products that can serve as implants. This project is being funded by the European Union and involves the participation of the Barça innovation Hub. The advantage would be to be able to design a suitable product for each type of injury, rather than using the same therapy for all problems with that tendon. The goal once again is to make recovery rates more effective and to reduce the times.

Finally, Nohra offered his point of view as an investor in this type of research. What he claims matters most to him is the legal regulation of new treatments and their scope. It is very important for them to target the entire population and not just a market niche of elite athletes because they are processes that require a lot of time and money.

“The big challenge with data analysis is getting it done in real time”

Susana Ferreras, Arsenal FC data analyst, has presented an analysis of phases of the game in the European leagues in the 2019-20 season, a problematic year due to the mishaps, interruptions and special conditions that the competitions have had to deal with due to the pandemic.

The analysis comprised 135 teams, the best of the English Premier League, Spanish La Liga, German Bundesliga, French Ligue 1, Italian Serie A, Portuguese Primeira Liga and the Dutch Eredivisie. A total of 41 teams and 2,047 games.

Her analysis of the European elite by game phases began with defence, and working out which teams used high pressure (high block) and which teams sat back (low block). The first category featured, in this order: Bayern Munich, Manchester City, Borussia Mönchengladbach, Wolfsburg, Liverpool, Bayer Leverkusen and Borussia Dortmund. Total domination by German football followed in second by English. As for the teams that defended with most players sitting back to exploit the counterattack, the result was: Valencia, Arsenal, Atlético Madrid, Inter Milan, Lazio, Tottenham and Athletic Bilbao.

By leagues, high block is most prominent in the Bundesliga, as stated, followed by La Liga and Ligue 1. It is more common to sit back in the Premier, Serie A and, again, in the La Liga.

The teams that attack using possession as the basis (build up) are FC Barcelona, ​​PSG, Borussia Dortmund, Bayer Leverkusen, Bayern Munich, Manchester City and Napoli. Meanwhile those who attack with quick, aggressive transitions are Ajax, Lazio, Monaco, Liverpool, PSG (which shows their versatility as they are in both categories), Real Madrid and Borussia Mönchengladbach.

By championships, possession in attack is most widespread in Ligue 1, then in the Bundesliga and Serie A. The Bundesliga is top for rapid transitions, followed by the Eredivisie in second and then Ligue 1.

This type of analysis can be used to analyse players in different models and measure their performance. However, the big challenge is to be able to obtain this information in real time for broadcasts and especially to be able to react to the areas where an opponent is likely to be most effective.

“Data analysis in football must evolve towards the creation of simulated environments”

Bruno Dagnino, co-founder of CTO Sports, has presented a study produced with Juan Carlos Núñez on mathematical models applied to football to simulate contexts. He began his presentation with a review of developments in the last few years in the mathematical analysis of football. We have witnessed a revolution in data extraction and analysis that has enabled and established measurement models such as control of the pitch, expected possession and goalscoring possibilities. Now he’s proposing that things should go a step further and move towards simulation.

By simulating matches we could examine an infinite number of games, as in chess, test tactics and compare different models. To achieve this, we need to create a football engine, in this case Google Research Football Environment and its Kaggle IA soccer competition, with different variables per player: dribbling, passing or shooting, and different directions to execute them, always under a model for pitch control, ball possession and goalscoring chances.

Passes would have variables for long or short and shots on goal would also be determined by the distance and the goalkeeper, according to the average effectiveness. In total, there are nineteen actions for which the aim is for a player with the ball to get into the best possible position to score a goal.

The idea is to enter the algorithms in order for the simulator to learn by reinforcement. However, football is an extremely complex endeavour, which makes bot development particularly difficult. Dagnino has taken Manchester City’s challenge on this platform, which consists of feeding an Artificial Intelligence by putting bots against bots.

At the time of this presentation, he was 13th out of 813 competitors, achieved by adding common variables to the data analysis. The technology is still at a very early stage of development, but in the future it could be used, among many functions, to create more realistic games with possible applications to real-life football.

“The word coach is fine, but I prefer teacher”

The current head coach of the Valencia youth team, formerly of Atlético Madrid and with international experience in countries such as Greece and Qatar, Óscar Fernández, has spoken with Isaac Guerrero about the philosophy of his training methods. It’s an approach that he takes both with young players and established professionals, because he feels that everyone needs the same thing.

For Fernández, footballers are at the heart of the game. Each of them is a project and the coach’s job is to do everything possible to make it happen. When he arrives at a new club, the first thing he does is interview the entire squad to find out the fundamental thing. Does the player know himself? From there, a path begins that must end with an autonomous, creative, spontaneous and responsible footballer.

He is no fan of predetermined models, and prefers players who can adapt to any situation regardless of style, since each team he coaches will be different. If Fernández sees that, for example, he has a player who is an extraordinary dribbler, he prefers to work on creating situations in which that player can dribble. He wants all his players to offer something that will help the team to develop.

When he works with the youth academy, he says that although it is always important to win, at those early stages of the players’ careers, success is very relative. It is more important for them to learn. One thing that he is proud of is that his players in the youth team at Atlético Madrid may have missed out on a long-awaited promotion, but most of them went on to reach the elite individually.

His training system is based on dividing the field into sixteen quadrants. He wants his players to know their zone and, from there, understands those of the others. He is more in favour of structures than of schemes. Ultimately, he says it all comes down to ‘outcome your opponent’. Here he quotes Juan Carlos Unzué: “The player who comes out to you, is the one telling you where the free man is.”

Another lesson that he has learned over the years is that all the exercises that are worked on by elite professionals already exist at street football level, where children develop these skills instinctively. This shows the cornerstone of his system. Ultimately, it is the player who decides the way the team plays.

“In recent years there has been an increase in muscle mass and a minimisation of fat mass in football players”

Francis Holway, a nutritionist with more than 20 years of experience in the world of high-performance sport, has analysed the importance of body composition in football today, how it can be measured and the decisions that can be made based on the data obtained. According to Holway, “body composition is not the main determinant of performance in football, but if the player’s body composition is optimal, it will help him to play better”. In recent years there has been an evolution whereby footballers have more muscle mass and less fat mass. This change in body composition has been linked to the demands of the sport, with players going from covering around 9 kilometres a game in the 1970s to more than 13 kilometres today.

Due to its relevance, Holway detailed the different methodologies that can be used to assess body composition, saying that “in most contexts we need a rapid, practical, inexpensive and portable assessment methodology like anthropometry.” Although DXA is a more accurate method, its high price and low portability mean that anthropometry is instead the main measurement tool in the day-to-day lives of football teams. In this case, the sum of skinfolds can help the technical staff to assess the amount of subcutaneous fat. Holway explained that “professional footballers should have a sum of skinfolds of less than 50mm, that’s the benchmark figure. The current trend is even getting as low as a sum of 40 mm.” Although it is important to control the amount of fat, he comments that some players are so desperate to minimise their levels by vastly reducing caloric intake, that this can increase the risk of injury and respiratory infections.

In the final part of his presentation, Holway detailed how he classifies players by relating the sum of skinfolds and the muscle/bone ratio in four quadrants, which he uses to develop nutritional and exercise strategies based on each athlete’s profile.

Meanwhile, Dr María Antonia Lizarraga and nutritionist Mireia Porta, both members of the FC Barcelona medical department, explained how the club analyses its players’ body composition. Like Holway, they mentioned changes in players’ muscle mass. According to Dr Lizarraga, “there is a trend in modern football for players to reduce their percentage of fat, but not because of a loss of fat mass, but because of an increase in muscle mass.” Hence, “when assessing body composition we should not focus solely on the percentage of fat, as muscle mass is also very important in modern football.”

Due to the importance of muscle mass, the club uses functionality indices obtained from body composition measurements that can be used to make comparisons between players. They can therefore assess the muscle mass index and check, for example, how it has evolved over a season. Something they particularly emphasised is that the goal of body composition assessment is to educate the athlete and coaches with regard to training and nutrition processes. To do this, they use reports that show the different parameters in the form of colours, rather like a traffic light, that helps make things clearer for coaching staff and players alike. In conclusion, monitoring body composition and proper analysis of the data can help to improve performance in sport.

FC Barcelona’s Return to Play for Achilles tendon tendinopathy

Xavier Linde, FC Barcelona physiotherapist, has explained how the club handles the Return to Play process in footballers with Achilles tendinopathy. Because in most cases players with tendinopathy conditions continue to train with the rest of their teammates, Linde says that “the most important thing in these cases is to control the player’s load while he is still experiencing discomfort.” Should the player need to stop doing his usual activity, Linde has practically addressed all the steps taken by the club for the player’s recovery.

The core factor for this process is physical exercise, always applied progressively. As he says, in the first phase, players do isometric exercises, which produce analgesia mechanisms and mean that the tendon will be able to withstand greater workloads in the future. As the player acquires resistance to stress in the injured area, he starts adding eccentric exercises to reduce pain and generate adaptations to the tendon structure. After that, he goes on to do dynamic functional work designed to improve coordination patterns and strength transfer, as well as hypertrophying the muscles around the Achilles tendon to help it absorb vibrations. In the final stages of return to play, now on the field, the player does exercises in the sand, on slopes or in circuits, which require greater motor and cognitive control. An important factor highlighted by Linde is the need to regularly check the player’s pain level, every 10-15 days, and always on a distant date from those of fixtures, as that may affect the tracking result.

In turn, Scott Epsley, physiotherapist, physical rehabilitator and injury consultant for elite athletes, analysed the impact of Achilles tendon ruptures on NBA and NFL players. A relevant aspect is that, although there are not many injuries of this type, when the players return to play their performances usually drop quite significantly. Also, if the injured player is over 30 years old or has been playing in the league for 10 years, the chances of playing again are somewhat more difficult.

As for the evaluation of Achilles tendinopathy, Epsley has expressed the need to study the strength of the soleus, gastrocnemius and flexors of the fingers. He also says a player’s footwear should be examined when assessing an injury, saying that “we have to consider the characteristics of the player’s shoes and their possible contribution to the onset of tendinopathy in the Achilles tendon.” Finally, as other specialists have said, for Epsley, the cornerstone of tendinopathy treatment should be exercise and load control.

Kinetic and kinematic analysis of running applied to the management of hamstring injuries

In this presentation, Professor JB Morin, from the University of Saint-Etienne, talked about the importance of kinetic variables (application of forces) and kinematics (movement of segments) during running, and their relationship with the risk of injury. Although complex and expensive systems have traditionally been required to measure kinetic variables in running (such as force platforms) and kinematics (infrared cameras), we now have simple field tests that can estimate the force, speed and power exerted by the athlete, as well as low-cost recording systems and analysis programs (e.g. Kinovea) that can easily evaluate the kinetics of movement.

As Dr. Morin comments, the hamstrings play a fundamental role in sprinting, being highly activated at the end of the swing phase of the leg. In fact, sprinting is the exercise that most activates the hamstrings, so other activities like strength exercises may not train this muscle group enough to decrease the risk of injury. Sprinting is therefore a kind of ‘vaccine’ against hamstring injuries.

Dr. Morin also discussed the role of kinetic and kinematic analysis during sprinting in injury management. For example, injured athletes who return to play frequently have a deficit in horizontal strength and power during sprints despite having similar maximum speed values ​​to uninjured athletes. It might therefore be advisable to wait until these strength and power values are recovered ​​before returning to play. However, although low levels of horizontal force can potentially be considered a risk factor for hamstring injury, this is just a piece of a larger jigsaw, as other factors such as kinematics can also increase the risk. Dr. Morin presents evidence for the associations between kinematic variables during running (specifically the position of the pelvis) and a higher risk of injury since, for example, greater vertical oscillation in running can affect the length of the hamstring muscles.

Dr. Morin ended by talking about possible lines of future research, commenting, for example, that in the near future we may be able to estimate the forces on the tendon when running, and force-speed variables too, instantaneously during a game (and not only during a test) thanks to the analysis of GPS data.

Groin pain originating in the adductors: steps to follow from diagnosis to return to play.

Telmo Firmino, a physiotherapist at Benfica FC, has spoken about groin pain originating from the adductors. The adductors are the main source of groin pain, accounting for 50% of these injuries. However, a correct diagnosis must be made as it can also be associated with pain in the psoas, in the inguinal muscles or in the pubis.

In this presentation, Firmino presented the procedure that Benfica FC follows for the correct management of inguinal pain associated with the adductors. To do this, he treats the risk factors for this injury (including hip and core muscle weakness, as well as previous injuries), and then spoke about the strategies for assessment and rehabilitation. Regarding assessment, Firmino mentioned the importance of multifactorial analysis of this pathology, including posture analysis, manual palpation, analysis of lumbopelvic stability, hip mobility, the squeeze test to assess pain and strength, the star excursion test of balance, and the presence of previous injuries.

He also described the procedure to be observed with players who present inguinal pain associated with the adductors. In a first phase, the main objective of which is to reduce pain, it may be useful to apply ice if the pathology is acute, as well as strategies such as electrotherapy, manual therapy, myofascial release, activation of the transverse abdominis and isometric contractions. In the second phase, the main objective of which is to reduce the strength deficit to <15% between the affected leg and the unaffected leg, in addition to manual therapy, gluteal and core muscle exercises, as well as exercises with elastic bands, can be included, together with aerobic exercise without load (bike pedalling and alterG, aquatherapy). The third phase includes functional strengthening exercises (e.g. multi-joint exercises, slide board skating and balance exercises), and running can be introduced too. One of the objectives of this phase will be to run without pain, as well as limiting the strength deficit in the affected leg as much as possible. In the final phase, the goal is for there to be no pain in adduction exercises with large joint ranges, as well as to improve the ability to work both eccentrically and concentrically. This involves more complex exercises, such as progressive running, sprinting on the slide board, and eccentric-concentric transition exercises for the adductors. When it comes to the return to play, there needs to be progression both in the frequency and magnitude of accelerations and decelerations, changes of direction (increasing, for example, from 45 to 180º), and the amount of technical-tactical content (number of passes). Ultimately, in order to return to play, the amount of training done with the team must be raised from 30 to 90 minutes, with at least 1-3 weeks of full training, to ensure that the athlete is able to perform accelerations, decelerations, and explosive movements to the level required in the highest level of competition.

 

 

 

 

 

BIHUB Team

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