Prevention, Treatment, Performance

Educational Videos from the FIFA Football Medical Network (@FIFAMedical): Techniques for football physiotherapists / trainers

Recently Justin (@backtoyourfeet) was asked to help make some short educational videos for the FIFA Football Medical Network with @DrMarkFulcher. Here is a collection of the videos that are available on FIFA Medical Networks Twitter page (@FIFAMedical).

This collection of videos demonstrate techniques physitherapists or medical staff use to manage footballers.

Taping, or strapping, can help reduce the risk of re-injury when returning to football, however the ankle still needs to be strong enough to withstand the forces that changing direction, tackling (or being tackled) or kicking produce. Therefore it is important to progress the return to sport appropriately, and only return to play when it is safe to do so. There are a number of different techniques that can be done depending on what has been injured around the ankle. Syndesmosis injuries are also known as ‘high ankle sprains’ and they tend to take longer to return to football than lateral ligament injuries. Be aware you can also get adverse reactions to taping such as skin reactions and some players may take more risks because they feel the tape will protect them.

The “Low Dye’ technique is used to support the arch of the foot and can be used to see if orthotics may be appropriate for players to reduce pain and improve their function. It can help players with midfoot pain or posterior heel pain. You can vary the technique to support different areas of the foot. Sometimes I use Fixumull or Dynafix to lock the tape off as it is more flexible than rigid tape.

Taping can also be used around the knee to help reduce pain associated with patallaefemoral pain (pain around the kneecap). You need to make sure the skin is clean and dry if you want the tape to stick. We use adhesive spray to help the tape stay attached during football, and have found that using elastic adhesive bandages can also help the tape stay on during training and games.

Thumb sprains are most often sustained by goalkeepers when making a save, but can be caused by falls, or when caught on opponents jerseys in outfield players but contact from the ball.

Players can injure themselves in many ways on the field. It is common for players to break their skin and bleed while on the pitch. In football, if blood is visible on a player or his apparel, he will be asked to leave the pitch until it has been cleaned, the bleeding stopped, and the dirty apparel changed. It is important to always be prepared to deal with blood on the pitch. I always wear gloves on both hands to protect myself and my players.

Although rare, it is important that serious medical conditions are managed well on the sideline. Recognising the signs and symptoms of serious medical conditions and knowing what to do in an emergency is important for all medical personnel involved in covering football teams.

It is important to understand how to do good quality CPR. At WSAFC, where Back To Your Feet Physiotherapy is based, we have 4 AED’s, and trained staff who know how to do good quality CPR.

Good quality CPR saves lives.

The following set of videos show tests that football physio’s and medical professionals use to help diagnose conditions or objectively measure changes and progress in conditions.

The Y-balance test can be used in the clinic to monitor athletes progress after they have had an injury, and can be used as a screening tool to highlight imbalances between limbs.

New Zealand has one of the highest incidences of asthmatics and so it is important to understand how to monitor their asthma.

If someone does have an asthma attack and they are struggling to use their inhaler then understanding how to help them using a spacer is important. At WSAFC we have spacers upstairs at the physio clinic.

With so many young players playing football, it is common for them to develop pain at their growth plates due to the combined load of growth and activities such as running, jumping and kicking on their skeletal system. Here are some common sites they develop pain.

Although most injuries happen in the lower limbs, payers can sustain upper limb injuries too. Shoulder relocations are best left to trained medical personnel. Here are a couple of techniques for relocating a dislocated shoulder.

Recovery strategies are important after trainings or games to ensure players can continue to perform. Nutrition is an important component as it helps to replace energy lost during exercise.

Justin was also involved as part of the World Wide Delphi Study into the design of the FIFA 11+ Goalkeeper Injury Prevention Warm-Up.

The Holmich protocol for long standing adductor related groin pain

If you have had a long-standing groin injury, then the 10-week Holmich Protocol has been proven to be effective as a treatment. It was first described in 1999 by Per Holmich in The Lancet (Hölmich et al., 1999) but is still one of the most validated programmes for footballers who have chronic adductor-related groin pain. There are two phases to the protocol, and they include exercises to build strength in the hip adductors, abdominals, glute's and lower back.

Recently the programme was validated by (Yousefzadeh, Shadmehr, Olyaei, Naseri, & Khazaeipour, 2018) who found that the Holmich programme may be an effective treatment for long-standing adductor-related groin pain (LSAGP). However, they suggested more emphasis should be paid to the hip adductor muscles' eccentric strength and have modified the programme to make it more effective. One of the exercises they included in their programme is the Copenhagen adductor exercise. The Copenhagen adductor exercise can reduce the risk of getting adductor injuries and should be done regularly to maximise the effect. Our Premier Football teams use the Copenhagen adductor exercise as well as the FIFA 11+ warm-up exercises to help reduce the risk of injury during the season.

Groin pain does not just affect footballers. If you have had an adductor injury, or have groin pain that is restricting your ability to play football or achieve your calls then we would love to hear from you. Make an appointment and we can hep prescribe the best way to help you return to your sport.

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Hölmich, P., Uhrskou, P., Ulnits, L., Kanstrup, I.-L., Nielsen, M. B., Bjerg, A. M., & Krogsgaard, K. (1999). Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. The Lancet, 353(9151), 439-443.
Yousefzadeh, A., Shadmehr, A., Olyaei, G. R., Naseri, N., & Khazaeipour, Z. (2018). Effect of Holmich protocol exercise therapy on long-standing adductor-related groin pain in athletes: an objective evaluation. BMJ Open Sport & Exercise Medicine, 4(1), e000343.

First Aid kits for football

Looking after athletes on the sideline is a challenge, and at lower levels of competition when funding is limited, is often provided by sports medics or trained First Aiders. I recommend you find a local physio that can help provide services for your team, and who you can contact if you have an injury on the field. If you are unable to source a professional then doing a Sideline Sports Medic First Aid course or a First Aid and CPR course will help give you the confidence to make good decisions when someone does get injured. Making sure you plan for all the eventualities and source a good ‘kit’ so you have what you need when an injury happens.

Sideline Kit

I think a good basic kit should contain:

  • CPR mask and resuscitation card x 1
  • Survival blanket x 1
  • Scissors stainless x 1
  • Gloves x multiple
  • Management of blood products
    Plasters Assorted water proof x 25 / gauze swab 7.5cm x 7.5cm / Sterile island dressings 7.2cm x 5 cm / Steristrips / non adherent wound pads 5cm x 7.5cm / swimming cap for head wounds / sealable bag to dispose of items with blood on
  • Wound cleansing wipes x2
  • Saline solution x 3
  • Antiseptic cream
  • Strapping materials
    38mm Rigid tape / 25mm rigid tape /50mm EAB / 75mm EAB
  • Compression bandages
    Coban 75mm / coban 50mm /tubigrip
  • Blister management materials
    Second skin / blister plasters assorted sizes
  • Vaseline / sports lube
  • Massage Lotion / massage wax / warm up rub
  • Cold spray / magic water
  • Sunscreen
  • Triangular bandage / Sling
  • Instant ice packs
  • ?Players medications / panadol
  • Sport specific tools
    Laces / studs / stud tightener / spare shinpads
  • Pocket Concussion Recognition Tool
  • Business cards for BTYF Physio

It takes a while to get a good kit together, and once you have created a good kit you need to remember to replace items you use.  Every team or athletes requirements are often slightly different so make a kit that suits your team perfectly and encourage athletes to take responsibility to bring the things they may need.


Physiotherapy’s role in the assessment and treatment of concussion in New Zealand

There are an estimated 35,000 head injuries in New Zealand per year, and many of those are sustained on the sports field.  Any concussion is a  serious injury, and once someone has suffered a concussion, it may increase the likelihood of suffering another head injury or injury to another part of the body.  Repeated concussions may also be linked to long term postconcussive symptoms such as depression or degenerative neurological conditions (Patricios et al. 2016)

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