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Leading tendon specialists have come together today to present the latest evidence on pathophysiology, pain treatment and protocols for prevention, intervention, and rehabilitation in tendon injuries.
After announcing it at last year’s edition, Dr Gil Rodas, head of BIHUB’s medical department, presented the FC Barcelona Tendon Injury Guide, a manual in which different experts offer a comprehensive view of tendon injuries: from their pathophysiology and risk factors, through their diagnosis and treatments, to the handling of different types of tendon injury depending on the tendon involved.
Tendon injury epidemiology and risk factors
In the first part of the day, on epidemiological analysis of the injury, Dr Martin Hägglund, from the Football Research Group, presented studies showing that outfield players have up to twice the risk of injury as goalkeepers do. He also analysed both intrinsic and extrinsic factors. For example, having had a previous injury is possibly one of the biggest risk factors, since there is around a 27% chance of recurrence of Achilles tendon tendinopathy in the first two months after starting to play again. He also stressed how, according to various studies, the risk of tendon trouble is 2 to 5 times higher in men than in women.
A relevant piece of information provided by Dr Hägglund is that the use of antibiotics like fluoroquinolones can multiply the risk of Achilles tendon rupture by 2.5. And if these antibiotics are combined with corticosteroids, the risk is multiplied by 5.
For his part, Dr Markus Walden, orthopedic surgeon and member of the Football Research Group, presented epidemiological studies that show how teams have an average of 4 tendon injuries per season, which represents 7% of all injuries in teams. And of these injuries, those to the Achilles tendon are twice as frequent as those that affect the patellar tendon. Remarkably, only 30% of tendon problems cause players to miss matches, which shows that most players are carrying tendinopathies on a regular basis.
Pathophysiology of tendinopathy: importance of the interfascicular matrix
Finally, Dr Jill Cook, physiotherapist and research professor at La Trobe University, analysed what happens on a pathophysiological level in tendinopathy. Although inflammation was believed to be the trigger for tendon problems in the 1980s and 1990s, Cook explained that “the model based on cellular changes appears to be the main driver of tendinopathy.” In relation to this, she focused on the importance of the interfascicular matrix, since changes to its structure mark the onset of tendon problems.
When we lose connective tissue due to overloading, the remodelling of the collagen matrix that this causes becomes an irreversible condition, and “if we don’t stop at the point where the interfascicular matrix is stressed, it could start to decompose and lose connective tissue, which causes the tendon to go from being a reactive tendon to a degenerative tendon.”
Hydration strategies to improve athlete performance
The third edition of the nutrition event being held as part of “Sports Tomorrow” was opened by Dr Ian Rollo, who analysed the importance of hydration in sports and the need to personalise hydration strategies due to major inter-individual variability in terms of sweat rates. He also presented the differences between thirst-based hydration and planned hydration strategies, highlighting the importance of an optimal hydration status both before and during exercise, and stressing the need to get athletes used to optimal hydration strategies.
In turn, Rebecca Randell, senior researcher at the Gatorade Sports Science Institute, said that “we cannot issue general hydration recommendations during exercise because every athlete sweats differently and therefore has different hydration requirements.” She hence highlighted the importance of making recommendations based on each player’s own sweat profile. One important fact explained by the researcher is that a large number of athletes know very little about their sweat rates, and therefore might not be hydrating themselves properly during training sessions or matches.
Randell introduced the technological advances that are being developed at the Gatorade Sports Science Institute, including the design of a digital ecosystem together with a series of wearables that can help coaching staff to accurately predict the amount of fluid and electrolytes that the athlete is losing. This information can be used to make personalised recommendations to improve player performance. One example is the GX Smart Cap that provides feedback to athletes to show them how much they need to drink to avoid both significant dehydration and overhydration.
Exercising during tendinopathy recovery: key to relieve pain and the athlete's confidence
On the first of the Sports Tomorrow physiotherapy days, Dr. Carles Martín, physiotherapist and osteopath for the FC Barcelona senior basketball team, summarised the possible causes underlying tendinopathy. He also presented the different assessment tools being used by the club and discussed how they should be used from the early stages after injury to the final stages before return to play.
Meanwhile, Dr. Peter Malliaras, researcher and professor in the Department of Physiotherapy at Monash University, analysed new approaches to the rehabilitation of tendon injuries in which exercise and its progression play a central role. Although the optimal amounts of exercise at different stages of rehabilitation are unknown, according to Malliaras, an approach that includes progressive exercise in order to build strength appears to be associated with better functional and pain-reduction outcomes than protocols that do not follow progressive models or simply do nothing. He also presented data from a study currently under review that seems to suggest that there is no relationship between the amount of exercise and pain in rehabilitation programmes. After 12 weeks, athletes feel significantly less pain regardless of the intensity of the exercise they do. The researcher therefore claims that correct progression of the load is important for addressing functional deficiencies and improving patient confidence in the face of gradual exposure.
The importance of having all the pieces of the jigsaw under control in sports planning
The first day of the Performance section featured Dr. Martin Bucheit, Head of Performance Intelligence Research at Kitman Performance Lab, and who has extensive experience in the field of football as Head of Performance at Paris Saint Germain. Dr. Bucheit described the importance of connecting all of the areas involved in high performance within a team, particularly underlining the need for a professional, and an organised system, that brings together information from different areas like medicine, nutrition and sports. He also presented the different organisation levels that need to be taken into account when planning, including everything from the broadest or ‘macro’ level (the whole season), to more focused levels including weekly scheduling, the conditions for each game, and the specific characteristics of each player and their contextual conditions. He included different practical examples of how a player’s individual planning can vary depending on all these levels (including, for example, extra training for some players and more rest for others). Finally, Dr. Bucheit described the importance of high intensity interval training in footballers, and also commented on the factors to take into account for its proper prescription and progression.
Discipline and creativity are not incompatible in a playing system
The coach of Brazil’s national women’s team, Pia Sundhage, spoke about how her playing system allows her players to be creative, but at the same time subjects them to certain rules. Two concepts, discipline and imagination, are not mutually exclusive, but what a coach has to know is how to make them compatible and to get them to feed off each other.
The system she wants her team to play by is fundamental, but a series of rules both on and off the pitch are too. It’s not a rigid system, but one that she adapts to the kind of players she has. But she does not go into the way her footballers should move the ball or move around the field. As long as they follow her instructions, they can adapt their roles as they like, and develop their game as they see fit.
She takes an individualised approach to group management, insisting that each player needs to be treated in a specific way. As she learned in the United States, the most important thing is to get to know each player in order to be sure what she is working with. Only then can one set goals and targets. That means she needs to have a close relationship with the whole of the squad, and as she is frequently travelling between countries, what she does is always keep the same coaching staff, professionals who can communicate with the group using the same cultural codes.
On a day-to-day basis, she likes to celebrate and discuss what has gone well on the pitch. Talking about what works is positive, she says, to create a good atmosphere, while there is no need to become too obsessed with the things that go wrong. All that matters is to understand what it is that went wrong: whether it is something tactical, technical or psychological. As for instructions, she prefers to do without video and only uses pictures. She feels that a single photograph with pointing arrows conveys much more than a sequence, in which there can be too many distractions. She likes to get her message across at a single glance. And by doing things this way, what she finds most gratifying is that her own players end up surprising her.
“Barça doesn’t seek to turn its fans into its clients, because its essence is passion”
Football clubs, despite being well-known brands throughout the world, do not have turnover like brands in other sectors that have achieved the same international relevance. This shows that there is still a long way to go in the field of marketing, says Enric Llopart, head of the FC Barcelona Digital Area.
However, a club like Barça’s commercial strategy can never be compared to that of ordinary multinationals. The club does not seek clients or fans, it already has them, and it should not aspire to turn them into clients, he warns, because the essence of Barça is passion. The core element of other companies is a product, here it is a feeling.
Llopart also listed a series of false myths in the world of marketing. First of all, turnover is not determined by the number of fans. There are many different kinds of supporter, especially considering that the fan base is multinational. The goal, in this case, is merely to try to identify the most passionate ones and draw them closer to the club. Because Barça does not seek to monetise its fans, but to create value for them.
In a similar vein, we must forget the idea that a ‘Culer’ will buy anything that carries the Barça logo. Fans are intelligent and demanding, and empathy is required in order to try to identify their needs with respect to the club. A study found that fans want two things from the club: recognition, as an official fan, and proximity, whereby fans who live thousands of miles away from Barcelona can feel that the club is close to them.
Regarding the challenges that lie ahead in this area, Llopart explained that in the changing scenario of current times, at the beginning of a new digital revolution, a lot of football clubs are getting left behind because they are not making this transformation. Another problem is the dependence on other platforms like Instagram and Facebook, which act as intermediaries between the club and its fans. Looking ahead to the future, he feels that one goal will be to break such dependencies.
After all, passion for the club is a double-edged sword. It can work in its favour, but if the results on the pitch are poor, it can go against economic interests. In the new scenario posed by the arrival of Generation Z in sports consumption, one opportunity for the future would be the creation of an ecosystem based on the Barça brand, but that is less dependent on results, competing in such fields as television and video games. With this strategy in mind, the club has already developed and launched its Barça Studios, Culers and Espai Barça programmes.
The NFL needs data experts
The National Football League has very recently started collecting data on the players in the competition. As explained by Michael Lopez, director of data analysis and statistics for the NFL, at first the only criterion they could follow was to try to offer the kind of information that someone who was watching a game on TV at home would demand.
To begin with, elementary data, such as points scored, yards run and other elements of the game were recorded. The set of tactics used, formations and strategies were also recorded, and finally by means of a two-device tracking system on the players’ shoulder pads, each of their movements and the direction could be recorded.
From there, the data managers realised that they needed to bring in more data experts to try to find more variables and coefficients in the sport. Together with Sunday Night, the broadcaster, Nex Gen Stats, the NFL statistics department, the AWS company and Football Operations, they held a meeting for data experts to brainstorm ideas to understand the game better via data analysis.
The event was called the Big Data Bowl and brought together thousands of specialists. And it was a remarkable success. In one year, it went from a hundred participants to several thousand. NFL’s partners presented the ideas they needed and the problems they had to solve, and the participants contributed with their projects. As a result, a large number of them ended up being hired.
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