Nothing more than a charlatanThursday, October 3 2019
The “Expert” Football Physio / Sport Scientist:
I'm going to cut straight to the chase for this piece as I know we are all time-crunched these days: It is generally perceived that certain people are termed “experts” in professional football. Let me dispel some expert myths right now on the so-called expert physio/sport scientist/S&C.
You are not an expert just because:
YOU work in the Premier League
YOU have treated/ worked with a famous person
YOU have a big following on social media
YOU are published in a scientific journal
YOU are part of the “clique” “cool gang” or mafia as I like to call you. Needless to say, I have never been in the cool gang.
YOU are a social climber and will only talk to someone if you want something from them.
YOU always voice your opinion on social media as the only way to do something right
YOU are invited to speak at international conferences because YOU either:
- Work in the Premier League
- Treated a famous person
- Published an article
- Have a big social media following
- Spoke at another conference etc. - you get my point right!!
First things first, if you are any of the above - get over yourself!!!
The above points might be very desirable to some people, but they are certainly not pre-requisites of what constitutes being assigned the “expert” tag.
You are only an expert if you work in the Premier League *emoji face* joke!
Let’s take working in the Premier League as an example. And let me be very, very clear here – it is the athlete who is the expert, not the support staff, be you a physio or sport scientist, no matter how good you might think you are - sorry to burst your bubble!! The recruitment process for a player (and associated pay package) couldn’t be any further from the recruitment of the support staff (and hence is reflected in their salary too).
Social Media Bullies:
I know plenty of physios/sport scientists/S&C’s who “piggyback” on the success of the athletes/club they work with and then become very vocal on social media because they assume that their opinion carries more weight because they hide behind a Premier League badge or superstar athlete. It’s as if the club or athlete owe all their success due to their “expert” practice. Complete and utter nonsense - again get over yourself.
I am a published author - seriously!!!
I know plenty of physios and sport scientists who have published articles in journals and thereafter assume that they are an authority in this field. For example, I know of a physio who considers himself an expert because he works in the Premier League and was part of a group who wrote a clinical piece on return to play decisions – thereafter he announced in his Twitter bio that he was an expert, again absolute poppycock. Furthermore, I read the piece and wasn’t all that overly impressed if I’m honest.
Expertism by Association:
There is a perception that the higher the status of the league or the more successful the athlete you work with is, then, the better a physio you are, and in some instances, I would imagine this to be true. However, this type of perception is more akin to “expertism by association” rather than a true measure of how efficacious that practitioner is. For example, a physio who works with Manchester United is assumed to be better than a physio who works for one of the lower league clubs such as Carlisle. Funny that because I know the physio at Carlisle and he is certainly without a shadow of a doubt one of the best in the business. However, this is a very shallow method for judging a person’s capability of how good they are as a physio/sport scientist /S&C. There are so many confounding factors, twists and turns in life, good and bad luck as well as timing which play a role where we all end up in our journey.
Learner or charlatan (expert) - Which one are you?
What makes someone an “expert” in their field? The quick answer is nothing. Nobody and I do mean nobody, is an expert in this field. How could they be? Seriously, how would you measure it? In my humble opinion, you have two types of people, those who think of themselves as lifelong learners and those who are delusional enough to believe they are experts in their field…. the charlatans!
Anyway, let’s get back to what the academics think constitutes expert practice.
A Reflective Practitioner:
This type of person according to Boud et al (1985) is able to reflect with purpose on their experiences, actions, emotions, feelings and responses in order to learn from them with the ultimate aim of challenging their understanding of themselves, their attitudes and behaviours to expose any biases they may have (Patterson & Chapman, 2013). The sequelae of such reflective practice may help improve patient care, bridge the theory-practice gap and fuel further critical thinking to promote ongoing changes in practice (Duffy, 2007).
Professional Craft Knowledge:
Benner (1984) argues that nothing trumps professional experience as the gold standard for “expert” practice - not even speaking at a conference or having thousands of followers on Twitter - imagine that?! Although she admits, it is very difficult to define what an expert is because this type of person operates on a deeper level. She believes that the expert clinician utilises evidence-based practice as merely another tool in the toolbox, a bit like k-tape, exercise or manual therapy or NICE guidelines for that matter. Again, I would argue against Benner’s choice of using the term “expert”, and this could be replaced with “learner”. Professional craft knowledge is reserved for those practitioners who are very experienced in their profession, who have seen the good, the bad and the ugly, and again who have reflected on and learned from all their experiences.
A novice practitioner, on the other hand, has “propositional knowledge” that is knowledge they have gained from books or courses but lack the real-life practical experience to inform their practice. They rely on and quote heavily, especially on social media platforms “scientific theoretic knowledge” because their personal practice is limited and inflexible. As their exposure to industry-specific scenarios increases (for example in professional football) as does their experiential practical knowledge (professional craft knowledge) and therefore they are able to lean on their propositional knowledge and anecdotal experience to make better decisions for the patient/athlete (Benner, 1984).
On the spot: Research action Research practitioner
The other defining aspect of an experienced practitioner is that they are able to reflect-in-practice, that is while the scenario is occurring which is in contrast to the novice practitioner who will be more likely to reflect-on-practice, i.e. reflecting on the event after it has occurred (Schon, 1983). This type of practitioner is able to carry out on the spot: research action research – they can generate a new understanding of the situation and change the situation there and then. They are able to consciously attend to the task in hand. In my humble opinion, the practitioner who is striving for best practice will be one who utilises both reflection in and on practice. The practitioners who view themselves as lifelong students, learners, reflectors, not those who think of themselves as experts just because of who they work for, what they have written or how many followers they have. But what do I know? I’m just a learner!
The Intuitive Practitioner:
This type of person uses intuition which is difficult to verbalise and has no rationale process – it’s simply a hunch!!! Again, you need quite a bit of experience to operate at this level. Your decision-making ability becomes fluid and effortless and not so cognitive anymore. Dreyfus & Dreyfus (1986) also refer to an “intuitive grasp” where the practitioner uses pattern recognition to inform their decision making. In essence, the practitioner compares their current experience with their past practice to make the right decision.
This occurs when you are able to reflect on your reflection, be critical about your own thoughts. This type of clinician can act as their own supervisor and question whether they are dealing with the situation effectively (Rolfe, 2011).
Being a good listener:
My whole aim in life now is to be a better listener, did I really listen to the other person, did I understand their fears, expectations and aspirations. If I have listened well, I can put that person at the centre of the rehab journey and build from there.
Is it correct to assume that someone is an “expert” in the field of sport and exercise medicine just because of who they work for, who they know or what they have written? In my opinion, this criteria defines what a “bureaucratic expert” is and nothing more than that. They hide behind smoke and mirrors, badges and athletes, journals and conferences.
If it's that important to you to be perceived as an “expert” in your field, then stop hiding, develop your own skillset as a practitioner and qualities as a good person. Listen more and stop telling people what to do on Twitter, realise that it is just your opinion that you are offering. Make your job your passion, reflect on your behaviour and become a nicer person. The more experience you have, the more you will realise that there are many occasions where current evidence does not advocate a particular practice. And, it is in these challenging situations of uncertainty – which you will constantly face within professional sport – that you, as a lifelong reflective learner, rather than who you work for, will help most.
Benner, P. (1984). From novice to expert. Reading MA: Addison-Wesley.
Boud, D., Keogh, R., & Walker, D (eds) (1985). Reflection: Turning experience into learning. London: Kogan Page.
Duffy, A. (2007). “A concept analysis of reflective practice: determining it’s value to nurses.” British Journal of Nursing, 16(22), 1400-1407.
Dreyfuss, H. & Dreyfuss S. (1986). Mind over machine. Oxford. Blackwell.
Higgs, J & Titchen, A. (2000). “Knowledge & Reasoning. Higgs & Jones (Eds.), Clinical reasoning in the health professions. Oxford: Butterworth Heinemann.
Jones, M. & Rivett, D (2004). Introduction to clinical reasoning. In M. Jones, & D. Rivett (Eds.), Clinical reasoning for manual therapists. London: Butterworth Heinemann.
Moon, J. (2004). “A handbook of reflective and experiential learning, theory & practice”. London: Routledge.
Paterson, C. & Chapman, J. (2013) “Enhancing skills of critical reflection to evidence learning in professional practice. Phys Ther in Sport. 133-138.
Rolfe, G. (2011). “Knowledge and practice. In G. Rolfe, M. Jasper & D. Freshwater (Eds.), Critical reflection in practice. Generating knowledge for care (pp.11-29) Palgrave MacMillan.
Schon, D. (1983). “The reflective practitioner: How professionals think in action. London: Temple Smith.
The Late Fitness Test podcast | Episode NineWednesday, October 2 2019
Getting down and dirty with all things injury-related. This weeks’ Late Fitness Test podcast covers a myriad of talking points… Johnny does his utmost to upset Frank Lampard while Stel pulls no punches as Manchester United’s on, and off-field, problems continue.
First up, we’re off to Stamford Bridge where the Chelsea boss is clearly unhappy following a recurrence of a hamstring injury which will rule Emerson out until after the international break.
(🎧 4:30m) The culture of blame
“Emerson is a similar injury to what he had, with a muscle. When you do that it means you’ve come back too soon. That’s not a slight on Emerson; everyone wants to play this game, fair play. Those things shouldn’t happen,” Lampard mused following the defeat to Liverpool.
“There is no blame when it comes to risk.” Practitioners need to delineate the risk of recurrence… to the player, to the manager to help make informed return to training, return to playing decisions… Research would postulate that your likelihood will lessen over time.
“You are not inoculated against the risk of injury…. What I find incredible is that he could give that type of answer, that type of answer might have held some water, let’s say 10-15 years ago, but not now. Everybody shares a responsible when returning players to training and playing.”
Physios reflect in practice, they’ll reflect during the event and use all their experience during that event and will be sympathetic to the fact that this hamstring may recur again. Lampard does not have that experience of returning a player to training and playing. He is reflecting on practice; he is reflecting on his decision after the event. This should not happen. He does not have the experience to reflect in practice.
(🎧 21:30m) Fitness, fitness, fitness
Fitness has always remained high on Ole Gunnar Solskjaer’s agenda since arriving at the club
Ahead of a warm-weather training camp to Dubai in January, Ole said. “We can get fitter, and we have to do that through the training sessions here. But Dubai is a good chance because now is the first time we get a week of work together.”
“Of course, we know our fitness is nowhere near good enough. I’ve said it before, I can’t wait to get a pre-season done,” he said following the 4-0 defeat to Everton in April.
While in pre-season, the United boss insisted “everyone should be as fit as they possibly could be” heading into the opening weekend. “It is not a case of breaking them down, it is not about proving a point; they are not fit enough. We are here to build them up.”
However, United's lethargy and growing number of injuries have called into question the squad, so much so, that the sports science department is said to be perturbed by the number of players breaking down so early in the season given that most of them are non-contact injuries.
“The easiest thing to blame, the easiest thing to change is the fitness of the players. However, you can’t hold onto that excuse 12 weeks later.”
(🎧 27:30m) Norwich injury record
The Canaries have suffered 18 reported injuries since the opening weekend, more than any other top-flight side. But how much is down to bad luck? And, how much is of their own doing?
"The first sessions and the first weeks have been good” Head of Sports Science Chris Domogalla told Norwich City TV in July. "I've heard that the guys are not used to double sessions, but they've done a really good job. We've increased the load softly in each session because we knew the background. We've pushed the guys to improve them. That's the way we want them to work."
“Did training have to get harder, or did you have to train smarter? How much reflection is going on in both those camps?”
(🎧 36:30m) Recruiting from within
“Sometimes I not sure whether the recruitment process on backroom staff, on players, is as robust as maybe how robust the conditioning of the players has been. So, maybe we’re just looking in the wrong direction here. They are still recruiting within…… I’m calling into question the recruitment process here. You’re at the best club in the world, but going to the best club in the world, have you got the best people giving you the best advice…?”
Meanwhile, Stel does not pull any punches.
“Marcus Rashford is bottler…. Things aren’t going his way, and I know in the past certain players, have refused to play because they feel that they are too injured even though they can. And, for me, this injury may be legitimate, but I just think that it’s convenient that he’s pulled up right about the time people are questioning his form, they’re questioning his ability….. It seems that a lot of players at this club are very quick to hide behind the managers failing, what’s happening off the pitch with Woodward. It’s like a shield, and it’s going to continue until the owners eventually sell up.”
(🎧 39:30m) Treating the person
In recent years the conversation has morphed from: “Shall I have an MRI?” On to.. “So, there’s nothing on the MRI? Well what do you think it is then? Stuff that players would’ve played with 10-15 years ago, they probably don’t play with it now.”
“It comes down to the person you’re dealing with. “You’re not treating a hamstring; you’re not treating an ankle, you’re not treating an ACL. You’re treating the person that’s in front of you and what are they bringing to you, and what type of behaviour, and what character, because their character will determine the outcome and the physiology.”
(🎧 40:00m) Evidence-based medicine
“You get all these practitioners, and they hide behind evidence-based medicine, you see them all on Twitter. They go and quote a paper on hamstring injuries; they go and quote a paper on ACL’s. This is called acquisitional knowledge. They’ve acquired this through reading, through books, through articles, they’re working in the Premier League and they don’t have the experience to go ‘matching my anecdotal experience over the last 10-12 years with the research I see…..”
(🎧 43:00m) Listener Question – Genetics.
“You’ve heard about people talking about the speed gene… There is no such thing as a particular strength gene, or a particular speed gene, or a particular performance gene…. Genes play a part, but the polarising notion that it’s nature – the way you were born – or nurture – your conditioning and training – well that’s archaic, and that’s proven not to be right.”
(🎧 46:00m) Andy Carroll comeback!
“Is he able to put back-to-back minutes together? No. Was this an emotional decision by Newcastle United? Absolutely, definitely!”
And on reports by the Telegraph that state the likelihood of Carroll starting a game in the short to medium term is extremely slim with his involvement almost certainly confined to cameo roles as a substitute.
“It’s a very, very, very graded return to play and not one I’ve been involved in that people have been afforded so much time to return. Because usually, a player is given restricted minutes for a couple of games, and then, if their status is high within the squad, then they’re back in.”
Have a listen; we would love to hear your thoughts!
How to pass a football medical...Monday, September 30 2019
Matt Nesbitt pulls back the strapping on what really goes on in a football medical
If you think that the football medical is merely a sideshow of Transfer Deadline Day. A formality to be rattled through in a few minutes, while the player’s agent is getting the last couple of critical contract terms over the line - usually his percentage and the sell-on fee (for the more-than-likely already arranged transfer). You’d be wrong. It’s crucial, often as a get-out-this-deal-free card for the player and/or the club.
John Beresford tells a great – and revealing - story about his proposed move to Liverpool from Portsmouth. Moments after his dream move was derailed by the medical team at Anfield, he passed a medical for Newcastle United – over the phone.
An Englishman’s fish is a Frenchman’s poisson
C’mon, you remember John Beresford… He was the diminutive blond left-back that played behind David Ginola for Kevin Keegan’s mid-nineties nearly men.
He was the one blamed for about half of the goals they conceded. Grossly unfair because he spent most of his time being double-teamed by the opposition winger and right-back, while the immaculately coiffured Frenchman in front of him strolled about on the halfway line clicking his fingers above his head.
“Garcon… Garcon. Le ballon, s’il vous plait.”
The story goes that John was on his way to join Graeme Souness’ Liverpool having impressed for Pompey in a cup tie (despite missing the all-important penalty in the shoot-out). But during the medical, an x-ray revealed a problem with his ankle. Apparently, it hadn’t set correctly following a fracture playing for Barnsley – four years and 150-odd games previous.
No-fault of the club, of course. They sent all their injuries to accident and emergency in Barnsley General hospital during that period.
But Liverpool were (and remain) bastions of the highest possible standards. And at the time were only a few seasons past an unmatched period of domestic and European domination. If they’d started taking chances on half-fit full-backs in 1992, it could’ve been decades before they began to challenging for the major prizes once again.
(Yes, I know that actually did turn out to be the case. But it wasn’t due to their medical team playing fast and loose with floating cartilage).
Anyway, the deal was off, and a gutted Beresford was marched off the premises.
As one gate slams, another one opens
Enter Kevin Keegan.
With the clang of the Anfield gate slamming behind him still ringing in his ears. John’s phone rings.
*NOTE FROM THE AUTHOR*
I know what you’re thinking.
‘There were no mobile phones in 1992! The credibility of this story has been compromised. ABORT! ABORT!’
I thought the same. But that’s how John tells it, and I’m not calling him a liar – he’s got an MBE now, y’know. Plus, there is no way of checking, and it is key to success of his story and this article.
So how about we say his agent had a car phone. Happy with that…? Great.
AS YOU WERE…
With the clang of the Anfield gate slamming behind him still ringing in his ears. John’s agent’s car phone begins to ring.
John is still disconsolate in the passenger seat. Head bowed. Eyes filled with tears.
The agent pulls his BMW 5 series (probably) to the curb and answers. It’s Kevin Keegan.
‘Hello Mr Keegan. Let me hand you over to my client John sat next to me, disconsolate in the passenger seat. Head bowed. Eyes filled with tears.’
‘John, Kevin here. Come and sign for me. I’d love it.’
John Beresford MBE spots an emergency parachute when he sees one but is a professional. Immediately ‘fessing up what has just happened in the Anfield treatment room, explaining to KK about the badly set ankle.
He needn’t have worried.
‘Oh, don’t worry about that. We’ve just signed Paul Bracewell – his ankle is f#@ked!’
And that was that.
Trust me; I’m a football manager
Later that day, Beresford was ushered through the medical department at Newcastle United with Keegan cajoling and heckling the physios throughout. And the deal was done.
He went on to play 179 games for Toon over six seasons, during the most exciting period in their history. So, this is no criticism of Keegan or Souness. It merely highlights the grey area around the football medical.
(Paul Bracewell also managed over 70 games for Toon. Training once a week and being packed in ice and pumped full of pain-killers the rest of the time).
Harry Redknapp has spoken openly about using a failed medical as an excuse to put the kybosh on transfers. Usually to make way for a late Peter Crouch or Niko Kranjcar deal.
So don’t make the mistake of thinking that football medicals are black and white. Or that medical teams or a latent injury carries more weight than the people running the club.
Football is a game of opinions. And so is match fitness, my friends.
Matt Nesbitt swapped his short, unspectacular but joyous football career for a much longer, successful one as a football tipster.
Ben is football’s leading injury specialist. The ‘go-to’ guru for big hitters like Sky Sports, ESPN and NBC Sports when they need data. Or the BBC, talkSPORT and the broadsheets when a quote is required. His unique insight has helped provide a better understanding of what is really happening in the treatment rooms.
Johnny is a respected physiotherapist and sports scientist, specialising in football injuries and rehab. Johnny has headed up the medical departments at Chesterfield, Scunthorpe and Notts County. Overseeing everything from player-specific training loads to pre-signing medicals. He has a proven record working with elite athletes in Private Practice and is regularly called upon throughout Europe to deliver presentations on the latest rehab innovations.
Matt's short, unremarkable football career was ended by his own bad driving. His long, distinguished career as a football tipster was ended by his own good advice. Because bookmakers don’t like a winner. First, they closed his accounts. Then his members’ accounts. Then his tipping service. And now they employ him as a consultant. Funny old game.