Unfortunately, medical staff can be left helpless during a game when a player tragically suffers a cardiac arrest. Historic high profile incidents of this upsetting nature include Marc-Vivien Foe, who collapsed while playing for Cameroon in June 2003 and Fabrice Muamba, who had a heart attack during an FA Cup tie between Tottenham Hotspur and Bolton Wanderers and was miraculously brought back to life.
The quick thinking actions of medical staff at White Hart Lane and a consultant cardiologist in the crowd helped to save Muamba, who was 'dead' for 78 minutes.
More recently, the football world mourned the death of former Hull City academy player Daniel Wilkinson, who sadly passed away after collapsing on the pitch while playing for Shaw Lane.
But, in the wake of this tragedy, Nick Oakley, Head of Sports Science and Medicine at Crewe Alexandra, believes the right steps are being taken to ensure the health and wellbeing of footballers in the future.
"The additional media coverage and great work from the FA, different sporting governing bodies and charities have raised awareness of the issue," said Oakley. "At Crewe Alexandra, and at the majority of other professional football clubs, it is a requirement that every academy player has a full medical screening on induction. A medical screening will involve a thorough review of the player's family history - some heart conditions are congenital - and an examination that involves listening to their heart and assessing rhythm. If anything concerning is brought up we will then refer the player for further investigations.
"If they are fortunate to progress to a full time scholarship at U18 level then they will undertake a further examination plus an echocardiogram and ECG, fully funded by the Football Association. The screening programme, ECG and echocardiogram are significant methods to reduce the risk of cardiac arrest but there will still be the occasional player with a condition that may have gone undetected, and so it is important that there is the equipment and appropriately trained staff in place for the worst case scenario.
"We have had a defibrillator and cardiology drugs readily available at all of our academy and first team training and matches for many years now, but the additional recent coverage has prompted fund raising and accessibility of defibrillators at sports teams at grass roots level, leisure centres, shopping centres and public places. It is great to see such proactive measures taken in the community."
Another issue that can potentially be as fatal as a cardiac arrest is a head injury. Players appear to be reluctant to leave the pitch after sustaining a blow to the head, but media exposure over the past few years has shed light on the immediate attention required to any player who is suffering from concussion.
"The media coverage on head injuries has been well received and is certainly justified," continued Oakley. "A primary head injury can be catastrophic but an individual who sustains a second blow before the initial symptoms have resolved - including days later - can be fatal; and it is essential no player is ever placed in this position. A life is much more important than the result of a game.
"The current law in football from the FA is that not even the physiotherapist has the final say and so the responsibility does not lie with me. It is the club doctor who has the ultimate responsibility of assessing and withdrawing a concussed player and I certainly agree with this. As well as headaches, dizziness and loss of consciousness, a key symptom of concussion is confusion so to give the player the right to make the decision to continue is certainly unthinkable. The doctor is able to provide an independent opinion and is usually the most qualified professional present to assess as to whether a player is truly concussed.
"The FA have been instrumental and worked hard thus far to raise the profile of concussion within football, but I think a few further steps could still help massively. One example I like occurs in Rugby League and allows for a temporary substitution to be made if a player is suspected to suffering a concussion. This provides additional time to conduct a thorough examination, allows the game to continue, and doesn’t punish the player’s team, who would be reduced to ten men whilst the assessment occurs. The substitution will also take the pressure of rushing the decision off the doctor and still allows the player to resume if he is passed fit.
"It is also difficult from the dugout to see how each injury has occurred. If a player sustains a head injury - or any injury, for that matter - I believe medical staff should have instant and full access to replays of the incident. Almost all games are now recorded live and being able to access a replay may be crucial to a player’s initial management and establish key markers like whether there was loss of consciousness."
BEHIND THE SCENES: THE PHYSIO
Part two of my interview with Nick Oakley, Crewe Alexandra's Head of Sports Science and Medicine
Article posted: 7 October 2016
NEW MANAGER, SAME OLD STORY
Still an underwhelming and uninspiring team selection for England following managerial changes and Euro 2016 failure
3 October 2016
BEHIND THE SCENES: THE PHYSIO
Part one of my interview with Nick Oakley, Crewe Alexandra's Head of Sports Science and Medicine
6 October 2016
Marc-Vivien Foe was just 28-years-old when he died on 17 June 2003
Daniel Wilkinson had just graduated from University
Fabrice Muamba was 'dead' for 78 minutes
Fortunately for Oakley, he has not had to deal with a fatality during his career. However, like any member of a medical team at a football club, he has had to tend to serious injuries on the field of play.
"The worst injuries I have ever dealt with are not your typical fracture or head injury as these will tend to heal well within a specific time frame," he explains. "It’s actually your degenerative joint conditions and/or complex soft tissue injuries that are the most challenging as a physiotherapist.
"I have had a 16-year-old academy player who has had two separate operations to remove partial meniscus tears within the knee and subsequently had to be monitored and managed differently to the rest of the squad. It is difficult for the player, their parents and coaches to grasp how a 16-year-old can’t train unrestricted like a typical teenager but it is operations like these that expose the joint to early arthritic changes, and limits the knee from being able to withstand a full career in football.
"The mental challenges that the player has to endure may also be more challenging than the actual injury itself; and it is in conditions like the aforementioned, that aren’t cited much in the media, that are definitely up there as the worst injuries you have to deal with.
"Complex pathologies such as Anterior Cruciate Ligament [ACL] injuries are still a significant challenge and, although there are a number of rehabilitation guides and protocols that have been published, I have never encountered two players’ ACL rehabilitation that have been identical. The current literature reports that approximately one in three players make it back to their pre-injury level within a year of surgery and so it is completely normal for ACL rehabilitation to last much longer than 12 months.
"I regularly see ACL rehabilitation time frames quoted in the media at six to eight months and, although I appreciate that this is possible, it is actually not as common or realistic as you think. Research has also found that approximately 66 per cent of players who undergo ACL surgery aren’t playing at their pre-injury level three years later, so there is a need for ACL rehabilitation to continue to advance and improve. I feel that incorporating other areas such as mental wellbeing is essential for long term rehabilitation as a significant time out surely has an effect on the emotional state of the player."
Most players will go through their career without suffering a serious injury, however, all players are suspect to minor knocks and muscle strains. Research has indicated that hamstring strains are the most common injury in football and more recent research has reported that hamstring injury rates are continuing to increase at roughly four per cent annually (Ekstrand, 2016).
"When dealing with academy players, the most common injuries by a country mile are growth related conditions like Osgood Schlatter and Sever's Disease," continued Oakley. "These injuries are related to adolescence, regularly coincide with a growth spurt, and occur as the player’s skeletal system is not fully mature. The repetitive use of the Quadriceps during football specific actions such as running, sprinting, jumping and kicking causes an accumulative irritation and inflammation at its attachment on ‘softer’ immature bone.
"The condition is self-limiting and will eventually settle and also completely disappear once the player reaches full skeletal maturity, and the bony attachment becomes much ‘harder’. I would however be wary to allow a player to continue to train and play matches whilst suffering with Osgood Schlatter as it takes much longer to eventually settle down and can lead to significant muscle weakness that may leave the player vulnerable to much more catastrophic injuries."
There has been scrutiny about the durability of modern day football boots, with some experts claiming that they offer little protection to players because of the thin material.
However, Oakley, who was presented with the Exceptional Services to Professional Football 2016 at the Football Medical Association Conference in May, believes the trendy footwear isn't entirely to blame.
"A player, if given the choice, will not wear shin pads in training, and will likely say it’s because they feel more comfortable," admits Oakley. "It is no different when it comes to football boots. Most footballers will tend to select their footwear based on how they look and also on how comfortable they feel and, truthfully, if given the choice would not select their boots based on how protective they are. The boots don’t seem as durable as previous eras and players are replacing them at a much greater rate, suggesting that they do wear down and become less protective far more quickly.
"I have had experience with certain types of boot and some serious injuries and do remain sceptical about them but I never think it is solely down to footwear alone; it is just one factor. A number of factors can be causative of any injury: from number of hours sleep, hydration levels, athlete's strength, the surface they train on, to just plain bad luck. Today’s culture demands that there is a clear cause for such serious injury but I think it is too easy to blame modern boots alone as a single, major cause.
"It is a fact that certain injury rates - hamstring strains for example - continue to rise and at the same time, the modern game is being played at a much faster pace, with greater distances covered at higher speeds. This correlation in injuries is clearly not down to modern football boots alone. Injuries are a cause of numerous factors and not usually down to just one issue alone; usually a combination. I certainly think it is essential that more research on player’s footwear is carried out to establish whether it is a myth or if a correlation does actually exist; and if it does, then these results should be openly published and accessible so that players can make a much more informative choice upon their footwear."
Special thanks to Nick Oakley for taking the time to conduct this interview, and for his brilliant, in-depth answers.
