Pre-season: Time to screen, or time to scream?

So pre-season training is well underway for all professional and most non-professional football clubs by now, and it’s a time of mixed feelings. For the players, it can be dread, frustration, and exasperation of four to six weeks of physios and sports scientists poking, prodding, and testing them to run, jump, squat, and lift, jump, and don’t forget fitness tests like the dreaded Yo-Yo which I’ve seen make some grown men cry and plenty more lose their lunch.

Pre-season is often weeks of hard graft to ensuring players regain and return to their full fitness and strength after a period of rest during the ‘off-season’ and that they are match ready to not only compete but also to minimize any risk of injury

But for medical and S&C staff pre-season has its different challenges as they plan and consider the most reliable and efficient way to screen a squad of players trying to identify any potential risk factors that could potentially lead to injury and then plan strategies and programs to combat these. Pre-season is, without doubt, the time I felt the most challenged and stimulated when working in sport.

So I met up with a few Watford FC players who I haven’t seen in a while since we gave them their ‘off-season’ programs and watched them leave the training ground for a few weeks and have some well-earned rest after a tough season some of them playing 46 full games last season due to the incredibly small squad we had!

However, a ‘helluva’ lot happened in those few weeks during the offseason at Watford FC with new owners, a new high profile manager, new coaching staff, and also a new medical team. This meant that as of last week my three years at Watford as a first-team physio came to an end as the new staff took over.

I enjoyed my time at WFC, and I will miss the lads but I’m also realistic and understand that in football this is just part of the game. Anyone who has worked in or around professional sport knows that change happens quickly, often, and ruthlessly and it’s part of the job.

But as one door closes another opens and so I now find myself developing my own sports injury rehab center in private practice working with amateur sports and athletes and the good old weekend warriors.

So how did I get to see the Watford FC lads if I’m not working for them anymore you might be asking?

Well, I got a call from the new physios at Watford FC who asked if I would mind helping them out with their pre-season screening we had planned as they were flying a little blind being chucked in at the deep end. They asked if I could do the Isokinetic tests on a few of the players that we had previously identified at the end of last season as possibly having a high risk of a hamstring injury due to past history and previous weakness.

Now I’m fortunate enough to have access to Cybex Isokinetic machine at my new place of work and over the last five or so years I have been using Isokinetic testing for both professional and amateur athletes as a tool to get some reliable data and objective markers for the rate of force development, peak muscle force, and agonist/antagonist ratios between muscle groups as well as between concentric/eccentric phases of contraction.

These ratios can identify players who may be at higher risk of injury, and so preventative strategies can be put into place to minimize this, as shown in papers by Croisier et al (2008) and Young et al (2009)

Isokinetic ratios used in conjunction with other screening tests as well as past history of injury can further increase the identification of athletes at risk of injury as found by Brockett et al (2004) and Gabbe et al (2006)

For instance one of the players I saw today had an ACL reconstruction 18 months ago and we found on the Isokinetic tests that he had a loss in his hamstring/quad ratio as well as poor eccentric/concentric hamstring ratio strength. Combine this with his loss of hip extension and reluctance to sprint at 100 max intensity still places him at the highest risk of another lower limb injury. So significant input and rehab are still needed from the physios to ensure that he can start this season’s training and competition.

And it’s this assessing, planning, and season-long interventions and adjustments that I will miss the most now I’m not working with the lads at Watford FC. But I’m not bitter, it’s just football, instead, I wish all the new staff and the players all the best in this pre-season ‘season’, a time of mixed feelings indeed.

Thanks for reading

PS the papers I referred to can be found here for the physio geeks like me that want to check them out…
1. Croisier JL, Ganteaume S et al. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med 2008;36:1469–75.
2. Yeung SS, Suen AM et al. A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor. Br J Sports Med. 2009;43(8): 589-94.
3. Brockett CL, Morgan DL et al. Predicting hamstring strain injury in elite athletes. Med Sci Sports Exerc. 2004;36:379-387.
4. Gabbe BJ, Bennell KL et al. Predictors of hamstring injury at the elite level of Australian football. Scand J Med Sci Sports 2006;16:7–13.



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