Once again I am indebted to our very own resident sports physiotherapist, Trev, for his professional view on a topical subject. We have players out for a variety of reasons, and it would take a series of articles to cover them all. Trev looks at one area this week as an example. Do you think you could persuade him to cover a different part of the body in each international break in the drinks? Thanks Trev.
Mark Verstegen – Shad Forsythe’s mentor,
“If we are screening every athlete and we see something that might take someone out of games, we want to address those inefficient movement patterns up front,” he says.
As injuries are once again taking their toll on our season and speculation mounts as to why, it might be interesting to get an overview of how problems can progress through the body.
Bearing the quote at the top of the piece in mind, I thought I might combine Verstegen’s words and one of my own personal experiences of The Arsenal. Everyone is clearly hoping that Shad Forsythe, the new Head of Athletic Performance Enhancement, is going to bring a new approach to avoiding injuries at the club.
One very good place to start, with any sports person and especially footballers, is with foot mechanics. I am not suggesting that the club has not addressed this issue now, but it does illustrate well how injuries can progress.
A number of years ago, fairly soon after the Shenley training and medical centre opened, I had a private tour of the facilities which included everything from the laundry and changing rooms to the coaches offices. It was fascinating and, at the same time, quite surprising stuff. One thing that has stuck in my mind since that day, and I promise you there is nothing weird or fetishy about it, is Robert Pires’ boots !
Robert Pires was clearly a quite brilliant footballer, but also a very flat footed one – if the indications from his gait were anything to go by.
Between the changing room and the training pitches was a room where each player had a peg with six pairs of boots on it. I was amazed to see that, in an elite team containing stars like Vieira, Bergkamp, Henry and Sir Bob, that for all his apparent flat footedness, Pires had no arch support built into any of his boots.
The foot is a three arch structure which should provide spring and balance points.
The main arch runs under and along the instep and is supported by the plantar ligament.
The second arch is formed along the length of the toes, and the third, or transverse arch, runs across the instep.
The balance points are at the heel, big toe and on the outside of the foot just behind the fifth toe.
If the main (plantar) arch of the foot drops – due to genetics or overuse – the centre of the foot rolls inwards ( hyper-pronates) and the person’s weight and main balance point drops back onto the inside part of the heel, leading to strains and inflammation of the ankle ligaments and Achilles Tendon, which is the amalgamated tendons of the gastrocnemius and soleus muscles of the rear calf.
This makes an athlete slower off the mark as the weight has to be shifted further forwards to get moving, but also creates a whole chain of events that can cause a succession of injuries.
As the foot continues to pronate, it drags the tibia (shin bone) into an inwards rotation too. That eventually causes the tibia to become misaligned which distorts the joint spaces up in the knee, leading to pinching and wear of the fibro-cartilages, strain and inflammation of the tendons and ligaments, and wear and inflammation of the patella (kneecap).
The rotation continues through the thigh into the hip causing misalignments of the pelvis, inflammation and even tearing of ligaments in the groin, and protective contractions in muscles around the pelvic girdle.
That, in turn, results in the spine not rising straight from the pelvic girdle, inflammation of the sacro-iliac joints, lumbar strains, misalignments and other back problems.
If the bottom end of the spine is not straight, the head, at the top end, will not be straight either. But the spine requires the eyes and ears to be level in order to be able to balance and coordinate efficiently.
Consequently, the brain causes the spine to compensate for this leaning to one side by bending back the other way, generally in the lower half of the thoracic spine (bottom half of the rib cage). A final compensation is then needed at neck level.
These compensations are achieved, at each point, by contracting the. muscles on one side of the spine to pull it back over. This can lead to pain in the shoulders, neck, headaches and migraines.
Hopefully, all this detail won’t have sent everyone to sleep.
The idea was to show how a simple mechanical failure in the foot can cause postural change in the body, and a whole set of related conditions.
It might put a bit of meat on the bones of Mark Verstegen’s quote at the top of the piece.
Whether it makes anyone feel better about our overcrowded treatment room is another matter entirely.
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