Transcript
Jonathan Bird: Right, hello everybody and welcome to another episode of Injury Time. With me as ever is Ian Beasley and Shabazz Murgul.
Ian : Evening.
Shabaaz Mughal: Hello, everyone.
Jonathan Bird: um So we're recording on Sunday 7th of September um and... ah We've managed to keep to it weekly this time. um And in this last week, um well, we've had Daniel Levy, who was on as chairman of Tottenham. And of course, Shabazz, you were the team doctor there for many years at Spurs. So what what are your thoughts on that?
Shabaaz Mughal: Yeah, um I was very surprised, shocked, I guess. I heard it on the radio as I was driving home. um But I guess everything comes to an end at some point.
Shabaaz Mughal: um Yeah, I mean, he was my old chairman. I really enjoyed working with him. He was very hands on, very involved in what we were doing, very supportive always.
Shabaaz Mughal: So yeah, um I think with Spurs, he's leaving them in an amazing position compared to where they were when he picked up. um And then I guess we'll just see now where the future holds for Spurs and where what the next direction is. But I think he can look back very and very proudly on his time at Spurs, definitely.
Jonathan Bird: Yeah, I mean, um purely this total outsider. um as As an Arsenal fan, you know, you always have to slightly think, you know, you want to try and laugh at Spurs doing badly. But I think, from my perspective, I think he's done, he's turned Spurs into, you know, they like they're in the so-called Big Six, and why should they be any more the Big Six than Spurs?
Jonathan Bird: and Villa or um or even Everton, you know, one of those is sort of ever-present kind of clubs um and a massive new stadium which has not been had to be built miles away.
Jonathan Bird: It's it was literally it it's in the same position as the old White Hart Lane um and um a big, lovely big stadium that's making the money with concerts and ah NFL and
Shabaaz Mughal: yeah
Jonathan Bird: you know All they need now is some success. They've won the Europa, of course. um so i don't i don't know you know Fans always want more. They want the Champions League to be won every single year. champions lead we won every single year and That doesn't happen. It's the chairman out, the manager out, whatever. but um
Shabaaz Mughal: And amazing training facilities at Spurs as well. So before the stadium, and they built this amazing state of the art training ground, um a sort of lodge facility there as well.
Jonathan Bird: And of course you you you were involved in setting up the medical facilities weren't you at the training ground?
Shabaaz Mughal: Yeah, so in actually in all three in all three things I was quite ah integrally involved in sort of designing and and the medical areas and and sort of the wider picture as well. so there' this a there's a lot that goes into it I think behind the scenes that that needs to be appreciated but you know as a club Spurs have got an amazing sort of infrastructure now um and you know as you say it's sort of you've got to
Shabaaz Mughal: expectations, what are the expectations and every fan wants their team to be challenging for the league. But ultimately only one team can win the league, only one team can win the Champions League.
Jonathan Bird: Yeah
Shabaaz Mughal: So, you know, I think as long as you're in the mix, that's more than what you can ask for really.
Jonathan Bird: yeah exactly, i mean bite you do it and you can't call 19 out of 20 Premier League managers failures because those 19 didn't win the Premier League. i and That's the the essence of sport I suppose. isn't it and Any he particular thoughts on Spurs Ian?
Ian : First game I ever went to, Spurs Man United, 1965. 2-2. um Best Law and Charlton were playing for Man United.
Shabaaz Mughal: Bye.
Ian : i mean, you know, ah for I'm an Arsenal supporter, but I want to see North London football do well. You know, it's a great reflection on London and North London in particular if Arsenal and Spurs do well.
Ian : I'm not one of those supporters that don't want to see them do well. I want to see them do very well. um you know, good luck to Daniel Levy. He's given a lot to that club and put them in a good position.
Ian : Let's hope they can push on.
Jonathan Bird: you know and Arguably, London as a city has underperformed in Europe. Chelsea has won two Champions Leagues and that's been it, isn't it? um Even the old European Cup, there was no no London team of one today. No, no they haven't. so yeah i mean Maybe that's because of ah you know London has developed a a lot of clubs, a lot of quite successful clubs, but maybe you know when one in every four or five games you play is a London derby, it makes it quite hard.
Jonathan Bird: You know, yeah we don't mind City winning, but we can't have them lot up the road winning. I don't know. Anyway, we're we're rambling often too about football. We're trying to try and get injuries. And we thought I would just talk just a little bit briefly about... um William Saliba in the warm-up against against Liverpool last week.
Jonathan Bird: um but what What is that like when suddenly someone injures gets injured in in the warm-up? how does it How does it work?
Jonathan Bird: Ian?
Ian : Well, you get a message in your earpiece that says so-and-so has injured themselves and then the whole world goes mad because, you know, you want to know if they can play, yes, but the manager has to know immediately because he has to decide what he may need to do if the player can't continue.
Ian : um And then you the player comes in, you assess them both anatomically, in other words, you examine them, but you also, you know, you test them functionally. Can they jump?
Ian : Can they hop on one foot? Can they do all these things? How does the player feel? Does the player feel he can really play or not? And that's such ah such a big thing. And I'm sure, Shabazz, you've been on both ends of, yes, i can I'll give it a go. No, I can't give it go.
Ian : And then the manager will make the decision. you know You go to the manager, you tell them what the situation is. The manager will then make the decision, often coming and talking to the player about it. um The fact that he didn't last very long, well, you know in some way, some people would say, well, you know perhaps he shouldn't have come on. Well, you know,
Ian : Everyone moans about professional footballers not wanting to, you know, rolling about and doing this, that and the other. Well, I think good on him for giving it a go. It didn't work out and doesn't always work out, but sometimes it does.
Ian : So, but that's the scenario.
Shabaaz Mughal: and all yeah and it all has to be done so quickly as well so there's a massive time pressure for that um i can't quite remember and if it's still the same but you had to let them you had to let the referee know as well if you were planning on any change within a certain time frame otherwise they'd come as a substitution so yeah there's there's that pressure as well um but yeah like ian said i think the main thing is
Jonathan Bird: So Shibad, do you have any particular
Ian : Yeah, you do.
Shabaaz Mughal: I always go on about this, but it's about communication. So everyone's got to be fully informed. So the player, the medics, the coaches, you know, you sort of work through these are the pros and cons.
Shabaaz Mughal: This is the risk. Are we willing to take it? we're all on board, we'll take it. But then, you know, you accept whether you play the 90 or you play five minutes, you accept it because you've made a decision together and you knew going into it that these were the sort of pros and cons of it.
Jonathan Bird: and And that's a conversation with you, physio, player and manager.
Shabaaz Mughal: Yeah, generally, yeah.
Ian : Yeah.
Shabaaz Mughal: Maybe assistant coaches are there as well. So basically, it's a group generally tends to be sort of a group discussion.
Shabaaz Mughal: But yeah,
Ian : And a group discussion by the couch with the player there.
Shabaaz Mughal: yeah, yeah.
Ian : There's no chance of taking it all anywhere else.
Shabaaz Mughal: Hmm.
Ian : Player comes in, takes his boot off, any strapping, you cut that off, you have a look, you test him functionally, and then you say the manager, don't think he's going to make it or he's got a chance.
Shabaaz Mughal: I mean, yeah. i mean
Jonathan Bird: And that chance, of course, is completely unknowable.
Shabaaz Mughal: and
Jonathan Bird: I mean, you know, it's just an in-the-moment judgment, isn't it?
Ian : Yeah, exactly.
Jonathan Bird: Because you've got all the time pressures of you know exactly the time that you've got. You have to, as you say, Chubaz, are you making a substitution? um i suppose maybe even if if the point that he had injured it and they were making a call was that it's now too late to name a new team, he may as well start because there's sub anyway.
Shabaaz Mughal: Yeah, I think it's something if you've been in the game more recently, but it's something about you lose a person off your bench, basically, if you delay too long making that decision.
Jonathan Bird: Would that be part of it?
Shabaaz Mughal: So even if they're not going to play, you have to use one of the subs and you can't bring someone else in, I think. Yeah.
Ian : Yeah, it used to be that you used to have to make a formal substitution. It's changed now and they allow changes based on injury in the warm-up.
Ian : But nevertheless, it's disrupting to the team.
Ian : You know, practice and things like that suffer.
Jonathan Bird: So if they decided not to start Saliba, and even if that was 10 minutes before kickoff, that would not have counted as one of the subs.
Ian : That's right, now.
Jonathan Bird: Okay.
Shabaaz Mughal: Do you have to tell the other team as well because you've already submitted the team sheets?
Jonathan Bird: Okay.
Shabaaz Mughal: There's something...
Ian : I don't know about that. That's a good question.
Shabaaz Mughal: Yeah, I'm sure there was something there.
Ian : mean, I think, I don't know if it's, it's probably up to the referee to do that because you submit them to the, to the, or the match official, because they're the people you submit the team sheet to.
Shabaaz Mughal: Yeah.
Shabaaz Mughal: Hmm.
Ian : But like I said, don't forget, you know, if, if it's, if it's one of your centre-halves, then, you know, the tactics change. If it's, um, you know If it's someone who's intimately involved in the tactics for that game, then it makes a big difference.
Jonathan Bird: And centre-hounds are not usually people that you would regularly sub. and Unlike attacking players, it's quite common to sub attacking players during a game.
Ian : and Yeah, that's true.
Shabaaz Mughal: Not unless you're Man United, I guess.
Ian : That's true.
Jonathan Bird: Say again, sorry Chabez.
Shabaaz Mughal: I'd say you don't sub off your centre-backs unless you're Man United at the moment. Yeah.
Ian : Yes. yeah yeah Yeah, yeah. Well, that's right, though. You don't know, ah you know, I don't know anyone that routinely does that unless you're chasing the game.
Shabaaz Mughal: Yeah.
Jonathan Bird: Yeah, well, and then go to pack three and try to, yeah, yeah, yeah.
Ian : Yeah.
Jonathan Bird: Anyway, look, also, the other thing that happened, that took the main, we've rammed on a little bit longer than we meant to with that, but the other thing, of course, that's happened this weekend as the start of the WSL, the Women's Super League, um and we thought we'd just talk a little bit about women's injuries, right?
Jonathan Bird: um ah and mainly really about ACLs, as it's a big thing in women's sport. um And it's something I've treated quite a few elite women's footballers, and it's been really good to see in my time a consultant for the last 15 years that even quite, even the big clubs are, you know, there there was very little interest, they got very little money.
Jonathan Bird: um And I think it was particularly, was it was when England won the Euros a few years ago, that really was, that led to such like a really big explosion in the interest in women's football, which has been great to see.
Jonathan Bird: And it's gone from the point of you know, women who are good enough to play professional football really do have to have another part, you know, another um living because because they were they will not make enough money.
Jonathan Bird: And you have to be really dedicated to think that this is going to be a career for you, whereas we've jumped forward you know, 10, 15 years, in my time, as I say, to see that a girl of eight, nine, 10, who's good at football can look at the elite footballers who are playing in front of packed stadiums, who are winning the Euros again, that I can genuinely have, that, you know, a 10-year-old who's going to professional footballer in 10 years' time can, I suspect, will earn a really good living.
Jonathan Bird: and can and it's ah it's ah it's a and And there's no no one's rolling their eyes or thinking that's an odd thing for a girl to want to do, to be professional football. It's completely changed a lot. But then what it has brought into focus is that ah we know that um the rate of women's ACL injuries is much higher.
Jonathan Bird: Men play more sport, so it doesn't look as if it's higher, but in terms of per minutes played, women have a higher rate of particularly knee injuries and ACL injuries.
Jonathan Bird: um To Ian Shabazz, I know you've got your perspective. I know, Ian, you've given some lectures about hormonal changes in ah in women athletes, and you and you still treat ballet dancers, don't you?
Ian : Yeah, yeah. Yeah. I mean, it's an interesting, it's a really, it is a very interesting thing. There are, as you rightly say, Jonathan, in the sort of, before we started this podcast, you were talking about all the factors and there are lots of factors that predispose women to having ACL ruptures more than, more than men do, certainly in football.
Ian : And, you know, I think that
Ian : Most women now, certainly the clubs that I deal with and at the ballet, they track their menstrual cycle. They know exactly when they're more at risk. And one of the things I always say is, if you know the risk time for a particular player and you're rehabbing them,
Ian : Don't do an on-field drill that's going to put their ACL at risk. So just a simple thing that you can do to help bring down the injury rate just by knowing what the most susceptible time of a menstrual cycle is.
Shabaaz Mughal: When is that Ian? Tell us a little bit more about hormone changes.
Ian : That's sort of in the pre-follicular phase. So just before ovulation really. And it's, so if you look at Achilles tendon for instance, Achilles tendon ruptures in pre-menopausal women are very, very unusual.
Ian : But postmenopausal women have the same rate of Achilles tendon rupture as men. um And that's because the tendons get a bit more stretchy um because of the effect of oestrogen.
Ian : The trouble is, if you're talking about the ACL, which has a similar structure to the Achilles tendon, then that gets a bit more stretchy too. And if it gets a bit more stretchy, then you're more likely to to injure it.
Ian : And if, as Jonathan was talking about, the biomechanical things and the environmental things, if you're in a situation where maybe you're on the edge and then the ligament's a little bit more stretchy and breaks, then it's a good reason why.
Ian : mean, you can't do much about... The timetable is a timetable.
Shabaaz Mughal: Thank you.
Ian : And that's just how it is. Certainly when I used to be the hockey doctor, was the hockey doctor for England and Great Britain and looked after the women in the 2000 Olympics.
Ian : I used to counsel the women and ask them about their periods and ask them when their periods were, what they wanted to do about them, did they want to do anything about them or did they want me to shut up and go away and not talk about them.
Ian : I think it's not an issue as such, but it's something that can make a difference to the health of a professional player.
Ian : And as Jonathan Riley says, we may be talking about a lot of money. And if someone has a couple of ACL ruptures and interferes with their career, then that's a big loss of income.
Ian : So I think it's just another thing that we do, we should do. I don't think there's any difference in that and talking to any player about, you know, what's your knee to wall on a Monday morning after the Saturday game.
Ian : I just think it should be routine.
Shabaaz Mughal: Mm-hmm.
Jonathan Bird: Yeah, I think there's, um in terms of the higher rate of ACL injuries for women, there is the reasons why, and then there is can we do anything about that?
Jonathan Bird: And there's still much research still going on. I think there's though there is a clear hormonal link. um The way women are built wide wider pelvises for childbirth that changes the angle that their muscles come from the pelvis in towards the knee, changes how they react to we twisting and turning forces.
Jonathan Bird: But can we do anything about that? And as you were saying, Ian, you know we we can manipulate the estrogen of a pre-menopausal woman, obviously, you know a young athlete is pre-menopausal, but there are you know there are obviously there are side effects to that.
Jonathan Bird: um But one of the biggest things I think that I've lectured about is the um
Jonathan Bird: So when you rupture your ac what tends to happen, if you look at if you look at the video in the 06 World Cup, when Michael Owen does his ACL, you see his knee goes into what's called valgus, where the knee's in towards the middle and his foot's out, so it's forming a kind of a zip a sort of sort of ah sort of Z with his foot outwards and his knee inwards.
Jonathan Bird: And then his tibia, his shinbone, twists and that's him rupturing his ACL. And it's that Zed, sort of valgus, Ved, sort of Zed look to his knee, that's the bit that is really dangerous.
Jonathan Bird: And that when you've got your knee buckled in and you're twisting, and that's really, really dangerous. And women tend to do that more. The elite athletes tend to buckle their knee in more.
Jonathan Bird: And there was much criticism, excuse me, recently, well not that recently but that's that there was much in the press about why women is uh... buy why are they approaching racial more often why on the medicine more about this if it was ronaldo or messi you've been doing the ratios and medical profession will be doing more about it and actually The research has been there for years and years and years, like 30 years.
Jonathan Bird: um There's been neuromuscular programs that train athletes, particularly female athletes, not to buckle their knee in. And it's been shown multiple, multiple times that um female athletes who go through these neuromuscular training programs have a lower rate of ACLs. it doesn't work as well for men, interestingly, boys and men, but it does for women.
Jonathan Bird: It absolutely helps. And why and why aren't women doing these neuromuscular training programs? Then that's that's a much, much bigger question.
Jonathan Bird: you know is that Is that to do with the clubs, is it to do with the schools? and um you know and I just don't think there's enough awareness. Maybe there's just not as much interest women's sport as this part of misogyny of society. I don't know. But that where there absolutely is a lot that we already know and it can be implemented at school level, at amateur club level.
Jonathan Bird: I'm fairly sure it's been done at the professional club level, but much lower down, you know, if if a 14, 15-year-old female athlete does her ACL, the chances of that a female athlete then becoming elite is much, much lower now after the fact I have an ACL reconstruction.
Jonathan Bird: Shabazz, do you have any particular, have you had much contact with female athletes professionally?
Shabaaz Mughal: Well, yeah, I think when I started off my career, actually, I worked for the England DFA and it was in the women's teams in the youth groups.
Shabaaz Mughal: I mean, thankfully, we never had an ACL on one of our camps, but I always thought at that time, the issue, which I think is still a bit of an issue is probably less now, but it was the resources that they had in the women's game.
Shabaaz Mughal: And by that, I mean, know, you'd probably be lucky to have a physio, full time physio for a women's team. You know, you certainly wouldn't have a doctor. You wouldn't have necessarily sports science strength and conditioning coaches.
Shabaaz Mughal: You may not even have a very big coaching setup. So I think all of that, you know, ties in with what you're saying is that you're not then Who's going to implement those programs?
Shabaaz Mughal: Who's going institute those programs of neuromuscular control if you don't have the staff and resources to take that through? I mean, that's putting a hell of a lot of onus on the players on top of, you know, at times they may not they may have had other jobs.
Shabaaz Mughal: A lot of them was obviously students as well. So I think the biggest thing from my opinion, as well as the controllables in terms of controllables is that put more resources in to the medical side, to the conditioning side, to the sports science side.
Ian : Yeah, I agree, Shabazz. And I think, you know, I worked at Bournemouth last year and saw the women players when they got injured. And it was very interesting because they would... It has the feeling of just getting started.
Ian : They're now in the second tier of the women's game. I mean, you know, I've watched some women's football over this weekend. Lots of people in big stadia watching it. And for those big clubs, they will have backup.
Ian : They will have S&C. and all the things to enable them to do the preventative work. The trouble is, is that, you know, as you go down the tiers pretty quickly, it all disappears.
Ian : And you're right, part-time staff and, you know, staff who are just starting out, really, in the game, is often the first port of call.
Ian : And even then, as you say, they're not full-time because the clubs can't afford it.
Jonathan Bird: Yeah, I mean, ive my my close relationship has been with
Jonathan Bird: Charlton women's and 15 years ago I was just i was randomly one of their players was in my French claim and I got in touch with their physio who was part time they had absolutely no money at all and i had do everything via the NHS and they are this kind of mid-table in the second tier the championship um and they have been It's interesting that how you know they're forced by the WSL to be more professional. They have to like for and you know they had to they had to pay their players, they have to have the medical um staff. And now I see some of the players still privately in it and they and they come along as like a you know the club doctor and the physio and the player come to the consultation.
Jonathan Bird: and Before it was just it was the play on the it was the same as seeing men's league player.
Shabaaz Mughal: Mm-hmm.
Jonathan Bird: immense sunday league player and Nothing particularly changed. Charlton are still in second tier, they were the second tier, they've kind of a permanent second tier club in women's football. um and What's changed is the professionalism and the money in in the game. It's still not anywhere near WSL1 and a team, um you know, and you saw the game yesterday at the Emirates, Arsenal against the London City line, London City line, they signed some ridiculous number of players over the summer and um there's a lot of money in that and they can see, you know, money begets more money and they can see that there is interest, it's on live on the BBC, you know, what why would you not want to be involved in that?
Jonathan Bird: and you know and And women's football, thankfully, has been a big success story, particularly the England women's football team. And hopefully it will change and and and we'll get better. But I know what you're saying, that women's football has had no money, but...
Jonathan Bird: that these injury prevention programs are pretty straightforward. um And, you know, Power Up to Play, which is um what they're trying to do in this country, should should have been in women's school, should be now in women in in women's school and girls in schools.
Ian : Get
Jonathan Bird: um And it just isn't. And it will come, it will come. But it could have been there 15, 20 years ago.
Ian : But the FIFA 11+, which was developed for women originally in Scandinavia, if you ask elite men's teams whether they do it, and we know that it works, even for men, no one does it.
Ian : Why don't they do it? Because it takes too much time. So this is, you know, it's a paradox. I mean, they have all the facility and yet ostensibly don't have enough time.
Ian : So it's a really strange sort of business. But I agree with you. I think that, you know, there's Holly Silvers, who's a physio in California.
Ian : She did lots of work on landing mechanics to look at, you know, the way the core works.
Shabaaz Mughal: Thank you.
Ian : to avoid that sort of not need appearance as you described Jonathan when players land so that there as you say there's been a lot of work done on this stuff and it is all out there but for some reason you know when people are talking about it on the telly and on media doesn't get mentioned quite so much it's a strange business I'm not sure why
Jonathan Bird: Yeah, I mean, they, um You know, there's, just you know, Kate Webster, Tim Hewitt, I mean, legends of injury prevention programs. and And maybe it's interesting you say that it is that actually it's it's just not just women athletes, it's male athletes as well are not doing these kind of things, but it's not, the effect is not as pronounced for men as it is for women.
Jonathan Bird: I think maybe that's part of it. And, the you know, they will, i i do I remember there's ah hearing more about these injury prevention programmes years ago at conference where we talked for hours and days about exactly how to do an ACL reconstruction.
Jonathan Bird: what grant What particular graft do you do to replace the ACL, where to put the tunnel, all sorts of minutiae which are deeply boring to anyone outside of knee surgery. Even people inside knee surgery is deeply boring.
Jonathan Bird: And the injury prevention programs can have a much, much bigger effect than any of our clever surgeons can be. No matter how clever your physio is or your team doctor or your knee surgeon or whatever it is, the injury prevention programs have a much, much bigger effect.
Jonathan Bird: and But then, you know prevention has always been an issue, hasn't it? Trying to tell people, don't eat this because it will give you a heart attack. People don't, you know, they want to know more about how you can sort my heart attack out after I've had it, not not to prevent it.
Ian : Yes.
Jonathan Bird: Because prevention is a thing that has hasn't happened. it's ah you know you know it's like It's like only having good news on the news. You don't but you don't have good news on the news because hearing that and a war has been averted is not news.
Shabaaz Mughal: Thank
Jonathan Bird: So, I don't know. Rambling on a little bit, but...
Jonathan Bird: Anyway, look, anything more to say, guys, about particularly... There's a lot more to say about women's sport, but we will talk mainly about ACLs today.
Ian : I mean, look, I think the other thing to say is, you know, fortunately surgery has come on leaps and bounds as well. And, you know, surgical technique and actually lots of players, men and women have ACL reconstructions.
Ian : and you know most of them get back the the thing is and this is goes back to your point about making a living out the game the thing is every now and again someone doesn't get back and you know if you can prevent it then why wouldn't you because if you're if you're the unlucky one that doesn't get back then you know you have to find another career
Jonathan Bird: OK, brilliant, thanks guys. um So that's been another half an hour podcast. Obviously we're expanding. We don't um don't have the reach of some other podcasts, but we do have the expertise inside the game. That's what we excel on.
Jonathan Bird: so thanks guys um and we will see you all next time hopefully next week but um uh if not sometime after that okay cheers guys cheers see you later
Ian : Thanks, Jonathan. Nice to see you, Shabbat.
Shabaaz Mughal: Thanks. You too. Take care. Thanks.
Ian : Bye, man. Bye-bye.
Shabaaz Mughal: like you
