Warm Ups, Fatigue and Injuries, from Espanyol
Interview with Jordi Escura Aixàs
Jordi Escura Aixàs is a professor of sports sciences at the University of Lleida in Spain. Previously he was a physical therapist for RCD Espanyol – in Spain’s top division, UE Lleida, and Buriram United in Thailand. He was responsible for players returning to play after injuries. Jordi is a UEFA A licensed coach and a UEFA Pro License Professor. As a player, he represented the country of Andorra, playing as a defender in 65 games in World Cup and Euro qualifiers against many of the largest countries in Europe. Along with Toni Dovale (formerly of Sporting Kansas City and FC Barcelona) he hosts camps and help coaches at clubs with their methodology through their company Barcelona Soccer Excellence.
How long do players really need to warm up for games?
It depends on philosophies. If you see one Barcelona warm up, it isn’t longer than 20-25 minutes and it is at a low level of intensity. Other teams though take 30-35 minutes and finish at really high intensity levels. As I see it, we have to do the least necessary that still allows a player to perform the exercise required of them at their peak during the game. Sometimes parts of the warm up the player should decide for themselves what they need or don’t. We will do some group mobility activity early on and some technical skills training, but then there is a part where they can decide. I’m talking about adults here obviously – we cannot do this with younger players. For them I would take maybe 15-20 minutes because they need less because the body is more prepared for the required changes in intensity. The climate on the day might affect the time slightly too. I would start with light running and mobility drills without and with a ball – passing and controlling it. After that I try to play 4v4, 5v5 games to start to create connections between players that we will need in the game. After that I give them time to drink and relax, then do a few short sprints for reaction times.
I wrote a blog about warm ups for my company Barcelona Soccer Excellence which you can see here.
Should players be cooling down and stretching after games?
There are some that may help and others that don’t. One thing that definitely helps is eating after exercise. Players need to recover carbohydrates and protein in the body and it is necessary to be done no more than one hour after exercise. They need to sleep well too. These are the most important factors that can help players after exercises. Other things like stretching, ice baths, compression socks, massage therapy and so on haven’t been demonstrated to help physiologically, but they do work for some players psychologically. If a player takes a massage after a game he will feel better. He doesn’t know whether he really is better, but maybe that isn’t important. At Espanyol the players were used to static stretching after training and we talked about it with the coach as I didn’t think it was necessary – maybe some soft active movement would be more helpful – but players need these movements. They cool down, they talk to each other during the stretches too, which is important for them.
As a physical therapist, how many players were you seeing on a typical day with a club?
It’s different because at UE Lleida we didn’t have the structure that we had at Espanyol, so I had to deal with all of the players every day. Obviously I wasn’t treating all of them every day, but I could have 6-10 players each day, depending on what they needed and how much they wanted to wait. For Espanyol there were four of us so we could treat 2-3 players each day before and after training.
What are examples of the kinds of injuries you were treating for them?
A wide range of muscle injuries – hamstrings, calves and so on. I had a torn ACL (Anterior Cruciate Ligament) at Lleida and another at Espanyol. Some ankle injuries too, but nothing too rare that you wouldn’t see in a typical soccer club. Both ACL injuries were non-contact (caused by the player injuring themselves turning or landing, not from hitting another player). In 7-8 years I only saw two ACL injuries so they tend to be relatively rare in the men’s game. The problem is though that when you have one it is a very long injury to recover from, so it is a serious concern.
ACL tears are more common in teenage girls and women playing soccer. Is there anything players can do to reduce their risk of getting them?
The best prevention is usually related to motor control – how they perform landing from jumps, how they change direction and similar tasks. Players can be screened for various movements to see whether they are at a higher risk for injury. If it is possible to evaluate them when they are fatigued, you tend to get better results because the injuries don’t often happen at the start of the game, they happen when they are tired later on when their form declines.
We have club teams here who are playing two full games in a day and four or more in a weekend tournament. It sounds like this could be increasing their exposure to ACL injuries. What else can they do about it?
Yes. When you get close to half time or the end of the match the risk goes up. Improved fitness might help, but really it is the control of the movement that is more important. How do they perform a single leg squat with the knee valgus or without? By changing the movement pattern you can protect yourself in some way. Using elastic bands around your knees to increase strength adducting your knees or externally rotating your hips. It helps program your brain to relate this strength of you glutes while you are flexing and extending your hips and knees. This is a direct way to reinforce this pattern.
A typical club coach here might only see their players for three practices of 90 minutes each week though. Should they be spending some of that time doing specific mobility patterns or should they do that outside of training?
As much as we can, we have to try to do it within the session, but without forgetting that the main objective is working with the team. If we are taking time from our session we don’t have enough time to work on it. What I do with non-professional teams is to get them to show up 10-15 minutes before so we can start the work outside of the field without needing much space. Then during the training session you can focus on your regular activities. The strengthening activities we talked about are not easy to do with the ball, but it is not impossible either. We have to be very selective of the movements we choose though. It is not always necessary to try to cover everything – we can focus on 2-3 specific tasks that we are most interested in.
How would you decide which strengthening exercises to choose?
You can be based on sport needs, team needs, or player needs. For sports needs we can have can read studies about which injuries are more likely to occur and we can focus on work to lessen the chance of those happening. If we have more information about the team, we can see specific areas where the team are weak, or problems that might arise from the way they train, which allows us to target movements that might be more specific to our team. Finally, and the most difficult to do, is to analyze every individual player on the team. Usually we don’t have the time for this, but if we can do it we can then write a custom plan for each of them – whether it involves eccentric loads, core stability etc., depending on what they need.
So when you target a player, how would you decide which activities are right for them?
When I analyze a player I can find their strengths and weaknesses. If there are problems with the knee valgus, where the knee falls into the middle line, then I need to be sure that I understand what the problem is that is causing it. It could be that the ankle is not moving properly, or that his glutes are not working properly. Maybe his core isn’t strong enough or his movement pattern has changed. I look at the different possibilities and can then find maybe one or more items that are red flags and I will focus my work on that.
It seems like the science is evolving at the moment because the routines we get from our strength staff will change from one year to the next. How should coaches know what to follow?
The first option should have to have a sport scientist working with the coach, so he/she provides what is best for the team. But we can have this help, we can choose two different options. We can try to self-learn using books and the internet (where we can find top soccer professionals who show, debate and explain different methodologies and exercises related to specific demands), but if we don’t have the time for this, we can get ideas from top teams’ methodology. Top teams have specific departments working on improving their training methodology, looking for best systems and analyzing whether “new fashion” ideas can be applied to their soccer teams or not, and how they can be implemented.
Do you also deal with the psychological component of rehabilitation – players fearing reinjury and so on?
We usually deal with it. There is discussion about clubs having a psychologist within the team for these moments, but at this moment we are the ones who have to address it. What I have found is that it depends on the player. I’ve seen players who you have to slow down because they want to get back right away. I’ve also seen players who are completely physically recovered but who are afraid of some specific movements or decisions that they think might bring the injury back. I had a case where a defender was afraid of being in contact with other players – particularly recovering the ball in tackles – as he remembered being injured when he went through it. The difficulty is that you have to make a player believe in themselves and this is not easy.
Is there any concern about concussions in the sport in Spain?
Not really. I’ve been surprised because I read a lot about it being a major issue in the U.S. but we haven’t had problems with it. It can happen and does sometimes but it isn’t common. We don’t have guidelines in place for specific ages that players can be heading the ball. As I see it, American Football is a very different game and there may well be concerns there, but we don’t have that. Players can collide in soccer head to head, but it doesn’t happen often.
If I’m a typical youth club coach, what kind of training should I have to be able to recognize injuries?
Here we have a medical component on coaching licenses, but it is short. What we try to focus on is first aid. If the coach suspects that there is some kind of problem, he is obliged to send them to a hospital and not to try to treat them himself.
After playing the game at the club and international level, did you always know what you wanted to do next?
I didn’t know exactly what to do. I had two ideas that were in similar directions but not the same – firstly using my sports science degree and secondly getting in to coaching. When I was playing I had good and bad coaches and it was hard to accept the decisions that bad coaches made. It troubles me knowing that these coaches are out there so I always thought that if I had the chance to try it, I could do things differently. This is one of the reasons we created Barcelona Soccer Excellence, to provide different methodologies of training to all coaches and kids that want to play soccer in a different way.
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