Keeping the Seagulls flying

When Adam Johnson graduated as a physiotherapist, he was ready to pursue his life-long ambition to work in football. A Stoke City FC supporter, he began by volunteering part-time at Crewe Alexandra FC and then, such was his dedication to his goal, he took a 12-month unpaid internship at Reading FC.

‘I was with the first team so it was a really great experience,’ he says. ‘I brought in some cash with a paid job three evenings a week, working with the young players in Reading’s academy. And my parents helped me. Then the club took me on in a paid role with the academy.’

He stayed another year, rotating between the under-18s and the under-21s before moving to Millwall FC as head of academy sport science and medicine. 

‘I mainly looked after the under-18s but, day-to-day, I was often the only physio on site so I had to think on my feet. But there was a really good group of coaches so I learned a lot in my 18 months at Millwall.’

In January 2015, when a job came up as head academy physio at Brighton and Hove Albion FC it was a chance he couldn’t miss, and he was successful in his application to join the Seagulls. The role involved intensive daily work with the under-23s while over-seeing the rest of the academy and managing four full-time physios plus a bank of eight part-timers.

Albion were promoted to the Premier League in 2017 and stayed up at the end of last season. A year ago Johnson won a promotion of his own when he became first team physiotherapist.

‘It’s very different to the academy as you are part of a bigger medical team and there are more physios for the same number of players. There are 10 of us in all – three physios, a sport scientist, a full-time club doctor, two soft-tissue therapists, two strength and conditioning coaches and a medical administrator. That’s quite small by Premier League standards.

‘What I like about the job is that you’re working with the same 25 players every day so you really get to know the person you are treating, and what they can and can’t do, much more than you would in a private clinic or the NHS with a half-hour slot.’

His passion is injury prevention. His blog is the Prevention Physio and on Twitter he is @PreventionPhys. He is something of an expert in preventing one of the most common and debilitating injuries in football: a pulled hamstring (see box). There’s a seasonal rise each autumn as players return to competitive action.

‘Prevention is my biggest challenge because the teams with the fewest injured players are usually going to be the most successful. You will always have injuries but our job is to minimise the number and severity so the manager has the players he wants on the pitch.’ 

Non-match days start with a medical staff meeting at 8am. Then injured players arrive for treatment at 8.30am followed by the fit players at about 9am. Johnson leads the group injury-prevention sessions from 10am. There will be one main gym session a week and he works closely with the strength and con-ditioning coach, taking responsibility for those who have just returned from injury.

 The working week varies. For a Saturday away game the squad will travel up the night before and stay in a hotel. On match day, Johnson will go to the ground early and set up the medical equipment. When the players arrive there is pre-game preparation, strapping and so on, and then during the match he will often be found sitting behind the bench, walkie-talkie in hand, following play on a television screen.

‘If a player has to come off injured I manage their acute treatment. Match day is what you’ve been working up to and if the players have been putting in the training, injuries will, hopefully, be kept to a minimum. We try different ways to motivate the players to train. They are competitive beasts so we use a leader-board to record their sprint scores or how much they are lifting. It spurs them on to try to beat their team-mates.’

Mr Johnson has a specific interest in research and bridging the gap between research and practice. Despite his all-consuming day job, he is due to complete a master’s degree within the next few months looking at joint hypermobility and a new screening tool.

Working with elite athletes in the rarified world of Premier League football is pressurised but rewarding. So is there a downside?  ‘I suppose it would be good to have more time for socialising but travelling and long hours go with the territory.

Brighton is a good place, and we have a world-class, state-of-the-art training ground with all the facilities you could want. I’m very happy doing what I’m doing.’

Author: Janet Snell

Keeping the hamstring healthy

Adam Johnson on what can be done to reduce hamstring injuries

Wages paid to injured players in the Premier League last season amounted to £217million. It’s a staggering outlay for clubs. If we then look at the most common injury from the past season, it appears to be hamstrings, which is not a new phenomenon. Ekstrand et al (2012) reported that within European football there has been a year-on-year increase in training-related hamstring injury of 4 per cent. Although this is the case in football, there has been a gradual decrease of hamstring injuries reported within Australian Rules football and cricket. 

So as a physiotherapist working in the Premier League I must ask: what can be done to decrease hamstring injuries at my club?

The Nordic Hamstring Exercise (NHE) is possibly the most researched, discussed and regularly implemented method of eccentric hamstring training within elite sport, especially given that it now forms part of the FIFA 11+ injury prevention protocol. Technology is now available to allow tracking of players’ force production when performing the NHE, which means that we can also easily assess if they are falling below the proposed modifiable risk factor of 337N (Timmins et al, 2016).

The exact prescription in relation to sets and repetitions of the exercise, timing of performance and addition, or not, of assistance is an argument still to be settled. Reports of poor implementation of the original programme within elite foot-ball (Bahr et al., 2015) supports the fact that further work is required to find prescription ranges that are feasible within elite sport, while also providing the required stimulus for physiological adaptation.

The latest evidence appears to support that as little as two sets of four repetitions each week may be sufficient to maintain the desired adaptations achieved after an initial high-load programme (Presland et al, 2018). One thing most professionals agree on, though, is the need for this eccentric loading to be maintained throughout the season with a loss of physiological changes noted with as little as two weeks rest from the exercise (Presland et al, 2018).

The NHE is not the only method of hamstring injury prevention, but it is an easy exercise to incorporate in all sports at all levels with no equipment required. It should be considered by all individuals involved in programming injury prevention strategies within sports suffering from high hamstring injury rates.

Author : Adam Johnson