I haven’t written a blog post for a long time, but have decided to make it more of a regular thing, to discuss some of the questions I get asked regularly.
I thought a good way to start these blogs would be to give, what I feel, is the 7 best bits of advice I have ever been given. I have been really fortunate to have the support of some excellent individuals from within the Sports Science / S&C profession in football, and that alone has helped me forge not only my own philosophy but some pointers that have stayed with me throughout my career. Here are some of those tips (in no particular order!).
1) Believe in your own ability to succeed
Football can be a high pressured environment, especially in S&C/Sports Science. Performance is everything, and lots of individuals will have opinions on how things should be done, and probably how you do things. If you don’t have the belief in your own ability, then it will be hard for anyone to believe in you. This goes for sending an email in hope of getting an internship or work experience to practically coaching a group of senior players. Have belief in yourself, and keep things real, you need to create opportunity for yourself in this game, learn all you can about coaching – do a level 1 coaching badge if need be – it will help you to become confident with groups!
2) Not all that glitters is gold.
If your sole aim is to work for a big 4 club and be the guy warming up the players during a Champion League game at the Nou Camp, then so be it (nothing like being ambitious!!). However, don’t expect to walk into a club with a bit of paper in your hand and find yourself working with players in the San Siro. Be prepared to put in everything you have to earn the right in the game. You will need to work long hours, and do many thankless tasks to earn the right for these golden moments and they are definitely to be savoured! In the beginning you will probably find yourself doing an awful lot of work for free, but what you reap what you sow. Professional football is a very small community, do the best job you can, and be willing to give your all, from making shakes to sweeping gym, whatever it takes – and who knows maybe one day you will make your BT Sport Champions League debut!
3) Knowledge is power, the use of knowledge is powerful.
There is tonnes of emerging research into virtually everything in football, from the nutritional side to small sided games and sleep patterns. Applying most of this theory can be challenging and can often have a reverse effect if the application isn’t suitable for your players. Trying to put novice players through advanced techniques is suicide. Learn the basics, and apply them. By all means use the research to guide your decisions, but by trying to re-invent the wheel you may end up doing more harm than good, or simply just be wasting your time and the players time! Contact time can be low in the game, so bang for buck is the key!
4) Be a sponge.
Get to conferences, get to know the people who are applying in the game, listen to podcasts, get yourself known and be a sponge. Absorb what you can from who you can. The internet and social media has opened up access to those within the game who are applying knowledge everyday. Read the books, push yourself to learn your trade everyday. Make it your craft, and be relentless in your own personal development.
5) Enjoy the process, be realistic, and learn from your mistakes.
Working with top level players can be extremely rewarding, but it can involve long hours, and lots of situations can arise, in which people will require your expertise. Don’t be fooled by thinking that a few hours a day is all it takes and then you are home with your feet up watching The Chase with a cuppa. You might get the odd day like that, but those days can be rare. Manage your time well though as your health and well being is just as important as the players and staff you work with. Be realistic. Walking into a top level job, with little or no experience is highly unlikely, but if you put the hours in and get as much experience as possible, whether it be with your local club or as an intern, the process needs to be enjoyable. You will make mistakes, but thats the best way to learn. Keep pushing yourself to attain high standards and eventually you will get to where you want to be in the game!!
6) We coach humans, not spreadsheets.
Our data drives the decisions we make, in some respects, and we collect the data to help us make informed decisions to assist the head coaches & management. However, we still need to be able to coach people, and that where I have seen others fall down or lose the players. This can be fatal. I personally love the research and academic side of sports science and its a pleasure to be involved in research projects, looking for areas where we can improve players through our own data collection and that of others in the research field – but we still have to be able to coach & communicate with our subjects. The best coaches understand this, they know the value of getting their messages across clearly & concisely and by avoiding jargon – players don’t want to be confused, they just want to perform.
7) Players are human too, take time to understand human nature.
Football is a highly pressured environment which so much going on at once it can be very intense to say the least. Players are human beings though, and they have the same wants, needs, desires, flaws, goals, ambitions, hopes, dreams as any other person you will meet. Not everyone in life will want to be open with you about their life or even like you, thats just life itself, but players are human too, do your best to understand what makes them tick (all individuals are different!), what their interests are away from football and so on. Their maybe a time in your career that you may have to have an awkward conversation with a player (maybe from your data collection!), but this can be made a lot easier when you have taken the time to understand the player – thats what the best coaches do, work with the people not against them.
“One trip or fall, one heavy blow to the head and it could leave you in a chair, or even worse, not with us anymore”. Those words will stay with me forever.
Booking in for surgery the clerk turned to me and said “You are too young for this”. I didn’t have time to take that in, but it was profound.
The 19th February 2021 is a day I wont forget. 6am, 6,000 miles from home and ready for emergency surgery. That’s when things hit me. Into a surgical gown, stripped of all my possessions and surrounded by medical staff. “Let us check your mouth, you will have a breathing tube…. let me just mark the spot for the incision”.
Let’s rewind a month earlier. Waking up with a pain along my left arm, that I can only describe as an intense burning. Throwing ice onto my arm to relive the heat, the pain. No feeling in my left hand. I knew something was up, this pain can’t be possible. Is it a trapped nerve? Yeah, probably. It will pass.
I saw the doctor as soon as I could and he gave me some strong prescription painkillers. Everything will be fine in a few hours I thought. Those hours turned into a day or two, then a week. Still the excruciating pain. Icing my arm every morning, mid-winter and joking I could heat a small city. The thing was, and little did I know, this was no laughing matter.
At the beginning of February I visited the doctor again still in extreme pain and discomfort. Aside from changing my medication, he ordered an X-ray. I had my blood pressure taken, which was 150/100. I knew this was concerning. The X-ray results were back quickly and were showing some damage to my cervical spine, degenerative disc disease. “Ok, so a slipped disc” I thought.
I went to see the doctor to discuss the results, my blood pressure was still significantly high. The doctor said he would order an MRI immediately. Two days later I was in the tunnel having my scan.
The results came around quickly and I had access to them. “Severe spinal canal stenosis with subtle abnormal cord signal in keeping with focal myelomalacia”.
Ok. What’s this then? Myelomalacia? That’s new to me. So I did the worst thing – and googled it…
Myelomalacia is a pathological term referring to the softening of the spinal cord…There is no known treatment to reverse nerve damage due to myelomalacia. In some cases, surgery to allieviate the injury to the area may slow or stop further damage. As motor function degenerates, muscle spasticity and atrophy may occur”
Wow. I don’t trust googling medical conditions, but this hit me hard. So I called the doctor. “Come in Wednesday and we will take a look”.
I went in to see the doctor again and my blood pressure was highly elevated, 159/109. Immediately I was prescribed some blood pressure drugs. It was concerning both myself and the doctor, I’m 44 years old, I don’t carry much weight and exercise regularly (aside of my working practice!). How can this be?
A few days later the pain had become worse and worse. What was more evident though was my forgetfulness, clumsiness and dropping everything I tried to pick up. I remember trying to put the keys in my apartment door and dropping them on the floor. I couldn’t even feel them to pick them up. Opening the door and stumbling into my apartment. Surely this can’t be right? What is happening to me? I’ve just turned 44 years old, surely this can’t be happening. But it was, at an alarming rate and deteriorating rapidly.
A day or so later the doctor called me to tell me I needed to see a consultant neurosurgeon in Seattle immediately. On Wednesday 17th February I visited the consultant. At first I saw a nurse who took my vitals. My blood pressure was still high, very high indeed. The nurse did a few manual muscle tests and then opened my MRI. “Oh God” where her words. I won’t forget that. Ever.
“Let me get the Dr.” she said. Within a few minutes the consultant came in and started some testing. “Stand over there and close your eyes” he said “now walk towards me”.
Then he sat me down. “We have to operate immediately, as a matter of emergency” he said. “Why? What’s up?” I said. Then there was a silence that seemed and eternity, but was probably a matter of seconds.
“This is an emergency procedure for a cervical myelopathy. The rate you are declining is of huge concern. We need to operate to take the pressure off your spinal cord”. Right there in that moment, I had no idea what to think. I asked when they needed to operate. “Friday morning, 6am”. Wow. “What next?” I asked tentatively. “Tomorrow you will need to come back here, we will do some tests and talk you through the procedure”.
Myelopathy describes any neurologic symptoms related to the spinal cord and is a serious condition. It occurs from spinal stenosis that causes pressure on the spinal cord. If untreated, this can lead to significant and permanent nerve damage including paralysis and death.
I left the hospital in some form of shock, but didn’t really feel any emotion. The first thing I did was call my parents back in the UK. Both of them were silent when I explained I needed an operation in less than 48 hours. I then called my club to let them know what was happening. They were just as shocked as my parents.
The next day I went back to the hospital in Seattle. It still hadn’t sunk in what was happening. The nurses took my blood pressure, which was still high, and then did some COVID testing. Pretty standard in 2021. Then the nurse who had been with the Dr. the day before came in. I don’t really remember too much of the conversation, as she outlined the potential risks of the surgery. “Spinal cord fluid leak, paralysis and unfortunately, death”. Wow. I though the operations was going to help was my thoughts.
I left the hospital and went to see the team in a friendly match. I started to hit me what was going to happen the next morning. The staff and players wished me luck. And that was it, I didn’t know when I would see them again.
That night I hardly slept. Every thought in the world went through my mind. ‘who’s going to let my parents know?’, “will everything be ok at work?’, ‘what about the players and staff?’. I would be lucky if I slept at all that night.
5am the next morning I was collected by our Director of Rehab, Nicole. I probably spoke absolute rubbish the whole way, but the nerves were pretty evident. Nicole dropped me outside and that was it. I walked into the hospital entrance, past a man and a metal detector and walked towards the lift.
I arrived at the admissions desk, which somehow felt like a basement. There were probably 20 other patients next too me. At that point I decided to reveal on my social media that I was having emergency surgery. My phone was red hot, so many lovely messages, but not much time to reply.
A nurse appeared and called out my name. I remember walking along a corridor and into a cubicle. That was it. Clothes off, gown on, X marks the spot on my throat. I remember a few nurses coming in and a couple of neurosurgeons, they explained the operation. “We are going to remove two cervical discs, add in a cadaver bone graft and then fuse your spine with a plate & screws”. Now it was getting real. There were tubes coming from my arms, both sides. All my clothes and possessions were put in a bag, labelled and taken away. The last thing I remember is being wheeled out the cubicle.
“Andrew, Andrew, can you hear me?”. Who the hell is that was my first thought. “Andrew, it’s the nurse. You are out of surgery now”. The whole operation, from what I know, took a few hours. There were no complications.
I was taken for a scan to check the surgeons work. All I remember was being cold and sleepy. Then I was taken to my ward.
Once I was comfortable on the ward, I managed to FaceTime a few friends and my family. I couldn’t talk much (I actually didn’t know I had a drain tube coming out my throat!). However, I didn’t sleep at all that night. I sat up until 6am, there was no chance of sleeping with the nurses in every hour, and the amount of medication I was on.
The next morning the Neurosurgeon visited me. “The operation was very successful”. I was relieved and grateful. The pain had gone, but I still couldn’t feel my hands. He had already told me there was no guarantee this will ever return. 6 weeks later and I still don’t have that feeling back.
The medical staff informed me that would keep me in for another night. If I was well enough, I could go home after two days in hospital. I live on my own which concerned them, but one of my colleagues was coming to check on me daily to change my dressing and observe. This was pleasing enough for the hospital staff and I was discharged the next day.
For the next week or so I was so heavily medicated that I really had no idea what day it was. I just wanted to sleep and recover. Even six weeks on, there is still some fatigue (afternoons seem worse) and my sleep was literally ruined for four weeks or so.
A couple of weeks ago, and after my first check up, I began my rehab programme. Slow and steady is the key. Gradually build myself back up. I lost 2kgs, mainly of muscle mass, during my time in pain. I can’t lift, and my left scapula is severely winged due to the lack of innervation on that side. I have to be very careful with sharp, sudden movements to my head.
I managed to get back to my job eventually, although for such a physically demanding job, I’m very much restricted (making it difficult to demo anything at all!). I’m lucky to have such great colleagues and players at my club. Everyone has been so supportive & willing to help out, both personally and professionally.
Despite being six weeks post surgery I’m still not out the woods. The doctors warned that while they have alleviated the immediate (and pain causing) issue, there is a chance that the bone fusion won’t occur. There is also the prospect of further surgery if things don’t hold up in there.
The doctors told me I am reasonably lucky that we managed to spot the condition early. The majority of patients they see are so far gone their loss of motor control means they cannot control their bladder and bowels. The doctor was complimentary that I recognised something was wrong. It wasn’t just me though, my colleagues had realised something wasn’t right, the clumsiness, the forgetfulness, the blood pressure – things didn’t add up, and they were onto it immediately. Trying to demonstrate a skipping motion during a warm up I fell to the floor. This was before the condition was diagnosed, but made sense. I couldn’t control a simple movement like that.
Of course, everything has come at a cost. The appointments and surgery has left me with a six figure medical bill. Even with insurance (thankfully!), I still need to find a five figure sum to pay the bills. Insurance covered the majority, but I am still liable for some of the costs, and thats after the excess had been paid. Somehow, I’ll figure a way to settle the medical bill. My collector’s item Jordan 4s and some of my signed shirts may need to be traded, but they are material things, I cant trade my health.
Throughout this experience though I have learn’t many lessons. Life is so precious. There are people in far worse positions in this world than me. Some have poor health and no roof over their heads. The pandemic has cost people their livelihoods, while I am blessed to work with incredible staff and players and continued to work throughout the pandemic.
I guess as they say, what doesn’t kill you makes you stronger. However, the last few months have taught me so much. I haven’t seen my family since Dec 2019, but I have good people around who have gone above and beyond to help and comfort me.
I am still human though. There are good days and bad days, I can’t deny that. Some days are comfortable, some are uncomfortable. It can be a easy to ignore these feelings and emotions, its all part of a process. The body is still healing, the mind is trying to make sense of it all. I try not to get overwhelmed or frustrated. I’ve always been a hands on person. Some might think I’m just a data guy, and thats an easy assumption, but I love problem-solving, finding solutions, getting creative with drill design and getting the best out of players physically whilst having fun ( a few players may disagree haha!)
I’m still recovering, although I have spent lots of time being deeply reflective and with introspection. I can’t control a lot of things and it’s pointless trying, but what I can control is how I face the challenges in this moment, and that will inevitably arise. Without challenge there is no progress, in life or sport.
Despite these challenges, I am still here to tell the tale and still doing my best to keep smiling.
99 Healthy is not 100% Injured. There is always something you can do, something you can do to get better, to improve in one area or another. Whether it’s physically, mentally, academically, it may not seem it at the time, but injury provides opportunity.
Nothing lasts forever.
There are still so many people I need to thank from everyone at OL Reign, Statsports, USSF, and all my friends and family back in the UK & Ireland. Your support has been invaluable, I won’t forget it x
2020 was one hell of a year. For many it was a very, very difficult year. The beginning of 2021 has already seen political scenes we may never witness again.
Throughout all of this turmoil we have seen mountains, upon mountains, of information. Social media becoming prominent source of information, sometimes good, sometimes not so good (as I write this Twitter has banned a Donald Trump).
From believers, non-believers, pro-vaccine, anti-vaccine, conspiracy theorists etc etc, it can become a minefield for anyone seeking facts. It can be overwhelming and somewhat confusing to separate the facts from the bullsh*t.
The aim of this blog is to explain what the difference in terms and terminology used between opinions, facts, biases.
A fact is a truth, or statement of truth, that can be supported or verified by evidence. It is a truth about events that is not someones interpretation or opinion.
A statement is a point of view that is based on beliefs, values, emotions or personal perspective. Of course, everyone has an opinion and are fully entitled to it. However, a person’s opinion can be supported or dismissed when the facts are presented (generally through critical thinking).
Its key to know the difference between fact, opinion and bullsh*t. There is so much of it out there it can be harmful, dangerous and spread very, very quickly. However, bullsh*t is different from a lie, which is just that a lie. As defined by Bergstrom and West (2020).
Bullshit involves language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence.
I’d also highly recommend the authors free course “Calling Bullshit: Data Reasoning in a digital world.
The scientific method and scientific inquiry:
Broadly speaking, scientists will generate a hypothesis based on the relationship between variables. A hypothesis is essentially a proposed explanation of a phenomenon. For example: there may be a relationship (correlation) between X & Y. But does X cause Y? Or why does X cause a change in Y?
Thus, scientists will take an educated guess (research hypothesis) about the relationships of the variables within their research study.
However, a null hypothesis maybe formed and accepted when the research does not accept or refute the research hypothesis.
Types of Bias
A bias, is simply the tendency of a human to have a positivetendency or inclination for something/someone, or perhaps a negativetendency or inclination against something/someone.
The concept of cognitive bias was first introduced by researchers Amos Tversky and Daniel Kahneman in 1972. Cognitive Biasesare limitations in objective thinking by seeing things through personal experiences and perceptions.
Below are some examples:
Groupthink bias: the tendency to put value on consensus, thus not thinking independently. A group will favour harmony, cohesiveness and agreement, as opposed to a lack of harmony and/or conflict.
Confirmation bias: The tendency to support new ideas or accept things that are consistent and congruent with their already held thoughts, beliefs, and opinions.
Overconfidence bias: This bias appears when someone is inherently biased towards their own perspectives and opinions. They may hold the belief that they are the only expert that ever exists and everyone else is dumb. A small bit of knowledge can be a very dangerous thing.
Dunning-Kruger Effect: This is when people who believe that they are smarter and more capable than they really are. For example, they are too stupid to realise how stupid they are.
The halo effect: when a the initial perspective of an individual (such as a first impression) tends to cloud the judgement of the individual as a whole. Therefore, it becomes difficult to re-think that perspective of an individual based on new or opposing information.
The horn effect: The opposite of the halo effect. The horn effect is when someone demonstrates a negative attitude or set of behaviours towards another based on their appearance or character.
The last few months have seen some challenging circumstances, both in life and sport.
Periods of deep uncertainty that have, at times, shown no promise of an end in sight. Colossal life challenges, comparisons with war time, lockdowns, and not forgetting those who have tragically lost their lives.
Whatever the outcome in the future, the past few months have undoubtedly changed our worlds – forever.
Whether we see it or not, there are many parallels that can be drawn between life and sport. Teamwork, camaraderie, a fast paced and dynamic environment, where thinking fast, and slow, can help determine the outcome we strive for, whatever that may be.
As a performance scientist, the current challenges within the profession are like nothing we’ve ever experienced, and it’s likely we will never see them again. But, it has also been a time of great reflection.
The game of football (soccer) is relatively simple, and adored by billions globally. Two teams attempt to kick a spherical object into a designated area, more times than the other team to win.
Paradoxically though, performance science is a multitude of complexities that may (or may not!) have a role in increasing the probability of winning.
In his book Behave Robert Sapolsky , discusses how when we are faced with multifaceted and complex phenomena such as human behaviour, we use a certain cognitive strategy to break down the individual facets into buckets of explanation. This leads us to categorical thinking.
For example, let’s take Lionel Messi vs Xavi and their ‘work rate’ as discussed by Fergus Connolly’s in his excellent Game Changer book, and was the feature of Isaiah Cambron’s 2013 article for Barcelona Football Blog.
Whilst comparing distances covered by certain players over a few games, Cambron noted that Messi covered 44,027m in 482 minutes, scored five goals and further contributed with three assists. However Xavi, the midfield genius, contributed with 56,552m in 441 minutes. If using total distance as the only metric, then Messi would be preferred player over Xavi. Messi appears to have played more minutes, but seemingly less ‘work’.
Dig a little deeper and contextualise these statistics, and a different picture emerges. Divide Messi’s lower distance by the higher number of goals and assists – and he is by far the more effective and efficient player. Furthermore, Messi’s m/min (91.34) was less than that of Fabregas (136.88), Jordi Alba (131.31) and many others. Over the same period of time, the only goalkeeper in the analysis by Cambron, was Celtic’s Fraser Forster who incidentally, covered 32,671m and 50 m/min respectively. Make of that what you want.
This poses a question – if we work in buckets or silos as performance staff – are we missing vital clues within the performance puzzle? Do we end up becoming victims of categorical thinking?
Sapolsky argues that it is no bad thing to put facts into these “demarcated buckets of explanation” as it can indeed help you better remember the facts. However, as he explains, it can also wreak havoc in your thinking about the facts.
As the past few months have progressed working procedures have changed exponentially, we are in the somewhat unknown as to when or how, or even if, respective seasons across the world will restart.
This has led to many challenges. We have seen so much uncertainty in our daily lives, and those of our players, you would think that uncertainty doesn’t exist. But it does. The world is uncertain, sport is uncertain. Science doesn’t give us all the answers, but it does allow us to somewhat reduce uncertainty.
It is human nature to avoid uncertainty in the best way possible, even if this leads to us being wrong. Certainty is a comfortable place to be. We want to be comfortable. We are, after all , simply human.
However, working with athletes in these times, and the potential restart of some leagues has left us with a risk factor too. Just to add to our woes!
But the world is generally full of uncertainties, and it has changed in many ways since the COVID19 outbreak began in late 2019.
When we consider risk, we assume to know all of the facts, the consequences of our actions, or maybe those of others and/or alternative ways of working to minimise risk to our players when bring them back into training/match scenarios. It’s like starting again, with maybe a higher risk because of the lack of training time in the last few months, which brings uncertainty to the table. Who knows?
As practitioners, this world of uncertainty brings a sense of many unknown unknowns. Risk we look to minimize, whatever it may be. Uncertainty, as the last few months has shown, has given us other things to think about. Things have happened unexpectedly, maybe I was naive, but personally I didn’t think it would take this long.
Maybe I have been lucky, here in Utah, and should count my blessings that I haven’t been in London or NY, where lockdown has been the norm for the last 6-8 weeks or so.
During the uncertainty, it has been nigh on impossible to calculate the exact risk to our players. There are now, more than ever, variables/risks that we would have probably never considered 6 months ago. But we still need to make decisions. Based on what we know, and what we don’t know – and that is no mean feat at all.
Whatever uncertainties or risks we face in the coming weeks/months, it us down to us practitioners to continue to provide the our players with the best possible environment to flourish. As difficult as the past few months have been, we must understand the risk or uncertainty that is involved in the coming weeks and months. This will involve many decisions, some that we may never thought of before.
When we know the risks, we can make informed choices based on logical and statistical thinking. When the risks are unknown, and uncertainty is paramount, then heuristics and intuition may drive the decision process.
However, if the last few months has taught me one thing, it’s that decisions aren’t really made one or the other, but more likely to be that of both risk and uncertainty.
Thus, working outside of silos, decreasing categorical thinking and coming together to become one team, may just help with the risk and uncertainty that we have been facing, and at present continue to face.
Four Action Steps for Healthcare Students Wanting to Work in Football
Hey everyone! My name is Andy Seraphin, and I am a strength coach and physical therapy student who aspires to work in professional football in the future. Although I am certainly a few years off of achieving my goal, I have put together a few actionable steps that I believe can help students gain valuable experience in sport, while still in school.
Get Strength and Conditioning Experience
Every member of a sport performance staff needs a solid understanding of strength and conditioning principles to succeed. There is no better time to learn the basics of strength training than as a healthcare student. I recommend taking as many courses as possible in physiology and sport performance, and earning a personal training or strength coaching certification. Afterwards, reach out to as many strength and conditioning facilities near you to see if there are any employment or internship opportunities. If none come your way, no worries- you can still gain valuable experience by training friends and family for free!
Get Experience in Sport Rehabilitation
If you aim to assist in the rehabilitation of athletes as an athletic trainer or physio, you need to get as much exposure to sport rehabilitation as possible. Generally speaking, practicing clinicians are happy to have students shadow or volunteer (especially if they have a strength training background). When it comes to volunteering, I recommend reaching out to facilities that have relationships with professional or youth teams. Be active while shadowing, and ask questions that reflect your current level of knowledge in sport performance. Furthermore, if your academic program has clinical internships, try to have at least one of them be within a sport performance setting.
Find a Club to Volunteer For
After getting exposure to both rehabilitation and strength and conditioning, I recommend finding a football club near you where you can volunteer. You can serve as an intern for the rehabilitation, performance, or sport science departments. When finding a football club, you will likely have a few options. You can reach out to your university team, local grassroots youth clubs, youth academies, or professional clubs. Most clubs have the contact info for their athletic trainers, physios, and performance coaches listed on their website. If not, I recommend reaching out to them via Twitter, Instagram, or LinkedIn. Also, try making a map or list of all clubs in your area, and reaching out to every single one of them. If you don’t hear back, don’t get discouraged. You only need one club to say yes for you to get a solid start.
Networking, Networking, Networking
Networking is key to advancing in any field, and the sport performance world is no different. Be sure to establish solid relationships with your peers, professors, and any practicing clinicians you encounter along your journey. In today’s age of social media, you can follow and connect with many of our field’s leaders with just a few clicks. Also, try and attend as many conferences as you can involving football and sport performance and network there as well.
That’s all for now! If you have any questions about any of the topics I discussed, feel free to reach out to me via email, Instagram, or twitter. If you’re a student, just know that we’re all in this together, and although our end goal is difficult to achieve, there’s a ton to learn on our journey J
Sleep disturbances and Sports Concussion- time to address the sleeping elephant in the room.
Meeta Singh MD (@athletesleepmd1)
A ‘sports concussion’ is a mild form of traumatic brain injury caused by a blow, a fall, a bump or a shake during play. Because our brains are essentially the consistency of gelatin and float in our skulls, any trauma that makes the brain move back and forth quickly, can lead to damage. The cells can stretch and tear, and this results in the symptoms of concussions. Usually, an athlete recovers from concussion relatively quickly (days to weeks), but some athletes have persistent symptoms that interfere with daily life. For most athletes who suffer a concussion, sleep disturbances are often an issue. In fact, the story of sleep and concussion is closely intertwined, and disturbances of sleep can occur both acutely and chronically after the concussion happens. Additionally, there is new data that shows sleep disturbances may in fact, increase an athlete’s risk of developing concussions. So, this relationship is bidirectional and it’s important for athletes, athletic trainers, coaches, to understand this better as it affects athlete performance and wellbeing.
For starters, the relationship between concussion and sleep is best understood by exploring what parts of the brain are affected by concussion. We know that sleep is produced in areas of the brain that lie deep under the surface and concussions often cause damage to those same areas, so it’s not surprising that disturbed sleep will occur in 30-80 percent of the concussion cases.
Immediately after the concussion, many athletes will complain of excessive sleepiness and will sleep longer. Research shows that this is a protective mechanism as most of the healing processes in the brain occur during sleep and so concussed athletes require more restorative sleep. Getting proper sleep during the initial recovery stage therefore, is beneficial to the concussed athlete as it restores the electrochemical balance in the brain and decreases the likelihood of the athletes experiencing prolonged symptoms. Thus, allowing athletes to rest and easing the athlete back to their full athletic schedule becomes important. Another complaint the concussed athlete may have acutely after concussion, is of variable sleep, with nights of poor sleep mixed with nights of “catch-up’ good sleep. The problem is that variability in sleep is associated with low mood, pain and feelings of restlessness. These factors interact to reduce the quality of life of a concussed athlete. Therefore, this complaint of variable sleep should serve as a cue to the athletic trainers to refer the athlete to the sports physician for an assessment.
The one important clarification that is needed here is regarding the advice that used to be given out immediately after concussion that seems to contradict the advice of letting concussed athletes rest. The advice was that “if you have a head injury or a sports related concussion, you may be warned to stay awake for several hours or to have someone wake you up every hour’.The reason for this advice was based on the idea that if you are asleep; your family or doctors will miss indications of serious brain damage (like seizures, loss of consciousness, weakness of one side of the body, etc. which can result if there is swelling the brain due to a bleed). This recommendation however is a myth. The new recommendation is that the concussed player should be observed for 3-6 hours and if they show any worsening, they should be sent to the emergency room immediately. If there are no such signs, the player should be allowed to sleep undisturbed.
In addition to acute sleep issues, changes in sleep quality and quantity, as well as new-onset of sleep disorders can also occur chronically (>1 month) after the concussion. As mentioned above, it becomes very important to address these, as the presence of sleep problems prolongs recovery time (3- to 4-fold increase) and negatively impacts quality of life in athletes. These sleep complaints range from players complaining of difficulty falling and staying asleep as well as changes in their sleep/wake pattern. They may be excessively sleepy during the day and complain of snoring or leg kicks at night. These complaints should alert the athletic trainers and coaches to refer these players to team doctors who can address these sleep issues. Additionally, the knowledge that sleep plays a starring role in athletic performance is only growing. We are learning more about its importance for optimal accuracy, speed, muscle growth and restoration, learning, and memory consolidation; so, it’s not surprising that sleep disturbances following concussion contribute to poorer athletic performance. Secondly, athletes with continuing sleep issues after concussion, feel that they have not recovered well, and this perception itself impacts performance. Finally, impaired athletic performance may add to the stress the athlete might feel. Thus, the bottom line is that sleep disturbances are often seen in athletes after a concussion. These should be identified and addressed as left untreated they tend to prolong the recovery time and affect athletic performance.
Now to come to the newer research findings that show that athletes who have poor and inadequate sleep may be at a higher risk for sports-related concussions. This study done in 190 NCAA Div 1 athletes found that athletes suffering moderate-to-severe insomnia saw concussion risk increased more than three times, and those suffering from excessive daytime sleepiness more than doubled their risk. Given what sleep scientists already know when it comes to the detrimental effects of poor and inadequate sleep on mental fatigue, attentional lapses, visual tracking, and reaction time, it is not surprising that the athlete’s capacity to minimize or avoid injuries is reduced. In addition, poor sleep will increase impulsivity, and risk-taking behaviors, both of which result in poorer in-the-moment decisions and may results in increased injury and concussion risk. Thus, it seems sleep disturbances may play a starring role in concussion causation, in addition to being caused by concussions.
Currently, concussions are a serious concern for athletes and a rising public health problem. For coaches and athletic trainers looking for modifiable factors that might improve athlete health and performance after concussion, identifying and addressing sleep concerns is key. Placing an emphasis on sleep education may potentially facilitate better sleep habits in athletes. Additionally, its important to be cognizant of the bidirectional relationship of sleep and concussion. Until recently the major risk factor for sustaining a sports concussion was a history of one of more prior concussions. Poor and disturbed sleep may hold the steps to developing the first and subsequent concussion. Assessing and proactively improving sleep issues may thus reduce sports-related concussion risk.
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Raikes, Adam & Athey, Amy & Alfonso-Miller, Pamela & Killgore, William & Grandner, Michael. (2019). Insomnia and daytime sleepiness: risk factors for sports-related concussion. Sleep Medicine. 10.1016/j.sleep.2019.03.008.