Lessons from Working in Elite Football – Injury Rehab Network February 2023

The third Injury Rehab Network event of 2023 featured Jon Fearn, a Physiotherapist with over 30 years of experience in elite football. The online event took place on the evening of 23^rd February with over 135 sports rehabilitation professionals in attendance.

Jon’s presentation discussed learning from the elite sport of professional football that can be applied in clinical environments.

The recording of Jon’s presentation is available to watch here.

Jon Fearn, Physiotherapist

Jon qualified as a physiotherapist in 1991 from St Mary’s Hospital in Paddington. Then he worked for over six years in various medical disciplines in the NHS, from neuro-disability to amputees at St Georges and Queen Mary’s hospitals. During this period, he followed his passion for working in sports, starting to work part-time in amateur rugby and American football.

In 1997 Jon completed a Masters’s degree in Advanced Musculoskeletal Physiotherapy at University College London, working in private practice and the academy at West Ham United. The following year, he joined the West Ham medical team full-time, working with the first team and enjoying four years there.

In 2001, Jon became Head of medical services at Reading FC, where over nine years, he was part of the management staff which saw Reading go from League 1 to the Premier League, developing the department to meet the increasing demands placed on it at the higher level of the game.

Jon then joined Chelsea Men’s first team in 2010, where he has undertaken numerous roles, including from a performance perspective travelling with the squad to games, managing and rehabilitating injured Men’s first team players, leading and coordinating the Academy medical team and assisting with Women’s first team injured players rehabilitation when required.

Jon has lectured at many international sport medicine conferences and on undergraduate and postgraduate degree courses. He is currently an honorary lecturer at Queen Mary’s University and a visiting lecturer at the University of Birmingham on the MSc programmes. He is particularly interested in managing lower limb tendinopathy, hip and groin-related pain and rehabilitation of football-related injuries.

Lessons from working in elite football

With over 30 years of experience working as a physiotherapist in the NHS, in private practice and elite level sport, Jon has noticed how the service we aim to provide patients differs enormously both in terms of the type of problems we see, facilities available and how we try to resolve them. Jon feels we can learn from the type of service we deliver to athletes in elite sports, to provide a more thorough approach to our patients in our clinical environments and endeavour to achieve a more successful outcome.

Be more creative, bespoke and analytical in our approach and on the way, enjoy ourselves!

Jon discussed how he started his career as a physio in the NHS, gained experience in football, rugby and American Football before starting work in the West Ham academy. Jon joined Reading FC in 2001 and enjoyed 9 year’s at the club including promotion to the Premier League. In 2010, Jon moved to Chelsea FC where he spent 13 year’s leading the medical team during one of the most successful periods for the club.

Adapt to survive

Jon discussed how he has worked with 16 different managers during his time in professional football. Jon adapted to develop an effective working relationship with each of the managers and worked hard to prove the success of the medical team to all the managers. This is especially important when a new manager joins the club.

Personal lessons

Jon shared some of his personal lessons from working in a multi-disciplinary team in professional including:

• Park your ego
• Learn from your mistakes
• Ask for help
• Have a philosophy
• Think simple

Football vs Clinic

Jon described some of the key differences between sports medicine in football and a clinic or NHS environment. One of the most notable differences is the time available to work with athletes where a football physio may spend a whole day with a player compared to a potentially short appointment in a clinic environment.

Pressure is high in professional football and Jon discussed the requirement to be reactive and to perform in a fast-paced environment.

How performance of medical teams in professional football is measured

Jon described the two key performance indicators in the football medicine team:

1. Match availability – From UEFA data the average match availability is 86%. Jon’s team had a target of 90% and averaged 92% over the recent 10 year period.
2. Re-injuries (per season) – UEFA data is 10% or 4 per club per season. Jon’s team had a target of zero and over the 10 year period the average was 6% (3 per season).

Clinical approach

Jon discussed the clinical approach to physiotherapy and rehab in professional football with the following learning points:

• Communication is most important
• Make decisions as a team
• Shared responsibility
• Build trust
• Bespoke – patient centred “Everyone is different”
• Power of belief and engagement
• Fix/ cure everyone – be realistic

Skills

Jon described the key skills required including:

• Respect the inflammatory process but…
• Be good at examinations and do not rely on investigations
• Get the basics right
• Marginal gains vs unnecessary tinkering – do the right things
• Prioritise what is important (necessary)
• Build on your strengths (what you enjoy)
• Treat what you see/ find
• Bespoke management

Rehabilitation process

Jon considered the rehabilitation process with the following advice for practitioners:

• Importance of a thorough assessment/ screening
• Get the diagnosis right before moving on to treatment
• What is the best management plan?

FUNCTIONAL ABILITY

V

STRUCTURAL PATHOLOGY

• Most injuries are minor
• Moderate/ severe injuries require additional interventions e.g., surgery

Functional load in rehabilitation

Jon discussed the need to develop functional load in rehabilitation and how this is best achieved by returning to training as soon as possible. Jon described how function is key and that rehab should focus on functional tissue loading. The stimulus should be increased to enable athletes to work through rehab progressively.

Jon summarised the stages or levels for function directed rehabilitation where the stimulus should centre around functional ability.

1. Level 1 focuses on early stage rehabilitation at low level intensity. Volume and time should be built through controlled uniplanar movement at low speed.
2. Level 2 is the intermediate stage where the focus is on building intensity through multi movement complexity at low to moderate speed.
3. Level 3 is the late stage which should replicate the complexity of the game and specific role of the player’s position. May include jumping and landing with a focus on ‘chaos’ and building high speed endurance.

Jon described how function varies with every sport placing unique demand on athletes. In addition, every position and every athlete are different and as such rehabilitation needs to be bespoke.

Re-injury

Jon discussed re-injury and how this is managed in professional football. To avoid re-injury rehabilitation needs to be effective and thorough and this may help to avoid other or new issues occurring. Jon aims to return players to play fitter than before their injury.

Jon described how the late stage process is critical with the need to spend more time in this phase, to push rehabilitation and to ensure players are tested under fatigue.

Players should return to training quickly and this may include making modifications to the training environments.

Injury prevention

Jon discussed the holy grail of injury prevention which is what practitioners are aiming for but in reality is difficult to achieve.  Jon described the key considerations and points for injury prevention including:

• What are you preventing?
• What strategies work?
• What is realistic to implement?
• When to implement it (pre-season)
• Adress the modifiables
• Time (microdose)
• Compliance…stick to your guns!
• Educate!

Data interpretation

Jon considered how practitioners may approach data interpretation in an age when vast amounts of potentially overwhelming data are available. Jon’s advice is:

• Take care with interpretation
• Do not chase numbers
• Be guided by data
• Understand what is normal for population/ athletes/ individual

Future thoughts

In considering future developments within sports medicine, Jon’s thoughts are:

• More collaboration is required – networking and face to face important
• Build a network
• AI – not there…yet?
• Empower the patient/ athlete
• Learn from your experience
• Get a mentor, talk to peers
• Keep learning
• Look after yourself
• Do what you love and enjoy yourself

Q&A

Jon kindly answered questions put forward by the practitioners who attended the session.

Q1. Which manager has required the most adaptation from you?

A1. Some managers such as Thomas Tuchel have embraced the club and the medical team whilst others are very specific about how things are done e.g., Jose Mourinho and Antonio Conte. Steve Coppell knew football and focused on preparation for games with a mentality that training was always a warm up for the match.

Q2. Does ego and assertiveness vary at different levels?

A2. There’s a different between confidence and ego. Practitioners should never let their ego take priority over good decision making and doing the right thing.

Q3. What advice can you offer for return to running protocols?

A3. Return to running (linear) is as and when the injured tissue and supporting evidence (testing) indicates the athlete is ready. Then there needs to be a logical progression in running load, volume, speed, distance, intensity in the functional movements required (in football) and this will depend on player position and the injury.

Q4. Which skills are required for a multi-disciplinary team?

A4. The best teams have a diverse mix of skills with a wide range of expertise to draw upon. This is far better than a team who all have the same skills and personalities.

Q5. At any given point in time, how many players are fully fit?

A5. This can vary between all players being fit and having an average of 3-4 players unavailable. More than this is unusual.Due to the nature and intensity of professional sport, pain and niggles are normal. Athletes understand this and know how best to manage their pain. Whilst some players will give everything, they also understand what’s safe and ethical so will seek help when they need assistance or if injuries are worse than just niggles.

Q6. What’s the worst injury you’ve had to deal with?

A6. When working in American Football a player dislocated their knee and there was no pulse in the lower leg. We used logic to treat the immediate circulatory issue as a priority.

Q7. How is pain managed with professional athletes?

A7. Pain is normal for not only professional athletes but in life. It is how we deal and manage this which can vary enormously. Different players have different tolerance levels to pain so it’s important to understand each individual and any red flags for when injuries could be serious. Physios should manage the person and consider the balance between structural pathology and pain. Risk management is important and should be a collective decision made through an open discussion.

Q8. What’s your advice on how to get into work in professional football?

A8. Work or volunteer in an academy as casual staff are often required. From there it should be possible to progress through the club. Get experience to learn and keep learning!

Presentation Recording

The recording of Jon’s presentation is available to watch here.

Follow Jon Fearn

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2023 Injury Rehab Network events

Find out about and register your interest for all the Injury Rehab Network events with BASRaT planned for 2023.