New advances in articular cartilage repair

The physical demands of football put enormous stress on the knee leaving the knee particularly vulnerable to injury. While tears of the anterior cruciate ligament are among the most serious of all knee injuries, recovery and full return to play are common. Not so for the articular cartilage that covers the surfaces of the bones.

On June 29-30, 2007, the first FIFA Medical Centre, the Schulthess Clinic, Zurich, was host to the first International Cartilage Repair Society Rehabilitation Consensus meeting. About 120 scientists and rehabilitation specialists from around the word discussed the many details of the injury, its treatment and rehabilitation. The FIFA-Medical Assessment and Research Centre (F-MARC) was a contributing sponsor of the meeting.

Treating articular cartilage injuries is a developing science with evolving techniques for treatment and rehabilitation. The process of rehabilitation is complex because of the nature of the lesion (size, location, and number of lesions), how the lesion is treated and the various details of rehabilitation. The important process of rehabilitation has to consider such critical topics as how long should the player be non or partial weight-bearing, when to begin movement of the joint, the necessity of a brace or passive motion, when to begin strengthening exercises, how fast to progress in strengthening, when to allow the player to start - and progress through - functional exercises that will eventually bring the player back to the playing field. The rehabilitation process is far longer and more arduous than most patients realize.

Over 2 million new articular cartilage defects are diagnosed each year and football is far from immune. Those without access to the newest technologies and techniques face a difficult road. Most patients begin with modifying their lifestyle to reduce the forces across the knee that lead to pain.... But a change in lifestyle most players are unwilling to consider.

The treatment protocols have shifted from repair and replacement to regeneration of cartilage. One of the most widely used techniques is arthroscopic microfracture where the surgeon pokes numerous small holes into the defect to stimulate the underlying bone to grow new cartilage that will fill in the defect. Think of the defect as a pothole in a street.

The problem is the replacement tissue is not normal cartilage and does not possess the features of normal cartilage. While there is relief of symptoms and return to normal activities, it is unlikely that the replacement tissue will be a permanent solution.

Regeneration of the normal cartilage is the new direction of treatment and research. There are a number of techniques that require a biopsy of the knee cartilage so that cells may grow in a laboratory prior to being reinserted. These regenerative techniques seem to be pretty good at getting normal cartilage to grow in the defect for a longer-term solution.

With such novel advances in surgical techniques, rehabilitation also must advance. Current rehabilitation protocols vary widely based on the age, size and location of the defect, expectations for recovery, type of surgery performed and so much more. An important question under discussion was "What is successful rehabilitation?" This will differ based on the patient because the needs of a 50-year-old office worker are dramatically different from the young athlete.

The conference concluded with a special segment entitled "FIFA-Cartilage Rehabilitation for Football Players" where F-MARC members and research partners discussed current practices. The football player is unique because they only have one question: "When can I return to play?" Just because some procedures are done through an arthroscope does not mean recovery is swift and players need to know recovery will be lengthy.

This special session included Mario Bizzini, PT, who was also the module chair for the session entitled Procedure-Specific Marrow Stimulation Techniques in which he spoke on the main rehabilitation issues for these novel procedures. Prof. Jiri Dvorak, MD, Chairman of F-MARC and FIFA Chief Medical Officer, joined Mr. Bizzini as chair for the special event. Presenters included F-MARC research partners Prof. Lars Petersen, MD, Sweden, Bert Mandelbaum, MD, and Holly Silvers, PT, Santa Monica (US) and Stephan Meyer, PT, from the Swiss Olympic Medical Centre in Magglingen.

After the conference, the speakers met in an attempt to minimize the differences in rehabilitation protocols in order to come to a consensus. A key question is whether rehabilitation for articular cartilage lesions can be accelerated in a manner similar to the rehabilitation programs for anterior cruciate ligament rupture. Their conclusions will be the subject of a future statement of consensus.

Health checks in football

For professional players, fitness tests and pre-season medical assessments are very important parts of the football season. From the amateur to the semi-professional and even the young player, you might wonder why these tests are valuable and what you might expect.

Fitness testing

Obviously, competitive games offer the best possible environment to test technical, tactical, physical and psychological skills of players. However, it remains difficult to compare match performance between players as no two matches are the same. There are several important reasons to test a player's fitness:

From a player's perspective, fitness testing: evaluates your readiness for match performance
- motivates you to further improve your fitness
- provides you with objective feedback about your weaknesses and strengths
- determines if you have returned to your original form after an injury.

From a coach's perspective, there are several good reasons for testing, such as to:
- increase the player's awareness of the aims of fitness training and assessment
- examine the effects of a specific training
- plan and assess the player's response to macro- and micro training cycles on a year-round basis

To obtain meaningful results from a fitness test, there are two major requirements. The first one deals with the validity of a test: Does the test really test the truly important football skills and abilities? For example, a continuous run without change in direction or speed is of minor relevance in football: A player changes the speed and direction of his movement about every four to six seconds.

The second requirement refers to test reliability. If the test is given twice, do we get the same results? If two different people give the test, do we get the same results? If the answer to both is yes, then the test is considered to be reliable. Your coach needs to take a few key factors into consideration before conducting the test:

1. As a player, you need to know the aim of the test and be given clear instructions on how to perform the test.
2. You should have performed the test on at least one previous occasion, so that you are familiar with the test procedure.

3. You should be well rested, but sufficiently warmed up prior to the test.
4. The test equipment should be fully operational and the test area clearly marked.
5. The test conditions have to be consistent from one instance to the next.

Pre-season health checks
A pre-season health examination is, at its most basic level, a general physical examination focusing on a player's injury history that attempts to identify deficiencies that could place the player at risk for injury or unveil risks of potentially catastrophic conditions. As a young player, this could be the only time you see a physician or other health care professional. You may benefit from advice on potentially risky or unhealthy behaviors.

Your personal physician usually conducts the pre-season medical assessment, but it might be conducted in a group setting where your entire team is examined in a time and outcome efficient manner. Ideally, this should take place about 6 weeks prior to training to allow for additional studies to be conducted and to allow for any physical deficiencies to be corrected.

You will be questioned about your medical history and this alone might detect a number of important issues:
- Medical issues, medications, immunizations and allergies
- Prior sports-related injuries
- History of heat illnesses
- Eating habits
- Psychosocial issues
- Menstrual history in women
- Past surgeries

The physical examination will address the following:
- Cardiovascular and respiratory systems
- Skin
- Head, ear, eye, nose, throat and past any head injuries
- Musculoskeletal system: contour, joint range of motion, stability and symmetry of the upper extremity, spine, hip, head and neck, knee, lower leg, ankle and foot.
- Your doctor will pay special attention when you have a history of concussion injury, heart murmurs, enlarged organs or a single, paired organ.

After the examination, you may be cleared for play without limitations or cleared pending further tests/therapy. If there are severe medical objections, you may receive only a limited clearance or may even be denied it in order to protect your health.

Medical Initiative

The African dilemma is often described as: People are poor because of poor health or they have poor health because they are poor. The new 'Football for Health' initiative of the FIFA Medical Research and Assessment Centre could become a milestone of the "Win in Africa with Africa" initiative offering the most precious win to every football player and fan on the continent: health.

Health is our most precious possession and the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. Nevertheless, in some countries of the world, the average life expectancy is over 80 years, while in others, such as Africa, South America, Oceania and Asia, the life expectancy is sometimes below 40 years with every second person dying as a child. Dealing with this discrepancy is not an easy task.

One fact is well known for sure - there is not enough money now or in the future to cover the health care costs not only in the emerging countries but also in the highly developed countries. This fact is well known to doctors, governments and health care organizations and a solution is urgently searched for. There is undoubtedly no magic remedy. But there is one passion shared by billions of people that offers immense possibilities just waiting to be explored. This passion is football.

Medicine for Football

In the past 14 years, the FIFA Medical Assessment and Research Centre (F-MARC) has invested in research to improve the game, to understand the cause of injuries and to develop their preventive programme 'The 11'. Applied appropriately, this programme could significantly reduce treatment costs for injuries caused by playing football. Considering the 250 million football players worldwide, this would mean billions of potential savings.

Doctors play a key role in this undertaking. The "winning part" of the game is not their prime objective, doctors aim at maintaining and improving health and preventing injury and disease.

F-MARC want to promote football as a health enhancing leisure activity for everyone. And F-MARC want to use it as an universal education tool to meet the challenge outlined above.

Health by playing

Physical exercise cannot only improve the well-being and the physical fitness, but can in fact be prescribed as a therapeutic modality to prevent and treat the major threats of our modern life style; such as obesity, diabetes, hypertension and diseases of the heart and vessels. Why not take this chance and prescribe 45 or 60 minutes of football, the one universal game, three times a week to tackle these diseases?

And why not tap the full potential of this unique tool to spread simple but effective messages on how to protect oneself from the most devastating infectious diseases such as HIV, tuberculosis and malaria? Because these 'big three' are responsible for about three million deaths in Africa every year, the FIFA World Cup 2010 South Africa will be an invaluable opportunity to reach those most heavily threatened by them.

Set the ball rolling

To realise FOOTBALL FOR HEALTH, F-MARC aims at developing a similar 'The 11' programme for the prevention of diseases, as it has so successfully done for the prevention of injuries. In close cooperation with African doctors and organisations such as AMREF (African Medical & research Foundation), this could become a milestone of the "Win in Africa with Africa" initiative offering the most precious win to every football player and fan on the continent: health.

source: fifa.com

Player's health - Mission and Goals

Mission
FIFA views sports medicine as a key factor in the positive development and progress of football at all levels. Through the FIFA Medical and Research Centre (F-MARC), world football's governing body plays an active role in sports medicine research, most notably in injury prevention and the fight against doping. FIFA publications, awareness campaigns and seminars and events help to disseminate medical expertise throughout the football family.

Goals

• To reduce the number of injuries during football matches and training by investigating their frequency, traits and causes;
• To assess the risks that play a part in causing injuries;
• To reduce the number of long term physical traumas suffered by footballers;
• To develop targeted prevention programmes for male and female players at all levels;
• To improve the standard of medical care;
• To fight against doping;
• To use the findings of scientific research to promote the health benefits of playing football.

source: Fifa.com

Nutrition for Football

Whenever highly talented, motivated and well trained players meet in a football competition, the margin between victory and defeat is small. Attention to detail can make that vital difference. Your diet affects your performance, and the food you choose in training and competition will affect how well you train and play.

It makes no sense to train hard and ignore the benefits that follow from good food choices!

While there is no such thing as a magic diet or food, there are many ways in which eating and drinking well can allow players at all levels of performance to achieve the special goals of their training and competition programmes.

A well-balanced and varied diet made of natural foods rich in valuable nutrients is the best performance enhancer you can use. Compared to doping methods and supplements, it has at least two clear advantages: First, it is allowed and will not place you at risk of a positive doping test and consecutive sanctions. Second, it is healthy and will make you feel better in training, competition and leisure time without any hazards to your physical and mental health.

Just one example: No other dietary strategies enjoy the reputation of proven performance enhancers as do the consumption of water and carbohydrate during exercise. The information on these web pages will provide players and coaches - and of course the team chef - with the latest guidelines in sports nutrition from experts in the field. They represent the key points from the consensus meeting on nutrition for football held at FIFA House in September 2005 in Zurich.

You can turn this science into optimum performance and well-being by learning the practical aspects. This information on nutrition perfectly complements the information on doping since it highlights the better choice for enhancing performance: healthy, effective and explicitly allowed.

source: FIFA website

Football For Health

Staying healthy need not be a chore. An hour of football three times a week keeps you physically and mentally fit - and is fun, too. Studies have now proved what many in the football family have thought for a long time: in the long term, regular exercise, such as playing football, is the best guarantee of health. In 1997, the World Health Organization (WHO) named lack of exercise as the most frequent cause of coronary artery disease. Since then, our understanding of the fatal consequences of physical inactivity has steadily increased. A main risk factor is obesity, one of the epidemics of our times.

More important than the body mass index however, is where the fat is - it is particularly dangerous in and around the abdomen. Your belt size is a useful guide. For men, it should be below 94cm and for women below 80cm. If the belt size is greater than 102cm (men) and 88cm (women) the risk of cardiovascular disease is significantly greater.

Public health awareness campaigns help most to know that exercise keeps us physically and mentally fit. But that does not necessarily mean we exercise more. Why should you exert yourself and dispense with comfort when you (still) feel so good? Many well-intended active programmes fail because many chronic diseases do not appear to be an immediate threat.

This is where football has an enormous advantage: If you enjoy playing the game and can use football to live out your exercise preferences, you will keep playing. For many, it is the psychosocial factors, not the biological ones, that fire our enthusiasm for exercise in the long term. And only then does it have an optimum preventive effect.

Although few people can become rich and famous through football, everyone can become and stay physically and mentally healthy.

source: FIFA website