‘In tournament football, fitness and conditioning are absolutely vital. They are among the most important things. You also need a little bit of luck with injuries and penalties and things like that.’ So says Sven Goran Eriksson ⁽¹⁾. Wise words indeed from the England manager, but can PP make him any the wiser? This article takes an in- depth look at some of the key factors that impinge on creating a winning World Cup team, by John Shepherd.

Next year’s playing season is designed to give the England squad more time to prepare for the 2006 World Cup in Germany. But will the rigours of a Premiership and European season for the majority of the English-based players have taken its toll on their readiness for the biggest tournament on earth?

Research by Ekstrand and his colleagues from Linkoping University in Sweden looked specifically at the domestic season’s toll on topflight footballers from across Europe in the lead- up to the 2002 World Cup, focusing on the impact of number of matches played on injury rates ⁽²⁾. Team doctors at 11 of the best football clubs in Europe monitored their players continuously over the 2001/02 season, when 65 of the players participated in the Korea/Japan World Cup. During the tournament the clubs reported the injuries sustained by these players, while three international experts analysed how well they played.

Domestic games played by Europe’s elite varied between 40 and 76. Not surprisingly, top players (or at least those in the more successful sides) played more matches, especially during the final period of the season, when there were more cup commitments. In all, World Cup players played 46 matches, compared with 33 for non-tournament players.

Perhaps surprisingly, given that they played more games, the World Cup players did not experience a greater injury rate than non-World Cup players during the season, However, 29% of them sustained injuries in Korea and Japan. And, ominously, 23 (60%) of the 38 players who had played more than one match in the week before the World Cup incurred injuries and/or underperformed during the tournament. This led the Swedish researchers to conclude that the number of games played in the last 10 weeks before the tournament was particularly crucial in terms of potential injury risk and/or underperformance.

What of the demands of international football? Are those who play regularly at this level any more prone to injury than others? And should Sven forgo friendlies in the lead-up to Germany in consequence? This question was the subject of further research by Ekstrand, who carried out a longitudinal study of the Swedish team between 1991 and 1997⁽³⁾.

During this six-year period the team played 73 official matches and attended three training camps. Fifty-seven of these matches and the three training camps were included in the study, amounting to a total of 6,235 training and 1,010 match hours. Exposure to football was recorded individually for each player, and the team doctor examined all injuries.

In all there were 71 injuries (40 incurred during training and 31 during match play). Five (16%) of the match injuries were major and resulted in more than four weeks out of the game. The incidence of injury during training was 6.5 per 1,000 player hours, while the incidence during matches was 30.3/1,000 hours.

Interestingly, a significantly higher injury incidence was found in matches lost than those won or drawn (52.5 compared with 22.7/1,000 hours), although no significant difference in injury rates was found between competitive and friendly matches and between matches played on home, away and neutral ground.

These findings led Ekstrand to conclude that the risk of injury when playing for a national team was comparable to that previously reported for professional football at a high level. However, given his previous findings ⁽²⁾, it would seem prudent for the English Football Association (FA) to limit their team to essential games only in the lead-up to the World Cup, to minimise the risk of injury and impaired performance in the tournament itself. England should also be careful to win all its games!

The quote from Eriksson in my introductory paragraph mentions the importance of luck, and there is certainly a huge element of luck involved in injury risk, as FIFA, the international governing body of football, discovered when analysing the incidence and type of player injuries that occurred during the 2002 World Cup ⁽⁵⁾.

The team doctors of all the participating teams reported all injuries after each match on a standardised injury report form, and a total of 171 injuries were reported from the 64 matches, equating to an injury rate of 2.7 per match. Of all the injuries, 73% were contact injuries and the remainder incurred without contact with another player. Half of the contact injuries (37% of total injuries) were caused by foul play as defined by the team physician and the injured player.

So, statistically speaking, luck will play a prominent part in determining Eriksson’s players’ injury risk, as there is not much than can be done to avoid contact injuries, especially if these are instigated deliberately by players on the opposing side. (Note: FIFA will be pushing the importance of ‘fair play’ in Germany in an attempt to reduce the incidence of deliberate fouls).

Hamstrings and hydration

It is beyond the scope of this article to go into detail about football conditioning and pre-conditioning methods. However, I do want to focus on hamstring protection and player hydration since these are among the most important determinants of player endurance (in all senses of the word) in tournament football. A strained hamstring will almost inevitably mean the end of the line for a player – at least as far as this particular tournament is concerned – while inadequate hydration can significantly impair performance and even increase injury risk.

UK researchers Dadebo and a team from Manchester Metropolitan University investigated the relationship between current flexibility training protocols and hamstring strain rates (HSRs) in English professional football clubs ⁽⁶⁾. Data on flexibility training was collected from 30 clubs in the four divisions during the 1998/99 season.

Although there was considerable variation in the way the different clubs trained for flexibility, the researcher discovered (surprisingly, given its limited relevance to match and training conditions) that static (passive) stretching was the most popular method.

In terms of injuries, hamstring strains accounted for 11% of the total and one third of all muscle strains, while about 14% of hamstring strains were re-injuries. HSRs were most prevalent in the Premiership (13.3 for every 1,000 playing hours) and least prevalent in Division 2 (7.8 per 1,000 hours), with forwards mostly likely to be injured. Most (97%) hamstring strains were grade I and II and two thirds of them occurred late during training/matches.

Just to explain this terminology, a grade I strain might consist of small micro-tears in the muscle; a grade II strain would be a partial muscle tear and a grade III would be a severe or complete rupture of the muscle.

When analysing injury rates in relation to flexibility protocols, the researchers concluded that about 80% of hamstring strain rate variability was accounted for by stretching holding time. In other words, the longer the muscle was stretched, the more likely a player was to suffer a hamstring strain.

The implication of this research is that if hamstring strains are to be reduced among elite players, club coaches need to be better educated on the merits of active warm-ups, including specific stretches (of which more later).

Fluid loss can inhibit performance and increase injury risk. We must hope that the England team will not assume that because the games are to be played in European conditions, albeit summer ones, there will be less need to pay attention to player hydration, as a large body of research suggests that such a lax attitude could lead to the team flying home early.

Maughan and colleagues from Loughborough University measured fluid balance during a 90minute pre-season training session in the first team squad of an English Premier League football team ⁽⁷⁾. Sweat loss during the session was measured by changes in body mass after taking account of fluids ingested in drink and excreted in urine. Sweat composition was analysed by patches attached to the skin at four sites.

On the day of testing, the weather was warm: 24-29°C, with moderate humidity (46-64%) – similar conditions to those expected next summer in Germany. Over the course of the training session, the mean body mass loss was 1.10kg, equivalent to 1.37% of pre-training body mass. Mean fluid intake was 971ml and estimated mean sweat loss was 2,033ml, with a total sweat sodium loss of 99mmol, corresponding to a salt (sodium chloride) loss of 5.8g.

Maughan concluded that sweat losses of water and solute (liquid containing electrolytes) in footballers in training can be substantial. However, there was considerable variation in losses between players, even in the same exercise and environmental conditions. There was also considerable variation in voluntary drinking, which was generally insufficient to compensate for fluid losses.

So it seems that Sven and his backroom team need to design and implement individual fluid replacement programmes for each player. To help them, Maughan recommends that players should drink enough to limit weight loss to 1-2% of their pre-training session/match weight. Since salt loss can make players more prone to cramping, he also advises that those with a tendency to cramp should consider taking salt supplements.

The whole issue of how to calculate your personal fluid needs was covered in a recent issue of Peak Performance (PP 212, 2005) and the message of the article, written by Professor Maughan himself, is summarised in the box below.

Warm-ups for big games

Finally, we need to consider how to warm up for the big games. And here Professor Angel Spassov has some key pointers for the England side. A football conditioning expert from Bulgaria, now based in the US, Spassov has worked with no fewer than six World Cup squads, most recently Portugal during Euro 2002. Although his warm-up is far from revolutionary (from a general sports conditioning perspective) it is nevertheless very thorough and specific (see panel above right) ⁽⁸⁾.

Spassov advocates a passive and active warm- up, the latter incorporating a specific warm-up. For the former he recommends that players loosen their muscles 30-60 minutes before the game by rubbing ankles, knees, all the muscles of the legs, lower back, neck and shoulders with heating ointment – preferably one that is odourless and not too hot on the skin.

The warm-up that follows is divided into two parts, as described in the panel.

Spassov’s suggested warm-up makes great sense and should control players’ progression to match readiness. With the first part of the warm-up performed alone, players should be able to focus on their own movements and progression rather than being tempted to lash out at the ball before their hamstrings are fully prepared, with potentially dire consequences.

Neither I nor PP is being presumptuous in presenting these findings to Sven. Indeed we would be delighted if the Swede and his team already knew it all and only needed to worry about the luck factor out in Germany – and those penalties of course!

John Shepherd MA is a specialist health, sport and fitness writer and a former international long jumper

References

1. From www.thefa.com
2. Br J Sports Med 2004 Aug; 38(4):493-7
3. Scand J Med Sci Sports 2004 Feb; 14(1):34-8
4. www.ontariosoccerweb.com
5. Am J Sports Med 2004 Jan-Feb; 32(1 Suppl):23S-7S
6. Br J Sports Med 2004 Dec; 38(6):793
7. Int J Sport Nutr Exerc Metab 2004 Jun; 14(3):333-46
8. www.overspeedtraining.com