The simple, conventional markers of fatigue - variations in neuromuscular performance, creatine kinase and hydration status in elite soccer players over a season.

Background and Purpose: Fixture congestion, game-intensities and limited recovery negatively influence physical/physiological responses during a competitive soccer season. Therefore, the aim of the investigation was to examine weekly alterations in neuromuscular performance markers, creatine kinase and hydration in elite soccer players throughout a season. Study Design: Longitudinal Observational Study. Methods: Sixteen male professional soccer players competing in the English Football League Championship were assessed over the course of a season. All players provided a urine sample, a blood sample to assess creatine-kinase concentration and performed a countermovement jump test at the start of the season, in-season, pre-and post-match over 38 weeks. Results: Jump height was the most common marker of performance to be significantly reduced in-season compared to baseline (-5.4 to -11.3%, P<0.05) with 45.2% of the time-points affected. Measures of FT:CT (-7.5 to -12.4%) and AP (-9.4 to -11.5%), also showed significant deteriorations throughout the season compared to baseline (P<0.05) at several time-points. Max force (MF) significantly increased in-season (+5.1 to 7.0%) in 20% of the observed time-points compared to baseline. CK concentration significantly increased during 19% of the time-points (P<0.05; 62 to 159%). Urine osmolality demonstrated significant differences in season compared to baseline, but none to levels of dehydration. Conclusion: Monitoring elite soccer players over the course of a competitive season shows alterations in neuromuscular performance and hydration status. These data suggest that assessing counter-movement jump performance may be a useful marker for monitoring responses to training/competition, while creatine-kinase and hydration status may be limited.

Case Study: The Conservative Management and Rehabilitation of Insertional Patella Tendinopathy in an Elite Footballer

Background and Purpose: Chronic insertional patella tendinopathy is a complex condition to manage within elite athletes. Pain and symptoms increase when spikes or changes in relation to training or game load are experienced. These spikes are often seen in football on return to training or in periods of fixture congestion, presenting a contemporary challenge for the sports medicine team. Study Design: Case Study. Case Description: The presented case summarises the conservative rehabilitation and pain free return to play of a 24 years (yrs) old elite professional footballer with a long-standing history of patella tendinopathy. Symptoms returned post a spike in training load during pre-season, with a diagnosis of a 7.4 mm insertional thickening detected through magnetic resonance imaging. Presented is a summary of the assessment process, 24-week treatment and rehabilitation protocol and subsequent 12-week pre-habilitation plan, routinely completed on return to training and game play. Outcomes: The implemented management strategy led to the successful symptom free return to play of the athlete. Conclusion: The management of this injury was facilitated through subjective and objective assessment markers and imaging obtained to manage the athlete’s symptoms. The authors suggest that medical and conditioning based specialists could apply a rounded loading approach with prescribed isometric and isotonic drills before progression to energy release and pitch-based training to advance the athlete through a safe and controlled return to sport clearance. Level of Evidence: 5.