Den medicinske indsats i elitefodbold

Abstract

Talentudvikling i fodbold er blevet et større og større forskningsområde, hvor blandt andet udviklings- og miljøbeskrivende modeller danner grundlag for at skabe den mest optimale vej til toppen. En gennemgående faktor i samtlige modeller er træning og hermed træningsmængde. I den forbindelse bliver den medicinske indsats essentiel. At kunne sikre spillere minimalt fravær fra træning og kamp ved effektiv skadeforebyggelse, virkningsfuld rehabilitering samt rettidig return-to-play, synes at skabe et fundamentalt grundlag for færdighed- og præstationsudvikling. Til trods for at det teoretiske fagfelt beskriver vigtigheden af kommunikation og samarbejde for at løfte denne opgave på bedst mulig vis, mangler der studier med fokus på, hvordan denne indsats opleves varetaget og hvilke konsekvenser dette har for den enkelte spillers fremtidige færdighed- og præstationsudviklingsmuligheder. Med udgangspunkt i det teoretiske fagfelt har jeg foretaget fem kvalitative semistrukturerede interviews med medicinske stab, spillere, og en træner med flere års erfaring fra en og samme norske elitefodboldklub. Gennem en induktiv tematisk analyse af det indsamlede datamateriale kom jeg frem til fire temaer: ”Eliteklubbens medicinske indsats”, ”Hierarkiet i en fodboldklub – det optimale for spillerens helbred?”, ”Fodboldverdenens virkelighed - skader som en del af gamet” og ”Skaders konsekvenser i fodbold”. Holdt op imod det teoretiske bagtæppe har jeg relateret deltagernes oplevelse af den medicinske indsats’ overordnede tre faser, skadeforebyggelse, rehabilitering og return-to-play til ”Decision-based RTP”-modellen. Resultaterne af dette studie viser til kompleksiteten i varetagelsen af elitefodboldspillerens helbred og hvordan denne indsats opleves forskelligt alt efter perspektiv, til trods for at alle aktører har samme mål. Der eksisterer et anderkendt og accepteret hierarki, hvori træneren i praksis er den øverst rangerede og endelig beslutningstager også når det kommer til den medicinske indsats. Selvom samarbejdet i denne klub skildres positivt og samstemmende med forskningens anbefalinger, oplever de enkelte aktører et fagligt og sportsligt pres, der i et evigt forandrende miljø påvirker den medicinske indsats. Den medicinske stab oplever det udfordrende at holde en spille fra at spille, da de medicinske faktorer hverken opleves eller i litteraturen beskrives som en facitliste. Dette skaber sjældne men potentielt karriereafgørende tvivlstilfælde, hvor spilleren føler sig nødsaget til at spille, selvom han ikke føler sig parat. Spillerne beskriver at måtte gamble med deres helbred, hvilket kan resultere i tab af værdifuld trænings- og kamperfaring samt begrænsning af mulighederne for fremtidig udvikling. Når tidligere skade og biomekaniske vurderinger samtidig beskrives at diktere i hvor høj grad en spiller regnes tilgængelige for kamp og træning opleves den skadeforebyggende indsats essentiel men skildres baseret på forskning af lav kvalitet eller evidens. Fundende i dette projekt afdækker områder i den medicinske indsats som har behov for yderligere forskning. Selvom ”Decision-based RTP”-modellen og hermed shared-decision-making antydes at skabe et mere optimalt grundlag for RTP-vurderinger, kræves der et åbent, trygt og forstående rum for diskussion af spillerens parathed for træning og kamp, både før, under og efter skade. Yderligere forskning i spilleres, træneres og den medicinske stabs oplevelser af indsatsen set i lys af en shared-decision-making-proces samt hvordan indsatsen påvirker fremtidig udvikling kan potentielt skabe bedre forudsætninger for at øge spillerens tilgængelig for træning og kamp.

The research on talent development in football has gradually increased in recent years, in which both environmentally descriptive and development models create a basis to structure the most optimal path to an elite level. A constant factor in the previously mentioned models is training and thus, the amount of training. In this context, the medical efforts remain essential. To be able to ensure the players experience minimal absence from training and competition through effective injury prevention, both efficient rehabilitation and timely return-to-play seem to form a fundamental basis for skill- and performance-development. Despite the fact that literature describes the importance of communication and collaboration to lift this task in the best possible way, there exists a lack of studies focusing on how this effort is experienced in practice and what consequences this has to the individual player's future skill- and performance-development opportunities. Based on existing research, I have conducted five qualitative, semi-structured interviews with the medical staff, players and one coach, of whom all have several years of experience from an elite Norwegian football club. Through an inductive thematic analysis of the collected data, this work uncovered four emerging themes through the interpretation of the results: “The elite club's medical efforts”, “The hierarchy of a football club – Optimal for the player's health?”, “The reality of football - injuries as part of the game” and “The consequences of injuries in football”. Using the results together with existing literature, this study applies the Decision-based RTP model to relate the participants' experience of the three major medical interventions in professional sports: injury prevention, rehabilitation and return-to-play. The results of this study point towards the complexity of managing the health of the elite football player and how this effort is experienced differently depending on perspective, despite the fact that all participants have the same goal. There exists a recognized and accepted hierarchy in which the coach is the top ranked and final decision-maker when it comes to the medical efforts carried out by the team. Although the collaboration in this club is portrayed in a positive lighting, and in accordance to the recommendations of the presented research, the individual actors describe a feeling of pressure of professional and sporting character in an ever-changing environment which challenges the medical effort. The medical staff finds it challenging to keep a player from playing as the medical factors used in the decision making are neither experienced nor described in the literature as a list of facts. This creates rare but potential career-critical situations of doubt where the player feels compelled to play even if they do not feel ready. Players describe feeling forced to gamble with their health, which can result in loss of valuable training and competition experience as well as limiting the opportunities for future development. When earlier injuries and biomechanical assessments are simultaneously described to dictate the extent to which a player is available for competition and training, the injury prevention is perceived as essential but is portrayed based on research of low quality or evidence. Though the Decision-based RTP model and thus shared-decision-making is suggested to create a more optimal basis for RTP assessments, the results of this project show a requirement for an open, safe and understanding environment for discussion of the player's readiness for training and competition, both before, during and after injury. In addition, this work uncovers areas in the medical effort that require further research into individual experiences of the shared-decision-making-process as well as how the effort affects future development. Such research can potentially create better conditions to increase player availability for training and competition.