Special Report: Inside Liverpool Medical Service

Darren Burgess was an Australian fitness and conditioning specialist whose appointment to Liverpool in 2010, an era of unprecedented turmoil at every grade of the club, was linked to that of its head of medicine and sports science, Peter Brukner.

Roy Hodgson is drowning as a manager and, two weeks before the takeover of Fenway Sports Group, striker Fernando Torres was left out of the Europa League due to new staff considerations about his physical condition.

As Torres simmered, Hodgson publicly explained the reason for his absence. This led to the claim that he had lost control of the team’s selection. Hodgson would only last a few more months at Anfield, but Brukner and Burgess made it to 2012 before continuing.

Having represented Arsenal, Burgess now works as a “high performance manager” in his local country. He also works as a representative for FIFPro, the global players’ union, which has designed a platform that monitors the workload of players.

Last year, Burgess contributed to a report describing the effects of various exposures to games, adding sleep disturbances, regularity of training, fatigue, increased risk of injury and intellectual fitness problems.

Liverpool were tested in the study.

Given the results, it’s perhaps no surprise that Andrew Robertson has become the newest Liverpool player to injure himself after contracting a knee problem towards the end of last week’s humiliating Champions League defeat to Napoli.

Robertson has played more than any Liverpool player since 2018, having played 17,213 minutes of football.

The FIFPro tool – which collected data from the 2018-19 season to the 2021-22 season – highlights the knowledge of the Scottish left-back, at least for his limited rest and recovery.

Among 270 male players, Robertson averaged 122. 7 hours of rest between appearances, the eighth lowest in a pattern that also assessed the number of “critical zone” matches, a reference to the number of times a player has played in consecutive matches for at least five days. . (or 120 hours) of rest separating them.

The found that 65. 1% of Robertson’s games over the past 4 years have been in the “critical zone”, with 19. 5% of games after less than 3 days of respite.

Mohamed Salah and Alisson, the goalkeeper, followed Robertson a lot in this domain of data, which also records the distance traveled by the player. Egyptian captain Salah flew the equivalent of 5. 6 times around the world for the club and the country this period. Foreigner from Brazil Alisson has done it 7. 5 times.

Trent Alexander-Arnold is rarely included much in the investigation, however, given that the right-back provides similar service and is rarely far behind Robertson in terms of overall minutes on the pitch in recent years, he can probably draw similar conclusions. about their degree of rest and recovery.

During Torres’ final months at Anfield in the early part of this 2010-11 season, it seemed that an alien species had taken control of his brain and body. He was only 26 years old and had been leading the front line at Atletico Madrid and then Liverpool since his teens had wreaked havoc.

In that 4-1 defeat to Napoli, as well as in other matches so far this season, the performances of some Liverpool players are reminiscent of those of the Spaniard a decade earlier. Increasingly, Liverpool have been outstripping themselves in distance. Travel, as well as sprints: the kind of knowledge jurgen Klopp takes seriously, as he knows where he can take it.

“I love it when I read after the game that we ran more than the opponent,” he said in 2013 after his team Borussia Dortmund won at the Emirates Stadium when their players covered a total of 117km compared to Arsenal’s 106km. I don’t like to win with 80% possession. “

After similar efforts, his mainz and Dortmund teams clashed in the seventh year. In Salivapool, he’s getting to the same level, having controlled himself to make sure the last game of each season counts significantly.

In his seven seasons in charge, adding the 2015-16, where he replaced Brendan Rodgers in October, Liverpool have covered the distance and there is now a public debate about whether any of their players have red wear at the same time.

While in some individual cases this theory might become true over time, the team’s preparation for the existing crusade is also considered applicable, just like in the summers of 2020 and 2021, albeit for other reasons.

In 2020, pandemic restrictions wreaked havoc on Klopp’s summer, but a year later he was able to coach the team for nearly a month in the foothills of Austria and France. Klopp has a very fundamental theory about pre-season: if the players meet their expectations of those weeks, everything that follows becomes much less difficult for them.

This means running lap after lap around a running track in scorching heat. Upon completion of this process, players will travel 70 km consistent with the week, adding friendly matches. When competitive matches begin, the expected mileage in a two-game week is reduced to around 55 km. which is less than they were conditioned but, according to estimates by Liverpool’s knowledge scientists, more than at other Premier League clubs.

At Salivapool, there are internal debates about the physiological and mental benefits attached to those education camps. However, as the 2020-21 season has shown, and this one turns out to prove, Liverpool’s functionality suffers when preparation is not well ordered, or when track or field time is limited due to remote tours involving the club’s abundant advertising obligations.

At the end of August, after five season games, Klopp was facing injuries to 10 senior players. Those who best perceive how he leads his team tend to agree that he encounters serious discomfort every time two or three players are missing from the court. Same time.

This presents the risk of a domino effect.

If a replacement player has traveled 28 to 30 km in training alone, what happens when they are suddenly expected to advance north of 40 km consistent with the week or up to 55 km, depending on the number of games they intend to play?The new expectation implies a massive increase in capacity, up to 25%.

They are obvious.

Understanding how Klopp and Liverpool controlled the fitness arm during their nearly seven years at Anfield deserves further examination.

Klopp has won almost every single trophy he competed for during his time at Liverpool in the direction of fitting in as the coach with the most years of service in the Premier League.

One of the main foundations of the club’s good fortune in this era has been Klopp’s connection with his players. Only Jordan Henderson, James Milner, Roberto Firmino and Joe Gomez are again important in the organization he inherited from Rodgers, but for the past five years the team has been relatively stable.

At other clubs, it doesn’t take much for players or their representatives to complain about a manager, but even in the toughest moments at Liverpool (such as when the reigning champions lost six games in a row at home amid a two-month defensive injury). crisis in early 2021), there has been loyalty to Klopp. Es one of the few coaches in world football who motivates such a faith.

Klopp’s trick is to give players the impression that he is their friend but not their most productive friend. The players respect him but also care about him. They don’t need to let it go. They know that their priorities are also his.

Players arrive at Liverpool first with Klopp. This culture has resulted in exceptional results, seasons and moments that will be remembered as long as the club exists, but the pursuit of glory has resulted in a significant amount of collateral damage.

Klopp works largely with a group of assistants and coaches selected through him and beyond that, there is a perimeter of appointments made through the sporting director. Previously, this duty fell to Michael Edwards and now to his successor Julian Ward.

In April, Klopp signed a new contract committing to Liverpool until 2026. The key to this prolonged stay is the loyalty of those around him. He would revise the names of Peter Krawietz and Pep Lijnders, suggesting he had only agreed to stay once. I knew they were also on board.

Klopp was not demagogic when he advised that if one of those two had wanted to move on, he would have seriously thought about his own future. In fact, he knows that Krawietz is helping to counter some of his sharper instincts and that Lijnders brings the kind of power he can’t provide to either or both of them. While Klopp did not seek to increase his salary in new deals with Fenway Sports Group (FSG), he ensured that both of his closest lieutenants received one.

It’s another thing if you’re outside Klopp’s circle of absolute trust. As with many big clubs and their coaches, those inside see the worst and most productive of their moods, while those outside have a tendency. have less of the worst but also less of the intelligent.

Most of the time, there is a professional distance. For many in this position at Liverpool, employment is more than a job. They are paid less and tend to feel more vulnerable about their future.

At all levels, the squad values players as the club’s highest value apparatus. As long as they are satisfied, Klopp will be satisfied as well. When Edwards was in charge, so was the athletic director.

Between 2018 and 2020, Philipp Jacobsen, as head of performance, operated between those central figures and the players. In June, he spoke to the Inform Performance podcast about his reporting running in elite football.

“In a way, you face similar pressure on the players,” said Jacobsen, who has also worked at Portsmouth and Greek club Panathinaikos. they (the players) are pressuring you. They (when injured) want to return earlier, which is absolutely normal. You want to go out to stay focused on making the right decisions in this high-tension environment.

He continued: “The same thing is going to run with the coaching staff. The spaces of interest are other but identical. We need to win by all. The difference is that they think about the next game and they need to have as many players to be there. “had as much as possible. So you also have to deal with that tension.

“It’s never a simple verbal exchange, with a technique about a player who isn’t ready. ‘Can you play 30 minutes?’ The truth is, you can’t say, “Yes, you can. “You may give up after the first two minutes, or you may never give up. It is very, very complicated to play this role and it is the biggest medical and functionality challenge. in general.

For a time at Liverpool, decisions were split between players and physiotherapists, but that replaced when Klopp was advised that he needed to get more involved. With this, the discussions have become triangular, the duty of diagnosis and diagnosis remains with the club doctor. personnel.

Klopp can be very full of life with his players and is an effective negotiator, but at the end of the day, if he feels that a player really needs to take a safe path to recover from a long-term injury, he will accept it. as is true with them. Especially if the medical team does not agree on how to take care of the situation.

It would hardly be unexpected if some have become distressed about how to express themselves in front of the players, the coach or any sporting director.

Klopp reacts to injuries than his predecessor. While Rodgers has relied on some positives, noting that any kind of unavailability brings opportunities to others, Klopp can be emotional.

The reaction is understandable given the strain of their role and how damaging injuries can be to their plans. But this means that the user, when talking to him about such advances, will have to feel that he has been placed in a difficult position: if the injury is serious and you promise too much, he is unlikely to do so. If it’s bad and you say it like it is, just as the workout is about to start, it will most likely provoke a reaction.

Klopp has to be picky about the players, but the extended squad sees less of that. Any kind of confrontation then arises in the face of a distant attitude. At the next point of contact, you can scream with laughter, pat someone on the back, and pass by. in with his day.

On May 16, the German physio Chris Rohrbeck made a miracle and transitory return to the club ahead of the Champions League final. This happened because of considerations about the physical condition of several players. The most sensible on that list is Salah, and he likes Rohrbeck. a lot, he went in 2020 to paint in Mainz at home.

Two days earlier, the Egyptian striker had been injured in the final FA Cup win over Chelsea. The meeting with Real Madrid in Paris in two weeks.

Within 48 hours, Rohrbeck in Merseyside, helping with his recovery. Club officials understood that Salah was looking for a new contract. Rohrbeck’s return showed him that Liverpool were willing to make special concessions in his case.

This was not the first time it influenced endowment levels.

Lee Nobes, the current head of physical therapy, was appointed to the position following an extensive recruitment procedure involving other serious candidates. While his delight in participating in a calendar involving football’s Champions League was significant, Nobes also understood what it means to work at a club he had been transforming educational grounds since moving to Manchester City.

Liverpool’s move from Melwood to Kirkthrough was a few years away and Nobes also went through various resources within the industry, adding Milner, who knew him from his five years in combination at City.

Since then, Milner was a very influential member of the team. He is close to other senior British players at Robertson and Henderson. Jacobsen, then in a decision-making position at the club, understood the importance of the dynamic and sanctioned the signing of Nobes. , a character said to be similar to Milner: an alpha male with a direct means of communication.

Klopp loves Milner for his commitment. Even when he wasn’t involved in a game-day team, he traveled to games away from home with his teammates and had access to the locker room. Milner will call the other players to give them their phones in certain parts of the education floor where they are banned. . Others in the leadership organization will drop this slide, but never Milner.

When injured, the former England player will ask the team a lot of questions. While some settle for that, it’s up to them to meet your expectations and standards, others find it hard to please you. Those who have worked with him tend to agree, however, that his absolute determination for education is helping to shape the culture Klopp wants.

Milner’s “total” attitude helped create an incredibly competitive environment in the team. However, this culture has also had consequences due to conflicting messages about education or rest.

Jacobsen referred to this kind of tension in football when he spoke on the Inform Performance podcast: “It’s possible for a player to say, ‘Hey, I feel smart, I can go back to the field. . . ‘”But you already know that the tissue is not ready, it has not yet healed. He hasn’t worked hard enough in the field. Then you have to be the sounding board. It’s hard.

Jacobsen would leave Liverpool, amid a series of departures, just months after Klopp guided the team to the club’s first league name in 30 seasons in the summer of 2020.

Two years earlier, he had been appointed through Edwards, after spending a decade in a clinic in Qatar, with that country’s national football team. Their agreement dates back to 2005, when they were colleagues in Portsmouth.

It is Jacobsen’s duty to align medical departments with each other. Despite the massive innovations on the pitch pushed by Klopp, long-standing behind-the-scenes problems existed among physiotherapists and sports scientists.

During Klopp’s time at the club there has been friction in this area due to culture clashes. He never followed an English-style backroom model, but he did impose a complete edition of the German formula he knows best.

In the Bundesliga, most of the work of a physiotherapist is regularly done in a medical study and rarely sets foot in the educational field, where the role of the physical teacher comes into play. Progress once back on the grass instead of entrusting everyday tasks to physical shoes or sports scientists.

Klopp’s decision to appoint compatriot Andreas Kornmayer as head of fitness in his first pre-season in 2016 exacerbated interdepartmental tensions, which became more complex due to the separation between English- and Spanish-speaking physiotherapists, who had other tactics to get things done. . .

Ryland Morgans, the former physical trainer, like his former boss Rodgers, had been guided through protocol. Morgans left the club at the end of Klopp’s 2015-16 first season, a crusade that marked a series of hamstring injuries as the players struggled to recover. adapt to new excessive physical tests.

Klopp needed some sort of primary sergeant to run his fitness department.

When Kornmayer arrived from Bayern Munich, he made headlines for his looks. With his thick-rimmed glasses and blonde hair back, he looks a lot like a smaller edition of Klopp.

When Xherdan Shaqiri signed from Stoke City in the summer of 2018 after being at Bayern from 2012 to 2015, he was surprised to find Kornmayer occupying such a vital position at his new club. Shaqiri arrived at Anfield, one of the toughest members of the squad, having earned Klopp’s absolute trust.

When Liverpool’s staff clashed at Newcastle in a tumultuous Premier League match last month, Kornmayer was there, at the centre of a side confrontation that resulted in fines and bans from both sides.

At the start of his time at Liverpool, Klopp was looking for his players to be able to travel long distances and Kornmayer was in a position to push them to the limit. This generated friction with more procedural club spaces. Kornmayer in the seat of power, the gap between the thinking of sports scientists and that of physiotherapists has widened.

With Klopp’s support, in fact, Kornmayer seemed untouchable, but his technique did not bring cooperation between medically similar departments.

Some team members said the lack of accountability in the formula could affect the availability of players later on and, at that point, threaten the effects on the field. This environment is believed to have contributed to the resolution. of more than one user to move forward.

Edwards posed the challenge and hired Jacobsen in 2018 to try to incorporate concord into the setup.

Jacobsen reportedly challenged Kornmayer on his first day at Melwood. It immediately became clear to many employees that this was not going to work for Jacobsen because of a clash of philosophies, where he sought to know the science in each and every decision, Kornmayer. he was more instinctive.

Although Klopp first gave the impression that he never fully agreed with Jacobsen’s role and responsibilities, some senior executives thought it was fundamentally a smart idea. it never happened. Instead, beyond Klopp’s inner circle, a non-unusual identity was missing as departments acted on what they knew and came up with.

Liverpool would win the Champions League and Premier League with Jacobsen’s time at the club, but until the end of 2020 he had left and returned to Germany on a gardening licence.

Jacobsen supporters were unable to do what needed to be done because some staff members were so attached to certain roles and responsibilities. However, it is also because he did not have the prestige or temperament to do what was necessary. He never understood the truth, it was his task to deal with personalities as well as injuries.

Still, Edwards greatly appreciated Jacobsen. Su contract was completely worth it and has since acted as a representative for the Boston Red Sox, the major league baseball team also owned by FSG.

After Jacobsen’s departure, the formula in Liverpool has temporarily become more disjointed than before, with each branch manager trying to convince themselves of their concepts without anyone publishing or directing them. Staff turnover in the Klopp era was significant, but a constant presence was Kornmayer. Despite the criticism, it is identified that despite everything he controlled to get a great distance in the legs of the players.

After winning the Champions League final in June 2019, there was a feeling in the medical service that Liverpool needed to start replacing some of the players after two seasons of so many matches (56 in 2017-18, as they lost the Champions League final to Real Madrid). ). in Kyiv, then 53).

Meeting Klopp’s expectations for a 50-60km solo season in a week is considered an achievement internally.

The desire for replacement might have been real, but when Klopp led Liverpool to the Champions League final in May, their opposite side to Real Madrid included 8 of the 11 starters who had beaten Tottenham Hotspur in Madrid 3 years earlier.

Some critics of Kornmayer admit that he must have done something right.

Eventually, he was able to replace at least a few other people’s opinion of what footballers could achieve with their bodies, pushing them more than some, even the closest inside acquaintances, believe possible.

Jacobsen’s departure came just after medical leader Andy Massey joined FIFA in the spring of 2020.

Massey had notified the club prior to his departure and this allowed Edwards to prepare a replacement. He had the idea that he had convinced Gary O’Driscoll to leave Arsenal before his new head coach, Mikel Arteta, begged him to stay. Under pressure from his circle of relatives to remain in London, O’Driscoll withdrew from the move 24 hours before the announcement.

This left Liverpool without a doctor just as the scale of the COVID-19 pandemic was becoming transparent and the UK was heading for that first lockdown period. Among the internal candidates, Jim Moxon was the wonderful choice. His past experience at Liverpool only extended to the academy, but he moved to Melwood when other personalities were unavailable.

It is believed in some quarters that Nobes favored Moxon, as his appointment would have allowed physiotherapists to regain some authority in discussions with other departments. Edwards did not have as many functions as he would have because staff at other clubs were reluctant to move as Britain went from one lockdown to the next.

Moxon has handled the pandemic well, with players and other staff largely adhering to safety protocols.

During this period, no one at Liverpool has become seriously ill, a match, a first leg of the Carabao Cup semi-final against Arsenal in January this year, was controversially postponed due to a batch of erroneous control effects that, according to the rules, I do not want to be taken.

Little by little, however, Moxon’s role has become more oriented to football and from there he judged his ability to manage personnel and make intelligent decisions quickly. He will last less than two years in charge, announcing his departure, exceptionally, on the eve of this season, having been active a few weeks earlier on the club’s pre-season excursion to Thailand and Singapore.

It is said that Moxon was more temperate than Klopp and probably the doctor did not like to fight with the moods of the manager.

As Liverpool seek Moxon’s replacement, Andreas Schlumberger, Jacobsen’s successor at the helm of the feature, has taken on greater responsibilities. take him to Merseyside faster than him.

Since his arrival in late 2020, some of Schlumberger’s work has focused on helping players who are no longer classified as injured but are not yet in a position to complete training.

Klopp and Mike Gordon, the president of the FSG, were willing to give him a greater reach so that he would only try to achieve greater coordination and communication between the departments headed by Nobes, Kornmayer and whoever would be the next medical director of the club. . Earlier this summer, Schlumberger added Frigyes Vanden Auweele as the new head of osteopathy.

Schlumberger has more experience in sports science than medicine, but he inspired his Liverpool colleagues with his ability to listen. It is not ego-driven. It was expected to create some balance in design with Klopp, but Schlumberger’s call is lately below Kornmayer’s on the club’s website.

Last season, Schlumberger’s price was marked through Klopp in his program notes ahead of Leicester City’s stopover in February.

After the last home game, the FA Cup third-round win over Cardiff City, Harvey Elliott thanked club physio Joe Lewis for helping to overcome an ankle dislocation last season. While it is true that Lewis did most of the transplants with Elliott on the return trail, it is also true that Schlumberger had discreetly mapped out the rehabilitation program.

It wasn’t an opportunity Klopp could simply ignore, given that Schlumberger was his favorite date.

Last season, Klopp almost led Liverpool to an unprecedented quadruple. After winning any of the domestic cups, they missed out on the league in the final 15 minutes of the final day of the Premier League as Manchester City rallied 2-0 to beat Aston Villa, before losing 1-0 to Real Madrid in the Champions League final.

For a unique moment in the club’s history, the team played every game imaginable. In this quest, Kornmayer extracted every last drop of power from the players.

It was understandable that, towards the end of such an exhausting campaign, they would struggle together to deliver the kind of intensity in performances related to a Klopp team. For the last month, at least, it seemed that Liverpool were beating the thank you. to the magical oils and experience.

Players who have left, after a succession of grueling challenges, now of course have one more year and this means that preparation becomes even more important.

After a very different pre-season schedule than 2021, with a shorter European camp, Klopp arrived at the end of August with his team already decimated by soft tissue injuries, which have been the main contributor to absenteeism at Liverpool since 2018-19.

A survey by UEFA, European football’s governing framework, suggests that soft tissue injuries have increased by 15% over the past decade and that number will only increase if calendars continue to increase and players’ treatment is not adapted.

Their efforts over a long period of time, combined with the tactical and physical expectations of the manager, mean that Liverpool players, with their developing age profile, are almost more likely to be injured than ever before.

A rebuilding program has already begun and availability is at the heart of player recruitment as of 2018.

Initially, Klopp had first sought explosiveness in any possible signing. Fitting in with the Liverpool manager, he was amazed at Daniel Sturridge’s ability to get away from an opponent. However, he would soon realize that Sturridge could not play in more than 50% of the matches. The same thing happened to the striker of the previous clubs Manchester City and Chelsea, and they did not ask him to run 55 km a week.

The medical service contributed to a new club focused on availability and presentations were made to the FSG. One of the first signs of the new era was Naby Keita, who was present in 78. 7% of RB Leipzig’s league matches the previous season. Liverpool reached an agreement to point it out.

However, Keita’s most productive season at Anfield was his first in 2018-19, when he racked up 1390 premier league minutes (40. 6% of Liverpool’s total), a season in which his average time on the pitch is also Liverpool’s highest. minutes consistent with the game. By the end of last season, he had missed 361 days due to injury since signing for the club. Given that track record, it would be understandable if Klopp was reluctant to put too much pressure on him when he’s in the team.

An Israeli study estimated that, on average, Premier League clubs lose £45 million due to season injury-related functional outages, meaning clubs have a more powerful economic incentive than ever to invest in injury prevention and rehabilitation programmes.

Between 2012 and 2017, the study found a relationship between the number of days lost to injuries per season and the difference between a club’s expected and actual final positions: while players who spent 136 days injured caused a team to lose a singles league. Period, with 271 days left, they charge the team a place in the final table of the league.

In the last 3 seasons, this theory can be implemented in the most sensible Premier League standings.

While Manchester City lost more than 500 more days when Liverpool won the name in 2020, the opposite trend tipped everything in City’s favour the following season.

In May, City would again finish just ahead of Liverpool, leading them into the league by a single point. Compared to Liverpool, Pep Guardiola’s players had spent 303 fewer days at the table during the season.

Margins may have been narrower.

(Additional report via Mark Carey)

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