Over the last 12 months my life has changed significantly, both physically and mentally. In April 2021, I wrote a blog about my journey from diagnosis to surgery and the few months that followed.
However, with hindsight being a wonderful thing, it was still very early days indeed.
Despite all the reading and research, I really didn’t understand myelopathy and I’m not sure many really do, apart from those who it has an effect on.
The last 12 months have been challenging to say the least, I was glad to be back at work, back on the grass, back working with players in the gym – and then you wake up each morning. Log rolls to get out of bed, sleeping with a pillow under the knees, disturbed sleep due to spasms.
It’s become more about management than anything else, something I’ve had to learn to work with. I guess more than anything, you can choose to be defined by this, or you can do your best to live with it and manage what it throws at you. Not ideal, but it’s the reality.
Degenerative cervical myelopathy is poorly understood, and this makes it difficult to diagnose (1). Before my diagnosis, and aside of the excruciating pain, I had become clumsy and forgetful. I couldn’t get in my apartment door without dropping the keys a few times.
This functional decline may be common, but this could easily be attributed, or dismissed, as just having a bad day, or just getting older (2). The symptoms may be distinct, but are still somewhat misunderstood. Therefore, it may take both high suspicion and neurological examination to diagnose (3). An MRI can help detect whether the spinal cord is compressed. I posted my MRI Images in a previous blog.
Rehab has never been a linear process. I know this from my practice as a sport scientist in football. More than ever before I have learnt to be patient. There are days when you just think “where is this taking me” or “when will this end”. It’s hard to say. Some days you wake up and really don’t feel like it. It can become tedious. It’s far, far slower than any football injury I have ever had.
It’s not a case of break a bone/snap a ligament, immobilise, build it up again and away you go. I acknowledge that’s an oversimplification, but I am sure you understand my point. There are neurological factors at play here too.
I still have no feeling in my left hand. I don’t really notice it now, but sometimes you wonder if it will ever come back. The doctors just can’t say. They are hopefully, but such was the extent of the nerve damage (and the length it needs to travel from cervical spine to hand during the regeneration process) it’s going to take time.
If anything, I still can’t thank the surgeon, Dr. Zhang, who realised the severity of the problem so quickly. It’s no secret it was emergency surgery and I will be forever grateful for the care and attention I received.
Despite the lack of feeling in my hand and the significant muscle atrophy, I’m getting stronger by the day. Every single day I do my rehab exercises. I see the guys in the gym, lifting heavy. I probably look odd, doing my 52kg bench press (My 1RM was once over double this!). I rarely wear short sleeved clothing as my left arm is still significantly wasted. I do get embarrassed by it, I’m not scared to admit that. However, every day is a positive.
Every gym session has a purpose – like they all should anyway. I know I am doing my best to get myself back to where I want to be. It could take years, it may never happen, but something is better than nothing.
I recently discovered myelopathy.org, a support group and forum for those with the condition. Their work since 2015 has been incredible and hopefully I can help them in raising awareness into this condition, which can be so debilitating for many. The organisation is dedicated to raising awareness, providing information, and supporting research for the condition. It’s great to communicate with others and some have had much worse experiences than I have. I count myself lucky, but also want to do my best to support others too.
So where does it got from here?
I’m positive and upbeat, but with a sense of realism. I think the initial few months I probably underestimated the condition and the length of recovery. I’ve said many times that one of the hardest things is that it isn’t visible. Apart from the neat scar across my throat, most people wouldn’t know. That can be hard at times. If I had of broken my ankle (thats pretty much fused too!) others would see the plaster cast and know something was up. This isn’t like that.
I had an MRI scan at the beginning of December and this was reasonably positive too. The determining factor will be how I am at the one year post-surgery point in a few weeks. This message has been consistent from the medical staff. It could take longer, who knows. But, what I do know is that I have to get myself to the best possible point that I can, to give myself every chance of full recovery.
I also know that there can be secondary issues post myelopathy surgery and for those who suffer from the condition, but one big advantage I have was the swift action of the neurosurgeon. It is possible that the early the surgery, immediately after diagnosis, may be a prominent factor in the outcome and return to functionality (4).
Overall, I know I have been lucky to have a lot of supportive people around me. I count my blessings daily, others aren’t as fortunate. I want to live life to the fullest, every day matters and counts. Maybe that wasn’t the perspective I took before, maybe it was, maybe it just wasn’t in the forefront of my thoughts. Who knows?
It’s not always visible, but I have learnt that this is ok – those who mind don’t matter and those who matter don’t mind.
(1) Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976)2015;40:E675-93. doi:10.1097/BRS.0000000000000913 pmid:25839387CrossRefPubMedGoogle Scholar
(2) Davies B M, Mowforth O D, Smith E K, Kotter M R. Degenerative cervical myelopathy BMJ 2018; 360 :k186 doi:10.1136/bmj.k186
(4) Feng, S., et al. (2021). “A systematic review and meta-analysis compare surgical treatment and conservative treatment in patients with cervical spondylotic myelopathy.” Annals of Palliative Medicine 10(7): 7671-7680.
In Carl Sagan’s book, The Demon-Haunted World, his essay ‘The Fine Art of Baloney Detection’ delivers his ‘detection kit’ against pseudoscience, something we have very likely become very accustomed too in recent times.,
Sagan, an astronomer, was an advocate of scientific skepticism (sometimes known as rational skepticism). Advocates of scientific skepticism take the stance that empirical knowledge is gained through empirical investigation of reality, and therefore the scientific method of inquiry is the best way to attain this.
Sagan sought to popularise science and improve public understanding of science. Sagan, adopted his position of scientific scepticism, opposing pseudoscience and its lack of scientific inquiry.
In his book, Sagan devised his suggestions about the “tools” that the skeptic should arm themselves with in their Baloney Detection Kit. The kit, Sagan argued, is built on the fundamentals of scientific skepticism.
According to Sagan, by reviewing the evidence behind a claim, and being able to spot fallacious or fraudulent arguments, is the best way to dismiss baloney (pseudoscience).
In his detection kit, Sagan suggestions don’t just provide tools to identify bad arguments, they also allow for the creations of better alternatives.
As put by Sagan himself:
“What skeptical thinking boils down to is the means to construct, and to understand, a reasoned argument and—especially important—to recognise a fallacious or fraudulent argument.
The question is not whether we like the conclusion that emerges out of a train of reasoning, but whether the conclusion follows from the premise or starting point and whether that premise is true”
1 Sport and Exercise Scientist, PhD student, Tacoma, Washington, United States of America.
Introduction & Aim
Change is ever present. It is a constant in life as we evolve and adapt as human beings. Change itself is often viewed as inherent by sporting organizations as the demand for continual improvement and success increases (Wagstaff et al., 2015). However, like the connections between individuals, change is multifaceted, non-linear, and fluidly evolves (Slater et al., 2015).
The world of elite soccer has become accustomed to change at regular intervals. According to the League Managers Association (LMA), and between 2005 – 2018, a total of 540 managers were dismissed, or resigned, across all four divisions in English soccer (LMA, 2018). Furthermore, only 40% of first-time managers make it to the 75-game mark, 50% of first-time managers are dismissed and do not get another management position. While it is typical of any organization to experience turbulent times and unexpected changes, there is often a higher instance of change, and the subsequent uncertainty, in elite sport due to the high demands for success, both demonstrable and sustained, from key organizational stakeholders (Fasey et al., 2021; Wagstaff et al., 2016).
Whilst there is a paucity of literature investigating organizational change in elite sport, early research has widely focussed on the negative impact of change and repeated change within sport organizations (Gilmore, 2009; Wagstaff et al., 2015; Wagstaff et al., 2016). Thus, the aim of this opinion article is to explore the current literature on organizational change on sports science and medicine teams (SSM) within the elite soccer domain.
Early literature on the effect of managerial change and team performance has led to mixed conclusions (Audas et al., 2002). However, it could be argued, from an organizational perspective, that a sporting organization is often unconventional, chaotic, and not typical of business practice. Indeed, working practice within elite soccer has been criticised within the literature with poor employment practices identified nearly 20 years ago by Waddington et al., (2001).
Thus, an elite sporting environment could be described as volatile, with management change often at the discretion of owners or stakeholders who demand the sustained sporting success and performance of the organization. (Fletcher & Wagstaff, 2009; Wagstaff et al., 2015). In this respect, the high turnover of managerial staff within English football may be explained by the constant demand for sustainable performance (Wagstaff et al., 2015). Whilst there has been an evolution in the creation of SSM departments within professional soccer clubs over the last two decades there is still a large degree of vulnerability for practitioners within the volatile climate in which they operate (Wagstaff et al., 2015).
Over a relatively short period of time, the impact that sports science & medicine-related factors can have on elite performance, has led to an exponential growth in elite soccer ‘support staff’. Thus, leading to many elite sporting organizations to increase, invest and enhance their teams of performance related staff, with the aim of seeking competitive advantages for their athletes. (Arnold et al., 2017; Gilmore & Gilson., 2007; Gilmore et al., 2017; Wagstaff et al., 2015; Wagstaff et al., 2016).
However, due to the innovations and the vast expansion of sports science and medicine (SSM) staff within elite sports environment, the levels of complexity and structure have also increased (Slater et al., 2015). Despite the somewhat exponential growth in the “team behind the team”, the domain of SSM within elite sport may remain a volatile one (Fletcher and Wagstaff., 2015). Thus, with the constant threat of change and/or repeated change to practitioners, the effect of this organizational disruption to SSM staff and their subsequent departments may be of interest to key stakeholders.
Given the volatility of the professional domain, and the demands of success from key stakeholders within the organization, it is common that within changes to the coaching and managerial staff, changes may occur further within the SSM personnel. (Fletcher and Wagstaff, 2015). However, the responses of staff members, from an emotional and attitudinal perspective, during a period, or periods, of organizational change may play a large, and somewhat significant, role in the effectiveness and the subsequent success of the change process (Liu & Perrewe, 2005). Thus, the efficient and effective implementation of change is required for successful performance across a variety of domains (Cruickshank and Collins, 2012).
Humans, by nature, are social creatures. Whilst humanity has evolved to be self-dependent, it has been suggested that a key characteristic of humans is indeed that of group membership (Forsyth & Burnett, 2010). However, athletes, coaches and managers do not function in isolation and the behaviours displayed by each subgroup may influence the other groups within the sporting organization environment (Martin et al., 2014). Indeed, early work by Carron (1980) has suggested that to understand individual behaviour, we must focus on the behaviours that occur within the group. This is congruent with the social identity theory (Tajfel & Turner, 1979), suggesting that an individual’s social identity reflects their internalization of group membership.
As an extension of theory, the social identity approach is the culmination of both the Social Identity Theory (Tajfel and Turner, 1979) and Self-Categorization Theory (Turner et al., 1987). Thus, the social identity approach suggests that behaviour that is based on an individual’s personal identity, fundamentally differs from the behavior of the individual’s social identity (the group). Furthermore, recent literature by Haslam (2014) acknowledged that “there is now a colossal literature that speaks of the importance of internalized group memberships for peoples’ sense of self, for their psychology more generally, and for their behaviour”.
A key tenet of the social identity approach is the contention that in social environments an individual defines themselves with a personal identity (‘I’, ‘me’) and as that of group members, or social identity, (‘we’ and ‘us’)(Slater et al., 2016). For example, an individual may define themselves within the realms of a specific social identity (e.g, the SSM team). However, when this specific social identity is relevant, within a given situation, an individual will see themselves and other members of the same group (ingroup) as somewhat interchangeable. Subsequently, this may lead to the exaggeration of differences between the ingroup and those who do not belong in this group (outgroup, e.g, coaches, technical staff etc).
Furthermore, when there is cohesion and salience within the ingroup, the group members may share the same perspective, with the emergence of group norms. Thus, this may see a collaboration with the ingroup to achieve any specific outcomes or professional goals.
Within a sporting organization, the social identity approach may appear in the form of a group (the team) and subsequently further groups (e.g., coaches, management, sports science, medical). An extension of this may include the development of sub-groups, which are often departmental in nature. For example, within the support staff, a club may employ a group of multi-disciplinary staff (sports science, strength & conditioning and medical) as part of the organization.
Therefore, it could be speculated that a subgroup of the team may be that of the SSM department.
However, it is worth noting, that depending on staffing levels within the organization, further sub-groups could appear from an interdisciplinary perspective (a group of sports scientists, a group of strength and conditioning, and a group of medical staff). Thus, recent literature by Slater et al., (2016) has suggested that group membership may be disrupted by change within the organization, which may have implications on individual, group, and subsequently organizational levels.
The functioning of the SSM team is one that is complex in nature. Adding to this complexity is the ever-changing demands on the SSM team. However, the functioning of groups within the elite soccer environment, and drawn from the social identity approach, may be of interest to those considering change. As proposed by Slater et al., (2016), the functioning of any internalized group may be disrupted during times of change. Subsequently, this may lead to greater implications for the individual, the group, and the organization. Thus, bringing further complexity to the operation of the SSM team on a wider scale, that may indirectly have an influence on-field performance.
Thus, understanding the social identity approach may be of value to key stakeholders, department leaders and practitioners during times of change. In essence, the social identity approach may assist with the fundamental understanding of both individual and group behaviour (Slater et al., 2016; Turner et al., 1987; Tajfel and Turner, 1979).
As the social identity approach describes both the individual and social identities of a person’s behaviour, Slater et al., (2016) suggests the criticality in the development of psychological belonging between individuals during time of change. By developing individuals to have a shared identity, an attachment to the organization or team, the individuals think and behave in a manner that compliments the group. Thus, by understanding the social identity approach and its influence on the individuals and the group, there may be clear advantages for key stakeholders and SSM staff during times of change.
Practitioner experiences of change.
Recent literature by Wagstaff et al., (2015) examined the longitudinal experiences of 20 SSM staff in 3 organizations (cricket and soccer), across a two-year period. Thus, the authors highlighted the potentially negative cost of organizational change on SSM’s working practice, within the elite sporting domain, and the subsequent effect on on-field performance. Therefore, disruption to the areas within the realms of SSM, (psychology, performance analysis, rehabilitation, fitness, medical), during organizational change, may indirectly impact or influence performance on the field.
The strength of this work by Wagstaff and colleagues is the longitudinal study design. Thus, this has allowed the authors to collate the experiences, thoughts, and behaviours of SSM practitioners as the change process occurred. Drawing on their conclusions, the Wagstaff et al., (2015) suggested that change occurred over four stages: anticipation and uncertainty; upheaval and realization; integration and experimentation; normalization and learning (Figure 1).
Later work by Wagstaff et al., (2016) investigated repeated organizational changes in the English Premier League (EPL). Participants (n=20) were sampled from two EPL clubs across various domains (sports science/ strength and conditioning, technical coaches, players and medical). While the sample size is low, one key strength of this study is the participants had encountered an average of 4.2 changes within the current working practices. Thus, demonstrating some relevance to the LMA (2018) data regarding managerial change statistics in elite English soccer.
Subsequently, the findings presented participants responded to repeated change both positively and negatively. However, the data suggested that repeated change was met with more negative connotations than positive. Despite some positivity during periods of change, such as personal development and growth, there are significant negative consequences, such as the weakening of emotional ties between employee and organization. Thus, during repeated organizational change there may be a decline in trust and subsequent increase in cynicism towards those who instigate change (Wagstaff et al., 2016).
At present, only one study has investigated the effect of change in elite soccer and the subsequent deinstitutionalisation of staff. (Gilmore and Sillince, 2014). Drawing on the principles of institutional theory, the longitudinal case study (2003-2011) investigated an EPL’s team (Club X) sports science team and the subsequent deinstitutionalisation post managerial change. The development and implementation by Club X of an SSM department was arguably seen as revolutionary given the club’s financial constraints at the beginning of Manager A’s terenure in 1999. One notable key aspect noted by the authors was the homogeneity between the group of sports science staff. Which is congruent with the social identity approach previously discussed. However, when Manager A departed in 2007, a change in staff was observed with some SSM staff joining the manager at his new club and some SSM staff departing for other clubs within the EPL.
Subsequently, with the introduction of a new manager, the deinstitutionalisation of the SSM department occurred within a six month period. The authors identified four key categories in which the deinstitutionalisation process occurred: asserting dominant institutional logics; reconfiguring institutional vocabularies and the contents of conversation; destabilizing the affective environment, and the disruption of a community of practice (Figure 2).
However, whilst it could be surmised that the creation of an SSM department by Manager A was seen to be a key in maintaining and sustaining performance in the EPL, this may have created the subsequent institutionalization. Thus, the departing of Manager A (and his performance staff), and the lack of interest in sports science by his replacement, may have led to the rapid deinstitutionalisation of the department. Therefore, continuity of key staff and practices may be of salience during times of change to preserve or maintain the group dynamics of SSM departments.
Whilst change is inevitable at some point during the SSM practitioners career the author supports the call for sport organizations, senior leadership, practitioners and potential practitioners and academic institutions (Wagstaff et al., 2015; Wagstaff et al., 2016) to consider the realities of staff turnover and the prevalence and subsequent effect on SSM departments during organizational change within elite soccer.
Thus, it could be postulated that within an elite soccer organization there are various groups, and possible sub-groups that may experience change and/or repeated change throughout their careers. An understanding of these groups may provide valuable insight to key stakeholders into the working practice, particularly of SSM practitioners, during times of change.
Due to the paucity of literature on organizational change and consequences in elite soccer, by gaining a fundamental knowledge of individual and group dynamics, alongside the positive and negative implications of change and repeated change on SSM practitioners, both SSM departments and key stakeholders may be able to navigate change successfully, whilst maintaining the identities of both practitioners and departments.
Subsequently, while more research is required, the understanding of change and associated effects, may further assist in the stabilization of on-field performance through departmental continuity and avoid any potential deinstitutionalisation which may prove costly.
2. Wagstaff C, Gilmore S, Thelwell R. When the Show must Go On: Investigating Repeated Organizational Change in Elite Sport. Journal of Change Management. 2016;16(1):38-54.
3. Gilmore S, Sillince J. Institutional theory and change: the deinstitutionalisation of sports science at Club X. Journal of Organizational Change Management. 2014;27(2):314-330.
4. Slater M, Evans A, Turner M. Implementing a Social Identity Approach for Effective Change Management. Journal of Change Management. 2015;16(1):18-37.
5. Wagstaff C, Gilmore S, Thelwell R. Sport medicine and sport science practitioners’ experiences of organizational change. Scandinavian Journal of Medicine & Science in Sports. 2014;25(5):685-698.
6. Fasey K, Sarkar M, Wagstaff C, Johnston J. Defining and characterizing organizational resilience in elite sport. Psychology of Sport and Exercise. 2021;52:101834.
7. Audas R, Dobson S, Goddard J. The impact of managerial change on team performance in professional sports. Journal of Economics and Business. 2002;54(6):633-650.
8. Waddington I. Methods of appointment and qualifications of club doctors and physiotherapists in English professional football: some problems and issues. British Journal of Sports Medicine. 2001;35(1):48-53.
9. Fletcher D, Wagstaff C. Organizational psychology in elite sport: Its emergence, application and future. Psychology of Sport and Exercise. 2009;10(4):427-434.
10. Gilmore S. The Importance of Asset Maximisation in Football: Towards the Long-Term Gestation and Maintenance of Sustained High Performance. International Journal of Sports Science & Coaching. 2009;4(4):465-488.
11. Arnold R, Collington S, Manley H, Rees S, Soanes J, Williams M. “The Team Behind the Team”: Exploring the Organizational Stressor Experiences of Sport Science and Management Staff in Elite Sport. Journal of Applied Sport Psychology. 2017;31(1):7-26.
12. Gilmore S, Gilson C. Finding form: elite sports and the business of change. Journal of Organizational Change Management. 2007;20(3):409-428.
13. Gilmore S, Wagstaff C, Smith J. Sports Psychology in the English Premier League: ‘It Feels Precarious and is Precarious’. Work, Employment and Society. 2017;32(2):426-435.
14. Liu Y, Perrewé P. Another look at the role of emotion in the organizational change: A process model. Human Resource Management Review. 2005;15(4):263-280.
15. Cruickshank A, Collins D. Culture Change in Elite Sport Performance Teams: Examining and Advancing Effectiveness in the New Era. Journal of Applied Sport Psychology. 2012;24(3):338-355.
16. Forsyth, D. R., & Burnette, J. (2010). Group processes. In R. F. Baumeister & E. J. Finkel (Eds.), Advanced social psychology: The state of the science (pp. 495–534). Oxford University Press.
17. Tajfel, H., & Turner, J. C. (1979). An integrative theory of intergroup conflict. In W. G. Austin, & S. Worchel (Eds.), The social psychology of intergroup relations (pp. 33-37). Monterey, CA: Brooks/Cole.
18. Carrón, A.V. (1980). Social psychology of sport. Ithaca NY: Movement
19. Alexander Haslam S. Making good theory practical: Five lessons for an Applied Social Identity Approach to challenges of organizational, health, and clinical psychology. British Journal of Social Psychology. 2014;53(1):1-20.
20. Martin L, Bruner M, Eys M, Spink K. The social environment in sport: selected topics. International Review of Sport and Exercise Psychology. 2014;7(1):87-105.
21. Turner J, Hogg M, Oakes P, Reicher S, Wetherell M. Rediscovering the Social Group: A Self-Categorization Theory. Contemporary Sociology. 1989;18(4):645.
Conflicts of Interest
The author declares no potential conflict of interest.
“One trip or fall, one heavy blow to the head and it could leave you in a chair, or even worse, not with us anymore”. Those words will stay with me forever.
Booking in for surgery the clerk turned to me and said “You are too young for this”. I didn’t have time to take that in, but it was profound.
The 19th February 2021 is a day I wont forget. 6am, 6,000 miles from home and ready for emergency surgery. That’s when things hit me. Into a surgical gown, stripped of all my possessions and surrounded by medical staff. “Let us check your mouth, you will have a breathing tube…. let me just mark the spot for the incision”.
Let’s rewind a month earlier. Waking up with a pain along my left arm, that I can only describe as an intense burning. Throwing ice onto my arm to relive the heat, the pain. No feeling in my left hand. I knew something was up, this pain can’t be possible. Is it a trapped nerve? Yeah, probably. It will pass.
I saw the doctor as soon as I could and he gave me some strong prescription painkillers. Everything will be fine in a few hours I thought. Those hours turned into a day or two, then a week. Still the excruciating pain. Icing my arm every morning, mid-winter and joking I could heat a small city. The thing was, and little did I know, this was no laughing matter.
At the beginning of February I visited the doctor again still in extreme pain and discomfort. Aside from changing my medication, he ordered an X-ray. I had my blood pressure taken, which was 150/100. I knew this was concerning. The X-ray results were back quickly and were showing some damage to my cervical spine, degenerative disc disease. “Ok, so a slipped disc” I thought.
I went to see the doctor to discuss the results, my blood pressure was still significantly high. The doctor said he would order an MRI immediately. Two days later I was in the tunnel having my scan.
The results came around quickly and I had access to them. “Severe spinal canal stenosis with subtle abnormal cord signal in keeping with focal myelomalacia”.
Ok. What’s this then? Myelomalacia? That’s new to me. So I did the worst thing – and googled it…
Myelomalacia is a pathological term referring to the softening of the spinal cord…There is no known treatment to reverse nerve damage due to myelomalacia. In some cases, surgery to allieviate the injury to the area may slow or stop further damage. As motor function degenerates, muscle spasticity and atrophy may occur”
Wow. I don’t trust googling medical conditions, but this hit me hard. So I called the doctor. “Come in Wednesday and we will take a look”.
I went in to see the doctor again and my blood pressure was highly elevated, 159/109. Immediately I was prescribed some blood pressure drugs. It was concerning both myself and the doctor, I’m 44 years old, I don’t carry much weight and exercise regularly (aside of my working practice!). How can this be?
A few days later the pain had become worse and worse. What was more evident though was my forgetfulness, clumsiness and dropping everything I tried to pick up. I remember trying to put the keys in my apartment door and dropping them on the floor. I couldn’t even feel them to pick them up. Opening the door and stumbling into my apartment. Surely this can’t be right? What is happening to me? I’ve just turned 44 years old, surely this can’t be happening. But it was, at an alarming rate and deteriorating rapidly.
A day or so later the doctor called me to tell me I needed to see a consultant neurosurgeon in Seattle immediately. On Wednesday 17th February I visited the consultant. At first I saw a nurse who took my vitals. My blood pressure was still high, very high indeed. The nurse did a few manual muscle tests and then opened my MRI. “Oh God” where her words. I won’t forget that. Ever.
“Let me get the Dr.” she said. Within a few minutes the consultant came in and started some testing. “Stand over there and close your eyes” he said “now walk towards me”.
Then he sat me down. “We have to operate immediately, as a matter of emergency” he said. “Why? What’s up?” I said. Then there was a silence that seemed and eternity, but was probably a matter of seconds.
“This is an emergency procedure for a cervical myelopathy. The rate you are declining is of huge concern. We need to operate to take the pressure off your spinal cord”. Right there in that moment, I had no idea what to think. I asked when they needed to operate. “Friday morning, 6am”. Wow. “What next?” I asked tentatively. “Tomorrow you will need to come back here, we will do some tests and talk you through the procedure”.
Myelopathy describes any neurologic symptoms related to the spinal cord and is a serious condition. It occurs from spinal stenosis that causes pressure on the spinal cord. If untreated, this can lead to significant and permanent nerve damage including paralysis and death.
I left the hospital in some form of shock, but didn’t really feel any emotion. The first thing I did was call my parents back in the UK. Both of them were silent when I explained I needed an operation in less than 48 hours. I then called my club to let them know what was happening. They were just as shocked as my parents.
The next day I went back to the hospital in Seattle. It still hadn’t sunk in what was happening. The nurses took my blood pressure, which was still high, and then did some COVID testing. Pretty standard in 2021. Then the nurse who had been with the Dr. the day before came in. I don’t really remember too much of the conversation, as she outlined the potential risks of the surgery. “Spinal cord fluid leak, paralysis and unfortunately, death”. Wow. I though the operations was going to help was my thoughts.
I left the hospital and went to see the team in a friendly match. I started to hit me what was going to happen the next morning. The staff and players wished me luck. And that was it, I didn’t know when I would see them again.
That night I hardly slept. Every thought in the world went through my mind. ‘who’s going to let my parents know?’, “will everything be ok at work?’, ‘what about the players and staff?’. I would be lucky if I slept at all that night.
5am the next morning I was collected by our Director of Rehab, Nicole. I probably spoke absolute rubbish the whole way, but the nerves were pretty evident. Nicole dropped me outside and that was it. I walked into the hospital entrance, past a man and a metal detector and walked towards the lift.
I arrived at the admissions desk, which somehow felt like a basement. There were probably 20 other patients next too me. At that point I decided to reveal on my social media that I was having emergency surgery. My phone was red hot, so many lovely messages, but not much time to reply.
A nurse appeared and called out my name. I remember walking along a corridor and into a cubicle. That was it. Clothes off, gown on, X marks the spot on my throat. I remember a few nurses coming in and a couple of neurosurgeons, they explained the operation. “We are going to remove two cervical discs, add in a cadaver bone graft and then fuse your spine with a plate & screws”. Now it was getting real. There were tubes coming from my arms, both sides. All my clothes and possessions were put in a bag, labelled and taken away. The last thing I remember is being wheeled out the cubicle.
“Andrew, Andrew, can you hear me?”. Who the hell is that was my first thought. “Andrew, it’s the nurse. You are out of surgery now”. The whole operation, from what I know, took a few hours. There were no complications.
I was taken for a scan to check the surgeons work. All I remember was being cold and sleepy. Then I was taken to my ward.
Once I was comfortable on the ward, I managed to FaceTime a few friends and my family. I couldn’t talk much (I actually didn’t know I had a drain tube coming out my throat!). However, I didn’t sleep at all that night. I sat up until 6am, there was no chance of sleeping with the nurses in every hour, and the amount of medication I was on.
The next morning the Neurosurgeon visited me. “The operation was very successful”. I was relieved and grateful. The pain had gone, but I still couldn’t feel my hands. He had already told me there was no guarantee this will ever return. 6 weeks later and I still don’t have that feeling back.
The medical staff informed me that would keep me in for another night. If I was well enough, I could go home after two days in hospital. I live on my own which concerned them, but one of my colleagues was coming to check on me daily to change my dressing and observe. This was pleasing enough for the hospital staff and I was discharged the next day.
For the next week or so I was so heavily medicated that I really had no idea what day it was. I just wanted to sleep and recover. Even six weeks on, there is still some fatigue (afternoons seem worse) and my sleep was literally ruined for four weeks or so.
A couple of weeks ago, and after my first check up, I began my rehab programme. Slow and steady is the key. Gradually build myself back up. I lost 2kgs, mainly of muscle mass, during my time in pain. I can’t lift, and my left scapula is severely winged due to the lack of innervation on that side. I have to be very careful with sharp, sudden movements to my head.
I managed to get back to my job eventually, although for such a physically demanding job, I’m very much restricted (making it difficult to demo anything at all!). I’m lucky to have such great colleagues and players at my club. Everyone has been so supportive & willing to help out, both personally and professionally.
Despite being six weeks post surgery I’m still not out the woods. The doctors warned that while they have alleviated the immediate (and pain causing) issue, there is a chance that the bone fusion won’t occur. There is also the prospect of further surgery if things don’t hold up in there.
The doctors told me I am reasonably lucky that we managed to spot the condition early. The majority of patients they see are so far gone their loss of motor control means they cannot control their bladder and bowels. The doctor was complimentary that I recognised something was wrong. It wasn’t just me though, my colleagues had realised something wasn’t right, the clumsiness, the forgetfulness, the blood pressure – things didn’t add up, and they were onto it immediately. Trying to demonstrate a skipping motion during a warm up I fell to the floor. This was before the condition was diagnosed, but made sense. I couldn’t control a simple movement like that.
Of course, everything has come at a cost. The appointments and surgery has left me with a six figure medical bill. Even with insurance (thankfully!), I still need to find a five figure sum to pay the bills. Insurance covered the majority, but I am still liable for some of the costs, and thats after the excess had been paid. Somehow, I’ll figure a way to settle the medical bill. My collector’s item Jordan 4s and some of my signed shirts may need to be traded, but they are material things, I cant trade my health.
Throughout this experience though I have learn’t many lessons. Life is so precious. There are people in far worse positions in this world than me. Some have poor health and no roof over their heads. The pandemic has cost people their livelihoods, while I am blessed to work with incredible staff and players and continued to work throughout the pandemic.
I guess as they say, what doesn’t kill you makes you stronger. However, the last few months have taught me so much. I haven’t seen my family since Dec 2019, but I have good people around who have gone above and beyond to help and comfort me.
I am still human though. There are good days and bad days, I can’t deny that. Some days are comfortable, some are uncomfortable. It can be a easy to ignore these feelings and emotions, its all part of a process. The body is still healing, the mind is trying to make sense of it all. I try not to get overwhelmed or frustrated. I’ve always been a hands on person. Some might think I’m just a data guy, and thats an easy assumption, but I love problem-solving, finding solutions, getting creative with drill design and getting the best out of players physically whilst having fun ( a few players may disagree haha!)
I’m still recovering, although I have spent lots of time being deeply reflective and with introspection. I can’t control a lot of things and it’s pointless trying, but what I can control is how I face the challenges in this moment, and that will inevitably arise. Without challenge there is no progress, in life or sport.
Despite these challenges, I am still here to tell the tale and still doing my best to keep smiling.
99 Healthy is not 100% Injured. There is always something you can do, something you can do to get better, to improve in one area or another. Whether it’s physically, mentally, academically, it may not seem it at the time, but injury provides opportunity.
Nothing lasts forever.
There are still so many people I need to thank from everyone at OL Reign, Statsports, USSF, and all my friends and family back in the UK & Ireland. Your support has been invaluable, I won’t forget it x
2020 was one hell of a year. For many it was a very, very difficult year. The beginning of 2021 has already seen political scenes we may never witness again.
Throughout all of this turmoil we have seen mountains, upon mountains, of information. Social media becoming prominent source of information, sometimes good, sometimes not so good (as I write this Twitter has banned a Donald Trump).
From believers, non-believers, pro-vaccine, anti-vaccine, conspiracy theorists etc etc, it can become a minefield for anyone seeking facts. It can be overwhelming and somewhat confusing to separate the facts from the bullsh*t.
The aim of this blog is to explain what the difference in terms and terminology used between opinions, facts, biases.
A fact is a truth, or statement of truth, that can be supported or verified by evidence. It is a truth about events that is not someones interpretation or opinion.
A statement is a point of view that is based on beliefs, values, emotions or personal perspective. Of course, everyone has an opinion and are fully entitled to it. However, a person’s opinion can be supported or dismissed when the facts are presented (generally through critical thinking).
Its key to know the difference between fact, opinion and bullsh*t. There is so much of it out there it can be harmful, dangerous and spread very, very quickly. However, bullsh*t is different from a lie, which is just that a lie. As defined by Bergstrom and West (2020).
Bullshit involves language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence.
I’d also highly recommend the authors free course “Calling Bullshit: Data Reasoning in a digital world.
The scientific method and scientific inquiry:
Broadly speaking, scientists will generate a hypothesis based on the relationship between variables. A hypothesis is essentially a proposed explanation of a phenomenon. For example: there may be a relationship (correlation) between X & Y. But does X cause Y? Or why does X cause a change in Y?
Thus, scientists will take an educated guess (research hypothesis) about the relationships of the variables within their research study.
However, a null hypothesis maybe formed and accepted when the research does not accept or refute the research hypothesis.
Types of Bias
A bias, is simply the tendency of a human to have a positivetendency or inclination for something/someone, or perhaps a negativetendency or inclination against something/someone.
The concept of cognitive bias was first introduced by researchers Amos Tversky and Daniel Kahneman in 1972. Cognitive Biasesare limitations in objective thinking by seeing things through personal experiences and perceptions.
Below are some examples:
Groupthink bias: the tendency to put value on consensus, thus not thinking independently. A group will favour harmony, cohesiveness and agreement, as opposed to a lack of harmony and/or conflict.
Confirmation bias: The tendency to support new ideas or accept things that are consistent and congruent with their already held thoughts, beliefs, and opinions.
Overconfidence bias: This bias appears when someone is inherently biased towards their own perspectives and opinions. They may hold the belief that they are the only expert that ever exists and everyone else is dumb. A small bit of knowledge can be a very dangerous thing.
Dunning-Kruger Effect: This is when people who believe that they are smarter and more capable than they really are. For example, they are too stupid to realise how stupid they are.
The halo effect: when a the initial perspective of an individual (such as a first impression) tends to cloud the judgement of the individual as a whole. Therefore, it becomes difficult to re-think that perspective of an individual based on new or opposing information.
The horn effect: The opposite of the halo effect. The horn effect is when someone demonstrates a negative attitude or set of behaviours towards another based on their appearance or character.
The last few months have seen some challenging circumstances, both in life and sport.
Periods of deep uncertainty that have, at times, shown no promise of an end in sight. Colossal life challenges, comparisons with war time, lockdowns, and not forgetting those who have tragically lost their lives.
Whatever the outcome in the future, the past few months have undoubtedly changed our worlds – forever.
Whether we see it or not, there are many parallels that can be drawn between life and sport. Teamwork, camaraderie, a fast paced and dynamic environment, where thinking fast, and slow, can help determine the outcome we strive for, whatever that may be.
As a performance scientist, the current challenges within the profession are like nothing we’ve ever experienced, and it’s likely we will never see them again. But, it has also been a time of great reflection.
The game of football (soccer) is relatively simple, and adored by billions globally. Two teams attempt to kick a spherical object into a designated area, more times than the other team to win.
Paradoxically though, performance science is a multitude of complexities that may (or may not!) have a role in increasing the probability of winning.
In his book Behave Robert Sapolsky , discusses how when we are faced with multifaceted and complex phenomena such as human behaviour, we use a certain cognitive strategy to break down the individual facets into buckets of explanation. This leads us to categorical thinking.
For example, let’s take Lionel Messi vs Xavi and their ‘work rate’ as discussed by Fergus Connolly’s in his excellent Game Changer book, and was the feature of Isaiah Cambron’s 2013 article for Barcelona Football Blog.
Whilst comparing distances covered by certain players over a few games, Cambron noted that Messi covered 44,027m in 482 minutes, scored five goals and further contributed with three assists. However Xavi, the midfield genius, contributed with 56,552m in 441 minutes. If using total distance as the only metric, then Messi would be preferred player over Xavi. Messi appears to have played more minutes, but seemingly less ‘work’.
Dig a little deeper and contextualise these statistics, and a different picture emerges. Divide Messi’s lower distance by the higher number of goals and assists – and he is by far the more effective and efficient player. Furthermore, Messi’s m/min (91.34) was less than that of Fabregas (136.88), Jordi Alba (131.31) and many others. Over the same period of time, the only goalkeeper in the analysis by Cambron, was Celtic’s Fraser Forster who incidentally, covered 32,671m and 50 m/min respectively. Make of that what you want.
This poses a question – if we work in buckets or silos as performance staff – are we missing vital clues within the performance puzzle? Do we end up becoming victims of categorical thinking?
Sapolsky argues that it is no bad thing to put facts into these “demarcated buckets of explanation” as it can indeed help you better remember the facts. However, as he explains, it can also wreak havoc in your thinking about the facts.
As the past few months have progressed working procedures have changed exponentially, we are in the somewhat unknown as to when or how, or even if, respective seasons across the world will restart.
This has led to many challenges. We have seen so much uncertainty in our daily lives, and those of our players, you would think that uncertainty doesn’t exist. But it does. The world is uncertain, sport is uncertain. Science doesn’t give us all the answers, but it does allow us to somewhat reduce uncertainty.
It is human nature to avoid uncertainty in the best way possible, even if this leads to us being wrong. Certainty is a comfortable place to be. We want to be comfortable. We are, after all , simply human.
However, working with athletes in these times, and the potential restart of some leagues has left us with a risk factor too. Just to add to our woes!
But the world is generally full of uncertainties, and it has changed in many ways since the COVID19 outbreak began in late 2019.
When we consider risk, we assume to know all of the facts, the consequences of our actions, or maybe those of others and/or alternative ways of working to minimise risk to our players when bring them back into training/match scenarios. It’s like starting again, with maybe a higher risk because of the lack of training time in the last few months, which brings uncertainty to the table. Who knows?
As practitioners, this world of uncertainty brings a sense of many unknown unknowns. Risk we look to minimize, whatever it may be. Uncertainty, as the last few months has shown, has given us other things to think about. Things have happened unexpectedly, maybe I was naive, but personally I didn’t think it would take this long.
Maybe I have been lucky, here in Utah, and should count my blessings that I haven’t been in London or NY, where lockdown has been the norm for the last 6-8 weeks or so.
During the uncertainty, it has been nigh on impossible to calculate the exact risk to our players. There are now, more than ever, variables/risks that we would have probably never considered 6 months ago. But we still need to make decisions. Based on what we know, and what we don’t know – and that is no mean feat at all.
Whatever uncertainties or risks we face in the coming weeks/months, it us down to us practitioners to continue to provide the our players with the best possible environment to flourish. As difficult as the past few months have been, we must understand the risk or uncertainty that is involved in the coming weeks and months. This will involve many decisions, some that we may never thought of before.
When we know the risks, we can make informed choices based on logical and statistical thinking. When the risks are unknown, and uncertainty is paramount, then heuristics and intuition may drive the decision process.
However, if the last few months has taught me one thing, it’s that decisions aren’t really made one or the other, but more likely to be that of both risk and uncertainty.
Thus, working outside of silos, decreasing categorical thinking and coming together to become one team, may just help with the risk and uncertainty that we have been facing, and at present continue to face.