Johan Cruyff used to say that “football is a game you play with your brain.” During a match there are a huge number of situations and stimuli that must be processed by the football player’s mind. Their overall performance depends a great deal on how they respond to these, hence the best players are those who not only have the skill and tactical knowledge of the game, but who also have enough mental abilities to outplay the rest. These abilities, although not yet fully appreciated, are already considered a relevant part of performance. But their importance could go beyond that: Do they also influence the injury risk, including recurrence, once the player returns to play? This is the main idea put forward in an editorial in the magazine Apunts.Medicina de l’Esport, in which Ricard Pruna, Head of Medical Services at F.C. Barcelona, participated.

Mental ability strategies

Intelligence in the game includes many parameters. For example: reaction time, memory, anticipation, perception of time and space, attention, and the ability to take decisions. Many of these—especially the latter—are disrupted in situations of prolonged stress, and various studies have observed that injury risk is also significantly increased. In fact, a decrease in cognitive performance can lead to changes in biomechanics and in the correct execution of actions during a game.

 “When we speak of mental abilities, we are referring to both abilities for perceiving stimuli (visual, sound), and cognitive abilities that imply a more integrated process for the formation of patterns resulting from those stimuli,” explains Pruna. The article offers different strategies at different levels to enhance these abilities, thereby increasing performance and reducing the injury risk.

It is important for players to train not only attention, but also the ability to shift their attention. In a game, there are situations where players must focus their attention on very broad areas and others where they must concentrate on much more limited ones. It is also necessary to pay special attention to the emotional state, both on and off the field. The probability of injury is more frequent in players who feel depressed, upset or who suffer from homesickness. For matches, tools can be provided that are based on internal dialog—with words or “trigger” phrases, for example—that allow negative thoughts to be set aside or periods of mental rest to be achieved. It can also be beneficial to implement visualization and relaxation strategies. Visualizations help form memories of physical patterns. Relaxation can be useful in multiple contexts, related to both competing and recovering from injuries. Even attention to pain can at times be beneficial. Although competing with pain is traditionally viewed as something positive, correctly managing attention to pain, both during recovery and during the game itself, can improve self-calibration of risk. There is still no solid evidence on the usefulness of these techniques, but there are indications. Among these is a Swedish study that set out to evaluate several of the aforementioned principles. Thirty-two high-level players were selected who, according to their psychosocial status, could present a higher injury risk. Half of them underwent an intervention program to train six mental skills, including attention, relaxation and stress management, in 6 – 8 sessions distributed over 4 – 5 months. During that time, there were only three injuries in three of those players, compared to the 21 injuries suffered by the 13 players who did not receive the program.

What are we doing at F.C. Barcelona

Several of these principles are being applied by the club’s medical services, especially during recovery from injuries. “We use random light circuits that produce an overload or a cascade of stimuli to train attention,” explains Pruna. “We also use visualization techniques, proprioception and positive mood stimuli.” To study physiological stress, “we use GPS devices to measure the external load applied, and we also measure the internal load with the perceived exertion evaluation method approved by UEFA or with blood indicators of fatigue, such as ferritin and interleukin-1, among others.” When applying these tools, the profile of the player is also taken into account. “There are players that we call field-independent,” says Pruna. “They are very creative and have a great capacity to generate patterns of action. On the other hand, there are also field-dependent players: these are less creative and tend to copy other players’ patterns. They need more emphasis on training attention and visualization during recovery so that they do not lose abilities and to reduce the injury risk when returning to competition.” “In the club we have very low injury recurrence and we think the attention we give to these skills may be partially responsible for that. The incorporation of these techniques in the recovery process supports the idea that they influence injury risk. They also allow players to return to play with high performance levels right from the start,” concludes Pruna.     The Barça Innovation Hub team