The World Cup: Back To Basics…
A reflection on the CP World Cup 2022, by Steven Conlan
22nd March 2023
In this blog I will reflect and share some insights, views, and training methods from my time at the World Cup as Lead S&C coach.
Being a Physical Educator and used to an elite mainstream S&C background, November 2021 brought about an exciting, challenging, yet extremely rewarding experience never to be forgotten – The Cerebral Palsy Football World Cup (April 2022, Spain).
What is Cerebral Palsy Football?
Cerebral Palsy (CP) football is a team para-sport that is played 7-a-side on a 70 m × 50 m pitch (goals 5 m × 2 m), where participants must present a permanent neurological impairment of hypertonia, ataxia, or athetosis. [1]
CP football is recognized internationally (e.g. IFCPF World Cup), with 84 countries worldwide across all five International Paralympic Committee (IPC) regions practicing the sport. Essentially a small-sided game, the sport comprises two 30-minute halves (instead of two 45-minute halves). Other rule modifications include the elimination of the offside rule and permitting ‘roll-ins’ in addition to ‘throw-ins’ when the ball goes out of bounds. [2]
CP Player Background
The body function deficiencies experienced by these athletes are provoked by congenital CP or related underlying health conditions (e.g., acquired brain injury), affecting the performance of motor activities. [3]
Some structural muscle differences in people with CP include decreased muscle volume and fibre length, increased intramuscular fat and length of Achilles tendon when compared to able-bodied people. [4] These changes typically induce lower aerobic and anaerobic capacity, also, the lower range of motion may affect balance and mobility. [5] The deficiencies and characteristics identified above were crucial for not just medical staff to understand but technical staff as well as myself in S&C when preparing and prescribing exercise programmes and training.
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Classification/Pre-competition requirements
Currently, CP football classification comprises three sports classes according to the impact of the eligible impairments
on general and football-specific skills performance. [6] Para-footballers are classified as FT1, FT2, or FT3 according to the severity of the activity limitation (i.e., from more to less severe impact), but also considering their functional profile [i.e., bilateral spasticity
or diplegia, overall coordination impairment (i.e., athetosis or ataxia), and unilateral spasticity or hemiplegia].
Each players final class is presented after thorough physical, technical and observational assessments prior to competition – a unique experience to witness. It required long efforts from players during warm conditions, being tested physically in mobile surgeries on their movement patterns, power, balance and reactions followed by speed and agility testing on the pitch.
Due to either worsening medical conditions or perhaps an improvement in physical qualities, some players classifications may change which in result may affect team selection as only so many players of each classification (FT1, FT2 & FT3) are allowed on the field at once thereby requiring all players to have a diverse and flexible skillset as well as high fitness levels.
Testing CP Athletes
From analysing literature, there are three main strength measurements used in athletes with CP: isometric, isokinetic, and functional strength testing.
The isometric-based test measures the power production ability of a muscle group without causing a change in the general muscle-tendon length. Isokinetic, means ‘same speed’ and indicates tests performed at a predefined constant speed [7]. Functional strength testing, I will delve into further, as this was a method I implemented with my athletes in preparation for the World Cup.
It is important to use functional exercises to test the functional performance of the major muscle groups in the body used during exercise. During the initial screening of athletes, I used two testing methods highlighted below:
The Lateral Step Test (on a 20-cm bench): This test is used to evaluate lower extremity muscle performance. The athlete is asked to stand on the tested extremity with the feet parallel and the shoulders separated. The proper/official lateral step technique is defined as achieving a position within knee extension for the tested extremity during the test’s extension phase. The number of times the untested foot’s heel or toes touch the ground is counted and recorded. It is important to note there is little research evaluating this protocol with CP athletes specifically [7].
Sit-stand up (from 90-degree knee and hip flexion to the standing position):This is a functional test and the athlete must be able to stand up without using his hands. The sits on a small bench with the feet on the ground and the knees flexed 90 degrees. The athlete then must be able to stand up without using the hands and without any help from the bench with the arms or body during the transition. The repetitions are counted [7].
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Exercise prescription and considerations.
It is recommended that for people with CP, the following training methods of strengthening should be considered (this doesn’t deviate too far from general training programmes).
Progressive resistance exercise
This is a well-established strength training method where intensity is gradually increased. The main elements of PRE are as follows: Providing enough resistance so that a low number of repetitions [usually 8–12] can be completed before fatigue starts, increasing the amount of resistance progressively as the strength increases and continuing the training programme for an adequate duration so that its benefits are seen. [8]
A typical PRE program for individuals with CP consists of 2–4 exercises where isokinetic dynamometers, weight machines, or free weights are used. The participants typically complete three or four sets with 5–10 repeats of each exercise with 50–65% training intensity of one-repetition maximum. They usually would trained for three times a week for a duration ranging from 6 to 10 weeks.
Bicycle and treadmill exercises
Bicycle riding is a rehabilitation tool commonly used in physiotherapy to improve power and cardiovascular form and is recommended to individuals with CP as a safe and appropriate exercise to keep in shape.
Walking/running on a treadmill provides an opportunity for repeated training in the total gait cycle, facilitates the advanced gait model, and decreases the effect of poor balance on the athletes ability to lift weights during walking when a body weight-supporting system is used. Treadmill training seems to be effective in the improvement of general gross motor skills for CP athletes.
Upper body strengthening
Muscle strengthening in individuals with CP is a general treatment intervention to increase strength and function. [9] Individuals with CP need consistent upper extremity training because CP can lead to muscle contractures and functional disturbance. [10]
Some health and safety factors to be mindful of when prescribing upper body strength work in CP athletes include: progressive accumulation of resistance, especially in weak adolescents/adults, that does not permit lifting weights (more so young adolescents) without supervision or hanging a weight from an extremity without muscular effort or external support. It is recommended that athletes do not train the same muscle group on consecutive days.
Aquatic training
The special characteristics of water provide a desired environment for children and adults with CP. [11] For example, the weight lifting conditions are better in water with decreased body control amount, joint load, and effect of gravity. Aquatic exercise has many observed benefits on flexibility, respiratory function, muscle power, and gross motor function, but there are very few studies on its effects.
My reflection….
The importance of screening
Essential in this environment, this process allowed me to observe the specific needs of each player in order to construct a plan. The “basic fundamentals” term which can be loosely thrown around by S&C coaches including myself (up until this point) was beginning to seem somewhat inaccurate and false. I learnt not to take movements for granted. For example, when observing CP players running mechanics/gait and how one side of the body may be delayed in comparison to the other; or when observing a body weight seated squat and one side of the body pushes with a lot more force than the other; and/or perhaps one foot due to mobility issues cannot be placed flat on the ground; and/or an athlete can stand well balanced on his right foot but not his left. This visual evidence helped to build a unique picture of each individual athlete and allowed me to construct tailored and diverse programmes….I learnt not to “assume” basic movements. For homework, I watched numerous clips of the game and studied articles on needs analysis/screening of CP footballers which led me to further appreciate the complexities of this role and the demands of the game.
Building trust is underappreciated?
For me in this particular position, trust was essential as I relied on a lot of qualitative information, personal feedback and honesty from each athlete in order to not only monitor their progress but to see how they were feeling and coping with the new demands placed on them. With the deficiencies experienced by CP athletes it was even more crucial to establish this trust so players could have the confidence to speak freely about any daily soreness/set backs. This took time as well as a desire to get to know each player on a deeper level building a strong, cohesive environment.
Unity – the path to greatness is along with others
Positive working relationships between the players and I, the physiotherapists, federation doctors, sport scientists and of course the technical and tactical coaches allowed for the successful care, monitoring and development of each players performance. For example, frequent discussion around rest and recovery was essential especially due to the warm climatic conditions and player load. These particular factors were monitored through frequent sweat loss testing as well as data analysis and player load monitoring (shown overleaf).
Player load monitoring (UA) – Northern Ireland vs Argentina
Max Speed Chart (Km/h) – Northern Ireland vs Argentina
The key ingredient to success…effective communication
Are you clear in your message? How do you know? I believe effective communication is crucial for player development and understanding. Not just through verbal dialogue but observing players body language can tell us a lot as S&C coaches for example, a players mood, confidence and even fatigue levels. Taking the time to listen to players and taking note, keeping our instructions clear and concise etc. Ultimately, take interest!
Some of the most renowned S&C coaches that I have admired and learnt from over the years have simply CARED about their athletes and built a strong rapport, even in some cases acting as a counsellor or friend providing unending support, putting the clipboard down for a while.
Don’t be so serious…
Think back to why you started playing sport? Why you started coaching?
Due to the fast paced, results driven environment placed on many current S&C coaches, it is easy to get bogged down by session plans, theory, practice and becoming very serious – this can rub off onto athletes.
My approach at the World Cup was the opposite, it was to try and provide a more fun, relaxed environment during recovery and rehabilitation sessions. As a result, this seemed to help players unwind for a period, having time away from the business of preparation. Playing music helped to create this atmosphere….be selective on your genre!
A few notes to finish..
- Give your athletes time
- Are you approachable?
- Ask questions
- Read, stay informed and connect
- Don’t be so serious
Steven Conlan
- Head of Strength & Conditioning, NI CP Football
For more content from Steven, follow him on Instagram (@stevenaconlan)
