What a return to the pitch means for healthy hearts and minds

What happens behind closed doors? At Manchester United Football Club’s Aon Training Complex, the last 12 months have been understandably quiet. However, as lockdown restrictions ease, Head of Football Medicine & Science, Dr Steve McNally and his team are returning to the full extent of their work – which, you might be surprised to learn, means not only looking after the health and performance of players, but conducting essential research for the benefit of all.

It almost goes without saying that a premier league club like Manchester United has a medical powerhouse behind it to ensure that players, from the first teams to the juniors, are in peak physical health. Under normal circumstances, Dr McNally and his team are based at the club’s dedicated Medical Imaging Centre, using the latest software on a selection of Canon Medical MRI, CT and ultrasound systems to continually monitor and screen players for optimum performance. However, pandemic restrictions have unfortunately shifted their programme of proactive health screening to reactive only, meaning that their state-of-the-art systems could only be used to treat injuries or existing conditions. While this has an obvious impact on the wellbeing of players, there is also a lesser-known knock-on effect of these limitations.

The medical data gap

Sports science is an important contributor to health data, and the necessary limitations imposed by the pandemic has meant that research projects have had to be put on pause – and with them the necessary flow of data collection. “It is certainly not the same as delays to NHS cancer care due to Covid 19 that may be life and death situations for people,” explains Dr McNally. “But there will be impacts on the speed and amount of knowledge we can cascade to wider patient populations.” The knowledge Dr McNally refers to relates to the important work undertaken in cardiac and neurological health – in other words, hearts and minds.

‘Cardiac profiling’

This is an important and mandatory requirement for anyone who is training vigorously or playing competitively. Players are screened to identify anomalies that can lead to abnormal or very fast heartbeats (ventricular fibrillation and ventricular tachyarrhythmias, respectively). These are the primary cause of Sudden Cardiac Arrests and Sudden Cardiac Death, rare conditions that are often asymptomatic and can be triggered by extreme physical exertion. “This involved our athletes undergoing a full structural and functional resting (baseline) ultrasound echocardiogram prior to exercise stress testing if indicated,” says Dr McNally.

At the same time, the club is part of a clinical study of 42 elite adolescent male football players with the National Institute for Health Research (NIHR) Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. Again, using the Aon Training Complex’s Canon Medical imaging technology – in this case, the the Aplio i800 ultrasound system – the cardiologists were able to evaluate and analyse the ‘strain rate’ on the left ventricular of participants hearts as they completed ‘cardiopulmonary exercise testing’, where the players have their vitals monitored during exercise of increasing intensity, usually on a treadmill, and then as they recover. The study showed a specific response to exercise stress and Dr McNally is seeing real value in this for the future: “Gaining new science insights will help understanding of sporting cardiac matters and eventually cascade into mainstream cardiac paediatrics or wider cardiology to provide preventative protocols that help to save lives or give people greater opportunities to live more active lives.”

The knowledge needed for safer impact sports 

The diagnostic imaging capabilities of the Aon Training Complex are also contributing to another high-profile and important area of medical research in sports – gathering data to analyse the long-term effects of head impacts, especially Chronic Traumatic Encephalopathy, which can lead to dementia. It’s a subject that has been under the spotlight for many sports, such as rugby and boxing, but in football it has meant the recent introduction of a new substitution rule if a player suffers a head injury, even if all replacements have already been used during the game. It’s been a welcome safeguard to player health, but Dr McNally is keen to do more. “There is so much more that we need to research to understand the structural and functional changes in the brain from impact in sports,” he says. “Greater knowledge will help to introduce unified national protocols to protect the long-term health of elite and grassroots sportspeople.” 

Back to the future of science and medicine

Despite a year of delays, Dr McNally is certain that research in sports imaging will bounce back as treatments and vaccine innovations continue apace. “This shows us the key positive from all the virus pandemic disruption and grief – that when science, medicine and research push the boundaries of existing knowledge, innovation expands, knowledge is enhanced, and lives can be saved,” he says. “This is a strong message to all involved in medicine and science, and why we continually quest to undertake our sports imaging research work at Manchester United Football Club.”