 Hello, welcome to Wolverhampton Wanderers Football Club. I'm Phil Hayward, I'm the Head Academy Physiotherapist here, and come on in. This is the first team dressing room where the players prepare for training. Come through the dressing room. This is where we have the contrast baths. Following training, the players will tend to be five times or five lots of hot-cold, hot-cold between the two just to really get that blood flowing through and get everything flushed out of the system. Steve Kemp, Head of Medical Services, Wolverhampton Wanderers Football Club. My role is to highlight the players at the most risk, address these risks, and then hopefully return them to sport and reduce the injuries in a football club. So, we're in the doctor's office. Here one of the players is having a scan of his cartel of tendon using the dual screen function. Everything that we do has an element of science in it really. Birds, singers, lorries, guitars, trumpeters, cats, lawnmowers, vuvuzellas, all make sounds. We can hear them because their frequency is between 20 Hz and 20,000 Hz. Although, old grannies sometimes can't hear everything. Anything higher than 20,000 Hz is called ultrasound and sounds like this. Unless you're a bat, but although you can't hear ultrasound, I can't hear anything. To physicists, you can use it to scan pregnant women, and in this case, footballers' knees. We're all trained in ultrasound. I just put the gel on. The gel just provides a medium through which the sound waves are able to be conducted. I tell the top there, then you can see your tendon coming down. Just a little dark area at the bottom of your kneecap there, where that pain is coming from. Pain is coming up gradually. After training, you'll be like a sore. You'll be like, I'm sure, fully flexed when it. They're like, you just kept getting worse and worse. We're very fortunate to have this type of equipment here. And not many football clubs actually have it. In a normal situation, you tend to have pain, and you sort of make assumptions as to what's going on in the tissues. Whereas we've got the facility to look on site. The method ultrasound is just the sound wave. So it's actually sending the sound waves through. And look as they reflect back, they give a different picture. And then we know what we're actually scanning through the different images we see. Ultrasound waves are sent into the body. The useful thing about sound is that it reflects. Hello, hello, hello, hello. So when the transducer sends sound waves into a knee, some of the sound is reflected and some absorbed, depending on whether it hits skin, muscle, water or bone. These echoes arrive back at the transducer at different times and are analysed by the computer and converted into a moving image. The different tissues within the body will transmit the sound waves at a different speed and reflect back at a different intensity. If you stood very close to a wall and said something, you may wouldn't hear that echo particularly well. If you stood a long way back, you'd hear a time lapse between you saying something and hitting the wall and bouncing back to you and you could that be measurable and you could calculate your distance from the wall. This is very similar so you can calculate the depth and type of tissue depending on what the intensity of the sound wave that you see back on the screen there. The transducer is made up of lots of little crystals aligned in there, some crystals sending out the waves downwards and then some receiving the information and the reflection or the echo back. Why use the gel? Without the gel, most of the sound waves wouldn't penetrate the knee but would be reflected off the skin surface. The great benefit of ultrasound is it's real time. You can actually see the muscle moving, you can see the muscle contracting, you can see the muscle stretching. No health risk at all so we can use it for long periods of time without any undue risk to the player. You can see the different layers of tissue that's shown. The transducer will be up there looking down so here's his skin, some hygienic fat layers, the kneecap there which is the sort of lighter area and then his tendon is this nice sort of grainy longitudinal tissue there and this sort of darker area is where someone has a bit of a problem with his patellar tendon whereby through overuse he's just had some inflammation of that, it's become a chronic problem and he's now got poor quality tendon tissue in there. Ultrasound is great for looking at football as knees. Knee injuries are all too common and by looking into the tissues using ultrasound physios can not only help players get better quicker but change their training programme so the problem doesn't develop in the first place. Tell tendons tends to be the biggest issue that we use the ultrasound for. Football is often a one leg sport so a lot of jumping, twisting tendons goes through one tendon. If the athlete has injuries or has weaknesses in different areas the tendon may not function in its biomechanically correct position develop micro trauma which is tiny tears to the tendon which is fine and the body will re-heal these if it's given time, if it's a professional athlete and he doesn't get time to heal it becomes micro trauma and develops injury. The scan is very useful for those particular players it gives a really good idea as to the state of the tendon that you wouldn't be able to identify without that equipment. You can certainly get an idea of how much pain somebody's got just from using your hands but if you can actually get a quantifiable image of what the tendon looks like it's much more useful and much more helpful to our practice. So this is the gym. We've got quite a lot of cardiovascular equipment which the injured boys tend to use. This piece of rehabilitation equipment which we have which is known as the Ulta G treadmill a treadmill which allows you to run at a certain percentage of your body weight, almost like a reverse vacuum if you like to blow air into a skirt and the increased air pressure in the bottom part of the treadmill actually lifts the player up. If you look at a lot of the equipment that we use is a scientific background and bases behind all of it really and everything that we do do we try and make sure that it's evidence based and that it's scientific improvement to work There is quite a lot of physics involved and having not taken that as one of my A-levels I did find it quite difficult at first to get my head around some of the concepts maybe had I known then what I know now and what where my career might have taken me it would have helped me and given me a bit more of a background. Myself I've done two degrees and two masters and I'm continuing to go on to PhD level and I think that's really important and all the staff here have an out masters level and something where you're encouraged and I think everyone's aware football and you can't just turn up and do the job you need to be qualified.