Bristol City head of medical on hamstrings, his homecoming and the state of play with injuries

New Bristol City head of medical Paul Tanner is confident additional measures and processes can be put in place to reduce the amount of hamstring injuries suffered at the club.

Tanner was appointed last month, having previously spent seven years at Championship rivals Millwall, with his experience also stretching back to stints at Norwich City and in rugby union’s Premiership with Gloucester and Wasps.

Tanner is Dave Rennie’s long-term replacement after he left the club in November alongside former manager Nigel Pearson, with Andrew Proctor having been placed in interim charge of the department for the second half of the season.

With a fresh pair of eyes at the head of the medical team, there is an opportunity for new thinking and one of Tanner’s primary objectives will be injury reduction coupled with increased availability across the first-team squad.

The spate of hamstring injuries suffered during the 2019/20 season under Dean Holden have thankfully not been repeated, while there is an acceptance across the game that such are the physical demands placed on players’ bodies, such issues are a natural byproduct. A UEFA study of 54 teams across 20 countries published in 2022 revealed that hamstring injuries had doubled over the last two decades.

But they remain an eternal concern at the High Performance Centre with Tommy Conway, Kal Naismith, Mark Sykes, Rob Atkinson, Ayman Benarous and Sam Bell all sustaining serious problems last term which had an adverse impact on the first-team’s fortunes.

“Every club is going to get hamstring injuries,” Tanner said. “You know, that's part of football. Football is getting faster. It's getting more competitive, and players are running bigger distances and at higher speeds, and there's more sprinting actions. So the demands on the hamstring are increasing year on year.

“But I think there are certainly things that we can add in here at Bristol City to improve things. And part of that is our testing battery. Part of it is going to be our monitoring - how we monitor the players’ muscle soreness and their hamstrings and how strong they are, and whether we think we need to get them stronger, or whether we need to get them more flexible, or what have you.

“And also, there's maybe improvements that we can make in terms of our return-to-play processes and our rehab protocols. I mean, I don't really like using the term protocol, but it's more a framework of how we're going to return people back to training. I think that will hopefully start to minimise, certainly, the re-injuries. That's something I'm quite big on.”

That work has already started in terms of Tanner’s individual player assessment, with the 44-year-old having sat down with each senior player to have returned for pre-season to analyse their respective physical status and how that sits in the overall squad.

Last week’s testing, including the Bronco run, also allows for various data to be logged with markers hit as to an individual’s expected output and how that then might be relevant later in the season, if and when they are in a position of having to come back from injury.

Tanner’s main concern, and point of order, seems to be reducing the prospect of re-injury, mentioning hamstrings as a particular point of reference given the information now available to physios in analysing such injuries and then being able to manage players back from them.

“There's a lot more technology now, we're able to be a lot more objective about things,” added Tanner, who has worked in professional sport for more than 15 years. “We’re able to measure things a lot better than we were before. One example would be hamstrings; the amount of data that we can get on a player's hamstring is incredible.

“We've got these pieces of equipment, things like a NordBord or a ForceDeck, which give you so much information about the hamstring; how strong it is, how well it's functioning.

“If you go back from when I started, we had none of that. So from that point of view, the technology involved has progressed massively.”

Although Tanner has spent the last 12 years in London and East Anglia with Millwall and Norwich, his role at City represents something of a homecoming for him given he grew up in nearby Stroud, where his mum still lives. "Part of the reason was coming back to the West Country," he added. "But also City is just such a massive club. They've got such good facilities."

Given he only started last Monday, pre-season had already been mapped out for the staff and players, with Liam Manning drawing up the summer schedule long before the 2023/24 campaign had finished and Tanner was still with Millwall. He has made some subtle alterations to parts of the programme but it had fundamentally already been laid out by head of athletic performance Del Bonsu and predecessor Proctor, now of Bristol Rovers.

“It was kind of a case of just coming in and tweaking a few little things,” Tanner said. “Some things that I wanted to be tested, and a few things which I wasn't quite sure that we needed to test. And so it was more just sort of refining what was already in place, really. So I didn't have a huge input in terms of the structure of the pre-season because the performance guys and the rest of the medical team had done that. And then I just sort of came in on Monday and made a few little changes I thought would benefit us.

“There are so many aspects to pre-season. Obviously, we've had our testing days now, and that's really important, because that gives us so much data and allows us to create a picture about the player of where they're at physically. And then for us, it's really important that we start getting to grips with the players and getting them in a position where they can get out there and do the important thing, which is the training sessions.

“So our focus now turns to putting together individual plans for them, so that we can try and make them as available, not just through pre-season, but for the whole season.

“The times of players coming back and being half a stone heavier, those days are just gone. The lads get an off-season programme, they follow it, and they come back in much better condition. You just don't see people coming back unfit.

“You look at them, you think you're almost ready to kind of go, and we're just sort of trying to fine tune them and trying to get them to optimal condition, rather than starting from a really bad level.

“When I was in rugby, you get lads coming back maybe five or 10 kilos heavier, and you'd spend eight weeks trying to get them to a condition where they were ready. But now lads come back and they're fighting way already.”

With the exception of those involved in international football over June, the vast majority of the City squad reported back last week for testing with numbers swelled not just by new signings Josh Stokes and Max Bird, but also the returns of Atkinson, Benarous and Bell.

Atkinson and Benarous didn’t play for the senior side at all in 2023/24, while Bell’s last appearance was against QPR on February 17 after sustaining a hamstring injury which ruled him out for the rest of the campaign.

The plan is for that trio to travel with the squad to Portugal at the end of the week for the training camp to help build them up towards hopefully being involved for the match programme, with City’s first friendly in three weeks.

“Everyone's come back in really good condition,” Tanner added. “There's no sort of new injury concerns, and the lads that have been out for a long time are making really good progress, and we're sort of hopeful that they're going the right direction, and we might be able to start integrating them into bits soon.

“We're going to take them all over to Portugal with us for the tour, and hope, hopefully we'll be able to get them involved in some of the sessions and start integrating them. So, yeah, we're really pleased.”

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