Johnny Wilson on the Howden Report and the Realities of Modern Football Injuries

Recently, Johnny Wilson, founder of Nottingham Physio and former head of sports medicine at Notts County, joined The Sunday Night Club with Mark Saggers to discuss the Howden Report. The conversation, centred around football injuries, provided deep insight into the pressures and realities facing both players and medical staff in modern football. Wilson’s vast experience in the sport, coupled with the report’s findings, painted a compelling picture of injury management at the professional level.

what is the Howden Report?

The Howden Report is a comprehensive analysis of injury trends and risk factors in elite football, commissioned by Howden, a leading insurance brokerage. Released annually, the report compiles data from major European football leagues like the Premier League, Serie A, La Liga, and the Bundesliga. It examines the types and frequency of injuries, the financial impact on clubs, and the implications for player welfare. The findings have significant relevance not only for clubs managing high-value players but also for those in lower leagues, where smaller squads face an increasing number of games. The report highlights the growing demand on players’ bodies, making it a key resource for understanding the modern-day challenges faced by professional footballers.

Truth on Rehabilitation in professional sport

Wilson shared the hard truth about injury rehabilitation in football. He explained that “in professional sport, everything is incomplete rehabilitation… You’re now day one on that day, and you’re rushing.

“Using a Grade 2 hamstring injury as an example, Wilson highlighted that players often have only three or four quality running sessions before returning to the pitch.

“They’ve injured their hamstring sprinting, and I’m talking about they’ve had three or four opportunities before returning back to play,” he added. The harsh reality, according to Wilson, is that “incomplete rehabilitation would have been my experience in 14 years of professional football.”

The conversation also delved into the Howden Report’s alarming statistic that 50% of injuries in the first 30 days post-return to training are re-injuries. “One in every two injuries in that first 30 days… they’re going to bounce regardless,” Wilson emphasized. This high rate of recurrence is a critical issue for clubs and players, with the Howden Report underlining the precariousness of returning to the field too soon.

behind closed doors

Mark Saggers raised the issue of the immense pressure players face to return, both physically and mentally. Wilson described the often-strained conversations between medical teams and management. “You’ll go in and have a chat with a manager on a Thursday or a Friday… and he’s asking about his player’s readiness to return to train and play.” But it’s not always straightforward. As Wilson pointed out, managers often resist discussions around risk and player safety. “A lot of managers don’t want you putting doubt into the player’s mind that they’re not ready to go back,” he said, emphasizing the tension between short-term performance and long-term player health.

The Howden Report also sheds light on the cumulative effects of frequent matches, particularly in lower leagues where squad sizes are smaller. Wilson explained how during the seasons Notts County was relegated, they used “the most amount of players,” adding that injuries often forced them into the loan market, sometimes bringing in players who were not fully match-fit. The strain of midweek games, coupled with insufficient training time, has created a “war of attrition,” where maintaining fitness throughout a gruelling season becomes nearly impossible.

A solution to the crisis?

Wilson’s solution to this crisis? He believes football could learn from other sports, like boxing or gymnastics, and be more ruthless in its approach. “Weed out those who are not fit for purpose,” he said bluntly, arguing that the sport needs to focus on retaining players who can endure the demands of 40 to 50 games a season.

The conversation is a stark reminder of the challenges facing modern football. The Howden Report and Wilson’s insights call for a re-evaluation of injury management, player welfare, and the unsustainable demands placed on athletes. For football to thrive, it’s clear that a balance must be struck between the relentless pursuit of success and the long-term health of its players.