By Rob Swire, former head physio at Manchester United.
In the highly competitive world of professional sport – and in particular Premier League football – there is huge pressure on results and winning, as at the end of the day that it is what it is all about.
Success defines a players’ career, and also that of managers. A failure to bring about results can see a manager quickly lose their job, and so therefore having their best players out on the field as often as possible is a major priority.
The relationship between a football club’s medical team and the coach or manager is therefore crucial.
The manager expects his head physio to ensure his players are kept fit, healthy, and ready to play as often as possible, therefore giving him the greatest chance of success on the field.
So, with so much at stake, who makes the final call on a player’s fitness when they’ve suffered an injury and are badly needed out on the field?
I was fortunate enough to work for a football manager for many years who trusted my experience and expertise and followed my advice on each and every occasion – no matter what the match or occasion, and its importance.
Sir Alex Ferguson was a manager under immense pressure to win major trophies each and every year at Manchester United, but in 15 years as the head physio at the club I can say that there was not a single occasion where he went against my advice over a player’s fitness and ability to play.
Even if a player came in at half-time and said he had suffered an injury that nobody had been aware of, and that I felt meant he really needed to be substituted, Sir Alex would not question it – no matter how important the player.
Sir Alex was a manager who trusted his staff to make decisions for the right reasons, and as a manager, he was always interested in protecting the player’s welfare long term. He was very good at that.
Obviously, I was at Manchester United for 23 years, spending 15 years as head physio, and in all but one final year under David Moyes, I worked for the same manager, so I can’t comment first-hand on what happened elsewhere.
Anecdotally, I heard frequent talk amongst physios at other clubs, raising their concerns about managers who did not take the physios advice, encouraging players to return to action earlier than was suggested, or urging them to play on against medical advice.
In any walk of life, such as business, some people think they know better than everybody else in every aspect of the job. Football is certainly no different, and I would imagine it is the same across many other sports.
For me, that is never the way it should be, and as I say, I was very fortunate to work with Sir Alex.
No matter what the occasion, no matter which player, if I said he shouldn’t play, he didn’t.
Mistreatment of injuries can be devastating and career-ending
Since moving on from Manchester United in 2014, I have become more involved in providing expert opinions in legal cases where the medical treatment of players from many sports has come into question. Negligent treatment is a massive issue, and mistreatment can prove career ending.
There is a huge responsibility on medical professionals to get things right from the start, and in this modern age, very few injuries should bring about an early end to a sporting career.
Go back a few years however and an anterior cruciate ligament injury could often have proved career-threatening. Nowadays, with the right treatment and rehabilitation – including giving the player sufficient recovery time before returning to injury – a full recovery can more often than not be made.
I mention that full recovery time because again it comes down to making the right long-term decisions. Returning to action too early can cause an injury to reoccur, or lead to new, additional injuries being suffered. You have to take a long term view.
This was perhaps an area I was again fortunate in at Manchester United.
Being the head physio for so long, I got to know the players and their bodies, what pressures they were susceptible to and even at what periods in a season they may be more at risk of injury. This enabled me to bring in injury prevention measures with people like Ryan Giggs, a hugely talented international player and key squad member who I had worked with many years and knew very well.
At many clubs now, coaches and managers chop and change year to year, and at the very top level it can mean clubs change their entire medical team, as they travel with the specific manager.
They may be first-class medical teams, but they lose that historical knowledge and for me, would therefore lose some ability to reduce the threat of injury to some players.
Professional sportsmen and women understand the need to care for their bodies.
Perhaps many people will wonder what role a player has in making a decision as whether or not to play with an injury, or to perhaps declare themselves fit early in order to secure selection for a big game – a cup final perhaps.
Although we’d all perhaps find this understandable, I have found that, at the top level at least, players are understanding of the situation and rarely need convincing not to take a risk.
They know their bodies, know the potential consequences of playing with injury, and make the right decision.
Obviously, it is often also not a sudden occurrence.
As a physio, if I knew a player was unlikely to be fit to take part in a certain occasion, I’d be talking to them about it in the weeks prior, and helping them to understand and accept the situation they were in. It is all part of the job.
Role of medical teams and treatment is more important than ever
Having worked in top-level professional football for more than 20 years, what I can say, without any doubt, is that players’ bodies are being placed under increasing pressures year after year.
With each passing year they become fitter, faster and stronger. Strength and conditioning and fitness experts are used, and because levels are improving across the board, the physical demand on players’ bodies is increasing.
It is therefore paramount, in my opinion, that sportsmen and women are properly cared for, and that protecting their long-term careers is the priority.
As I said, that was something Sir Alex always had at the forefront of his mind, and as a manager under huge pressure, at the highest level of professional sport, it was a fine example to set.