You have to know your players, certain ones will go down and the gaffer will say you better get on mate. ’He’ll be alright’ I would reply back ‘Are you sure?’ ‘Yeah he’s fine.’ And he would be.
Dealing with injuries is the nitty-gritty of a physio’s life. You look at the game in a different way from anyone else at the ground. A corner comes in, everyone challenges in the area and the ball is headed away. All eyes on the play as it moves upfield but the Physio would always be looking back to see if there are any bodies left on the ground.
I have been fortunate in that there haven’t been too many really bad injuries to deal with in my career. Treating injuries on the pitch can be difficult enough business on its own without the added problems that can come with it for a start there are referees who will often try to rush you. You have a perfect excuse on your side though; ‘This player is injured and I need to do a proper assessment before I can move him.’
Referees don’t have the answer to that because they know they could be in major trouble if they rush things and serious complications follow.
Then there are fans watching on. Dealing with them can be a harrowing business. Remember that at a lot of the old grounds the standing is close to the pitch and fans would push to the front if there was something kicking off between players. I have lost count the number of times I have had stick at away games whilst running around the touchline to or from an injury. I have never been spat at like some of my counterparts or had coins thrown at me. Sometimes I’d deliberately run back in front of the goal to avoid a hazardous few yards close up alongside the opposition’s hard-core fans. Often there isn’t much space behind the net and find myself staying on the pitch much easier.
Former Everton Physio Wayne Jones would be greeted by ‘Who’s eat all the pies, who eat all the pies…’ on after treating an injury on which he would get a pie out of his bag on his way back to the dugout silencing the crowd.
Vital to the role of Physio is the relationship with the manager and there is plenty of cat and mouse taking place when it comes to dealing with injuries. Once your manager knows you are competent, they will start to listen to you but you often have to battle to get your voice heard at first. When you are dealing with so many situations in such a passionate and demanding sport there is bound to be difficulties. Most managers want players back from injury soon as possible. However, I don’t want them back playing to early and then returning to me injured again. I would constantly question myself; ‘Should I have got him back by then, was it too quick, should I have left it longer…?’
In football one player’s injury gives another player a chance. Having complete trust in my judgement which helps a lot. With other managers I would adopt different tactics; ‘‘In my opinion he’s going be out for three weeks, boss.’ ‘Well I need him in two….’ His reply is,’…just tell me when he’s ready to come back. That’s your job.’
In that instance, you knew you had a deadline so I would deliberately start put a little bit extra time on my assessments to give myself a cushion.
From time to time there are fitness tests to supervise. Don’t get me going on those! This involves taking a player through a series of set exercises to determine whether or not he can play. At our level ideally, I would like to do them on a Thursday evening. But for special cases I do them on the day of the match. I will say to the player after the test ‘Are you fit to play 90 minutes at a pace that we can’t match in a fitness test?’ If I see a doubt I will say; ‘I don’t think your fit are you?’ Legally it is there decision. I cannot demand a player plays because he could break down. You shouldn’t put yourself in that position. ‘Are you fit to play?’ Pause from player… ‘Are you fit for 90 minutes? ‘Not sure.’ ‘Right we will leave it another week and I will go and tell the gaffer.’
There are loads of factors involved in determining fitness for game. significance of a particular match being one example. As the Physio we are obviously involved in diagnostics, treatments, rehabilitation, prevention of injury and many other areas in patient management.
Other areas responsibility could include care and lifestyle counselling including the use of leisure time, hygiene in living habits, nutrition and safety. But areas can differ from team to team.
Ultimately though we manage risk. It is often not just our decision if a player is deemed ‘fit to play.’ We have to be able to discuss with the player and the manager what is the risk involved if he plays with an injury. We have to try to quantify the risk in our current state of knowledge this is not something a computer or algorithm can tell us. It is not something we can look up in a book or read in a journal.
It is what some of my academic colleagues’ frown upon, as it cannot be quantified, calling it clinical acumen. It is a combination of knowledge and experience that allows decision-making.
Managers look to us to advise them on medical issues but not pick the team. In taking risks we must be aware of potential breakdown and possibility of re-injury. This, however, cannot dissuade us from offering these options to the manager and players. A quality I believe helps to cement a good relationship with the manager and the rest of the coaching staff.
It is important to let the manager have the facts as you see them and not say what he would like to hear, and give your views as upon which he may act or not. This is where the core values of leadership qualities of the manager become critical. Key decisions made by the Physio need professional acceptance when a player can return, and should not be tainted by the opinion of the manager. This categorical statement illustrates the need to find the right balance between the medical and footballing standpoints. The transcendental of the importance of certain matches can justify an element of risk-taking with full consensus of all concerned including, obviously the player himself and I can give many examples of this. Awareness of the risk-taking and the grandeur of the fixture justifies an exception to a rule.
What is important to remember is you work with the manager with the aim to provide him with as many fit players as possible for each game.
The club is in the business of playing matches fielding teams and hopefully winning. Ultimately aiming to keep the ‘show on the road’ with pragmatic compromises along the way. Football operates under such extreme pressure these days that the is little time to deal with anything but the immediate demands of the next fixture. The clinical and functional picture of recovery maybe quite a long time apart. Fit For Saturday is the short term aim. But fit to play again is in the players best interest.