Doctors on side when it's all to play for

Sports medicine has advanced dramatically in recent years from treating injury to helping players get the most from their bodies

PROFESSIONAL SPORT is as cut-throat as any business, with lucrative sponsorship deals, players’ salaries and owners’ profits to consider. Injury can spell disaster for a team’s fortunes, so keeping the players in peak condition is critical.

Having the right medical professionals on side can be as integral to success as having a top-scoring striker or a sensational centre.

Dr Éanna Falvey, the team doctor for the Ireland rugby squad, and Prof Peter Brukner, the head of sports medicine at Liverpool Football Club, have had plenty of practice in getting the best out of elite sports stars.

Gone are the days when players were sent back into the game after nothing more than a slug of water and a rub with a cure-all magic sponge.

“You do still have the magic sponge,” says Falvey. “Well, you’ve got a bag of ice, freeze spray for the acute stuff and, if there’s an injury you can’t patch up on the spot, they’ll come off for suturing [stitching].”

There’s tape for strapping up and glucose gels for fatigue, but Falvey says the on-pitch treatment caught by the cameras is just a minor part of the role. Sports doctors now also use blood tests, MRI scans, electrocardiograms and surgery as needed.

Drawing from their experiences, Falvey and Brukner have co-written a book aimed at helping health professionals get to grips with understanding the anatomy of sports injuries.

Falvey, who is also a former super-heavyweight boxer for Ireland, is currently in camp with the Ireland rugby team in preparation for the World Cup campaign.

“A huge amount of work goes into conditioning players before a game to prevent injury,” he says.

Over the past few months he has been dealing with any injuries lingering from last season and guiding players through fitness and muscle-bulking work.

As the season approaches, his focus is on immune profiling, which involves assessing the strength of their immune system. “One of the biggest things that can rob you of a player, particularly at the end of a hard six weeks of pre-season training, is a weak immune system,” he says.

“The immune system of a high-level athlete drops right down at the end of hard training, so they are more prone to respiratory tract and gastrointestinal infections. We’ve done a good deal of work now making sure that none of our players have any gaps that might pre-dispose them to a problem.”

Working alongside two physiotherapists and two masseurs, Falvey oversees a squad of 43 players, but with just 30 World Cup places, will the next few weeks bring some tough calls?

“Some of the harder decisions would be if it’s an injury that might or might not be ready in time,” he says. “If a player isn’t right by now, he’s unlikely to be involved . . . but the injuries that happen in the next four weeks, they’ll be the tough ones.”

But with every player desperate to go, is it difficult to deliver bad news?

“They’re a super bunch and nobody is going to put you in a position because of their desire to go,” he says. “No guy is going to go to the detriment of the team, they are all very professional like that.”

A number of players have had cruciate ligament injuries this season – are such problems are on the increase for some reason?

“I think that’s just a cluster in the elite players. Taken out of context, I don’t think it means anything,” he says. “If you look at the total number of cruciate injuries among GAA players in Ireland, it’s probably no higher this year than last. It’s a statistical anomaly more than anything else.”

He says there are many reasons for this and increased player body mass plays its part, though he dismisses player studs and the state of the pitches as the sole cause.When rugby went professional, the average player’s weight jumped by seven kilograms between 1998 and 2004, he says.

The increased use of strength and conditioning coaches by inter-county teams may mean that the same phenomenon is occurring in the GAA, he says.

Some amateur players may be overtraining in the mistaken belief that “if 10 laps are good, 20 are better”. This can lead to injury, particularly if players have no rest between servicing county, club and college league commitments – while also working full-time.

So with a ringside seat, does he get to enjoy the games? “You watch behind the play,” says Falvey. “You watch the guys picking themselves up off the ground after ruck.”

He’s on the watch for subtle signs of concussion, too. “You’re watching for players that are missing calls. It’s a time-pressured situation, you’re on the pitch and you’ve got 10 or 15 seconds to make sure they are looked after.”

Refusing to be drawn on the travel prospects of individual players, he’s hopeful for Ireland’s tour.

“The mood is great, they’re training really well and they’ve had a fantastic pre-season,” he says. “I think the guys are really raring to go.”

Clinical Sports Anatomy,co-written by Dr Éanna Falvey, the director of sports medicine at the Sports Surgery Clinic, Dublin, and Dr Peter Brukner, the head of sports medicine and sports science at Liverpool FC, is published by McGraw Hill

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Dr Peter Brukner is no stranger to the world of elite sport. Plucked by the then Liverpool manager Rafa Benitez from his World Cup duties with Australia’s national team, the head of sports medicine at Liverpool FC is also a veteran of Australian Olympic and Commonwealth Games campaigns.

The bodies he treats now are traded for tens of millions, so does he feel more pressure? “Injuries can make or break you,” he says. “It’s a challenge to get them into the best condition possible. You’ve got to train them hard enough to get them to their maximum potential but not so hard that they are getting injuries. It used to be an art but it’s more of a science now.”

Brukner’s Melwood medical squad includes 11 other full-time health professionals including a doctor, five physiotherapists, three fitness experts and two masseurs.

Prospective players undergo an eight-hour medical inspection. There are blood tests, ECGs and “MRIs of every joint you can possibly think of”.

Brukner describes the final hours of the 2011 transfer window, when Chelsea offered £50 million for Liverpool striker Fernando Torres, as the most amazing day of his life.

“Torres was standing outside the manager’s office waiting to know whether he was allowed to go or not and all week we’ve told him, ‘you can’t go until we get another striker’,” says Brukner.

With just hours to go, Newcastle striker Andy Carroll got the nod – with Liverpool prepared to pay £30 million for him if he passed a medical. Arriving at Anfield by helicopter at 6.30pm, Carroll travelled in Brukner’s car to the hospital for his scans.

Fans in the street were “chanting, burning Torres shirts and belting the car”, he says. “The paparazzi on motorbikes following us – it was an absolute circus.”

With X-rays revealing injury, the decision to sign rested with Brukner. “It was a tough call because if I had said no at 10pm that night, it was too late to get anyone else. We would have had to play the rest of the season without a striker.

“We had to say yes . . . but he’s not going to be able to play for eight weeks.”