LaLiga Exclusive: Invisible Training – Injury Recovery
HOW LALIGA CLUBS ARE WORKING TO PUT AN END TO INJURIES IN FOOTBALL
There’s no better signing than investing in health, ever larger and more professional medical departments are benefitting from the very latest in technology, and RC Celta is making its facilities and doctors available to the general public.
“Every club in the big four European leagues loses an average of €15 million a year through player injuries. Each club loses between 10% and 30% of their squad each year through injury.” The verdict pronounced by Dr Xavier Alomar at a medical conference held in February 2018 is an alarming one. While traditionally it was common to trot out the familiar tune that injuries cause “incalculable damage to clubs”, someone finally took the time, calculator in hand, to do the numbers. And they are eye-watering: those €15 million could pay half the squad’s current wages at clubs such as RCD Mallorca, Real Valladolid, Granada CF and CA Osasuna, and that money is squandered on injuries alone. Every time someone hobbles through the sickbay doors, a hole appears in the club coffers.
It is for this reason that LaLiga clubs are working tirelessly to try to cut back on the losses accumulating in their clinics, in the knowledge that injuries are the most commonly occurring setback and that one of the best ways they can remedy this is by investing in a constantly evolving branch of medicine. “When I was Pontevedra’s doctor some 20 years ago, we only took one chest X-ray a season,” admits Dr Juan Jose Garcia Cota, RC Celta’s head of medical services and a doctor with the Spanish national team. “When I left Real Valladolid in 1995, and before signing for Racing de Santander, they gave me a single scan to check the state of my health,” recalls Alberto Lopez, the legendary 1990s Real Valladolid frontman, who now works as a doctor for his old club. The goals Alberto Lopez scores today are against injuries.
The generational shift has been immense, and we could not expect anything less given the professionalization of even the most minute detail in modern-day football, where improving player health has become a fundamental issue for all clubs and one inextricably intertwined with science. At Betis, for example, since the 2018/19 season they have been placing an emphasis on scientific study, with dedicated staff working exclusively on research, development and innovation in a highly targeted R&D department. Some clubs also include the role of a sports scientist. In February, Real Madrid organised a medical conference which immediately became a global benchmark. And other LaLiga clubs have genuine medical royalty in their ranks, such as FC Barcelona whose medical chief, Dr Ricard Pruna, has been with the club since 1996 and has earned several awards for excellence. Medical departments are becoming ever larger – with some clubs even having outsourced them to Spain’s major health companies –, in the best of cases including as many as seven highly specialised physiotherapists (osteopathy, invasive therapy, manual therapy, joint mobility, etc.), five sports therapists and a nutritionist. The facilities are much better equipped and, in general, the culture of health is taking root in leaps and bounds. As we can see, Spanish football’s battle against injuries is at a truly exciting juncture.
Although the main yardstick when judging the work of doctors in football is recovery times, the sphere of action is in fact much broader. “Multidisciplinary work takes place in a football club, and everything surrounding injuries is not just down to the doctor, but also to the fitness coach in terms of how to prepare for the season, the manager as to how to distribute playing time, the physiotherapists who work on a daily basis, the players themselves… We all have to work together, based on loyalty, in harmony, trusting in each other,” explains Dr Cota (RC Celta). As was the case in the field of fitness training, in the present day there are several departments which need to be seamlessly coordinated in order to look after players’ health: nutrition, psychology, fitness training, etc. And the doctors, physios and fitness coaches not only get involved once an injury has occurred, but also in the prevention stage to stop players from being side-lined in the first place. This is the first step towards trying to mitigate that annual €15 million black hole.
MEDICALS: SOME PLAYERS HAVE FALLEN OFF THE TREADMILL DURING THE STRESS TESTS
In order to prevent injuries, doctors’ first weapon is the medical, evoking that very familiar picture for all LaLiga fans every time a new signing is brought in or the pre-season kicks off in the summer: players undergoing physical tests hooked up to all manner of wires and surrounded by professionals in white coats staring at a myriad of screens. Alberto Lam is the head of medical services at CD Leganes -one of the most humble clubs in LaLiga, south of Madrid, in the shadow of giants in Spain like Real Madrid and Atletico-, and the responsible of the tests which the club carries out each season: a very sophisticated exploration of the respiratory system and listen to the heart and lungs; complementary tests, such as a spirometry to examine pulmonary ventilation; scans on specific joints depending on the player, and also full body scans; objective measurement methods, such as strength tests; etcetera. Some players have fallen off the treadmill during a stress test, and they even must place limits on medical tests for maximum strength exercises, because the possibility of injury exists.
For example, at Real Valladolid -the historic club in central Spain that today is chaired by Ronaldo Nazario and that however have only played in the top division in four seasons during the last decade-, they also subject players to a broad panel of lab tests, a dental check and a gait test, as well as many others. In the case of Villarreal CF, the head of medical services, Adolfo Muñoz, goes one step further in terms of heart-related prevention. They conduct a 12-lead electrocardiogram and echocardiogram to monitor the activity and shape of the heart. Also, there’s the stress test to see the heart under stress. And they run these tests together with a cardiologist. Muñoz was at Sevilla FC and was particularly moved by the case of Antonio Puerta –a promising youngster who had already carved out a place in the Sevillian side, who died in 2007 three days after suffering a heart attack in the middle of a match at the age of 23– and this is where his sensitivity to heart problems stems from. As part of his doctoral thesis, he’s designing artificial intelligence studies to determine patterns that can detect the risk of sudden death indeed.
Tests, tests and more tests, which are more and more specific: listening to the heart and lungs, eye, nose, ear, lung, and gland exams… All with the objective of drawing up a comprehensive biological map of each player which allows their extensive medical history to be combined with their current physical condition. This allows for an individualised design of medical treatments as well as the planning of physical workloads. The fact is, as covered in the previous chapter on Fitness Training, the future of football training is inevitably linked to individualisation. At Real Betis they design individual plans for player rehab that never existed before. And they perform preventive group controls together with the coaching staff and the fitness coaches. These never existed before and can bring potential problems to light. Based on that, they insist on the specific training required to correct them. They try to identify the shortcomings, the physiological deficits of each player to react properly.
This individualisation is founded on detailed monitoring of all of the tests which are carried out at the start of the season. However, they are not performed in isolation, rather they are followed up throughout the season. At Real Valladolid they run between four and six exams a year. At Villarreal CF they run tests every month, as well as electrocardiograms in December. Follow-up is fundamental, recognize LaLiga clubs, and it is for this reason that the results of these types of tests are constantly compared with the pre-season results at Leganes. So sometimes a player recovers better from his injury because he undergoes a specific treatment in light of his history.
REHAB: “SOMETIMES IT’S TLC RATHER THAN ANTI-INFLAMMATORIES THAT’S NEEDED IN BIGGER DOSES”
Work on injury prevention is a mammoth task at LaLiga clubs, as we have seen. Even so, there are injuries which cannot be avoided. They remain a part of the game. So for the doctors, that signals the time for diagnosis and to start the rehabilitation process: the thorniest issue for all parties involved, especially the players. “In the world of sports teams and football, it’s not just a case of we medical professionals needing to have significant abilities in terms of training, which we obviously have to have. You’ve got to understand the philosophy of football as well. Sometimes it’s TLC rather than anti-inflammatories that’s needed in bigger doses. Footballers are demanding patients, because this is their livelihood, it’s their profession, they’re in a hurry. And sometimes the treatment is in line with that,” explains Dr Cota (RC Celta).
That said, whilst first and foremost it is obviously the players who bear the brunt of their injuries, it is the doctors who come under the spotlight at this point. Ironically, as they themselves admit, they often have to go against the sporting interests of their clubs. They need to act as a counterweight to the needs of the competition and the player’s desire to get back out on the pitch. But there’s no other choice. Health always comes first.
Dr Cota (RC Celta) is under no illusions as to which issues are currently the most sensitive ones for doctors in football: “First, the decision out on the pitch, on whether the player can continue or not. In the clinic you’ve got time to order tests and think about it. On the pitch, you don’t. The second point is managing patient information. Because of the popularity of footballers and data protection, it’s a very sensitive topic. These kids are public personas and have a big influence. And the third point is the most complicated one: deciding when they can return. Because we’re juggling very tight timelines. When you have a patient in your office, you can extend the timeline. But with players you give very tight timelines because the effect of them being out is even greater now. But obviously, although there’s greater urgency, everything has improved: medicine, knowledge, treatments, protocols… We have things today we didn’t have before. For example, scans are an everyday thing for us when before we didn’t have much access to them. The training and treatments of physiotherapists have improved a lot. Before you had a shortwave system at best. And now there are much more powerful induction machines, TECAR therapy machines… Both from a technical and a human perspective, we have improved a lot.”
Although things have improved significantly in the rehabilitation of injuries over the years, from their prevention to their treatment, Dr Cota also points out an area in need of attention in the area of rehab: “Downtimes from muscular injuries have not been reduced, according to multiple studies. The rehabilitation of ligaments has improved a great deal. For a cruciate ligament, a great deal. Due to surgical techniques. A torn meniscus, a sprain… But not muscle injuries.” It is a question which is now beyond the realm of sports medicine and almost about overcoming nature. Nevertheless, given the evolution in recent years in terms of training methods, equipment, and health culture, who would currently dare claim that it cannot be overcome like so many other obstacles to footballers’ health? Who would currently dare claim that the €15 million hole cannot be reduced to zero in the near future?
THE RC CELTA CLINIC: THE PLAYERS’ DOCTORS, ATTENDING TO THE PEOPLE
One of the LaLiga clubs which has found a pioneering way to reduce that financial loss is RC Celta: by creating a club clinic which is open to all. The RC Celta Clinic was launched in the 2018/19 season. It all started on the back of an idea by Dr Cota himself when he arrived at the Vigo club in 2008. “It was a professional concern. RC Celta is closely connected to the city of Vigo and its people. The project involved everyone, and it was one we were very excited about launching: a club clinic, but one for the city and for everyone who needs our services.” This way they could make their facilities and know-how, which are at the forefront of world sports medicine, available to the rest of society. That was the prime objective, and at the same time to recover part of the financial investment.
In 2008 it was impossible to give it the green light because the club was in administration, but as soon as the club recovered its financial independence and health, the project was put back on the table. Initially, the attempt was made to carry it out at the Abanca Balaidos stadium, which hosts RC Celta’s home games, but because the club does not own the stadium the decision was taken to postpone it until it had its own premises: A Sede opened in March 2018. The head offices are open to fans so that they can feel close to the club – as was common in the ’70s and ’80. In addition to the offices, the academy residence, dining areas, a function room and an official club shop, it also includes the RC Celta Clinic where Celta players mix with outpatients.
“The players are our raison d’être and we see them at different times. But we’re clear on one thing: in this profession you can’t give preferential treatment to one kind of patient over another. There can’t be a difference between treating a first team player and any other patient who walks through the door. I can’t see things that way. You have to apply all of your knowledge to treating them. We would never kick a patient out of an appointment because a club player arrived, for example. Of course, if Rafinha is in pain, I’m going to see him today. But we try to avoid having a waiting list for the others,” Dr Cota strongly defends, who in addition to acting as head of RC Celta’s medical services also acts as the director of the Clinic.
In any case, Rafinha, Denis Suarez, Iago Aspas and their ilk are permanent fixtures in virtually every appointment. “In a clinic like this, something curious happens: in many appointments you talk about football and not pathology. About whether the team won or not, about whether pedrito is playing… Today’s our day,” explains Dr Cota with a smile, acknowledging that many of his patients are very familiar with them from watching them on television when supporting RC Celta. What’s more, the club offers RC Celta members reduced rates to attend the Clinic, which currently only works with one health insurance company.
“We get very good feedback from the patients, the majority of whom are people who play sport, although we’ll see any patient,” notes Dr Cota. “We want to maintain the relationship with the city, to intensify our relationships with our patients, and become a reference centre for athletes as well as a comprehensive health centre,” he explains, while insisting that one of the main pillars of the Clinic is to instill prevention as the best way to anticipate ailments or injuries, especially in occasional athletes and children. To do so, the Clinic offers a wealth of services, provided by doctors Cota, Galán, Quirós and Piñeiro, all of whom work for the Vigo club, along with its physiotherapists; that is, literally the same hands that treat the RC Celta players. Its specialties are orthopaedics, physiotherapy and cardiology, which they have made a big commitment to, especially in terms of prevention. They also have a nutrition unit and a wide range of external consultants to treat other specialties: hand, shoulder and maxillofacial surgeons, and the list goes on. The staff have the same high level of training as those who treat the professional players, and obviously they also use some of the most technologically advanced equipment currently available.
“We invest in health. The club always gives us freedom and, little by little, we’re improving the facilities. The latest piece of equipment we acquired is a super inductive system, with great potential for treatment. It’s like magnetotherapy on steroids, with a 3-Tesla capacity, and which we really wanted to have because it gives such good results. But in the end, what we’re most proud of is our professionals. I really mean that: the very best tool we have is the physios’ and sports therapists’ hands. Salvador Domínguez, Pedro Docampo… ¡everybody indeed!” explains Dr Cota, in an earnest nod to those who make up his staff, both for the RC Celta squad and the RC Celta Clinic. It is an innovative and inspiring project, and also one with a bright future. “After a year and a half, the clinic has been very well received. And for a health professional, nothing beats being able to help people,” says Dr Cota, the father of this revolutionary initiative.
ANA DE LA TORRE, THE ONLY WOMAN ON THE MEDICAL STAFF OF A LALIGA CLUB
Talking about the ability of the medical professionals of the Spanish clubs, it is worth highlighting the case of Getafe FC, which is the only LaLiga Santander club with a woman on its medical staff: Ana De la Torre. “It’s an honour. There has been a barrier for women in football for a long time, and this is changing. I want to thank Christopher Oyola, the head of Getafe CF’s medical services, who was the one who opened the doors of the club to me,” explains the Getafe doctor.
What’s more, this humble but successful club in southern Madrid also has a female doctor, Fátima Breña, who works with the reserve team. The commitment is towards aptitude and professionalism, regardless of gender, an issue where we are finally seeing progress in Spanish football.
“Having a woman doctor seems completely normal to the Getafe players. Lots of footballers have come through Getafe during these years and they still call me for consultations, even though they’re at another club or in another country. Even retired players,” explains Ana De la Torre, who also has some more rather more extravagant stories to tell: “When we’ve played away, because I’m the only woman in the group, once one of the marshals even thought I wasn’t part of the club and was trying to sneak in with the players. And the players were the ones who said that I was with them, that I was their doctor.”
Fortunately, LaLiga clubs are not only making giant strides in terms of looking after their players’ health, but also in other areas such as gender equality. And the fact is that health in football does not distinguish between men and women, only injuries, time on the side lines… and that black hole gobbling up €15 million every year, which LaLiga is making important inroads into plugging.