Transcript
Jonathan Bird: Right, welcome everybody um to our new podcast that we've called Injury Time, ah where we try and delve into injuries in elite sport, in amateur sport, and try and raise the curtain a bit and give you some some insights as to what really happens. With me, as always, we've got Ian Beasley and Shabazz Moogle, who are both sports medicine physicians, who have both long careers in elite sport, mainly at Premier League football clubs.
Jonathan Bird: And me, Jonathan Bird, I'm a knee surgeon. I treat athletes from amateurs up to professionals. So, ah this week we are talking about player medicals. We're in the closed season um before we start the 25-26 football season and there are a lot of transfers and a lot of the players need medicals.
Jonathan Bird: So we thought we'd chat a bit about what exactly happens in a medical. um And so Ian, and take us away with a few insights.
Ian : Thanks, Jonathan, and good evening, everybody. and but ah Look, the first thing you need to know is who's coming, and then you do your research. You find out where he's played or she's played, what their injury history has been, if it's available online, how many games they've played over the last couple of years.
Ian : So you have a really good idea about what's going on, and you make sure that everybody in the club who's responsible for the signing knows what their history is. And then there's...
Ian : there's No one's left in the dark about what you're getting.
Ian : I don't know what you think, Shabazz. Did you used to do that when you were in and football?
Shabaaz Mughal: Yeah, definitely, definitely. ah Yeah, I think you've got to do your research. But I was going to just ask you there, Ian, how, you know, how much would you know about who is coming and how quickly would you know? Because I think in my experience, you you kind of, it's not, it's not like, you know, well in advance, you kind of, you may find out the evening before.
Shabaaz Mughal: um
Ian : yeah
Shabaaz Mughal: So it's, yeah, a little bit.
Jonathan Bird: is it Is it that late? Is it really that late as the team doctor that you the that that you're finding out just like everybody else when you know when when you've got all the all the transfer rumours and suddenly...
Ian : Oh, definitely.
Ian : ah yeah
Jonathan Bird: to So so you don't you you don't really know beforehand who the club are negotiating with?
Ian : It can be like that. um You know, I've certainly been rung up eight o'clock in the evening and been ringing around trying to get an um MRI scanner for the next morning. And I remember when I was at one club, the manager driving in at the end of the the the last day of transfer window with a player. And I thought, who's that player?
Ian : And they signed in without a medical because it was too late.
Jonathan Bird: yeah
Shabaaz Mughal: Yeah, I think it can vary so much. And sometimes you don't know who it is, but you know, there may be a medical, so you will um set everything up, but you may find out who it is quite late on.
Shabaaz Mughal: And then, like Ian said, there is, you know, the they're the ones that are really close on deadline day where you may be able to do some part of the medical or you might, I don't, I'm not sure actually, it'd be interesting.
Shabaaz Mughal: I don't think that it's allowed anymore. or It used to be where it would be pending medical. um But I think now now, certainly in the later years, it would go through ah regardless. You'd still do all the the relevant checks. But yeah, I can't remember and when maybe earlier on in your career, would there be a pending medical and then it would go through or not go through?
Ian : Yeah, I think you're right. it's not There's no sort of pending medical now, but they I think these days for big players and big money, you know want to be sure about what you're buying.
Ian : It's no different to us going and buying anything in a shop. You want to make sure that there's nothing underlying and that's going to stop this player from from performing as you require them to perform.
Ian : you know There's such a lot of pressure everywhere.
Jonathan Bird: like ah Or it's like a house where you know where you need your surveys and your and your and your um legal report and everything before before you go ahead and purchase Except you haven't got as much time, have you, I suppose?
Ian : Yeah.
Ian : That definitely takes a bit longer than the medical.
Jonathan Bird: does, doesn't it? so so like yeah so so when when you're um so when you've So you've got your player...
Shabaaz Mughal: Or a set headphones.
Jonathan Bird: um and other pitches up the new striker that's going to bang in 30 goals and they're desperate for him to sign. How does it work?
Jonathan Bird: Who's there? Who's in there in the room with you? are you Is it like ah is a bit like someone going to see their GP? Is it just like that? um Have you got everyone around you? have you got is it just you and the player? who Who's there?
Ian : it It, again, it sort of depends. It can be a bit of an entourage that arrives with the player, including family, agent. And then sometimes the player just comes on their own.
Shabaaz Mughal: Thank
Ian : um i these days i never do anything on my own i always make sure that um i work with a physiotherapist the head physiotherapist usually make sure that the sports science guys that are going to do all the measurements are all in the next room so the player goes round and round and does everything cardiac screening obviously that's a yes or a no so they have to have a clear cardiac screen um to make sure that you know nothing serious is going to happen to them during the time of the club
Ian : And there's quite a lot of arrangement, quite a lot of- coordination to do. um everybody's impatient for you to get it done.
Jonathan Bird: Yeah. and And so is he where where is it that where is it done? there Does it tend to be done at the training ground? Have you got in the in the in the in your medical bit of training ground or do you hire somewhere because because you've got all these all these tests to do?
Ian : Well, the the short answer to that is yes, because it it just depends. um The last a signing they did at Bournemouth, they did in Paris. um Often it's done at the training ground.
Ian : Sometimes it's done at a clinic in London. the If the player's coming in from abroad, they may land in London. um And so the medical gets done there. ah So it it depends on where the player is um and what's the most convenient and, you know, and being able to arrange everything that's required, you know, around the same time.
Shabaaz Mughal: depends where you are as well.
Jonathan Bird: And so how go on, Shabazz. so so i can ship that
Shabaaz Mughal: was going to say it depends where you are as well because ah in pre-season invariably you're going to be away with the team so sometimes they'll come to you as well and you may need to arrange ah things wherever you are in the world um and work around those logistics as well ah which can be a bit challenging because normally you want to work with
Ian : Yeah.
Shabaaz Mughal: I mean, it's is's much like we do now. You you know who your sort of trusted colleagues are. You want to work with the same colleagues. And if you're in a different country, different city, you may have to adapt. You take recommendations.
Shabaaz Mughal: But the general principles are the same. You want the cardiac screen. You want to go through and do your and screening. You want to do some blood tests, etc.
Ian : You're right. and I mean, I think we were i was at the Euros in 2012 and one of our players, and national team players, ah was transferring somewhere else.
Ian : I spent the afternoon with him at the local um MRI scanner, arranging the scans ah so the team that he was going to sign for could get all the scans while he was away.
Shabaaz Mughal: Thank
Ian : I'm actually on standby for Bournemouth to do their medicals if someone something happens while they're in the USA. They fly tomorrow morning. So, yeah, it you're right. And there are clinics in London where where they will do medicals for you at the drop of a hat.
Jonathan Bird: and and who's And who's doing that? do you have you got Have you got people who are who were special sort of sports doctors? As Shabazz said, if you're pre-season and you're physically in America or something and the guy you're signing is in Paris, do you...
Jonathan Bird: is it is it would it be would it Would you trust a sports doctor at, say say let's say, PSG? Would you trust them or would you get someone independent in Paris or fly them London or fly them out to America or...
Ian : yeah I mean, you've got a, you know, usually got a ah sort of a list of people that you trust. So but when I was the doc at City Football and I was working in in Qatar, I used to arrange medicals for them around the world.
Ian : And I had a list of people in different areas and different regions in the world where players could get to and have their medicals. And yes, they it's a sports cardiologist.
Shabaaz Mughal: Yeah.
Ian : It's a sports doctor. um it's a It's an MRI scanner.
Jonathan Bird: Yeah, yeah.
Shabaaz Mughal: Sometimes you've got to, there's a lot of secrecy around the medical. um So yeah the sort of, ah it's got to be quite close knit.
Shabaaz Mughal: So those people involved has got, you know, it's a tight, tight network and it may involve you having to travel out at short notice. um So even if it's arranged to at a different country, you may need to go to that country.
Shabaaz Mughal: ah If it's more, you know, there's a pressure to get the deal done. So there are, you've got to I think working in football, you've got to be very adaptable and fluid and ready to, you know, move at the drop of a hat.
Ian : Yeah, I agree.
Jonathan Bird: and so um okay so you've got so So the medical is, there are lots of standard things that you do. Take a history, examine, cardiac screen, and variety of MRI scans.
Jonathan Bird: but That's what every player gets. Now, what about someone who has an injury history? how do you Do you trust the player? um Do you have have access to the to their confidential notes? how How does it work to try and delve out if they're maybe hiding an issue?
Jonathan Bird: or Or even not hiding an issue, just it's known that they've had surgery for for an ACL or ankle fracture or something.
Ian : a I mean, if it's a Premier League to Premier League, then you will get access to the notes.
Ian : But if it's from abroad, you don't necessarily get access to their clinical notes. um If you know where they had the surgery, and they have and you have consent, you can get in touch with the surgeon and find out you know what happened and you know what sort surgery they had and you know You'll find out from their playing history how long it took, how long they were out and how long it took them to rehab and get back to playing.
Ian : And then when they got back to playing, you can see on the internet you know, how long were they were so they were on the bench as substitute, how many minutes they played, how long it took them to get back to full performance.
Ian : So you can find all that. um And some of the tests that you do, are you know, ah the sports scientists do, it's they're really good tests because they give you an idea about whether the player is still favouring his good limb over his operated on limb.
Ian : um it doesn't mean that you're not going to sign them but it gives you it means that you have something you've got to address during the time that they're with you and the manager and the coaches may want to know that actually this player may be not ready yet to perform in the way you want him to but he will be or she will be but it's it's it's giving people the information so that they understand what they're getting and they don't
Shabaaz Mughal: Mm-hmm.
Ian : run out in the first game, get injured, and you say, yeah, well, I'm not surprised I got injured. I mean, you know, they've got this still, and no one knew about it. you've got to make sure that everyone understands exactly what they're getting.
Ian : And then you have a rehab plan. And you can give the coaches a good idea about how long it would take for them to get up to speed.
Shabaaz Mughal: Yeah. yeah
Jonathan Bird: So if you do have a concern, like it's um whatever limp whatever bit it is from their shoulder, maybe you got dot got a ah keeper, their shoulder was dislocated or their ACL or their ankle or like hip impingent or something, at what point do you feel you need to involve a specialist?
Ian : Shabazz, what do you think?
Shabaaz Mughal: Yeah, I think, like Ian said, I agree. um That's generally the the the way it goes. And you'll have a standard set of tests that you're doing on all players. But again, you've done your research beforehand. And if you know there's one area where they've had a big injury, you will do some further tests on that injury.
Shabaaz Mughal: and Part of your medical will involve ah almost a second opinion, so review with a orthopaedic colleague and you may see you know you might home in and go and see a specific colleague, particularly because there is concern about a previous injury.
Shabaaz Mughal: So then you've got a second opinion. so it's much like We treat people in the general public, they come to us, we see them, if we have a concern, we want a second opinion, we might do further investigations.
Shabaaz Mughal: So it's not a ah one size fits all. Everything, again, um you you adapt depending on the actual presentation in front of you.
Ian : I agree and I think that the way that i look about it is if you throw a pebble in the pond and there are ripples, you know, you've got the club staff around the player, which is where the pebble goes into the water, and then the next concentric circle is your extended NDT, so that might be your specialist, it might be
Jonathan Bird: So sorry, Ian, just explain to us what does MDT mean?
Ian : Sorry, multidisciplinary team. So everything is a multidisciplinary team these days. And, you know, everyone talks about multidisciplinary teams. Not everybody likes working in multidisciplinary teams.
Ian : But in these situations, you have to make sure that you get opinions from the appropriate person. So think about those
Jonathan Bird: so So that would be, so so as an MDT would be, who would be, what what does that what does that look like? So you're a doctor, got doctors, physios.
Ian : Well, it your you're small yeah you' small circle, which is the club staff, which is doctor, physios, sports scientists, performance director, sporting director, that's your your multidisciplinary team that will sit and say, yeah, we think this player's going to be fine for us.
Ian : We don't have any problems with him. Or he's got this problem. We're going to have to adapt the way we rehabilitate him and play him for the first three months. Or he's not suitable. um And then you've got your orthopaedic surgeons, your rheumatologists, your anybody else that you think might need to be seen.
Ian : So for instance, if the sports cardiologist says, I think there's a problem here, you may go to the countrywide expert and say, what do you think about this? Two opinions.
Ian : Because if you're spending a lot of money on someone, you want to make sure that they're worth it.
Shabaaz Mughal: Thank you.
Ian : Or it's only fair to the player that's coming in that you don't leave any stone unturned. So if there is any problem with them, they have to know as well, as well as the club.
Jonathan Bird: Yeah, and um if there is a problem, said specialist says, you know, I think there's an issue here. Who makes the final call on whether you buy the pro or not?
Jonathan Bird: I mean, do you, is there ever a dispute?
Ian : That's a good question. Yeah, I mean, yeah, of course, there I've only ever been involved in one massive dispute in the sort of almost 40 years I've been doing this.
Ian : And I, i denied someone getting signed for the club I was working at at the time. And they flew a specialist over from South America.
Ian : We had a massive argument in the manager's office. um I'd taken all the scans and all the investigations to see, ah kind again, a countrywide expert at the Royal National Orthopaedic Hospital.
Ian : And he said, don't touch this player. And I stuck with that. um This player went on to play for the club that he was at for ages afterwards, never had a problem.
Ian : And my point is, is that, you know, you you can only do what you can do. um
Shabaaz Mughal: Amen.
Ian : I was trying to protect the club. And to be fair, trying to say to the player, look, you've got this issue, you may need to do something about it. um As far as I know, he chose not to do that, but I don't think he ended up having a problem with the issue that I found.
Ian : But nevertheless, he's that's the only time. And I think you make a decision together. um And you might go to the to the sporting director and say, look, we found this.
Ian : We think it's going to be okay, but you know don't think about a 10-year contract.
Jonathan Bird: Yeah, um I know the knee surgeon that advised a big club, a big Premier League club in the North not to buy a player and with his well-known injury and he never, it was a shambles.
Jonathan Bird: He had to retire early and and he said, you know, i I told them not to buy him.
Ian : yeah
Jonathan Bird: um So, you know, you can go you know, you can't, I suppose ultimately is it's like anything, someone has to take responsibility ultimately for for that decision.
Shabaaz Mughal: Yeah,
Jonathan Bird: You can only advise. You can only ultimately only advise.
Ian : And Shabazz will tell you hundreds of times I've signed players that I'm thinking not sure about this and the manager says I definitely want him.
Shabaaz Mughal: I can feel yeah i think
Shabaaz Mughal: But it's in ah it's more of a... So I see a medical and people people love to sort of term it pass fail. I don't think there's any such concept. I think a medical is a risk assessment.
Shabaaz Mughal: And it's something that, like Ian described, this close circle, you will all sit together with the facts.
Jonathan Bird: Yeah.
Shabaaz Mughal: And what we're doing in the medical is we're gaining facts. And then with the facts, you're making an assessment and you're evaluating risk and you're taking everything into account, not just an injury or an injury history, but also playing history, playing style, age, previous clubs, how they're going to play, where they fit in.
Shabaaz Mughal: So when all of that is taken into account, it's not a one person decision, it's a club decision. And then everyone's got to be comfortable in making that decision. And there may be, you know, ah occasions where they'll take a chance or more of a risk, should we say, and it works out fine, or it may not work out fine, or they don't take the risk and they go elsewhere like in described and do really well.
Jonathan Bird: you
Shabaaz Mughal: But ultimately, everyone's got to be comfortable with the fact that you've all made an informed decision and you've made a decision.
Ian : Yeah, you're right. It's risk stratification. And so these days, you know, big clubs will do personality assessments, psychological assessments, look at their family, look at their background.
Ian : And so they should. um So it's yeah the extent of the examination of players' pasts and their playing history, personal history, social media.
Ian : They'll sweep the social media and make sure they haven't done anything silly in the past or said anything silly in the past.
Shabaaz Mughal: no
Ian : All these things come into play now. um You know, the book's open. Everybody can see what's going on all the time. and So nothing is left done you know and undiscovered.
Shabaaz Mughal: Again, it depends on the club as well, doesn't it Ian? Because you can't, you know, every club will have their criteria and It's how do you, you know, if you're club A, how do you attract this player as opposed to club C?
Shabaaz Mughal: So the question is, are you willing to accept certain things, knowing that your club is potentially a less attractive proposition to the player? So I think it's it's not just based on the medical.
Shabaaz Mughal: Whereas sometimes it's you know it may be coming across as it's something that's happened in the medicine.
Ian : Yeah, and there's hero there's no yes, there's no pass or fail. but There might have been a once upon a time, not anymore. um
Jonathan Bird: Is there ever any comeback? If you say, yeah, the player's fine and then they end up having injury after injury after injury, do you ever get blamed?
Ian : That's a good question.
Shabaaz Mughal: Yeah.
Ian : I mean, Blamed isn't. I just think by the time they come through the door and I've got a pretty good idea about what's going on, I will point out to the the hierarchy of the club exactly where this player sits physically.
Ian : um and how how they appear. I mean, you know, for the player, it's it's a taxing time because, you know, they obviously want to come because they're sitting there next to me.
Ian : um But, so so it's very hard for them. But, you know, I've got a pretty good idea about what it takes for a footballer to perform. and you know whether they're going to be able to do that um and if i think they they're going to struggle i'll i'll say so and then and then and then it's up to the sporting director usually the manager and the agent to to sort it out i had one player we did a medical on um one late one evening went up to see a specialist in london even later one evening he was definitely going to sign then didn't sign
Shabaaz Mughal: I
Ian : ah And that's that's what happened to him Shabazz he had and ah more attractive offer from another club.
Shabaaz Mughal: a know also sometimes the information from a medical may be used as part of the sort of negotiation as well and it might be, you know, a contract based on performance or some element of that as well.
Jonathan Bird: Yeah.
Jonathan Bird: Interesting. Right. Okay, right. So we've... we've um That's our first episode. Thanks all. um
Jonathan Bird: We're not entirely sure when the next episode will be, but come back come back and join us and join us again on Injury Time, where we'll be talking about, again, something involving athletes, their injuries, um and how to re rehabilitate them.
Jonathan Bird: Thanks, everyone.
Ian : Thank you.
Shabaaz Mughal: Thanks. Bye-bye.
