Dr Imtiaz Ahmad: Football Club Doctor – An Evolving Role – Injury Rehab Network Event

Acute Injuries

Dr Ahmad described the processes for the treatment of acute injuries and the associated teamwork and communication required. On match days at QPR FC the medical team includes the doctor, 2 x physios and 1 x sports therapist. When an injury happens, the medical team are prepared to manage the injury as follows:

1. Review injury on the pitch
2. Review injury in the medical room
3. Book scans if required
4. Review after match
5. Next day – review and ultrasound
6. 2+ days post-injury – MRI scan

After receiving the imaging report, Dr Ahmad then follows a carefully controlled protocol to discuss and communicate the injury, initially with one decision-maker, then with the Head Physio, a specialist if relevant, with the player, with the manager, director of football, medical team, logistics team and finally the board. Any media announcements will only be made after all the above individuals and teams have been informed and discussed the injury.

Return to Play

Dr Ahmad discussed the milestones for players to return to play, with assessments from medics and the sports science team:

• Initial gym-based functional movements
• Multidirectional function
• Ball striking
• Progressive rehab
• Doctor review
• Player confidence
• Speed test and jumps (within 10% max)
• Injury specific markers
• Player confidence in contact
• Position-specific drills
• Ball striking (100% effort)
• Achieved match load profile
• Complete full warm-up
• Aerobic fitness tests

From experience, Dr Ahmad’s view is that it’s best to carefully plan the final stage of the return to play protocol with a managed increase of minutes played in matches.

COVID-19

Dr Ahmad described the huge workload and learning from COVID-19. Imtiaz saw first-hand the importance of professional football in supporting the nation’s wellbeing and managed the vast work required to manage COVID. Imtiaz and the team needed to upskill fast.

To reduce the risk of and manage COVID, Dr Ahmad’s role included work around communication, social distancing and self-isolation, health, risk assessments and return to play for players recovering from COVID.

A range of processes was put in place in collaboration with football clubs and the league for risk assessment, planning, education, enhanced hygiene measures, monitoring and testing and collaboration.

Imtiaz helped develop a 4-4-2 of COVID-19 transmission avoidance to support player education including enhanced hygiene measures, use of PPE and ways to manage infection control.

Dr Ahmad has now added COVID as a third C to the critical Cs of sports medicine management = Concussion, Cardiac Arrest + COVID.

Non-COVID and COVID Affected League Comparisons

Data was presented with a comparison of the pre-COVID 2019-20 season and COVID affected 2020-21 season. During the COVID affected season, the same number of league games were played during a shorter time and with less training time.

The incidence of injury during 2020-21 was lower and Imtiaz stated that this may be because there was less training time and therefore fewer training-related injuries. Injury location varied between the two seasons with less hamstring but more quad injuries in 2020-21.

In the 2020-21 season, there were no injury recurrences compared to 5 in 2019-20. Dr Ahmad is focused on continuous improvement in relation to injury prevention and injury reduction and compares the number of injuries across the team against other teams in the Championship.

Recovery for Performance

Dr Ahmad discussed the many strategies and tools available to aid recovery and performance in professional sport. Imtiaz noted that the three most important factors are good hydration, a balanced diet and sleep. Other tools such as ice baths, massage and stretches may support recovery but should be secondary to hydration, nutrition, and sleep.

Health, Training, and Research at QPR

He described how QPR FC are involved in and support training and research. Current research includes an exit health examination for players, a study into communication with the University of Bournemouth, research into the importance of sleep and student placements at QPR.

Imtiaz shared details of some health education with players that were completed pre-COVID to promote healthy lifestyle choices, hygiene, and infection control measures to reduce the risk of illness.

Mental Health and Football

Statistics were presented about mental health and men with 1 in 4 people affected by mental health and sadly 12 suicides in men per day. Mental health is equally important in football with several high-profile cases. The PFA and Premier League provide support to players and staff.

Imtiaz was involved in a FIFPro study completed into the mental health of football players during COVID. This study showed that during this period, depression was 2 x higher and anxiety 3 x higher.

Dr Ahmad discussed the reasons why footballers may suffer from mental health problems including:

• Pressure to perform
• Continual monitoring
• Injuries
• Regular change
• Addictions
• Retirement
• Support networks

Imtiaz presented examples of how young footballers can quickly become well known public figures with huge public following. This high level of interest can put pressure on young players.

Dr Ahmad described the large circle of people associated with professional football players including family, teachers, medical professionals, coaches, agents, football club managers/ directors and the media. Whilst there is potential for this circle of people to provide support and encouragement there is also potential for pressure and conflicts of interest where the players welfare may not always come first. Imtiaz described the important role of therapists to identify mental health problems and provide support to players.

The Growth of Sports Medicine

Imtiaz discussed the growth of sports medicine and the growing teams of staff at professional football clubs. He believes that good staff development can support good player development. Staff must be good at their job and have credibility with players and elite staff.

Dr Ahmad described what medics can learn from professional sport including accountability for performance, leadership, looking at the bigger picture and learning to be confident in giving an opinion.

The concept of marginal gains has become popular following the success of Sir Dave Brailsford, British Cycling and Team Sky/ INEOS. Dr Ahmad described how marginal gains may be useful at the fringes of elite performance, but that professionals should focus on being brilliant at the basics before investing time and resources in potential small areas of improvement.

Imtiaz advised that professionals should firstly focus on being brilliant at the important things and then develop specialist skills. The fundamentals never will change, and basic principles of organisation, confidence, hard work and enthusiasm should always apply. Good communication is vital as is listening!

Take-Home Messages

Dr Ahmad summarised his presentation with some take-home messages for sports rehabilitation professionals:

• Understand the importance of health and its impact on performance
• Understand the organisation you are working for
• Do your role to a high standard
• Be confident in giving an opinion
• Top staff can help to change the culture of an organisation
• Brilliant basics before marginal gains
• Communication, communication, communication!

Q&A

Here are the questions he kindly answered following his presentation:

Question 1 – Is there a conflict between managers and the medical team for the time out players require for injuries?
Answer – There are weekly differences in opinions. Professionals can use a range of options to communicate and influence including 1-2-1s, groups discussions and emails to summarise key points and actions.

Question 2 – Is mental health included in risk assessments for player health and wellbeing?
Answer – Yes, mental health is considered as part of screening. Medics and therapists have a role but also signpost to mental health specialists for support.

Question 3 – Is there an increase in the prevalence of RED-S in professional football?
Answer – RED-S is prevalent with lots of growing research into the condition. We would use measures to assess fatigue to identify RED-S.

Question 4 – How do you communicate with and manage players who haven’t taken up the COVID vaccine?
Answer – People have strong views and opinions about COVID so it’s important to offer informed advice. Information is provided to players through group presentations and one to one discussions. It’s important to talk on a normal level, to take time to listen and understand individuals and to try to influence change by building rapport.

Question 5 – Is permission required from players before any injuries are discussed with managers and/ or the media?
Answer – Yes, this must always be signed off with the player before any further discussions take place.

Question 6 – If a player discloses a mental health problem, does this need to be communicated to the manager?
Answer – Any disclosure must be kept confidential unless the players agree, for information to be shared with other staff. Medics must not break players wishes. If players are performing at the required level and are managing their mental health, then it may not be necessary to share information with the management and coaching team.

Question 7 – How would you recommend that therapists upskill regarding concussion and cardiac arrest?
Answer – National Governing Bodies such as The FA offer good training such as the ATMMiF course. The FA medical society offer CPD and learning opportunities and events such as the Injury Rehab Network offer an opportunity to collaborate and learn. Professionals should practice emergency care skills regularly and remember that applying knowledge is harder than gaining it.

Questions 8 – How did you get into sports medicine and what advice would you give for students?
Answer – Imtiaz enjoyed sport as a young athlete. After suffering an ACL tear Imtiaz experienced first had treatment and rehabilitation from a sports injury and this sparked a personal interest in sports medicine. The best advice for students and those new to sports rehabilitation/ medicine is to be confident and competent, to upskill to be ready for any opportunities that arise and to continually learn on the job.

Follow Dr Imtiaz Ahmad

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Twitter – @DrImtiazAhmad7

Watch it Back

The recording of Imtiaz’s presentation is available to view here.

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