The second part of a three part interview where we look in some depth at how the medical team approaches the treatment of players...
From Ian McCulloch
You mentioned previously that we now have a full-time doctor, Charlotte Cowie. This is a new development for the Club?
We didn't have a full-time doctor before, we had a number of doctors who worked here part-time during the week. One of them was Dr Simon Kemp who had ties with Rugby Union as well as us and he has very recently moved on to a full-time position with England Rugby. I know he enjoyed his affiliation with Fulham, but I think his ties were strong in the rugby world and it was a brilliant opportunity that came up for him.
We also had Dr Mark Witherspoon who worked with the Academy, and he too had ties with other areas. I think that the demands placed on a doctor within a football club are very high, and trying to cope with working in other practices at the same time is very difficult. You have responsibilities to patients and you have to be available all the time. If they need you at the football club you can't just drop your patient load and leave. It's quite hard for everyone when you're in that position.
So it's a fantastic opportunity to get a sports physician, someone who's trained at a high level and has lots of experience, to come on board full-time. Charlotte has some exceptional qualities and has fitted in very well. I suppose some people might question bringing a female into the male environment, but we already have a number of females on the medical staff here and the players don't have any issues with that at all. They all fit in very well, they're all heavily involved and the players don't treat them any differently from anyone else - unfortunately they don't behave any better either!
We've got a really enjoyable, positive environment here, which I think is important in a medical room. Players need to be confident that they're going to get quality treatment, but they also need to be comfortable so that they can interact with the medical staff. They need to be able to trust them, rely on them, have a good rapport, otherwise they're not going to be reporting their injuries properly - they're not going to want to go anywhere near the medical room. I know we've been able to create a situation here where players are happy to come and tell us that they have a problem. We can then manage that problem straight away, and I believe we manage it very well.
Charlotte is a fantastic addition, and the experience she brings having worked at the highest levels both in football and sports medicine in general is tremendous. The value of having a number of highly trained and experienced staff is that you share the load and you share the responsibility. Three or four minds wrapping their thought processes around an injury is far more likely to manage it optimally than one person carrying all the pressure on their own.
Is it possible to quantify the effect this level of support has on the team, both in the prevention and treatment of injuries?
It is difficult to quantify, but perhaps you might say that Fulham players aren't sidelined with niggling injuries as much as they used to be. The biggest thing, and the management have a huge role to play in this as well, is that without being overly cautious we are very protective of the players. We won't put a player at risk. He won't be put out on the park if it was thought that there was any risk whatsoever of sustaining further injury.
Presumably that's not always the case at other clubs?
Absolutely not. We have had players who have gone to other clubs, and I know a lot of Australian players who are now over here, and what's clear is that many clubs just don't have the trained staff. In addition there is also a lot of pressure put on those staff to get players back, sometimes too early. And that quite often ends in disaster, with injuries being exacerbated - something that could have been managed in a week if it had been looked after appropriately, ends up taking a month or more. It can be a real problem, but I think it highlights the importance of the communication channels and the attitudes of the medical staff with the management. It's very cliched to talk about the "team" approach, but it is essential. And players need to know that they're going to be looked after properly, because if a player doesn't have confidence in what you're doing with them, then the actual recovery process itself is slowed. There's a lot to be said for positive thought.
Would you say that here at Fulham you would be able to improve the fitness levels of a player who may have been considered injury prone?
Absolutely. And it comes from a commitment from the player and also a commitment from the staff. We have players who basically don't get a day off, because to maintain themselves they have to come in every day to get some on-going management to their bodies. It's a commitment of time and effort and planning from the medical staff, but also from the player who has to realise that they may have different issues from everyone else and therefore will need to devote more time to them.
There are always going to be unfortunate accidents. Some injuries are unavoidable, the bad tackle, the cheap shot from an opponent, the physical thing you've got no control over. But there are other things in terms of a player's flexibility, the strength they have, the stabilisation of their muscles, where we can have a big effect. This is where Roger, the fitness trainer comes into his own. He is 110% motivated and devoted to achieving the optimum for the players. If a player show a deficit in some area then he will co-ordinate with us and drive the programme. Unfortunately, when you're pushing the players you can almost become the villain. You're hounding players all the time and the schedule of a professional footballer is very rigorous. But the one focus of all the staff is to get the players to their best and keep them there - to do what it takes to get them back as quickly as possible without putting them at risk.
Measurement seems to be a very important part of looking after the players?
It is. It's hard to know whether your intervention is of value unless you have some sort of objective measure to determine whether you're making a difference or not. Is it worthwhile, or am I doing it just because the textbooks say I should?
We have some devices here which are very useful for that, one of them being the Cybex machine. This is a machine that will exercise any part of the body, and it's hooked up to a computer that collates all the information. It can determine how strong each muscle is, relative to other muscles or relative to how strong you would like it to be. It can determine the strength at a certain point in range of motion. It can tell you if you have a weakness at higher speeds of movement. Basically it has the ability to analyse a player's deficits, which then gives us an indication of how to structure their training programme to address that. And then you can re-test them to see if they have improved or not. It takes some of the guesswork out of what we have to do which is terrific, because human error is a huge component of medicine. It usually come down to the medical practioner's own perspective and experience, but the beauty of a machine like that is that it takes a lot of the error out of it. Something is either there or it isn't. It's either strong enough or it isn't.
At the start of the season all players are put through the machine. They undergo a number of exercise protocols to determine what are weak areas and what are strong areas. They also go through running tests like the VO2 Max, which measures the volume of oxygen the body uses when it is maximally exercising. This really determines how fit a person is. They do a treadmill running test, basically to fatigue. They start running, and the pace gradually increases until they can't keep up, and at the same time they have devices on where we measure the volumes of air and oxygen they are using. In exercise physiology terms it's the most accurate test of a person's aerobic fitness, and so by ascertaining that at the beginning of the season, Roger can sit down and devise an individual training programme for each player.
We also take into consideration what a player's position is. Obviously the speed, agility and energy requirements of a defender are different from a striker which are different again from a midfielder. So each player in their relative position can have a programme tailored to their strength deficits and their fitness deficits, and the results of all that should hopefully come through on the park.
The science of it all is quite amazing. Unfortunately, a lot of this equipment is quite expensive and many places won't have access to it, so again it's another bonus that we have.
And hopefully it gives Fulham that little bit more advantage on the pitch?
It does. It gives us that opportunity to take things that little step further. All the staff here have very open minds, so quite often we look at new products just coming out, things used in other parts of the world for other purposes. If we can see its application in football and justify it's value, then we will use it.
Look out for part three of the interview next week, where we find out exactly what goes on behind the scenes on match-days.