A Physiotherapist’s Role When Working With National Squads

My primary goal when I started my physiotherapy training many years ago was to work with elite level athletes and specifically football and I have progressed from youth academy physio to full-time 1st team physio in the SPFL and then on to the national team set up. I consider myself extremely fortunate to have been given these opportunities and I thought it would be interesting to give you an insight as to the role of the medical team and specifically physiotherapist.

National team dates are now a fixture in the football calendar with 7-10 day trips that normally involve 1 or 2 games at each trip. With the U21 squad, we receive our squad letter with details before the press conference which highlights which players have been selected, the full staff that accompanies the squad and details of hotels and times/location of any games and training sessions. Training facilities are key to a successful camp as players are used to top-class facilities as many are with top-level clubs in Scotland, England and now abroad with some players recently playing for clubs in Spain, Holland, Belgium and Italy. With the recent opening of Oriam, Scotland’s national sports performance centre, the training facilities are comparable and in a lot of cases, superior to what players have at their clubs.

When players are called up they may be carrying injuries that require assessment as to whether they will be fit for duty. A good communication link between clubs and national medical and performance teams is crucial here. Players that have issues that will completely rule them out of the squad will be withdrawn after consultation with the medical team and coaching staff whilst those with more minor issues will be asked to attend the squad gathering for assessment by the physio’s and team doctor. Some will also travel with a specific request from the club as to the type of training and intensity that the player would be advised to do. This is generally when players are getting back onto full training after injury and we have to be careful as managing the training load.

I see our role outside of match days as being there to help the players if they require any medical assistance. Players that are travelling with national teams are elite at their age group and generally are aware of what their bodies need to keep at the optimum level. This can range from taking an active recovery session for some players who may have been playing a couple of days earlier and are not going to take part in full training to maintenance treatment where they need some input for a specific issue. Players are encouraged to seek our help whilst with the squad rather than the medical team constantly asking how they are. They will take self-ownership of their bodies and we will assist when we are needed rather than hold open clinics twice daily.

Throughout the week the training schedule is all worked out around matchday changes being made as required. At under 21 and A-squad, we travel with 2 physios. One will generally provide cover at training sessions and one will look after any players that are carrying injuries and modify a session as per their fitness and rehab. If the training session is in the morning then physiotherapists and sports scientist will have a 2nd session that may involve gym or pool work.

Throughout the week we do get some downtime and we use some of this go through our emergency pitch side care and evacuation. As a physio, this is something that we hope we will not have to face but we need to prepare for any eventuality. This could range from dealing with a fractured limb, concussion, potential spinal injury and pitch-side evacuation. Our team doctor will always go on the pitch with any physio now for injury assessment and at the side of the pitch, we have our ‘ghostbusters’ bag. This is all our emergency care medical equipment including a defibrillator, neck brace, airway management devices and critical care medications. We would aim to practice a scenario each day and also assign specific jobs to each medical team member so if we have to, we all know our roles clearly and we have practised for the worst-case scenario. During match day’s we are lucky to always have a paramedic team pitch-side as per rules of UEFA for international matches at this level.

Matchday is the key to the weeks work with all focus about getting a positive result. There are very little friendly matches now with so many qualifiers being played. One of the physio team will go-ahead to the stadium early with the kit man to organise all medical equipment within the dressing room. The team is generally announced just before the players board the team bus with players arriving 90 minutes before the game, it can be quite frantic. Strappings, pre-match activation and mobilisation routines are completed and all players have the specific tapings that work for them. As we don’t meet up with the players out with squad gatherings you have to be quite adaptable as to each player's individual needs and the dressing room can get quite frantic up until the players go out for their warm-ups.

During the match, I would sit with the team doctor on the bench and try and enjoy the match. We need to keep an eye out on the whole pitch and not just follow the ball the way a fan would whilst attending the game. Players can sometimes go down injured when the ball is up the other end of the pitch with a variety of issues. They may have suffered a potential concussion earlier in the game and symptoms can be difficult to detect and sometimes delayed. They may show signs of confusion which can be subtle so surveying the whole pitch regularly is something we would need to do. In recent times we also use comms equipment which you may see as an earpiece on the physio team. We can relay information back to the medical team in the stand about an injured player or to the sports scientist on the bench to inform that a player may not be able to carry on so a substitute can quickly warm up. Another useful way this is used is to contact the video analysis team who we can ask to review a specific incident and feedback information. This is particularly useful in spotting subtle signs of a concussed player.

It’s a challenging trip at times but hugely enjoyable. You are part of the staff from managers, coaches and administrators who are all there to create an environment for players to go and perform at the top of their game. Very often you wouldn’t appreciate the work the goes on behind the scenes but rest assured that we are all focused on helping put the best product on the pitch at optimum fitness levels to give the fans a successful and winning team....

If you have any football or other sports injuries - please contact Alan or any of the clinic team to make an appointment…