A day in the life of a physio

The long and packed schedule of the IPL isn't just gruelling for the players but also the support staff who look after them

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	Physios have to be prepared for all eventualities during a game © Associated Press  Enlarge
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"What is it like working for an IPL team?" is a question I get asked a lot. Following the last column, in which I introduced the topic of sports medicine, it seems fitting to describe an average day of a physio on tour.

My most recent stint as a cricket physio has been with the Kolkata Knight Riders. During the IPL we have a number of different daily scenarios to plan for, and these can be broadly divided into: camp, match day, travel day, practice day and recovery day.

Preparatory Camp
Ideally, every IPL team wants its players arriving for the tournament with plenty of time to get accustomed to local conditions, get over jet lag, and to get to know the rest of the team. This applies not only to players but to the coaching and support staff as well.

Most physios like to start the preparatory camp with medical screenings. The threat of litigation is very real in professional sport, so it is important to assess each player on his arrival for a number of details, with his current medical/fitness status being the main concern. In a squad of up to 30 players these screenings take up a lot of time. It is critical to assess a player's current condition because while he might not have an injury on arrival, a lack of basic physical fitness in Twenty20 cricket can predispose him to one. This is obviously a liability to the team from a performance and availability perspective.

Screenings also identify potential problems, which, if addressed early, could prevent injuries. IPL teams pay fat salaries to players and have every right to expect them to arrive and stay in top physical condition. Adrian Le Roux, our legendary fitness expert, likes to measure a number of physical fitness parameters, such as the yo-yo intermittent recovery test for testing repeatability of efforts, and skinfolds measures for an estimate of body fat levels. This information supports my injury assessments.

Practice days
I start a standard practice day by organising and prioritising a treatment list. I'll do a recce at breakfast of players who have been undergoing treatment. Then it's a matter of guessing how much time I need with each player and scheduling treatment around other team commitments such as practice. Some treatments are relatively quick, taking no more than 20 minutes, whereas with those who have multiple injuries or niggles, I can spend over an hour. The treatment room is often a hive of activity as players hang out and chat whilst waiting for their turn on the table. When there are so many players it is often challenging examining them all in the available time.

The thing about practice days in the IPL is that since all the matches are under played under lights, it makes sense to have most practice sessions under similar conditions. But this is not always the case because of the cost involved in switching on the stadium lights. Lights also attract trillions of flying insects and these can become a real issue, with various mosquito-borne diseases being endemic. It doesn't seem to bother local players but the foreign ones are justifiably cautious. I go through a lot of repellent.

At practices, I need to be present to work with anyone who needs me - from managing acute injuries, strapping bodies, mobilising joints or testing whether the player is ready to return. Many injuries also occur during practice and need to be managed correctly, and various medical interventions tested before match situations. Often I need to try various strapping techniques to obtain the best functional result. The first practice at a new ground is also an opportunity to evaluate the local facilities, meet the doctors, assess the medical room and emergency plan, and even review the food provided.

	Match day doesn't end with the last ball. Injury and recovery management begin immediately after the players come off the field. There is also frequent drug-testing, usually a lengthy process, since you wait until a suitable urine sample can be produced. I have returned to the hotel after 3am on more than one occasion

Match day
Due to the late start and finish times of IPL matches, players often come down late for breakfast or miss it entirely. If this means a good night's sleep then it isn't a bad thing. The players' absence gives me the opportunity to catch up on administrative work or to schedule any doctors' or radiology visits. The post-lunch period is reserved for fine-tuning the playing squad, with individual appointments either in the treatment room or in the gym for specific rehabilitation. At some stage in the afternoon, there will be a team meeting to discuss the match strategy and team composition. We aim to allow approximately one and a half hours at the ground before the start of the match. The players like to use this time to unpack their kitbags, have a snack, wander onto the field to discuss the wicket, and to generally calm the nerves. Warm-ups begin about an hour before start. I use this time to set up in the medical room, prepare ice packs and stock the run-on medical bag before proceeding to work with players who need my assistance. One particular player needs specific ankle-taping that takes me 15 to 20 minutes to complete, so I usually do such work at the hotel.

Any fitness issues might also need to be resolved during this time, and decisions must be made on the status of the player before the toss. Such decisions are better made before match days, but because of the packed itinerary we're sometimes forced to take a last-minute call after putting the player through a battery of fitness tests.

One night on arriving at the ground, one of our key foreign players tweaked his upper back getting out of his seat on the team bus. I recall working frantically to settle it down as best as possible and then test his "fitness" before the toss. He said he'd be okay and decided to play. Fortunately in this case, he loosened up as the match progressed and woke up feeling okay the next morning. This is just one of the challenges of working in the IPL.

Throughout the match we must be ready for any medical or non-medical situation. The usual suspects include impact injuries, muscle strains, joint sprains, cramping, headaches, concussion, bugs in the eyes, nausea, and split finger webbing, to name a few. But we're also frequently asked to cut shoe toe-boxes, provide superglue (to repair bats) or cover inappropriate logos with tape. It is surprising how many players do not prepare themselves more professionally. One has to be prepared for as many eventualities as possible during a match.

Match day for me doesn't end with the last ball. Injury and recovery management begin immediately after the players come off the field. We encourage them to use ice baths and cryotherapy, and most of them are professional enough to know when they need it. There is also frequent drug-testing, usually a lengthy process since you wait until a suitable urine sample can be produced. I have returned to the hotel after 3am on more than one occasion.

Travel day
The team management meets at the start of the season to discuss the flight schedule so we can optimise player recovery. Early-morning flights after a match are avoided wherever possible to allow players time to sleep. Some coaches feel a travel day is not strictly a full recovery day but it does allow time for a 30-minute recovery pool-and-stretch session before we fly. A later flight also gives the players an opportunity to get medical treatment, a massage, or to squeeze in a gym or rehab session.

	Pool and stretch sessions can often be squeezed into a travel day © Associated Press  Enlarge

If a pool session isn't possible before leaving, we usually try to sneak one in immediately after arriving at the new hotel. Soon after arriving, I check out the hotel's gym and see what equipment is available, for it differs from place to place. A rehab programme in one gym might need to be modified to suit different equipment in another. Then it's time to set up and start planning treatment times again. As funny as it seems, players often don't come forward with injury information, not because they want to hide it but because they might consider it insignificant.

Recovery day
The IPL is a hectic tournament. Lots of travel, training, matches and practice. A recovery day is a complete day off for the players from all team commitments. T20 might not be the most physically tiring form of cricket but the length of the IPL and the number of matches can get mentally tiring.

For the physio, recovery days are opportunities to work intensively with the injured. It also means we don't get days off throughout the tournament. But that's the IPL.