This interview was originally published in the Aspetar Sports Medicine Journal and is reproduced with the kind permission of Aspetar – Orthopaedic and Sports Medicine Hospital. 

– Interview by Cristiano Eirale, Qatar

Every sport has its star. In squash, it’s Ramy Ashour. It’s not that he has the highest point average in the history of the professional tour. It’s not that he went unbeaten for nearly 2 years (or 49 games). It’s not that he has reached the final in more than half the events that he’s ever played in. The appeal of Ashour lies in his unique playing style and off-court charisma which have undoubtedly contributed to increasing the global appeal of squash. 

But it’s not just his shots that are unique. Ramy Ashour has gone his own way and taken his health and training into his own hands. He doesn’t have a coach and he doesn’t have an entourage. He teaches and trains himself, using an innate creativity that has led him to be described as ‘the artist’ and ‘mesmorising’. His fluid movements mask the dynamic speed at which he flies across the court; his humble nature masks a passionate fighter. But this has come at a great physical cost; here he tells Dr Cristiano Eirale about his training routine and what it feels like to be told he might never play squash again.

The first time I saw you play, the announcer told the crowd that they were very lucky to witness you playing squash that day because if you played to your full ability, there was no chance that your opponent would win. I have never heard this said about any other champion.

Are you, or do you feel like, a legend of sport?

To be honest, sometimes I don’t feel like a legend at all. I’m grateful and blessed to be called that and to be thought of as a good athlete, but at the end of the day I can’t think too much about that kind of thing, I can only think about being bad or not. I can’t think about how ‘good’ I am because otherwise it will go to my head. That’s happened to me before – once or twice my success got to my head and my level of play actually started going down. I learnt a lot from that so now I just do my best and play squash and surround myself with the best people that I can. I try to be myself, I try to be as genuine as possible and then just leave the rest to a greater power because I know I can’t control everything.

To be a champion athlete, how much is talent and how much is hard work?

I think talent and hard work have to be equal and work parallel to each other. I can’t just be more talented or skilful than I am a hard worker. I believe that to stay on top in squash, which is such a physically and mentally demanding game, you have to find that fine balance as much as you can. That’s what I’m trying to achieve now. I’m trying not to overdo it with squash so that I can leave enough room for my fitness and vice versa. I believe they have to work parallel to each other and that if I keep this balance, I’ll probably be able to stay at the top for a while.

How much time do you dedicate to squash every day?

I’ve always thought it’s a quality thing rather than quantity. There has been a revolution recently around fitness and conditioning that doesn’t focus on training for 5, 6, 7 hours a day. Rather, it’s about how affective you can be in the time you’re training, even if it’s just for 1 hour. So I’ve based my training around this philosophy for the last 2 years. I’m really interested in nutrition and physical fitness con-ditioning so I read about that a lot and I base by squash and fitness sessions on the latest information. These days, my fitness sessions don’t last more than an intense 1.5 hour session and never less than 45 minutes of intense training. My squash sessions are 1 to 1.5 hours in the morning and anything up to 1.5 hours in the evening.

I was impressed that you once told me that you like to put music on and to just play. Does this count as training?

Yes this is true – I try to imagine myself singing on court! I love music and I’ve always been involved in music since I was young. My grandfather and father both used to sing a lot – just for themselves – but it meant that I was raised in a musical atmosphere. I sing too and even hope to release a single soon! It will just be for my own pleasure and for the love of music, not a career move. I would never take music on as a career because I know that to start a new career, you have to begin at the bottom and I’m not sure if I could do that again.

When I started using music, I thought about how much I love squash and how much I love singing, so I thought I would link the two. No one really knows a lot about the connection between physical movement and music but I’ve found that it actually helped me come up with a lot of new shots. I started staying on court with my iPod and the more I did that, the more I found I was ‘high’ on music. It made me feel so liberated when I discovered that I could have not just one pleasure in squash but two pleasures with music too and I just felt like I had so much room in my head that I could come up with new shots. Basically, once I started listening to music and playing squash at the same time, I found myself being more creative.

At what age did you discover your talent?

My dad was the first one who got me to try squash as a new sport. At that time there was a glass court behind the three pyramids of Giza in Egypt and that was quite a scene! They used to black out the dessert and the only thing that was lit up was the glass squash court – it looked amazing. I was 6 years old at that time. My sports were horse riding and swimming so I decided to play squash and I never left the court since. I’ve always felt comfortable being on a squash court, like that’s where I belong. I know it’s not as big as tennis but it’s a great game. We’re trying to get squash into the Olympics and I will support that because I believe in this game. Wherever squash takes me I’m going with it because it is the thing I know the most in my life.

How important is sports medicine in your success e.g. nutrition, fitness, physio?

If I had to say a percent, I would say it has contributed 100% because I would never be where I am now without the help of my doctors, nutritionists and physios that I have worked with at Aspetar. The way I function on court has everything to do with my success and sports medicine takes care of that. I think sports health is very important and our game is very demanding, physically, so if you are not in the good hands of someone you trust, who trusts you and someone you feel comfortable with, you don’t stand the same chance as someone who does.

Sports medicine professionals also help me on a mental level. Sometimes I call my doctors in Doha at a time of intense stress and they just treat me calmly and give me advice. I know all my doctors are busy but they are still keen to connect with me on more of a personal level. They know how important squash is to me and what a big deal an injury can be. To be honest, I rarely received this level of care with any doctor in my life apart from my recent doctors. They have made me feel that I could not let them down because they have put so much effort into me. I just have to do well! When you have people working with you who genuinely want the best for you, you have to do your best for them.

Have you ever had an injury that threatened your career?

Yes, I have been told a couple of times that I won’t be able to play squash again and these were the most devastating moments of my life. I have never been able to imagine my life without sports. I love squash so much but not playing sports at all? I wouldn’t feel right living that way. But yes, I had an ACL operation when I was 16 years old and a doctor that I saw in Germany helped me a lot with that injury. He operated on me and I’m proud that I have come back after that operation even stronger. You never know how strong you are until you’ve been put in a situation where you don’t have any other option but to be strong. My mother was one of the people who helped me the most during this time because she is very strong, mentally. She’s always positive and I have learned that attitude from her and now use it on court. She is a good balance with my dad who is pretty relaxed and takes things very easily.

I’m proud to have overcome my injuries. I wasn’t necessarily rehabilitated well after my first operation and after that I didn’t do much prevention training. I also never paid attention to nutrition or physiotherapy treatment and my current doctors can see today what a beating my body has taken over the years.

What is the most common injury in squash?

I believe it is the hamstring, so I always take care to focus on this area. In the last 2 or 3 years there have been a lot of players who have had a lot of hamstring problems. Some have started contacting me asking where they should go for treatment and I found out through this contact that, surprisingly, there are a lot of players who have suffered from hamstring injuries. A lot of players take care of their quadriceps but no one really pays attention to their hamstrings or to the ratio of strength training that they should be doing to balance these muscles. I’m speaking about players who mainly come from Egypt – I can’t be sure about players all around the world.

Ankle sprains are also common.

Do you believe in prevention?

Yes, I definitely believe in prevention. I don’t refer to it as ‘prevention’ specifically, but I do work out in the gym and do the exercises I’m prescribed.

Do you think that a coach can help to improve a squash player’s performance?

I have always believed that the word ‘coach’ is a big deal. You can’t just call anyone a coach. To be a coach you have to earn it. I was coached in squash until I was about 19 years old. After that, I haven’t had a coach in that sense of the word, I’ve had training partners.

I have to give full credit to everyone who helped me because without them I wouldn’t be where I am but at the end of the day, I’ve had an unbelievable season, one of the best of my life where I haven’t lost a game since May 2012. I never expected that doing my fitness programme on my own with just one training partner would give such good results. I think that because I’m interested in fitness conditioning and I’ve seen so many fitness trainers, I can tailor my training myself. It was a risk, of course, but you have to be risk-taker in squash. You can’t be too safe. If you’re too safe you’ll be an ordinary player. If you want to be a little bit different you have to take risks and you have to accept the consequence of these risks, good or bad. So that’s what I applied to my fitness and it worked 100%. So of course I would say that a coach can make a difference but a real coach should be an inspiration who will stay close to you mentally and will train with you physically. There are a lot of important aspects to being a coach and unfortunately I wouldn’t say that I’ve met someone who is all of those things. But, at the same time, I’ve had people who have helped me throughout my whole career so I’ve benefitted from that.

Is there a process of testing for doping in squash?

Yes. We follow the WADA protocol so we have to be tested. I’m in the top 10 players in the world so I am tested every 3 months. I have to give them my whereabouts throughout the year and when it’s time for testing, I have to give them an hour in that day. So the anti-doping protocol is quite rigorous.

Do you think there are squash players who dope?

A couple of squash players have been caught. The doping programme in squash is relatively new. We never thought that squash players would dope but actually a couple of them were found to be positive and they were banned from playing for a while.

I think that the doping programme might seem like a bit of a hassle, since you have to constantly update your information online etc but it ensures that what we do is totally fair and transparent and that whoever is at the top has earned it 100%. Everyone knows that he didn’t do it with any illegal substances in his body, and that’s a good thing.

You have tournaments all over the world. Do you find a big difference between the medical care in each country?

Yes. One of the best places that I’ve found that has a lot of good institutes with good sports physicians, physiotherapists etc is New York. They’re very good and sports medicine is so big over there. In Egypt, where I have been treated for my whole life, I have a lot of respect for the doctors there but I got a lot of injuries when I was being treated there and I was mis-diagnosed a lot. I suffered from this and I could have avoided a lot of negative side-effects to my body if I hadn’t had that incorrect advice.

What are the ideal characteristics of doctors and physiotherapists working in squash?

Over the years I have been treated by a lot of doctors so I feel like I understand this role quite well. The main quality of a good doctor in squash is that he or she should understand the player’s movement. They should want to watch the player play to understand the mechanisms involved. This is rare, I haven’t found it much. A good doctor tries to really understand the squash player and apply their expertise to me as an individual, not just treat everyone the same. A good doctor also tries not to complicate things too much. They try not to make things bigger than they need to be, especially when the athlete is panicking. This is the way that the doctor can connect with a patient. I believe a big part of the curing is mental, not just physical.

Do you believe in sports psychology? Have you ever used it?

Yes, I believe in it. I used it for a while from when I was about 16 years old and until I got to the stage where I didn’t want to analyse things too much. Eventually I just felt that I didn’t need my personality analysed anymore. I know what I think about and I can address this myself.

My father once told me not to be superstitious about anything, whether it’s a piece of clothing or a day of the week, and not to pay attention to good or bad omens, just focus on the game and success. This helped me a lot. In terms of psychology, I tried to break every hurdle in my head and just be as free as I can.

I also live by the saying “if in doubt, work out”. There are times when I’ve woken up in the morning in the worst mood ever and I know that nothing will get me through the day unless I put 100% into what I do. I have always found life to be hard, not easy, but I have found that the good part comes after the hard part – that’s what I have always experienced and hopefully when I get older things will get a bit easier.

Do you use sports supplements?

I wouldn’t say I believe in supplements too much but I do use them a bit. I never used to take them but my nutritionist has given me a simple regimen to follow which involves a few supplements. He thinks they might help enhance my health and thus my perform-ance slightly. The effects won’t be anything major – I won’t end up like a body builder or anything like that – but these supplements can just help me get the right things to my muscles and help me perform. To be honest, I don’t want to get into supplements too much. At the end of the day I still want to feel natural. I don’t want to feel that I’m putting anything unnatural in my body or that I’m focussing too much on the elements outside of the court because squash is already such a big part of my life. I don’t want to overdo it.

Interview by Cristiano Eirale, M.D.

Aspetar – Orthopaedic and Sports Medicine Hospital Doha, Qatar