In “past, present, future”, we ask clinical or academic experts to reflect on selected Sports & Exercise Medicine topics. Today Paul McGinley on Athlete Health Management
Tell us more about yourself
I graduated as a Physiotherapist in 1999 in Scotland, and my sports career started in professional football (soccer) in early 2002 at Hibernian FC. I undertook my Masters’ degree at the University of Western Australia in 2005 and began working with Scottish Rugby in 2006 where I progressed to become the Lead Physiotherapist for the Scotland National Team and the Head of Performance Medical. I attended the Rugby World Cup in New Zealand in 2011 with Scotland and the Rio Olympics in 2016 as the Lead Physiotherapist for GB Rugby 7s for Women. I am a registered International Sports Physical Therapist (RISPT). In 2017, I joined Cirque du Soleil as the Director of Performance Medicine, based in Montreal, and in 2020, returned to Europe and am now based in the Netherlands.
What was hip and happening 10 years ago?
I was working as the Physiotherapy Manager at Scottish Rugby, and we were implementing far more assessments of our players, alongside our S&C colleagues. We were really starting to work more closely, but there were vivid conversations also over “cotton-wool” cultures of support for players across our teams, and how to create autonomous athletes in these team sports, who drive their own agenda in terms of performance and care.
We had started to implement a Player Profiling assessment to “prevent injury”, as many sports organisations were – and we were exploring exactly what the content of such an assessment should be for rugby players. This was a conceptual wrangle – should we be undertaking movement quality analyses, such as those which simply describe movements, or should we objectify these and turn these descriptions into scores e.g. 1-5, that we could then total. Or should we simply be measuring joint ranges, or using functional tests such as the Star Excursion Balance Test, or Crossover Hop Test? What we should be doing wasn’t clear, and the available evidence was confusing – we were still really in the earlier stages of agreeing conceptually on what we should do to assess these players, and how frequently.
We were also getting heavily into Recovery as a concept – what wasn’t clear was what was optimal to do to support this, or indeed preferable for the players. From tart cherry juice to help with sleep, to ice baths and recovery compression devices. Lots of new concepts came onto the table and were being used/enforced/applied.
We had also seen from AFL that performance databases could help with gathering all our data together for analyses, and the holy grail of “injury prevention” really was being given a lot of focus.
Lastly, concussion was beginning to get the priority it needed across sports. The assessment systems (SCAT 2 soon to become SCAT 3) were under focus, and the tuition in pitch-side emergency courses around concussion was ramping up. This was the start of the building of pressure to better manage concussion that has continued.
What are we doing now?
It is important to note that 10 years ago it really felt like we were in search of the best ideas, systems, new concepts and expertise to be able to bring to our athletes. With Injury Prevention and Recovery being pushed as part of the High-Performance concept, S&C and PT/Medical were aware of the possibilities and requirements to work together more closely and the push was for multi-disciplinary working. Agreement on what was important or even possible wasn’t settled. Moreover, the discussion of the athlete at the centre of this was largely as a recipient of expertise, and someone who would best follow the advice of the experts, but that expertise was based largely on conjecture, theory or established practices or concepts. The science was thin and so action was often exploratory.
Nowadays I see that this concept is changing – many higher performing teams and sports have settled on the assessment of their players/athletes and have started to form their own evidence for what they think is important. A lot of the work in profiling, for example, has moved towards Muscle Dynamometry for strength scores, or muscle endurance scores, ratios between muscle groups and rates of peak force generation. Sports are more content with what they assess for their athletes, and why, and athletes are better able to be informed on the reasons for recommendations. They are also more content on their recovery strategies and why these are best in their environments, having worked out how to motivate or convince athletes to do these extra workpieces (or changed the recommendations to be more palatable, for better compliance). It seems fair to say that the evidence to support certain actions in these areas is still evolving.
Furthermore, the conversation has shifted conceptually from “injury prevention” to “injury risk mitigation”, as we realise we can’t really evidence that any injury was directly prevented.
The goal of good multidisciplinary working has become good interdisciplinary working instead. Performance teams are more closely aligned, with S&C, Athlete Performance Coaches and Medical Team members working in structures that support collaborative working.
Lastly, mental health is finally being given consideration in ways it never was before. This wider societal issue has been given the profile it merits, in a drive to identify and support athletes better. Though there is a lot of room for this area to grow and develop, it seems it is finally on the table and will not be going away.
Where do you think we will 10 years from now?
The progression I see over time has been towards the gathering of science or expertise, and the establishment of systems through which this knowledge can be delivered to athletes, through interdisciplinary working. Where this has remained difficult at times has been in the implementation of change, and the adoption of evidenced practice, and conceptually the athlete has been the passive recipient rather than the active participant.
I see this changing, as the evidence will predominantly be strong, and the systems which deliver this evidence will be mature. We will better understand how to effectively implement change or best implement the actions which are well evidenced now. Athletes will have more of an educated voice, and our staff will continue towards closer working, most likely through the growth of multi-qualified professionals, who work across previously distinct areas (e.g. PT and S&C).
Hopefully, we will have experienced a real change in the culture and support of mental health issues, though I imagine based on the speed of change over the past 10 years, that we may only just have established settled systems with good care pathways as a routine within our sports.
Now, in the best traditions of sport – let’s see who gets there first!