Why do we really do this job?

      Sitting on a dirty airport floor awaiting our return flight back home on a cloudy Sunday morning, word around the airport is that no planes are currently taking off or landing. Struggling with the lack of sleep and still deep in thoughts of the events that took place the night before at our match. The result, the threatening and unwelcoming environment, the latest injury that occurred, and the frustration from a less than an ideal team outing mimics the overall picture of an already difficult season filled with challenging and unusual pathologies and injury presentations. This certainly weighs heavily on the brain, adding more irritation from the already delayed return home. Later that same day, texts come in from multiple sources with footage highlighting what it is happening in a match where one of my colleagues working for another club is having to deal with players from an opposing team hassling him and keeping him from being able to do his job on the pitch without distraction. This continues to add more frustration to an already crappy day. One question comes to mind…why do we really do this job? 

      I am sure for many of us, to work as a sports medicine clinician at the professional level has been a dream for years. We all go to school to learn our craft in our respective areas of specialty, and we all have spent hours and hours volunteering and observing others. But not much is taught or said about the challenges we will face while working in this environment. Perhaps, these words go out to those young clinicians that are searching for opportunities to fulfill their career goals in working in professional sports. The idea here is not to discourage those who are pursuing and searching for ways to work at this level. On the contrary, these words are meant to openly provide a viewpoint that needs to be shared, discussed, and ultimately accepted by those who aspire to apply their knowledge and want to commit to this lifestyle of providing care for professional athletes. These words are meant to ideally inspire current and future generations of health care providers in the sports arena to be the change, to be forward thinking, and to help the sports medicine field advance, not just in the body of knowledge, but also in its perspective and its essence. As the years go by, I find myself thinking more and more…what can we do to make a positive impact for those clinicians entering our field? Yet, I can’t help to think that it shouldn’t only be about the future. It should also be about the now. What can we do to make things better for us now? How can we advance ourselves, our situations, and make progress even today? Let me be clear here because I am not specifically talking about our work conditions. It is certainly not fair to talk about work conditions as I am not fully familiar with specific team set ups, internal procedures, philosophies, beliefs, and how we, as medical providers, are managed by each club. I am referring more to how we, as sports medicine clinicians, are viewed, and how a lot of our day-to-day actions and abilities to do our jobs are ruled and governed by entities even bigger than our own clubs. I am talking about the hurdles and the bureaucracy that we encounter countless times and must overcome to execute our duties properly. Yes, we all have policies and procedures. These are important to make sure we are safe, and we are being safe with our athletes while caring for them. Policies and procedures keep us in line, provide us with the standard, and keep us safe. But who is really driving and creating these policies and procedures?  It only makes sense to me that those fully involved, and those who are most knowledgeable about the medical care of athletes should be the ones creating and helping dictate policy. It should be us, the clinicians, who dictate policy. So here I ask, is that what is happening? I am not sure it is worth continuing to write about this. 

      Let me continue by sharing a personal note. To add more to an already defeating and deflating season full of medical adversity, I recently had to explain to individuals and even entities external to my own club a series of bizarre injuries that we are dealing with. The amount of guilt and embarrassment that this has produced has created more uncertainty and doubt personally. It is almost like I am supposed to say that I am fully responsible for these injuries so that everyone else can “wash their hands.” I certainly captured a sense of blame that wasn’t necessarily expressed directly to me, and yet, I didn’t notice or sense any desire or real interest from anyone else involved to help us deal with the significance of the injuries and the negative repercussions that us as a club and our players are facing.  As a clinician who cares deeply about the wellbeing of our players, this is a difficult and an uncomfortable thing to comprehend. I am positive that no clinician or medical provider working at this level (or any level for that matter) want their players to get injured. “No, in case anyone is wondering, we are not purposely trying to injury our own players.” Anyone who is familiar with our sport knows that player availability on the pitch makes a significant impact for the success of a soccer club 1,2. The research is clear, studies show that those clubs who can keep their players healthy and competing have better success, especially at the highest level1,2,3,4. So while I understand that overriding bodies and leadership entities that look after our policies and procedures need to be involved, I believe that a much more successful and helpful way to look at the issues that my own club is facing with our medical status and health of our players would be to collaborate and engage in efforts to work as a team and to provide support and resources that can actually make a difference for those who are truly affected by this: our players.  

      Going back to the topic of policies and procedures, and the topic of what we can do to make a positive impact for us as sports medicine clinicians, I think the answer of this lies exactly in the title of this blog post: Why do we do this? Why do we do this job? I think those who are currently able to work in sports medicine in professional soccer can agree that we don’t do this for the life-work balance (not many days off), the flexibility of the job (very little time with our families and significant others), or the ability to pursue other hobbies or interest (the longest season in professional sports in the US), and certainly not for the money (I am not even going to go there). I get asked very often for advice as to how to become a clinician in our sport. The answer is simple: Why do you want to do this? Anyone can obtain the education needed to work in sports medicine at any level, so I don’t think it has to do with an education requirement. Sure, there may be a few extra certifications or courses that can get you more familiar or advanced in the treatment of professional soccer players and in soccer medicine in general. Besides your education, I think new and experienced clinicians should take advantage of the opportunities available to observe, volunteer and collaborate with other experts in the field, both domestically and internationally, and with clinicians that are already working in other soccer clubs. This is why internship opportunities are so important. Internships provide the opportunity to become familiar with clinical settings and methods (both clinical and philosophical) already established in the care of athletes. It also allows clinicians to become fully immersed in the environment that is truly unique with the social interactions and the understanding of the psychological aspects of dealing with professional soccer players. It allows the clinicians to learn and be open to dealing with the cultural richness of the multiple backgrounds and nationalities present in our league, and the many languages that are spoken at any given moment in our medical rooms. We all, at some point in our training, had to “pay our dues.” We all had to perform those tasks that were less than ideal. We all had to carry water, and fill coolers, and fill refrigerators. We all had to do activities that at the time were considered auxiliary to the actual care of the athletes. However, it is important to embrace them. As young and less experienced clinicians, it is important to perform these activities because it can help you decide if this is the field you want to be in. Because not every case is the fancy rehab process or the exotic treatment intervention full of success. Seeing and having to perform some of the things that are secondary or “less important” to the job can show you the reality of working in this environment. Furthermore, seeing the failure of an injury that is not responding or having to deal with complex situations that are difficult to resolve can help you shape up or solidify your thoughts of being a clinician in the professional athletics realm.  

      But most importantly, you must ask yourself - What do you want to do in this field and who do you want to work with? What kind of athlete population fits your personality best? Regardless of whatever answers you may have to these questions, there must be two things you have to have to be successful. The first one is one you don’t acquire or learn or study for. It is passion. Passion and love to work with athletes at this level, passion to sacrifice time away from family and friends, nights, weekends, and holidays. Passion to always be available almost every day of the year at most hours of the day and some nights to help your players and their families when they are in need. Passion to suffer with players’ injuries with compassion and to deal with the psychological strains of long-term rehabilitation processes that are as mentally draining to us clinicians as it is for the players. Passion and emotion of excitement and the nervousness that you feel on the bus ride to the stadium before a match and the adrenaline that pours in the sideline as the wins and losses take place. You cannot buy passion, or love, or empathy, or any of these personality traits that make us clinicians perfectly fitted to work in professional soccer. The second thing is work ethic and willingness to adapt and learn. This is the other part that can make you a great clinician. This is what separates those clinicians that are only smart and good clinically to those who are also outstanding at communicating and have the “people skills” to deal with the complicated aspects of treating athletes. The willingness to collaborate and to adapt is what brings comfort to the players when they are dealing with significant issues or time loss from what they are paid to do, some from what they love to do, which is play the game. The willingness to adapt and explore new ideas and concepts come from your work ethic. It is how things can be improved. Never being afraid of making mistakes. Because making mistakes is what in fact drives policy. This is how we can all make a difference in our profession now. This is how you drive and create policy. Not being afraid of messing up but rather being a leader while proposing and developing new philosophies and new methods even if we get a slap on the hand from our governing entities later on.  

      So again, why do we do this job? Simply because we have the love, and we have the passion to help soccer athletes perform at their best. Because we have the empathy and the passion to pick a player up from the pitch, seconds after they become injured, and either, a minute, a day, or a year later, you guide their way back to health. But we also do this job because we have the remarkable ability to adapt and navigate problematic issues and unique presentations, and we are ultimately able to withstand tremendous amounts of pressure and stress all for the benefit of our players and our clubs.  

      Sitting on that dirty airport floor, that Sunday morning, next to my good friend and colleague, listening to his words: “this is what they don’t tell you about working in professional sports.” I agreed with my colleague one hundred percent as we both shook our heads.  This job is certainly not fancy or glamorous, but if we do it well, with passion, love, work ethic and willingness to advance the profession, we can positively impact our players and those around us.  

Mario F. Cruz, DPT, SCS, ATC 

Atlanta United FC  

References:  

1. Hägglund M, Waldén M, Magnusson H, et al. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study. British Journal of Sports Medicine 2013;47:738-742. 
2. Williams S, Trewartha G, Kemp SPT, et al. Time loss injuries compromise team success in Elite Rugby Union: a 7-year prospective study. British Journal of Sports Medicine 2016;50:651-656. 
3. Christopher Carling, Franck Le Gall, Alan McCall, Mathieu Nédélec & Gregory Dupont (2015) Squad management, injury and match performance in a professional soccer team over a championship-winning season, European Journal of Sport Science, 15:7, 573-582, DOI: 10.1080/17461391.2014.955885  
4. Drew MK, Raysmith BP, Charlton PC. Injuries impair the chance of successful performance by sportspeople: a systematic review. British Journal of Sports Medicine 2017;51:1209-1214.