Gavin Blackwell: Physiotherapy in football across the decades

The photographs featured in this article have been provided to us by Gavin Blackwell who has written approval for their use.

You are a physio with a lot of experience in football and I wanted to take you
back to the beginning and ask you how did your journey start to becoming a physio
and going on to work in football?

Yes, it all started for me with the 1978 and 1979 FA Cup Final and seeing John Wile in the semi-final with his head bandaged and the physio coming on and sorting that out and int he 1979 FA Cup Final against Manchester United hearing the commentary of John Motson “What must they be thinking on the bench? Fred Street, the Physio on the right seems to know it’s almost there. It is now Arsenal have won the Cup.”

It was also Scotland 78 World Cup and Physio Hugh Allen who traveled to six World Cups the Medical aspects with Willie Johnson making the headlines for falling a drugs test. Then there was England and the fitness concerns of Trevor Brooking and Kevin Keegan in 1982 and again in 86 this time Bryan Robson with his dislocated shoulder.

I was also able to make contact with Fred the
year after that who sent me an England match day programme, with an article in Fred’s Show
Must Go On was the title. It’s about keeping the “Show on the Road” that Show is playing
matches fielding teams and hopefully winning. I also came across another good article he did
in FA News Fit for Saturday. When he said working for a football club in whatever capacity, is not so much a job rather a way of life.

Your job title or job description defines a very narrow view of your function and the broader application being a member of the staff team is
probably more accurate and how it is caring for players you are running a ‘mini welfare state.’
That’s the ethos and standards of which I have always worked from.

Manager Paddy Page, Assistant manager Henry Crampton, trainer Fred Birch and physio Barry Wile were the backroom team. I learned so much from all have them in those early days with Halesowen Town. Lads my age would be aspiring to be a footballer hear was me wanting to be a trainer and a physio.

Like I have with all I have those I have worked with both players and managers John Morris another manager who along with Stewart Hall taking the club to more success at Halesowen Town at other clubs they include Joe Jackson, Bernie McNally Rob Smith, John Hill and my current one Dave King. The physio is in a unique situation in a football club, you are the player’s therapist but also often his confidant and advisor.

It’s a very intense environment with wild mood swings. You might be treating a player who is out of favor, with the manager or is worried because his contract is coming to an end. You have to be able handle all of that. If you don’t, you’ll soon fall by the wayside.

I remember writing to the former England trainer Harold Shepherdson back in 1987 asking advice after I had taken the FA preliminary treatment of injuries course.

He wrote back with sound advice. That I had taken the best positive steps in doing that course then joining the St Johns Ambulance and learning about First Aid that is and still is the most important aspect of the role.

Things have moved on massively since those days with Defibrillator’s, medical gases Entonox and Oxygen, splinting devices with standard stretchers being replaced with scoop and basket and (EAP) Emergency Action plans. Ie nearest hospitals both A&E and Neurology units.

Along with mandatory specific FA pitch-side (Trauma, medical management qualifications)
also advising that you are able to deal and recognize what kind of treatment is required as
with any form or Emergency or injury. Get books on anatomy and physiology that will give you
the idea of how the muscles function and how they need treatment to recover from injury and
the right treatment is given. Gather as much knowledge as you possibly can.

You mentioned before we started today about going to meetings of the Football
Association Medical Society at Highbury Stadium in North London and looking at the
likes of Fred Street and Gary Lewin in particular. Did you ever receive any particular
advice or encouragement from Fred Street and Gary Lewin especially with both having
achieved so much in their physio careers?

Yes, they both gave me immense encouragement particularly Fred Street I remember phoning Fred at his clinic he gave me advice on all aspects of the job but you also learn on the job and you cannot buy experience.

While qualifications are an essential pre-requisite for a club physio, the right personality is equally important. As a general rule someone who stays
outside the hysteria of results, and the heat of the moment, is probably best equipped to deal
with the snap decisions that have to be made on the pitch and the transient drama of some day-to-day problems.

The physio is part of the backroom “team” along with the assistant manager, coach, goalkeeping coach and others who are part of the support machinery who advise the manager in his day-to-day quest to field his strongest team of players usually twice a week for something like a total of sixty plus games a season, using a recognized playing squad of 18 to 20 players. A difficult equation and one that does not work a great deal of the time. There are at least two definitely out for the next game, and a string of “running repairs” who will play but may have to be nursed from training until the last minute. Add to that suspensions, simple illness, domestic unpredictable and you can see a great deal of juggling goes on day-to-day week to week.

Against this background, the physio has to make clinical judgement in the first place and then
understand the manager’s dilemma and help “keep the show on the road.”

You need to be part of the players, but also apart from them. Part of the management team, but not judgmental so that players feel your impartial, yet concerned. It is not an easy tightrope to walk. Go on as many courses for example anatomy and physiology, gain as much experience as you can,
with Fred Street.

Harold Shepherdson, who wrote a helpful book alongside David Sutherland Muckle an orthopedic surgeon Football Fitness and Injuries was my first of an impressive collection on the subject. When asked what are the essential qualities of a good physio, one would confidently suggest a quiet, but knowledgeable person with an easily approachable personality.

Because you spend many hours with a player after injury and teaching them remedial exercises, and during that period there must be a close bond of respect. because being a physio is much more than treating knocks and strains an easing aches and pains.

You are not just running on the pitch either you are so much more to the players, you are a
psychologist, masseur, nutritionist, chiropodist and social worker. On Away games they had
overall responsibility for the players welfare hotel liaison officer, sorting out room keys where
they sleep where they eat, and pre-match meals.

Football has changed a lot now where you have six or seven people doing those roles in the
Premier League. The likes Fred Street and Gary Lewin who was around the same age as
myself when I started out and would always watch them treating injuries on Match of The Day
or the odd live game that was shown on television. They did the lot back then I still enjoy
being involved in my current level at Non-League where a guy like me does everything he can
to support the players as much as possible.

I learned so much on Football Medicine from those meetings listening to eminent doctors,
surgeons and other specialists over the years along the various courses and conferences. I
have developed my craft knowledge in lots of ways really but chatting to opposition physio’s
after games helped me. Bob Lucas of Weymouth FC and Joe Miller of Fisher Athletic and
Cambridge City.” Dave Pover Stalybridge Celtic, Harry Hill and John Cotton.

Given your experience within football and becoming a physio have you noticed a
huge difference in medical advances and the speed of recovery from injuries from
when you first started to players in this day and age?

The biggest change is surgery that was once a hammer and chisel to more precise
invasive fine technical work. That is evolved massively orthopedics is very sophisticated
discipline progress in surgical procedures such as the arthroscope have cut down the post-
operative physiotherapy dramatically.

Along with the diagnostics when I started, we had
clinical and X-rays or bone scan is it broken or not. Nowadays we now have clinical but over
reliant MRI Scans, Ultrasound scans, CT scans and isotope bone scans. I do not think healing times have changed despite advancements of modern techniques. Muscles still take the same time to heal as they ever did. Principles of Treatment have not changed. Strangely despite the advancement of modern electro-therapy, which plays its part, the most valued piece of equipment is still the ice machine.

Cold compresses remain the most effective means
of stopping the internal bleeding which is the basis of most injuries. Broken bones, are
mercifully rare occurrence, have to mend themselves after appropriate immediate action and when anything truly serious comes along the doctors and possibly specialists are consulted to
guarantee that the best possible treatment is provided.

Squads being bigger we only had 12 players now we have 16 in a squad and 3 substitutions allowed compared to one when I started. Other changes players boot design, artificial pitches, players individual fitness levels, an advancement of sports science. The have also been a number of changes in The Laws of the Game (IFAB) Law 5 The Referee on injuries covering a number of aspects on how we treat and assess injuries on the field of play for example any player bleeding from a wound must leave the pitch. The player may only return on receiving a signal from the referee, who must be satisfied that the bleeding has stopped and no blood is visible on players clothing before being allowed back on.

The physio is the team behind the playing the team and match day are always the most
special as well as stressful, and it is a solitary job out on the pitch. During a match I deal with
a lot of pressure and often I do not notice much of what’s going on in the game because I’m
so focused on medical issues not only injuries but physical problems but also if players need
anything tape, for a loose sock used to be a tie-up a shin guard loose stud, consequently the
run-bag has a supply of kit as well as medical needs. When a player goes down, there is an initial pressure to deal with the injury.

You have to communicate with the player and find out what is wrong and what you can do about it. You are also under pressure from the referee who wants to get the game going again as soon as possible and there is pressure because you are making a decision that can affect the outcome of the game. If you leave a player on who is injured and they make a mistake or is out longer, your head is on the block. The training and experience really come into play when you have to make that assessment.

Although fans only see me when there is an injury on the pitch, I can say that my busiest
period is the last hour before kick-off. Preparing players for the match between 2 pm and 3
pm, is a ritual routine that the physio plays an important role in. At this time players are in the
most vulnerable and suggestible state as they prepare for the game before them. It is a time
of stress and test for them, and they need support. Support that the staff should provide in
any way that they are qualified to do.

Strappings for ankles, oil massage for the legs, a word of re-assurance for a player who has just recovered from injury that he will be alright.
exercises to the nuts and bolts of preparation by the backroom staff should be done to the
same level of care and attention for all matches and players. The motto is “Just in case”
and it is easy to take that lightly. But it really means I cared for players for 34 years.

A lot of the time those “Just in case” plans are never needed, and players and indeed managers will never know that such back up was there. many things are taken to a match and never used
but you never know. My equipment and the medical skips were always checked the night
before with the ice packs made up on the morning prior to leaving for the match.

Any omissions could be embarrassing. You are there to facilitate performance and what the players are trying to do and to make that task a little bit easier in any way you can. You must have time for the idiosyncrasies that players display, such as a special bit of tape around a toe, or Vicks rubbed on the chest or shorts being too big or too small. After the game I will treat the players who have picked up knocks. It varies from game to game but there is always something to do and a few players will need looking after.

Like players and managers that play and manage abroad with your experience in
the medical profession being a physio and your experience in football have you ever
received any overtures to work in a different country and would you like to work
abroad and have you ever had any dealing with foreign counterparts in your

Not really no, I have not received any invitations outside of the UK. I did have a bit of
tentative contact to go and work in China but that was only just passing really but it did not
sort of interest me too much. I don’t really harbor ambitions to work abroad in all honesty.

The medical side is not only the role that I do it is also a massive interest in terms of reading
about various physio’s and their history and I would like to pay tribute to a guy that is really
etched in my memory a guy called Jimmy Headrige who was ahead of his time.

A highly regarded physio who Ron Atkinson described as the “Best in the Business” took to Old
Trafford as part of his backroom staff when he became manager Manchester United back in
1981/82 season sadly, he passed away just a few weeks into his dream job. Someone who
inspired me as well even though I never met Jimmy. I had read up about him and listened to
everyone spoke so highly of him and I managed to recognize his contribution with The
Football Medical Assocation posthumous award for outstanding contribution to his family in
2015 and it is just a big interest in terms of scrapbooks and articles and books on him and
anything regarding football medicine.

Headrige like Fred Street inspired Alan Smith who was a young apprentice at Middlesbrough FC who broke his leg when Jimmy was physio there
and he encouraged Alan to get back to fitness and he also encouraged him to take up the
medical side of the role and Alan Smith went on to Darlington FC, Blackpool FC Rotherham
United and Sheffield Wednesday going on to work for England with both U21s and senior
team where he worked under Terry Venables, Glenn Hoddle Kevin Keegan and Sven-Göran Eriksson.

Finally Gavin, you have accrued a lot of experience. In terms of the future going
forward is there anything in particular that you would like to ideally achieve or go on to
raise awareness off in the remainder of your career as a physio?

I have done well on the Physio side but to have also fortunate to have been part
of successful teams and gained what Brian Clough used to say his football qualifications my league and Cup winning medals at every club I have worked at.

The ups and downs huge ups huge downs that you get being in football in the same
week. You get that huge buzz of winning an important game on a Saturday and you
may lose one on a Tuesday night you up and down like a roller coaster that adrenaline
rush throughout the week.

Football is a rigid structure volatile and unstable nowadays does it give physio’s the same opportunities to connect with players due to the cutthroat nature of the higher leagues.

Winning a game is the best feeling in the world but passion is needed to get the best out of yourself and the players something I feel is missing today.

As the merry-go- round keeps spinning people off to other club’s physio’s barely have time to be emotionally invested in their club, so do they care? Does it spoil their weekend when the team loses? Does it spoil the weekend when the Centre half gets some bad news
about an injury, I don’t think it does.

Winning and losing means so much to me.
I haven’t had the luck to work under just one manager like Rob Swire at Manchester United had under Alex Ferguson. Similar to Colin Lewin had at Arsenal under Arsène Wenger. That is rarity and they are very fortunate to have had that with stability being very rare.

Going to another club for them would have been a big risk the volatility and insecurity. The biggest factor in developing a relationship is communication, trust, honesty being obvious ones. Working with a manager for so long you build a trust and relationship. Most clubs change manager on average every 14 months 25 managers have left clubs already this season. Something I have experienced a few times.
Traditionally a physio or medical team have been less likely to be affected by managerial changes [unlike an assistant manager, coach, goalkeeper coach or scouting staff, times are changing.

Almost half of the current premier league clubs
have changed either the first team doctor or physio in the last three years on the back of a new manager. You have to start from scratch and build that relationship trust doesn’t come naturally so if you lucky to only work with one manager it makes it easier you have that continuity with one man you know his habits the meetings speaking to him the phone calls, text messages the emails. They make it clear what they wanted.

I had that with John Morris and Stuart Hall at Halesowen Town for five and six years
respectively and Rob Smith for five years at Hednesford Town – all of which were very
successful periods. Building a trust is not being afraid to make mistakes easy to
become self-preservation you not insatiable. You didn’t get it right all the time
obviously and if you make too many you wouldn’t last but at the same you able to hold
your hands up and be honest with yourself you develop that trust.

However, success for a Physio is two things. Success is trying to get as many players available for selection for each game if you can do that for each day, week, month, each season and get to the end of each season and you have had a huge compliance rate of player availability for the manager to choose from that is success. But also, you are a football person, well I am a football person success is winning things winning games winning trophies winning leagues no better feeling.

My aspirations remain the same to work
with the manager, coaches and players to move the club I work for forward as far as
possible and hopefully if that happens, they will be able to move on to better things. A
physio’s work is never done, not when every match training session even, can
produce a range of injuries from the most minor strain to things eminently more
serious and long-term. Yet an adult life as physio have left me with a matter-of-fact
capacity to take what comes in an unruffled stride.

I remember them all with affection and
had good working relationship with all of them. What is important is you look after all
of your players from the senior professional right through to the injured schoolboy,
“They all need looking after to the best of my ability regardless of who they are”.

You are doing your best clinically and technically but injuries are injuries the fact that
the game kicks off tomorrow evening at 7.30 injuries don’t acknowledge that.

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