Dr Kal Parmar discusses the medical challenges facing the England Football Team ahead of the World Cup in Brazil.
The England World Cup squad have arrived in the heat and humidity of Brazil this week ahead of the start of the 2014 Fifa World Cup. The England team will open their World Cup campaign against Italy on Saturday,14 June.
England’s warm up games against Ecuador and Honduras in Miami provided the perfect acclimatisation for the players, unused to the conditions they will face in the Amazon rainforest.
The Institute of Sport, Exercise and Health (ISEH) recently spoke to Dr Kal Parmar, ex-club doctor for Tottenham Hotspur Football Club, Honorary Clinical Teacher at the ISEH and current club doctor at Leicester Tigers Rugby Union Team, about the preparation required for such a major tournament in an unfamiliar and challenging environment.
ISEH: In terms of preparing for Brazil, are there any medical challenges the team hasn’t encountered before?
Dr. Kal Parmar (KP): I’m sure there will be a few new challenges for the selected squad; heat and humidity is always an issue as well as dehydration, but there will be a strategy in place to combat this as well as a rehydration strategy for cooling. It will certainly be more interesting for the doctors out there compared to a game at Wembley! Physically the challenges change because every country is completely different. The team is going to Miami first and then on to Brazil; the regulations change because the two countries are very different. Also logistics will be an issue with importing medical equipment and supplies.
ISEH: Regarding the challenge of heat and humidity, will there be specific strategies in place?
KP: A heat acclimatisation process will be put in place as soon as the team is selected. However, you can’t acclimatise to humidity so that will all be down to cooling and rehydration. Players will be weighed before and after training and playing and will have to make sure they replace their fluids. A sweat study will be conducted to analyse what the content of the players’ sweat is. The challenge is that 25 minutes into a game the England Medical Staff will not be able to assist the players if they are dehydrated although they may be permitted a drinks break if the referee allows it.
ISEH: In terms of travelling to the Amazon are there any illness prevention/ vaccination strategies in place for the players?
KP: There is a vaccination programme implemented by the Foreign and Commonwealth Office and they will have to seek advice from the London School of Hygiene and Tropical Medicine.
ISEH: What are the typical strategies for managing jet lag?
KP: In my experience as club doctor at Tottenham Hotspur we would look at the programme and make sure there was plenty of time to acclimatise to the time zone changes. From here to Miami might be a problem but Miami to Rio shouldn’t be too bad at all. Rio to Manaus isn’t bad either. The doctors just need to ensure they give time between travel and don’t make the team go out on the training pitch straight away after landing.
ISEH: The players are being prepared off the back of a busy Premiership season; do you think the players are better prepared because they have been physically conditioned throughout the season?
KP: The biggest challenge is that there are 23 players at 23 different levels, some players would have played 60 games during the season, others only 25, and some might have been injured or had a natural break. Each player is usually given a week off between the last game and the get together – predominantly because they need a mental rest above anything else to get away from the pressures of performance.
ISEH: One of the goals of the ISEH is to become the leading sports injury clinic in the world, how does that impact your job and is it something the country’s sporting teams will benefit from?
KP: The ISEH is modelled on a multidisciplinary model where there are a variety of specialists and paramedical staff (such as physiotherapists and podiatrists) all under one roof. The patient is at the centre of it all and is the main focus. At ISEH, any player/patient can be initially assessed, scanned and undergo treatment more or less there and then – this may involve an injection if necessary! In reality, we tend to follow a conservative management plan in close conjunction with our physiotherapy colleagues and involve different specialists such as radiologists and orthopaedic surgeons as appropriate co-ordinated by the Sports Physician, who will be able to piece it all together.
ISEH: So being able to see a consultant, have an MRI scan or an X-Ray, and receive specialist physiotherapy under one roof is the ideal scenario?
KP: Absolutely, the ISEH is the most multidisciplinary centric place in London where you can have your MRI and see the appropriate specialist on the same day, and this is what patients love.