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Therapy in Sport During The Pandemic: A Reflection

In this series of blogs, we look at the roles of therapists beyond those listed in job descriptions. Our aim at Thrive PES is to provide education beyond the typical university education setting and give insights into what working in sport is really like. Something classrooms cannot give us is ‘on the job’ experience, that reality of what jobs actually entail, beyond the application of knowledge and theory gained through education and degrees. Some may see these ‘additional things’ as soft skills, and this may be the case in some walks of life, nevertheless, they are more and more frequently being appreciated as key skills which set the best above the rest in high performing,  competitive environments!

The purpose of the blog series is to give reflection on the experiences of therapists working in sport and help others gain an understanding of the additional roles, skills, and duties one may have to complete, beyond those usually associated with a therapist. We will hear from a variety of professionals working in different sports across varying levels. As much as we encourage people to seek experiences for themselves, knowing that there is no better way of developing one’s own skills, we recognise how useful it can be to have a basic understanding and appreciation of the roles you may be stepping into. This is particularly applicable when experience can be hard to gain, which has never been more evident than the times we find ourselves in now.

It seems appropriate then, in these current circumstances, that we begin with the role of the therapist in the new, COVID-19 world that we live in.

For the purposes of anonymity, our guest writers have been offered the choice of remaining unknown if they choose to do so. This is especially the case for writing about working during the pandemic. If COVID-19 working has taught us one thing, it is that there is no real ‘right way to work’ or even go about daily life, for that matter. On the contrary there are definitely some wrong ways to go about things and examples of ‘bad practice’, however the constantly changing picture of the virus, the use of ‘guidelines’ and no concrete direction of what we must do has made gold standard practice effectively impossible, or rather, non-existent. We have seen the difficulties that guidelines and advice pose on everyone, whether that is testing your eyesight by driving to Barnard castle or wearing a mask on your weekly shop. Therefore, it does not seem productive for those to share their experiences of working, with the aim of helping others see the challenges faced, to come under scrutiny or any possible litigation.

On that note, we hand over to our guest………

It is fair to say that any threats of litigation, scrutiny, finger pointing and blame probably come second on the list of worries, when returning to sport, to the number one worry of your place of work being the source of a COVID-19 outbreak. Whether any kind of spread or outbreak stems from one athlete or staff-member falling acutely unwell, or the whole team/staff contracting the virus, the consequences travel much further than the court, pitch, or training centre.

It can often feel like something near normal being around sport again, but the fact remains that the virus kills and just because statistically it isn’t likely to do that to anyone in your immediate vicinity, it doesn’t mean it cannot be transferred to any persons family, friends or whoever they sit next to on the train home. Obviously, every measure is taken to mitigate these risks as much as realistically possible, but they can never be truly eradicated. Ever present risk is something therapists are used to when discussing a hamstring strain or an ACL injury but not so much for a respiratory disease that is expected to have killed somewhere around 60,000 people in the UK to date.

Now this might seem a bit dramatic and you could probably say that everyone in the world right now has the same responsibility, to reduce the risk of and stop the spread of the virus in every possible way, which is true. The difference, especially in the past few months, for therapists and members of the medical team, is found in the title…

Medical Team’.

The term ‘medical’ in situations like COVID-19 suddenly holds a completely different weight. The usual role of attending to athletes ankle sprains (the job), providing a plaster for the receptionists paper cut (sometimes the job) or just having a quick look at the coaches Nans back pain (not the job) suddenly morphs into the roles of Doctor, virologist, epidemiologist, infectious diseases control officer; you name it the medical team in some way or another has an expectation to become all of the above. As if being qualified in some form of medical training magically gives you the skills to manage a global pandemic.

Steadily, regulatory and governing bodies have begun to provide guidance, difficult discussions and meetings followed on from these and the chance to highlight to people what your scope of practice actually is in this mad situation we find ourselves in occurred. The expectations on us as therapists hopefully eased slightly, sometimes with the addition of a polite reminder to others regarding the role you are employed to do and that you are still doing that role (with the added challenges of coronavirus) is needed. It can be a challenge to stand up and say no when you are asked to take responsibility for things that are not in your scope. Especially as sometimes you can feel like you are in a good place to advise and certainly the best placed members of the MDT to assume some form of responsibility in a medical crisis. However, we are not Doctors and the need to distinguish your scope of control is vitally important in protecting yourself as well as those around you!

It was a pretty grim picture initially, there have been many occasions when I have wondered how things will actually work, and in terms of getting back to normal I still very much do, but over time, things have settled down and a new normal started to take shape. As planning progressed roles began to be allocated, the realisation of the mammoth, continuous, task ahead set in, potential solutions were actioned and more responsibility was inevitably taken on by the medical team (some medical knowledge is better than none and it is often far better to leave the coaches to get on with coaching). Before we knew it weeks and weeks of planning were completed and return to training was upon us!

The excitement for getting back to the day job was soon met with the realisation that everything is lovely on paper and all runs very smoothly. However, in my opinion there are 2 key factors that do not live on paper and will continually be a challenge. 1, The Great British weather, government guidance to train outside and keep indoors spaces well ventilated only works very well on paper, in Spain. 2, The Athletes, welcoming back athletes after months of no training was always going to look more like lunchtime at the local primary school than any drawn up socially distanced training plan. As a body of staff you feel prepared with the ability to exercise responsibility and control, to the extent that you can trust some athletes with some responsibility. Trusting athletes in the wind and rain after a few weeks/months of restraints? Good luck everyone!

Joking aside, these factors do have to be accounted for and you begin to question, especially as the medical team, how many times will I have to remind someone how far 2 metres is? How many times will I need to disinfect a piece of equipment after someone touches, sweats or spits on it and just how many times will I have to shout ‘STOP FIST/ELBOW BUMPING EVERYONE’?! I am fully prepared for the conception of ‘typical medical staff always nagging to be bear fruit……. Well, someone has too!

To mitigate all the above swathes of temporary structures, appeared on sports grounds up and down the country. Signs, posters, tape, barriers, and segregated seating all become the norm. PPE is handed out left right and centre and becomes a part of everyone’s kit and sanitiser is placed everywhere possible. But, whose job actually is it to implement and maintain most of the above?……. You get the drift!

Even with the best will and persistence in the world I do not think any levels of signage, PPE or distancing measures can combat the inevitable questions:

  • “Why can I not sit next to her on the side of the pitch, but I can tackle her to the floor on it?”
  • “Well when I watched the football the other night, the managers fist bumped then hugged after wards, should they have done that? And if they can do that why can’t I do that?”
  • “I saw so and so spit during the cricket the other day, they washed the ball and got on with it, why can’t I just spit on the floor it’s natural”
  • “Why were they allowed to meet up and watch the game that meant they won the championship together, but I can’t watch sport with my mates?”
  • “Well I have been playing 5 a side down the park with my mates for the past 3 months why do I have to train in smaller groups and not get changed or shower after it?!”

You can try, with the best intention, to answer all the above! And of course we should try to, especially in scenarios like the last question, where reminders that this is/was against government advice and we must follow the guidelines at all times. Of course, these genuine responses are often to be met with a laugh and a sarcastic “okay sure”…… good luck with it everyone!

Obviously, it is hard for me to go into details of what training looks like for each individual sport but speaking with friends and colleagues in different fields the general themes and guidance is based heavily around checking symptoms of individuals and their households as well as taking of temperatures daily, prior to training. Other daily differences involve PPE distribution and the cleaning of all equipment, every time it is used by and individual or group whether that is bats, balls, cones, stumps, posts, hurdles, weights, or bands.

Groups remain an interesting challenge, ensuring that players trained in small groups at different times of the day initially, with no swapping between groups, was a challenge. Over time groups were allowed to become bigger and slowly ‘merge’ but the big emphasis is still on crowd management, with the challenge coming when players aren’t actually on the pitch. From arriving, leaving, doing any form of prehab/gym/meetings to just eating in the canteen, the challenges persist, and all of these examples need managing. With competitive seasons progressing and winter closing in this is even more pertinent.

We have seen many examples in the press of fixtures postponed due to coronavirus moving through squads. As inevitable as illness may seem, if individual cases arise within a team or camp, the quality of management around the athletes and venue will be vital in ensuring the whole team and staff do not suffer. Who contributes to enforcing the above seems to vary but one consistent and often leading figure certainly seems to be the medical professional! 

With managing new responsibilities, expectations, questioning, everchanging guidelines and the pressures of living in a global pandemic this blog may portray a grim outlook or even seem like a bit of a moan and even an attempt to off put anyone interested in working in sport at the moment. It certainly is not aimed this way. Despite never underestimating the severity of the situation I hope everyone can see the hope and humour that can be taken out of a bad situation, a very British response to adversity that I am sure most can identify with! As I say it is not my aim to deter people from working in this situation or to joke about it. The severity of the situation is huge and our roles have changed completely, I have not touched on how my typical therapist duties have been impacted by new responsibilities, a whole new blog in itself could be written on that I am sure the Thrive guys will look into sharing something along those lines. The key points I wanted to portray here are:

  • Constant awareness that every individuals’ actions could lead to the spread of COVID 19, the medical team will be the main combatants of this
  • Medical emergencies = increased expectation on medical teams
  • Always expect to take on small day to day responsibilities and roles that are not in the job description, muck in!
  • Know one’s scope of practice and only work within this, despite any pressures or expectations that may come from elsewhere
  • Planning is vital and there will always be new barriers that appear along the way
  • Follow guidelines to the best of one’s ability, knowing that they we will not have all of the answers all of the time and things will often change without notice!
  • There will be return to play differences between sports, yet another reason why knowing the specific demands of a sport is very important for therapists
  • Do not lose faith with working in sport during these times, be adaptable and maintain positivity (just not for COVID-19)

Finally, most therapists portray the same key values and behaviours in their practice, whether you have been working on the frontlines battling COVID-19 or remain in the sporting setting. I feel we as a profession can be heavily relied on to take extra responsibilities because of these traits and that should be something we are proud of (without being taken for granted). I know Thrive’s podcast guests have discussed how unglamorous working in sport can be and that you need to be involved for the love of it, willing to graft and do the time in the trenches. COVID-19 is certainly no exception. It will test the best of therapists, but it certainly is not beyond us.

I hope this blog has been a good insight into some of the challenges and fears I and my colleagues have been confronted with and I am sure there will be many more along the road. Hopefully this blog gives a space to discuss this current climate further, any feedback will be much appreciated, and I’d love to hear what your experiences have been like. Please do comment with any questions and I will try and come back to you!

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