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INTRODUCTION: HEAD OF MEDICAL SERVICES - KEITH GRAHAM

26 October 2016

In this first of a series of articles looking at the new recruits to the medical and management teams, we begin with Head of Medical Services, Keith Graham.

After a long and chequered career, he has finally been persuaded to work for a football club in a full time capacity, something he vowed never to do!

“I’m not sure about a chequered career,” he said when I caught up with him at the training ground this week, “but it’s certainly been a varied one!

“I’ve spent a great deal of time working in the NHS and I’ve also worked in private hospitals and in universities. I have undertaken a great deal of work in sport along the way, much of it on a part time basis and one of my earliest positions in sport was with the Crewe Alexandra U-17 team.

“I’ve also worked in a number of different sports, including a full time position in rugby. More recently I was the lead medical practitioner for the wheelchair basketball for Team GB Men’s team, and was supposed to be in Rio in September, not Rovers at The Mem!”

He’s actually been associated with the club since the end of last season; “The club needed someone at the time to help our push towards promotion and, because I have a private practice in Bristol, I had the flexibility to be available for what they needed so I came in to help out and the gaffer asked me to stay on.

“I had to think about it…briefly! However it was too good an opportunity to turn down, though there were a few conditions I need meeting before deciding to come on board.”

It should be said that those conditions didn’t include money, they were all about building a medical team to help the club cope with the demands of League One football. As a result of that, we now have a medical team of four people, with a fifth on the way!

“I think it’s fair to say that, historically, the physio/medical department here has been a little bit of a  one man band with people helping out as and when.

“I’ve worked in a lot of different sports, some of which are medically intensive and I know that many sports have a great many staff lot of staff and when you are working in elite sport and professional sport these days, you come to realise that it’s such a specialist area.

“Sports specialists, for example, didn’t exist until about 20 years ago and the physio from the local hospital would invariably look after the team.

“It’s recognised now, of course, that one person cannot really do everything that’s required, in the medical sense, for a League One club.

“Thankfully the manager and the chairman recognise that and when I explained that I didn’t want to accept the position if I had to do everything, they were fully supportive and have allowed me to appoint a strength and conditioning coach and two sports therapists as well as brining in an intern in a voluntary capacity.

“That means that, as a group, we can now cover all aspects of the work we need to, from nutrition, to strength and conditioning and sports therapy, and new equipment has also been purchased.

“As long as I have been able to show that everything we do is in the best interests of the players, then the club has been extremely supportive and bought into everything we are doing, and attempting to do.”

One of the first things a physio, or medical team, is to win the players over and prove to them you know what you’re doing!

“If I’m honest, I feel that fell that’s the easy part of the job because I have been physio a long time and I really hope it comes across that I know my stuff and that it sits right with them. It’s all about knowing how to handle certain situations and, having worked in a hospital A & E in my time and dealing with hostile parents, then this job is relatively straightforward!”
Whilst it’s difficult to describe a typical working day, the morning always kicks off with a meeting with the manager and his coaching staff.

“The manager made a decision, early on, that my desk should be in with him and his staff so my first task of the day is to meet with him and the other staff to update everyone on injuries and rehabilitation programmes. In effect, it’s a daily update on the current welfare of the players and who is available to train, who is still undertaking rehab and who needs to be at the gym.

“In other words there is a new assessment of all players every day. The management team will let me know of their plans for the day so we try to manage the players as best we can and, for example, if we know that certain players aren’t going to be involved in a match two days down the line, we can increase their workload while those who are going to be involved will ease off a little bit.

“I will give the manager and his staff as much information as I possibly can, but he makes all decisions.

“The injured players arrive before those who will be training and they need a review of where they are at in terms of recovery. Work is done by sports therapists, mainly, while the strength and conditioning coach will start to prep them for activating muscle groups and begin a pre warm up.

“Then, when training begins the injured players, or those on rehab programmes, will spend more time with the sports therapists, the strength and conditioning coach, or myself.”

These days, of course, players are monitored almost all of the time and the recent introduction of the Global Positioning System (GPS), has given the medical team access to even more data on which they can assess if a player is ready to resume training following injury.

“GPS measures everything, from what the players are doing, how fast or slow they are moving, acceleration/deceleration. You name it, we can monitor it!

“At the end of a training session, for example, we can tell how many metres a player has moved, what speed they have moved at, how fast they have gone and the system also monitors their heart rate and whether some players are struggling, or haven’t worked hard enough. Not every player will get the same benefit from the same session; some will find it easy, others will find it hard, so we can change/adapt individual programmes in order make a difference

“We are still in early stages of using the system, but it will eventually really help what we do in terms of coaching and rehab work. For example, if a player has been out for six weeks and is covering the same amount of distance that is required in a match, then that will assist the manager in making an informed decision as to whether he should return to play.

“Injured players are also monitored. When they are following a rehab programme we watch their statistics and if that player is a full back, for example, we can compare him to other full backs in the same training session and what they would be expected to do in a game to make sure that they have undertaken a rehab load that matches a match load.

“If the statistics show that a player on a rehab programme has covered more distance than in a game and is quicker and has made more contacts and is, technically, ready for a game then I will  sign him off on his fitness  and say that he is medically ready to train.

“The strength and conditioning coach will sign him off to say that he has undertaken the rehab protocols with them and the coaches take them for the final phase. It’s one thing to say that you are fit, but another to say that you can play and so it is a group decision as to whether or not a player can resume training.

“Essentially, an injured player starts with me and as I do less with them they do more strength and conditioning work, though we make sure that the are having an input. There are players who are fit to play, but the coaches might not feel that they are ready to play and, ultimately, it’s the manager who determines if a player will play.

“Obviously, the fixture list has an impact on the speed of process and we also have to beware that rest is as important as hard work. The first priority for any player is that he has to be able to play and perform and be fit and ready to play. The second priority is that players have to be able to recover from playing. The old school of thinking, whereby a player was expected to be in every day and work hard every day is not the model anyone adheres to nowadays.

“If I’m honest, football is a bit behind the times when compared to many other sports and I have been on courses where some physios believe GPS to be a waste of time and say they can tell if someone is fit just by looking at him. That’s fine, but we will continue to work in the best way we see fit for Bristol Rovers and that will involve using GPS.”

The team off the pitch, therefore, is just as important as the team on the pitch; “We have to work together and I believe that communication is the key. I tend to lead the flow of information into the management team, but the medical team often works in different places at different times and coordinating what one player is doing on three sites is not always straightforward.

“Players sometimes have to be cajoled through system a little bit but communication is everything and we have a method of communicating that we will use three or four times a day which means that everyone always has the same information. Nothing is hidden from the staff. It’s really important that there is no division within the medical team and a lot that is down to having the right staff around you.

“I was fortunate in that I inherited some of staff who were here last season, so they knew the players and I were well liked and we brought them on board in a more formal capacity, which was an easy decision.”

In spite of some initial hesitancy about accepting the job, you get the impression that he’s happy in his role; “For 20 years said I would never work in football, yet here I am working for a football club!

“My plan was to finish my involvement in sport in Rio, something I told my wife before accepting this job. However the offer to come here was a good one, with the brief of building a team to be part a of a new set up in terms of a new stadium and training ground.

“Manager Darrell Clarke impressed me with his outlook and whilst I’m sure that there are many managers in football I might not be able to work with, Darrell isn’t one of them and part of my decision to accept this position was based on the manager’s personality and the way he conducted himself.

“There is so much to look forward to here; I’m thoroughly enjoying my job and believe there are exciting times ahead.”


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