The Travelling Team Physio

Life as a travelling Team Physio  

Rugby League World Cup 2013

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Among other sporting teams I have worked with during my career, I have been privileged to be the team physio for FIRL (Federazione Italiana Rugby League) or Italian Rugby League, since 1994. This has involved administrative as well as the obvious medical position.

To give you a brief history of FIRL…

Rugby league was played in the north of Italy in the 1950’s and early 60’s. The Kangaroos (Australia) actually toured to Italy during this time. Then, for political reasons, Rugby league became dormant and was no longer played. In 1994, two Italo-Australians (Mick Pezzano and John Benigni) recruited an all Italian side to play in the Coca-Cola World 7’s of 1995. These were obviously Rugby Union players who were keen to learn a similar game.

From this point on, Rugby League development re-commenced in Italy and has grown to a point that today sees a 10 team domestic competition and participation in a European league. Rugby League in Italy co-exists with Rugby Union and discussions between the codes have been made in order to strengthen both. The growth and profile exposure in Italy has required the assistance of experienced and professional players from Australia, England and France over the years.

My position as the Team Physiotherapist has involved travel to many countries including Fiji, France, USA and of course Italy. The role of a travelling Team Physio is multi faceted. You are not only treating and managing the obvious injuries, but are also required to be the travel co-ordinator of equipment and accommodation (to ensure suitability for athletes), dietician, interpreter and often sole medical coordinator when a Dr is not travelling or available.

In 2013, Italy headed to its first World Cup, which was held in England and Wales. A gruelling twelve months of administrative work and trials/selection of players preceded this chapter in the history of Italian Rugby League.

The team selected was awesome and promised our most successful campaign. Team captain was Anthony Minichiello (Sydney Roosters) who had just skippered his NRL team to being premiership winners. He was supported by his vice captain, Cameron Ciraldo (Penrith Panthers) and a line up including Aiden Guerra, Mark Minichiello, Kade Snowden, James Tedesco, Anthony Laffranchi and Paul Vaughan, amongst other greats. Unfortunately prior to departure we had two late withdrawals through injury in Terry Campese and Graig Gower.

Anthony and Mark Minichiello

We were based in Leeds, however had quite a bit of travel to meet our game schedule. We began our preparation camp at Loughborough University before a trial game against England in Salford. This was an amazing start to the campaign as we beat them with a last minute field goal 15-14. This set the rugby league world alive with massive attention placed on our team. Exposure in Italy was also huge, helping development along. We then travelled to Cardiff, Wales, to play on the opening night of the world cup at Millenium Stadium.  The atmosphere was absolutely electric. It was a double header. Australia had just beaten England and we were up against the other home nation, in Wales. We were convincing victors with a perfect start and a score of 32-16. The campaign was underway. Best of all we suffered nothing more than a few typical knocks and bruises. We had a full squad available for selection during the week. Seven days later we were up against a tough Scotland at Workington.

It was during this period that the fun (aka pressure) began. Tuesday field training went without a hitch. We headed in to the gym for the usual session when Chris Centrone dropped down from the chin up bar, landing on the leg of a bench. His ankle rolled suffering a grade 2 lateral ligament tear. He was an important player required for the Scotland game 5 days later. Rehab sessions began in earnest. They were long, intense and frequent. Chris was all but written off. This injury under normal circumstances at home for the average punter would be 3-4 weeks. He was determined and so was I. With each passing day, improvement was made. Full confidence must be given to the player to keep their motivation and psyche alive, however, giving unrealistic outcomes can end in failure and tarnish your reputation in the teams eyes. It all worked to perfection with the Friday training session being my scheduled ‘running’ day for him. This was 2 days before the game and 3 days post injury. Warm up was timed and Chris performed well with a variety of running, turning and cutting drills. he passed the medical and was seriously being considered for the final selection. The next day was ‘captains run.’ We didn’t have access to a field early in the day, so I took Chris to an open piece of grass we found on the side of a road a few kilometres from our hotel. He was again surprised with the results as he ran, jumped and caught balls from all angles. He made selection to everyones surprise.

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 Chris Centrone fitness test

Scotland at Workington was a different story to Wales. A very challenging game ended in a 30 all draw. Pressure was now increased as other results meant that we had to win our final group game against Tonga to qualify for the quarter finals. Pressure was again mounted on me as Kade Snowden injured his knee in the closing 60 seconds of the game. He suffered a grade 2 Medial collateral ligament tear and patello-femoral contusion. Kade was one of our NRL players and one of the best players on the park that night. So a familiar week commenced again. Intense, frequent and timely sessions with the ultimate aim to play 7 days later. A special relationship is created with the more seriously injured athletes. They trust you completely as you prove to them your knowledge, professionalism and ability to predict outcomes in the future. So it was with Kade. He rehabilitated perfectly. Quite a turn around from 2 days on crutches 5 days earlier. Kade played well but our fortunes ran out that night in more ways than one.

 Kade Snowden’s Injured knee

Kade Snowden’s Injured knee

We lost the game, underestimating Tonga’s determination. Our vice captain, Cameron Ciraldo, was struck in a heavy tackle and on our return to the hotel deteriorated with pain and vomiting. We called the ambulance and rushed him to hospital. I stayed with him while the squad were out celebrating the end of our World cup campaign. It went from bad to worse. Scan after scan and then transfer to a second hospital found that he had ruptured his spleen. Consultant surgeons were called in at 4am to decide on the need for surgery. Fortunately on deciding not to, he made a complete recovery but only after 7 days in hospital. My campaign ended at 6am when I arrived back at the hotel, had 2 hours sleep and then packed my bags for the long trip home a few hours later.

It was a disappointing way to end the campaign. We came so close, however, history was still written in the most memorable way. The team had contributed to opening rugby league doors in Italy in a journey to further international recognition.

Team travel is not a holiday regardless of the amazing destinations. My day begins before most, checking that medical and physio supplies are in order, in some cases monitoring the breakfast setup and then commencing reassessment of the injured players (and staff!) who need their first rehab session. The earlier you start rehab, the more sessions you can offer the players during the day. Sessions are frequent, sometimes 3 or 4 in a day. This ensures greater recovery and chance of return to the next game or training session. The rehab sessions include a traditional physio/manual therapy work up with stretches and target strengthening exercises or it may be in the gym to increase loads and demands on the injured area. If a pool is available then all recovery sessions and more acute injuries will be managed there.

Then it’s off to training. Medical bags and sometimes treatment tables are packed onto the bus. On arrival, the change room is set up and player preparation is commenced. This involves strapping, massage and monitoring of the injured players returning to training for the first time. A dash out to the field to check on these same players and then commence specific field rehab with other individuals who are ready for running drills as a progression in their recovery.

Following training, hydration and protein recovery is critical. Field sessions were followed by gym and functional resistance training set by our head performance and conditioner, Brendan Inkster (Manly Sea Eagles). We head back to the hotel and another cycle of rehab commences, usually in the pool. Regular ice sessions continue throughout the day. When all are resting, the physio is documenting treatment and plans for the next sessions.

…and so the day continues…more treatment sessions, more planning. Most days end at 9 or 10 pm. Co-ordinating visiting masseuses and after dinner treatment sessions were common on tour.

Game days are a little different in that most preparation and recovery of injuries has been completed. The team is selected, so only last minute fine-tuning and loosening up of players is normally required. Players have a late start, sleeping in until mid morning. I’m busy preparing my kit and making sure all my on-field gear is packed and organised. We pack the bus and off we go with plenty of time to spare, arriving under police escort two hours before kick off. I organise the change room and start game preparation. Unfortunately, not all change rooms are state of the art and spacious as Millenium stadium, Cardiff. On arrival to our Scotland game at Workington, we were shocked to find a tiny change room hardly fitting all players at the same time. My treatment area was in the shower room, which was narrower than the length of my plinth, and we had to bag one of the shower heads as it was dripping on to my back during strapping time. Strapping is followed with any remaining massages and then I’m out on the field to check that everyone is set.

The game is obviously emotionally tense and my job is not only to watch play but also to watch players off the ball who may have been injured in the last play. I’m running on and off the field, assessing injuries and treating them on the side line. Communication with the doctor and coach is of high importance in order to keep fresh, uninjured players on the field. The 80 minutes is intense but you are emotionally charged so the job comes easier.

…and then the post game period. Easier if we’ve had a win as the players are on an obvious high. A loss is sometimes a balancing act as players are annoyed and emotionally sensitive, but I still have to get my job done in assessing and treating injuries. It would be easier to lgive them space but I’m already planning recovery for the next training session or game so I push on. The bus trip home is a little more relaxing. Ice packs and compression continues. On arrival, we prepare for dinner, further checks on the injured and post game discussion with coaching and management staff. Win or lose, the team sticks together and there is always time for a celebratory drink as we have all worked hard in our respective roles.

It’s not all work, I must admit. There is occasionally time for a quick walk around town and a coffee (easier to find a good one in Italy than England!).

Touring with a sporting team is an incredible experience and privilege. The workload is massive, much greater than in the clinic at home but it’s the reward of seeing players turn an injury around in a very short period of time, to perform at their very best again that makes it so worthwhile. The camaraderie and bond you develop with your team and staff is difficult to explain to someone who is not part of it. Best of all, I have made lifelong friends in the years of teamwork and travel.

 Celebrations following win against England

Celebrations following win against England

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written by Paul Fioretto