Just want to clarify this point because I've seen a lot written about 'medical teams' and I don't think people really understand/appreciate how
little say the backroom staff have at a professional club, let alone a Premier League one. All decisions about playing time and injury management ultimately come down to the manager and his staff.
This is because there is a huge power differential between the backroom staff and the manager. At a PL club, the manager will typically earn half the yearly salary of the most senior medical professional in a week. Club doctors are not renumerated more than any other specialist in private practice, and physios/allied health are paid roughly the same as in private practice. Wages are low because the sector is extremely competitive and the expectation is that staff 'do it for the privilege' as much as the wages.
Every manager brings along a bevvy of their own support staff, which usually includes a performance coach; regardless of club structure, this person becomes the defacto head of department because they are the conduit to the manager. One problem at Chelsea is that manager is Pochettino, and his sports scientist of choice so happens to be...his son. The power dynamic is shifted away from medical staff and the ability for medical staff to critique or disagree is at a low.
What people also may not realise is that players, their agents, and their hangers-on
insist they are ready to play. In an era of PL footballers with money and personal trainers and social media etc, this quickly gets out of hand. This is an all-too typical scenario:
Medical staff: We have assessed the data and Johnny Smith is still 4-6 weeks away from playing
Coach: Johnny, the medical team said you can't play, what do you think?
Johnny: Coach, I feel fine and I want to play against Tottenham next week
Johnny's social media: I'll be back soon
Johnny's agent: If he doesn't play soon I'm going to be looking for new clubs + the sponsors are getting restless.
Coach: Okay Johnny, I need you to play and I don't want to cause trouble so you'll play.
To resist this cycle requires tremendous authority by a manager, and unfortunately most managers will prefer to keep the peace instead of having difficult conversations. Now add to that a team under pressure, a conflict of interest with a family member, and a whole new medical team and you have a very sub-optimal situation. If there is a reason why poor-performing clubs tend to devolve into injury crisis, this is my theory.
Fortunately this is an easy problem to fix with strong leadership. The board could set a few ground rules such as:
- Playing decisions are subject to medical advice
- Manager must use club medical staff. Club medical staff have authority over managerial hires.
- Manager must act on the advice of the medical staff with respect to training
- Player input is always weighed against objective medical advice
- Agents and associates of players must not influence playing decisions
I had the privilege of interning in such a setup some years ago where the club/board set clear demarcations in the role of manager/managers' staff and club human performance staff. There was an agreement that players belong to the club and are managed as club assets, rather than a manager's to use and abuse, resulting in an excellent injury record.
