By Andrew Allen
Muddy pitches, dodgy haircuts, tucked-in shirts, dangerously packed terraces, tackles more akin to assaults…watching highlights of English football in the 1980s is like being transported to a different world. For better or worse, it was more often a battle than ballet.
Since then, the game has changed beyond recognition. Today, at the highest level, finely tuned athletes with unparalleled technical ability implement detailed tactical plans. They play on pristine pitches in state-of-the-art stadiums with fans paying big money for the privilege of taking cushioned corporate seats; prawn sandwich in one hand and prosecco in the other.
Money has poured into the game. In 1980, the average weekly wage of a top-flight footballer was £550. Not an insignificant amount but, even with inflation taken into account, pocket change compared to the £100,000 a week that last season’s English champions Liverpool are estimated to have paid each of their squad on average. Paris Saint-Germain’s Brazilian striker Neymar is thought to be earning eight times that amount (£782,000 a week), a deal he agreed when signing from Barcelona for £200 million. Football is big business these days.
In the quest to build powerhouse brands and a global customer base, you could be forgiven for questioning whether silverware is as important as generating revenue. And yet, time and again, it’s the quest for glory that prevails. Despite existing on a financial knife-edge, clubs repeatedly throw the dice, gambling heavily in the transfer market in the hope of finding an uncut gem or the missing piece of their jigsaw.
The pressure on the players is subsequently huge. And it’s even greater on the managers charged with getting the best from them. To stand even half a chance of lasting longer than 26 months — the average tenure of a Premier League manager in 2019/20 — they need their stars fit and healthy.
That’s where the medical team comes in.
Not so long ago, clubs were happy to rely on a couple of part-time physiotherapists to keep their players on the pitch, now they dedicate significant resources to building world-class departments that incorporate doctors, masseurs, nutritionists, psychologists, strength and conditioning coaches and more.
Over the course of 32 years at Arsenal, cousins Gary and Colin Lewin built one of the best as a revolution in sports science kept pace with developments on the pitch and in the boardroom.
Proximie caught up with them to learn more.
Gary Lewin wanted to be a footballer. As a teenager, he was a goalkeeper at Arsenal harbouring ambitions of playing at their iconic Highbury Stadium. His dream never came true, but four years after being released, he returned as a part-time physiotherapist for the club’s reserves while still training at Guy’s Hospital. He was only 19.
In 1986 he was promoted to work with George Graham’s senior squad; a position he held until 2008 when he was headhunted by the Football Association to be England’s Head of Physiotherapy.
Having worked with the national team on an itinerant basis since 1996, by the end of his spell with the Three Lions, which ended in 2016, he’d worked with eight managers across five World Cups and four European Championships. Just for good measure, he was also lead physio to the Team GB Football Team at 2012 London Olympic Games.
The most recognisable face in football physiotherapy, it was little surprise when he returned to the domestic game, spending a season with West Ham United in 2018.
For 13 years at Arsenal, Gary worked side-by-side with his cousin Colin as the club enjoyed one of the most successful spells in its history under legendary manager Arsene Wenger. Between 1998 and 2005, the Gunners won the Premier League on three occasions and the FA Cup four times, twice doing ‘the Double’.
Wenger managed the club for 22-years before stepping down in 2018. Colin Lewin book-ended the Frenchman’s time in North London, serving for 23 years; a remarkable feat in the modern era.
Holding the title Head of Medical Services for a decade, Colin helped revolutionise the club’s medical infrastructure. He was a member of the planning group that designed a purpose-built medical building in 2012 and a new £17 million player performance centre in 2017. Both facilities remain envied in world sport.
The Lewins now run their own sports injury clinic, which they opened in late 2019. When we catch up with them, Colin reveals that business is booming, in part because “everybody became Bradley Wiggins and Mo Farah” during the Covid-19 lockdown and inevitably got injured. Even on the phone, the duo makes for entertaining company.
Having experienced football’s rapid evolution at first hand, it feels logical to start with a comparison between their formative days and the world of sports science as it is today.
Three years ago, Gary and Colin co-authored a paper “The Changing Landscape of Football Medicine” in which they highlighted the evolution of radiological advances, screening protocols and recovery strategies between 1987 to 2017. Advances in technology is a subject that Gary is quick to revisit.
“When I first started in sports medicine, we had X-rays, radioisotope bone scans and that was it,” he says. “The biggest advancement now is diagnostics.
“You’ve got MRIs, CT scans, three-dimensional MRIs, open MRIs, ultrasound scans, dynamic ultrasound scans…there is such a variety of imaging that diagnosis is far, far easier and much quicker.
“That said, you have to make sure you don’t lose track of your clinical skills in assessing and diagnosing. You need to read a patient, not a scan.”
Having a well-rounded understanding of the patient becomes a common theme of the interview.
“In my early days, and even more so in Gary’s early days, it was a one-man-band,” says Colin. “You had to put on quite a few hats during the day.
“When it comes to making a diagnosis these days you want a nice rounded view on things. You can ask the fitness coaches for their input and they’ll go back and look at the data. You can ask the psychologist if there are any stresses going on behind the scenes.
“The vast majority of the time though, if you have a relationship with the players and have known them for years, between your subjective history and objective examination, plus or minus a scan, you’re going to come to the right decision.”
He adds: “The relationship of a player to physio and player to a doctor is really important. You often hear about physios and doctors getting too close to players. It’s nonsense. You have to be close to the players, you have to have a relationship because you need to have fairly intimate knowledge of what’s going on in their lives in football and to a large extent outside of football.”
If football was slow to embrace the data revolution compared to some of the biggest sports in America, it’s been making up for lost time in the last decade. Nowadays, top-level players undergo extensive testing during the off-season and are monitored weekly throughout their gruelling schedule.
From strength and speed to respiratory function and eyesight, the data at the disposal of clubs is extensive and goes some way to explaining why medical departments have expanded so much. Constant analysis is required and the results, depending on the manager, can be very influential.
While having so many experts to call upon is a boon, Gary and Colin note in their 2017 paper that “it does bring some challenges”. Namely, the need to maintain efficient communication between teams.
Over the years a series of managerial appointments were made at Arsenal, introducing titles like Head of Performance, Head of Medical, Performance Director, and Head of Science & Medicine into the mix.
In 2015, Colin and colleague Dr Gary O’Driscoll (now Head of Medical Services at Arsenal) even launched a Research and Development wing to sift through the regular approaches made by companies proffering everything from new technology to training methods. “There was a lot of stuff ignored, but you didn’t ever want to miss one good one or a gem,” explains Colin.
A typical Premier League side’s first team squad will include around 25-players with a number of academy youngsters on its fringes.
If, as has been the case at Arsenal since 1996, the team is playing in European competitions, the season could pack in up to 60-games between August to May. To give yourself the best chance of winning trophies, it’s vital to maintain the fitness of as many of the squad as possible. Pick up a few injuries in quick succession and all eyes fixate on the medical team. The scrutiny is unfair in Gary’s eyes.
“If you have a lot of injuries, the perception is it’s the medical team’s fault,” he says.
“Let me make it clear; the medical teams do not injure players. The medical team picks up the pieces once the players are injured. This perception that because you’ve got a lot of injuries, therefore, you must have a poor medical team is an absolute load of nonsense.”
In 2016 the results of a wide-ranging study with input from the medical staff at 36 elite teams in 17 countries concluded there was an association between injury rates and players’ availability and the leadership style of the head coach.
The incidence of severe injuries was up to 40% lower in teams where coaches communicated a clear and positive vision of the future, supported staff members and gave staff encouragement.
Given the high rate at which clubs churn through managers and coaching staff, the Lewins remain sympathetic towards their peers working in volatile environments.
For context, between 1986 and 2018, Gary and Colin worked with two managers at Arsenal. In the same period, Chelsea switched coach 22 times.
Over a long season, friction between the coaching staff — desperate to field their best team — and the medical department — who have a duty of care to the player — can build. Operating in such an environment is not for the faint of heart, but as Gary explains, the guidelines are clear.
“We have an ethical and a professional duty of care to players,” he says. “This is where physios and doctors are probably different from any of the other support staff. If we make a mistake in our decision making because we’re influenced by what’s right for the club or what is right for the team rather than the patient, we will get struck off. Other people — and this includes managers, coaches and sports scientists — can influence that decision making and it won’t affect their livelihoods because they have made a judgement call.”
That’s not to say their decision-making hasn’t been influenced by the club’s need to win matches. “The win metric trumps all others” they wrote in 2017.
“We were very lucky, we had stability at Arsenal with Arsene Wenger for a very long time,” reflects Colin. “When there’s trust there, you can have difficult conversations and it doesn’t come down to pressure. You can trust in each other’s views and do what is best for the player and the club. I feel sorry for physios now when they are having to work with so many managers. You have to build your relationship from scratch every time because it’s vital.”
It’s not just the managerial roundabout that can cause headaches. In an age of unprecedented interest in the game, when every decision is scrutinised on social media, in the papers and on TV, rumours and misinformation can spread like wildfire.
“It was always one of my bugbears when I was at a World Cup or a European Championship,” says Gary.
“I’d be sitting in the team hotel listening to all these experts on TV telling the world what an England player had done, what the treatment was and why we were wrong in fielding the player. Quite often they hadn’t even got the diagnosis right! Of course, I can’t say a word, you’re not allowed to say a word, you have medical confidentiality to stick by.”
If the duo misses the cut and thrust of elite sport, you certainly get the sense they don’t miss Fleet Street’s finest hacks.
As Gary heads off to tend to a patient, Colin again reflects on how far the world of sports medicine has come since he graduated from the University of Brighton in 1995. He almost sounds envious of the next generation of students following in his footsteps.
“I think the amount of evidence-based research on sports injuries has grown exponentially in the last 10 years,” he tells us. “The universities are churning out sports medicine research by coal-faced practitioners and it’s helping things improve unbelievably.
“Thanks to the internet and social media, the world is so much smaller. I find it far easier to be in touch with my peers and to make links with universities and people doing research in the outside world.
“There’s far more collaboration and it’s improving things dramatically.”
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