In the world of modern professional sport, while skill, practice, tactics, and fitness remain at the heart, sitting alongside those fundamentals are conditioning, science, and medicine.
Derbyshire’s Head of Science and Medicine and Lead Physiotherapist is Ally McKenzie and he sat down in mid-November with Heritage Officer David Griffin to discuss his role and background.
I’m sure your work is extremely detailed for obvious reasons, but is there a simple definition to your purpose here at Derbyshire?
Yes, I’m responsible for the medical care of the players throughout the season as well as helping prepare them both physically and mentally for the challenges of playing elite sport.
How did you enter the world of sports medicine, or in simpler terms, physiotherapy?
Actually, I didn’t really want to be a physio! I’d studied sport and exercise science in my undergraduate degree and after that I went to Australia where I worked with athletes who were suffering pain and that really was the point where I became interested in becoming a physio.
So, your academic route wasn’t one which included physiotherapy?
No, the normal way is to do your A-levels and then a degree in physiotherapy and I did a relevant degree although not physiotherapy.
It was only after about a year of working with athletes in pain that I realised I wanted to understand that better and so decided to study to become a physio.
Had you played any sport?
Yes, I played basketball, although you might think with my genetics that might be a bad choice (!) but I was quite good up until about 18 and I played county level for Worcestershire.
And then once I went to university the opposition was a lot better – and bigger – than me, so I stopped playing basketball but concentrated on staying fit and being healthy.
I’m interested in all sports and in many ways, as a physio, the specific sport doesn’t really matter if you learn and understand the demands of that sport. Ultimately, as you gain experience, it makes you a more rounded physio, capable of dealing with a wide range of issues, regardless of the sport.
Can I just take you back to something you mentioned earlier about working in Australia with athletes in pain; how did that role arise?
I worked in a high-performance gym and people would come to use the facility because it had a very good reputation and I encountered people with injuries or who were seeking rehab and we were able to do gym-based rehab.
But at this stage you weren’t a physio?
No, I was working alongside people with medical qualifications, but I was basically an S&C (Strength and Conditioning Coach). Working in this environment opened me up to the complexities around injury, ethics, and everything else that comes into play in the medical world.
I received an offer to stay in Australia but having decided that I wanted to become a physio I decided to come back to the UK.
Where did you train to become a physio?
I worked at the QE (Queen Elizabeth Hospital) in Birmingham for a year to get onto my physio degree because I didn’t have the right credentials to get on the course and then I did a Masters Degree in physiotherapy.
Was the plan to go into sport, or general physiotherapy in hospitals?
I always knew that I wanted to work in sport or musculoskeletal physiotherapy but I had to learn all the different facets of physio including respiratory physio, plus work in the NHS.
Did your work in the NHS during this period offer a good grounding in the profession?
Yes, the masters in physiotherapy is really condensed – into two years instead of three – and from there I went and worked in the NHS for a year. I struggled with respiratory physio and knew that was an area where I needed to grow and so I opted to do that for six months working in intensive care wards at Worcester and Redditch.
Many people tend to see physiotherapy as dealing with injured backs and knees; can you explain the wider elements of physiotherapy?
Well, there’s musculoskeletal – backs, elbows, knees, ankles; then there’s cardiovascular physio which is for patients who need help but who perhaps can’t move in any significant way – we assist with their breathing by helping them to mobilise, even if only minimally. Then there’s the intensive care physio where apparatus is generally used to help severely ill patients. There’s also neurological physio – post-brain or post-spinal injury – which often means working with multiple practitioners.
Working in the NHS certainly prepares you for dealing with time pressures and of course, working with people from different backgrounds and cultures. One minute you’re alongside consultants, the next you’re explaining the complexities of a medical situation to a parent. Very challenging but also very rewarding.
That period in the NHS was fundamental to my work and experience as a physio.
Did the period working in respiratory physio deliver the necessary experience you were seeking?
Yes, I did six months and then went to do six months of musculoskeletal which I knew was the area I wanted to work in.
What and where was your next physiotherapy role?
I was offered a job at Worcestershire County cricket Club as their assistant physio. I jumped at the opportunity – Worcestershire had never had a full-time assistant physio and so it allowed me to get a foot in the door in sport and see the differences between working in general physio within the NHS and elite sport.
What was the biggest difference?
Time. Fewer patients and therefore more time to work with them. Plus, it was very rewarding to know that I was working towards a collective team goal. And then I was seconded to the first team during the Covid-19 year – my boss was seconded to England so it was a great opportunity to work with the first team. Games were behind closed doors and the period provided me with a quick learning curve, working with first team coaches and first team players.
After that season my son was born at the same time as my contract at Worcestershire expired.
Fortunately, I was appointed as physio to the Aston Villa football academy which was a wonderful experience because football has taken sports science and medicine to a whole different level. There’s obviously huge investment in players with high expectations. I really enjoyed it – the resources were so much greater than in cricket.
I was responsible for the junior element of the club but even they were treated like professionals, in fact some of them did play in the first team. That environment exposed me to the standards being set in a sport where there is so much money and resources appear almost endless. It was also a very organised and structured place to work.
But cricket was obviously calling you, so how did you end up coming to Derbyshire?
I applied for the job because I saw a leadership opportunity, and a chance to improve the department and create a high-performance environment. The interview obviously went well!
Do you play cricket and does having cricket-playing experience make any difference to your role?
I played a bit when I was younger, although my family members play a lot more. Ultimately, I’m learning all the time about the technical and tactical side of the game, but as a physio I think having a wide range of skills within the framework of the job is vital, regardless of the sport.
You mentioned that you saw an opportunity at Derbyshire to lead and create a high-performance environment. How successful has that been?
It’s been enjoyable and there’s been a lot of learning. When I came in to the job it was difficult to change things immediately but I was able to observe things, identify the strengths and weaknesses of the department and then look at how to make the necessary changes in line with my expectations.
One of your predecessors, Julian Calefato was a Strength and Conditioning coach here and then returned several years later as the lead physio. How does your experience working as an S&C in Australia complement your physio work?
I think having the fundamental understanding of the S&C role and what the S&C is trying to achieve makes my job much easier. I think it’s important that the physio doesn’t work in isolation – although some do. I’m clinically registered as a physio but I’m a performance practitioner in reality.
From a practical perspective, once the cricket season ends, how do you plan the close season for the players?
I’ve been pretty busy while the players have been off mainly looking at what I want to achieve over the winter period, working alongside James Bell (Strength and Conditioning Coach).
The culture we’re trying to create is at the heart of what we do and it’s very simple; we want to create the optimum environment for players to thrive within the physical and mental demands of elite sport.
Do players understand that? You’re dealing with a disparate group of individuals after all.
Yes I think they do. That’s why the culture we’re trying to create is a simple one. Their job is to play cricket; our job – everything we do – is designed to ensure they are the best-prepared they can be to play cricket. But you can’t ignore the emotions involved, performance and contractual pressure, work-life balance.
It’s interesting that you mentioned contractual pressure, and earlier you talked about ethics and morals. How do you manage a situation where because of contractual pressures a player wants to play but is clearly unfit; or what about when a coach wants a player to play but you don’t feel the player is fit to do so?
The interesting thing in sport is that there is often an ethical conflict of interest. We want to prevent injuries but people engaging in sport are doing something which offers some risk of getting injured because they’re pushing their bodies, often to the limit and beyond, for a living.
I have to look at that risk and try and reach a determination with all parties involved.
Can you explain that process?
Yes. So, a player will come to me with an injury. My first job is to establish the nature of the injury and if it’s severe, the decision is easy. The player doesn’t play.
It’s much harder to deal with an injury which might be exacerbated by playing or training, and I have to state my case both to the player and the coaches. If, in my opinion, the injury will only get worse by continuing to play, then I have to make that clear to all concerned.
That does happen.
However, most of the time, we’re in grey areas where there is a possibility of the injury worsening and then it’s a case of using my skills to understand the injury. For example, a player pulls a muscle while running. It’s my job to estimate how severe that injury is. Is it low grade and can a gamble can be taken to get the player through? Can the injury be protected?
How does the format of the game to be played impact on whether a player plays?
There’s pressure to take a risk for an important T20 game or any other big match – that’s undeniable – so we do have to look at the context, but ultimately I endeavour to provide the player with as much useful information as possible to allow them to make a considered decision. Explain the risk, and the potential repercussions of a lengthy lay-off and make sure the coaches understand this too.
There’s a lot of apparent cynicism amongst some cricket followers about back injuries which seem to affect an increasing number of pace bowlers. Are bowlers more susceptible to injury or are we just more aware of them because of technological advances, like MRI scanning?
Spinal injuries in cricket are like the ACL (anterior cruciate ligament) injuries in football; essentially an occupational hazard for fast bowlers. It’s a complicated injury and the more you try and understand it, the more complicated it appears! Some players can have a stress fracture but are asymptomatic and every player is different and every fracture is different.
We don’t have a definitive answer in terms of prevention although workload is one consideration, but so too is a bowler’s action. However, we could scan every player in the middle of a season and find someone with a stress fracture who doesn’t feel a thing and can bowl rockets.
As we sit here in mid-November, can you anticipate a fully fit squad come late March?
Yes. We have six months to rehabilitate any injury suffered during the summer and that’s a long time for most injuries. However, it’s impossible to replicate the workload of an entire season over the winter, so our job is to steadily rehabilitate players with injuries.
We do anticipate having everyone available in April but it may be that some players will still be in the end stage of their rehabilitation when they begin playing next season.
The fixtures are out for next season. Are you already looking at them trying to calculate workloads for the players?
From an injury point of view, we’d prefer a 50-over competition to start the season.
Really? The old Benson and Hedges Cup group games were usually played in the first two weeks of the season throughout the latter part of the 20th century.
Right, well from a workload perspective that would be much better as it would allow the bowlers the opportunity to build up their overs rather than being thrown into consecutive red ball matches where they can often bowl high numbers of overs.
But we can’t control that. All we can do is prepare them as well as possible.
Players in all sports, including here at Derbyshire, wear sewn-in GPS tracking monitors. What information are you recording?
We quantify how much they do every day. How far they run, how far they sprint, working out their safe limits. As a clinician, if I see that a player has performed 105% of his expected maximum in sprinting, I know that the next day he’ll be sore. What can I do to ease any pain reaction? Do we ensure he has an ice bath to help muscle repair? Our nutritionist will get involved, recommending the best food intake to ensure the fastest and most effective recovery.
This sounds very technical but I suppose all sports now engage in this methodology. Is it fair to say the days of a physio with a bucket and some sponges are clearly long gone?
Yes, I think we work in the shadows now! Spectators see me run on to the pitch now and then but that is the most basic part of my job. The bulk of my job is endless hours of planning research and trying to make sense of everything.
I presume the modern player fully buys into the processes and strategy surrounding sports science.
Ultimately, we’re dealing with people, so regardless of the science and technology, I need to read the person in front of me and work out what is the best way of communicating relevant information to them.
I might want to provide a programme for a player who is going overseas for the winter which includes a lengthy period of gym work. However, I might also know that that player never really wants to do more than 45 minutes in the gym at any one time. So, then I have to work with the player to tailor his programme accordingly.
The academic, technical stuff is one thing, but dealing with an individual and getting them to buy into it is another thing and it requires building good relationships with each player.
Concussion injuries are a hot topic in the game now, specifically because every time a ball hits a player on the head, there must be an assessment, legislated for in playing regulations. How do you deal with such incidents?
When a player is hit on the head it helps if I’ve witnessed it which is usually the case because this gives me some idea of the likely severity of any injury. I’m looking at who bowled the ball, where the ball has ended up – if the ball has flown to the boundary behind the wicket it’s probably as the result of a glancing blow to the helmet. If the ball has stopped dead in front of the player onto the pitch, it’s more likely to have been a full-blooded blow.
As I run out I observe whether the player is interacting with other players or umpires, or like Suranga Lakmal at Chesterfield earlier this year, is on the floor and clearly hurt. The Suranga concussion was an easy one to diagnose.
I’ll inspect the helmet, ask a few simple questions – just testing recall. This is a protocol known as Maddocks Questions, a tool for assessing possible concussion in sporting environments. Questions to see if they know what day it is, what they had for breakfast, who we played last week. I’ll also check for whiplash.
Ultimately, if I believe that they are suffering concussion, or just as importantly, if I can’t be sure, the player must come off.
If the player stays on, I’ll monitor from the side of the pitch, and I’ll then go on a few overs later to check again. Delayed responses to concussion injuries are common and we always need to be aware of that.
To conclude, what do you like to do when you’re not working?
I spend the bulk of my time away from cricket with my family – partner, two children and a dog – and I love being a father. And the close season does allow for us to spend more time together. We just try to do family things.
Thanks very much for providing us with an insight into your role, and here’s to a successful 2024.
It’s been a pleasure.
