Opinion Articles

‘From magic sponge to magic spray’: football and sports medicine

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Round-the-clock medical bulletins on the fitness of footballers have become an established part of the pre-World Cup ritual. As much as the selection of the final squads, competition predictions and completion of the Panini sticker album, no World Cup would be complete without constant updates on any tournament threatening injuries to star players. At the end of the tournament it is useful to reflect on the history of sports medicine.

Before the 2002 and 2006 tournaments, journalists spilt much ink on chronicling the treatment of, and recoveries from, the metatarsal injuries suffered by David Beckham and Wayne Rooney. Not only has this coverage implanted the language of sports medicine more deeply in the popular consciousness, it has also highlighted the importance sport now places on medicine in trying to improve sporting performance. All World Cup squads are now supported by a host of sports medicine and science specialists. At England’s first World Cup in Brazil in 1950, the manager, Walter Winterbottom, and two trainers, supported the team. For 2014 England had an entourage of 72, which included a medical team of 10, nutritionists and a psychologist, a turf specialist and a cook.

The relationship between sport and medicine, especially at the elite level, has been underpinned by three historical developments. First, the commercialisation of sport; second, the nature of sporting competition; and third, the management of the excessive stress placed on athletes’ bodies.

The first sports medicine practitioners were the trainers of early 19th century boxers, runners and rowers whose training theories and ideas for treating injuries were empirically based. Sports medicine’s most emblematic image, however, has been that of the football trainer running on to the field with his bucket and ‘magic sponge’ to ‘miraculously’ revive an injured player. Professionalism in football had been legalised in 1885 and ever since footballers have been seen as club assets; and because injuries were an occupational hazard, their welfare and medical provision took on greater importance.

Initially, football trainers had backgrounds in other sports and provided day-to-day medical care, although early medical facilities were far from primitive.  In the 1890s John Allison’s ‘Footballers’ Hospital’ was opened in Manchester, probably the earliest example of a sports injuries clinic, while the bigger clubs offered the best medical facilities. In 1914 Aston Villa planned to build ‘a special room for the doctor’ to be equipped with ‘x-rays, radium and other modern appliances’.

From the inter-war years most trainers were former players. They began to take on a more physiotherapeutic role, linked to the legacy of the First World War, during which physiotherapy had been used to help rehabilitate injured soldiers. Some trainers had gained medical experience during the war and there was a growing trend for electro-medical apparatus and exercise machines.

Following the Second World War there was a gradual if uneven incorporation of professional medical practices in football. Some clubs began to hire trained physiotherapists and some trainers had a background in remedial gymnastics at Wakefield’s Pinderfields Hospital. This institution acted as a de facto training school for football trainers and catalysed a move away from machines towards manual treatment techniques.

By the 1960s the medical context was changing. Footballers were becoming increasingly critical of the treatment they received and some began to seek unsanctioned second opinions, including osteopaths, outside the football club.  In 1958 the FA had instituted a three-year ‘Certificate in the Treatment of Injuries’ for trainers, and in 1973 an Association of Chartered Physiotherapists in Sports Medicine was formed as a response to unqualified rivals such as the ‘bucket and sponge men’.

However, football clubs were reluctant to surrender control over whom they could employ and many appointments were made through football’s ‘old boy network’. The FA first formed a Medical Committee in 1983 but the establishment of its Medical Education Centre in 1989 ushered in a more professional approach. By 2001-02 the Premier League and the Football League required all newly appointed senior physiotherapists to be chartered and from 2003-04 they had to have achieved the FA’s new postgraduate diploma in sports medicine.

The role of the football club doctor has undergone a similar, if less intense, transformation. At first many acted in honorary roles - some were even the club director. In other cases the job was passed down amongst partners in a practice. It was only in 1963 that the FA appointed the first England honorary team doctor, Alan Bass from Arsenal. From 1990 the FA organised sports medicine conferences with the Royal College of Surgeons in Edinburgh. Because of the greater commercial stakes more clubs now employ sports medicine qualified doctors on a full-time basis. However, the market for sports medicine doctors was, and remains, a narrow one.

Despite the professionalization of sports medicine, sports medics can only do so much. Athletes are not ‘normal’ patients who cannot just ‘rest’ to recover. Instead, a fundamental dynamic of sports medicine remains: judging when an athlete is fit enough to return to action. Moreover, the intensification of football’ innate competitiveness – driven by commercial forces, especially the media – has increased the threat of injury to players, thus creating a vicious circle. With greater media scrutiny of their injuries and the treatment they receive, the work of sports medics and their professional credentials will come under even more pressure and at the same time highlighting the ever closer relationship between sport and medicine.

Please note: Views expressed are those of the author.


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