Real Madrid's changes in the medical section explained

According to AS yesterday there are changes about to be made to Real Madrid's medical section.  The medical team have taken a bit of flak of late with Luka Modric, Cristiano Ronaldo and Karim Benzema all being treated outside the club last season and that's never going to be an ideal situation.

The report briefly states that Dr Ximo Mas, who had previously left the club, will be returning; and that as a result of this some positional changes will be made within the existing medical team.  The current doctor, Jesus Olmo, will remain with the club although Ximo Mas will assume overall control of the department.

The punchline from AS' report yesterday lies in the final summary:  "Madrid's idea is to avoid players from constantly having to go abroad for injury treatment".

If the medical changes have been made with this in mind then I think that's a huge step forward; although in reality it's a policy change within the club that will limit the number of external consultations as opposed to just a personnel change.

However, if the personnel changes lead to the medical department delivering results in terms of successful injury management, thereby ensuring that players don't need to go outside of the club for medical opinion and / or treatment then the changes will have been worth making.

The problem of players going outside of their clubs for treatment is commonplace in football today and not only at Real Madrid.  Going elsewhere for treatment is now so widespread in football that a cultural change is needed throughout the game.

This is a problem which can only be solved by providing such a high standard of care within individual club medical departments that it negates the need to go outside of the clubs in the first place.

It's not as easy as it sounds, though, and in practice it only takes one of your big-hitters to be unhappy with the in-house care and take himself off somewhere else for another opinion before the time-bomb starts ticking in the medical room.

Most medical people in football will agree that there's nothing wrong with taking a second opinion about an injury that's proving difficult to treat; after all, that what should happen anyway and is good medical practice.

The real problem comes when the person offering the second opinion also wants to deliver the treatment; and it's at that point where the seeds of doubt are sown.  In the eyes of the players, it's not just your ability to come up with a correct diagnosis that's being called into question, it's your treatment skills as well.

As we've said before in this column, players will sit in the changing rooms and talk.  If someone has been outside for treatment and feels that the outside care is better than anything the club can offer and can back that up with results in terms of successful treatment, then you can't stop the next guy from going there unless you can deliver better results.

Another problem with allowing players to go outside for treatment is when the consultation takes place in a different country.  An example would be if a Real Madrid player was to fly to the USA to have knee surgery, although the actual rehab would be done by the physio team at Valdebebas.

If your player comes in one morning and says that his knee has swollen up, the surgeon in America is going to want to see it.

He's not going to be happy to let the Madrid medical team manage the swelling in case it's something that's might affect the outcome of the operation, so you need to get the player on a flight as soon as possible to the USA for the knee to be checked by whoever operated on it.

Furthermore, if players are away for weeks at a time doing rehab in an outside clinic, the responsibility for managing that injury gradually shifts to the treating unit.  They become the prime movers as far as the injury management is concerned and before you know it, these outside clinics are calling the shots.

Your player will then walk in six months later with a different problem and tell you he's going back to Switzerland / Germany / France or wherever to see these guys again.  There's nothing you can do to stop him since a precedent has already been set.

That's when the onus falls on the home medical teams to deliver.  The new team will ultimately be successful only if they can deliver results in terms of returning people to full match fitness.

I've commented before that clubs like Real Madrid should be able to manage every condition ‘in-house' and there should be no need to have players flying here, there and everywhere for ‘specialized' treatment.  That should be able to be delivered at the club.

If a second opinion is warranted then there should be enough quality people around to deliver this as well.  On that note, Real Madrid are a big enough organisation to request that any doctor or consultant invited to deliver a second opinion on any Real Madrid player actually does so at the club in the presence of the Madrid medical team as opposed to the other way around.

The players will be happy to stay in Madrid provided that the treatment they are given makes any talk of going outside irrelevant.  At the end of the day, all the players ask are to be fit in the shortest possible time and to avoid inviting a recurrence of the same injury by coming back to play too soon.

Provided that the new medical changes can deliver those basic principles then nobody should need to go outside of the club for treatment.  However, it's going to take strong personalities to convince the players that the care can be delivered at home.

This might not be something that can be done overnight.  The medical teams will need the support of both the football management and the club hierarchy if this is going to succeed.