Suture and gloves in the inner pocket. The automated external defibrillator (AED) at your fingertips. The bag with other medical devices puts Erwin Brans, head of medical staff at SC Heerenveen, right next to him in the dugout for a duel of his club. When he just started as a club doctor, he did it extremely meticulously. A bit more relaxed now, but still focused. He always has competitive tension, a kind of jitters that he doesn’t know at all in his ‘ordinary work’.
It is a special profession, that of club doctor in the Eredivisie, all doctors say NRC spoke for a series about the staff behind football clubs at the highest level in the Netherlands. Top clubs such as Ajax, Feyenoord and PSV employ full-time doctors, but that does not apply to the vast majority of clubs. Doctors work there who do it ‘on the side’, and therefore know the football world from the inside, but can also view it from the outside.
For example, Brans also has a half job at a specialized sports clinic (Sports Medicine Friesland) next to the SC Heerenveen stadium, and at the Martini Hospital. Sanne Hesselink, FC Twente’s doctor, comes to the club for two hours a day and continues to work at OCON, a sports medical and orthopedic clinic. Hans de Vries, head of medical staff at FC Emmen, comes to training a few times a week and is also a sports doctor at the sports medical clinic Beweegcampus and the Martini Hospital. They all also work during matches of ‘their’ first team.
The differences between their regular job and the work in the Eredivisie? There are quite a few. Football players have much more physical and mental information at their disposal. There is always time pressure on treatment – and football players are often used to having their worries taken care of. In addition, there are trainers who ultimately decide whether a player will participate in the next match, which in turn can put pressure on the doctors. “There is always a gray area. You have to be able to deal with that,” says Hans de Vries of FC Emmen.
A strange world
“I didn’t really have anything to do with football before,” says Sanne Hesselink of FC Twente. She was trained at the Isala hospital in Zwolle and was asked there if she wanted to provide medical support for the PEC Zwolle youth teams. That’s how she rolled in, and eventually ended up at FC Twente when the club was relegated in 2018. It is great work, she thinks, but sometimes she is also surprised about the football world.
In any case, she keeps an eye on everyone, not just players who come to her with complaints, as patients normally do. Every morning, players fill out a questionnaire about how they feel, whether they slept well, whether there are any physical complaints. After the competition weekend, the entire selection will be discussed by the physical, technical and medical staff. Then the week is also planned. “How do we build up the training, who can handle what load, who needs treatment, who do we have to pay extra attention to,” says Hesselink.
She pays particular attention in the medical room, from where she can oversee the players’ home. It is a somewhat elusive part of her work, and also different from the treatment clinic: there it is always about people who are in physical pain. At FC Twente she also wants to know if there is something mentally wrong with players. Hesselink: “What happens at home, in the family or relatives, can play a role in the capacity to cope. We have young boys who are going to live on their own and suddenly have to cook and make sure they go to sleep on time. That doesn’t always work out well.”
She notices that football clubs arrange quite a lot for their players. Healthy cooking, what they shouldn’t do before going to sleep (gaming, being on their phone a lot), how to take care of themselves. “Players are therefore not always used to taking responsibility. Everything is settled. That is partly good, because it provides stability, but sometimes I think it is a lot. Sometimes they are very pampered.”
The medical staff themselves are also participating, according to Hesselink. If a player is in pain, they want to provide clarity as soon as possible. Otherwise it will become restless. Then agents, trainers, sometimes family members get involved. Because football is the livelihood of the players, if it is endangered, many people will be affected.
Hesselink: “The best thing is to have clarity right away. So, for example, we have a scan made fairly quickly, while you would normally wait longer. That’s the biggest difference between my work in football and beyond. There is no time, and you want to be able to make a clear plan immediately. And even then, players are sometimes angry that they have to wait a week for an MRI scan. A week. If only you knew how long someone else has to wait, I think. And then I am surprised again, and I think: this is not the real world.”
Interests, that’s what it all has to do with, says club doctor Erwin Brans of SC Heerenveen. Players themselves and often also trainers want an injured person to be available again as soon as possible. “That can be quite difficult,” says Brans. In case of injuries, his staff must make a risk assessment. Ideally, the club doctor makes a plan together with the player to get back to top fitness. But there is a considerable gray area when it comes to risk assessment. You can continue to play, but it can also aggravate the injury. “In top sport you always work on the edge. We are not a doctor, can’t just look at it. We always push the boundaries,” says Brans.
Football players often have pain, says Hans de Vries of FC Emmen. And every player handles it differently: one wants to continue playing, the other is more careful. Sometimes you have to draw a ‘red line’, says De Vries. A player with a concussion? It just needs to recover. Often there is no discussion about this, because the player understands that, and the trainer as well. It is more difficult in the gray area, says De Vries. “But luckily we still have the last word. It’s part of your job to say ‘no’ sometimes. If a coach would outdo me, if he said: ‘I don’t care that the cruciate ligament is too weak, he’s playing against Ajax’, I wouldn’t be working here. It is ultimately about mutual trust.”
“I give advice,” says Hesslink. “If a player does not want to follow that, that is his choice – you also have that with normal patients. But it is quite difficult to put on the brakes, because the trainer, and ultimately the whole club, is also involved in the decision whether or not to take a risk, together with the player. I try never to see it as a struggle. Irresponsible is irresponsible, but beyond that you try to work it out together.”
Brans tries to pull himself out of the mode where the next game is always the most important thing. “I try to get the players to make as many healthy training hours as possible. If you keep that up, then they are generally the fittest and their bodies are preserved as best as possible for after their career. After all, that is also our responsibility.”
A version of this article also appeared in the January 16, 2023 newspaper
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