Marita, the physio
Late last month, former West Indies Women’s physiotherapist, Marita Marshall was kind enough to speak with me concerning the physical aspect of the gentleman’s game and sports in general. The Barbadian—who is owner of her own physiotherapy practice, Physiotherapy & Optimal Performance Services (POPS), and co-founder of The Health & Wellness Physios Inc—has seven years of clinical practice under her belt. In our hour-long Zoom call, she broke down who exactly physiotherapists are, touched on topics from T20 cricket to pink-ball cricket, the huge risks associated with fast-bowling in stark contrast to spin bowling, injuries, treatments, recoveries, etc. Buckle up.
When did you know you wanted to pursue a career in Physiotherapy?
Well, I wanted to study medicine initially and then I changed my mind from that. I knew a bit about physio from sports and I did some research into the requirements and started volunteer hours [after secondary school] at the hospital here in Barbados. After I did those volunteer hours, that was when I really decided that this was something I really wanted to do.
And your educational choices on your way to that dream?
I spent a year at UWI Cave Hill and then I transferred to [UWI] Mona in Jamaica where I did my undergraduate degree in Physical Therapy. I then returned home [to Barbados] and worked for two years and then I left for Scotland for a year to do my masters in sports medicine.
What did the events in your life look like leading up to your employment with Cricket West Indies?
When I came back home from doing my masters, I was working in the clinic for about two months or so. Then, I started working with the Combined Campuses and Colleges (CCC) team. The physiotherapist that was supposed to go with the team (WINDIES Women) could no longer go on the New Zealand tour and my boss, at the time, would have sent in my application and recommended me as the physio. They [CWI] contacted me and used me as the physio for that tour to New Zealand. After that tour was completed, they decided that they wanted to move the girls to Antigua to train in preparation for the 2018 T20 World Cup in the Caribbean, and they asked if I wanted to continue with them—to move to Antigua. And that’s how it happened.
And are you currently employed by WINDIES Cricket?
No. Right before the India series [India Women’s 2019 tour of the Caribbean], that’s when our affiliation would have ended.
In your time with CWI, did you ever work with the Men’s teams?
Down to business
Firstly, can you break down who exactly a Physiotherapist is?
Most people are familiar with sports physios because you see us on TV in sports coming in as the person that runs on to the field if a player gets injured. [However] there are many other aspects to physiotherapy that persons may not necessarily be too familiar with. So, physiotherapists also work in hospitals, in public clinics, outpatient facilities, rehab centres, in sports, etc. Physiotherapists basically look after the rehabilitation needs of persons, those (patients) may be persons with injuries, as we commonly see in sports where we have a variety of injuries. And then we also sometimes have to deal with medical issues.
But physiotherapists are generally just persons who work with individuals to help them restore their movement and function. The main difference between us and other healthcare professionals is that all of our treatment methods are non-invasive; we don’t give injections [or] prescribe medication. The mainstay of our treatment is usually exercise and movement. Along with those, there are a lot of soft tissue techniques we use, [such as] trigger point techniques, shockwave therapy, dry needling and many others. The main thing is the use of exercise and our hands.
What are the most common injuries batters are faced with in your experience? And fast-bowlers? Spinners?
In batters, hamstring strains are common from the sprinting between the wickets. For fast-bowlers, it would be back pain or back injuries. Sometimes they have slippage of the vertebrae, either forward or backward, on each other, spondylolisthesis or retrolisthesis. As well as, side strains [in fast-bowlers]. Spinners are usually okay; they don’t have too much of an issue.
Similarly, what are the most common injuries you’ve come across in cricketers, in general?
The most common injuries in cricketers would definitely be shoulder rotator cuff injuries, and then back injuries.
Are rotator cuff injuries the most common for both male and female cricketers?
Yes, you get both males and females having the same issues with shoulder injuries because in cricket they have to throw a lot. Most times due to the amount of cricket and training that they are doing, their shoulders can be overworked and overuse injuries pop up. And that happens with both males and females.
How would you have gone about deciding the method of treatment for a rotator cuff injury?
You have to make sure that the person is properly diagnosed and that you know exactly what is going on. That would guide how to treat the patient. You also consider the position that the person plays and the amount of time that they have to recover; if there are any important matches coming up, if the injury comes up during a training camp or World Cup series. There are a lot of factors you have to consider and those would guide you on how to treat the player. In the early stages, in terms of the icing and rest, that is standard.
If it is a case where it’s a player you desperately need to be ready in a short period of time and you don’t necessarily have the time to take them away from playing completely, there are different things we can use. So, we’ll make sure something like taping is done, and that person might get more frequent treatments. Then, obviously, depending on what’s needed for the match, if it’s possible, that person could not field on the boundary, then we would avoid having that person in that position. Or change the number of overs they are required to bowl, etc. So, we can allow that player to play but still have some restrictions. [However] there are risks, [therefore], you have to weigh how important it is.
Would you mind explaining how you would go about treating a rotator cuff injury, in detail?
First of all, you have to give the shoulder a bit of rest from that particular offending activity. Not total rest, but in this case, the aggravating activity would be throwing, so that would either be restricted completely or restricted in terms of the number of balls that are being thrown. So that’s the first thing. Generally, in the acute stages of an injury, you want to get the inflammation down. This is where you make use of ice. Sometimes some anti-inflammatory medication, whether that be taking tablets or topical application or both.
Sometimes they use taping and from there, once the pain starts to go down a bit, you can begin to strengthen the exercises. So, you’ll start generally with exercises where the shoulder doesn’t have to move that much and then you progress to other exercises that include movement and then gradually work back into activities.
In brief, could you say that the format one plays, influences the injuries he or she is exposed to or more prone to?
Based on the demands of Test cricket, and in particular, [for] bowlers, [they] have to bowl a lot of overs over a period of time and that’s where the issue really comes in. And then the overall strain on the body, being out there [on the field] for days on days. Their recovery in those cases is what needs to be optimal. They don’t have much time in-between to prepare for the next day. In those cases, yes, you have a greater injury risk, in particular fast bowlers, and [especially] for the [strike] bowlers.
For all the players, their recovery is what would really need to be their focus, in terms of rehydration, what they are eating, and making sure that their energy levels are up and restored each day in terms of their rest. Make sure that they get their sleep and allow their muscles the time to recover and recuperate. Ice baths are very important also. So, from that aspect [of Test match cricket], for sure, fast-bowlers are at greater injury risk.
Overall, the other players need to make sure all of their recovery techniques and strategies are being utilized to ensure they can perform at their best. And [even] when the series is over, making sure that they put heavy focus on their recovery and making sure they remain fit and healthy for the next one.
Consequently, would you say the required levels of fitness vary for each format of cricket?
Yes, I could say so because the shorter formats focus more on explosive hitting, they don’t necessarily have to do much running. So that’s where you might see older cricketers who are not as fit as others. I mean, not [referring to] agility, because in the field you have to be able to move and get to the ball and such, but in terms of running between the wickets, there is a little bit less of that and more focus on hitting the ball and getting runs as quickly as you can. I don’t want to say you require less fitness, but we can see how players get by not being [at their] optimal fitness levels in those formats.
More specifically, how about the different levels of fitness you find that works for batters versus fast-bowlers versus spinners, etc?
Definitely, I think that the different positions – in any sport really, the different positions you play require different or slightly more specific training, to focus on whatever you are required to do in your actual game. So, for the wicketkeepers, crouching for a long period of time, they need really good hand-eye coordination in order to get to the ball quickly. So, there are different aspects of training that will be incorporated based on the role that the players fill. The fitness test is a set standard for everyone. However, if you have cases where the person did not pass [the fitness test] then based on the position that they are playing, you could examine why or what could be the reason. But in terms of fitness levels, those are standard.
Aside from cricket, can you give us an insight into the different levels of fitness required for the various sports in general?
Different sports call for focus on different energy systems. In cricket, they have to do quite a bit of sprinting. In football, they also do a lot of sprinting, but they end up running for longer periods and covering greater distances over a period of time. Therefore, different levels of fitness are required for the sport that you are training for.
Speaking solely from a physiotherapist’s perspective, how healthy is Test match cricket and its five-day format?
There’s a lot of different factors to take into consideration here. Um, obviously cricket is played all around the world. And in some countries, the heat is a big issue and that’s where most problems come from. So that is something that I, as a physio, will be on the look-out for. I would want to know what the temperatures are like, the humidity… So, in terms of 5- day cricket, the heat illness is definitely the biggest risk factor.
Now, we often speak of players coming to you after the damage is done, but what forms of treatments can cricketers undergo to best prepare themselves for Test match cricket, apart from exercise?
In terms of preparation for Test matches or any match, their diet and the amount of rest that they get is very important, in terms of preparing for those long hard days out there. You have to make sure that you eat foods that are high energy foods; your carbohydrates and stuff that can be stored [so] that the body is able to use them. You have to make sure you hydrate in advance, two to three days before—stay hydrated during the match itself also. Sleep and rest are very important because when you sleep that’s when the body actually does most of the work in repairing the muscles that would have been damaged. Getting that time to rest your mind as well, so when you’re out there and having to focus for those long hours, you have to find time to give your mind and body a rest from activity. I would definitely say diet, rest and then the recovery practices. Making sure you’re doing your stretching, your ice baths, massage to help reduce that lactic acid build-up, to help deal with the sore muscles and help get your body ready to go again as quickly as possible.
Speaking of Test matches, can you elaborate on the toll that fast-bowling takes on the body.
There’s a quote: “Fast-bowling, in cricket, places the same stress on your body as a minor car accident”. The toll of fast-bowling is immense on a bowler’s back, for sure, because they are required to run in hard and deliver really fast, repeatedly. So that, over time, takes a really crazy toll on their body and their backs in particular.
Now that you’ve brought up pain, can you shed some light on the issues wicketkeepers leave the game of cricket with?
[With] sports in general, players can develop knee issues. For example, we see it in volleyball, hockey [and] cricket. And in the older [patients], that’s something I can definitely say we see a lot of complaints of—knee pain, with their arthritis being pretty much accelerated. They develop early arthritis in the knees from playing these kinds of sports. So, identifying a type of injury that’s common post-sport, it would definitely be knee injuries—knee pain.
Meanwhile, are there any physical adjustments that occur when moving from daylight to the night portion of pink-ball matches?
I think the biggest adjustments there would probably be in the eyes: the lights and going from the sunlight to fielding under the lights and even batting. But the more often you are put into that situation and the more opportunities you have to play day/night cricket, then you would naturally adjust and feel more comfortable in doing it. But there aren’t any major risks. Obviously, fielding under the lights is more difficult. It mostly takes getting accustomed to, but there aren’t any major risks there. It requires practice and allowing yourself and your body to get familiar with what it is like.
Continuing the topic of adjustments, does the body require any such adjustments regarding changing climates?
Yes, but all this would be taken into consideration when the management team is planning how much time in advance they need to travel for the team to acclimatize and there is the additional consideration that needs to be made in terms of diet [when relevant]. You don’t want players having stomach issues when traveling to countries where the food is completely different to what they are accustomed to.
In your opinion, what time period would be ideal for this adjustment to take place?
It varies, because if you’re traveling over time zones then it will be different. If you are traveling to a place of high altitude, it’s going to be different.
The last one on climate, now. Have you found any relationship between injuries and unfamiliar environments in cricket?
If you are going to places like India, then you would expect players to have some issues based on the fact that the food is very different to what we would be accustomed to at home. Some places we don’t drink the water at all. [Physical injuries], though—if it is colder than normal and you don’t warm up properly then you are at a greater risk of getting injuries. These are things that you can plan ahead or prepare for. That is basically the job of the physio and tour manager, to take these things into consideration and make sure that the team is best prepared for the environment that they are going to be in.
Let’s broaden the scope here. I note that you treat athletes from various sports. Which sport would you say is the most taxing on an athlete’s body?
I would probably have to say rugby. Because rugby is a high contact sport, they are constantly running into each other and their body generally gets a lot of hits and blows. So, from that aspect, I’d probably say rugby.
Finally, are you at liberty to say which sport dominates your retired patients’ list?
I think everybody that plays a sport at some point in time, in their older years, requires some sort of physiotherapy. Because of the load that they would have put on their body in their younger years. For now, it’s kind of hard to say.
With that, MostlyCricket, would like to thank Ms. Marshall for taking the time to speak physiotherapy with us!
You may find her on Instagram @ physiom_24, on Facebook @ physiom246, and on WordPress @ physiom.org.