LEADING PLAYERS FROM THE SIDELINE
A striker limps off the field after a tackle and millions of fantasy football fans scour the internet for updates on his injury. A 10-year-old swimmer wants to go one more lap but her coach refuses and her parents want answers. A middle-aged jogger feels a sharp pain in her heel—and she searches for answers on google. Welcome to sports in the information age. Thousands of people play sports in Nepal today and millions are self-professed sports fans. All of them want information, and they want it in a form that is fast, accurate, understandable, and entertaining. But while we drown ourselves in the forefronts of sports, we usually tend to forget what goes on behind the scenes. One such individual that most Nepali sports fans have yet to applause is Dr. Gyanendra Shah. An orthopaedics and trauma surgeon, Shah is Nepali sportspersons’ go-to-doctor. For the past seven years, he has been providing consultations on injuries, treatments, surgeries, and other sports medicine topics.
Shah, who is armed with an MS (a postgraduate degree in general surgery) in Orthopaedics and Trauma from the National Academy of Medical Sciences (NAMS), was always interested in sports since he was a kid, as he used to watch football a lot. However, his interest in sports medicine did not stem from just that. While he was studying, he saw many sportspersons spending hours in line to get treated in the hospital. Sure they would get proper care and treatments but things would remain pending here and there and the players would have a hard time even during follow-ups. “Sportspersons are like gems of our nation. Seeing them struggling in medical settings made me want to do something for them,” remembers Shah. “I then approached the National Sports Council and offered to be a medical officer and provide counselling to the players,” he further says.
According to Shah, a portion of sports medicine does fall under orthopaedics but there are no specialisations here in Nepal. “After completing my MS, I went to India through a fellowship program where I studied sports injury and management at SAI (Sports Authority of India). Most of the sports medical officers here in Nepal have been a part of such fellowship programs in the foreign countries,” adds Shah. These programs help the medical officers to understand the injuries better so that they can be of help in different sporting events. “Once you are a trauma surgeon, you will most likely know the different types of injuries one can sustain during different types of sports. For example, in the case of football, ACL (anterior cruciate ligament) injuries, ankle twist, and muscle sprains are common, whereas in boxing it is mainly facial injuries like cuts, lacerations, and broken nose and teeth. A karate player on the other hand usually injures his/her hands whereas a weight lifter sustains disc slipping injuries,” he claims. “Swimming is one of those sports where fewer injuries are observed, however, we have to be very careful regarding hypothermia,” Shah adds. Even during the recent South Asian Games, the pool wasn’t warm enough so heaters were placed in different areas for the swimmers.
“Earlier if a player dislocated his elbow during a game, the coach would stretch it, ‘fix’ it, and send the player back to the field. But now, they are mindful that it is not just the bones that are dislocated; there are tissues, nerves, and vessels which also get affected, so they contact us whenever there is any form of injuries.”
Sports medicine has two major wings—doping and sports injuries. “Overall, we look after both these wings. We do have doping control officers but during bigger events, the World Anti-Doping Agency sends their own officers. For the 13th South Asian Games, doping control officers from countries like Sri Lanka, Japan and Korea were here,” he says.
Shah shares that contact games like boxing, football et cetera cannot start without a medical officer in the side-line. “There are matches held all throughout the year in different parts of the world which makes it impossible for our team to be at all those places—sometimes because of unavailability and other times due to lack of budget. When this happens, the team requests for one where the game is being held,” says Shah. However, during bigger events like Asian Games and Olympics, they send doctors, nurses, and even physiotherapists.
When asked about the most common injuries he has seen amongst the players, Shah says it has to be the ACL injury. “ACL is one of the key ligaments that help stabilise our knee joint. It is most commonly torn during sports that involve sudden stops and changes in direction—such as basketball, football, volleyball, and rugby. Without any infection, a player can recover within six months from an ACL injury. But in the case of Nepali players, even six months can greatly hinder their career, so some of them avoid getting surgery right away,” he shares. However, Shah is glad that both sportspersons and coaches have now become more aware of the injuries and medical assistance. “Earlier if a player dislocated his elbow during a game, the coach would stretch it, ‘fix’ it, and send the player back to the field. But now, they are mindful that it is not just the bones that are dislocated; there are tissues, nerves, and vessels which also get affected, so they contact us whenever there is any form of injuries,” he adds.
With sports medicine slowly gaining popularity, Shah is glad that people now understand that there is a big difference between injuries that a normal person sustains and the ones that a sportsperson sustains. “Sports is the bread and butter of the players. Some of them wait for years to be a part of a sporting event and when something as minor as an ankle twist hampers their whole career, it takes away everything from them,” he laments. “You and I can get a plaster cast and rest at home, but most of our players do not have the privilege to do so. So whenever we come across these situations, we provide them with proper counselling and prescribe them medicines which will speed up their recovery without putting them in danger of doping,” adds Shah.
“Nepal, as a whole, is in need of multiple sports doctors. There aren’t any courses available in our country at present but the fellowship programs outside Nepal are very beneficial,” shares Shah. “The knowledge my team has gained from these programs have allowed us to conduct regular classes and workshops on injuries and doping in sports centres all over the country. This has been a big help to the players as they are more aware of TUE (therapeutic use exemption) as well. It is an exemption that allows a player to use, for therapeutic purposes only, an otherwise prohibited medication. They can obtain approval to use a prescribed prohibited substance or method for the treatment of a legitimate medical condition without falsely falling under doping,” he adds.
At present, Shah and his team are preparing players for the Olympics (Tokyo 2020). From conducting general checkups to taking first aid classes, the medical team is making sure that the players can fully focus on their training. “We conduct tests and provide them with health passports. This helps them in clearing the medical stages wherever they go. We do this from the hospital inside the Dasarath Stadium. Earlier, the hospital was in a sorry state, but it was renovated properly for the recent South Asian Games,” says Shah. “The country needs a well-equipped sports hospital and rehabilitation centre so that our players don’t have to spend thousands elsewhere. People now understand the importance of sports and I believe that with time, we, as a nation, will be able to cater to the medical needs of our players,” he concludes.
Photos by Royal Raj Manandhar