Q&A With Dr Akshai Mansingh

Is there a direct correlation between fitness delinquency and the recent spate of injuries in the West Indies team? Does the West Indies Cricket Board (WICB) have a plan to deal with the growing problem? What's the latest on injuries to Marlon Samuels, Jerome Taylor, Omari Banks and Jermaine Lawson?

In a wide-ranging interview with CaribbeanCricket.com editor-in-chief Ryan Naraine, co-chairman of the WICB's medical panel Dr Akshai Mansingh discusses injuries, health and calls for a new mindset among the region's cricketers...

RYAN NARAINE: What are the priorities for the medical panel this year? What do you think is the single most pressing issue you need to address?

DR AKSHAI MANSINGH: The single major priority is to have a basic minimum level of fitness at all levels. From Under-15, through Under-19 through the first class level and the Test players, we need to put the emphasis on all aspects of fitness -- from nutrition to immunisation to physical training. In other words, we have to start at the lower levels so that by the time a player gets to the senior level, he will have developed a professional approach to fitness.

RN: How do you expect the juniors to understand this when the paid professionals in the senior team are failing the basic fitness requirements ahead of a long tour?

AM: The bottom line is education and training. What we're doing on the fitness side is trying to develop specific fitness programs for every team, complete with a trainer. Jamaica and Barbados already have fulltime trainers. Hopefully, this could be spread across to the other territories. Barbados is the only team that travels with a fulltime physiotherapist and it is felt that those teams have a higher level of fitness than all the others in the region. We're hoping to get this culture embedded to the other teams so it won't be such a big step up when the players get to the senior level.

At the first class level, the issue of staying fit should be seen as a requirement to get into the senior team. These are players who are vying to make the senior team and that's what we want to achieve. The key is in education. We (the medical panel) discussed this a few weeks ago in Antigua. We just don't want to deal with injuries but extend it to include education at the very junior levels...from nutrition to immunisation to training.

But, at the end of the day, it boils down to the desire of the players. I understand where you're coming from when you talk about the senior players not being fit. The average first class cricketer on international teams is much fitter and stronger than our players and that's because they're exposed to it at the lower levels.

RN: During the last Under-19 tournament in Guyana, there was a scary situation with a concussed player on the field and no ambulances or doctors available to render treatment. How do we avoid this going forward?

AM: The medical panel has already recommended some basic minimum medical requirements for all matches under the auspices of the WICB. These requirements include personnel (doctors), transportation (ambulances), facilities and referral centres. The existing set-up calls for the national sports medical associations to oversee coverage of matches. We want to incorporate these associations but we want to institute certain minimum standards.

Regarding that incident you referred to in Guyana, there was a physio at the ground so it's not fair to say there was no one available. But, we understand there are certain minimum requirements that must be met and we have made the necessary recommendations to the board. Another thing to bear in mind is that medical coverage at cricket matches has been offered on a voluntary basis for the most part. It is up to the WICB to decide whether they want to have a fulltime paid medical person at the ground. Or, whether it will remain voluntary.

The medical panel has gone as far as saying that if any of these [minimum requirements] are not met, the game should not proceed.

I want to make it clear that since this medical panel has been formed, we have received full backing from the WICB and its executive. A small budget has been allocated for expenses and all our recommendations thus far have been accepted. from the appointment of a physio for the West Indies team to the immunisation to Under-19 players going to Bangladesh, every health issue has been dealt with professionally.

RN: Let's talk a bit about the recent spate of injuries that have hit the senior team. The injuries have followed the majority of the squad failing the minimum fitness requirements. Is there a direct link between fitness delinquency and injury?

If you look at our injury figures the last few years, it's a fact that we've had less than the other international teams. What's happening now (in Zimbabwe and South Africa) is shocking and out of the ordinary. The main surprise here is that a lot of the players getting injured are new players to the team. That's a bit of a surprise and I'm alarmed like everyone else that there's no end to the number of injuries.

Some of the injuries were expected, like Marlon Samuels. With him, you knew it was going to happen with the chronic nature of his knee injury. But, some of the others just came out of the blue. We've looked back at medical records of all the players who returned home and we're convinced they were not harbouring these issues before leaving, there were no symptoms beforehand. That's what surprises me even more.

To answer your question, the only thing I can blame is the level of general fitness in the squad. I don't know if the injured players were the ones who failed the minimum fitness requirements because I haven't seen the data but there certainly is a correlation there.

We've started an injury database and we're feeding the results of the fitness tests there. In the future, we'll be able to see a scientific correlation. We've got to show the link that the difference between an Australian team and a West Indies team is not talent. The difference can be found in application, education, approach and mindset. That's what we have to change to get back to the top.

RN: How exactly do we change that mindset?

AM: The retainer contracts for senior players is a good start. That way, the players are directly employed by the board in the off-season and we can implement fitness programmes on a year-round basis. But, that's not the only way to fix it. It has to be a series of things. [The players] have to understand that changes have to be made in their lifestyle, nutrition and fitness. It's a general thing to adopt a professional approach to everything.

RN: What's the latest on Marlon Samuels. I'm hearing he's adamant about not having another surgery on the knee...

AM: Marlon is going to New York to be seen by Dr Answorth Allen, the specialist who examined him just before the World Cup. It's a follow-up visit and it makes sense because further treatment has to be done outside of the West Indies. I'm firm in my belief that surgery is inevitable. I'm willing to discuss the timing [but] prolonging surgery isn't in Marlon's interest.

RN: I get the sense the trip to New York is to help convince him that surgery is really his only option...Can he sustain a professional career without the surgery?

AM: We're not trying to convince him of anything. He has heard my opinion and I've heard his. This follow-up is for someone who is likely to be involved in his injury management to allay certain fears he might have. He had certain issues that I answered and we agreed that we'll send him to New York to have further assessment and further opinion. This is not an attempt to convince him to do anything.

This injury is potentially career-threatening so it's a decision Marlon has to make. I've made it clear to him that it's doubtful the knee could put up with the high demands of international cricket without surgery but he has certain fears because he has had three procedures on the knee already. So, technically, this will be a fourth surgery.

The unfortunate scenario is that no one can guarantee 100 percent that he will make a full recovery even with the surgery. He needs bone graft surgery which is a significant procedure so it's understandable that he would be nervous about it. Can you imagine what he's going through to fathom that he may not get the perfect outcome? And, at the same time, you have to understand what the WICB is going through...having someone with Marlon's talent and not knowing if he can last through a series with that injury.

RN: What's the update on Omari Banks. Has he started rehabbing from the stress fracture?

I saw Omari two weeks ago and he's progressing very well. He developed his injury on tour and, luckily, it was picked up very early. He's on a rehab programme right now that's being overseen by a physio in Anguilla in conjunction with Jackie King, another member of the medical panel. It's going to require at least three months before he is reassessed to determine the healing of the fracture. He's being kept out of cricket and the rehab is limited to work in the pool and on the cycle. He's working on back strengthening without bearing weight.

RN: And Jerome Taylor?

Jerome is also coming along nicely. He has actually started some light bowling exercises. Right now, it's limited to some very light work. He is walking up and going through the bowling motions. We'll monitor his progress and step it up to more intensive activity. The best-case scenario is for him to be back for the second round of the Carib Beer Cup. But, that depends on his progress. It's safer to say he'll be back around the 3rd round.

RN: Why the rush to bring him back for this tournament? Doesn't he have some other biomechanical issues with his bowling action to sort out?

There is no rush. I'm spelling out best-case scenarios for his return. He is in touch with Philip Service on the biomechanical side and a determination will be made once we assess his progress. My aim right now is to see if he can go to next stage - bowling in nets. Every step is reassessed carefully and we'll be taking a cautious approach with him. But, I won't rule him out of the entire Carib Beer Cup season. Everything depends on how he reacts to the rehab programme.

RN: What's the word on Jermaine Lawson? The last time we spoke, you gave the odds of him playing this tournament at 50-50. Has that changed?

AM: He bowled six overs in a trial match in Jamaica a few weeks ago. He's still getting some occasional pain in the back. Interestingly, the pain is in another area of the back, different from the original injury. We're dealing here with a lot of muscles doing a lot of things differently. We're trying to get him through his training programme alongside a bit of bowling but, again, we don't want to rush him into anything.

I won't rule him out of Carib Beer competition completely, but we're not going to rush him into cricket. He still has to get clearance from the WICB for the issue with his bowling action. Jermaine is doing very well but he has to deal with some stiffness in the back areas. We did some additional scans and recognise the problem and it's nothing that's too alarming. This is not going to be a major setback for him. He'll continue bowling but with lesser intensity until he gets over this new stiffness.

RN: Daren Powell came back from South Africa with a back injury as well. What's the extent of his ailment?

AM: His problem is mainly stiffness from long flights back and forth. I saw him as soon as he came back from South Africa and we've determined it's just stiffness. His injury is not at all serious. He could have played for Jamaica in the first round but we kept him out as a precaution. He'll definitely be back for the second round.

RN: In a previous interview, you lamented the fact that the West Indies team was the only international team without a physio or a doctor on tour. Are you happy with what has been done so far?

AM: We've appointed a physio for this tour and advertised the job so we should have a long-term physio on staff very shortly. That's a very positive move. If the injury levels are going to be high, the board may have to consider a doctor travelling on these long tours. These tours incorporate a number of venues within a country and that means that injuries are reassessed by different doctors. On certain lengthy tours, it's important to have your own doctor, especially if you are managing an injury throughout. But, like everything else, it's an issue of weighing the expenses. If you can only take one, I'd say go with the physio but in a perfect world, the team should also have a doctor travelling.

RN: In a column for this Web site, Reon King spoke about being introduced to modern treatment and recovery methods like the hot-and-cold treatment. Is that something you would consider implementing in the Caribbean? Why are we so far behind in getting modernised?

AM: We have already started implementing some of those techniques in the senior team. On the last tour of India, we introduced the hot-and-cold treatment. On this tour of Zimbabwe and South Africa, all the bowlers are involved in it along with rehydration and replenishment of energy.

This circles back to the first question you asked about the medical panel's priorities. That's what we want to accomplish. We want to introduce these things at the base -- at the club level and have it work its way up to the national teams. Most of our regional teams don't even have a physio so we have to start with baby steps.