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How the English Institute of Sport's focus on Athlete Health has optimised athlete performance and preparation

John Portch, Leaders in Sport | 23 March 2021

Craig Ranson explores the creation of the EIS Athlete Health directorate, its successes, and how its strategy will evolve as attentions turn from Tokyo to Paris.

The English Institute of Sport [EIS] introduced its Athlete Health team to help better prepare British athletes for the Tokyo Olympic and Paralympic cycles. Little did it know it would play a vital role in managing a pandemic.

“We’ve faced considerable challenges since last March but we’re in a better place than we would otherwise have been,” says Craig Ranson, the EIS’ Director of Athlete Health. Ranson tells the Leaders Performance Institute that one of the Athlete Health directorate’s key priorities during the last five years has been respiratory health. “Our data tells us that respiratory illness is the health issue posing the greatest performance threat in Olympic and Paralympic cycles,” he adds, “and Covid is a respiratory disease.”

The EIS provides sports science and medical support to UK athletes across 40 different sports and its Athlete Health directorate has been able to use the resources at its disposal to offer them better health provision. “We have good associations with the best hospitals and world leading respiratory health specialists and we’ve been able to support EIS doctors’ good management for our most susceptible athletes.”

Of course, respiratory health is just one of Athlete Health’s priorities and, during the course of our conversation, Ranson reflects on the EIS’ decision to create a broad strategy aimed at optimising and impacting upon athlete availability for preparation and performance.

Optimising athlete availability

The Athlete Health directorate was founded by the EIS in 2016, with Ranson subsequently installed as its first Director. Its role is to work closely with EIS and Great Britain’s World Class Programme Sports, as well as with the doctors and physiotherapists who serve as the primary health providers within the UK High Performance Systems.

“The EIS has been centred on athlete health since it started,” says Ranson. “We’ve always had very good physios and doctors in particular working with the sports. That’s evolved within the Rio cycle, with our Performance Innovation Team, where some specialists in health, started working on some new innovations in proactively supporting athlete health. At the same time, in that period up to 2016, there was a growing awareness around a world that actually athlete availability to be on the training track and availability for selection was having a huge bearing on a lot of sports.

“So, UK Sport [the government agency responsible for funding Olympic and Paralympic sport in the United Kingdom] and the EIS got together at the back end of the Rio cycle to put together a strategy aimed at optimising that availability for preparation and performance because of the performance impact. I was invited in to help develop the strategy back in 2016 and then came onboard to lead it through this current cycle in 2017.”

The Athlete Health directorate has continued to evolve during its first four years. “One of the aims of the strategy and one of the things we’re putting in place is good athlete health intelligence. We know now, within each sport, even within each athlete and across the system, what the priority health problems are based on our intelligence systems that come from our medical records. They come from the medical insurance scheme data, and they come from constant interaction with the sports. They might say, ‘this potential medal-winning athlete has a history of injury or health problems that are likely to affect their performance in the future, how do we tackle that?’ There is one particular sport where the biggest problem is in back injuries, and so, if we tackle that, it’s going to give them a much better opportunity to meet their medal target.”

The ability for Ranson and Athlete Health to take a helicopter view has allowed for greater impact. “When you’re working by yourself in a sport or within a team within a sport, you’re looking after the athletes in front of you, you’re being as proactive with them as you can, but then you’re able to step back and say, ‘what’s happened over the last six months, three months, a year?’ We can talk to the Athlete Health support staff in that sport and ask, ‘what do you need to do in the future to make your lives easier and give athletes the best opportunity to be preparing well and available for selection?’”

The priorities of Athlete Health

The aforementioned focus on respiratory health has been revelatory. Ranson delivered a presentation at July’s Leaders Meet: Total High Performance Summit and provided some statistics around athlete health burdens. “All of those different diagnoses here pale in significance to upper respiratory tract infection diagnoses, which affect nearly half of athletes in that two-year period [2016-2018], and account for nearly eight days lost per episode,” he commented at the time.

He is just as firm in his conviction today: “If we were going to tackle one thing, it was respiratory illness, as it was going to give us the biggest bang for our buck. We can also continue to keep looking at that intelligence and working out what we need to tackle next.”

Mental health provision is another priority that has, like respiratory health, proven essential over the past year in particular. Ranson says: “This is one of the biggest topics currently within sport and we established an expert mental health panel of clinical psychologists and psychiatrists. We have also expanded our referral network and have provided mental health education and raised awareness.” A key part of that initiative has been the training of EIS mental health ‘champions’. “These have put us in a really good place, particularly now. Having all of those things in place to be able to deal with the extra mental and psychological stress of the pandemic and being able to support staff and athletes.”

The third priority has been the female athlete. “We focused on respiratory health because it’s the biggest effect on availability; mental health because it was the biggest cultural and wellbeing issue. The female athlete is a priority because we see it as a real opportunity to look after female athletes better and to maximise our chances of medal success in British female athletes.

“We have in place a dedicated female athlete team who have undertaken some brilliant initiatives around being able to measure female hormones and then being able to adjust athlete training sessions and better look after their health. We have also been able to run education programmes for staff and on how to best support female athletes with issues that are particular to female athletes. Our aims are starting to be realised and that will another area that will evolve significantly in the next cycle.”

Indeed, all three will remain high on the agenda for the Paris cycle. “Covid is going to be with us for a while yet and respiratory health in general will remain an Athlete Health priority,” says Ranson. He adds that we are only just starting to see the impact of focusing on mental health and on the female athlete. “There’s masses of head room for supporting each of these areas that will improve athlete wellness and thereby enable performance.

“What are our biggest injury problems? We have brilliant physiotherapy and sports medicine teams who look after athletes really well; how can we make that even better and evolving best practice in those big-hitting areas? Back pain is one of the greatest health burdens across the system; stress fractures, Achilles and patella tendinopathy in the lower limbs – they’re priorities that we want to be able to tackle. Those three problems don’t necessarily mean that you’re out for six months, but they can really compromise your day-to-day training. If you’ve ever had a sore Achilles, a sore patella tendon or a bad back, it just means that you can’t train to the capacity that you would like. Making those 10% or 20% differences really adds up on a day-to-day basis.”

Paris 2024 and beyond

Even with Tokyo on horizon, attentions at the EIS have begun to turn towards the 2024 Paris cycle. Ranson can already see how the Athlete Health directorate is evolving to meet the athletes’ ever-shifting needs. “The greatest difference from Tokyo is in how we’re looking to bring everyone working in Athlete Health strategically closer” he says. “The doctors and physiotherapist working on the ground were in a separate directorate for the Tokyo cycle. We collaborated brilliantly with the 70-odd physios and the 30-odd doctors working in the system with our Director of Medical Services, Rod Jacques. That’s been really productive, but we’ve done that with collaboration rather than by design and, in the next cycle, we will bring everyone working in Athlete Health together under one umbrella, under one Athlete Health strategy; all working towards the same objectives. That will involve people from performance innovation, medicine and physiotherapy, sports science and performance lifestyle all collaborating on priority health projects.”

All in all, Ranson is optimistic for the future of EIS Athlete Health. “As I’ve said before, one of the key things is having the world’s fastest-learning network,” he says. “We want to get better at managing athlete health than anyone else, so that we can look after the wellbeing of the athlete and give them the best opportunities to perform and succeed. We think we’re well on the way to doing that. All of our strategies are about how can we connect better, how can we work together collectively so that every penny we get from UK Sport is being used as efficiently and effectively as it can, giving coaches and athletes the best opportunity to prepare well and to perform well.

“Everything is designed around tackling your biggest health problems, getting the biggest bang for our buck, with smart initiatives that give athletes the best chance at availability to prepare and perform.”

Originally published by Leaders in Sport.