A room with a view: managing subtle injuries at Man Utd’s imaging centre

Manchester Utd Football Club requires no introduction. It’s the world’s most valuable football brand, enjoying the adoration of an estimated 1.1 billion fans and followers. In football at this level, players are not only elite athletes, they are globally recognised, resulting in constant interest in their performance. This means that something as normal as a routine trip to the hospital is simply out of the question. This, along with continued commitment to player wellness, has led Manchester Utd to invest in their own medical imaging systems.

While not every injury is immediately obvious, they are frequent and Dr Steve McNally, Manchester United’s Head of Football Medicine & Science is well used to the day-to-day muscular problems that are often the result of playing at peak performance. “Hamstrings, groins, thighs and calves, these occur on a daily basis and are part and parcel of the routine, but the vast majority don’t lead to any time loss from training or playing,” he explains. “We manage players through them with preparation, such as stretching or manual therapy, focused preventative exercises and sometimes modifications of the training exposure. Recovery practices after training and playing are also vital.”

However, even minor damage carries a risk and here is where medical imaging comes into play, as part of an evaluation that distinguishes between injuries. “Even the smallest injury in elite sports has implications. Having the right diagnostic tool at the peak of its development is vital to diagnosing subtle injuries that could impact player health,” says Dr McNally. “Using high resolution MRI therefore helps to identify very minute intra-articular joint injuries, muscle oedema changes or very small fibre tears.”

Dr McNally’s expertise in musculoskeletal medicine comes from a background in general practice, followed by joining the world of football. He’s gained international respect in his field with a reputation for scrupulous and holistic attention to player health and wellbeing. The implementation of in-house imaging supports a wider system of proactive monitoring – as well as players volunteering any symptoms – in Dr McNally’s balanced approach to ‘wellness’. This involves a triage that then cascades into an assessment process, which may involve practitioners from many different disciplines, including Dr McNally himself.

The aim, ultimately, is to prevent a subtle functional injury from becoming a significant structural one. In the short-term, this means the occasional missed or modified training session. A lack of game exposure can be disruptive to team planning and preparation but worth it to avoid a long-term absence from the team and any potential long-term performance impairment. Manchester United’s new Vantage Galan 3T MRI from Canon Medical Systems UK is therefore an essential addition to the club’s state of the art imaging centre at the club’s Aon Training Complex. It sits alongside CT and ultrasound imaging systems, supplied in Canon Medical’s role as ‘Official Medical Systems Partner’.

The centre plays an essential role in health evaluations, but it also means that players can undergo MRI procedures without the unwanted attention and the media speculation that hospital visits can bring. Both premier and youth leagues feel the benefit of these technologies, alongside a wide multidisciplinary team of experts. This team monitor every aspect of an injured player’s workload during their rehabilitation in order to replicate game demands as closely as possible. “This includes everyone from the physio to the nutritionist, sports scientist, strength and conditioning coach, doctor, technical coach and – most importantly – the player as the patient,” says Dr McNally. A player is only considered to have regained ‘match fitness’ fully once they have played several games in succession.

There is high clinical confidence in these outcomes and in imaging technology itself. Indeed, technology overall plays an important role in the current and future development of the team. Dr McNally is excited by the direction that it is taking in sports medicine. “We’re experimenting with the use of VR as a rehab tool which is interesting but advances in real-time physiological monitoring of things like heart and lung function or early markers of fatigue are exciting for both the medical practitioner and conditioning coach,” he says. And while these developments may take some time to bed into the existing programme for Manchester United, innovations in medical imaging are already pushing the boundaries in the prevention, diagnosis and faster rehabilitation of sports injuries.