WORLD CUP WATCH: The Fitness Challenge

Getting the USA to arrive at peak performance for the World Cup is a complicated task. Soccer America examines the medical and training aspects of preparation for World Cup 2006.

By Dev Mishra, M.D.

During its quarterfinal run at the 2002 World Cup the U.S. national team was widely praised for its high fitness level and work rate.  There are many skilled professionals responsible for the players' physical performance, such as physicians, physical therapists, trainers, podiatrists, chiropractors and dentists.

Three men leading their respective teams are Bert Mandelbaum, the head team physician; James Hashimoto, the head athletic trainer/physical therapist; and Pierre Barrieu, the head fitness trainer.

The medical and training staff has been involved with the team for several years. Mandelbaum has served as head team physician since 1991; Hashimoto has been with the team since 1995; and Barrieu leads fitness and training since 2001.

This longevity contributes to a very high level of trust not just from the players, but from the coaching staff, too. Hashimoto has seen it all.

"I'm amazed sometimes at the care guys don't get at their club, Hashimoto says. I remember a guy with a chronic groin strain who was treated by dental work."

Not surprisingly, players will often consult Hashimoto for advice even for injuries that occur during their club training. They will frequently come to Hashimoto's Delaware clinic for extended rehabilitation.  Hashimoto cares so much that he will even put players up at his home if necessary.

Going in to this year's World Cup, the big question for the training staff is: How do you get players to peak at the same time and the right time?

Mandelbaum, Hashimoto and Barrieu say that the ultimate responsibility for this rests with Coach Bruce Arena, and they were unanimous in praising Arena for his particular skill in knowing when to rest a player and when to push.

"Bruce is very on top of a player's injury status," says Mandelbaum.

The entire process starts with clear communication and information.  The medical and training staff has been tracking injury, training and performance status on a larger player pool for several months. This is done by speaking to the players and their club staff, and doing evaluations in camp.

Performance issues need to be modified based on what stage of the season a player is in, for example, European-based vs. MLS.

A player like Eddie Lewis of Leeds in Englands second-tier league could be playing full-tilt until May 21, giving him very little time to "rest" prior to World Cup training. Handling a situation like that requires as much art as science.

The bulk of the evaluation is done directly by the U.S. staff when players attend training camp. The U.S. Soccer Federation utilizes an extensive group of consultants. Players coming in to camp undergo an extensive orthopedic and medical exam.

There is blood and urine testing for banned substances as well as medical conditions. Two main podiatric surgeons do foot evaluations and orthotic fitting.

Three dental consultants fit the players for mouth guards and attend to any necessary preventive care.

"The last thing you want during the World Cup is an abscessed tooth keeping you from playing," says Hashimoto.

New for this year is extensive heart screening.  Players will have a Cardiac Stress Test to look for problems with the heart's electrical system, and another test called "echocardiography," which looks at the anatomy of the heart.

These sophisticated heart tests will be done toward the end of April and are designed to screen for factors that could predispose a player to a devastating problem called Sudden Cardiac Death.

The goal of all the testing is to try and identify any potential problems ahead of time, correct them, and give the player the best chance of peak performance.

(Dev Mishra is an orthopedic surgeon sports medicine specialist in Burlingame, Calif. He serves as a consultant to UC Berkeley and AC Milan.)

IN AN UPCOMING WORLD CUP WATCH: Dr. Dev Mishra looks at how fitness trainer Pierre Barrieu tests the work rate of the USA's World Cup-bound players.

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