Preventing injuries the main aim of sports medicine: First Indian sports MD Thiagarajan

“Sports medicine is not only about injury and ailments, it is also about assessing the athletes and preventing injuries. It is a proactive approach rather than a reactive one,” says Dr. Thiagarajan Alwar to The Bridge, right at the start of the conversation.

Dr. Alwar, as he is popularly known, is India's first-ever Doctor of Medicine (MD) degree holder in the field of Sports Medicine. Having trained at the University of Cape Town and Sports Science Institute of South Africa, he has worked with a some of the elite Indian athletes.

"Initially I was interested in pursuing orthopedics as my postgraduate specialty but then I thought there are a lot of orthopedic doctors in India doing well, so why not do something different," Dr. Thiagarajan opens up about his journey.

"The quest for something different took me initially to physical medicine and rehab because there was not much sports medicine in India back then. But, once I joined the Sri Ramachandra Medical college after my physical medicine degree, the MD sports medicine degree was started. I took a sabbatical and applied and got through in 2010," he adds.

Difference between Orthopedics and Sports Medicine

While Dr. Alwar initially wanted to pursue orthopedics before entering the field of sports science, is there really a difference between the two?

"Well, there are more similarities than differences," accepts Dr. Alwar.

"Orthopedics is the mother of physical medicine and sports medicine. There are parts of orthopedics, especially non-operative orthopedics and parts of physical and rehab medicine, in sports medicine, apart from an element of general medicine. Basically, every part of medicine is there in sports medicine," he explains.

Dr. Alwar believes that it is majorly the unique requirements of sportspersons or athletes which makes sports medicine different from all the other medical disciplines.

"We have to be a complete physician for the sportsmen with a particular interest in common injuries, ailments, and requirements of the sports and exercising population. For example, the way you treat a muscle or joint pain in sports medicine will be slightly different to how you treat in orthopedics or general medicine," he adds.

Working with the 2023 Squash World Cup, and Joshna Chinappa

Dr. Thiagarajan Alwar continues to work with the Sri Ramachandra Institute at the Centre of Sports Science, where he collaborates with some of the elite Indian athletes and athletes at the grassroots level.

The Centre for Sports Science was born with a vision to bring more Olympic medals to India in association with sports federations in a scientific way. While the centre was initially opened to the BCCI and cricketers, over the years it has opened to various other sports, including squash.

"We first started working with Indian squash in Chennai, thanks to N Ramachandran - the former president of the World Squash Federation (WSF). We have this lovely collaboration of sports science, sports medicine, strength and conditioning support to squash players both at grassroots and elite levels. We also provided the required sports medicine support to the Squash World Cup held in Chennai recently,” Dr. Thiagarajan says.

He has also worked with ace Indian squash star Joshna Chinappa, who is a part of the Institute's assessment programme.

Attaining a podium at the global level requires a lot multi-tier approach, wherein a lot of athletes need to be trained under strict guidance right from the grassroots level. Dr. Alwar hopes the collboration with HCL Squash Podium Program will help them in achieving this.

"HCL Podium Program is a very important, innovative and a much needed initiative. Reaching a podium takes a lot of effort. To make one athlete reach a podium, you probably have to train hundreds. So again it boils down to grassroots development and how to advance it at medium level and take care of elite athletes. The HCL programme has taken cognisance of all this and has formed a very good design also taking sports science into consideration," he says.

Working with coaches

Be it any sport, the coach is the king. A coach usually dictates everything - from technique, to strength and conditioning, to nutrition - of their ward. Though this approach seems to be changing in recent times with every elite athlete possessing a larger support system, keeping the coaches in loop is one of the most crucial aspect of his job, feels Dr. Thiagarajan.

"Nowadays elite athletes have a big support team consisting of doctors, physios, etc. to help out the coach. The coach still needs to be aware of all that is happening because sports medicine is an ever-changing field," he says.

"How we work with the coaches is that we try to bridge the gap between the labs and the field. We start with some coaching education programme called Sports Science Refresher Program where our experts interact with coaches to let them know what are the scientific developments and methods happening in an athlete's assessments, their prevention of injuries, their treatment of injuries and their overall fitness and nutrition. This equation keeps evolving through regular interactions," he adds.

Injuries in Squash

Squash is one of the most demanding sports in the world. Since it involves a lot of lunging, jumping, and sideways movements, injuries are a common occurrence in the sport.

"Generally we get a lot of muscle strains muscles injuries in squash. Muscle tears soft tissue injuries as we call it. There are upper limb injuries like in shoulders, while ankle and knee injuries are also very common," Dr. Alwar explains.

If the injuries seen in athletes are quite common, can a generic training programme be developed to prevent such injuries?

"Generalising an exercise program is a bit unscientific, but we can say that a good amount of warm-up, including good stretches and good cardio warm up, muscle warm-up, some short sprints, jumps and good static and dynamic stretches before the match can help," he opines.

Dr. Alwar also advocates pacing around the court, going for a massage, or taking a ice dip post match depending on the resources available as a part of injury prevention plans.

He also stresses that athletes need to be educated in terms of their diet intake and that they need to be made self-aware as to what and how much to consume so that they can handle themselves in the absence of a nutritionist.

"Normally while creating a diet plan, the nutritionist takes into account a lot of factors including the athlete's culture, where they are travelling, and training. It has to be highly individualised. But an athlete needs to take ownership of his diet himself. They need to be educated about their diet plan so that they can take care of diet when they do not have the nutritionist alongside them," Dr. Alwar says.

Corporates need to chip in for holistic development

Sports is not a single man's business. A lot of stakeholders need to be involved to make a country a sporting nation. Merely putting a talented athlete and a coach together does not guarantee overnight success.

"A lot of support in terms of finances, logistics, and others are required to develop a sport especially in a lesser known sport like squash. HCL has played a big part with their obvious intellectual strength, monetary strength, and through their connections and through their proactive thinking. All of this helps in brining in a much needed change in the sports ecosystem," Dr. Alwar says.

"It is not only that they provide monetary support, but I see HCL really getting into sports by understanding the requirements of athletes and devising strategies and new initiatives. It is an important cog in the wheel and we need more such corporates to truly develop India into a sporting nation," he adds.