He welcomes me to the RU Active Sports Physiotherapy & Rehabilitation Centre, one of the leading sports physiotherapy clinics in the UAE located inside the ICC Academy, where he works alongside his main role as the physiotherapist of the UAE cricket team.
Asif is very welcoming and just as casual in his demeanour. I take a seat in his therapy room to talk about his career, the role of physiotherapy in national cricket teams and his journey as the first Pakistani to have taken up the role at three different national cricket teams (Pakistan, Afghanistan and the UAE).
Zushan Hashmi: Let’s start with your career, tell us a bit about life leading up to being a sports physiotherapist.
Asif Ejaz: Well, I belong to Lahore and Karachi, and in a strange way, Dubai, as well. I was born and brought up in Karachi but my father, originally from Lahore, moved to Dubai in 1973.
He was an architect-engineer so he saw Dubai’s rapid development. And having grown up here myself, I have a very unique relationship with the city. After my primary schooling, all of which took place here in Dubai, I returned to Pakistan.
After finishing high school, I always dreamt of becoming a doctor, and the idea of physiotherapy had never crossed my mind. However, due to Pakistan’s education merit system, I did not qualify for an MBBS degree.
I then had to choose between dentistry and physiotherapy, and without giving it much thought, perhaps it was the disappointment of not getting into medicine, I blindly opted for physiotherapy. I completed my degree from Isra University Islamabad and graduated in 2004.
I came across the opportunity in sports physiotherapy for the first time in 2005 when Saudi Arabia held the first-ever Islamic Solidarity Games. On this occasion, I was selected by the Pakistan Sports Board (PSB) to work with the team on the games in April 2005.
There were various smaller sports [in Pakistani standards] such as football, karate and tennis. For example, Pakistan’s finest tennis player, Aisam ul Haq was with us. I was looking after the karate & basketball teams.
There were around 80 different sporting disciplines at the event and it was held at 4 different locations: Madinah, Makkah, Jeddah and Taif. I was based in Madinah, where I also had the opportunity to perform umrah [religious Islamic pilgrimage] as our hotel was near the Mosque there.
Our camp was based in Jalalabad, it was the closest and safest place at the time, an approximate 3-hour drive from Peshawar.
When I got back to Pakistan in 2005, I thought of pursuing sports physiotherapy. At the time though, there were no masters or any other degrees specializing in sports in the country. So, I started to learn on my own in the sports field. We generally dealt with orthopaedics in the clinics.
Interestingly, there were positions available for physiotherapists with the Pakistan Cricket Board (PCB). I happened to apply to one of the said positions and was offered a role in 2007 as a regional physiotherapist in Islamabad and Rawalpindi, where I worked for the next 5 years until 2012.
I was the head physiotherapist for the whole region, which meant that I used to oversee national, under-19 and first-class teams.
Several of the players, at that time, included the stars of today such as Mohammad Amir, Hamad Azam, and Imad Wasim, they are all very good mates of mine. Shadab [Khan] had just started his career back then, he was around 13-14 years old.
I was also honoured to treat Shoaib Akhtar, as my region was Rawalpindi. In the process, I also got to know Yasir Arafat, Sohail Tanveer and Shoaib Akhtar, and Bazid Khan
Bazid Khan was with us in the Quad-e-Azam Trophy cup and used to play for Islamabad. He is a very good friend of mine and by far the fittest player I came across at the time. he really took care of himself, often the first in the gym, and the last to leave.
In 2012 when I left, Awais Zia and some other players were coming into the team via the emerging development squad. Then I got an offer from the Afghanistan cricket team. As I was on rotation, at the time, I joined their national team.
Back then, Nowroz Mangal was captain and Kabir Khan was their coach. I did that for almost 1 year and I had to go to Kabul as well, where I lived there for 2 months.
I thought of working with them for a long time, and I successfully oversaw their tour of Nepal for the Associate Cup, we won. UAE were the runner ups at that time.
The Afghanistan team then asked me to oversee their domestic cricket as well, and as my family was based in Islamabad, I declined the offer and left the Afghanistan national team.
How was the experience of going to Kabul?
To be honest, I thought they would offer me an air ticket [laughs], but I was asked to travel by car through the Torkham border, as there was a newly built motorway.
Thankfully, I was usually accompanied by Mohammed Nabi and Asghar Afghan. This was quite advantageous because as soon as we crossed the border, all the Afghan military guards [who were huge cricket fans] recognized the players and would offer us coffee and tea, making the border crossing far more entertaining and safe.
Our camp was based in Jalalabad, it was the closest and safest place at the time, an approximate 3-hour drive from Peshawar. I went to Kabul only once or twice where the Afghanistan cricket board is located, as the situation was not the safest there at the time.
What came after the Afghanistan National team stint?
After my tenure with the Afghan team, I began to work in a clinic in Dubai, however, my heart wasn’t satisfied due to my interest in sports. I applied for the UAE national team as there was no sports physiotherapist involved with the squad.
Luckily, because I was bilingual and experienced in cricket physiotherapy, everyone in the team was originally from Pakistan and India, including most of the players and staff, I had an edge in getting the role. Aqib Javed was the coach at the time, and since 2016, I have stayed with UAE cricket.
The introduction of T20 and T10 cricket has resulted in the overuse of players, in turn, causing far more injuries.
It makes perfect sense, after all, Dubai is a hub with so much professional development and other opportunities. I decided to invest in myself over here. I did a course in acupuncture and dry needles. I am also certified in strapping mobilization, manipulations and the likes, in essence, this platform has enabled me to possess various skills that are required by a sports physiotherapist.
Most recently, I completed modern injection therapy from the UK, called intra-articular injections. Physiotherapists are allowed to inject this medication in the UK, so it was a very good course for me.
In your daily routine, what are the most common types of issues with players that arise? And what type of injuries do you help rehabilitate?
There are two types of injuries in cricket that are by far, the most common, shoulder and lower back issues. Bowlers are definitely more injury-prone than batters.
Batters have a good age span. For example, in Pakistan, they often play until the age of 38 or 39. Due to the introduction of the shorter forms of cricket and the busy cricketing calendar, the percentage of injuries has increased.
Over the course of my career, I have seen the introduction of T20 and T10 cricket, which has resulted in the overuse of players, in turn, causing far more injuries.
I try my best to connect to the players on a personal level so that they can share their issues with me and I can refer their problems to the coach.
Bowlers mostly have lower back pain, as the playing load can sometimes be too much, so we have to give them a rest period to recover. Sometimes we seek help from the coaches, where we review their health and decide if the issues are mixed or biomechanical.
Once there was a boy in the Pakistan U-19 squad, back in 2009. He was a good player but had significant pain in his back, and the coach asked me to work on fixing his bowling action.
After we were able to align his body perfectly, he no longer possessed any back pain. This was one of my earliest steps in understanding this aspect of physiotherapy in cricket.
Meanwhile, batters have to field as well, which means they mostly injure their shoulder from throwing the ball repeatedly towards the pitch.
Interestingly, in October 2017, Sri Lanka toured the UAE to play 5 games against Pakistan. As their physiotherapist was on leave at the time, I was requested to work with them for the series, it was an amazing and unforgettable experience for me to work again with my home country, where I dealt with many such issues as well.
What is the process of managing a players rehabilitation after an injury? Could you tell us a bit about what this involves?
Rehabilitation will vary a lot. We always make a diagnosis from the signs and symptoms. We work on the injury and assess to see if we’ve made any mistakes. The rehabilitation process has different grades.
I have seen that in younger athletes rehabilitation results are good, however after the age of 35, the metabolism slows down, so it takes a lot more time.
Rehabilitation has no fixed timeline. Injury types differ and their duration does too. Alongside this, as a physiotherapist, it is often my role to motivate, mentor and keep the mental health of a player in check, especially when a team does not have a dedicated psychologist. You know the saying, ‘healthy mind, healthy body’.
So do you believe it is imperative for teams to have sports psychologist as well?
When I worked for the ACB and PCB, we had a sports psychologist, as we stressed holistic approaches to health & wellbeing. We provided basic education to the players too, as many were not educated and English courses, as well.
Based on the feedback from their teachers, us and the coaches, the players were groomed and mentored. I believe it is necessary to have a good sports psychologist on the team. We are trying to introduce that in UAE cricket as well.
Do you believe that sports psychology is lacking in South Asia and what is it like for the associate nation teams?
Well, in Pakistan and India the funding is great at a national level. However, in Pakistan, at the domestic level, players often have to care for themselves.
We now talk to the athletes a lot more openly. I am frank with the players, I would rather have them talking to me than struggling and suffering in silence.
I try my best to connect to the players on a personal level so that they can share their issues with me and I can refer their problems to the coach. My work is completely useless if they do not have strong mental health.
Let’s talk a little about sports nutrition. Where is the research pointing nowadays? And what do you think cricket diets should be like?
I think when it comes to any sports, nutrition is key. We always tell players that the gym is 40%, but 60% of your fitness is your diet. I learnt a lot at the PCB when I had to make nutrition and diet plans.
Prior to that, we were not aware as to the ideal number of calories for a cricketer to maintain their fitness. What I always stress to players is that during the off-season, players avoid a high carbohydrate intake, such as eliminating sugary drinks.
Recently, I attended a sports medicine conference in the UK, where Peter Bruckner renowned sports medicine experts, who were discussing their book called sports medicine. Peter Buckner emphasized the importance of the keto diet.
I tried to play devil’s advocate and ask him about ketoacidosis, where protein production exceeds the normal threshold and is sometimes considered a risk of the keto diet.
His argument also emphasised that rather you pay farmers, than pay pharma.
Nonetheless, we always try to get players to load on carbs during the on-season as they are able to burn it off.
You touched on how you ended up in physiotherapy, but what was the exact moment where you knew that you had to do this?
This is a really good question. Well, after graduating, I realized that there was a significant shortage of physiotherapists in Pakistan.
For example, patients would usually call physiotherapists, Doctor sahib, which is not the case.
When I was a physiotherapist [in Pakistan], my nameplate had physiotherapist written under my name and not a doctor.
I realized, that physiotherapy is very important in sports and you can make a decent living out of it as well. Secondly, I was featured in a national newspaper about my work and I was very happy.
Additionally, when I travelled internationally I met other physiotherapists. For example, in Saudi Arabia, there was a basketball coach whom I asked a lot of questions and gained great insights into the need for this field.
That is probably when I realized physiotherapy is a very powerful field and there on out, I began my journey.
What are some of the challenges that you have faced in your career?
Well, I faced a lot of social and medical challenges in Pakistan. For starters, every physiotherapist in Pakistan used to claim that they are doctors. This is utter nonsense, and cannot be farther from the truth. However, there is no legal practice around it.
When I was a physiotherapist there, my nameplate had physiotherapist written under my name and not a doctor. This did not account and amount to the same as being treated by a ‘doctor’, but I knew honesty was key and continued with this.
As far as medical challenges go, the field progresses so quickly and it can be quite difficult to keep up to date with it.
For example, I may be working on soft tissue release however, it is now considered an out-of-date therapy. I was not aware of how fast the science was evolving. However, I have overcome this challenge by constantly learning and educating myself.
What would you say to aspiring physiotherapists, particularly those in sports?
I would like to say that you will have to learn a lot because this is a creative field and not a field of formulas. You will learn from experiences, so keep working hard.
You will start at a low level but slowly you can grow and find your footing. Aim high and take in as much as you can.
The writing of this article was supported by Atiqa Ashfaq.
Zushan Hashmi is a sports enthusiast who works in the policy space in Australia. He is an avid fan of climbing, football, cricket and all things sport. You can follow him here on Twitter.
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