Even the toughest rugby players are not immune to injury and Michael Keating's job is to get them back on the field as soon as possible.
A former athletic trainer in another tough contact sport - he was with the Chicago Blackhawks in North America's National Hockey League - Keating is the head of the USA Eagles' medical team at Rugby World Cup 2011.
This is his second World Cup with the Eagles and he made sure in the lead-up that nothing was left to chance.
“The matches have been laid out for months, so our planning’s been laid out in correlation with that, in terms of staffing, preparations, training regimens and how to prepare the best we can,” Keating said.
A trained physiotherapist with 20 years' experience, Keating is working in New Zealand with another physiotherapist, a massage therapist and two team doctors.
After the intense match against Ireland on 11 September, they even brought in three extra masseuses from New Plymouth to ease the players’ sore muscles.
“We’ve brought a pretty heavy medical staff, with a diverse background in terms of sports medicine, orthopaedic surgery, trauma, massage therapists and physiotherapists to counterattack (injuries) and plan recovery sessions,” Keating said.
USA players have to attend a daily medical check throughout the tournament and can have up to three physiotherapy sessions a day.
Whether they make the starting XV, sit on the bench or miss the cut, every player on tour has his own ‘pre-hab’ plan, which involves exercises he has to do on a regular basis.
And, when the match is over, rehabilitation starts right away - even if there are no injuries.
“Back at the hotel, we immediately do a medical check. It’s mandatory, regardless of who you are, even if you didn’t play,’ Keating said.
“We go through an exam, check you off, make a list and then tell you what the plan is for the following day.”
While giving players the green light to play and dealing with injuries as efficiently as possible is the priority, Keating says that mental health also plays a vital role.
Lucky so far
“Being injured is tough," he says. "Letting a player know that he’s going to be fine is half the job. How you present it to a player is monumental. It’s about successful return to sport and you have to give these guys confidence.”
The Eagles have been lucky enough to get through their first two pool matches, against Ireland and Russia, without any major injuries.
Full back Chris Wyles made his comeback against Russia after an ankle injury had sidelined him for several months, and Keating said his ankle is holding up nicely.
Wing James Paterson has had his right arm in a sling since the Russia match, but a scan on Friday showed no damage to the shoulder joint or any internal problems.
With two more gruelling matches ahead in Pool C, against Australia and Italy, Keating knows his team’s skills might be needed sooner rather than later. And he is confident no players at RWC 2011 will get better medical attention.
“We certainly know that we’re not a tier one nation in rugby right now. We’re not the greatest rugby team in the world, but we are the best at medicine and in particular sports medicine,” he said.
“That’s where we can lead and that’s why we’ve come strong with our medical staff to this event, because you don’t always know what’s going to happen.”
The Eagles play Australia in Wellington on 23 September and Italy in Nelson on 27 September.