By Russell Kempson
Just what does a football club's physiotherapist do?
To the ordinary fan, the answer is simple; not a lot. A physio is seen by the average supporter just once or twice a week, and briefly at that. He or she sits quietly in the dug-out, trots on to the pitch when a player is injured, administers treatment - often a pain-killing spray, no longer the 'magic sponge' - and scurries off.
If the stricken player does not respond quickly, especially if he is from the opposing team, he can be jeered by sections of the frustrated home crowd - they just want the action to continue. Perhaps even the physio will get a bit of stick for not providing his miracle cure swiftly enough.
Easy life? Dave Appanah would, politely, beg to differ.
Appanah, 37, has been the Leyton Orient first-team physio and head of medical services for the past three seasons and, although he understands the public perception of his job, it irks him that so much of the conscientious work he and his peers do behind the scenes goes mostly unnoticed and unappreciated by the ordinary man, woman and youngster on the street.
Maybe time to set the record straight? And Dave does, succinctly and with a passion born of many years in the business since graduating with a BSc (Hons) degree in physiotherapy from the University of East London in 1996. The match, the vital 90 minutes for player, manager and fan, constitutes just a fraction of his monthly graft.
"It's more or less a seven-day-a-week operation," Appanah says. "When people look at it from the outside, they just see someone running on the pitch and running off again. Really, that is the most insignificant part of the whole job. When we get on to the pitch, it's primarily to decide whether a player can carry on or not. To be honest, any competent first-aider can do that.
"The benefit for us is, because we're with the players every day, we know them and they are different characters. There are those who will run through a brick wall and those who will split a toenail and want surgery on it. Two different people will react completely differently to the same situation, the same injury.
"In that 90-minute period, all we do is: 'Can he carry on, can he not carry on? Are they going to damage themselves if they try?' If it's a head injury, it's obviously a big decision: 'Do we need to take them off straight away?' Our important work - the difference between being a good and bad physio - is done outside the pitch - at the training ground, every day, every week."
Orient's training ground is tucked away amid expansive woodland at The Old Chigwellians Club in an affluent area of Essex, with delightful views towards Epping Forest and just half an hour from the Matchroom Stadium. Even though you can hear the buzz of the M11 nearby, it is unseen and does not spoil the tranquil setting. Sir Alan Sugar, in his gated mansion, is a neighbour.
Out of necessity, as at many lower-league clubs, Orient rent their facilities. Should the need arise, the adjacent Chigwell School provides extra training space for manager Russell Slade and his 20-man squad. But, in the evenings and at weekends, Old Chigwellians reclaim the football pitches, cricket square, tennis courts and octagonal-roofed clubhouse for their members.
The car park is small, barely enough to cater for all the vehicles, which include a gleaming Range Rover with a personalised number plate. Perhaps the tiny Smart Car next to it better reflects the club's pay structure. In the distance, Lee Southernwood, the fitness and conditioning coach, leads a group of players on their cool-down after Kevin Nugent, Slade's assistant, had exercised their minds and bodies for a punishing 80 minutes.
Southernwood, 32, works closely with Appanah. Both are ex-Army and know all about strict regimes. Yet in football, they always have to be ready to create room for manoeuvre, always have to be able to cope with the unexpected, the sudden injury setback, and always have to be open to rapidly changing schedules.
This pre-season, the crucial lead-up to the new campaign, was especially important to Southernwood.
"Our number one aim was to get every player through it and fit for the off," he said. "And we did that. It's rare but we achieved it.
"OK, maybe a bit of luck was involved, you have to have that, but we achieved it. And if it happens, you like to take a bit of credit for it." Slade was chuffed; no doubt Sir Alex or Jose Mourinho would have been, too.
Appanah takes lunch with Chris Hughes, the club doctor - pasta, baked potatoes, cheese, ham, salad, etc. - usual healthy fare. Dr Chris recalls his brief 2012 London Olympic Games experience, looking after the football teams. He was mostly involved with Mexico, the men's gold-medal winners.
"I was so pleased for them," he said. "They really were lovely people."
Baked potato demolished, Appanah is off again. No rest, no time for idle conversation. He has been on the go since 8.30am - catching up on overnight problems, chatting with Slade and the coaching staff, strapping the ankles of players before training, planning with Southernwood the programmes for the day, the week. Who needs this? Who needs that? Maybe a trip to the close-by Loughton Leisure Centre, for swimming and gym rehabilitation that the charming yet limited Old Chigwellians venue cannot offer.
"I've taken calls at 12.30 at night," Appanah says. "Sometimes silly calls like 'can I take Lemsip? Can I take Paracetamol?' I know a physio who had a player ring him from a supermarket to ask him what cheese should he buy - perhaps that was a bit over the top. But because here, at Orient, there's really only one of you, you're almost always on call 24/7.
"One day, Lee might be out there training with the lads and I deal with the all the injuries. On another day, Lee might say they don't need me in training so I can take some of them down to the pool or gym or do some stuff with them here, or vice-versa. Lee and I work well together, we both mix and match. We have to, there's a lot of overlap."
At Old Chigwellians, the first squash court - long unused by the members - has become a medical room for Orient. It is now a mini-gym, a massage parlour, a general meeting place for the lads - injured or just wanting a chin-wag, and an echoing sound chamber for the younger generation of rap and hip-hop devotees. The rules of the singles game of squash rackets are still fixed outside, just in case someone wants a quick thrash of the rubber ball.
The two large mirrors have been seconded from Appanah's home, the multi-task hand bike, bought via eBay for £350.
"It could have cost us about £3,500," Dave said. "We get what we need, that's what you do. By borrowing, doing favours for people, whatever it takes.
"Actually, for League 1, we're not too bad. At a previous club, the gym was housed in a shipping container."
In the second long-unused squash court, along the corridor, blue exercise stretching mats lay on the floor. It is another multi-use space for muscle invigorating and fitness toning. Big white walls also offer video presentation opportunities for boss Slade, which he takes regularly.
Back at the first squash court, in the overlooking gallery above, Appanah holds court in what amounts to his office - a large desk with a higgledy piggledy array that seems to contain anything and everything physio-wise. The chaotic spread, it appears, is just about organised. "We have to do all our own admin," he sighs, "we have no admin support."
Music thunders from the gym below, growing louder as our conversation continues. Appanah ignores the trance-like background rhythm and talks with clarity, pointing to a board with the players' names on it and their respective health updates.
"That gives me and Lee a quick reference point, 20 players might not sound a lot of numbers to deal with but the intensity of what you do with them is massive and you do forget sometimes.
"It's not like a private practice, when you're seeing them for half-an-hour and then you might see them next week, you are here all the time with them. With 20 players, you need 18 for a matchday squad, so there's not a lot of leeway for injuries, illness or suspensions.
"We have to be very proactive with what we are doing, to keep the players out there as much as we can so the manager has his options available. We're just trying to be a bit clever with the tools we've got."
If Orient don't have the necessary tools, then it's off to Loughton. "Their pool is invaluable," Southernwood said. "We do a lot of swimming - for recovery or for those who can't run. It gets the guys off their feet."
Southernwood - a former Staff Sergeant in the Army Physical Training Corps, who spent four months in Iraq - has introduced yoga sessions this season. "We try to make it player friendly," he said. "It's a flowing routine, with three eight-minute rotations. The players have taken it on board and it's just a question of getting the right balance. Too much and they get fed up with it, too little and they don't get the benefit of it."
When Appanah needs the benefit of further expert advice, it's off to hospital in London.
"We use the same surgeons who many of the Premier League clubs use," he says. "We've developed a relationship with them over the years so that even if they're busy, they can usually fit us in. In return, a surgeon might ring me up and ask for some match tickets or a signed shirt for someone. That's the currency we kind of work with.
"We've managed to get some players sorted out quicker than even some of the Premier League boys might have done. One of our guys ripped his hamstring on a Saturday, we scanned him on the Monday, he saw the surgeon on the Tuesday, he was operated on on the Wednesday. Bang, bang, bang, bang. That makes a massive difference to the rehab time.
"We always go with a player to a hospital appointment. If you let him go on his own, it can become a bit like Chinese whispers - the consultant meant this but the player interprets it as that and, by the time he comes back, it has changed completely. There's no substitute for actually going there yourself."
The music from the squash court grows louder, 'Dancing in the Moonlight' the latest tune to alleviate the tedium in the gym. However, boredom rarely afflicts Appanah. "From February to May last season, I had one day off," he says. "It does have a huge impact on your family life and you have to have an understanding wife."
Dave has. Helen is also a physio and can at least empathise when the Orient calling, yet again, suddenly whisks her husband away from her and their young daughters - Lily, two and a half, and one-year-old Elena. That can often happen should Orient play poorly and Slade order them in for extra training on a Sunday.
"Any time the players go anywhere, me and Lee go with them," Appanah reflects. "So, yes, we suffer if they play badly. I've told them that before. They come in and moan 'We're in on a Sunday' and I say 'Well, you lost the game and yet me and Lee have had to come in as well. How do you think we feel?'"
Not that Dave blames Slade. It is paramount that their relationship is stable, and it is. "It is the whole crux of it," Dave says. "We have to trust each other. He's got to have faith in me if I tell him not to play a player for whatever reason. If you haven't got that faith, you've got a big problem. We're always talking to each other, weighing up the pros and cons."
In the past, though, Appanah has agonised over the conflict of interest between his duty to the player and duty to the manager. "We're employed by the club but our code of professional conduct means that we have a responsibility to the individual," he explains. "Sometimes, that isn't the same thing. What happens if a manager wants someone to play when I know that would cause him an injury?
"I've only had one or two instances - not here - where I've had to turn around to the manager and say; 'this is what should happen and if you don't agree with it, I want it in writing'. If the player had played, he could have done permanent damage. At that point, I put my foot down. But it all went well. In the end, the manager accepted it."
Putting one's foot down is not difficult for the former captain in the Royal Army Medical Corps, who also served for three months as a member of the UN Peacekeeping Force in Bosnia. Such firm instruction, though, is not needed with Lee Butcher, Orient's sole long-term injury victim. Appanah trusts Butcher, a goalkeeper, especially when he is involved with the other first-team players and Butcher has to go it alone with his numbingly laborious rehab.
"It's sometimes difficult for us to give the long-term guys that individual attention they require," Dave says.
"At this moment, it's quiet, so I can do things with Lee. But if we've got four players out and we're trying to get them back for Saturday, then Lee, unfortunately, is prioritised as low.
"It's all about the personality of the player and Lee's very good. I know he will get on with his programme when I'm not there. Sometimes, I have to stop him doing too much. Thirty per cent of this job is psychology, 70 per cent is what you know. It's about knowing what motivates each individual. Some need a cuddle, some need a slap, some need shouting at. Some people, if you shout at them, you lose them. You've got to be good at gauging what button you need to push to get a reaction."
Back in the clubhouse - next to The Barker Room, in which Slade and his coaches plot the way ahead - all is silent. Butcher, 23, ponders that fateful moment in February when he fell awkwardly towards the end of Orient's 3-1 home defeat against Scunthorpe United. As he crumpled, his left knee effectively imploded. He tells it in matter-of-fact fashion but, for the squeamish like me, it is grim to listen to.
"As I landed, my knee's just gone in, dislocated and popped back," the former Arsenal and Tottenham Hotspur youngster recalls. "When it dislocated, it snapped the cruciate and the meniscus was damaged as well. I tried to get up but, wow, I was in so much pain, the worst I've ever had. I just wanted to crawl off the pitch and out of the stadium. I went off on a stretcher and had to have the gas and air as well."
A scan confirmed the fears, and Appanah took over. "Dave told me; 'you don't do things by halves'," Lee says. "He said that the knee was pretty much shattered and that me and him were going to be the best of friends for quite a while. After that, everything he was saying just wasn't sinking in."
Butcher underwent two operations. He shows me a series of surprisingly small scars, one of which is "where they pulled the hamstring through". Thanks for that, Lee - rather too much information. Constant rehab has followed, all through the summer and with Appanah - a confidante, father figure and shoulder to cry on - always on call. His remit is remarkably all-embracing.
"Dave has seen a lot of cruciate injuries before and told me; 'people have come back even stronger'," Butcher says. "When I was really down in the dumps, he said; 'don't worry, you will get back'. He's played a huge part in my rehab and I'm hoping to be ready to return by Christmas. I should be running again in three weeks."
Butcher leaves, to resume his solitary struggle. The floor of the canteen is hoovered by two of the youth-team lads and the car park, overflowing earlier, is now almost empty. Soon, in the evening, the clubhouse will be full of Old Chigwellians. In the morning, the Orient hustle-and-bustle will take over again.
As usual, Appanah and his medical crew will be in at 8.30am. Ready to go again. Easy life? Dave might disagree.