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What happens in a Medical and why some players don’t pass it

Alexis Sanchez and Henrikh Mkhitaryan are set to undergo medicals as Manchester United with Arsenal finally reaching an agreement on a sensational swap deal.

Sanchez had been set on a move to Old Trafford, though Arsene Wenger reiterated that the deal could only happen if the Gunners received Mkhitaryan in return.

The duo is set to undergo medicals as the two clubs finalise the deal.

Ruud van Nistelrooy’s move to Manchester United was delayed by 12 months after testing, while Liverpool pulled the plug on the deal to sign Loic Remy a couple of years ago due to concerns flagged down by results of his medical.

what a medical actually entails

Just as every footballer is different, so does football medical. The requirements of the club, the brief from the manager, the age, position, medical and injury history of the player, are variables that change every time.

There is no standard for conducting medicals, as such every club has its own way of carrying out a medical.

Usually, a player being transferred to most clubs will undergo a two-day medical, although when it comes to transfer deadline day, time isn’t always a luxury one can afford. In both cases the role of the team physiotherapist, club doctor, and fitness teams is to provide all required information to the manager and the club’s executives, to assist in making the final call.

There are key elements that most medicals will feature. For instance, health check to identify any heart concerns; since Players up to the age of 24 ideally have annual checks to detect any heart-related issues.

The timing of the transfer will influence things too. For the January window transfers, teams are usually looking at players who will need to hit the ground running – it’s rare to see clubs signing a player with an existing injury at that time.

THE TESTS

Test 1: Heart and health

The club conducts a cardiac screening with an Electrocardiography (ECG), Echo monitor and heart health history questionnaire; these may also feature blood tests and a fitness check.

The club doctor may include a urine test to detect proteins or ketones indicative of health issues such as diabetes.

Test 2:  Musculoskeletal stability

The physios-therapy team in-depth look at possible weak spots like the lower lumbar (back) and pelvic region where hamstring and adductor problems can originate from. The team may also check for any defects in function or muscle tightness when performing straightforward moves by using drills like squats, hop tests and lunges.

Test 3:  Isokinetic issues

Focusing on muscles and movements (like the quads and hamstrings), the physiotherapist can work out the ratios between the two muscle groups as it work together and identify weaknesses which may predispose to injury or have developed post-injury. Knee flexion and extension drills are also used to check the player’s movement.

Test 4: Deep scanning

If there exists previous history of injuries, the medical team will have a hospital on standby for a magnetic resonance imaging (MRI) or ultrasound scan. Scanning units are used to assess the majority of muscles and joints in the human skeleton.

Test 5: Body fat score

Clubs may use Bioelectrical Impedance technology, a body fat monitor that sends an electrical signal through the body to measure lean tissue and fat. Most professional players are expected to be around the 10% body fat mark. Fat calipers are still used in many instances for reliability, as long as the same examiner is involved in any re-testing.

Test 6: Ergo metric sprint test

This measures a player’s speed over a set distance. A result of sub-three seconds for the 20m sprint test would be expected for outfield players in the Championship.

However, there are some instances where a player ‘fails’ a medical at one club but is successful in another.

Charlie Austin’s proposed move to Hull City in 2013 broke down after testing, only for him to sign for QPR three weeks later.

“Sometimes a manager will want or need a player so much because either their squad is depleted or it’s a player he has wanted for a long time, that they overlook some injury risks in order to get them,” Dr Cowie said.

Some ‘big players who had transfers called off after medicals

  • Demba Ba: The Senegalese hit-man failed a medical at Stoke in January 2011 (not for the first time), before joining West Ham for an undisclosed fee based on appearances.
  • Leroy Fer: Had his transfer from to Everton in January 2013 called off, after his medical revealed a long-term knee injury.
  • Ruud van Nistelrooy: The free-scoring striker had his dream move to Manchester United twice put on hold after knee ligament damage in 2001.
  • George Boyd: The Hull winger should have joined Nottingham Forest, but for an “inconclusive eye test” to bizarrely scupper the move.
  • John Hartson: Rangers had the burly Welshman in their sights in 2000, but he failed his Ibrox check-up and later joined Celtic.
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