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The Canada men's national team medical staff. Courtesy Canada Soccer
VANCOUVER — The door to the Canada treatment room is always open for the national team players. Hanging on the wall inside is a homemade sign. It says everything about the group of people it represents.
When they enter, they will often see the sign, beside other lengthy lists of a player’s recovery needs for that day.
“We are Canada for f—’s sake”, the sign reads in red writing above a red maple leaf. “All in!”
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The six members of the medical team chuckle about the sign designed by their fearless leader, head of Canada’s medical and sports physiotherapy department, Greg Bay. But the message, inspired by head coach Jesse Marsch, still propels the unsung heroes of Canada’s men’s national team: their six-person medical unit who might be the busiest of any at the World Cup.
Before the World Cup, Canada was nursing a variety of debilitating injuries that looked to throw their tournament off course before it set sail. But it has been the medical staff who have gotten its team to a new place: where they can genuinely contend in a World Cup knockout round game for the first time.
“I had my walls just wallpapered with people’s names and what they have to do every single day to get back (for the World Cup),” Dr. Ryan Leaver, Canada’s sport physio and on field return to play specialist, says. “In the first game, there were 90 minutes of playing time by players that I don’t think in regular time frames we thought would be on the pitch. That’s why we work our days: the edge of what’s possible. Once you can start counting the minutes and the players, it’s big numbers that influence what our lineup can do.”
Moise Bombito could start in Canada’s round of 32 game after breaking his leg this season. Alfie Jones is close to playing, depending on how far Canada go. Ali Ahmed has returned to fitness thanks to the medics.
And in the worst moments of Ismaël Koné’s career after suffering a World Cup-ending broken leg against Qatar, the medical team was there in unseen ways.
If this Canadian team has a chance against South Africa, it is in part because of the tireless work done behind closed, er, open doors.
“Their desire and their love to help the players is like nothing I’ve seen,” Marsch says. “They’re a really genuine and careful group of people.”
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The Athletic was granted exclusive access to the team’s treatment room to tell the story of how Canada’s medical team operates during the World Cup.
So, what does a medical team do at the World Cup?
The level of detail it showcases through a typical training day is part of what has elevated Canada into the round of 32.
Get free access to the most comprehensive World Cup coverage in The Athletic app.
A typical day begins when the sun has just poked up. Bay and Dr. Scott Howitt, the team’s acute care therapy specialist, hit the pavement for a brisk morning walk. They sip coffee and discuss the day ahead and review what they’ve immediately learned: the first thing Canada’s players do after waking up is answer five questions on a wellness app tailored to the team.
Questions revolve around a player’s sleep, soreness, mood and illness. Answers provide the staff with an immediate understanding of what players need on the day.
“Our motto is ‘No surprises’,” Bay says.
The staff say confidently that 24 of 26 players provide their answers in the app on time. They can get that high a number because the staff have earned the team’s trust long before this tournament.
“It’s by being in the trenches with them this long that they trust you,” Leaver says of Canada’s players. “They know you’re not going to ring an alarm bell if they tell you something, they’re just going to quietly get told by whoever needs to deal with it to come see them. Things aren’t going to be a fire and rushed straight to the coach.”
This is not a newly assembled group for a home World Cup. This is a group that balances their main jobs while being pulled into Canadian camps every few months.
Dr. Dave Simon is Canada’s MD and orthopaedic surgeon. Howitt runs a clinic in downtown Toronto while teaching. Leaver runs a physiotherapy clinic in North Vancouver. Justin Warsylewicz is the team’s massage therapist from Calgary and a former Olympic silver medal speed skater. Neville Wright, from Edmonton, rounds out the group as a massage therapist and focuses on the team’s speed and strength training.
And of course, Bay: he has worked with the men’s national team since 1984, before their first World Cup appearance. Bay would always prefer those around him get the credit they deserve, but the reality is his tightly-cropped white hair, beaming smile and jolly way of whistling and singing through a day have become a source of happiness for the entire Canadian team. He’s the type to take extra food that is left uneaten by the Canadian team to homeless shelters, as he did last year in New Jersey before Canada’s friendly against Colombia.
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“He’s the most excited man, every morning in camp,” Leaver says. “The more the days get longer, people have fading moments. Greg rarely fades.”
Bay’s attitude permeates into the team. Players believe in their ability to play, even with injury, partly because of Bay’s sanguinity.
“Greg is an optimist through and through,” Howitt says. “When a club tells us that a player has a five percent chance (of playing), Greg automatically converts that to a 20 percent chance. He always adds 15 percent. It’s very obvious to all the players his level of care.”
That care continues once Bay and the rest of his staff begin greeting players before breakfast. The staff builds relationships through what Bay calls “personal acknowledgements,” every morning.
“Whether it’s a fist bump or a handshake, everybody looks each other in the eye,” Bay says. “And when we look players in the eyes, it’s with the knowledge that ‘I’m here, is there anything for you to say?’”
Each has specific roles during training: Simon takes a 360-degree approach while paying attention to the goalkeepers. Leaver ensures players in return-to-play protocol are adhering to specific recovery programs. Howitt watches players for signs of issues with mechanics and ensures targets for training loads are being met. Warsylewicz handles player hydration and on-field treatments. Wright sets up the high-speed running drills that ensure Canada is one of the most aggressive teams at the World Cup.
“So many different people,” Leaver says, “have to get each player tuned up and ready to go.”
After training, players will generally nap but the staff continue. They begin a treatment window. Their door remains open for players to seek various treatments on six different tables. During the afternoon, players returning from injury will have scheduled treatment appointments.
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For diehard Canada fans: Alistair Johnston is apparently the chattiest player on the treatment table, though Promise David will announce himself to the group before he even storms through the door.
Throughout this window, the medical staff members will review the morning training session player data from their GPS vests. The staff’s assessment of that data will inform how a player’s training the following day is handled. Those assessments are communicated with a player’s club to provide updates on their performance.
They will move throughout the team dinner to check in with players in a calm, personal manner. The final part of their day comes in the evening, when Bay and Simon meet with Marsch. They will deliver an honest assessment of the team’s health to help Marsch plan the following day’s training.
“There’s always some negotiation and we have to be firm,” Simon says. “We need to be strong to protect the players and integrity of the process.”
“When (Bay) and (Simon) go to (Marsch) and say ‘You can pick whoever want to play for the game, whenever you want’,” Howitt says, “we are absolutely celebrating.”
How they get those players back on the field matters. Their blend of skill and experience is elevated by compassion that could elevate Canada’s injured players’ performance.
“The one they deserve the most credit for is Alfie Jones,” Marsch says of Canada’s medical staff diagnosing Jones’ ankle injury. “They all solved the issue of what was going on with Alfie, where many people thought it was something completely different. Maybe they haven’t boasted about it, because it’s not how they are.”
Jones, who plays for Middlesbrough in England’s second tier, has since suffered a hamstring issue in training but remains in contention to return.
Bombito? Leaver took the unconventional, but important, step of travelling to Nice in France for three days to determine why the centre-back’s recovery was taking as long as it was.
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“(Bombito) needed certain things. We went there and said, ‘Can you give this to him or should he get extra help?’” Leaver says. “We ramped up the testing and we studied his numbers.”
The staff designed specific sprinting exercises that Wright would work Bombito through upon his return to Canada camp in May. If Bombito makes a difference for Canada in the round of 32, it will be because of Canada’s staff and how they instilled belief in his ability to return.
“We identified if there were gaps along the way,” Dr. Simon says of Bombito’s recovery, “and then where and how to close those gaps to get to optimal readiness to perform, while removing some fear of re-injury. A big chunk of it is physical, but a big chunk of that is mental.”
Alphonso Davies? “We’ve just been helping his helper, showing him, educating,” Dr. Leaver says of how they have assisted Canada’s star left back through his hamstring injury recovery. “By the time (Davies arrived in Canada’s training camp), I was down the road with three or four guys with the same tissue injury.”
“You have to work with biology, physiology and psychology,” Simon says of Davies’ injury recovery. “And then have to work with multiple stakeholders who are in all of the players’ orbits, more so now than in the past. It takes a lot of effort at a lot of levels to try to gain alignment, and then there’s some negotiation within that. You have to get everybody rowing in the same direction and then the athletes will fight to be ready.”
Players show their appreciation in an interesting way: when a player is fined for being late or for another team-defined infraction, that player must pay a member of the team staff in the form of a gift of the staff member’s choosing, $250 value max.
Players have contributed expensive steaks, sneakers, headphones or bike gear to Canada’s staff.
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“(Canada’s fine system) is another way to have really good interaction and sharing with players because it’s not just money,” Bay says, “you created an occasion out of it.”
Because so much of their job goes unrecognized, it is worth highlighting what Canada’s medical staff have done in a player’s lowest moments. In the seconds after Koné’s injury, they followed their emergency action plan. Leaver takes control of a player’s head component, Bay looks after crowd control before he connects with emergency response staff.
“I don’t think people appreciate how challenging that really is. And that was on almost day 30 in a row for us,” Warsylewicz says. “I see it as our superpower: to rise to the occasion when needed.”
It was Simon who first sprinted to a stunned Koné. He knew immediately Koné’s leg was broken after a tackle from Qatar’s Assim Madibo.
Simon checked Koné’s breathing patterns and calmly asked him to look him in the eyes, not at his leg. “You could see it in his eyes,” Simon says. “He knew.”
Simon reassured Koné he would be OK and told him he was going to the hospital. But he also delivered a strict set of instructions.
“’Before you go off,’” Simon told Koné, “’You have to wave to your mom. You have to let her know you’re OK’.”
His reasoning is one any parent will understand.
“It’s harder to be in the stands and have such a helpless feeling for your child or your loved one than it is to be doing what you were trained to do,” Simon says.
Multiple members of the staff then moved to Bombito, Koné’s close friend and one who had suffered a similar injury last year.
“We had to make sure he was alright,” Simon says.
After the game, Bombito showed he wasn’t just alright: he delivered a fiery speech in a postgame huddle, underlining how dedicated he was to having a strong tournament in Koné’s honour. He was all in.
If Bombito changes Canada’s World Cup, he will have the medical staff to thank. He will know where to find them: first in a room where he was healed. And then throughout the pitch, where a staff who rarely get credit are turning Canada into a World Cup force.
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