Hospital.Help

Berlin – He looks after the German football champions and DFB Cup winners of the 2023/24 season: Internist Karl-Heinrich Dittmar has been Director of Medicine at Bayer 04 Leverkusen since 2009 and a member of the club’s management.

The German Medical Journal Shortly before the start of the European Football Championship for men in Germany, we talked to him about how the professionals train these days, what the optimal nutrition looks like before, during and after the game and what his “workshop” in the stadium is all about.

Even though Dittmar believes the German team can pull off a surprise and reach the final, he is more likely to believe that France or Spain will win.

5 questions for Karl-Heinrich Dittmar, Medical Director at Bayer 04 Leverkusen

What are you particularly interested in about the European Championships? What will you see differently than the average TV viewer?
On the one hand, I look at the European Championships as a fan who is interested in the football aspect alone – I couldn’t do my job without enthusiasm for the sport. On the other hand, I am of course concerned about the medical aspects. It’s about the well-being of our own players. Behind that are the questions of how fit they will be when they return from the tournament and what that means for our next season.

Bayer 04 Leverkusen not only has players in the German national team, but also in several other national teams. The South American championship Copa América is also taking place parallel to the European Championship. We are in contact with all the national teams in which our players are active. We provide their team doctors with fitness data in advance.

During a game, I pay close attention to whether a player stays on the ground for a longer period of time. The question immediately arises as to whether and what kind of injury it could be. I am particularly critical if it is one of our players. In such cases, I would contact the team doctor afterwards to find out what happened and whether everything is OK.

Sometimes you can tell from the TV pictures whether there are typical injury patterns, such as a cruciate ligament tear. In such cases I feel for the player, regardless of whether it is a Leverkusen player or another one.

You sometimes see players hastily consuming a colorful liquid or gel before they go onto the pitch. What is this all about? Is there a medical concept behind it and to what extent do you influence their diet?
What the players take are gels with quickly digestible carbohydrates and minerals. The drinks are isotonic electrolyte solutions, the color is irrelevant. It’s good for the head, for the psyche – but not something you absolutely need. Except maybe when you’re exhausted after 85 minutes of play. But not when you’ve just been substituted.

We pay a lot of attention to the right nutrition before the game: we eat together. No pizza, no chocolate, but light, high-quality meals, such as classic pasta or rice pudding. Our chefs accompany us to away games and ensure a high quality standard.

You don’t need superfoods. There are all kinds of powders for shakes to help you recover – but you shouldn’t overestimate that. The ideal food after a game to replenish your carbohydrate stores would be cocoa and a banana.

There is also criticism of today’s professional circus, with a high density of games and short regeneration phases. How do you see this – and can a team doctor assert himself against non-medical interests?
High-performance sport has nothing to do with recreational sport. The players are exposed to high levels of stress and can suffer health problems at a relatively young age, no doubt about it. The stress and speed have increased significantly.

The German national team, which won the World Cup in 1974, would probably no longer be able to keep up with the top teams today with its skills – but neither would any of its rival teams at the time.

Nevertheless, we try to do everything we can for the health of our players. We have to build a relationship of trust with every player and every coach. And fundamentally, we have the same interests: we want to make the players as fit as possible available as often as possible.

At Bayer Leverkusen, we have to make sure that we have our top players on board, as we have a smaller squad than some other clubs (e.g. in the Premier League). This means that we are extremely dependent on a high presence of our top players, because we cannot easily replace them from the bench.

My experience from the past 20 years at the club is that there is usually a consensus among those involved. Sometimes we have to protect players who absolutely want to get on the pitch despite an injury from themselves – but there are also cases where you have to push them. For example, when there is no risk of injury despite minor complaints, such as when a nerve is only irritated.

Pain usually indicates very well which movements should be avoided. We try to avoid painkillers.

When the Bayarena was modernized around 15 years ago, the club pointed out an area that you had helped to design, including high-tech equipment, a cold chamber and an anti-gravity treadmill. What are the advantages of such equipment? Do all professional clubs have it these days?
We call this area the “workshop”: it is a center for diagnostics, medicine, prevention and training. We try to identify deficits in individual players at the beginning of the season during the initial diagnostics. If someone has a problem with hip abduction, for example, we work on it over the course of the season.

Training today is no longer like it used to be, with all the players going out onto the pitch together at 11 a.m., warming up for three laps and then doing the same program. Training in football today is something very individual.

The team still does certain exercises together, certain things are done by parts of the team. The athletic trainers organize certain things for each individual together with the medical team.

We have various devices in the “workshop”. This is still an ongoing process today: we sometimes find that one or the other thing we have tried is not really useful. Then we make adjustments. In the beginning, for example, we were less concerned with the role of biomechanics in injuries: functional diagnostics. In the past, in addition to the clinical aspects, we primarily focused on imaging (sonography/MRI…).

Many other clubs also have such equipment, but not always in-house. You can cooperate with external institutions, such as sports science institutes or other service providers.

The solution right here in our stadium lowers the threshold for actually taking advantage of offers. We are at a top level, but we could still improve on that. The cost-benefit ratio looks good: If we manage to get an injured top player back on the pitch two weeks earlier, that is worth a lot of money.

What is it like for you as an internist to deal a lot with sports injuries?
Most team doctors actually have backgrounds in orthopedics or (trauma) surgery. After 23 years in the club’s medical care, I like to call myself a hobby orthopedic specialist: I think I know most football injuries and I can deal with them, but I still rely on the specialist in the team in this case.

In my job, it’s less about treating knee or ankle trauma itself and more about the bigger picture: logistics, prevention, control and stress management.

It is important to dovetail everything. The medical department then makes its contribution to the team’s success, especially when it comes to injury prevention and fitness. In May, we had 100% squad availability: no injuries, no dropouts. That is unusual.

I have to delegate many tasks in the club. In addition to my work as a practicing internist, the position is very time-consuming and comes at the expense of my free time and family.

I think I missed two Bayer Leverkusen games in the last few years. And before I became the team’s internal medicine doctor in 2002, I sat in the stands as a fan. © ggr/aerzteblatt.de