Sports science, nutrition, and recovery have undergone a revolution over the last few decades. Arsène Wenger’s for the time ‘radical’ approach to fitness (basically, eat less chocolate and don’t drink all afternoon) seems far behind us now. Today, clubs all over the world invest heavily in ensuring their players are in peak physical condition.
It’s no coincidence that, at the same time, the physical demands of professional football have increased dramatically. The game is faster, with more high-intensity sprints and greater distance covered by players. Meanwhile, fixture congestion, increased travel, and shorter recovery periods are putting even more strain on athletes.
One of the key figures in managing this load is the physiotherapist, whose role is critical in both injury prevention and rehabilitation. In this interview, Saraih Nkhoma-Pipe, the lead physio at Malawi’s most successful club - Nyasa Big Bullets - offers insights into the unique challenges of working in Malawi and discusses pressing issues in the game today, from doping to match congestion.
The interview has been condensed and lightly edited for grammar and clarity.
[ Background in football ]
I played football as a student and in college - where I was captain. I liked watching football growing up - then it was only men’s football but these days my interest is much more for women’s football. I stopped playing after graduating college because I needed to focus on work and the schedule was really hard.
[ Did you have this career in mind when you started university? ]
Honestly, I wasn’t initially excited about studying Physiotherapy because I had other interests, but my parents encouraged me to pursue it. By my second year, though, I really started to enjoy the programme.
After I graduated, I did my internship at a hospital for a year but I didn’t really like it! After that experience, I decided to work in sports. Malawi, we are far behind in sports medicine, so I thought maybe I can make a big contribution in sports. That’s how I ended up doing this.
[ How did you find the job at Nyasa Big Bullets - one of the biggest clubs in Malawi? ]
I had already been volunteering at Nyasa Big Bullets and Mighty Wanderers FC since my 3rd year of university. So, when I made the decision to start in football medicine, I already knew a few things. I heard there was a vacant position for a physiotherapist at Nyasa’s women’s team - I applied and got lucky!
Big Bullets has 4 teams - the men’s team, the women’s team, a reserve team for the men and a youth team. I started with the women's team (in 2022) but since last year I’ve been helping with injury management in all 4 teams.
[ What sort of things are you responsible for as the club’s top physio? ]
My main responsibility is to manage injuries that require clinical rehabilitation and lead a team of medical staff. Think injuries that need management for a few weeks and recovery from longer injuries, those are the kinds of injuries we mostly deal with. My team has 4 interns and 3 other physios and a nurse, we collaborate with each other across all the teams at the club.
If a player has a more serious injury, they will go to a hospital and see a doctor or specialist for treatment. Once they are back at the club, my team and I handle the physical therapy part and everything until they can return to the pitch.
I also give talks and help educate the players on injury prevention methods and other health related topics.
[ What are the biggest challenges you face regularly? ]
We are still facing challenges with managing major injuries in Malawi. When a player suffers a severe injury, such as a complete ACL tear, we often have to refer them to hospitals outside the country. This process is time-consuming and expensive, primarily because certain types of surgeries are not available in Malawi.
"When a player suffers a severe injury, such as a complete ACL tear, we often have to refer them to hospitals outside the country"
[ Are you at each training session? Do you travel with the teams? ]
Yes, I’m at training for all the women’s sessions and a couple times a week for the senior men’s team just to follow up on things and keep an eye on any issues. I travel with the women’s team for matches - unfortunately, we haven’t had any matches outside the country yet.
—^interviewer’s note: the men’s team is a frequent qualifier for the CAF Champions League and has played against opposition from Tanzania, Equatorial Guinea, the Democratic Republic of the Congo and Zambia in recent seasons
[ Are there disagreements with coaches or the players themselves around a player’s availability? ]
Yes! We’re making progress but we’re still a little behind - sometimes people don’t understand or listen to what we’re doing, especially before big matches. It used to be much worse but now, the coaches understand more when you tell them that the player isn’t fit to play yet. They understand you’re not trying to ‘sabotage’ the team, you’re just trying to help the athlete!
The communication (between coaches and the medical staff) is improving and sometimes coaches will come to me and ask what I think about a player’s availability and give us a chance to explain and give recommendations.
But it still happens when you tell a coach a player isn’t fit to play and then you see later, that the player is playing in the game! So there’s still some work to be done…
[ Do you network or share information with physios from different clubs? ]
Yes, within Malawi we’re networking - sharing things and learning from each other. I’m very interested in connecting with physios from other countries but I don’t have any connections outside Malawi at the moment. I know that some other countries are very advanced in this field so I’d like to learn from them.
[ You’ve done quite a few certificates, including the FIFA Diploma in Football Medicine - how important is ongoing education in your role? ]
In the medical field, you need to stay up to date on best practices, new techniques and how things are done elsewhere. I think it’s recommended for anyone working in my role to do the FIFA Diploma.
I’ve done several other courses, including one in anti-doping. As someone who is practicing football medicine, I need to be aware of all the rules around supplements and things like that.
The club helps and will pay for the courses if you tell them in advance - and the FIFA Diploma was free!
[ You also published a scientific paper on performance enhancing supplements in football? ]
That was part of my undergraduate research. We found that most players in our study were using some form of performance enhancing supplements (PES) - for different reasons, including improving performance and injury recovery. The most common ones were caffeine, different herbal products and energy bars.
[ Outside of a few high profile cases (e.g. Paul Pogba), football has been largely unscathed by doping scandals - especially in comparison with other sports (and given the huge incentives) - do you think doping/using banned substances is more prevalent than it appears? ]
I think so. I think it's happening but it’s not always the fault of the players. One of the main reasons is players do not know what is ‘illegal’. A lot of players, especially here, didn't really go to school and cannot read and understand - and for anyone it can be difficult to know which substances are banned.
It’s something we are trying to educate the players on but we’re still far behind, I’m sure some players are using banned substances unknowingly. We talk with the players, especially during preseason and throughout the season but of course no one can keep an eye on a player all the time.
[ Fixture overload and managing players’ workloads is one of the hottest topics in football right now - how is this affecting you and your role? ]
I think it is the responsibility of the people who are scheduling the games. We have a lot of competitions and it can be really hectic and hard for the players and their bodies to recover. It’s common to have a game on Sunday and then again on Wednesday, so the period between games is short and probably there is some travel involved - so the time to recover is even shorter.
It’s really hard to manage and it’s one of the reasons we have a lot of injuries.
[ What is the longest trip for the club? ]
Big Bullets are from Blantyre in the southern part of Malawi. Our longest trip is to Karonga, way in the north. It can take up to two days by bus! By the time we get back, we have another match so it’s very hectic for the players. Another thing to keep in mind is different regions in Malawi have different weather which can make it even harder to manage the players’ recovery.
"Our longest trip is to Karonga, way in the north. It can take up to two days by bus! By the time we get back, we have another match so it’s very hectic for the players"
[ How do the next steps in your career look? ]
Right now, my goal is to do a master's degree. Whether it’s sports medicine, sports physiology or exercise physiology, I really want to do this. I know I’m behind and need more knowledge - this will help me a lot in my career. These courses don’t exist in Malawi so you have to go to another country. I’ve been eyeing programs in Sweden. They have very good courses in sports physiology. There’s a lot of competition but I’m still trying!
However, having been accepted into sports physiology school twice but unable to attend due to lack of funding, my immediate goal is to establish a sports injury rehabilitation center in Malawi. I’m currently focused on acquiring the necessary equipment to meet the Medical Council of Malawi's certification requirements. While much of the equipment is costly, I'm sourcing some locally made items at more affordable prices and looking for functional second-hand options. For the more expensive equipment, I’m exploring partnerships with institutions/people that can assist. My target is to have everything ready by June 2025, and eventually, I aim to raise enough funds for my Master's degree and for new, suitable equipment.
—^interviewer’s note: if you can support or help Saraih in any way to build this rehabilitation center, please send her an email!