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The sports doctor with a difference – An exclusive interview with athlete Dr Danica Bonello Spiteri

Dr Danica Bonello Spiteri, 37 years of age, graduated as medical doctor in 2004, later specialising in Sports & Exercise Medicine in Leeds, UK. She has been an active sportsperson from a very young age competing in athletics, cycling, martial arts, dancing (ballet & modern) and cycling. For over two decades, she distinguished herself mostly […]

Dr Danica Bonello Spiteri, 37 years of age, graduated as medical doctor in 2004, later specialising in Sports & Exercise Medicine in Leeds, UK. She has been an active sportsperson from a very young age competing in athletics, cycling, martial arts, dancing (ballet & modern) and cycling. For over two decades, she distinguished herself mostly in Triathlon where she holds 29 national championship titles and other international awards. She has also been decorated as Sportswoman of the year, winner of the SportMalta Award, Sportmanship Award as well as numerous Malta Olympic Committee Sports Awards.  Danica is happily married to Elite Cyclist and bronze medallist in GSSE Etienne Bonello.

Dottore, you have an incredible, colourful CV in Sports and in various disciplines too. As mentioned above, you are an all-rounder and notwithstanding this, you excelled in many of them. Athletics, Cycling and Triathlon above all. What are the highlights which really remain engraved in your mind? To tally all this, this October you took part in the Elite Category of the Grid too? From where do you manage to gain such energy and cope with time to tackle sports at such high level and with efficient results?

Many thanks Ray for the elaborate introduction and this kind interview. If I had to pick one highlight of my career it would be my 15th place at the commonwealth Games in 2014, as it was the hardest and highest level race I've competed in, and worked hard for. In terms of energy, well, the more active I am, the more energy I have it seems and it's always been like that since I was a young child (just ask my parents what a hard time I gave them!). I believe that my sporting ability has developed through a very good basis in dancing (ballet) since the age of 2 years which helped me develop marked control, agility and co-ordination of my body, thus it made me capable of adapting and learning new techniques and movements in different sports that I enjoy.

Dottore, a recent study by MFA showed that the top 3 Local Sports preferences are Football, Motorsport and Athletics. From a sample of 1008 respondents: 50% follow Football, 8% motor sport and 6% Athletics. We are both very fond of Athletics so let us discuss Athletics. It is true that local athletics has seen a boom in numbers especially in long-distance running. The latter are mainly former track and field athletes, enthusiasts of a certain age who are working and/or their studies are over. On paper we cannot expect to meet certain international standards. On the other hand, at the track and field, we are encountering an exodus by the age of 16 where only a handful pursue to the next level. In your opinion, why do athletes leave their sports at such a crucial age, where they can achieve much more than before? I have been told by some local athletes who used to beat international athletes by the age of 14 but then they see their fellow counterparts competing at high level at the Olympics, Europeans and World Championships and with efficient results? Do you think that we develop our athletes too early for competition or what? Some of our athletes are mainly early bloomers and tend to achieve so much at a tender age and falter when it really matters. What are your views on this?

I am exposed to athletes both locally and internationally. The main difference I see is that on the larger scene, there is more competition to be selected to compete for your county, and this in itself makes one need to 'work harder' for that spot. Dedication, commitment and determination to succeed are crucial. Unfortunately I sometimes see this as one factor as to why athletes do not progress in Malta as they are not prepared to work hard enough in Malta. Another issue may be the lack of appropriate coaches who are able to guide athletes towards long term development. Some coaches do push athletes too hard, too soon for instant results. Being a good athlete does not equal to one being a good coach. Abroad, a coach often has to attend university for 3-4 years before they are appropriately qualified, and they are mentored by other top coaches along the way. In some sports in Malta, this is starting to change and we are starting to see younger coaches taking the interest in reading, learning and becoming appropriately qualified. This will yield better results in the long term, which is a very positive thing. Today's youth tends to get distracted at the age of 16 due to external factors - studies, work, relationships and weekend 'entertainment'. University itself does not contribute at all towards the importance of sport. In the UK, one essential part of university attendance is being part of a sports team, practising different sports, competing for your university and scoring points. It is from here that many junior athletes make the jump towards senior international competition, competing at European, World and Olympic level. Needless to say, the universities actually support such student athletes to pursue this - both in terms of university attendance and examinations, as well have having specific acknowledgements of their successful athletes in their sporting facilities, magazines, online etc.

Dottore, your profession is one of the very few on the island. To my knowledge, sports doctors on the island are just a handful and the way local Sports is developing, the demand is on the rise. Moreover, you are not just a doctor who assesses injuries and recommends the subsequent rehab program but you specialise in running technique. The latter is the mum of the majority of all sports and it includes the likes of Athletics, Football, Basketball, Triathlon etc...In Sports, injuries are almost the order of the day. It is imperative that one practices sports in a smart way but unfortunately it is easier said than done. From your experience so far, and referring to Athletics only, what are the major factors of recurrent injuries? Are they related to over training, improper bio mechanics, lack of rest, mal nutrition, too much pressure from coaches and clubs? If you were to give a percentage of your monthly visits, how would the scale balance from high avoidable self-injuries to those which are accidental?

What I often tell my athletes in clinic is that if you wished to learn how to play tennis, you would go to a tennis coach, to teach you how to make use of a racquet and how to move your body - hands and feet, so as to move in an efficient way to make you fast and avoid injury.In athletics, we are just handed a pair of running shoes and told by coaches 'go run' and out come the training plans and stop watches. Unfortunately, our western lifestyle means that we spend a considerable time of our day sitting down (to eat, drive, school, work, socialising etc), so it means our body habitus changes over time, and we end up moving incorrectly so as to compensate. Children are not running around and playing games like hopscotch and 'lasktu' or skipping a rope or throwing balls, so the body co-ordination does not develop appropriately.Then when one starts running, there are compensation movements that occur, and the athlete is not moving in the best way possible, with resultant incorrect forces on the body. The athlete is often not aware of these movements. This results in 'repetitive use injury' movements causing injury. The athlete often 'rests' thinking that once the pain stops, the problem is solved, but once they re-start running (still in the incorrect manner), the injury will return, or else another new injury arises.Overtraining is not a common issue I see in the average athlete, but the other side of the coin - not enough rest is more important. Athletes have full time jobs, families and commitments to take care of, and sleep deprivation is one of the side effects of all this.Malnutrition is seen, where athletes often skip breakfast, thinking that it is OK to eat at 10am, where as their last meal has been at 8pm the night before. Constant re-fuelling is crucial for training and recovery.

Dottore, injuries in sports are a mental and physical blow for athletes of any sports discipline. The pressure for a quick recovery tends to make matters worse but today let s face it, some rehab time frames ,thanks to the latest development in health technology, can be shortened or even halved by the usual envisaged recovery time. For instance a sprained ankle, decades ago was handled by just RICE treatment and the process took not less than 15 days. Do you agree with such technology? Athletes tend to do less core training because it's physically demanding and they do it either in the preseason or when they are injured.  Do you think that strength and conditioning can help avoid injuries too? What are the dangers one should avoid to risk injuries?

The speciality of sports and exercise medicine has developed rapidly and is still growing. Gone are the days of just treating injuries with 'rest and anti-inflammtories', and as you say, treating an ankle sprain with RICE is only one part of management. Today we have much better imaging facilities and also much more options of treatment to ensure better, faster and more appropriate recovery for athletes. Unfortunately what we lack in Malta is a proper dedicated large scale sports and exercise medicine centre that gathers the relevant specialists working together under one roof. This should also be offered through the national health service, in the same manner as other specialities in medicine are offered.The way forward is going towards pre-hab and not rehab. This means taking an active role towards prevention of injuries, rather than waiting to get injured and then taking action. This mentality is slowly, slowly entering into Malta, which is encouraging.

Dottore, you have been involved as a sports doctor in major sporting events such as the London 2012 Olympic and Paralympic Games, Glasgow Commonwealth Games 2014, the Tour de France Grand Depart in Leeds 2014, World Cup football (women u/17) Jordan 2016, FIFA Euro Finals (3 occasions), and the Games of the Small States of Europe in Cyprus 2009 and San Marino 2017. Here, we are talking about Sports in its grandeur, how do you feel working with International Federations and dealing with their athletes? The pressure is by far bigger than the normal routine visit at a local clinic. How do you manage to sort this out? Do you work in a group of professionals? Were there any instances where you did not agree with the rest? Any positive stories which gratify your hard work?

I've been trained in sports medicine in the UK, and it's not about ego, but it's about team work. Successful athletes are so, because there is a united team behind them, working hand in hand. It's not about 'disagreeing with the rest', but it's about communication and finding the best option for the athlete. Working with the England football team, we have daily 'technical meetings' where the medical and coaching team each give their point of view, with pros and cons and we come to a conclusion as to what is the best choice. At times we may have taken a wrong decision, but fingers are not pointed at anyone, as it is a joint decision, but it is a learning curve for all. On the other hand, when you successfully manage an athlete through an injury and they go on to the pitch, perform and end up scoring a winning goal, the feeling is indescribable! I've been lucky enough to have been part of a team that won a bronze medal in the FIFA Euros in 2016 with the u/17 women, and this lead us to go to the world cup, where we lost in the quarterfinal stages.Working with international federations helped me learn how to manage the bigger scale of things, the professionalism that goes on in the organisation and management of the sports medicine side of things. In Malta, the attitude of 'professionalism' lacks greatly. We fail to prepare on a number of things, hence we only prepare to fail, and then we end up as a last minute scramble of trying to fix 'last minute things' When I've tried to approach this to change mentality, it is very hard. It would be easier to ask for funding, rather than suggest a change in set up and mentality. This makes me sad and frustrated, hence my reason for seeking to work with international teams, where the set up is dynamic and we constantly strive to improve things and make things better.The mentality 'we have always done things this way' is incorrect and does not allow us to improve in Malta. The lack of reflection after an event, and trying to see what can be done better is another missing link in the Maltese mentality, but is a key factor as to why internationally sports improves.

Dottore, you have gone places from a mere school student to a qualified Sports Doctor. Your sports career went hand in hand with your studies and even though your doctorate is deemed by many as the toughest degree at the University of Malta, you still managed to juggle pre Uni, during and post your graduation. Such outstanding feat is not done by all but by those who really dare and strive hard in a concerted effort to fulfil their dreams. How was your life as a school student vis a vis athlete and now as a married Doctor vis a vis sports?

I never looked at the big picture, nor thought about 'success', but I just followed my heart, my passion and kept striving to be better. In life, an opportunity may only come once, and I always ensure that I seek and then take that opportunity, as it may never come again. I'm not scared to take a leap into the unknown. I believe that in life you always regret what you don't do, rather than what you do.When I was informing my superiors (medical consultant) that I will be resigning from my secure employment as a doctor in Mater Dei hospital, to go specialise in the UK as a sports doctor, I was told that I was being rather silly and I'll be wasting 4 years of my time, as I'll return to Malta without a job. I refused to listen, and I'm glad of my leap into the dark. I literally left Malta (including my newly wed husband, who lived in Malta alone for 4 years, waiting for my return and supporting me), to work in the UK in sports medicine, with just a suitcase in hand, to a place called Leeds, that I'd never been to. It was daunting, but I was bold and did not think twice about it, and soldiered on. As it is common knowledge, Leeds has moulded me into the athlete I then became, as well as the sports doctor I now enjoy working with such passion. Nowadays I find younger medics approaching me asking me the pathway I took to become sports doctor, and I totally support them, guide them and offer to assist them, as I know that my path was not easy and lacked support from the Maltese aspect, so I do not wish them the same difficult path.In sports, I also find a similar picture. Recently, the parent of a promising athlete, who is also talented in schooling said that it may be hard for her son to manage what I've done, saying 'but Danica is Danica' When this conversation reached my ears, I contacted the parent directly, outlining that it is also possible for her son to succeed in a dual career and I'm ready to support if/when I can to ensure he arrives at similar successes.

Dottore, I am always of the opinion that the best professionals in the sector can be those who were former athletes of a certain level. I am sure that you will agree with me partially. Obviously, the determining factor were the studies at the University of Malta and abroad that really make you the Doctor you are and not your sports career.  I keep on claiming, however, that they are the best cause Professionals like you have better understanding of how an athlete should be handled, understood, referred to etc.... since they have experienced the same and can tell what it looks like being pressurized pre race, injured for long and relapses, lack of motivation, frustration for not obtaining good results etc. What are your views on this regard?

I will tend to disagree with you in this regard! One case in point....one of the GB canoe coaches managed to coach athletes towards winning Olympic gold medals, yet he never got into a canoe himself! Being a top athlete does not mean one is a good coach. I'll make a distinction between a 'trainer' and a 'coach' A trainer is one who dishes out training programmes and makes athletes tired from their training and they feel good. We find plenty of those!A coach is one who constantly teaches their athlete, understands the athletes, wants feedback, analyses the response to training, tries to find ways of improvement. The coach must have an understanding of the sport and be able to deliver this to the athlete and guide them towards performing what is required of them.

In terms of sports medicine, I work within the football field. I openly admit that I do not fully understand football as a game itself, and I have never played in any football team, let alone played at a 'certain level'. However, I can understand the athlete's football demands, the movements involved, the biomechanics, injuries and time frames of returning an athlete back from injury. Liaison with the coaches and what they wish the footballer to perform is still adequate to enable me to perform my role as a sports doctor to my utmost.

Dottore, in the past you have worked with Leeds Rhinos Professional Rugby Team, Tough Mudder obstacle course racing and you were a long time contributor to Vida Magazine and TVPM TV program and lectured at the University of Leeds. Presently, you are also Sports Medicine Consultant to England Football team for 5 years, and the Dynamic Doctor of Liquorish reality show for 13 years, as well as a lecturer at the University of Malta for 8 years, and invited as a guest speaker on various TV programmes. I am tired of listing each commitment let alone dealing with it! Reading between the lines you have to have a strict time table which you need to adhere to almost every day if you are to cope with such demands. Is it so tiring? How do you manage to find time for training too? Are you still finding motivation for competing or doing some maintenance to keep up?

Reading the whole list of things, I've been up to makes me realise that I've been around quite a few years and makes me feel older! J However, I have no regrets, and it means that, as I've outlined before, I seek and take every opportunity and I do not live my life saying 'what if', but that I've lived my life to the fullest. Coping with all my work and training schedule is demanding, yes, but I don't see it that way, it's just doing what I enjoy. I need to be a very organised person, preparing my training/work bags (including clothes and food for lunch and snacks) from the day before. My car has often been my 'mobile house', or else a large bag on my back, when I'm able to commute with my motorbike. Time management and time efficiency is also crucial, as otherwise there is no way I'd manage to keep up with everything. I'm a very highly motivated person, self-driven and goal oriented. I never see any task as too hard, but I take it step by step each day, and that is what led to the bigger picture I guess.

It's only when I look back that I realise these things. If I find something challenging, or when I'm told 'I cannot do something' it makes me work harder to prove that I can!

Dottore, Triathlon, Cycling and Running are three sports disciplines which are very time consuming in particular the first two. Moreover, cycling has almost become a nightmare with regular accidents on the road. Cyclists are travelling to Sicily and other places to train properly and safely given the limitations of our roads and their safety. This adds to more expenses incurred by the athlete. Is there a real proper way where cyclists can enjoy their training safely on their mother homeland? Do you remember better times or it was always perilous to cycle on Maltese roads?

I have been cycling for over 20 years in our roads. Previously few cyclists, especially females, were on the road, so there were difficulties back then too. The roads were also not well tarmacked too.  Nowadays there are increased numbers of cars on the road and everyone seems to be more stressed, rushing from one place to another. I agree totally in this regard.In terms of training, the option of going to Sicily is not a necessity, as it always was there. It is simply an option that more and more athletes are taking, to enjoy their cycling, as well as the Sicilian roads.I do not go to Sicily for training, as I do not have the time to do this, but only travel to Sicily for racing. In Malta, one learns which roads to go to for training and at what times, so as to find quieter training options. I opt for this, so as to undertake my training. There is also tonnes of mountain biking routes in Malta (and Gozo!) that can be practised, away from the cars and people, and it gives a very good training result too, as mountain biking can be a harder training ride than a road ride, if one chooses so. The Maltese countryside needs to be discovered in more detail too.

Dottore, you are a living example that only the sky is the limit in terms of both achievements and tackling tasks. You are an inspiration to many. Your dedication to sports both as an athlete and profession is contagious. We badly need more persons who embark on what they like most. Thanks

Thanks Ray for your kind words! I do hope that we have more athletes, especially women, who follow their hearts and their passion. I hope this article inspires more people to follow this path, and I'll be more than willing to help guide/give advice, should this be required.

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