Catching up with Professor Nick Webborn

a picture of Nick with a paralympic athleteAs a preview to his upcoming inaugural lecture we spoke to the clinical professor of sport and exercise medicine at the University.

Nick Webborn OBE has been at the forefront in the development of Paralympic medicine, and is now chair of the British Paralympic Association.

Nick incurred a spinal cord injury while serving in the Royal Air Force in 1981 and his own experience of the rehabilitation process inspired his career in sports medicine. In this episode, ahead of his inaugural lecture on Wednesday 27 February, Paralympic Sports Medicine – The Evolution of a Specialty, Nick traces the story of his career journey and mission to bring the same level of support to Paralympians as Olympians.

To book your place at the lecture, click here.

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Most of the interview is also transcribed below.

 

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Tell us about your lecture…
 It’s about the evolution of sports medicine as a specialty and really how it’s evolved from being rehabilitation into trying to provide the same support for Paralympic athletes as Olympic athletes. And that’s been my kind of journey over the last 30 years.
I was aged 24, doctor in the Royal Air Force, pursuing a kind of a career probably in surgery or something and I was working at a Royal Air Force Station now in East Anglia, flying phantoms and playing rugby and just being a young active guy with a future ahead of him, and then I broke my neck playing rugby, while playing for the Air Force, and ended up for a period of time completely paralysed from the neck down, from C7 level, so it involved my hands, and at the time the surgeons told me that’s probably likely to be how things were going to be. But after about six weeks, I had a little flickering in one thumb, and that moved a little bit and I said to the consultant “Look I can flex my thumb”. And he said “well if we can’t extend it’s not much use to you”. So I thought, right okay – and so the battle started really to fight back.
I had a nine month period in Stoke Mandeville Hospital as a patient and then because of the Air Force went to Headley Court, the RAF rehabilitation unit, and that period as a patient, understanding about the rehabilitation journey, got me inspired to look at how I could then impact for people having kind of a personal experience and developing the knowledge to help them. So when I left the Air Force, I went into general practice, but in 1992 persuaded my partners to let me go to the Royal London Hospital to do the sports medicine diploma course. And that was a full time course for a year. And during that time I then started to get involved with Paralympic athletes. A colleague of mine in the Air Force came back from the Barcelona Games – the chief medical officer – he knew of my personal journey but also that I was doing this sports medicine course and he said would you like to get involved with the British Paralympic Association. And that was kind of the start of it.
I started looking in to the research base – when you go into a new specialty you’re looking for, ‘right, where is the literature that you can rely on?’ And there was hardly anything there for me. It was then ‘how could I apply the principles and practice of the sports medicine that I’ve been doing over the last year, and start to bring that to the Paralympic athlete’.
When it comes to the level of elite performance for a Paralympic athlete – the level has increased at a rapid rate hasn’t it, so keeping up with sports medicine for a Paralympic athlete must be quite tough, because the standard has gone through the roof hasn’t it… 
Yes it has. I mean there have always been exceptional performances. I mean even back in those days you know you’d have someone who was a below knee amputee being able to clear two meters in the high jump – quite extraordinary athletic performance.
If you say to an able bodied person “I want you to hop up to that bar and clear two meters”, you know it’s just kind of..and the world record for the wheelchair marathon is around 1 hour 25 minutes, so well below the able bodied record. Obviously there are reasons for that, in terms of the wheelchair…but there has been a significant rise, and that’s been the application of the principles of training, recovery, equipment enhancement and people being able to have the time to devote to training (though funding).
So my first Paralympic Games was Atlanta in 1996 and that was pretty (National) Lottery days, and we were just starting to evolve. Then, we were looking at heat mitigation strategies for the athletes going to that hot environment, and we did some work around that, but the athletes were still part-time, self-funded, and the introduction of the National Lottery post-Atlanta in the UK, needing to fund elite sport, really had a major shift in what athletes could do in terms of their devotion of time to training.
It’s fairly easy to trace a boom in the level of interest of Paralympic sport and disability sport isn’t there because, go back to London 2012, and you’ve just got these huge crowds – everywhere was packed. It was beamed across primetime television, on the back of a very successful Olympics (for Team GB). Have you seen that growth since London 2012? Did it take you by surprise and has the momentum continued? 
I think that I did believe London 2012 was going to be really successful for the Paralympics and the Olympics, from a participation perspective – an engagement by the public but not perhaps to that level. And three things which really struck that home for me. The first one was when (para-cyclist) Sarah Storey won the first gold medal for the British team in the Velodrome in London, and in the medical centre in London, we had a board where if someone won a medal, we’d put a little sticker up there of a medal and they would come and sign it, and it’d be like a little ritual and we’d record the number of medals.
So when Sarah came in that morning to the medical centre, the front page of every national newspaper had her photograph on, and I’ve got his photograph I took with her and the medical team all holding up these front pages of the national newspapers, and then I knew something had changed. You know that has never happened before. After the Atlanta Games, first of all there was no live coverage of the Games and about two weeks afterwards there was a one hour programme showing snippets of it. Here, we had this full time coverage, multi-channel, we had things like The Last Leg programme coming in and creating another element to it.
Then it was sitting in the Olympic Stadium with (wheelchair racer) David Weir in the 5000-metre race. As he was going around the track, there was this kind of wall of sound following him around, and people were just fully engaged in watching an elite sport performance. It was a truly amazing athletic performance and they’d forgotten this is a person with a disability or whatever, it was just captivation by this, so that was amazing.
The third thing was after the day after the Games, we did a parade through London from Mansion House to Buckingham Palace, and the crowds! It was just packed. It was just extraordinary to see the engagement of British people in support of the Olympic and Paralympic athletes together. And as we go by, all the other international athletes refer back to London as the key thing – the game changer.
Talking about Paralympic sport specific medicine, it’s very wide ranging isn’t it because you’ve got people with physical disabilities, in terms of their their limbs or you could be visually impaired – it’s a very broad range that you’re at the forefront of. 
Yes I mean it’s huge. That is the both the fascinating element and and the challenge, because in terms of the medical or health risk of participation, it may not relate to the visible impairment that they’re competing. So someone who’s a wheelchair athlete, people see the physical limitation but they may not understand that they have difficulty of thermal regulating, they may not understand that they have limited sensation, so they may be susceptible to pressure areas or urinary tract infection, or their cardio-vascular threshold is limited by the level of the spinal cord injury. So what people see, and what the underlying health elements may be completely different.
For your amputee athlete, when you go from a normal training base or a World Championships to a Paralympic Games, the amount of additional walking is about an 83% increase, they found, an additional 5000 steps per day – from getting from your accommodation, to the dining hall, to the accommodation to the transport mall – so whatever, and this sudden increase causes skin problems around the residual limb, on the stump, which can cause skin breakdown. It’s a completely different environment these people go into, which lead to challenges which may cause problems.
Or you mentioned someone with a visual impairment. The reason for their visual impairment may be part of a syndrome, which has other medical issues relating to that. There’s one that affects collagen, and so their tissue healing and response to injury is different, but they’re competing because of a visual impairment.
So as a physician, you have to have this wide ranging knowledge, and a lot of the time I’m looking up rare syndromes, because you see people and they say “well there’s three of me in the world with this particular syndrome” so you’re then thinking “OK, what are the other factors that I associate with this, from supporting this person from a health perspective and not just from the sport perspective”. So as a physician it’s really challenging but fascinating.
It must be really rewarding, because you’re finding all these new solutions…
Yes, and that’s the beauty. I mean in 1992, when I did a search for literature, there was about eight articles, and there were mostly little reports about how we did this Games here and you know, it was very little to base any preventive medicine on. This year there have been over 100. So the change in the literature output in the interest worldwide has been markedly changed.
There’s always the negative side of sport as well. The profile of Paralympic sports is so high up there now. It means that the interest is greater and their reward is greater, which means the profile of athletes that may cheat, drugs cheats – there may be more temptation to do that – so I guess the other challenge must be trying to keep on top of people finding ways to try and cheat their way to the top of the sport… 

Yes, I mean I think sometimes people think that just because you have an impairment, you’re not going to be subject to the same pressures or desire to win through unfair methods won’t exist. I mean, we are fortunate that within para-sport, the number of doping cases are relatively limited.

The majority of those cases which have occurred have tended to be in sports like powerlifting, the use of anabolic steroids – some in athletics, but also the other challenges are that because of the different medical conditions the athletes have, they may be taking medications to support a condition which may be prohibited, and one of the issues we have world-wide is the level of anti-doping education for those athletes may not be so good.
So you go to someone who goes to a Championships who’s got high blood pressure because of kidney disease associated with spinal cord injury, and they’re taking something for the blood pressure which is prohibited, and they didn’t realise that they would need to get a Therapeutic Use Exemption for it. That’s one of the challenges – education. There are the same issues and the IPC (International Paralympic Committee) is a signatory to the WADA (World Anti-Doping Agency) code – so it’s exactly the same regulation, the same (prohibited) list.
A lot of people may also believe that the IPC has even been stronger than the IOC (International Olympic Committee), in terms of its stance on countries like Russia – complete bans from the Rio Paralympics, from Pyeongchang (2018 Winter Olympics) as well – it’s a very strong message to send isn’t it, from the IPC? 
Yes I mean I’m really proud the IPC did stand up for that, because there was clearly systematic malpractice within the Russian system, designed to cheat the system and cheat other athletes of their medals their place on the podium. And the sad thing is although we may through analysis of these samples find out other cheats, and there may be retrospective adjustments…those (clean) athletes will never get their moment of glory, you can never recreate that situation where you go into the stadium and receive your medal for that.
That’s kind of the sadness for me and why it’s really important that we are so strong in the fight against doping.
You’re chair of the British Paralympic Association – so well-placed to answer these sort of questions, but Malaysia has been stripped of the 2019 World Para Swimming Championships – because the country won’t let athletes from Israel take part – what are your thoughts on that? It’s another strong stance from the IPC, but it doesn’t leave a long time to get a replacement venue… 
Yeah I mean that is the challenge, finding the replacement, but again I think what they’re trying to do is distance politics from sport, and their stance is that everyone should have an opportunity and that applies both ways. So if it was held in Israel they would expect a reciprocal situation where anyone would be allowed to participate and I think that’s the view that the IPC is taking is that sport should be for all, as long as you are competing fairly and honestly, then you know you have the right to participate. And I think that’s laudable.
It’s remarkable that we’ve already just a year and a half away from the Tokyo Games – Rio doesn’t feel that long ago that Rio. So, 147 medals for ParalympicsGB in Rio, 64 of them were gold – the target this time is a range, but the overall total is a little bit higher. Are you looking on course for that? 
Yes I mean medals are important because without the success, you don’t get the attention which allows you to demonstrate the positive power of the Paralympic movement and the achievements of people with disabilities to change society.
So if we didn’t win any medals you know the interest would go down. But the standard is constantly increasing. I think the thing that we can be proud of in the UK is that we have been consistently, pretty much, a top five nation throughout the whole history of it. And the top three in the most recent Games, and that’s showing consistency where other nations tend to have kind of waxes and waning in terms of performance. Australia, at the Sydney Games peaked and then dropped away – you have to have a consistent system to give people with disabilities opportunities to participate and train at the highest level so you can then perform and then we will give athletes hopefully the best opportunity, and then it’s up to them on the field of play to perform.
Going back to London 2012 – how much has the success of the Paralympic Games in the past decade acted as an inspiration for people with disabilities to take up sports? Not necessarily at the elite level but at a recreational level possibly opportunities weren’t as accessible previously. Have you seen a massive change there? 
I wouldn’t say it’s been a massive change, but there has been a change, there has been an increase in the number of people with impairments participating. That’s partly kind of feeling that they have the right to do so, to go into your leisure centre and I think Sport England has been helping to fund the equipment, so before people you would go into a gym and say “oh well there’s no wheelchair users here” -well, that’s because there’s no equipment from them to use, so if you put equipment in that gives them opportunities to go and participate.
The BPA run a website called Para Sport which is currently being redeveloped in partnership with Toyota to allow people to look in their area for their particular impairment, or the different sport they would like to see and look at the participation opportunities. This is great, because one of the things people say is I’d like to do this, but how do I find the right person? So, by developing this it’s been giving people opportunities to find out more, and that’s just for participation. And then from then on obviously it will then feed into the individual governing body into development through to the more elite programmes.
And with the Paralympics, and how it how it has grown, events like the Invictus Games, do you think without the success of something like London 2012, we would have the Invictus Games? Would they have quite the profile that they have as well? 
I mean the Invictus Games is fantastic and I’ve been very privileged to be involved in that as well. It’s interesting because the Stoke Mandeville games came about from injured servicemen after World War Two, and they were predominately people with spinal cord injury and that’s how the Paralympic Games evolved.
Unfortunately, due to ongoing conflicts around the world we now have a lot of servicemen with injuries, and also recognising that a lot of it is around, you know, the mental health aspects of being exposed to that environment of seeing your friend or colleague blown up in front of you or shot, you know it’s quite traumatic experiences. So it’s understanding that the mental health is equally important. I think that’s where Invictus is different. It’s about an individual’s recovery and reconnecting with with various aspects of life, family, but the sort of impairments you have there from a physical side are different because people who had their legs blown off on the battlefield in World War Two would have died or bled to death on the battlefield.

Now, because of the medical care, those people are surviving and there are different impairments – you know, people with triple amputees who are participating…I saw amazing rowing in the Invictus Games with triple amputees – extraordinary performances. So for some people, it’s just a re-engagement with life. But actually, there is also a pathway through to elite sport for those who want to choose that.

And in the Pyeongchang Winter Games last year, we had Scott Meenagh in the Nordic program, who’d come through the Invictus pathway, and there have been others as well in summer sports. So it’s great, and this year they’re going to hold a UK Invictus Games for over 500 people up in Sheffield in July, which is fantastic.
You’ve just been confirmed as one of the keynote speakers for the Vista conference in Amsterdam – can you tell us what that’s about, and what the purpose of that conference is 
The Vista conference is the International Paralympic Committee’s science and medicine conference, and it gathers the experts from around the world to do with areas relating to medicine and health, science and technology, but also classification, which is one of the key elements as well. It’s one of the cornerstones of the Paralympic movement because until we ensure the classification is as good as it can be, it’s one of the weaknesses, I would say, in the system.

People need to have confidence when they’re on the starting line up that the people in their class are of a similar impairment. And it’s great to bring the experts from around the world together to talk about the research to discuss this to showcase it. I’m really looking forward to going to Amsterdam to do my talk there.

There have been some quite high profile instances in the media, and in athletics, about the classification system… 
I think firstly the media attention is interesting because some years ago, we couldn’t get any attention for anything! Athletics is more challenging, because across track and field events, you’ve got about 47 different classes. So, the more divisions you have, you have more people who are just above or just below that change in class, and so you’re going to get more issues. And if you look at the history of it, it’s come from a medical model initially – so people with spinal cord injury “right you’re a T4, you go in this level”, “you’re L2, you go in this group”, because it’s more obvious, but as the movement has become more diverse and inclusive, you’ve got different types of impairment coming together – you’ve got people with cerebral palsy may be competing against people with polio or a spinal cord injury, and you try to match these together, of how their particular impairment impacts on their ability to do that sport.
So it’s gone from going from a medical model to a sport function model. And that evolution and understanding of getting the cut lines takes time and science and input and constant evolution. And it’s never, I think, probably likely to be perfect but we as long as we keep re-examining it and getting more evidence in and building that then there will be greater trust.
Just coming back full circle to your work here at the university, what is the rewarding part of being involved in higher education for you? 
I think being able to develop research interests, share that with colleagues, make networks not only in the UK but across the world, discuss ideas and with a real purpose that has an impact on people. For me, my research, unless it has an impact is the end point, there’s no point in doing it. It has to be purposeful to help improve safety, to improve education, change the way that sport acts for the benefit of the athlete. So it has to be purposeful.
By doing that and engaging colleagues, the teaching element, the education element, is really fantastic, but working with others to develop that research base…I was talking at the beginning about how it’s changed from you know nine articles altogether up until 1992 to over 100 this year, forming that network and taking the whole specialty forward is really rewarding. And when you have a job that you love doing, then it’s easy to continue doing it.
On to some quick fire questions, which we ask at the end of every podcast – first one, can you pick your favourite place in Sussex? 
It probably has to be on the Downs. Particularly a place where you can see the sea as well. I mean, we’re so fortunate to have the sea and the Downs and to be up on the Downs on a lovely day, and you can see the sea too, that’s probably the best – and then finish the walk with a pub.
What are you currently reading, watching and/or listening to? 
I’m currently reading a couple of books. One is Tombland by C.J. Sansom. Chris Samson is actually someone I know, he’s a Sussex resident, and it’s kind of a historical fiction – it’s fascinating, the detail he goes into is extraordinary. And the other one is the latest in the Strike series – J.K. Rowling’s alter ego (Robert Galbraith) – they’re extraordinary. That’s quite interesting because it involves an amputee as the protagonist, so they’re the two books I’m reading at the moment. And I’m waiting expectantly for the next series of The Crown, which I enjoyed immensely.
Describe your perfect weekend… 
It would probably involve, again, a nice walk on a visit to the pub, see the family and grandchildren, and have a good meal somewhere.
And finally if you could invite three people to dinner, past or present, who would you pick? 
That’s a good one. I mean many people would probably say the likes of Nelson Mandela and so on – and and that would be extraordinary to have a chance to share some words with him. From a sporting perspective, my hero has always being Gareth Edwards or Sir Gareth Edwards as he is now. He was inspirational to me as a rugby player and an athlete, so be good to spend time with him.
But I do like funny people people with a sense of humour, and you can imagine a dinner party probably some like Dara O’Briain, or someone like that – somebody who would bring a bit of joy to the evening. ​

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