The physio behind some of our top athletes
He helps to keep some of the world’s top cyclists on the road, but the Welsh physiotherapist who looks after champion rider Geraint Thomas is now encouraging people working from home to be active and mobile rather than stay hunched over a computer all day. Nathan Thomas has also given Amanda Powell a behind-the-scenes insight into the world of professional bike racing
HE’S usually out and about, helping to keep world-beating cyclists on the road, but the physio who supports top sportsmen like Geraint Thomas and Chris Froome, like all of us, is spending a lot more time behind closed doors.
And lockdown has brought home to Nathan Thomas how much our sitting-down-to-work culture puts office workers at risk of similar injuries to those suffered by elite cyclists and what we can do about it.
You may have spotted Merthyr Tydfil-born Nathan in The Road Will Decide, a BBC documentary which closely followed 2018 Tour de France winner Geraint as he rode in defence of his title last year.
The film showed the intensity of cycling’s toughest endurance race and we had glimpses of the kind of work physiotherapist Nathan Thomas (no relation to Geraint) has to do to help keep all eight of the Team Ineos riders mobile.
Nathan is now part-time with Ineos, the rest of his working life taken up with his own physiotherapy practice in Cardiff.
He talks to me about how being a cycling physio compares with his previous jobs in rugby union and league, the sheer brutality of what’s demanded of top cyclists and how punishing life is for everyone when there’s a big race on.
But there’s a family atmosphere too and Nathan gives an insight into how they’re maintaining that relationship even though the cyclists and other professionals are now scattered around the globe.
For a man more used to seeing the cycling stars on the screen, he’s finding himself in front of a camera these days as he’s turned to encouraging desk-based workers to get up every hour and make themselves mobile.
The most common injuries he finds cyclists suffering from after extended hours in the saddle are also ones we’re prone to have from sitting down too much.
“Lower back and sacroiliac [pelvic] injuries are the most common because of the amount of time they’re in the saddle, you’re talking maybe six or seven-hour days when they’re racing,” he says of the pro racers.
And, back in Cardiff, it was partly from seeing his wife Eve working 50 to 60-hour weeks from their home office that made him realise how much physical damage lockdown might be doing.
“My wife is working stupid hours at the moment on the computer,” he says. “Come the end of the night, you’ve sat in that position all day, you’ve not moved.
“Over a period of weeks and weeks, that’s going to have a huge detriment to your health and wellbeing.”
He also realised a lot of office workers are busier than ever, perhaps hunched over cobbled-together desks and working with their necks and backs at a strange angle over a laptop as they juggle emails and conference calls.
Although he admits he’s not expecting Hollywood to be calling any time soon, he’s taken himself out of his comfort zone of working one-to-one as a physiotherapist and is fronting short social media videos. He hopes people will follow them at home to break up their working day.
“You can do something at the desk that could prevent neck pain, lower back, hip pain, whatever you’re susceptible to,” he says. “It could be simple, simple things you could do at your desk at any time of the day and it’s movement and mobility.”
Nathan started off as a sports scientist at what was then the University of Glamorgan, before going on to a physiotherapy degree in Manchester and post-graduate studies in Bath, about eight years’ study in total.
He’s been a physio for coming up to 11 years, working in the NHS before moving into private practice and a range of elite sports including rugby union, boxing, rugby league, cricket and now cycling where he’s in his seventh year with Team Ineos, formerly Team Sky.
Nathan says the nature of professional cycling makes it very different to other sports.
“With rugby, obviously most teams play on a Saturday, they have the week then to prepare for the next Saturday, so you’ve got the recuperation and regeneration time,” he says.
“With cycling, when you’re on a race, it’s every day.
“For instance, you could be on a stage race, which is a week long and you’re literally riding for seven days straight, or it could be a Grand Tour like the Tour de France or the Giro d’Italia.
“Your acute injury management skills have to be very good in cycling, because you’ve got to patch them up, get quick fixes, ready for them to go again the following day, whereas, say for instance with rugby, you’ve got the time in the gym and over that week to iron out the problems ready for the next week. In cycling you don’t have that luxury of time.”
While we might think of boxing and rugby as punishing pursuits, those who don’t follow cycling closely almost certainly don’t realise how brutal it can be.
The Tour de France is over 21 days and around 3,500km (2,174 miles). Temperatures on a Grand Tour can range from a searing 40ºC (104ºF) down to as low as -5ºC (23ºF).
Part of the reason Geraint Thomas finished second overall behind teammate Egan Bernal in the 2019 Tour was because of a hailstorm and landslide which halted the 19th stage in the Alps. The Welshman couldn’t make up the time difference after that.
“Until I actually went into cycling, I honestly had no idea of the brutality of the sport and how stressful it could be,” Nathan says.“It’s not just what you see on the cameras either, it’s everything around cycling.
“You could be getting to the hotels at stupid o’clock in the night and you’ve still got to get treatment, you’ve got to eat, you’ve got to go to bed, you’ve got to wake up the following morning really early because you’ve got a two or three-hour transfer to the start the next day. It’s relentless, it really is. It’s tough, physically and mentally.”
The support staff pitch in together when the riders are out on the road and Nathan is one of the people you might see on TV at the side, handing out food and drinks to his team’s cyclists as they whizz past. It means he often doesn’t know how the Ineos riders are doing.
“Sometimes I’ll have a race radio, but if you’re stuck in a valley or up a mountain with no internet, until they come past me, I don’t even know the situation of the race.”
They may be racing on closed roads, but cycling crashes are legendary too, with high speeds and close proximity to other riders leaving little room for error.
What goes through Nathan’s mind when he hears one of his riders has come off the bike?
“Because I know the riders on an individual basis now, I’ll know each one’s risk of injury,” he says. “So if they injure certain parts of their body, it’ll be a bit more problematic than other things.
“Like, some riders will get road rash [abrasions] as they crash. For most riders, they just grin and bear it and get on with that.
“But, for some riders, they’ve got a history of shoulder injuries, collarbone or back injuries and that’s my first thought, it’s like, ‘Have they done their back in again, have they done their shoulder again?’
“Some of them have had surgery on different parts of their bodies, so that’s the first thing I can think of, ‘Right, it’s this rider, this is his medical history I know of, I wonder if it’s any of those?’ And you hope then that it’s not.”
One of the fascinating discoveries he’s made is how the physiology of top riders is different, they loosen up during the Grand Tours rather than become stiffer over the weeks.
“It’s a crazy thing to be honest with you and, if you look out there, there isn’t any specific research on that at all,” he says.
“What I generally find is the past few winners of the race, you’ve got the likes of Chris, Egan and Geraint, over the three weeks and the longer the race goes on, they increase their flexibility, they increase their range of movement, the tendons, the joints become a bit more supple. Whereas if me or you did three weeks of a route, I wouldn’t be supple at the end of the three weeks, that’s for sure.
“My cycling efficiency may improve, but I’m pretty certain my body would stiffen up, I’d become immobile. It’s a crazy thing, but you can tell pre-race and at the end of the race, their bodies are completely different, how it moves, how it stretches. The neural tension of the body is completely different.”
I ask whether there’s anything the rest of us can learn from that.
“Oh, good question,” he replies. “Ultimately, they’ve prepared so well for that. If you’ve come in a superior condition to all your competitors, you’re going to reap the rewards, whereas if you’re someone who’s come into a race like the Tour de France and you haven’t really looked
after yourself, you haven’t done all the finer details that you think you could have done, you’re going to get found out during the race. Your competitors are going to gain time on you.
“Whereas, if you’ve put everything into it and you’ve got luck, form and condition on your side, they tend to reap the rewards. So, I suppose, [with] endeavour and perseverence, anyone can take it, the better-prepared you are.”
After his part in the documentary, a few people have remarked how he seems to share the same sense of humour as Geraint Thomas. The film shows the pair in a friendly argument over whether they’re in the same anonymous French hotel as they’ve been in before.
He lost the bet – it was the same hotel – and was supposed to buy the pints for Geraint in Pontcanna last autumn. “I haven’t,” he laughs. “He’s forgotten about that, I think.”
He also has a special relationship with Ineos’ other Welsh cyclists Luke Rowe and Owain Doull.
“I’m lucky, I get on with all the cyclists, but with the Welsh cyclists, you have that affinity with those because you have that massive thing in common and you have your national identity in common, you know the culture of your country, the culture of the people at home and you naturally bond with the people from your country.
“You’re trying not to take yourself too seriously, I think.
Another insight from the film was just how basic the conditions can be when they’re on the road, staying in hotels that are far from luxurious.
“I could be staying in some place where, to get my physio table into my room, I’ve got to move my bed out of the room,” he says.
As the team physio for eight riders, there’s little time to look after his own fitness when there’s a big race.
“It’s very difficult, because for the full month, we support staff could be living off five to six hours sleep each night,” he says. “My workload in the night is sky-high and then obviously during the day we’re travelling, so if you’re going to do anything, it’s got to
be at the crack of dawn.
“I try to find myself 30 minutes in the morning for a jog, yoga or a strength circuit with resistance bands, whatever it is, to set me up for the day.”
Around this time last year he would have been in an altitude training camp in Tenerife, but, of course, everything is now on hold. Geraint Thomas has been cycling away in his garage raising funds for the NHS, while the two other Welsh Ineos riders Luke Rowe and Owain Doull are also back at home. Other riders and support staff are scattered around the world.
“We’ve got people in Italy, Spain, Germany, Colombia, America, literally globally, so everyone’s very remote,” Nathan says. “Obviously, with the pandemic, everyone’s at a slightly different stage as well, so we’ve got riders in Italy, who, for the last few weeks, have been unable to actually go out through the door, whereas you’ve got the lads in the UK whose training is still massively detrimentally affected, but are still able to go out once a day and ride on the roads, it’s very difficult.
“They’re all super-professional athletes, they’re all still training in the background, but it’s a different level of intensity of training.”
The Tour de France is now due to start at the end of August instead of June, but much of the rest of the men’s and women’s professional cycling calendar is up in the air. It’s all had a knock-on effect on training schedules.
“The thing is, if you know you’re six or three weeks out of a big race, that level of intensity and purpose you’ve got is there,” says Nathan. “So, what we’re trying to do with the team is try to keep everyone together, like a family, and promoting people’s health and wellness.
“It’s constant communication with the team, with the riders and staff,
there’s strengthening work for injury prevention, there’s conference calls, there’s group Zoom (video meeting) sessions. There’s a lot of communication to keep people together.
“What I’m doing with my private business and with Ineos is virtual physio. It’s tele-health, basically, so you’re assessing people over the camera.
“As a physio, there’s a lot you can pick up from just looking at someone’s movement. It’s not the same as oneto-one in clinic because obviously you’re not able to get your hands on people and see things with your own eyes, but there’s a lot you can do just looking at someone’s functional movement.”
He came into cycling in 2014, a sport which had been heavily tarnished by doping before that. From the 1980s into this century, one champion after another had been caught out – Marco Pantani, Alberto Contador and Lance Armstrong, who was banned for life and had his seven Tour de France titles taken away. The testing regime has been transformed and the sport is now as clean as it can be.
“The amount our cyclists get tested is unbelievable,” says Nathan. “I know how much other sports get tested and it’s not a lot, but the current generation of cyclists are paying for the last few generations and what they’ve done. They get tested at home, during racing, at training camps. They never argue or complain about it, they just get on with it and, I must say, the amount of professional testing these days is a lot, so to be fair to the authorities, they’re doing a lot there.”
The race leader, who wears the famous yellow jersey, comes under special scrutiny at the end of each stage and, if that’s an Ineos rider, as it often is, it means Nathan, and the
cyclist, has a later night ahead.
“Sometimes, having the yellow jersey is a curse in itself, because you know you’re going to be at the finish for probably a good hour after all your competitiors, so that’s an extra hour eating into your recovery time. Interviews, drug testing, filling in forms, doing all the documents, everything like that. The bus won’t wait for the leader of the race sometimes because they’re taking so long, so they have their own vehicle to get to the hotel.”
He’s named his own business À Bloc Physiotherapy, inspired by his French connections.
“The first time I heard ‘à bloc’ I was working in rugby league for Warrington Wolves and we used to have a French forward play for us and, every time he came to see me, he would say, ‘Nathan, I’m à bloc,’ and it went on for months and I never questioned him.
“Then one day, I said, ‘What are you talking about?’ He said, ‘I’ve given my all in training, that’s my limit today, I’m done.’
“It’s widely-used in cycling as well, so in training and even in races, you’ll hear riders coming on the race radio sometimes and say, ‘I’m à bloc.’
“I thought you could relate that to a lot of things with physio, because if people need physio, they’ve hit their limit and they need some guidance.”
His Instagram videos and posts bring a range of hints and tips for people working from home. One shows an ironing board brought into use as a standing desk to “get out of that horrid sitting posture”.
“A lot of big companies now have standing desks, which is great,” he says. “There’s definitely something in that, because you’re putting a lot more weight through your joints during the day, so you’re encouraging better bone health and, ultimately, if you’re standing most of the day, yes you’re going to be tired at the end of the day, but you’re not getting into those horrible slumping postures which most people do.
“It’s just finding ways of mixing it up. We weren’t designed to sit at desks for eight to 10 hours a day, we were designed to move, to run.”