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In days gone by, the pre-signing medical was a formality and over in less than a couple of hours. In today's environment of plc's and multi-million pound transfer fees and wages, it has become a far more rigorous procedure. Recent high profile players who have failed medicals include Ruud van Nistelroy, whose move to Manchester United was put in doubt by medical problems. It is not surprising that the buying clubs want to ensure that the player is in top condition, but what exactly do they examine?

The first part of the medical will be undertaken by the club doctor, who will ascertain the player's medical history during the subjective examination. In the case of a foreign player, it may be necessary for the player's agent and/or interpreter to be present.

The club doctor will check for any previous significant illnesses and ask if the player has had any operations in the past. In addition, the doctor will check the family history of the player, which may be indicative of hereditary conditions.

Apart from major illnesses or operations, the doctor will check for past sporting injuries, which should be recorded in the player's medical file, made available by the selling club. This will give a picture of how often the player has missed training or matches and if the player has had any recurrent injuries such as hamstring strains or ankle sprains.

The subjective examination is followed by a thorough physical examination of all muscles and joints. The doctor and physiotherapist will assess the range of motion in each joint and compare it with the normal values. Some football clubs use isokinetic devices which give an indication of muscle strength. Some conditions can reveal themselves due to characteristic readouts from this machine.

Once the musculoskeletal system has been checked a more routine examination is undertaken, including checking height, weight, body fat, lung capacity, pulse rate and blood pressure. In addition vision, hearing and dental health are checked. An electrocardiogram (ECG) and echocardiogram are usually undertaken to rule out cardiac abnormalities.

The findings of the subjective and objective examinations will lead the doctor to order more specific diagnostic tests if required. For example, if the player has had a previous surgical reconstruction of an anterior cruciate ligament rupture, and there is laxity in the joint when it is examined, it may be necessary to have a repeat MRI scan of the affected knee to check its integrity. Or, if the player has complained of not feeling well in the past, the doctor may order blood tests.

If a problem arises, it may be necessary to refer the player on to a consultant, who can assess the player and advise the buying club on his medical status and prognosis. These supposedly routine examinations take three days, since the buying club must arrange for the player to see the consultant and have diagnostic tests at very short notice. It is not simply a case of opening the player's mouth and getting him to say "aagh"!

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