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They’ve got your back: Inside India’s sports physiotherapy industry

LiveMint logoLiveMint 17-06-2017 Shrenik Avlani

Five years ago, Milind Soman, the model and fitness activist, set out on an incredible run: all the way from Mumbai to Delhi, covering more than 1,400km. As the long days of running stacked up, his body started showing the wear and tear. He began to feel a sharp pain in his left gluteus muscle each time he stopped and started again, or sat down and tried to get up. Soman still finished the run in just 30 days, pounding out over 45km a day on an average. He decided then to rest a while, hoping this would address the pain. It didn’t. It troubled him for the next eight months.

“I went to an orthopaedic specialist in Mumbai, who sent me for an MRI,” Soman says. “He diagnosed me with a slipped disc, advising complete bed rest for 15 days. After a couple of days, I consulted Dr Google, as most of us do. The more I read, the less convinced I was. Still, I believe the doctor knows best, so I persisted with the treatment.”

When Soman visited the orthopaedist again, he was prescribed another 10 days in bed. “That’s when I sought a second opinion, this time from a physiotherapist, which is what various forums suggested. A young physiotherapist from a local hospital came home and listened carefully as I explained my problem. Then she massaged the affected muscle for a few minutes. Miraculously, the pain was gone. She explained that it was a mere muscle spasm.”

Fast forward to December 2016, when Anjali Saraogi, 43, sprinted past the finish line at the Tata Steel Kolkata 25K, finishing in just under 2 hours. She had just set the fastest time for amateur/open category women in that race (the next-fastest woman, barring the elite category, was about 20 minutes behind her). The first thing she did was to point to her right hip and hamstring, covered in neon-blue tape, explaining to a fellow runner how she managed to pull through. “Kinesiology Therapy (KT) tape is my best friend,” she says, recalling that day and several others when she has hit the road with her legs and back sporting bright multicoloured KT tape.

Trainers exercising at Reebok CrossFit Bandra in Mumbai.

I see neon blue

A Japanese technology that shot to global attention after the Beijing Olympics, KT tape is no longer the preserve of cricket and football fields, tennis courts and gyms—it has made its way into dining and living rooms. And is quite the statement accessory with a little black dress. “Any dinner or party you go to in Mumbai or Delhi, you’re likely to run into a runner, a CrossFitter, a recreational endurance athlete,” says Sidharth Agarwal, a CrossFitter and a businessman from Mumbai. “Chances are one of them has some taping out there in plain sight. I hear discussions between men and women about which sports-massage specialist works on them periodically, or which physiotherapist they consult.”

The ubiquitousness of KT tape is the spillover effect of a range of top-of-the-line physical-therapy solutions that are increasingly available in India’s biggest cities, targeted at the globally oriented, upwardly mobile Indian. Forget the physiotherapist of yesteryear, called upon only when you cricked your back or neck or tweaked a knee. These are highly trained professionals who provide the same kind of care for your body that professional athletes receive. They help chief executive officers train for marathons and endurance athletes build strength; they help distance cyclists, weight-trainers, amateur sportspeople of every orientation, all the way to office-goers whose bodies are suffering owing to sedentary lifestyles.

Those following the lifestyle and travel industries would need no convincing that wellness is the new frontier of luxury. Health and fitness, along with a more conscious approach to living, are the drivers. And as people take up a range of fitness activities, the most prudent among them are also making a beeline for sports scientists—to find out how their bodies will react to the rigours of strenuous exercise, and to stay injury-free.

“You can see the increased awareness,” says Shayamal Vallabhjee, a sports scientist and the managing director of H.E.A.L Institute, a chain of high-end sports medicine and physiotherapy centres in Mumbai. “Whether it’s amateur athletes or weekend warriors, more people now know the importance of physiotherapy and proper nutrition. They know it will enhance their performance.”

A few years ago, when marathons and other races started getting an unprecedented number of sign-ups and cricket and football pens sprang up in every city, people had to be educated about the importance of exercise and strength-training. “Today, the same active people need to be made aware of the importance of simple biomechanics tests and sports therapy, in order to maintain and protect their own bodies,” adds Dipali Pandey, a sports physiotherapist with certification in advanced sports rehabilitation from Australia’s Curtin University. Pandey is the founder of the year-old Peak Performance, a Bengaluru clinic that specializes in physical therapy and sports rehabilitation.

Both Vallabhjee and Pandey prescribe specialized therapies that are used regularly by sportspeople. Vallabhjee got his start working on the ATP World Tour from 2008-12 with Mahesh Bhupathi—he cites the tennis player as a mentor on his website. But it was a struggle. In 2012, when he began, he had a one-bed physiotherapy clinic. Now he has four centres in Mumbai, which get around 1,000-1,200 clients every month; most of the corporate employees are aged 25-40 years. Vallabhjee also offers fitness advice on Star Sports.

Abinav Shankar Narayan of National Corps Fitness conducting a fitness class in Cubbon Park, Bengaluru. Photo: Hemant Mishra/Mint

Regular physiotherapy—which most might associate with unglamorous rehabilitation—is about easing you back into normal life. Sports physiotherapy is about improving your movement, agility, and relieving your muscles of fatigue and tightness. Techniques such as deep-tissue massage, dry needling, assisted stretching, KT taping, and cupping are par for the course. These specialized therapies, which cost an average of Rs1,500-2,000 per session, are aimed at preventing injury and improving athletic performance, movement, body maintenance and wellness. A recreational athlete typically needs two-three sessions per week depending on the intensity and frequency of his/her physical activity.

“Corporate executives and so many others have taken up running marathons in a big way,” says Vallabhjee. “The quest to better their timings has led to the understanding that performance manual therapy can help. Scientific research and advancement give professional athletes only marginal gains. But the same science can potentially lead to an exponential difference in an amateur athlete’s performance. This is why your friends and neighbours are embracing new techniques, knowledge and science.” And this is why CEOs and white-collar executives, competitive by nature, constantly chasing “personal bests”, are regulars at these sports-medicine facilities.

Vallabhjee grew up in apartheid-era South Africa and used to play amateur cricket himself. As a man of colour, he knew he could not become a professional cricketer in South Africa. He studied sports science in order to stay involved with the game in some way. When he moved to India in 2007, he started working as a consultant with the Indian Olympic Association. He is an avid runner, with several marathons under his belt, plays football regularly, was the sports medicine specialist with the Indian Premier League’s Kings XI Punjab team as well as Athletics Kenya, which produces some of the finest distance runners in the world.

Pandey, on the other hand, moved to Australia to study advanced sports rehabilitation and returned home to work with the Indian women’s and boys’ under-15 football teams. With her partner Yash Pandey, she set up Peak Performance last summer in Bengaluru. Yash, who has a master’s in sports injury management from Sheffield Hallam University in the UK, is the head of sports rehabilitation at Peak Performance. Dipali Pandey cites the importance of educating people about simple biomechanics before they start any fitness or sports activity, because this goes a long way in preventing future injuries.

Milind Soman. Courtesy Facebook@MilindRunning

Harder, better, faster, stronger

Vallabhjee strongly believes that health and fitness is the new lifestyle trend. “Feeling good is the new looking good,” he says.

The sports medicine and sports physiotherapy space has been growing at 7-9% every year, he says, and is projected to increase significantly in the years to come.

The increased focus on a fit and active life is a direct result of India’s economic growth—as people become wealthier, they make more time for leisure. “We are witnessing a very exciting period of health and sports in the country,” says Philippa Stewart, physiotherapist and director of the Hong Kong-based ProHealth Asia, which has five centres—in Hong Kong, Singapore, Beijing, Manila—and launched its first facility in India in south Delhi this February. “As India continues to show consistency in economic growth, the awareness and attention towards being fit, staying healthy and being active is constantly rising,” she adds.

When she started Peak Performance, Pandey expected to have clients primarily from CrossFit or running groups. “But we have a fair share of IT workers and housewives with no interest in exercise or fitness coming to us with a variety of requests,” she says. “From helping them to move freely to fixing back pain from sitting in one place for long hours. In Australia, I saw that people—whether in a fitness/sports arena or in an office—are taught how to ergonomically manage and conduct themselves in their given environment. That process is also a part of physiotherapy. But that doesn’t happen in our gyms, running clubs or offices. So people come to clinics like ours. No one likes living with pain or restricted movement.”

Champions club

As Indians look for new (and creative) ways to get healthy, activities such as CrossFit, zumba, Pilates, boot camps and combat sports like mixed martial arts (MMA) are emerging in a big way. “When you get hooked on something new, you also want to find a way to get better at it. This has led these aficionados to physiotherapy,” says Vallabhjee.

A number of fitness coaches have played their part in creating awareness as well. In Mumbai, CrossFitOM and Shivfit founder and celebrity trainer Shivoham Bhatt advises his clients to go for a weekly deep-tissue massage when following his six-week powerlifting programme. At Bengaluru’s National Corps Fitness strength and functional fitness gyms, founder and head coach Abinav Shankar Narayan initially used to send members who suffered injuries or complained of reduced mobility to Peak Performance. They are now setting up small Peak Performance pop-up clinics at their outlets.

At his Endorphins gym in Kolkata, Indian golf team coach (and Mint contributer) Ranadeep Moitra has appointed two full-time in-house physiotherapists. If members complain of niggles the trainers cannot address, they can consult the physiotherapy team—the service is available at an extra cost.

Newer techniques and treatment methodologies are resulting in faster recovery times and better training techniques . “The new-age athlete is fine-tuning his body. World records are shattered and the perceived upper limits of human performance constantly recalibrated,” says Vallabhjee. “Sports medicine and physiotherapy play a very central role in this.” As Pandey says, physiotherapy is exercise and training, too.

Common problems, popular solutions

Though each case at these clinics is considered unique, and a specific recovery plan designed, the problems that people seek to address can often be guessed easily. If an IT professional who does not exercise goes to a physio, it is usually to fix issues with the back, neck or carpal tunnel syndrome; a common complaint of the CrossFitter is the shoulder and lower back; a fast bowler’s grouse would be the knees and back; runners face tight hamstrings, ankle pain and plantar fasciitis.

Physiotherapists used to rely on ultrasound and heat therapy to treat all these syndromes. But today there is a vast arsenal of manual therapy to choose from: apart from KT tape, there’s manipulation, mobilization, dry needling, Dynamic Taping, cupping, sports massage, deep-tissue myofascial release. The science in this field is evolving constantly.

At H.E.A.L Institute, the most sought-after treatments are dry needling (muscular release), sports massage, joint mobilization and preventative taping. At Peak Performance, the simple biomechanics assessment, deep-tissue massage, taping and corrective exercises are in demand. At ProHealth, the emphasis in on correcting dysfunctions through manual techniques, followed by exercises or rehabilitation programmes to reinforce better movement patterns and function.

The business of getting fit

India has never before witnessed such popular participation in community sports and fitness regimens. Still, considering the huge population, Stewart argues that there is a dearth of quality physiotherapy care, and that demand will continue to surpass supply in the future. “There is serious potential for more physiotherapy practices to emerge and prosper,” she says.

Anil Prasher, the founder of fitness discovery app GoodVice, says the Fitternity app is a market leader in the space. Fitternity has 250,000 subscribers and more than 12,000 workout options, and had included a separate section on sports therapies when it launched three years ago—it stopped shortly afterwards because there wasn’t enough traction. “Services like sports physiotherapy and deep-tissue massage are sought by highly driven recreational athletes, usually with deep pockets,” says Neha Motwani, founder-CEO of Fitternity. “When we launched the section, we didn’t have enough takers for the services. However, we are seeing a growing demand and relaunching these services is on the drawing board.” Motwani’s venture has received two rounds of funding, from Exfinity Venture Partners and Saha Fund as well as from marquee angel investors from India and the Silicon Valley. The first round of funding was $1 million (now around Rs64 million), while the figures for the second round have not been disclosed.

Prasher sees huge potential in the sports-therapy sector in the next year or two. GoodVice, which launched last year, plans to include sports therapy services soon. Its 25,000 users can choose from over 5,000 offerings every day across 250 activities such as gymming, yoga, zumba, aerobics, CrossFit, martial arts, etc. GoodVice, which has partnered with over 1,500 gyms and fitness centres, and its app is being used by people in as many as 22 cities in India.

The fitness industry is not really tracked by analysts as yet. But there is greater focus on it and it’s attracting more investment. Recently, two top Flipkart executives quit their jobs to launch the healthcare and fitness start-up CureFit.

Even as it grows, the market is evolving, moving from purely medical to wellness. Clinics train staff in specialized sports therapies. Sports medicine and sports science are highly specialized fields and still something most Indians have to go abroad to study. The demand to study sports medicine is definitely picking up.

In Kolkata, Saraogi spotted the potential in sports medicine and manual therapy and, this April, set up a state-of-the-art 800 sq. ft facility for sports medicine at MedStarClinics, a local chain of diagnostics centres and polyclinics owned by her family; she is the director and chief executive officer. The in-house sports physiotherapy expert, Avisek Kar, has recently completed a Fifa diploma course in football medicine in Barcelona. Football medicine, it is said, helps understand an athlete’s need better.

Among the high-end sports medicine and physiotherapy clinics in India are AktivOrtho in the National Capital Region, and the sports medicine facility in suburban Mumbai’s Kokilaben Dhirubhai Ambani Hospital. There is room for more, believes Vallabhjee. “It’s important to realize that the end user is extremely conscious of his needs and quality treatment. Selling substandard treatment will not work. The market needs more clinics and brands but it needs people who are going to invest time and money into a sector that will only reap rewards in 10-15 years,” he adds.

Both angel investors and private equity funds see potential in this sector. The H.E.A.L Institute received initial seed funding from former Standard Chartered executive director Jaspal Bindra and steel magnate Sajjan Jindal’s son Parth, last summer. Vallabhjee is currently in talks with a private equity (PE) fund. “We have also been approached for acquisition by a healthcare brand,” he says. “Moving forward, brands will need to diversify portfolios into premier and mass market and online aggregators and offline clinics, as they complement each other.”

High-profile sports personalities are getting on board too. Golfer Jyoti Randhawa used to visit ProHealth in Hong Kong for treatment and when they announced their plans to launch in India, he became a partner in the joint venture. “Physiotherapy forms an integral part of the healthcare system across advanced nations and the same space is developing in India too, with physiotherapists involved in preventive, restorative and long-term rehabilitation of patients,” Stewart says.

“The health and wellness fields will impact growth in food, infrastructure, fashion, medicine, agriculture, aviation and many other fields. Gen Z is already influencing the marketplace as we know it,” says Vallabhjee. “This is the next trillion-dollar industry.”

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Vallabhjee conducting dry needling on a client at his H.E.A.L clinic in Mumbai. Photo: Aniruddha Chowdhury/Mint

Talk physical

Your guide to understanding manual therapy

Kinesiology Therapy taping: A scientific taping technique developed to provide support and stabilize muscles and joints in affected/inflamed areas of the body. The tape is like a second skin and has enough elasticity to ensure it doesn’t hamper one’s range of movement and yet, facilitates the body’s natural healing process.

Dry needling: A dry needle, without medication, is inserted into the trigger points in your muscles in order to release or inactivate the trigger points, relieving pain and improving the range of motion. Not the same as acupuncture.

Cupping: An ancient Chinese technique—made famous by swimmer Michael Phelps—which uses special cups to create suction on your body. The suction causes the skin to rise and improves blood flow. Helps with pain, inflammation and relaxation.

Mobilization: The perfect antidote for stiffness. Manual therapy that breaks up fibrous muscle tissues and relaxes muscle tension, reducing scar tissue and stretching fascia. Those who suffer from reduced joint movement undergo this therapy to improve their range of motion.

Deep-tissue/sports massage: Depending on the client’s choice of sport, the technique and focus areas of the massage therapy change. The therapist concentrates on body parts that are overused and stressed from repetitive movement. Research shows that sports massages improve flexibility, cut down injury risk and reduces soreness. Be prepared, however, for a pretty painful session.

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Mapping fitness

Tracking sports medicine centres in the country

Mumbai

H.E.A.L Institute

Kokilaben Dhirubhai Ambani Hospital

Delhi

ProHealth Asia

AktivOrtho

Bengaluru

Peak Performance

Attitude Prime

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