The UAE: Sports Rehabilitation Destination & Science Hub?

The adoption of cutting-edge technologies in the field of sports science in injury prevention/rehabilitation has increased substantially in recent years. This is primarily due to the escalation in sports participation related injuries, which creates demand for innovative sports science products and technologies, causing increased public and private investment and funding in regenerative medicine. Embracing such technologies has in turn boosted the sports medicine market which is expected to surpass USD 9 billion by 2025 ^[1]and is poised to register an annual Compound Annual Growth Rate^[2] in excess of 6% from 2019-2025^[3].

This upsurge can be attributed to several factors such as:

1. Increased incidence of sports injuries caused by escalated participation in sports, physical activities;
2. Growing trend towards healthy lifestyles and healthcare campaigns promoting the importance of sports and physical exercise in combatting and reversing the effects of cardiovascular diseases, diabetes, obesity etc.;
3. Rise in adoption of computer assisted robotic surgeries and sports medicine products, which reduce recovery time, hospital stay and result in faster return to normal activities;
4. Technological advancements in implants and increased R&D activities in the fields of regenerative medicine; and
5. Increased demand in minimally invasive surgical procedures^[4] such as arthroscopy resulting in reduced complications and shorter hospital stays.

Regional Insight

North America dominates the global sports medicine market, accounting for over 50.5% of the market in 2018^[5], which is not surprising given the high profile nature of sporting events like the Major League Baseball World Series (MLB World Series), National Football League (NFL), National Basketball Association (NBA), Professional Golfer’s Association (PGA), the Hockey Leagues, ATP (Association of Tennis Professionals) and Grand Slam tournaments and the enormous amounts of money spent on sponsorship of sportspersons. The European sports medicine market is the second largest, followed by the Asia Pacific region. The MENA^[6] sports medicine market though currently much smaller, is set to grow at an accelerated pace.

Technological Advancements in Sports Science

Constant advancements in sports science research, development and technology has resulted in numerous innovative technologies. Such technologies have helped in preventing injuries, improving training standards, maintaining high performance and reducing the otherwise massive costs incurred by injuries alone. Some examples of such technological developments are:

a.  Analytics – VU by Pivot is a device that uses Pivot’s sensors to observe an athlete’s body and performance in real time. The technology is capable of analysing player landings, cuts, sprints, and other movements to understand an athlete’s performance and technique;

b.  Cryotherapy – The concept of cryotherapy is to expose parts of the body to freezing or near-freezing temperatures. With cryotherapy, it is possible to immerse most of the body into a cryotherapy chamber, or target specific areas such as the arms or legs which helps athletes deal with muscle pain, joint pain, soreness, and promotes faster healing from injuries;

c.  Hyperbaric Oxygen Therapy – In this process, the patient breathes pure oxygen in a pressurised room or through a tube. Inside the chamber, it is possible to set the air pressure to three times the regular levels. The increase in air pressure causes the lungs to receive even more pure oxygen than is otherwise possible under normal atmospheric pressure. The pure oxygen is then carried by the blood throughout the body, where it can help muscles stimulate growth factors, promote healing, and enhance the speed of recovery;

d.  Sweat Analysis -Teams have begun using smart patches to help analyse a player’s sweat as they train and compete. These patches are useful for monitoring health signs, gathering data to boost recovery, and eventually improving athletic performance. Sweat analysis can provide information about the many solutes in a person’s body, such as sodium, chloride, potassium, ammonium, lactate, proteins, peptides and even alcohol; and

e.  Wearable technology – Examples of successful implementation of wearable technology include the Catapult OptimEye S5. The device was used to great effect by the English Premier League Club, Leicester City, when it defied all odds to win the 2015-2016 Premier League title. Players wore small, pocket-sized GPS trackers on the back of their training tops and the device helped track in real time a player’s acceleration, positioning, collision impact, intensity, and explosiveness during games and training sessions. The benefit of real time player updates gives the coach the decision making ammunition to make an instant substitution, change strategy during the game, or make a decision that could decide the fate of the match and sometimes the season. Wearable devices have also been successfully used across different sports by teams such as the NFL Club, Denver Broncos, NBA team, Sacramento Kings, the Brazil national football team, EPL football club, Newcastle United, and Dutch football club, Ajax.

How have cutting edge sports science technologies lifted standards of performance, training and rehabilitation?

Following are a few examples of effective usage and implementation of cutting-edge sports science technologies in elevating standards of training, performance, fitness and expediting recovery and rehabilitation:

Wearable Technology by Indian Premier League Cricket Franchise, Rajasthan Royals 

The Rajasthan Royals have implemented the wearable technology involving usage of athlete tracking device technology and helped raise their overall standards of player training, performance, recovery and rehabilitation. These devices relay near accurate information about player speeds and speed bands most frequented by players during their training. This in turn, helps coaches make a logical assessment about the match fitness of players by understanding the average and maximum speeds clocked by players while game-fit and performing at their peak. This data becomes particularly useful in assessing the match-fitness of a player who is returning from an injury. Adopting such a data driven approach also facilitates the coach-player communication when it comes to the non-selection of player on grounds of match-fitness. For Eg. A Player who is informed through data of his lack of match fitness and the progress he needs to make to be considered for selection is in a lot clearer headspace than a player who is blatantly told off about his lack of match fitness without any supporting data to back it up.

Whole Body and Localised Cryotherapy by Lebron James

The NBA Superstar has incorporated the whole body and localised cryotherapy^[7]technology into his everyday training routine for quicker recovery. The NBA involves a gruelling schedule, which increases the possibility of suffering from repeated nagging injuries. Cryotherapy helps him reduce inflammations, swellings, muscular stiffness and speeds up his recovery and healing. This has helped him maintain peak physical fitness, prolong playing time and optimise performance.

Why the UAE is an attractive destination for sports science/rehabilitation?

One major obstacle in opting for complex injury treatment in state of the art globally accredited hospitals is the high cost involved. By focussing on offering affordable quality specialised healthcare services and raising the overall standard of healthcare infrastructure, the UAE has emerged as the go-to destination for sports injury treatment and effective recovery and rehabilitation.

The UAE government along with the Ministry of Health and respective health authorities within the Emirates have each had a big hand in driving medical tourism, improving the healthcare standards, attracting greater investment and boosting the healthcare industry.  This has been made possible with the introduction of new initiatives, travel incentives and measures such as:

• In June 2016, the Dubai Health Authority (DHA), announced that all Dubai residents must be covered by health insurance and tied this requirement to the renewal and issuance of their UAE residence visas;

• Focussing on establishing a centre of excellence in sports medicine under the DHA Health Strategy 2016-2021;

• Increased healthcare spending, with the UAE projected to have the highest projected annual compound growth rate in public and private healthcare spending in the GCC of 9.6% between 2017 and 2022;

• Establishment of 45 free zones^[8] within the region which promote ease of doing business through relaxed business regulations such as, (i) permitting 100% foreign ownership of enterprises/foreign direct investment in enterprises, (ii) permitting 100% repatriation of capital and profits (iii) complete exemption from payment of corporate, income and export/import tax and (iv) ease of start-up and licensing procedures.^[9];

• The introduction of the 10-year visa for highly specialised professionals, such as doctors and researchers; and

• DHA’s launch of the Dubai Health Experience (DXH), the first medical tourism portal in the region enabling tourists to book their entire medical holiday online; 

Such initiatives have helped the UAE medical tourism industry grow at healthy annual rate of 5.5 per cent to reach Dh 12.1 billion in 2018^[10].  This growth momentum shows little sign of slowing down and could reach 19 billion by 2023^[11].

Legal considerations of opening rehabilitation establishments:

Licensing Requirements

Those interested in setting up health care establishments and/or working as medical professionals within the UAE are required to obtain a licence to practice professionally and, additionally, a licence to set up the health establishment from the authority concerned, depending on the nature of establishment. For example, healthcare professionals intending to carry on healthcare services and/or run a healthcare establishment in Dubai must:

• Obtain a healthcare professional licence to practice from the Dubai Health Authority (DHA) and must at all times conform to the requirements relating to eligibility to practice and general licensing requirements provided under the Unified Healthcare Professional Qualification Requirements; and

• Obtain corporate licenses from the DHA and Dubai Department of Economic Development and comply with the DHA health facility guidelines.

Framing Certificate of Need Guidelines

In its endeavour to constantly advance health care services, the DHA is in the process of framing Certificate of Need ^[12](CON) policies and guidelines for facilitating need based investments in health care sector. The purpose of CON is to prevent oversupply of healthcare services and direct investment towards underserved areas in the public interest.

Future Potential in the UAE

Overall, the growth potential of sports science and healthcare service industry in the UAE looks extremely bright with a Government that is proactive in its policy making to attract medical tourists and increased investment in this sector. With the slew of initiatives and measures launched by the UAE Government to advance healthcare services, and the resultant demand created, it is only a matter of time before the UAE emerges as a global sports science hub.

Ujjwal Ashok

Written under the guidance and supervision of Andrew Moroney (Associate,Sports and Event Management Practice,Al Tamimi & Co.) and James Mcmillan (Senior Associate , Regulatory and Investigations Team, Al Tamimi & Co.)

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Footnotes

• ^[1] According to a new research study published by Global Market Insights, Inc
• ^[2] Compound Annual Growth Rate
• ^[3] According to a new research study published by Global Market Insights, Inc
• ^[4] Minimally invasive” means that instead of operating on patients through large incisions, miniaturized surgical instruments are used that fit through a series of quarter-inch incisions 
• ^[5] As per the Sports Medicine Market Analysis and Global Forecasts carried out by Markets and Markets Research Pvt. Ltd
• ^[6] Middle East and North Africa
• ^[7] The application of cryogenically cooled air to specific parts of the body
• ^[8] A free zone or free trade zone or free economic zone, is a designated geographical area where certain taxes or restrictions on business, employment or trade do not apply in the same manner that they apply to the country in which the zone is located as according to the website of Dubai 
• ^[9] As According to the United Arab Emirates Government Portal 
• ^[10] As per the analysis of the Dubai Chamber of Commerce and Industry.
• ^[11] Government of Dubai, Media Office
• ^[12] A Certificate of Need (CON) is an endorsement that numerous states require before approving the construction of a new health-care facility