Paul Balsom: Six essential learnings for building an MDT
Written by
Training Ground Guru
February 24, 2025
From helping pioneer the use of sports science at Bolton Wanderers to winning the Premier League with Leicester City to working with the Sweden national team for 26 years: Paul Balsom has been at the vanguard of football performance for more than three decades.
Few know more about building a multi-disciplinary team (MDT), which is why we asked Balsom to present on the subject at TGG Live 2024. TGG Members are able to watch Balsom’s full presentation HERE.
You can watch Paul Balsom’s full presentation – and the others from our industry-leading TGG Live Conference – by becoming a TGG Member. To find out how, click below.
He began his session at St George’s Park by sharing his definition of an MDT: “A group of professionals from diverse specialities working collaboratively to support the holistic needs of the players, the Head Coach and the club.”
He added: “We need to recognise that players are the visible force behind every victory, but the MDT empowers them to reach their peak potential. Stars shine brightest when supported by a galaxy of experts.”
Balsom has seen an exponential growth in the MDT since he first began working in football. One of his first roles was at Bolton Wanderers and he described then Manager Sam Allardyce, with whom he worked at the club from 2002 to 2004, as a “pioneer”.
“When he took over in 1999 at Bolton, he inherited seven staff,” Balsom remembered. “Five years later, seven had increased to 40 and I was very fortunate to be one of them. We had some great people in that team.
“Sam’s big thing – and something I will never forget – was making sure that the MDT functioned together as a team. We had off-site days when the psychologist would take us away, we had team building activities.
“He was very pioneering in bringing that team together and making us realise the importance in our role in supporting the players. He said that while I might not have the money to buy the best players, I can recruit the best support staff.”
Balsom has worked with a lot of top staff during his career. At Hull City, they had a young Head of Performance Analysis called Laurence Stewart, who is now the Sporting Director at Chelsea.
“Laurence has gone on to have a great career,” Balsom said. “When we came to Hull, he didn’t have an office. We got him an office in a broom cupboard.”
Leicester City, where Balsom was Head of Performance Innovation from 2011 to 2021, proved the value of sports science and the MDT with their miracle Premier League win in 2015/16.
“I was very lucky to be part of the MDT at that time,” Balsom said. “The players won the Premier League and we were able to support them by having the lowest number of injuries – 18 in the whole season.
“We didn’t have two games a week, we were knocked out of the league and FA Cup early and had no European competition, but facts are facts.”
If we look at the Premier League in 2024/25, the typical MDT is completely different than it was even a decade ago.
“The MDT is no longer just a medical and sport science department, it’s a lot broader than that,” Balsom said. “We are surrounding the players with specialist care from all the different areas of expertise, allowing them to perform consistently.”
We now have performance departments, with fitness coaches, strength and conditioning coaches, nutritionists, sleep experts, biomechanists and more; medical, with a Head of Medical, doctor, physios, therapists and osteopaths; and data science, where roles include performance data analyst, training analyst and performance physicist.
A big question is who should lead the whole MDT and Balsom had an interesting suggestion after listening to an opening presentation by Dr Claire-Marie Roberts, Coventry City’s Performance Director.
“It struck me this morning, after listening to Dr Claire-Marie, that maybe a psychologist should be at the top of the tree, especially in the bigger teams, where we are talking 40 plus staff,” Balsom said.
After a record 26 years as Sweden’s Head of Performance, Balsom is now working as a Performance Consultant with Tigres in Mexico. He described it as a country, “where football is huge but the MDT isn’t.”
He added: “Sport science isn’t offered at the Universities. They pretty much had nothing and didn’t even have a reference as to what high performance looked like, but I was very fortunate to have a direct relationship with the President and we were able to sit down and talk about what investments were needed.”
Balsom concluded his presentation by sharing six essential learnings for building an MDT:
1. Staff recruitment
Paul Balsom: I spent the first year-and-a-half at Tigres treading water. That was until one appointment – Oscar Tojo, who came in from the Portuguese Football Federation and changed things overnight. It was a real eye opener for me and showed the importance of bringing in not just the best-quality people, but also the best fit.
We changed things in a very small period of time and Oscar became a great friend of mine. I am still big on keeping the Mexican staff, but am also supporting them with Continued Professional Development (CPD). I think it is quite easy to forget that and it’s so important. We need to show the Mexican staff where the next level is and give them the tools and the chance to get there.
2. Organisational support
This is about commitment and full support from above, whether that’s from the owner or the Board. It’s so important. If any of you are applying for jobs, I would urge you to find out about the people above. Are they going to support you? Hopefully they will.
Without that, it’s almost impossible.With Sam (Allardyce), we used to have breakfast meetings with bacon butties and talk about the importance of sports science. So you are always trying to educate – both the coaches and the people up above.
It also ensures that we, as an MDT, gain the trust of the coaches, players and owners, which allows us to make decisions and to have an impact. It’s not just about investment, it allows us to build an identity and to have an impact.
3. Return on investment
The players are the club’s biggest asset: we need to take care of them, because they need to perform. So we need to build an MDT that can support the players. I also want to build an infrastructure where staff want to be at the club and develop together. I don’t want people leaving and for there to be a high staff turnover.
4. Organisational infrastructure
It’s amazing that I still see clubs and practitioners that don’t have a clear job description, don’t have roles and responsibilities and don’t have KPIs. I have just put together a whole page of KPIs for a Medical Doctor Co-ordinator.
It’s not about injury stats, it’s about things that he or she can control: how many staff are doing CPD, how is the transition from analogue to digital, how is the security around our data.
5. Communication
I will pull out one thing here as an example: onboarding.
Imagine when a new coaching staff come in: ‘Here is my nutritionist, neuroscientist’ and so on. It’s the same for new players too, it is a must. I have been guilty in the past of coming into a new team and getting introduced to the players 10 minutes before the first training session and off you go.
Suddenly you’re there, six months later, and wow, some of you don’t know what I’m doing. Some of you don’t even know who I am!
6. Data driven
Data, data hygiene and security are so important.
All of our strategy should be based on some form of data. Data doesn’t make decisions, humans do, but it’s important that it’s there for us. We also need to make sure that the data we are using is consistent and accurate. This is so important.
And I can promise you that it isn’t always consistent and accurate. As soon as I see an outlier, my first thought is, ‘There’s something wrong.’ And more often than not there is, so we need to be on our toes when it comes to data hygiene.
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