As Boston Falls for Scotland, an MCPHS Expert Explains What the World Cup Does to the Body

From 8-mile matches to hydration breaks and recovery science, physical therapist Steven Lachowski breaks down the physical toll of soccer's biggest tournament.

The Scottish invasion of Boston became one of the unexpected stories of this World Cup.

From Faneuil Hall to Fenway Park, thousands of supporters clad in tartan have transformed the city into a sea of blue-and-white flags, bagpipes and orange traffic cones. They've drunk Boston bars dry, marched through downtown streets singing “Flower of Scotland” and earned a reputation as perhaps the tournament's most enthusiastic traveling fan base.

The affection has become so mutual that Mayor Michelle Wu announced plans on June 18 to establish a formal partnership between Boston and Glasgow, citing the goodwill generated during the tournament and the growing connections between the two cities.

For many Bostonians, it felt like a weeklong love affair.

But while Scottish supporters are logging miles between pubs, fan zones and Red Sox games, the athletes they're cheering for are enduring one of the most physically demanding tests in sports.

What exactly happens to an elite soccer player's body during a World Cup?

To answer that question, we spoke with Dr. Steven Lachowski, an associate professor of physical therapy at Massachusetts College of Pharmacy and Health Sciences (MCPHS), board-certified Orthopaedic Clinical Specialist and former collegiate soccer player. Lachowski completed an Orthopaedic Residency at The Ohio State University Sports Medicine Center and recently earned a PhD in Physical Therapy. His doctoral research examined the impact of soccer specialization on adolescent athletes, focusing on strength, neuromuscular performance and athlete burnout. He also remains clinically active, working with athletes throughout the year.

"Soccer is certainly one of the most energy-consuming sports that there is," Lachowski said. “World Cup players typically run between 6 and 8 miles during a World Cup match, and midfielders will tend to run the most."

That’s not a leisurely jog around the Charles River. It is activity filled with explosive sprints, sudden stops, sharp cuts, physical collisions and constant changes in direction. Players may cover more ground in a single 90-minute (plus extra time) match than many fans walk in an entire day, all while operating at an elite level of skill and decision-making.

The challenge becomes even greater in summer heat. Performance-impairing heat is about 82.4 degrees. Lachowski said that’s one reason FIFA introduced hydration breaks during this year's tournament. Rather than stopping play outright, officials allow players opportunities to hydrate during natural breaks in the game.

"We're looking at a lot of hydration-related muscle fatigue," Lachowski said. "Cramping is a big one."

The injury risks are familiar to anyone who follows soccer. ACL tears remain among the most feared injuries, but ankle sprains, groin strains, calf injuries, Achilles’ problems and other soft-tissue injuries are common concerns throughout a tournament that can stretch more than a month. The World Cup winner will play eight games in 40 days.

Fortunately for today's players, sports medicine has become dramatically more sophisticated than it was even a decade ago. Lachowski said he remembers when having an athletic trainer felt like a luxury for college athletes. Today, World Cup teams travel with physicians, physical therapists, athletic trainers, nutritionists, sports psychologists and performance specialists. And increasingly, they rely on technology.

Many players wear GPS tracking devices beneath their jerseys that monitor heart rate, distance traveled, acceleration, workload and movement patterns in real time. Medical staff can watch the data from the sidelines and alert coaches when a player begins approaching a threshold associated with fatigue or elevated injury risk.

Those numbers, he said, can influence game-changing decisions, like “putting a pitcher on a pitch count.”

During the United States' opening 4-1 victory over Paraguay, star midfielder Christian Pulisic was surprisingly substituted at halftime despite helping the Americans build a comfortable three-goal lead. Lachowski pointed out that decisions like that often reflect long-term thinking rather than short-term strategy.

After taking contact to his calf, Pulisic's walking pattern appeared altered. Rather than risk worsening an injury, the United States chose caution. "The team opted to protect one of its most valuable players for the matches ahead.”

The philosophy reflects a central reality of tournament soccer: surviving can be just as important as winning. Once group play begins, recovery becomes a science.

"The first 24 to 48 [hours] is a lot of active recovery," Lachowski said.

Players spend those days focusing on mobility work, nutrition, hydration and sleep. Minor aches and injuries are addressed before they become larger problems. Training intensity is carefully managed throughout the week, gradually increasing before tapering again as the next match approaches.

The planning is remarkably detailed. Teams account for travel schedules, time-zone changes, practice loads and nutritional needs. They monitor not only physical stress but also mental stress.

"That cognitive load is a huge amount," Lachowski said. “Imagine carrying the expectations of an entire country while competing before millions of viewers worldwide. Then imagine doing it after running 8 miles in 90-degree heat.”

That's the reality for World Cup players.

"The amount of planning that goes into this in preparation for the next game while recovering from the last is remarkable," Lachowski said.

What fans can learn from the pros

It turns out the recovery strategy for World Cup fans isn’t entirely different from the one used by elite athletes. Both groups are battling heat, long days and physical fatigue. One side is running 8 miles against world-class competition. The other kilt-clad group just made their way to Miami for Scotland’s next match against Brazil on June 24, where temperatures are nearing 100 degrees.

Different challenges. Same solution.

"Hydrate," Lachowski said with a laugh.

Maybe add some sunscreen. Maybe mix in a glass of water between beverages.

Then get back out there.

There are still 56 games to go.

Who Are You Rooting For?

Watch our Cardinal on the Street to find out who the MCPHS community is rooting for to win the World Cup.