The Premier League is is hailed by many as the most competitive (and, therefore, best) league in the world. It is the most watched football league in the world too, with millions of fans supporting from the stands and at home across the globe.

Having the opportunity to manage in the Premier League is deemed a privilege. But, just how much does working in the top flight affect a manager’s health? Treated.com dug a little deeper to see what risks await the most powerful managers in league football. 

Stress

Stress can affect anyone, but having such a high-pressured and public job can make these managerial roles even more stressful. If the squad you’re managing are having a bad run of games, all eyes are on you rather than your players. You are responsible for the bad days and rarely receive credit for the good ones. You have to manage a team of players, your extended squad, and your backroom staff, ensuring the whole operation can run smoothly. It’s a lot to expect of one person. 

There are stresses and worries with the team itself. With the ever-changing nature of the Premier League, some management tenures are a flash in the pan so when you arrive at a new job, you’ll inherit a squad you had no say in. This can bring ego and even subordination. It’s your job to decide who plays and who doesn’t, leading to upset. Any issues with your line up choices, management styles and the club itself can lead to negative press when it comes to players - they are known to speak out in the media or give unfiltered views on their social media accounts. 

You have to battle to be liked off the football pitch too. You need your club’s loyal fanbase to get behind you, as they will be vocal if they aren’t. Football fans are quick to turn on managers, expressing their disdain loudly in the stands before taking to social media to tell you how they feel. Even if you don’t use social media yourself, fans have been known to target the family members of football managers. Then there is the issue of how you’re perceived in the media - your interviews, their opinions and if there is any doubt on your abilities, it’ll be splashed all over the back page of a newspaper. With such an intense working environment, you will struggle to switch off, leaving you feeling stressed, isolated and increasing your blood pressure. 

With the incessant nature of the job, it’s clear to see why Premier League managers are at risk of burnout. Burnout is defined as the “physical or mental collapse caused by overwork or stress”. As much as Premier League managers love their job, the passion they have and the constant connection to work can take its toll physically and mentally.

Loneliness

A football manager’s job can be lonely. Being offered a top job could mean upping and moving miles away from home - the club will more than likely help you with the move, but it is a tiring and stressful experience. If you have family commitments, it may not be viable for them to move with you either. During his time as Manchester United manager, José Mourinho famously lived in Manchester’s Lowry hotel. When Mourinho managed Chelsea in 2015, he stated that he is a “lonely guy in this modern world of football.” 

It is not just The Special One who has opened up about feeling alone. Former Swansea manager Garry Monk spoke up about the transition from player to manager and how difficult it can be. Monk said, “It can be a lonely job. It’s all consuming, you have your home life, you don’t really have a social life, it can be hard… People look at you differently because you are responsible for what goes on, on the pitch.

“The players have been great with the transition but you don’t get invited to meals anymore… That lonely feeling is worse when things aren’t going well. You bear the brunt for it all as the manager.”

Whilst some managers have been outspoken about how the job can make them feel, and there is a much more open conversation surrounding mental health in football, not everyone will be as honest about how they feel. Due to the culture created within football, it can leave managers suffering in silence and not getting the help they need. 

Dr. Daniel Atkinson, Clinical Lead, Treated.com spoke about the dangers of loneliness in one of the most sought after jobs, “Being a football manager may seem glamorous but the effects of loneliness are huge. It’s not just your mental health that it takes a toll on, there are physical aspects to worry about too. Cardiovascular disease and stroke are linked to loneliness, so it is important that football managers put their health first.” 

Irregular working hours

It’s not as simple as your team are playing at 3pm on a Saturday every week. Premier League games are spread out over the weekend, depending on the time of year. Should your club be competing in cups and in Europe, that means an even busier schedule with added irregular hours, often in the evening. 

What about the time you spend off the pitch? There’s more to managing a football club than showing up for your league game and taking training. You must spend vast amounts of time thinking about tactics, checking in with scouts, analysing your game and your opponents. 

In 2016, Aitor Karanka spoke about the lengths he would go through before a Premier League fixture. With a deep focus on analysis, Karanka and his staff would look at video footage to find issues, sift through hundreds of pages on each player on the opposing team and potential tactics as well as suggesting a line up for the next game. Being so thorough is important for success, but it can mean long, intensive working days for the manager. 

Working so much and in differing patterns can affect the sleep of a Premier League manager. It is estimated that one in three people in the UK suffer from insomnia, and not having a regular working pattern can contribute to this. Having difficulty sleeping can affect a manager’s ability to concentrate and can leave them feeling tired a lot of the time. 

Fatigue

Taking into account the hefty reading list week in, week out, alongside the travel and the pressure to keep your team afloat, it’s likely that managers will feel the strain and could suffer from fatigue. 

Your location can play a huge part in it as the more you have to travel, the bigger toll it will take on your body and mind. The Stats Zone have determined that Newcastle will travel the most in the 2019/20 season, racking up 4,444 miles and the average matchday trip covering 233.9 miles. Steve Bruce and his squad will travel almost 1,000 miles more than any other club in the league.

The demands of a Premier League manager’s job can lead to poorer diet choices if they’re suffering from fatigue and working often unsociable hours. Not being able to keep to a routine for mealtimes and going to bed can lead to weight gain and a lack of vital vitamins. Relying on fast food, sugary snacks and caffeinated drinks will seem like a quick fix to get by but can cause health issues further down the line. 

Avoiding your own health problems

Men who take up high profile positions in football management tend to be of a certain age (most commonly over 40). Men in this age range, whether they’re football managers or not, are more prone to developing medical conditions like high blood pressure, high cholesterol and prostate problems.

The early signs of conditions like these can be very easy to miss. And keeping such a busy working schedule can mean that unusual symptoms might be dismissed, when really they merit attention from a doctor.  

When speaking to Prostate Cancer UK, former Premier League manager Alan Pardew admitted that managers can often neglect their own health because of the intensity of their job. Pardew said, “Managers absolutely neglect their health. You’re so engrossed in your job that you kind of ignore it… You’re totally busy and you think ‘Oh, I’ve got a slight problem there’, and you put it off to the next day and start thinking about something else.”

Being so engrossed in your own job that you don’t consider your own health, may it be an ache, pain or a mental health issue, is a problematic approach. Leaving a problem and trying to forget about it won’t help to cure it. Your health is your biggest asset and it’s important to keep it in check. 

However, it’s not just Alan Pardew who has supported Prostate Cancer UK. A number of Premier League managers have donned the Man of Men pin, including former Newcastle boss Rafa Benitez, Manchester City manager Pep Guardiola and Liverpool’s Jurgen Klopp. Around one in eight men in the UK will get prostate cancer at some point in their lives, with men over 50 most at risk.

Anxiety 

Feeling uneasy, worried or fearful defines anxiety which can be expected for the men who manage in the Premier League. One of the biggest worries for managers, arguably, is the lack of job security. Even if you sign a long-term contract, there is no guarantee you would ever fulfill it.

A handful of poor results, in spite of your opponents strength is enough for you to lose your job. It can leave you feeling unsettled throughout your tenure, and it can be difficult to find someone to confide in and relate to. Getting sacked is an incredibly public affair - you’re likely to be faced with media interest and considerable analysis into where it all went wrong, whether you want the attention or not. It can also have a detrimental effect on getting a new job due to your dismissal playing out so publicly.

Losing your main source of income can be anxiety-inducing, particularly with nothing lined up to supplement it. If you’ve signed a long-term contract, you’ll likely receive a payout but unemployment could trigger your anxiety and exacerbate feelings of loneliness.

Dr. Daniel Atkinson commented, “Financial worries can lead to anxiety and depression. It’s demotivating having your job loss out in the public domain, but it’s key that a football manager stays active, plans their next move and keeps a daily routine. If you’re struggling after losing your job, please speak to someone to get some help.” 

Heart problems

In 2005, the World Council of Cardiopulmonary Rehabilitation released the results of their two year study into the health of football managers, which highlighted that 44% of football managers working at the time had “significant cardiovascular risk factors, some needing immediate attention.” 

The issues discovered included high blood pressure, dangerous levels of cholesterol, atrial fibrillation which is a chaotic, irregular heartbeat arising from the top chambers and aortic stenosis, the narrowing and hardening of the heart’s main outflow valve.

Aside from the study, the heart issues of Premier League managers has been well-known, with a number succumbing to illness. In 2001, then-manager of Liverpool, Gerard Houllier had 11 hour open heart surgery in order to save his life, having fallen ill during a game. 

Just nine years later, Premier League veteran Sam Allardyce experienced discomfort in his chest. Because of his poor health, he missed three Premier League games with Blackburn Rovers, who he was managing at the time. Allardyce underwent a coronary angioplasty - a procedure that widens blocked or narrowed coronary arteries. 

Dr. Daniel Atkinson commented, It may seem surprising how common heart problems have been for Premier League managers. It’s so important to look after your heart, so get your blood pressure checked, keep active and if you’re a smoker, you should seriously consider quitting.”

Smoking

Smoking in public places was banned in 2007, so neither a spectator nor a manager would be able to have a cigarette within a stadium. However, football managers smoking is not an uncommon thing. Former Arsenal manager Arsene Wenger has smoked in the dugout way back when, previous Chelsea manager Carlo Ancelotti has been spotted with a cigarette, as has Liverpool’s Jurgen Klopp.

Although his tenure at Stamford Bridge has now come to an end, former boss Maurizio Sarri was renowned for a serious smoking habit. Reports claimed that Sarri would smoke as many as 80 cigarettes a day, roughly four or five within an hour. 

The nicotine in cigarettes makes them addictive, and inhaling it can reduce feelings of anxiety. The more you smoke, the more your brain gets used to the nicotine rush associated with smoking, so you have to smoke more to feel it.

Such an excessive smoking habit increases the risk of developing other serious illnesses. Smoking is responsible for the majority of lung cancer cases in the UK but it can also cause cancer of the mouth, throat and kidneys - to name just a few. Your chances of having a heart attack, stroke or even pneumonia increases with smoking. 

Drinking

The Premier League may have eradicated its drinking culture, but it’s not unheard of for a manager to have a tipple after a game - often inviting the opposing manager to join him. It keeps football related issues to the pitch, shows solidarity and it gives you an opportunity to unwind after a game.

The customary tradition is still alive and well, but it is important that we all (Premier League managers included) drink responsibly. The recommended intake of alcohol is 14 units a week, which for a low-alcohol wine (11% ABV) works out at around a bottle and a half.