Heavily injured Toronto FC makes changes in medical department

Injury-plagued Toronto FC is parting ways with its chief medical officer.

A source, granted anonymity because the MLS club had not announced the news, confirmed Dr. Ira Smith’s departure from the team after more than a decade’s service. The decision was mutual, according to the source.

The change is not the first on TFC’s medical side this season. Adam Brett, whose resume includes stints with England’s Tottenham and Brighton, was brought on board in early July as director of player health and high performance.

TFC had been without a sport science head since director of performance César Meylan left on the eve of the preseason to rejoin former Toronto coach John Herdman with the Indonesia men’s national team.

Toronto’s lengthy injury list has been a cause of concern for some time.

Davies, Crépeau will miss Canada’s World Cup homecoming games in Toronto, Montreal

News of Smith’s departure comes the same day that TFC announced defensive midfielder Nelson Palacio is out for the season after undergoing thigh surgery. The 25-year-old Colombian has not played for the team since joining in early July in a deal with Real Salt Lake that cost Toronto US$1.1-million and up to US$550,000 in conditional cash if certain performance-based metrics are met.

Smith has extensive sporting ties, having also worked as an assistant team physician with the Toronto Raptors as well as the Canadian women’s basketball team and Canadian synchronized skating team.

Smith, who served as FIFA medical officer in Toronto during this summer’s World Cup, did not immediately return a telephone call Wednesday.

The Toronto training room has been full for much of this season, averaging as many as seven players listed as either out or questionable on the league’s official weekly injury list through early July.

The low point came in the last two fixtures before the World Cup break. Ahead of the May 16 game at Charlotte, the league injury report listed 12 Toronto players as out and one as questionable.

At the time, Toronto general manager Jason Hernandez said TFC was “top three” in the league in terms of injury burden this season.

While those numbers have thinned in recent weeks – captain Jonathan Osorio (knee) designated player Djordje Mihailovic (thigh) and Palacio were the only players listed as unavailable for Saturday’s 3-0 loss at Orlando City – Palacio has been a sore point.

The Colombian made 34 appearances in all competitions last season on loan with FC Zurich. Prior to that, he had appeared in 55 games for Salt Lake across the 2023, 2024 and 2025 seasons.

Hernandez told reporters last week that the club was “heartbroken” over Palacio’s health issues, given his lack of injury history and efforts to get back in action.

“He’s been quite robust … I feel for him,” he said. “He joined us in a moment where he had a lot of downtime. He came in, obviously passed the medical and the whole bit and was having a tough time getting himself going and dealing with the niggling issue.”

Hernandez cited the team’s “conservative approach” in dealing with injuries – a pathway he said that sometimes led to “more drastic” measures.

“So for me, it’s a real question mark about the efficiency in which we are given the remit to move these players along. Because we waste time,” he added.

What started as “some lower-body soreness” turned into season-ending surgery for Palacio.

“We’re all left disappointed,” Hernandez said. “But ultimately Nelson wasn’t brought here for a four-month project … We’ll get through this challenge now and get him as right as he needs to be.

“I think he’ll make the supporters very happy when he gets himself right,” he added.

In his Sept. 9 virtual availability, Hernandez said the team was “looking at what improvements we need to make in the medical space.”

“Ultimately the responsibility sits with us – and with me – to ensure that we have all the right people and the right processes and the right standards that support all our players and to get everybody out there performing at their optimal level. And like with every single department that we’ve had at the club, that we’ve looked to revamp and improve and revise, we won’t stop. We’ll do it in every space in this club … to make sure we’re operating at the best standard we can.”

While MLS requires teams to have a chief medical officer in place, TFC can cover the position through other MLSE medical personnel for the time being.

Toronto (6-8-11) currently sits 12th in the 15-team Eastern Conference but has shown a marked improvement on the pitch in recent weeks as players return to action. Prior to the Orlando loss, TFC had gone unbeaten in its last seven league outings (3-4-0).

Palacio is in his final year as a U-22 Initiative roster player, having signed with Salt Lake as such. Under league rules, U-22 Initiative players come with a reduced salary budget charge – US$150,000 for players 20 and under and US$200,000 for players 21 to 25.

Palacio, whose actual salary last season was US$473,167, has won one cap for Colombia, in a friendly against South Korea in March, 2023, and represented his country at the youth level.

The task of keeping players healthy will be tested next year during Major League Soccer’s so-called Sprint Season, a truncated 14-game regular season that starts in February and ends with the MLS Cup in May.

The shortened campaign serves as the precursor to MLS’s move to align its schedule with the world’s top leagues. The 2027 MLS regular season will kick off in mid-July and conclude with the playoffs and MLS Cup in May, 2028.

The Canadian climate does not help Toronto’s efforts to keep its players healthy. Injuries are a constant, especially at the start of the season with wintery conditions forcing players to train on artificial turf and then play on natural grass.

Hernandez, a former TFC player, said the team’s preseason preparations this year were not helped by record rainfall in Spain where the team held its camp.

The club is looking to make significant improvements to its training ground, such as adding underground heating to its natural grass fields so it can avoid having to train on artificial turf under a bubble-style dome, that covers outdoor venues in the winter.