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Editor's note: With the news of Therese Alshammar's pinched nerve injury just days before the start of the swimming competition at the London Olympics, today's editorial is a timely look at the crucial role sport medicine personnel play at the Olympic Games.
Guest Editorial by Scott Rodeo, MD
NEW YORK, New York, July 27. WHEN the 2012 London Olympic Games open today, team physicians will be playing an essential behind-the-scenes role in the preparation of their nation's athletes. I will be attending as official physician to the United States swimming team, as I did at the 2008 Beijing Games and the 2004 Athens Games. Swimming — always one of the highlights of the Summer Games — will begin on the first day of competition (July 28).
Like team physicians from other nations and in other sports, my job is to help keep the athletes (and coaches, managers, and other staff) healthy. At the Olympic Games, team physicians will treat both musculoskeletal injuries as well as medical illnesses. For swimmers, common musculoskeletal problems include shoulder pain, low back muscle strain, and patellar (knee cap) pain. Common medical illnesses include upper respiratory tract infections, cough, sore throat, and gastroenteritis.
Other issues that we address include jet lag, adjusting to new foods, dehydration, and problems with sleep. Swimming in new pools with varying water quality and chemicals can lead to sinusitis and other upper respiratory symptoms. The stress of travel and international competition can also lead to transient alterations in immune function and result in some of these illnesses. The team physician's job is to anticipate and treat all of these issues in a timely fashion.
Athletes become successful by intense preparation; similarly, the success of the sports medicine team is also based on thorough preparation. We start by assembling a team that includes a physician, a certified athletic trainer, and massage therapists. We travel with a comprehensive supply of medications, physical therapy equipment (including ultrasound and electrical stimulation units), massage tables, and other essential items. I arrange for local physicians and hospitals that will be available to our athletes in the event of any emergency while at the Games. Over the years I have developed an expanded set of physician colleagues all over the world who have been available to help our traveling athletes.
Our preparation for the London Games started well over one year ago. We identified our staff members and communicated frequently. We stocked our medical bags, and our trainers arranged for all of their supplies. Local medical contacts were arranged, in London as well as at the sites of the domestic training camp (Knoxville, Tennessee) and the overseas training camp. The U.S. Olympic Swimming Trials were held just prior to the Games (June 25-July 2), so we have been busy reviewing the athletes' medical histories as the team was assembled. I will personally review each athlete's medical history, and any medications that he or she takes, and will speak to their local physicians as needed.
Once we arrive in London, all members of the U.S. team will stay in the Olympic Village. There, the U.S. Olympic Committee will set up a sports medicine clinic that will be available to all members of the U.S. delegation. The overall U.S. sports medicine team has a comprehensive staff of physicians (both orthopedic surgery and internal medicine), athletic trainers, physical therapists, chiropractors, massage therapists, and a pharmacist. All of the U.S. team physicians will provide coverage in the clinic.
In my capacity as physician for the U.S. swimming team, I will cover the pool swimming team, as well as diving, synchronized swimming and open water swimming. When I am not at the swimming venue during training or competition, I will be staffing the clinic. When I am not covering those obligations, I will assist other sports and athletes until the end of the Games (August 12).
An important role of the team physician is to supervise the doping control process. Athletes undergo urine and blood testing after competition. They can also be tested randomly at any time (“no advanced notice”). The physician must know how the process works in order to ensure that all steps are carried out appropriately. The physician must also know what medications are banned in order to be sure that no such medications are used by our athletes. For example, some over-the-counter cold and cough medications contain banned stimulants.
Some athletes may need to use medications that are on the prohibited list for a legitimate medical problem (for example, some medicines for asthma or attention deficit disorder, and insulin for diabetes). In this situation, we help the athlete arrange for a “Therapeutic Use Exemption” (T.U.E.). The dangers of unregulated over-the-counter supplements are constantly discussed with the athletes.
The Olympic Games are unique in challenging the best of the world's athletes and uniting the world in a single pursuit. The opportunity to serve as a team physician is truly an honor and a privilege — and one that plays a key, if often overlooked, role in the perpetuation of the Olympics as the ultimate in global sports competition.
Scott Rodeo is Co-Chief of Sports Medicine and Shoulder Service
Professor, Orthopedic Surgery at the Weill Medical College of Cornell University;
Attending Orthopedic Surgeon, Hospital for Special Surgery; Associate Team Physician, New York Giants Football