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Behind The Scenes With Pro Cycling Physiotherapists

20 Oct 2014
Randall Cooper
It sounds like a dream job, and for many young physiotherapists that I meet it’s the ultimate aim, to travel with a sporting or pro cycling team around the world. And you’d be forgiven to think that the job is straight forward and easy - just tag along with the team, massage and stretch the athletes after they have competed, and watch the races unfold from the team bus. Heaven! But it’s not as glamorous as it seems. Long stretches away from home, family and friends as well as long repetitive days are the norm for physiotherapists who travel with our best cycling teams. Robert Brown is the Head Physiotherapist for Orica GreenEdge, and he describes a typical day whilst on tour with the team…

“Staff meet at 7am for a run and/or exercise session. Dan Jones, the team’s video producer usually brings a set of boxing gloves pads. These proved a hit, with our owner Gerry Ryan and sponsors also participating in the exercise sessions. A healthy body is a healthy mind.  8am is breakfast. After breakfast I attend to any riders that may require treatment, and prepare nutritional and hydration requirements for the stage. This is usually race food and water for the team bus and carbohydrate and protein drinks and food for after the race. On the bus, before the stage I assist riders with preparing for the stage, such as strapping and hands-on treatment.”  

“During the race I stay on the team bus and travel to the finish. Here I prepare food and drinks for the riders for after the completion of the stage. I will sometimes be required to go to the finish line and attend to riders if we make the podium or if they have doping control. As the riders finish and come to the bus I assess each rider. If the rider has a complaint or injury I will attend to them on the bus.” 

“Back at the hotel I help coordinate the riders post-race recovery: massage, ice baths, compression and stretching. I assess each rider and treat any complaints they may have. 8.30pm is dinner and then a staff meeting. The directors will debrief the day (what went well, what didn't and how we can improve) as well as organizing and planning for the next day. The medical staff and directors will then meet to discuss appropriate course of management for any riders with injury concerns.” 

Robert rarely gets to bed before 10.30pm, and will get up again at 6.30am the next day to do it all again. If you’ve got a rider that is very sore and needs additional treatment time, you either go to bed later or get up earlier, or both.

The team physiotherapist is also a key in monitoring the riders’ physical and mental condition. Obviously the medical team is responsible for any injuries that have already occurred, but there’s a big push now to try and prevent injuries before they occur, and monitoring the athletes’ overall wellbeing is a key component of this. Head Physiotherapist and Physical Therapies Co-ordinator for the Cycling Australia High Performance Programs David Hayes describes how he does this when on tour with our National Teams. 

“Knowing the athlete well and learning to pick up on non-verbal cues is very important, so a level of familiarity with the athlete is paramount to effective management. Very few elite level athletes will openly admit that they are tired, sore, sick, or carrying an injury due to the effect this may have on their ability to race and be available for selection. Having said this, talking to the athlete in appropriate circumstances can reveal a lot about how they are feeling and what may be compromising their current ability. It is important to establish a relationship of mutual trust, whereby the athlete recognises that you have their welfare and subsequent ability to perform to the best of their ability at the forefront of your mind.  Talking with other staff who have regular contact with the athletes can also assist in building an overall picture of the athlete's current condition.” 

As well as being familiar with the rider and their general disposition, various objective measures are also taken each day and combined with the staff’s subjective feel for the rider. “These measures include weight, resting heart rate, blood pressure, and rider ratings on how are they feeling, quality of sleep, eating habits, and fatigue levels” says Robert Brown.

Information and data provided by the riders helps the team not only prevent injuries, but also helps to fine tune the athletes to perform when it counts. When competing in an event such as the Tour de France riders just aren’t capable of maxing themselves out everyday. If a rider is flat and fatigued they may be instructed to back off for the day and let the others shoot it out. Or you can use the data to make sure your hill specialist is ready to go when the tour gets in the mountains. The information can also be used to influence management off the bike, such as increasing recovery strategies or letting the rider who is struggling to sleep well get their own room for a couple of nights.

Unfortunately injuries occur in cycling and it’s the physio and doctor’s job to help manage the process from start to finish. Robert Brown explains his role; “If a rider sustains a serious traumatic injury from a crash (eg. Concussion, broken bones) I may be required to accompany the rider to the hospital. Other than that a serious crash is more of a medical issue and would be managed by the team doctor. If the injury is less serious (eg. contusions, abrasions, muscle or joint strain) I will assess and treat the rider directly after the stage on the team bus. Once we arrive to the hotel I will conduct a more thorough examination and provide treatment to allow the rider every change of participating in the next stage.”

Occasionally, riders and injuries can place the medical staff in difficult situations. Being a medical professional your duty of care and responsibility is to your patient, in this case the rider. This relationship in principle should also be confidential. However you’re employed by the team, and have been employed to not only help manage injuries, but assist the team win races. When an athlete comes to you and says “I’ve had a really sore lower back for the past few days and I can’t shake it. I’m losing power in my legs and the pain is distracting. I need you to help me, but don’t tell the other athletes and coaches, I don’t want them to know as my spot in the team is in the balance”. What do you do? What if you feel that their lower back pain is only going to get worse and the teams performance will suffer? It’s a tricky and ethical situation that many sports physios encounter, and takes a good deal of experience and skill to deal with effectively. The best resolution for the athlete and team is for the athlete to divulge their injury to their team on their own, but you earn your money and spot on the team by getting to this outcome without the athlete losing trust in you.

David Hayes remembers an intense time leading into the Olympic Games; “Cycling is a physiologically demanding sport, often requiring athletes to work at the limits of their physical capacity and capability. Being injured often compromises an athlete's ability to 'go deep', and so this effect on performance often dictates whether an athlete is able to compete or not. The most challenging times of late surrounded pre-Olympic preparations in 2012 - this period is like a steam train that stops for no one. What it takes to win and to train accordingly is fine in concept, provided the inevitable niggles and more acute injuries are well managed and respected. Experiencing the heat of coaches and trainers who expect athletes to be free of compromise (injury) can be a tough but rewarding challenge.”

One further challenge to a physiotherapist on tour with a pro cycling team is continually changing location. When you’re in your own practice, you’ve got everything available and ready to go such as rehabilitation equipment, ice machines, tapes etc, but when you’re on the road you’ve got to basically set up your ‘clinic’ every time you move. And sometimes you don’t know what’s going to be available at the next hotel. “The logistics of implementing injury management and recovery protocols on the road is a major hurdle.” says Robert Brown. “There is only a small window of time from when the riders arrive to the hotel until dinner. For example, at the Giro d’Italia, the transfers are so large the riders may not get into the hotel until 9pm at night. Ice baths are great for recovery but where can you get ice when you are staying on top of a mountain in the middle of the Italy?” Successful tour physios are the ones who plan ahead and have contingency plans for situations like this. Team managers charge you with the responsibility that elite sports medicine and sports science is available to riders all the time. No excuses.

Logistics, long days, medical and ethical issues aside, the hardest part of being a physio on tour is fitting in with the teams rules, customs, and culture. Many sports physios and doctors just don’t last, and survive only one tour or stint with a team. The physios who are there for a holiday, insisting they have their own time to sightsee and rest don’t last long. I also know of physios who thought they were one of the athletes and partied a bit too hard or became a little too friendly with other athletes of the opposite sex that were sent home. It’s a professional job, and it needs to be handled as a professional. The best physios and doctors are epicenters of stability within the team and not only fit in, but also influence how the team conducts itself. David Hayes puts it well; “Having an understanding and appreciation of the pressures on both athletes and coaching and support staff is paramount. Knowing when to voice an opinion and when not to is very important in ensuring harmony, and making sure your personal goals align with that of the rest of the high performance team. If personal accolades and recognition are high on your list of priorities, find another environment to work in as this doesn't gel well with the team concept”.

It’s also interesting to hear what Robert Brown has to say about his role in team culture, “GreenEDGE was hatched with a vision from Gerry Ryan to apply the Australian sporting principles and culture of hard work and cutting edge medical and sport science, to form an Australian based World road cycling team. Culture and principles that have seen many Australian sporting teams and athletes achieve success on the world stage. As an Australian sports physiotherapist I contribute to the team's philosophy of creating our own culture beyond the highest ethical standards and sports and medical science protocols. We work hard to win races, and we have a great time doing it.”

Life on the road with a pro cycling team, or any sporting group for that matter is a challenging but very rewarding experience. If you ever get the chance to travel locally or internationally with a team I would encourage you to do it, but it’s not for everyone. The touring experience allows you to work with some of the world’s best athletes and help them a little on their path to success. You get taken to places that are amazing and at times frightening, often meeting unique people and forging life long friendships along the way. The lessons and values you take from being part of an elite organization permeate your whole life and you’re a better person for being involved.

Photo Credit: Neil Walker

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