The Olympics, Medically Speaking

The author and her mother in Olympic stadium at the 1996 Olympic Games in Atlanta

Citius, Altius, Fortius is the Olympic motto. Translated from Latin this is Faster, Higher, Stronger. Names like Carl Lewis, Michael Johnson, and Michael Phelps and so many more are synonymous with the Summer Olympic Games.

As a child, I was fascinated by the Games. In the summer of 1984, I was nine years old and watched almost every minute of it. I was glued to the TV as Mary Lou Retton captured the gold medal in the individual all-around gymnastics competition. I wanted to BE her, even though I had never taken a gymnastics class and was already taller than her. But, it led to a love for the institution and planted a deep respect for competition at the Olympic level. This led to my Olympic “moment” as a summer volunteer at the 1996 Games in Atlanta. It was the closest I would come to my Mary Lou-like moment.

As the 2016 Games approach—August 5 through 21 in Rio de Janeiro, Brazil—we start to hear about today’s athletes and wonder as we do every two years: How DO they do it?

Practice, hard work and even genetics play a big role, but these star athletes don’t do it alone. Olympic-level competition requires a support team of coaches, physicians, physical therapists, counselors and motivational and behavioral support.

“So much of success at this level is a brain game,” said Cory Newman, PhD, a professor of Psychology in the department of Psychiatry, who over the years has treated a number of elite athletes in his practice at the Center for Cognitive Therapy. “These athletes compete at levels in which they must maintain unwavering focus and concentration and in which there is little to no margin of error. The rigors of their training can also cause high anxiety about potential injury; if an athlete is injured, they can’t perform at their highest level, which often means they can’t win. Also devastating is the prospect of having a ‘down day’ on one of the most important days of their career, such as the Olympic trials.”

Newman has also counseled athletes about life after their athletic career, helping them see the value of their unique skills in the areas of self-discipline, overcoming fatigue and maintaining self-confidence in spite of adversity, and channeling these into other areas of interest.

“Every person and situation is different,” he said. “Their histories of training, competing, traveling, and dealing with pressure are so rich. I learn at least as much from working from these patients as they learn from me.”

Gary Dorshimer, MD, chief of General Medicine in the department of Internal Medicine at Pennsylvania Hospital, traveled to the 2014 Winter Olympics in Sochi, Russia as a consultant for the National Hockey League (NHL). He served in the same role at the 2010 Vancouver Olympics, 2002 Salt Lake City, and 1998 Nagano Olympics. He is also the Head Team Physician for the Philadelphia Flyers and team internist for the Philadelphia Eagles.

“We dealt with everything from minor injuries to concussions,” Dorshimer said of his Olympic experience. He currently works alongside several Penn neurosurgeons who serve on the sidelines at Eagles home games as independent consultants providing clinical expertise in cases involving head trauma and concussion.

Among them is M. Sean Grady, MD, chair of Neurosurgery at Penn Medicine.

“I think, increasingly, a head injury is understood by players and coaches to be no different from an ankle or knee injury: the body needs ample time to heal before it is safe to use the injured area again, said Grady, in advance of this year’s Super Bowl to weigh in on the concussion climate. “There are also now known long-term consequences to not letting the brain heal from a traumatic injury such as a concussion.”

Real risk for concussion exists in Olympic sports, including soccer, equestrian events, rugby and more.

It is clearly a concern of the International Olympic Committee’s (IOC) Executive Board (EB). According to the Rio 2016 website, the IOC EB recently reviewed the technical decision of the International Boxing Association (AIBA) to remove the head guards for male competitors at the Olympic Games. While this may seem counterintuitive, the AIBA provided medical and technical data that demonstrated that the number of concussions is actually lower without head guards.

Brian Sennett, MD, chief of Sports Medicine and Vice Chair of the department of Orthopedic Surgery and Rahul Kapur, MD, a Family Medicine and Sports Medicine physician, have both worked with athletes at the top of their game. Three years ago they were leaders of a multidisciplinary team of Penn Medicine physicians supporting the Philadelphia 76ers of the NBA. One of their main roles was to make sure all players are medically “cleared” for play at the start of each season. Sennett is still involved in as a consultant for the team.

Olympic athletes also undergo medical testing to test their overall physical condition. In addition, they are tested rigorously for use of banned substances, known as “doping”. The test consists of both blood and urine. The first five finishers of each Olympic event are immediately tested following their heat.

“Today’s athletes now also have a fear of inadvertently taking a banned substance,” noted Newman. “They know that even an over-the-counter medication can taint or end their careers, and that leads to tremendous anxiety.”

The IOC now has one of the strictest drug testing protocols in all of sport. Olympic athletes can be randomly tested 24 hours a day, 365 days a year, no exceptions, with penalties from two years to a lifetime ban on Olympic competition.

And so, for a fortnight in August, I will again watch with the world as athletes push themselves to the brink of exhaustion and injury and run, jump, row and swim for the gold at this year’s games, with more knowledge than ever about the physical and emotional supports holding up each and every athlete.