Behind the Gold: Sports Medicine's Role in Olympic Success

Cindy has made a significant impact covering events for various sports such as USA Gymnastics, Judo, Wrestling, Womens Soccer, Mens Paralympic Soccer, Cycling, Volleyball, Ultimate, and USA Boxing. Her most exciting role was with USA Taekwondo from 2013 to 2020, where she traveled with the Senior National Team to prestigious tournaments worldwide. She provided round-the-clock care and support at Grand Prix tournaments, Pan Am qualifications, and World Championship events across the United States, Mexico, Bulgaria, China, Japan, Russia, South Korea, England, and the United Arab Emirates.

It's great to hear directly from Cindy about her experiences and insights. Her journey is a testament to the dedication and expertise required to support elite athletes. Let's have a Q&A session with Cindy to learn more about her remarkable work and her unique challenges in Olympic sports medicine.

Q: How did your healthcare training prepare you for the specific challenges of working with elite athletes?

A: I have a unique background as an Athletic Trainer and a Doctor of Physical Therapy. Both of these professions have been pivotal in preparing me to work with elite athletes. As an athletic trainer, I am comfortable with emergency management, injury assessment, and keeping athletes "in the game." Additionally, as a manual physical therapist, I am equipped with additional methods to expedite an athlete's recovery from an injury. This could involve analyzing and correcting movement biomechanics to minimize the risk of injury or devising sport and position-specific rehabilitation programs to aid their return to their pre-injury level of performance. I love the combination of the two professions!

Q: What unique medical or health issues did you encounter when working with Olympic athletes that you don't typically see in the general population?

A: Time pressure is the most unique issue when working with this population. When working with elite athletes, you must keep them participating as much as possible, even when rest and rehab might be the "ideal" situation. Sometimes, these athletes don't have the time to take that time off; there might be a world event or a qualification right around the corner. They may be injured during a competition but must compete again the same day or the next day. So, you need to know how to judge your athletes to know how much they can push the boundaries without creating long-term detriment. There have been times in which I have allowed an athlete to compete with an injury (at an Olympic Team Trial event, for instance) where I would have told a recreational athlete, high school or collegiate athlete that they should not compete and would need to care for the injury before being allowed to compete again. This is mainly for musculoskeletal injuries in which there is not a high risk of long-term harm. On the opposite spectrum, some injuries require you to put your foot down, make the call, and not let them proceed. Athletes want to push through or hide the severity of what they are experiencing to get through the next event. Concussion/head trauma is one of those situations. It doesn't matter what level of an athlete you are; you will NOT be cleared to continue if there is suspicion of concussion. It is tough when they have been working for 2 to 4 years to get to the point of competing in a world-class event, and you have to decide and tell them that that is no longer feasible.

Q: How did you collaborate with other healthcare professionals (e.g., physiotherapists, sports psychologists, etc.) to support the athletes' health and performance?

A: Multiprofessional care is imperative for the care of elite athletes. I regularly worked with a team physician to make decisions regarding injury management. Whether it was the need to get imaging performed for diagnostic purposes or decisions regarding the need for surgery, depending on the Olympic ranking of the athlete, this care may be required to be obtained through the USOPC network of providers to be covered under their insurance, so there were many layers of loopholes to consider. Higher-level ranking athletes may qualify for other services at the Olympic Training Center, such as massage therapy, chiropractic, etc. The professionals I most often communicated with were registered dieticians (RD) and sports psychologists. RD's are a big part of success for athletes in weight-controlled sports. Suppose you cannot maintain your weight within your classification and must constantly restrict food for weight management. In that case, you will not have the proper fuel to perform. I had a few medical incidences with athletes new to the senior national team who did not understand how to do both. Sports psychology is another vital profession with which we have worked a lot. For performance, the pressure placed on an elite athlete is enormous, the pressure to perform and be THE BEST. This is especially difficult if managing an injury, not performing at their best, or recovering from surgery.

Q: What are some critical differences between providing healthcare in a traditional clinical setting and working with athletes at the Olympic level?

A: Time frames differ between providing care in a traditional clinical setting and caring for a world-class athlete. In a conventional setting, medical care and rehabilitation are done promptly if a person is injured. If surgery is needed, the surgery is performed, and rehabilitation starts. There may be some delays from insurance, or the person may have the luxury of waiting until it is a more convenient time. At an elite level, competitions are at set times, and everything is built within a four-year time frame. If an athlete at this level is injured, they may still have a critical competition in 3 weeks. You do not have the luxury of allowing a typical 6-8 week healing time frame. If a typical patient has to miss a game/tournament/competition, there is always the next one. This is not always the case with athletes eager to compete at the Olympics. They might not have that next chance. You may have to wait until the end of the season or after a critical competition to perform surgery, when they might have more recovery time without jeopardizing their ability to do what is needed toward Olympic qualifications. On the opposite spectrum, some things occur much faster. Typically, when a diagnostic test is necessary, the athlete in this population does not have to wait weeks for their MRI to be scheduled. Often, they can get a test performed within a day or two from the time of injury and the results back immediately to implement a care plan as quickly as possible. The system is just a little different.

Q: How can healthcare providers in other settings integrate some of the best practices from sports medicine to improve patient care?

A: In the care of an elite athlete, especially in rehabilitation, the more specific you can rehab that injury based upon their sport and position, the better the outcome will be. For instance, end-stage rehabilitation for an MCL (medial collateral ligament) of the knee should be different for a hockey goalie who has to quickly dive into a butterfly save, versus a shot putter who has to spin on his plant leg, versus a taekwondo athlete needing to perform an axe kick. It is easy to lose treatment specificity in a traditional clinical setting. You see the same type of injury so often in these settings, and you get comfortable with interventions and exercises that work well for that injury. This will get most people pretty far in their rehab process, and often, that is where people exit from the physical therapy setting. Typically, patients in a traditional setting don't get to the performance part of their care. Performance does not have to mean athletic performance; it can apply to performance in anything important in that person's world. If a patient is a mechanic and needs to lift heavy things overhead repetitively, daily, just instructing them in basic rotator cuff exercises is not sufficient to get them back to perform their required tasks. Every patient can and should be treated with the same specificity.

Q: How do you envision the role of healthcare professionals evolving in supporting the health and performance of athletes in future Olympic games?

A: I believe technology will be one of the most significant changes in supporting the health and performance of athletes. This may be protective technology, surgical advancements, or newer rehabilitation and injury care technology. If there is something out there that can legally create even a minuscule advantage, it will be utilized. Musculoskeletal Diagnostic Ultrasound, for instance, allowed healthcare providers trained in this intervention to immediately evaluate and diagnose muscle tears, ligament injuries, etc., without waiting for MRI or CT scans. Our team physician always traveled with an MSK (musculoskeletal) ultrasound. Blood flow restriction and dry needling are other interventions that have become much more common in supporting the care of athlete performance. Healthcare practitioners need to be aware of how to keep up with the ever-changing best evidence-based care and be able to integrate new treatment tactics aptly while weeding out the shams.

Cindy Endicott PT, DPT, FAAOMPT, ATC, Cert Dn.

Cindy Joined CEUFast, Inc in 2023 as a course planner.

Dr Cindy Endicott is a Doctor of Physical Therapy specializing in orthopedic and sports physical therapy. She has been a Fellow of the American Academy of Manual Physical Therapists since completing her Certification in Orthopedic Manual Therapy and Diploma in Manipulative Therapy, including advanced manipulations modules. She has 18 years of experience working in collegiate sports medicine and seven years in outpatient physical therapy practice.

She is currently a United States Olympic and Paralympic Center volunteer sports medicine provider. She has worked with the following Olympic National Governing Bodies: USA Taekwondo, Soccer, Mens Paralympic Soccer, Boxing, Wrestling, Cycling, Gymnastics, Judo, and Volleyball. She traveled as a team physio and athletic trainer for USA Taekwondo with the Olympic Senior National Team between 2013 and 2019, with extensive international travel to elite tournaments, world championships, and Olympic qualification events. She is on the medical advisory committee and a provider for USA Ultimate.