Physical therapists may not be standing on the podiums at the awards ceremonies at the 2010 Olympic and Paralympic Winter Games in Vancouver, British Columbia, but PTs will have played crucial roles in helping the athletes go for the gold.

“It’s a huge role,” says Richard Quincy, PT, MS, ATC, medical director for the United States Ski and Snowboard Association. Quincy will volunteer with the U.S. Alpine Team throughout the Olympics and eight days later with the U.S. adaptive ski team at the Paralympics. “Physical therapists are an essential part of the team, along with the coaches, along with the physiologists, along with the sports science people. They are one more piece of that fabric that makes it [Olympic and Paralympic competition] incredible.”

About 5,000 international athletes are expected to compete in 86 medal events in seven sports during the 17 days of the Olympics, Feb. 12 to 28. More than 1,000 athletes are expected at the 64 medal events in 10 days of sports during the Paralympic Games March 12 to 21.

“The athletes are incredible specimens of performance,” says Bob McCormack, an orthopedic surgeon who was the Canadian Olympic Committee’s chief medical officer for the Beijing and Torino Olympic games as well as this year’s games. “The flip side is that they also consume a lot of physical therapy services because they’re expected to deliver and they push themselves to the extreme. It’s not unusual during the Olympics for the physical therapists ... to work 18 hour days.”

Ten PTs (two dually credentialed as athletic trainers) will be going to the Olympics as staff with Team USA. That staff will be supplemented with volunteer PTs to provide adequate therapeutic services for the athletes. Quincy says there will be a PT, an ATC or a dual-credentialed clinician at each of the ski and snowboarding residences. “We’ll have to be self-sufficient in each of those residences to do treatments,” he says.

Equipment was shipped to Canada months ago in preparation of the teams’ arrival. Quincy left for the Olympics Feb. 2 to make sure all the facilities are set up in the different residences for the Alpine skiers.

Once the athletes arrive, the focus will be on pain management and recovery, Quincy says. “Recovery post-workouts,” he says. “Recovery pools, recovery massages, stretching, massage — treatments of minor injuries because any athlete who has a major injury isn’t there.”

Quincy says he can’t wait to see the culmination of their efforts, achievements, accomplishments and what they do when they get there. “And it doesn’t have to be a gold medal every time,” Quincy says. “It’s just a matter of them having success and having their best performance. If it’s a gold medal, fantastic — watching their faces, watching their thrill and realizing that you had a small part of it.”

The Paralympics will be a homecoming of sorts for Jessica Tidswell, PT, DPT, ATC-L, CSCS*D. Prior to her current position as the resident physical therapist at the Center of Excellence for the U.S. Ski & Snowboard Association in Park City, Utah, she not only was a PT for the U.S. adaptive ski team, but wore hats as an assistant coach, team manager and photographer as well. She will be reunited with her old team when she volunteers as head PT for the team during the Paralympics.

A former elite skier herself, Tidswell suffered a career-ending pelvic fracture several years ago. “I worked with a team of physical therapists and athletic trainers, which is why I became a physical therapist,” she says. “I thought that working with the disabled skiers was the perfect marriage of physical therapy, skiing and ski racing.”

Tidswell developed a year-long strength and conditioning program to help the adaptive skiers work out throughout the summer, ensuring that they were strong enough and flexible enough during ski season. Although each athlete’s program has many common elements (for example, all the wheelchair athletes had a rotator cuff strengthening component), she customized workouts for the athletes to take into account their varied medical conditions and ages (ranging from 18 to over 60).

During the games, she anticipates that most days the athletes will do the typical warm-ups, stretching, skiing and recovery, “whether it’s spinning on a bike, whether it’s doing some contrast bathing with the hot and cold tubs, putting ice on their sore extremities, massage, or just coming in for PT treatments should they have a new injury or illness.”

Tidswell expects that with the visually impaired and standing class skiers, the two most common injuries will be ACL injuries and back injuries — just like with the Olympic athletes. The sitting class athletes compete seated in monoskis and wear poles with skis at the bottom strapped to their arms. They are more likely to suffer injuries to their upper extremities, head and neck, because their lower extremities are strapped to the monoskis.

The goal of treatment during the games — Olympic or Paralympic — is to get the athletes safely back into competition, Tidswell says.

Though the method of skiing may vary from their Olympic counterparts, Paralympic skiers are no less motivated. “So when we go to the Paralympic Games, especially for our top performers, it’s, ‘I want that gold medal.’ End of discussion,” Tidwell says.

Some of the PTs traveling to Vancouver have been on the road with the athletes all year, which comes with its own challenges.

Gillian Honeyman, PT, SCS, CKTP, didn’t know much about snowboarding when she first started working as a PT for the American team. “One of the things in the Olympic qualifying process is that you’re going through the highs and lows of every athlete and it becomes a challenge of supporting those who don’t achieve their goals,” she says. “I’ve seen the highest of highs and the lowest of lows.”

Tara Fontenot, DPT, ATC and head physical therapist of the U.S. Women’s Alpine Ski Team, once found herself careening down a mountain road on a two-hour odyssey from La Parva, Chile, to Santiago as she and her team rushed an injured athlete to the nearest CT scan machine available. “We had an athlete crash training downhill and she had a head injury but we weren’t sure of the severity and we also couldn’t rule out internal bleeding,” Fontenot says.

Fontenot says that one of the most daunting aspects of providing PT services is the lack of equipment. “I usually treat out of my hotel room, so I’ve learned to rely mostly on manual therapies for treatment,” she says. “Also, the injuries usually don’t have obvious solutions. For example, if you saw a patient in the clinic with chronic non-specific LBP, the first thing you would do is get them on a core strengthening program, but all these girls already have incredible core programs so you have to think outside the box, which is good.”

Many of the issues that the Olympic PTs deal with might not even warrant an office visit for non-contenders. “They are relatively minor in the grand scheme of things,” Fontenot says. “But those minor aches and pains can be a big difference in races that are decided by hundredths of a second at times.” •

Jane Ammeson and Anne Federwisch are contributing writers for Today in PT.