DOs at the Tokyo Olympics share the joys and challenges of working with world-class athletes

This month, James Lally, DO, is attending his seventh summer Olympics as the chief medical officer for the International Shooting Sports Foundation.

Over the years, Dr. Lally has personally witnessed a number of historic U.S. Olympic moments, including seeing members of USA Shooting win gold medals in 2008, 2012 and 2016.

However, he loves the global nature of the games, and also delights in seeing big wins by athletes from other nations. The international win that stands out the most to him is from 2008, when he watched sport shooter Abhinav Bindra become the first person from India to win an individual gold medal in any sport, in the 10-meter air rifle category.

“The amount of emotion that went over this guy was so incredible and made everybody cry,” says Dr. Lally, who is also an AOA Trustee.

Joining Dr. Lally in Tokyo are Alexandra Myers, DO, team physician for USA Rugby, Naresh Rao, DO, team physician for the USA Water Polo men’s team, Jonathan Finnoff, DO, chief medical officer of the U.S. Olympic and Paralympic Committee, and Kentaro Onishi, DO, who will be supporting athletes as a sports medicine physician.

The DO spoke with Dr. Rao, Dr. Myers and Dr. Lally to get an inside scoop on the highs and lows of practicing sports medicine at the highest level. Following is an edited Q&A.

Walk us through what being a physician at the Olympics looks like?

Dr. Lally: As a team physician for USA shooting, I help with preparation, travel arrangements and anything else that is needed. I will get there a few days before the games start. It’s my responsibility to make sure that the venue is ready from a health perspective. With COVID, it’s a little different this year.

When the games start, my responsibility will shift to athletes in competition. I’ll liaison with a local doctor who will be there to help take care of any athlete who needs local health care.

The Olympics is pretty autonomous. They bring a small hospital with them and they put it in the village. They use outlying hospitals, but the coordination is pretty phenomenal. Athletes have gotten top-notch care at every Olympics I’ve been to.

What does the pre-Olympics prep looked like?

Dr. Myers: For rugby, athletes train at the Chula Vista Elite Athlete Training Center in Southern California. I practice in San Diego, so I see them on a regular basis.

Whenever they have injuries during training, or when they’re competing abroad, they come back and I see them here. In a given week, I’m seeing one or two players. So it’s a pretty close-contact situation.

I also cover their scrimmages. The men had Argentina in town recently, and the women had Brazil in town.

How are you anticipating this year’s games to be different due to COVID?

Dr. Myers: The safety protocols are necessary, but they will make things more complicated. The process of traveling to Japan will be more arduous because we will have a five-hour screening session with the Japanese government when we arrive, after a day of travel.

My teams are mostly vaccinated. There’s one person on each team who has refused vaccination.

But Japan has not widely vaccinated their population, and their Olympic volunteers aren’t vaccinated. So I’m concerned about our exposure there.

Once we are there, we have to carry our phones on us physically 24/7 because the Japanese government is going to randomly do FaceTime phone calls with us. To confirm our location, we have to keep our Bluetooth on at all times, so that they know where we are. They’re going to use our phone data to do contact tracing.

What should viewers watching your sport be looking for when they watch the Olympics?

Dr. Rao: For water polo, on my team, the men’s team, our team captain is Jesse Smith and this will be his fifth Olympics. He’s phenomenal.

The women’s water polo team won gold medals at the 2012 and 2016 Olympics and are favored to win gold this year as well.

Dr. Myers: Olympic rugby is a very quick game, so you have to pay attention. There’s no stoppage time. In football, when the ball is down on the ground, the play is over. But in rugby, it’s continuous play until somebody gets a try, which is like a goal or touchdown. You have to keep watching the ball.

Dr. Lally: A lot of people don’t know that the first gold medal of every summer Olympics is the women’s 10-meter air rifle. Worldwide, shooting sports are very popular, but in the U.S., they are usually broadcast in the middle of the night. But people can stream the competitions on the NBC website.

Vincent Hancock is our most accomplished shotgunner in skeet. He won gold in ’08 and ’12.

What do you like most about working with Olympic athletes?

Dr. Lally: The athletes have such incredible passion and drive. The joy that they have from winning and the despair that they have from losing is so extreme that it’s overwhelming, even for spectators.

Dr. Rao: I love being in the field, by the pool, and traveling with the team. It’s a family—the athletes, the staff, and the families. I’m honored that they trust me to take care of them, and it’s very gratifying to help them.

What are the greatest challenges of working with Olympic athletes?

Dr. Myers: It’s a huge time commitment, and at the same time, I don’t get paid for this role. It is a voluntary role.

Also, no matter what the injury is, you want to know the answer right away. But I have to get insurance authorization to get an MRI, I have to arrange for my patients to see a specialist. There are a lot of demands on my time for communication and coordination of care.

Dr. Lally: It’s a lot of time and a lot of traveling. Being away from your job and your family.

But it is for the greater good. It’s a wonderful thing to be at the opening ceremony and see your country’s flag and know your work is helping the athletes.

What are the common injuries you see in your sport?

Dr. Rao: In water polo, the most common things we see are overuse injuries, especially in the hips and the shoulders. The hips are because of the rotatory forces that they have to endure.

There’s a lot of tugging and pulling and wrestling in the pool, and the shoulders take a lot of force because there’s a lot of shooting and blocking and swimming. We also see plenty of trauma.

Dr. Myers: In rugby, we see lots of broken hand bones, broken fingers and concussions. The big thing we worry about is spine injuries. We’ve had a couple this year, but they weren’t catastrophic. One of our athletes went through getting a cervical disc replacement and rehab and getting back into contact sports.

The laws of rugby are constantly evolving to make it safer when it comes to head injuries. Over the years, the referees’ union has altered the legal and illegal moves that can be done with tackling. They’ve also implemented protocols for recording and monitoring follow-up assessments after head injuries.

What advice would you give to medical students who would like to become team physicians for athletes competing at the Olympics one day?

Dr. Myers: I recommend shadowing a sports med physician and working with local sports teams. When I was in residency, I worked with one of our ER doctors who covered high school football. I took over the high school football coverage, and I had three years of high school football experience before I got into fellowship, which was super helpful.

You may have to recalibrate your income expectations. Sports medicine is not the highest paid specialty, and most of the cool jobs are actually volunteer positions. At the same time, there are ways to make more money in sports medicine. There are all sorts of new injection therapies that are available for athletes. I don’t personally do a lot of those because I wanted to maintain a family medicine practice in addition to doing sports medicine.

Dr. Rao: Remain curious and continue learning. Find a mentor through the American Osteopathic Academy of Sports Medicine. Get out in the field and volunteer your time. Time is tight, of course, but if you love it, you will make it happen.

Related reading:

Road to Rio: DOs help Olympic athletes go for the gold

“Doc Thor” recounts his time on The Titan Games, journey to sports medicine