The orthopedic surgeon's role in youth sports amid COVID-19

The orthopedic surgeon's role in youth sports amid COVID-19

As athletes head back to the courts, fields, and rinks, team physicians find themselves in uncharted territory. As we're learning from watching major league sports, there is no exact science on how to play sports safely during a pandemic, but there are certainly plenty of complications and potential setbacks.

Team physicians have always played an important role in youth sports teams. But this year, their responsibility is even greater: to develop a clear plan with athletic departments and local government officials that mitigates the spread of COVID-19 among youth athletes. While there is no one-size-fits-all solution to this dilemma, I have a few thoughts on how to establish a plan that suits your organization by utilizing what we currently know.

First, it's important for team physicians to commit themselves to be part of the return-to-sports conversation. Their usual responsibilities include establishing a chain of command for injury and illness management, clearing athletes to participate in sports, and making return-to-play plans. This year, they'll need to add prevention of viral transmission, and possibly outbreak management, to the mix. If there is an outbreak of illness on a team, it would be helpful if the team physician already had the contact information for relevant colleagues (eg. primary care physicians or infectious disease specialists) who can immediately offer assistance.

Due to scheduling backlogs, some athletes may have difficulty obtaining a physical evaluation in time for play. This means that team physicians will need to play a greater role in the 2020-2021 seasons in facilitating pre-season evaluations and ensuring athletes are fit to play. If an athlete has recovered from COVID-19, a team physician will need to be especially thorough with their cardiac exam and ensure all proper screening is done to stratify risk. A team physician may choose to consult colleagues for a more thorough cardiac evaluation (in the form of an electrocardiogram or even echocardiogram) to rule out myocarditis.

As play begins, team physicians can advocate for a greater grace period in the first part of the season. This will ensure athletes have time to build up their fitness level. Physicians can raise awareness of possible deconditioning and the need to factor in seasonal conditioning into the regular season.

Many athletes may have been away from training and the gym for an extended period of time, so this year's transition period needs to be handled strategically to prevent serious injuries. In the typical off-season, athletes go through a period of recovery, followed by conditioning, strengthening, and then building explosive power. By the time the season begins, athletes are usually at (or close to) game shape and headed towards peak performance. But because this off-season looked so different from the usual ones, the focus needs to shift back to generalized conditioning even as play begins. Team physicians can also emphasize the importance of cross-training in injury prevention. A combination of strength, endurance, balance, agility, and coordination training will greatly benefit athletes who have been out of the game for a while.

As the season goes on, a gradual increase in athlete workload can be recommended. However, team physicians still need to remain acutely aware of signs of fatigue that happen earlier on in the participation than normally expected. They can recommend a greater amount of substitution and rotation to allow shorter bursts of maximum energy as athletes work back to full power. For example, a baseball pitcher could start with just three to four innings and see how they perform and — very importantly — how they recover afterwards. In football, coaches can utilize more of the bench, rotating athletes out more regularly so no one plays more than two quarters. Physicians should be highly interactive with the coaching staff and athletic department in the evaluation of the condition and fatigue of individual athletes.

Educate — thoroughly and often

Finally, education is of paramount importance in managing the risk. Team physicians should be an educational resource and create a sense of a medical home for the team. They should make time at the beginning of the season to speak to all stakeholders — including the entire team of athletes, coaching staff, and the athletic department — to educate everyone on the real risks of COVID-19. It can be hard for young athletes to absorb the importance of following guidelines put into place. Many of them may have a feeling of immortality and are not yet skilled at-risk analysis. This conversation may sound like: "We've created an opportunity for you to participate and do what you love to do. Now we need you to make a commitment to the safety and wellbeing of others in your life. Your actions will not only affect you, but will also affect your parents, grandparents, your coaches, and their loved ones."

As part of a team physician's education effort in managing the risk of viral transmission, here are some areas they can consider discussing with the team:

● Transportation: If buses are being used to transport athletes, then the athletes should wear a mask and sit as far apart as possible. Hands should be sanitized before and after riding the bus, and the bus itself should be disinfected. Of course, the best-case scenario is private transportation to games, therefore avoiding the need for group buses. ● Spectators: The audience should be kept to the bare minimum. Spectators should be socially distanced throughout the stadium or arena and should also wear masks and sanitize their hands often. ● Team personnel: All non-players, such as coaches and scorekeepers, should wear masks and frequently wash their hands or use hand sanitizer. Social distancing should be practiced to whatever extent is possible and care should be taken when managing equipment to avoid possible cross-contamination. ● Players: Even though they may not like it, players should try their best to follow social-distancing and sanitation guidelines. When they're not in the game, they should wear masks on the bench. ● Sharing isn’t caring: Athletes should not share clothing, towels, food, or water bottles. In the locker room, each athlete should use their own toiletries (eg. soap or shampoo), and towels should go directly into the hamper after first use. ● Celebration: While handshakes, high-fives, and chest bumps are out, athletes can get creative in celebrating victories. Because team gatherings of all kinds should be avoided, team celebrations should be done digitally via social media or team videos.

Given the new set of responsibilities and the complexity of adhering to local, regional and national regulations — as well as working with public health departments and sports-specific organizations — the role of team physicians will look very different this year. They'll need to work closely with athletic departments, coaches, parents, and athletes to promote compliance with team rules related to COVID-19. My hope is that with their commitment and diligence, the game can go on.

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