Let the Games begin

Dissecting the medical side of major athletic events
Jonathan Maister
February 18, 2014
By Jonathan Maister
The bleachers and box suites at major games are occupied by thousands of enthusiastic and excited spectators. Those fun-filled moments are the realization of a process, the evolution of a final product, so-to-speak. Athletes have spent countless hours honing their skills for the competition. Likewise, for every group of fans taking in the sights and sounds of the spectacle, there is a large number of people who have helped organize the occasion and support it while it is happening.
It could be argued that a major game resembles a large rock band concert, but on a far grander scale. At such an event there are travel consultants and equipment movers. Often, construction is involved, and stage managers, medical people, officials and volunteers are present.

The Pan Am and Parapan Am Games bearing down on Toronto in 2015 will be such an event — perhaps second in size only to the Summer Olympics. In fact, sport venues stretch across Ontario’s Golden Horseshoe — from Welland to Oshawa and from the downtown area up to Lake Simcoe.

The Pan Am Games — to be held July 10 to 26, 2015 — and Parapan Am Games — to be held Aug. 7 to 14, 2015 — will include countries from North, Central and South America, as well as the Caribbean. Some 41 national teams, totalling close to 7,000 athletes, will be participating. Competitors will represent their countries in 36 sports and 15 sports in the Pan Am and Parapan Am Games, respectively.. Around 20,000 volunteers are needed to make these events a seamless and outstanding success for .

An event of this magnitude requires medical personnel of all stripes — emergency medical personnel, athletic therapists, massage therapists with a sport massage background, sport physiotherapists, sport chiropractors, sport physicians, orthopaedic surgeons.

Prior to participation, all must receive accreditation, which often involves a police check to determine that the prospective participant does not have a criminal record.

Participants are briefed on a number of topics — some obvious and others less typical. Athletes must be a ware of cultural considerations with different athletes, health issues with participants (Think Special Olympics where participants have special needs), equipment issues (depending on the sports, wheelchairs, helmets). Cooperation protocols for different professionals must be established so everyone knows what his or her role is in the team.

Participants in medical teams have indicated that at special events, recognition and respect for the skills of different professionals is far better than in the regular medical system. It is a common lament that, if only the daily medical system mirrored sport events, patients would have superior and faster medical care.

Preparing medical coverage is multifaceted. The logistics of various locations are important. Depending on the size of the contingent competing at that location, more personnel will be required. Who staffs that location also depends on how far it is from a major hospital and what events are taking place. Motor cross and skiing events may be farther from a major hospital compared to, say, track and field events, and might need a more comprehensive medical presence. Injuries are more likely to occur with certain sports hence, professionals trained in emergency care will be more of a presence in events with higher risks of injury, like rugby. On the other hand certain events, such as swimming, are more likely to require massage. Hence, the profile of the medical professionals present depends on the sport and location.

Larger foreign teams do come with their own medical team.  The insurance of their medical staff indicates they may work with their own athletes even though they are in Canada — which to them is a foreign country where their insurance usually does not apply. The corollary is that the Canadian host medical team may work with all athletes — foreign and Canadian — so long as contact occurs in Canada. Foreign medical doctors may assess their own athletes and suggest treatment or medication, but their Canadian doctor counterparts will then have to prescribe the appropriate medication.

Frequently, when a variety of languages are spoken, translation services will be required. The Pan Am Games will most likely have English as a predominant language. However, French and Spanish will also be official languages of the event. Volunteers are asked, if possible, to brush up on their Spanish and French.

Medical personnel at major games can be divided into three groups. Individual teams from all countries, including Canada, may have their own dedicated team therapist. This is usually someone who is very familiar with the sport and who has worked extensively with the team previously. Often, that therapist has themselves been an athlete in that particular sport.

Large foreign contingents will also have a core medical team who serve their athletes in general. There is also a host medical team provided by the home country, which is usually based somewhere central as well as in satellite clinics close to event locations. The host medical team serves all athletes — the host country's athletes, as well as foreign athletes. Smaller foreign contingents with little or no medical staff of their own will rely more heavily on the host country's host medical team.

Head therapists and physicians often have a cell phone dedicated to the event, enabling other staff to reach them at all times. In truth nowadays, it is realistic that everyone on the medical team will be equipped with a mobile communication device such as a cell phone. Health forms,record keeping and consent protocols must be organized. An emergency action plan (EAP) must be established with all involved personnel knowing exactly what to do in this eventuality. Equipment (stretchers, spinal boards, treatment tables, modalities), and supplies (tape, tensors, ice etc), as well as sanitizers for the equipment and hands must be available and paid for — hence, the value of sponsors. If concussions are likely in the sport, SCAT forms (sport concussion assessment tools) must be available. 

Massage therapy at major sporting events will focus on sport massage and when necessary, soft tissue work to treat injuries. Participating therapists would be wise to take a sport massage course to bone up their skills. This type of preparation is often a requirement by organizers to ensure that all therapists providing massage to athletes are fully equipped to deliver the best possible care.

Canada prides itself on the quality of care of its sport medicine professionals. Physiotherapy has a sport medicine designation (Sport Physiotherapist), much like  Chiropractors and MDs have sport medicine fellowships. Their presence will be reflected in the volunteer schedule.

Aside from the resume building and networking opportunity — which is substantial — participants report being part of such an event is as exciting as it is rewarding. Such an international sporting event comes only rarely to Toronto. This is absolutely an opportunity to be embraced.

All interested therapists are welcome to examine the event website for further information: http://www.toronto2015.org

Therapists interested in sport massage or participating in a sport event should start getting involved through their neighbourhood sport events. Year round, events are happening at the local and national level. Volunteers will gain experience in sport medicine, make contacts and improve their skills.

Information about a number of sporting events are available on the Internet. Sport massage courses recognized by the Canadian Sport Massage Therapists Association are held at regular intervals and are strongly recommended for therapists who wish to become involved with sporting events.

Jonathan Maister is a Canadian trained Athletic Therapist, Massage Therapist and Sport Massage Therapist. He is in private practice in the Markham, Ont., area and has lectured on a number of sport massage and sport medicine topics across Canada. He has authored articles that have appeared in various associated journals across North America. He can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 905-477-8900.

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