Dealing with Detours- Lessons Learned as a Sports Medicine Physician

I have become more comfortable dealing with detours

Detours are going to happen.

We like to live in the ideal world where performance and recovery both travel a straight line ahead without and obstacles or set-backs. After carefully evaluating a situation, we thoughtfully construct a comprehensive plan, then look to execute it with frank precision.

Then reality kicks in, and the detours begin.

When I was asked to speak on behalf of friend and colleague Benjamin Strack, PhD on his installation as 2017 President of the Orange County Psychological Association, I shared insights that have been taught as part of the team behind the team learning from our best teachers- our patients and their families.

My focus was on Dealing with Detours.

Let’s be real.

Our athletes certainly also do not like to admit that detours occur.

How many athletes when asked about the start of season are going to tell you anything other than they're going to have an awesome time, the youngsters are going to come through, the opponents aren’t that tough, and big accomplishments on the horizon.

Does anyone ever say that they're going to anticipate obstacles, team dissension, untimely injuries, more talented and prepared opponents, bad losses and maybe even firings?

Detours come in the crucible of athletics that often place unique demands on young athletes.

While some athletes can handle detours without the blink of an eye, others will suffer from anxiety, depression, and other challenging coping behaviors.

Those of us who serve as the team behind the team are charged with the task of helping build a supportive culture focus on big picture outcomes such as success in sport translating to success in life, building healthy habits, and yes, navigating those detours.

Our presence as a sports medicine team is based on reacting to detours. 

Just like no one athlete can emerge victorious to win all by him or herself, no good sports medicine effort is a solo performance. It is the ultimate function of a team that will often lead to the best possible outcomes.

Building the team behind the team and our relationships with athletes is a dynamic process.

The process starts with being available and that might be nothing more than hanging out at a practice, chasing volleyballs before gold-medal match, or helping fold towels between points. Those menial tasks are often the pathway to a higher level of engagement.

That availability also means being dealing with atypical situations at atypical times (before 9 AM and after 5 PM for certain) in atypical venues (on fields, over the phone).

No matter your level of availability to the team and athlete, you must keep your eye on the goal.

Developing trust that contributes to the ultimate short-term and long-term health of each individual patient.

This takes building a relationship.

When meeting with “the athlete” I attempt to separate the person from the the athlete identity.  I may also separate from my team physician role- first and foremost, my priority is to be the medical provider for the athlete, above any team or group commitments. 

Before asking about sports, I want to know what is going on in the life of the athlete: school, grades, outside jobs, family and friends, changes, substance use, sleep, appetite.

Once I get to know someone's goals, fears, and what truly is important in their life, then I feel I can make a greater impact with them. It often takes listening to the kid, independently from the parent, to meet these goals.

Be alert for transitions such as end of eligibility/career, injury, new team, new coaches, higher level of participation (intensive, summer camp, showcase). 

Remember to emphasize confidentiality. Teenagers especially are quick to shy away from anything that will cause embarrassment or public scrutiny. They may Instagram multiple things about their life, but then can hide behind a wall of silence when they feel necessary.

When I eventually get to the sports thing, I ask about:

• Demands of the sport- time, intensity, and level
• Team Dynamics
• Multiple coaches and teams
• Flux of rosters, positions, starting spots
• Travel
• Financial/time commitment
• Perceived role
• Perceived voice

 If you don't know exactly when an athlete does with the demands of their activity ask them. If they won't tell you then Google or YouTube it.

If there's been an injury, ask how the athlete is dealing with the new found free time away from sport demands.

Some find it liberating...don't be surprised.

Some don't  miss their sport.

This leads into one big thing I have learned- don’t assume anything. Let me repeat that. Don't assume anything.

Believe in the art of negotiation. Our job is to advise and offer suggestions not unilaterally dictate a treatment plan. Amazing how sufficient discussion leads to the best answers, and often the athlete is the one coming up with the best answer.

Be ready to be pummeled for specifics- "what exactly can I do"? This can be painstaking but is absolutely necessary.

 Allow exit strategies.

The ultimate best outcome of your professional involvement may not be wins or titles- it very well may not even be a return to sport. 

Sometime a preconceived detour is actually a path towards something more rewarding.

Offer to take the hit for the athlete- if decision not to play, put all the blame on the medical team.

Give athletes the opportunity select how they want to mourn an injury or decision to retire. Some will totally distance themselves from the sport or team, while others want to have an active role. Help them in this choice

Don't feel the need to be a hero or go solo. Feel free to share the burden of difficult cases.

Always keep common themes and consistent messaging with athletes, families and other professionals.

Respect the hard work, past efforts, goals, dreams and commitment of the athlete and their schedule, but don't make decisions strictly based on the next big event.

Even if it's the Olympics. 

Develop rapport before dropping bombs

Focus initially on performance enhancement. No kid will shy away from wanting to get better. Once you've built their trust and rapport, then you can delve into more of the sensitive emotional or behavior issues.

Learn to deal with uncertainty, with taking appropriately aggressive decisions that may work, or may run into those detours.

When confronted with setbacks or plateaus in recovery, continue to encourage the athlete. Try to limit conveying disappointment.

Finally, never wondering how to do something better, to keep learning, to keep finding more people to add to the team and help negotiate those detours.