Medical Needs of Paralympic vs Olympic Athletes

In this exclusive video interview, Jeremy Faust, MD, editor-in-chief of MedPage Today, sits down with Jonathan Finnoff, DO, chief medical officer for the U.S. Olympic & Paralympic Committee, to discuss the differences in providing medical care for Olympic athletes versus Paralympic athletes.

The following is a transcript of their remarks:

Faust: Hello, Jeremy Faust, editor-in-chief of MedPage Today. I’m so excited to be joined today by Dr. Jonathan Finnoff.

Dr. Finnoff is the chief medical officer for the United States Olympic & Paralympic Committee. He’s board certified in physical medicine and rehabilitation and in sports medicine. Paris is his 10th Olympic and Paralympic Games.

Dr. Finnoff, thank you so much for joining us here.

Finnoff: It’s my pleasure. Thanks for inviting me.

Faust: So right now you’re in between the major events. In Paris the Olympic Games have concluded, and you’re gearing up for the Paralympic Games, also in Paris. You’re back in the States and you’re going back to Paris, is that right?

Finnoff: That’s exactly right. Yep.

Faust: Talk to us about the transition, because these are two very different events with different medical challenges.

Finnoff: Yeah. It’s interesting because for most countries, their National Olympic Committee and their National Paralympic Committee are two separate organizations. So they have one team that’s there for the Olympics, and then when they leave, they have a completely different team come in with different personnel, different management, the whole thing. So it’s not just the athletes, it’s everybody.

In the U.S., we are the U.S. Olympic & Paralympic Committee. And so it’s the same management team overall, the same organization that is running both Games. Thankfully, because of the size of our delegations, we actually keep the same place in the Village. So we were able to just clean up our clinic, lock it, and we go back in and unlock it and move right into the same space, and we use all the same equipment and same supplies.

We have different personnel coming in, still the same leadership, but this is a huge time commitment for people to go back and forth between the U.S. and Paris. So we do have different volunteers coming over for the Paralympic Games versus the Olympic Games.

Faust: And I imagine that the diversity of athletes in the Paralympic Games means that every Games would be slightly different, as opposed to maybe the Olympic Games [where] we know that soccer players turn their ankles. But I imagine in the Paralympic Games there are really different challenges.

Finnoff: There are. In general, a lot of the Paralympians have multiple comorbidities, and those comorbidities result in a lot more medical complexity.

So, for instance, if you have a spinal cord injury and you have insensate skin, then decubitus ulceration is a far more frequent occurrence, of course, than in your Olympic athletes. And on top of that, that person might also have intermittent catheterization, so therefore they’re more susceptible to a urinary tract infection. Because of recurrent urinary tract infections, they might have some underlying renal disease.

They have osteoporosis because of lack of weight-bearing movement. So when they crash, they break a lot more things and they can’t feel it. If their spinal cord injury is above the T6 level, they can have autonomic dysreflexia, where your blood pressure and stuff goes a little bit crazy and it can cause somebody to have a stroke or to die.

You have all of these things in somebody who, if you’re a triathlete, normally, you might crash on your bike, but with these other comorbidities, you have a crash on your bike and you’ve got all these underlying problems, so it becomes much more complicated.

Faust: At the Games, I certainly noticed that there were varying approaches to risk management around COVID. And I imagine that the Paralympic athletes may have a different approach, or there are various approaches across the board with different athletes.

Do you sense a difference in terms of the questions the athletes are asking? Whether they want certain protocols, or just things like whether they’re masking up into their events?

Some of this may not really even be medical as opposed to just strategic. I mean, there were athletes who, quite frankly, you could argue lost a medal because they didn’t get themselves to their starting event without COVID.

Finnoff: Yeah, absolutely. We have pretty consistent protocols for our infectious disease. We follow the CDC guidelines.

So if somebody has a respiratory illness, then we have a certain period that we don’t have them staying in the same room as another athlete because we don’t want the other athlete to get sick. We’ll transport them separately, we’ll have them wear masks when they’re indoors around people. So we follow CDC guidelines on that and GI illness and stuff.

But we do encourage athletes to be up-to-date on vaccinations, use hand sanitizer, wear face masks when they’re doing travel with lots of people, just to minimize their risk of getting an infectious disease because absolutely that will affect their performance. And different athletes take that to heart to different levels.

Faust: Can you tell me a little bit about moving from the Olympic Games to Paralympic Games? I did discuss with some of the experts on your team about the sort of psychological stressors and the mental health strain of this moment. You know, you’re training your whole life or for many years to get to this place.

I’m wondering about in the Paralympic Games whether it’s just the exact same thing or whether there’s something different about it, because I really don’t know. I can imagine both answers, right? It’s the same thing, or there is a different kind of vibe or different needs. What’s your assessment of the difference between events for the athletes in terms of the psychological piece?

Finnoff: Are you talking about the psychological piece during the Games or more the transition after?

Faust: Oh, both. I was specifically thinking about the Games themselves, but I’m also very interested in the sort of post-Olympic blues as well.

Finnoff: Number one, psychological services — which is a combination of clinical mental health provision as well as mental performance, which is sports psychology — we provide those services. I would say that we’re a world leader within that infrastructure for our athletes, both on the Olympic and the Paralympic side. It’s something that we take very, very seriously.

The first sign that we really had that full spectrum was at the Tokyo Games. We had just over 200 interactions with our psychological services personnel during the Tokyo Games, which I would say was an incredibly stressful environment. The delay for a year, all of the things surrounding going to the Games and what you could do and couldn’t do at the Games and so on.

We had over 800 at this Games, and this was a wonderful Games with minimal restrictions and so on. But what that shows to me, Jeremy, is that we have this service that people believe in and they feel is appropriate, and there’s less stigmatization or negative stigma associated with it. It’s probably related to some high-profile athletes coming out and talking about their experiences and how positive working with psychological services providers has been for them. And so we see a lot of athletes using our psychological services providers during the Games.

We work a lot in the lead-up to the Games because [for] a lot of people, their dreams kind of end when they don’t make the team. So we want to make sure that we’re there at the Olympic and Paralympic trials to help those who did not succeed. And maybe they’re going for it in 4 more years, but maybe this was their shot.

We work with them through their successes and failures during the Games, and then also after the Games in that transition. The post-Games blues is a very real thing. And it’s not just for athletes that are transitioning out of sport, it’s also for athletes that have gone through and had this big experience and then it’s done and what is the next big thing, whether it’s in their career, whether it’s outside of sport. It happens.

So we have peer support groups, we have one-on-one psychological services, we do all sorts of different things to help athletes with their different psychological stressors.

Faust: Yeah. And I think it really has been great that some prominent Olympians have been so forthcoming to make it so that whether you’re Michael Phelps or whether you’re Simone Biles or whether you’re someone who we haven’t heard of because they’re not on the medal stand all the time, it’s okay to address these issues and not hide from them. I think that’s been really important.

Finnoff: Yeah.