ICSC10 International Sports Chiropractic

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ICSC10 _FICS and the World of Sport - Part 1

Download English Transcript: ICSC10 _FICS and the World of Sport – Part 1

ICSC International Sports Chiro Module 10
ICSC10 _International Sporting Events
Instructor Christine Foss
Video Lesson: 56:56

Welcome to module 10 of ICSC, the International Sports Chiropractic module. Congratulations on making it this far, this is the final module for your ICSC, as we work our way through this module, we will be learning a lot about how to become an international sports chiropractor, what you can expect, how you can prepare, and the pitfalls also. At the end of this module, there will be ten assessment questions that you will be required to answer in order to successfully completed, so, pay attention and hopefully that this is enjoyable enough, and the mission with this module is that you can really avoid some of the errors that are so easily made as you travel internationally and just  make a smoother transition for you, as you travel out and become part of international teams, it is important to be prepared and we are going to talk about that as we go through this module.

Our objectives for the course are to recognize your role as a FICS chiropractor in the world of sports, understand what you can do to promote FICS and be an ambassador for the chiropractor profession, understand what FICS rules regulations are for international games, and gain a basic understanding of the history of sports chiropractic. As we go through this module we will see what it should look and what you can expect, which I hope will be a really nice information to prepare you for working with international teams. FICS mission is “empowering athletes to achieve their optimal performance naturally”, and our vision is “every athlete deserves access to sports chiropractic”.  Many times, we travel with teams and depending on the federation’s funding, they might not have the ability to provide any medical staff with the team, whereas you might be traveling with a team that has a chiropractor physical therapist, athletic trainer, massage therapist, sports psychologist. Our ideas are to level the playing field and provide care for all athletes, so that we do not have some athletes not having access to a roll of tape against some athletes that have a team of experts highly trained to help them.

Leveling that playing field mantra is where FICS is coming from with all our international events. What are the things I need to do to before travelling and working with an international team? The trick is to be prepared for anything and everything, take your time before you travel, and make sure you are prepared, not only with the supplies you are bringing, but also, with the skills you are bringing to the table, understand that at a sporting event, anything can happen. There is never a perfect scenario, so, be ready to roll and change, and be a professional, which is the key here with everything, and be prepared. We first need to start with the basic rules of what it is like to travel with FICS and what we are expecting of you.

These are not of a stringent set of rules, they are basic and pretty straightforward. The most significant points of consideration, you need to make sure you follow these rules, and be prepared. The number one rule is simple and easy. This is all what we want to do on a daily basis, be on time, honest, reliable, consistent, positive, and polite. We are not going to be treating any staff, athletes or management with any curve behavior, we are there for the athlete, and we should think about the big picture which is you are there for that athlete, you are part of that team, your job is to help the athlete  perform better, and everything else just falls away, we just  keep our eyes on that mission.

Rule number two is to practice safely and legally, and with respect of others. Be able to communicate what you are doing and communicate with others you might be working with. You might not be there with just another chiropractor, you might be assigned with a physio, a massage therapist, or other professionals, so open those lines of communication up to form a formal cohesive team and work together. That is the whole trick here is that you want to make sure the athletes’ experience is as positive as it can be. Understanding as we plan a venue, much like the one you see here in this picture, these schedules are premeditated well in advance. That being said, we are not going to come in and try to change those schedules at all, we are going to comply to the schedules that have been laid out for us. If there is a change of schedule, you will report to your team lead, which is called the “Chef de Mission”, and that team lead will be able to communicate directly with coaches and staff to see all the necessary changes, if they have been put in place or how you can be made aware of changes on a more timely fashion.

FICS code of ethics, rule number three-five. This is not how to self-promotion type thing, you are there for the athlete, first and foremost, you are not giving out your own personal business cards, or marketing yourself, you are there for FICS and you are a FICS representative.  Dress requirements are simple, you will be dressing nice and neat, professional, nothing bizarre, and nothing wild and crazy, no real ornate jewellery. Make sure that any of your private property is self-maintained. If you borrow any equipment make sure you return it in the same fashion in which you received it, and then, keep your area clean and professional.

Rule number six and seven, conduct-based. Make sure that we refrain from any gender, ethnic or racial remarks, any jokes that are not appropriate, understand that we are in multicultural events when we travel, and we want to make sure that you are a professional at all times. Your treatment area that you develop becomes an area that abides by the FICS roles, and one of those rules, of course, rule number seven is no smoking.  You can see in this picture here, that there has been a tent set-up and this becomes this medical area.  Inside that medical area, you are going to make sure that everybody is safe, your patients, athletes, are safe and there are no people coming in, spectators coming in to view athletes. You are not going to let smoking in there, people to get out of the sun, this becomes a medical area, and should be treated as such.

FICS code of ethics rules, number eight and nine. No use of non-prescribed or illegal drugs, and that goes without saying that you are not giving any prescription items or non-prescription illicit drugs to athletes as well, staff or management, drinking alcoholic beverages, strictly prohibited during your schedule time, and out of your schedule time. If you decide to go out and have a few drinks, a few cocktails with the team that is fine, but, you need to understand that you are always under a watchful eye and public displays of drunken behaviour is really not tolerated. It reflects poorly on you as an individual, and it reflects poorly on FICS. We ask you to please refrain and maintain your level of professionalism at all times.

Sexual content with participants’ management and fellow medical professional is strictly prohibited. This is a strict moral code of conduct and behaviour between team members. We need to make sure that this will always be enforced. What you do privately, of course, as your concern, but you are a representative of the FICS team, and you should maintain that standard when you are traveling. Any of the breach of these ten codes of conduct and the code of ethics are grounds for immediate dismissal from the event, and you will be asked to leave, and that puts the Chef de Mission in a very bad position if you have somebody misbehaving and he or she, decides to send you home.  What is it like to work at an event? Let us talk about being selected for a team and about what your expectations are. What do I bring? What is expected of me? How does this work? What team am I with? So many questions, so let us let us have some fun and talk about that. You have worked so hard to travel with high-level athletes and teams and worked with a fabulous and outstanding group of doctors, this is the fun part. Get rid of all the possible drawbacks that you could maybe stumble over, and try to make it a smoother transition for yourself.

First understand the medical team, who makes up that medical team? If we look at this graphic here on the right side of your screen, we see that this team is headed up by your head of medical commission and your commission members. In other words this is the super organizer of the venue. If we move here to the right side, your local organizing committee “LOC” and that might be your State Association or Regional Association that is helping supply and plan, and organize this venue.  As we run very large events, you may see that these local organizing committees who might have invited an EMS Squad to be on the field or paramedics or staff MDs, however, they might also have asked massage therapists or local physio teams to be there. They all become part of the larger medical team underneath FICS, which our doctors will be working with. We need to form a good working relationship and open that communication up, so that when we are working together in a nice cohesive group, the athletes’ safety and care is taken into account.

On this side we have FICS and our Chef de Mission, which is your supervisor at the event. That is the person looking out for you, if there is any change of schedules, the person you will report to with any problems or issues, and then you have your other FICS chiropractors’ colleagues here. Remember some teams will travel with their own medical professionals, and that is okay. Those medical professionals will give you a different scope of practice, and they might ask for your assistance, however they might not need your assistance. Yu are not required to share your equipment with those medical professionals at all, but, having a good relationship also makes for a very nice competition as well. Here is your hierarchy of how we work in FICS when there is a very large venue. Understanding that there be some times that you will travel in a smaller group, there might just be two chiropractors traveling to an international event, and that would work quite differently, we would not necessarily have the Chef de Mission or the head of medical commission right there for us to discuss and talk about changes, we might have to switch things up a little bit, so we will talk about who becomes the point of contact in all events later in this lecture.

Before you jump on a plane, some great things to consider; take some time before you travel and look at that local scope of practice, see what chiropractors can and cannot do in the country or area you are traveling. Some areas, chiropractors can diagnose concussion, some you cannot, some places chiropractors can look at x-rays, take x-rays, some you cannot. There are many different things to consider and there are some countries that chiropractic is not even allowed so, understanding what you are walking into prevents a whole host of possible problems. Take some time, do your research, look at the local scope of practice, see what chiropractors can and cannot do in the area you are traveling to work at. While you are doing that, familiarize yourself with what local emergency numbers and locations are like, and the distance to the nearest hospital. What is the response time of the local emergency or paramedic squads, are they there on site or do I need to call them? Familiarize yourself with your lodging, how far away is the hotel from where the venue are, what is my travel time going to be like? Learn a little bit about the language where you are travelling to, this makes it fun and really nice for athletes to hear a little bit of their own language. “Hello, goodbye, thank you, cheers”, all these things are nice to learn when you are working with teams from different regions of the world and makes for some camaraderie too.

Important apps to download; WhatsApp is how we all stay in touch with each other when we are in a large venues such as a The World Games. This is a very nice app to have to enable us to stay in communication with each other. It is no charge to use, from continent to continent, post-games, and it makes for a very nice relationship for all these great chiropractors that you are going to be meeting globally, as we touch base after games with many of the people that I have worked with from many different countries. It is through WhatsApp that we do that, and I think it is a very important one for us.  Google Maps and Maps.me is also important, you can download the local area map, in case you get lost or you are confused where you are. If you do not have Wi-Fi you can pull that map up and  figure out how to get back to your hotel or back to your venue safely.

Skype is another App for video chatting, and other ones to consider are Google translate, very important if you are going to have a multi-regional event where you have athletes from many different countries there, you are not expected to know all these different languages, however, Google Translate is great to assist you. I can give you a fabulous example of one particular time that I was traveling in Austria covering World Championships for Bobsled, and they brought a Romanian Bobsled athlete down to the clinic area and left him there for treatment. I certainly don’t speak Romanian at all and he certainly did not speak English, so, it was really quite interesting to try to explain how I was going to treat him and how communicate how we were going to try to return him to play. Well, Google translate really came in handy and helped open those lines of communication up, so I can have an effective treatment and he could have a good result and truly understand what we are trying to do.

Other things like Uber, lift, train, or bus schedules of the local area are also important. If you are in an area that you are going to be doing a lot of traveling, do not wait until you get there to be prepared. Take a couple of nights ahead of time and do some research .Download your Apps, get prepared, double-check your transportation that is set to and from the airport, who is picking you up from the airport, who is taking you to my hotel, who is going to pick you up in the morning and take you to the venue? What time does the venue start all these things you need to prepare ahead of time? Do I have phone numbers of the person that are picking me up at the airport? What if my flight gets delayed? Let me contact somebody. Remember, prepare, it will just ease your tensions as far as traveling goes and also ensure you have a smoother and more successful trip.

You will bring your passport, ID and Visa, but a great tip is to take pictures of them, so, you have them on your phone in case they are lost or stolen. Make two photocopies of them and one photocopy should be in your luggage that you check, and one photocopy should be left at home with somebody that has access to them, in this way, if you lose the original, you have the pictures from your phone, you have the copies in your luggage, and you have a copy at home. There is no way you are getting stuck anywhere if you have taken the time to do all these steps, these copies will be a lifesaver if you ever have a problem with customs or your passport, they will get you back to your home area, pretty safely.

Before the event begins, it is important to know a few people that you will have to stay in contact with and work closely with, and we talked about the Chef de Mission or your FICS supervisor and team lead, and the point of contact who is the person that coordinates the FICS volunteer needs. This person might be somebody more locally in the region that tells us where our hotel is, tells us where the local food is, how we are getting to and from the venues, supplies that are there or not there, they are there to help us make a smooth transition and provide the care that we need to provide.

Make sure you know the medical commission, or at least the head of the medical commission, in case the worst happens so you are familiar with the faces of these people. These are important as we run the event, and then, the local organizing committee and local paramedics, and staff. How it works with larger events where FICS are asked to cover is the local organisers will bring a local paramedics or athletic trainers to cover the field injuries and sideline. Most times the FICS doctor will be in the warm-up area, and at the clinic area back at the hotel. This will vary but will be one or the other or sometimes both. It is not always our role, most times not our role, to provide that acute injury care on the field, however, sometimes things change and you may be asked onto the sideline or you are the only person traveling with a team, and now, you are the sideline person, so, making sure you understand how your hierarchy is working for your particular event and what your responsibilities are.

Plan ahead of time, understanding what your scope of care is, what are you allowed to do with this venue and when you are allowed? Research again, go back and research the country you are traveling to define your role at the sporting federation, making sure you are talking to your FICS Chef de Mission as to what your role is for that venue or event. Remember if you don’t have a Chef de Mission, you will talk to your point of contact person, the person that has assigned you this venue, and making sure you understand what are they expecting of me, what is my role? Who do I contact and who do I stay in touch? Another tip, make sure that you rehearse your vitals, cranial nerve exam, and your SCAT5 exam for adults and paediatrics, making sure you have it on the tip of your tongue. We should not be downloading this SCAT5 App onto your phone when we are doing an evaluation for concussion, you should have that already well in advance, you should be well-prepared. Making sure that skills, you do not use every day, which you might be required to use at this event take a little extra time to brush up so that it is fresh in your head.

We talked a little bit about that there are different times to treat, that clinic-like setting that might be back at the hotel or at a venue, and then, there is the sideline treatment area. Two different views, and that might change depending on the number of doctors you have, if it is a very large venue, you might have a polyclinic or a clinic set up for a certain number of hours a day to take care of the athletes, and we will also have a group of people right on the sideline or on the field in the warm-up area getting athletes ready.  Understanding that this is  a state of flux, this plan and that communication is really important to know, we are not treating athletes inside of our hotel room or not treating athletes unsupervised, we are not treating athletes in their hotel room. The only time is if they have an emergency, please make sure that you have proper chaperone and proper supervision when you are with an athlete, and that you are not putting yourself in a compromising situation alone.

We talked about every venue having its own unique setup, and very infrequently is that setup a perfect scenario. You are going to have to  bend and be flexible with changes, and sometimes changes happen on a minute to minute, hour to hour, a day to day basis. Some sporting events are weather-dependent, some are not, some might change venues from one to the other, have an area for medical staff, some might not, you will do the best you can with the area you have, it would not surprise me to see that you might be setting people up like we see in this picture here, however, if you need to travel with your table to the venue, you will have a reasonable amount of time with an area setup, so that, you can have your table and time to do a have a nice area set up for the athletes to get treated. My mission here, is not everything is perfect, and that is okay, we are just going to do the best job we can with this set of circumstances which are given each time. When you are working a venue for FICS, understand that your mission is to treat the athlete, that is your job, and that is why you are there. Treating staff and friends is not the priority. We are also there for coaches’ officials and staff, but the athletes have first priority. We are talking about practice time or time right before competition, that is the athletes’ time that they get treated, that is not the time for a coach to get treated, it will be okay to treat coach or officials at another time, but not if there are athletes waiting, they come to the front of the line.  No treating anybody at the venue, public or family or friends or spectators, you are there for those athletes.

As for treating athletes at an event, and this picture is at The World Games, if you are at a large event like, you will see this scenario where you have many tables setup, and then, a line about athletes waiting. This is not going to be similar to your office where you will have a patient come in, and then, they will come back several times a week, three times or four time a week, you might only see this athlete one time or maybe two times, you have to make the best of that time and keep this in mind when you are treating the athlete. If they are coming in to get treated just before large competition, there are certain treatments we will stay away from. We are not going to do deep tissue release or something that is going to make them sore before a large competition. Less is more, remember since we do not have a whole treatment plan lined up for the athlete we cannot see them multiple times, so consider what your treatment will be and how you can be the most effective for that treatment. If you are in a different venue where you are traveling with a team for an extended period of time, that may be a different story, and you may need to switch gears and can have a little bit of a treatment plan and then you can manipulate treating the athletes after practice doing more of a deeper release versus only before. Most importantly, consider that you are not keeping an athlete away from practice for competition because of your treatment time. They should not be late to practice because you are treating them, you must comply to the standard, getting them to practice on time or getting them to the competition on time. If there is something that precludes them from practice or competition, we need to discuss what you need to do in that instance.

As we start working with these athletes, some of them may not have experience chiropractic care before or even heard of chiropractors. Take time to explain everything that we are doing ahead of time, and inform the athlete what you are thinking, what your tentative treatment plan is for that day, and what they can expect.  Athletes know their bodies very well, sometimes they will tell you how to treat them, and they will tell what not to do.  Take a little extra time, as you are running through your clinic day at an international event to ask each athlete about what worked for them and what did not work for them, that is really important because you need to save time, you need to make sure that your treatment is the most effective it can be. But also, we want to see if there are any contraindications to care, do they have a past medical history or a surgical history? Are they taking any medications that might be causing a problem? Did they have a surgery that there is an area that I should not be manipulating? We need to check all these things and see how we can best serve them, not just jump right in there and adjust somebody, and maybe they have had a bad experience in the past.

Remember your role is to help the athlete achieve optimal performance through your skills as a sports chiropractic physician, and that is really where it begins and ends.  It is your hands on that athlete, and this is an important point. You are not there to help change their technique because they have coaches and professionals for that, we are not there to change their mindset, there is other people to do that, we are there to be chiropractic sports physicians, and we are there to help them enhance their performance naturally. Please keep that in mind when you are planning your athlete’s care, as you  might see them one time or for two weeks. Consider what type of gear do I bring when I travel? I remember traveling for my first event, I truly had no idea what I was to bring and maybe I had brought too much to my first event. Well, that be a problem for you because you have to be able to carry everything that you bought, and sometimes, you are carrying your equipment to treat into different areas a day, maybe more than that, depending on your venue. Let us go back to what your general equipment should look like. Personal protective equipment: rubber gloves, masks, bring your table if requested as part of your planning. If travelling with a table, try to make sure you have more of a lightweight table with and it would be a little bit easier to transport basic first aid supplies, blood pressure cuff, reflex hammer or other equipment you are taking. Traveling with some tape is a great idea, and some of the other things you might like to consider are cuffs, or instrument assistive soft tissue.

Keep an eye on what you are packing for your carry-on and what you are putting in your check in suitcase. Customs love to pull out these instrument-assisted soft tissue tools and keep them. Don’t get caught with that happening, pack those in your carry-on luggage, so that we can safely get through check in and get to the venue with all of your supplies. Check the weight of your luggage because if  your bag is an overweight, it becomes very expensive. Please make sure you are keeping an eye on all these things and pack wisely, bring the things that are critical which you think you will need and leave the others at home.  As we talk about personal protective equipment, we need to make sure that we are keeping the surfaces clean around the athlete’s treatment areas, we do not want any cross-contamination at all. It is necessary that you disinfect your table and your tools between each athlete encounter, keep them clean, we do not want any athletes getting sick or getting any type of contact dermatitis of any type. Make sure that we have gloves and disinfectant. I usually bring a bag, box or long tube of disinfectant wipes with me as my backup plan. I will talk to the local organizing committee whether they have something for me to use and if I can have disinfectant and a few rolls of paper towel which I can use for headdress paper, the disinfectant, I can clean between each person. However prepare ahead of time.

Emergency medical equipment, this might be different depending on what type of venue you are working at. If you are traveling with a 1, 2, 10, or 30 doctors, you might get on a WhatsApp and decide who is bringing what. Everybody is not bringing 30 blood pressure cuffs, 30 thermometers, we might not need, however, consider too, that if you are working on several venues, for example, at The World Games, you might have ten different venues going on, one person is in a field, one person is in a gym, one person is in a different location, so we might need three blood pressure cuffs or we might need three thermometers.  Just checking, what your setup look like for your event, and then, you can step back and say, “What do I need to bring to provide, what emergency medical equipment, how many doctors are coming?” Think of those logistics and type of athlete you are caring for? What is the climate where I am going, is it cold or hot? What type of emergency equipment would I need?  For example, if I am working a marathon in South Africa, I might need very different equipment than working at Bobsled in Switzerland. For one, we want to think about heat-related illness, compared to high-altitude or cold-type related illnesses. You are going to pack differently, just taking a step back and saying, “What are my most common injuries? What is the climate going to be like? Let us take a check at the weather, what is the weather going to be like?” Consider what you are bringing, what is the terrain and what type of supplies you need?

As you get to your event, the first thing you should do is visit the venue you are working at the day before that event begins, that day before is vital for planning. Most importantly that day before will assist you undertake a site inspection and walk the track or look at the floor or evaluate the field for potential hazards, things that could be fixed ahead of time to prevent a bunch of injuries.  Do your whole site inspection, walk the whole area, keep an eye on where you will be setting up versus where the emergency squad will be, what the evacuation route is, can we get into the field with a rig or EMS squad car or can we not? Think about the emergency evacuation plan. A great example here is a track event I worked at, when I Google Mapped the track the night before the event started,  it would take me to the front entrance way of the track, which is great for spectators however I am certainly not getting an EMS truck in there if there was a problem with an athlete. I also checked the weather for that day noting it was going to be very hot and humid for a track event, so I was worried about heat illness.  When I got to the event, I made sure that I wrote down the directions on how to get a car or emergency vehicle with equipment to the venue entrance which would allow them to drive onto the field. Thank goodness I did that because I had somebody with heat exhaustion that day, and I had to bring an ambulance into the ground. I was able to quickly copy and paste those directions and send them to the emergency person, to get the ambulance, which was able to come in the backway safely. That could have been a disaster if I had not taken that time and figured out how to safely get a car in ahead of time. This athlete would have been in pretty rough shape by the time the ambulance figured all this out and if I had to leave the athlete to assist them go all the way around and come back in another way.

It is super important to take that little extra time that day before meeting the administrative personnel, meeting any other EMS people that might be working at the event, looking for and addressing hazards, and that site inspection. Be on time for your venue, understanding where your travel is, be able to carry all your own luggage and equipment. Looking for people to help you out will delay or make you late. When you are traveling, know that you must be portable, so, you might be treating on a field or in a gym during the day, pack all that up, bring all of that at home, and then, you might be setting the clinic up in the hotel. Be portable, be wise with that precious packing space, and make sure that you are checking with that event director, if there are any changes in the schedule or one of those drop-off times, can I jump on the van with the athletes on there and plenty of time, ahead of time? Or do I need to get my own ride? All these things are very important to consider that day ahead of time, all logistics, but they make for a pretty rough event if you cannot get there.

If you are going to be late or an emergency has come up, please contact Chef de Mission or your supervisor in the area, making sure that there is no last-minute surprises or no-shows. Nothing is worse than having a bunch of athletes and teams on the field, and there is nobody there to help them, so, let us just avoid that, and if there is a problem we can get somebody else to fill your spot, remember if this does happen, there is grounds for immediately dismissing you from the event and that is at the discretion of the Chef de Mission. Let us talk about,  your volunteer status as a FICS representative, so typically, how it works with FICS at the moment is that it is your responsibility for the air travel fees to get there, once you are there, FICS will cover your hotel and FICS will cover your meals, and your transport to and from the mountain, that is how it is most times, however, I cannot say that is that every time, things change and FICS are working to get more funding to support volunteers.

Sometimes you are travelling to some fun areas that you might never go to on your own or with family or friends. You might decide to arrive a few days ahead of time to do some touring and see the sites, and that is okay, but that is on your expense. You would not have the transport available to you nor necessarily the hotel of your choosing, for those days you arrive early. That hotel would be your responsibility for those nights, until the day before the event, so, understand that is at your own personal cost. Remember FICS services are reserved for acute injury management and prevention, they do not extend to emergency care on the field, remember we talked about that earlier in this lecture, most times we are in the warmup areas or in the clinic area, and most times the local organizing committee would have provided an emergency or paramedic squad for on field treatment. It does not happen all the time, if that is not happened and you are there, and you have got to be trained and ready, and well prepared. Brush up on your skills and make sure that you know the appropriate emergency contact phone numbers to get an emergency medical squad (EMS) in there and be able to stabilize somebody adequately before the emergency team gets there, so that, you can get them ready for transport. Any staff members that emergency-certified will have priority to cover the emergency injuries if they do arise.

What is the selection process? What does that look like? How do you get picked for a FICS team? There are two different venues here and that is why I provided these two pictures, if we look at the picture on the left, this is CSIT World Sports Games, Spain 2019. This is the group of doctors that provided care for athletes, and you will notice a larger group and then on the right side, which is me in the front left, I am traveling with the Austrian Bobsled Team for World Championships, and I was the only chiropractor.  Two very different roles, you are the only chiropractor on the right photo, and then you have this larger team on the left, team of great doctors with all these fabulous skills from all around the globe. Let us talk about how FICS pick these individuals and the selection process? FICS have a team of personnel that have been selected ahead of time that select the general teams to go to events. They have a very nice process where they prioritize experience and new doctors. You might be prioritized based on geographical region or your prior experience or if you have worked at a sanctioned event before or maybe you have worked that particular sport before, and if you have worked with FICS in the past.  These are some of the general criteria which FICS consider for selection. The whole idea is to provide a fair, non-biased selection of sports doctors, so the same people are not going all the time to the same events. This is aimed at giving everybody an opportunity to travel, looking at a balance of very experienced doctors and somebody on the newer side so that you can be trained and gain that experience working at event. This allows a terrific process on mentoring old experience doctors with the new doctors and growing this great professional sports chiropractic team in a positive way.

What is it like to work at an event? What can we expect as you become part of a team and you travel with a team, or you work at a large event? What do I need to think about? We talked a little bit earlier about the tools that you would bring, I would like to bring utility dolly, and I put my table on it and I roll it, and then I have my medical kit that goes over my shoulder, and then I bring a small shoulder sling bag for when I got to go on the run and really treat acute things, and I need a small amount of things. I typically travel with three different sized table and two different sized bags, and in those, I might have my different types of tape that I like, different types of lotion or emoluments, whether it is Biofreeze or or any type of massage lotion, I always like to bring different types of instrument, assisted tools that I like personally. We have limitations with traveling, things like liquids and gels, we need to keep to a minimum unless you are going to put them in your check back.  My advice with your check bag is to put some tape over the tops of any lotions or gels so they stay closed, because these lotions love to explode in your bag and ruin all the rest of the content of your luggage. Chalk that up to experience and I hope that does not happen to you.  I have used sport tape to tape the tops of gels and liquids to keep them secure, it will save you a lot of time in clean up.

FICS require documentation of each athlete encounter, this is important for many reasons, and we need to always have documentation for what we do, and how we have treated. FICS has a research team that we keep track of all our patient-athlete interactions, and this helps FICS predicting how many doctors need to be on event or which teams utilize doctors the most or least, and what type of treatment they typically do. We take this research, the documentation records that we collect, and the research team analyse this deidentified data to project the future needs for events. This is good for FICS when talking to the sporting federations about the event needs. They can see, where the FICS chiropractor where used the most, for example when we did 200 treatments in three days, we definitely need more doctors in that area next year.

That documentation reporting is very important, that is a mandatory thing. Talking about concussions, anything that poses a threat to an athlete or something that what I call as a “no-go”, in other words, not allowed to participate, cannot return to sport, we need to know what our steps are for precluding somebody from care. Do I need to talk to the Chef de Mission? Do I talk directly to the coach? What is my step for somebody that has an injury that means they cannot return to play. Talk about that at the meeting the night before, and  figure out what your plan is, who you are making the call to discuss it with, the coach, your supervisor, and making sure that we are following good sound medical evidence-based practice medicine, and we are not returning somebody to the event, in an unsafe way. If we are diagnosing a concussion, they do not return to sport the same day, make sure we are following good medical guidelines.

As we are treating an athlete, we talked a little bit about what happens before coming into your treatment area, and if we look at the picture here on the left, we see that you are not always going to get that nice private medical room or the nice tent. You might be given a table in a hallway, and you don’t want cameras around that area. Your treatment area becomes a safe zone for athletes, that is a zone where the athletes can come in and feel safe, and not on cameras, spectators, Paparazzi, or you asking to take pictures of them, that is really not permitted. We need to make sure that we are making the athlete comfortable enough to come in, discuss their medical health with you, get treated in a very private way and they are trusting you to do that. Therefore don’t confuse that with an opportunity to take a picture. If you want to take a picture with an athlete at another time, and it is not a treatment time, and not in the treatment area, it must be done with athlete’s consent.

We have already talked about documentation, but I want to discuss the athletes that maybe younger than 18, what do we need to do about that? We need to have a signed consent form to treat anybody under the age of 18. All the athletes older than 18 will sign their own forms when they come in, if they come to you with an injury that is under the age of 18, we need to talk to their coach or their contact person, I am getting the appropriate signature, so that I can provide treatment and put my hands on them, do not begin treating anybody that is underage without the proper consent.  I am going to just say one more time, we need to have our documentation. It is important, if you are at a venue today and a different venue tomorrow, that the next chiropractor coming in to your first venue can come in and look at your notes and have an idea of what care was provided. In this way, if the athlete comes in and says, “I felt great with that doctor who was here yesterday.” That new chiropractor can review the notes and try to replicate that treatment, or if the athlete felt worse, the doctor can try to change that treatment up. This is vital information for the FICS research committee and data tracking. I want to another time that documentation is done, as chiropractors we all hate documentation, let us be honest, myself included, but it is a necessary and very important for us as we move through an event.

Nothing brings culture together better than sport, it is fun and the bond that you get with athletes and other chiropractors that you are working with, coaches, really makes the world a small place, and is very rewarding and fun. But your professionalism is important, please make sure that you know every situation might be a little bit different than you are accustomed to, let us not offer your opinion or anything unless you discuss that with the Chef de Mission or your local supervisor. If there is a problem or an issue that you see may be arising, let us go back and let us discuss it before we act from a single point of view. We talked a little bit about this earlier in the lecture and I want to bring it through one more time, as you are traveling to different countries and regions, you are experiencing different cultures and with that come a different set of values and concepts as to what is normal, what is abnormal, what is socially acceptable and what is socially accepted.  It is important you understand that, and your way might not be the only way. Keep discussions and your opinions to yourself because we never know who is around and listening, and you might be offering suggestion just based on your point of view.

We are all from different areas in the world and we need to respect everybody from their regions, and their own culture. I think that is the great thing about sport and you honour that as you consider that culture. Remember your role as an international sports chiropractor is challenging, there are lots of things to consider, but it is so rewarding, it is just an unbelievable experience to travel with these teams and take care of these athletes that works very hard to get to this level of competition. It allows you to see the world and treat elite athletes, remember, you are an ambassador for your profession, you are just a small view of a big profession. Back to the Bobsled team that I worked with in Austria, the Romanian team had never heard of a sports chiropractor, and at the end of my stay they asked me to go in and find a sports chiropractor in their area that they could go to. That is what it means to me to be an ambassador, and that is what it should mean to you. We are opening the doors for our profession, and so, we need to understand that it is just not us they are looking at, and they are looking at your profession. Let us step up and be the best chiropractors we can be and the best professionals we can be, this is a positive representation for FICS, but, it is mostly a positive representation for your profession. We are going to finish with two case studies, just to get you thinking and I will work through it to show you how to think a little bit differently?

Case #1 Muray Thai event in Italy
You are not in your office anymore and it is not only your rules anymore. Let us talk about a 17-year-old male from team Spain, who presents with a headache and right shoulder pain. He does not speak much English, but they were able to tell us that the injury took place the day before. You see some bruising on his eye as well, and you think about concussion. If we got bruising on the eye, we want to make sure we rule out a concussion first, I know he has right shoulder pain, but you have to take the priority that might preclude them from participating first, and then after we rule that is ok, we can get to the shoulder injury.

I want you to think about head trauma but you must go back and make sure you have proper consent from this person. This is a 17-year-old male, and you are not to begin your SCAT5 or anything until you get that proper consent. Sometimes it is a little bit of a delay in treatment, so you can have the athlete sit and wait while you send his friend or team member to go find the coach. Maybe you already have the proper form sign, that would give you the release to start your assessment, and then you can sign your documentation that you have received that release to treat that person. Once you get that release, you can start working through your head trauma protocols. We covered these protocols in the first ICSC01 module, and we talked a about what you are seeing, looking for, your signs and symptoms, ruling out emergency concerns, and we are ruling out a concussion that would preclude them returning to play, in other words not allowing them to play. So, we will do our SCAT5 concussion screen, and we can report whether there is any projected concussion or not.  We need to document this, have we returned them to sport, or have we not returned them to sport, and then we would go ahead and work on the shoulder injury second, making sure that you think about if the athlete is safe to return to sport, are they going to make the injury worst if their return to play, or are they safe and you don’t believe they will sustain another injury? That is where your brain needs to think.

Case #2 Tug of War Championship
This female from the Swedish team presented with a sore right-sided arm and low back pain, and a 6 out of 10 on the pain scale. If you read the left side of your screen in the orange area, you see that she reported that lower back pain kept her from sleeping, she had a restless night’s sleep and has never been to a chiropractor before, which may not be too uncommon. She travels with a physio but the physio is busy, so she thought she would give the Chiropractor there at the event a try.  You should be thinking how to proceed and where to go, do we have proper consent, do we have our documentation started with the age of this athlete, what treatments can I provide in this country and in this setting? Consider whether you can talk to the physio quickly and see how she cares for this athlete or her pending diagnosis? Has she had any imaging? Does she have the larger herniated discs that I need to treat or need to maybe change my treatment plan? Does she have a history of Lumbar fracture? Making sure we understand all the contraindications to care for this athlete before we jump in and adjust her. You may only treat this person one time and it is not uncommon, so, what I like to say to the everyone I teach is, let us try to educate and guide the athlete in a positive way to sports chiropractic. Communicate with the athlete and their coaches as to stretches or exercises. The athlete maybe able to these on their own, maybe they are with a sporting federation that does not have a budget for a sports chiropractor to travel with them, so ensure you give them a positive experience and some of your knowledge, sharing stretches and exercises they can travel with and take back home for follow up care? Can we point them in a direction to help these athletes to educate themselves as to their injury, which will help them be successful in the future. That is what we are all about, we want to see each person achieve their optimal performance.

The experiences you gain when you travel as a sports chiropractor are super rewarding, I would not change even one of my travel experiences for anything. You walk away a better sports chiropractor with each experience, you understand what other athletes have at their disposal or what sadly the athletes do not have at their disposal, you learn a lot about health care in different countries, and you also learn how to treat high-level athletes. It is a time that I feel like you gain these great relationships, and you walk away a lot better each time, not even a little bit better, as you travel, you are educated in a different way, and this broadens your perspectives in so many ways. I emphasise the positive attributes of doing something like this and the extended personal growth that you will gain. You are an ambassador for the chiropractic profession. If you stick to these four bullet points you will be in great shape for your travel, and you will have a successful venue.

  • Always present yourself professionally.
  • Be there for the athletes above all else.
  • Function within your scope of practice.
  • Stay connected for possible delays or changes in schedule.

Remember, greatness is your being, and excellence is your doing.

I thank you all for taking this module with me and I look forward to your continued journey as sports chiropractors and being the best professional that you can be. I applaud you for your continuing education and trying to better yourself, and lastly, I look forward to meeting many of you at future events.


ICSC10 _Section 1_International Sporting Events_Part 1

Download English Transcript:ICSC10 _Section 1_International Sporting Events_Part 1

ICSC International Sports Chiro Module 9
FICS and the World of Sport Presentation (Part 1)
Instructor Brian Nook
Video Lesson: 21:12

I am Dr. Brian Nook. I am currently the associate dean of academic affairs at Palmer College of Chiropractic West in San Jose, California. I am also the liaison for FICS to the International World Games Association. I have been involved with FICS for many years and have worked on many of their international sporting events. It is my pleasure to be presenting to you today FICS and the world of sport. My hope that through this presentation, you will get an understanding and appreciation of FICS’ involvement of chiropractic and sports chiropractic in the world of sport, how FICS and you, yourself, fit into this world of sport, and how you might be able to become more involved in sports chiropractic in sport. To begin with, I would like to give you a little background about where FICS actually fits into the world of the sport. We are involved with many different groups. Most people think that the IOC is the parent organization of sport and represents sport from around the world and all sports. In reality, there is a larger body called the General Assembly of International Sports Federation, which used to be called SportAccord. Sport Accord, now, is just the organization that holds a congress of all the different sports federations, which are near 100 different sports federations, for GAISF. The General Assembly of International Sports Federations, or GAISF, is the parent body that represents all international sports federations that are currently recognized.

There are those sports federations that are new and just starting, and they must make applications in order to be part of GAISF. The IOC actually only represents certain sports federations that compete in a well-recognized event called the Olympics, either the Summer Olympic Games or the Winter Olympic Games. The other sports federations compete usually in the World Games, which I will talk about briefly.  Most of you, of course, have an interest in professional sports or Olympic sports, and I would like to talk a little bit about the agenda and where the IOC is headed with their organization. If we look at the third slide, you will see that the IOC has recognized organizations. The first is the IFs, the International Federation Associations. As I say, they put on this event of the Olympics, either winter or summer, every four years for certain international federations or IFs. They recognize other federations, but their sports currently do not compete.

We are seeing a trend now where there are a core groups of sports, such as ice skating in the Winter Games, such as track and field and gymnastics in the Summer Games, that are core and will probably always be involved in the Olympics. But we are also seeing a rotation of new IFs that are recognized that are being brought into sports, and in particular to the Olympics that are hosting the games those years.  For example, in Japan in the upcoming Summer Games, baseball will be one the sports that will be at those games that has not been involved in Olympics. We have also seen that rugby in Rio was part of the Olympic event. They also recognize National Olympic Committees, education, multi-sports organizations events, disabled sports, and has a large contribution into sports medicine and science through a group called IXBY which is wanting us to get involved with them more as far as FICS, and sports equipment and facilities.  Interestingly, they have also recognized certain groups from an organizational paradigm. This is, as I have already talked about, is the Association of Summer Olympics International Federation, or ASOIF, and also the Association of IOC Recognized International Sports Federations, which is ARISF, and then, of course, GAISF or Sport Accord. We, as FICS, became a member of the GAISF back in 1991 and continue to be a member. We are only an associate member. We are not a full member, because full members are only for federations that represent sport.

Since FICS is an associate member, that means that we have full rights and privileges and are involved in being recognized through GAISF, but we are not too a full voting members. We have membership and representation through the associate members. But since we are not a sport, we cannot be full members.  This gives us an involvement within the IOC but also especially GAISF. Then there are the Alliance of Independent Recognized Members of Sports or AIMS. We have a provisional membership within that, and we have currently trying to become more involved with AIMS to have more of a voice in the world of sport and with the IOC.

Additionally, you will see that there’s multi-sports organizations that the IOC recognizes. In particular, the International Workers and Amateurs in Sports Confederations, or the CSIT. CSIT has a standing agreement with FICS that whenever they provide a games, which is every two years, a delegation of FICS chiropractors will be there to support their athletes. Then the International World Games Association, or the IWGA, which we have had a standing agreement, again, with the IWGA that whenever they have their event, which is every four years, FICS will provide a delegation for these games. Then the International Masters Games is one in which we are working closely, but yet do not have a standing agreement, and we hope to become more involved with them. As you will see, these three groups are very important, especially with our strategy to eventually get the IOC to recognize FICS. A goal for FICS for many, many years is to get the IOC to recognize us, so that FICS can provide the support for their Olympic games, and we can have access to the athletes at the Olympics. There are two primary strategies that we work with in the Olympics and is the goal for FICS to get as many of our members working with the national Olympic committees and go with their countries’ teams to provide care for those athletes. Additionally, the Olympics provides a polyclinic, which provides services that a doctor with a team may not be able to provide, such as dental, other care, or MRI, or special imaging, and special diagnostic services, and of course emergency services.

One strategy is to support you and our national sports chiropractic associations to get as many people working with their country. Additionally, if we can get the IOC to recognize FICS, they will then, as they do with all their host countries, mandate that FICS provide a delegation to the polyclinic in order to allow any athlete from any country this service in chiropractic care.  Up to this point, we have had involvement with certain Olympics, for quite some time now. But these have been mainly generated from a local organizer of the Olympic games, such as in Vancouver, the London Olympics, and Rio. We had chiropractors that were in the polyclinic and providing this care to all athletes.

However, this has been generated mainly by that local Olympic committee and not the IOC. So, unfortunately, it only happens for that event, and it is a one-off type of event. The goal for FICS is to get the IOC to recognize us fully. As some country puts in a bid for the Olympics, we are part of the agenda and the requirements for them to work with us to provide care through FICS for all athletes in the polyclinic.  This has been the aspiration and the goal for FICS for many years. For over 35 years, they have been working with the IOC in order to try and get this recognition. A monumental change happened in the Olympics a couple years ago in 2014, when they opened up their Olympic agenda with the 2020 paper.

In the 2020 paper, it was unanimously agreed to take the 40 recommendations out of this paper about where the future of the IOC and the Olympic agenda was headed. In interest to FICS and to us as sports chiropractors are that in Recommendation 6; it is stated to cooperate closely with other sport event organizers. In particular, they mentioned the IOC and the International World Games, the IWGA, to closely cooperate regarding sports program composition and their respective evaluations. The primary goal was this, is to continue to monitor those sports, those disciplines, and those international sports federations that might become part of the agenda of a future Olympic game. The IOC also in this Recommendation 6 stated that the IOC and the International Masters Games Association to study the possibility of the Olympic games hosting the IMGA event in the years following the Olympic games.

They are conscious that building all the venues, resources, and infrastructure necessary for the Olympic games for a one-off event is not the best use of resources. Getting a bidding or a host Olympic city to then go on and support the IMGA would be a better use of these resources. From a strategy point of view, FICS is working closely with the IMGA to become involved with them so that we can continue to support the Olympics and, of course, the IMGA. The IOC also has a strong association with the Youth Olympic Games. It is one of our strategies to work closely with the Youth Olympic Games. The nice part about this Olympic Agenda 2020 paper is it really helped to identify a key strategy for FICS and what we need to focus on in trying to align with as close as possible and outline a clear strategy for us to work with the IOC and also other associations, so that we can support the IOC and further our recognition with the IOC, with the possible involvement with the Olympics in the future.


ICSC10 _Section 2_International Sporting Events_Part 2

Download English Transcript: ICSC10 _Section 2_International Sporting Events_Part 2

ICSC International Sports Chiro Module 9
FICS and the World of Sport Presentation (Part 2)
Instructor Brian Nook
Video Lesson: 16:03

This goes now for me to talk a little bit about our involvement with the IWGA, the International World Games Association. They provide a multi-sport event called the World Games. They strive to provide the widest possible exposure for these sports and their governing bodies to the public and media, and that is the World Games concept. They have had games since 1986. The first games occurred in a place called Santa Clara, California, which is very close to where I currently am here in San Jose. We have been involved in the last four games. The first one in 2005 was FICS. We had a delegation there in Duisburg, Germany, and also then in Kaohsiung, Taiwan in 2009, Cali, Colombia, in 2013. Last year (2018), we were in Wroclaw, Poland, providing care there.

The World Games is made up of different types of sports from different types of federations, and they have divided them into artistic and dance sport, ball sports, martial arts, precision sports, strength sports, and trend sports. Interestingly, you will see that there are some sports disciplines there that come from very well-known international sports federations that are involved in the Olympics, for example, gymnastics.  We all know that artistic gymnastics is one of the foundations of the Olympic agenda and participation in the Olympics. But at the World Games, we have involvement in rhythmic gymnastics, tumbling and trampoline, acrobatic gymnastics, and aerobic gymnastics. By being involved with the World Games, we are actually supporting, again, an IF that’s so very involved with the IOC and the Olympics. We are continuing to work, through the World Games, we have been able to then get some great relationships with those international sports federations that are opening up doors, not only for us to then work at their world championships and other events, but we have now formed agreements with some of the federations to put chiropractors on their medical commissions.

By working with their medical commissions, again, this is an ultimate strategy for us to be more involved with the Olympics, but with the federations that are involved in the Olympics, but also to demonstrate to the IOC that we are not just there to provide care for their Olympic games. But we really are there to become integrated more into the world of sport. The next slide, I have got a video of the International World Games, which I encourage you to watch. It gives you a really nice background on some of the events at the World Games and what is happening at the World Games. So, as an associate member of Sport Accord, or now the General Assembly of International Sports Federation, GAISF, since 1991, we have become more and more involved in multiple sport games, such as the World Games, GAISF, since 1991, we have become more and more involved in multiple sports games, such as the World Games, the All African Games, Commonwealth Games, Pan-Am Games, Mediterranean Games, and so on. These doors have been opened up through this association with these sports federations, the IFC, and GAISF. We are continuing to work through those by attending Sport Accord every year to continue developing this relationship and educating the sports federations on the value of working with FICS to provide chiropractic care to all athletes in the world sport.

I have demonstrated some of the different logos of the World Games and our involvement in them, as I have previously talked about. If you are part of a FICS chiropractic delegation, what are really your roles and responsibilities, and what you do at an international sporting event? You support and follow the regular medical protocols. You are part of a medical team that is made up of the local organizers, and we are attached to that. We cooperate fully with the athletes and coaches and the rest of the medical team to provide additional chiropractic care for all athletes that are competing at that event and all the volunteers. The delegation is representative of chiropractors from all around the world that have a minimum qualification of the International Chiropractic Sports Physician accreditation (since March 2019 now called the International Certificate in Sports Chiropractic ICSC), as that is a requirement from the International Sports Federations that our docs have this minimal level of qualification. We will continue to assist at the World Games through this standing agreement and the CSIT Games, and we hope to open up other opportunities in the future.

The FICS chiropractic delegation really represents the best sports chiropractors in the world. They go through a stringent selection process. Our goal is to provide the opportunity for many different chiropractors worldwide to be a part of this chiropractic delegation. The nice part about the selection process is that we do not only take all those with the highest rank within the selection process. But we often take newcomers into sports chiropractic because we know that that is our legacy, that we need to continue to have a good delegation that represents, first of all, a balance in gender, a balance in representation from all over the world, so that the IOC and others, and in proper support of our profession, we get representation from all around the world at an international sporting event.

The FICS delegation, once they have responded, they need to provide their own way to the games. But once they are there, the host city provides the FICS delegation with housing, food, transport around the games, a uniform, and the equipment in order to take care of the athletes. The real benefit of going on a FICS chiropractic delegation is, first of all, working at an international sporting event and working side by side with your colleagues from different parts of the world to provide this care to the international athletes. It is a phenomenal experience, and everyone that has gone on a FICS trip to an international sport comes back with a life-changing type of experience. It is also one of the best lab practicals you will ever have in your profession to learn from each other and help each other as you assist the athletes at an international sporting event.

Our role as the FICS delegation at the World Games is that you are part of the medical provision for the World Games. As the SPEAKING FRENCH for the World Games, I meet every single morning with the medical commission and the chair of the medical commission in order to discuss what has happened in the previous day, what areas do we need to improve on, and what FICS is doing to provide their service at these games. This allows us, again, to fully integrate into the world of sport as it is happening at an international venue. We do not provide care on the field of play. That is the domain of the local medical providers, and so we are there mainly to provide chiropractic care in the form of treatments and not so much an acute care injury. This really gets us back to our grassroots of providing hands-on type of care for the athletes and the volunteer both pre and post-competition. This care is extended to any of the volunteers that are accredited or support personnel through the World Games.

The nice thing about FICS and the World Games is that the World Games is one of the largest multi-sports games around. It is an organized sporting event that is very much in the Olympic fashion in how its run. The World Games support federations that may someday be in the Olympics, which strategically allows us to be part of that group that may then move with them to support their athletes if they are called up to the IOC and the World Games. The World Games are now, as I have said previously, under direct view and review of the IOC. This positions us to indirectly be reviewed and observed by the IOC on what we have to offer, and so the World Games and the support of the IWGA establishes really a template for FICS involvement in the IOC and other sporting events, such as the Olympics, and that hopefully we will someday move up into the Olympic involvement. It really entrenches our legacy as an organization and as individuals in the world of sport.

What is the continued work for FICS? We need more national chiropractic sports councils. We need more sports chiropractors active in their NCSCs. We definitely need volunteers to work at events. We need a much more diverse delegation that we have providing at the World Games, CSI Games, and so on. We need to really focus and target on certain IFs to become involved with them, because we are already working with them at the World Games, but we need to work with them at their world championships and get our NCSCs working with them at a national level. This is really important. FICS really works on an international world stage and does not get itself involved in a national championship. That is the role of the NCSC in that nation. So, we do not conflict or tread on those areas. That is the responsibility and the role of that NCSC, to work with your national championships. If it is a world championship, yes, then FICS is involved.  We will support the NCSC if they need any of our assistance for national championships, but that really is the responsibility of the NCSC to work at the national level. For FICS, we need to continue to present and be present to the IOC and the IOC Medical Commission, GAISF, and any time that we have the opportunity to educate the administrators of the world of sport on what chiropractic care is and what we can provide for their athletes.

The future of FICS, we are a special interest group. We need more members both at the National Chiropractic Sports Council and their individual members. They need to be active in their NCSC and within FICS. Of course, we always need to continue funding so that we can go to GAISF and go to world championships and support our members that are providing this very important service to athletes from around the world. We need to support our research projects and researchers on what sports chiropractic is and the possibility of furthering sports performance all through chiropractic care. We are doing a very important job for chiropractic internationally in the world of sport. We are the only organization recognized on the world stage of sport through our recognition as the associate member with GAISF. What can you do? Well, if you feel it is important that chiropractic is represented internationally with the IOC, if going to the Olympic Games, World Games, world and regional sporting championships is something that you feel is important for our profession, if having direct access to Olympic athletes, that all athletes should have the provision or right to access of chiropractic care, that providing and supporting research into the effects of chiropractic on athletic performance is important for our profession, and if you feel your country’s athletes need chiropractic and have a right to access of this type of care, then it is important that you set up an NCSC if there isn’t one in your country. Or join your NCSC and be active and support FICS.

It has been my pleasure to talk to you today about FICS and the world of sport. I hope you have gained an understanding of really the organization of the world of sport and how FICS and you as an individual sports chiropractor can become involved and more involved. I have also tried to share with you some of the strategies that we have within FICS in becoming more involved in the world of sport and, ultimately, not only getting recognition by the IOC and firmly entrenching our place and our legacy in the world of sport, with the IOC, but it is mandated that FICS and chiropractic is part of the core services provided at all Olympics, and not just certain Olympics when the local organizers will allow us to be involved in them. We need to gain our rightful place in the world of sport. But in order to do that, we have to do the homework. We have to get involved in the world of sport. That first means that we need to understand it, and as you can see, it is very complex, and it is oftentimes difficult to understand. However, by navigating through this, becoming more involved, seeing what we do, and educating the administrators on what FICS can do for their athletes, will hopefully someday gain us this full recognition and our rightful place, providing support for athletes from around the world in the world stage of the Olympics and other world championships. I will leave you with a video of the World Games that I hope touches you and goes to the core of why you are involved in sports chiropractic. I encourage you to get more involved with your NCSC and with FICS. I hope to work someday alongside you at a world sporting event. Thank you very much, and I appreciate your time and effort.


ICSC10 _Working at Sport Event as Chef de Mission

Download English Transcript: ICSC10 _Working at Sport Event as Chef de Mission

ICSC International Sports Chiro Module 10
Working at Sport Event as Chef de Mission
Instructor Lotte Langhoff
Video Lesson: 19:01

Hello, everybody, and welcome to this presentation about working at sports events, seen through the eyes of a Chef De Mission. My name is Lotte Langhoff. I’m from Denmark where I also graduated from chiropractic school at the University of Southern Denmark in Windsor in 2005. I’m a partner at a large interdisciplinary clinic in Haslevvej where we are currently seven chiropractors. The clinic islocated within the region largest private hospital, which has more than 20 medical specialties. This, of course, gives us plenty of opportunities to work with other health care professions. As mentioned, I graduated in 2005 from chiropractic school, but that year I also received my ICSSP from FICS. A few years later, in 2010 I finished my postgraduate diploma in sports chiropractic medicine by Murdoch University in Australia.  The very same year that I received my FICS diploma, I also worked my first FICS event. This was only three weeks after I graduated. And it’s safe to say that I was blown away. My very first event and one of the first things I ever did as a licensed chiropractor, was the World Games in Duisburg in Germany. I’ve since then, three more World Games. One in Kauhsiung in Taiwan another one in Cali in Colombia and lately Wroclaw in Poland. I am definitely planning to do more. In Wroclaw, I assisted Brian Nook in his work as Chef De Mission. I have been Chef De Mission at the two World Games that FICS has been involved in so far. Planning has already started for the third one in Catalonia in Spain in 2019. At the first one, the FICS team got to walk onto the field during the opening ceremony. That was the very first. This was a great honor indeed.  In 2017 I was Chef De Mission at the Asian Indoor and Martial Arts games in Turkmenistan, which is north of Afghanistan. I would definitely never have made it to Turkmenistan if it had not been for FICS. Other than these major games, I worked at various World Cups and other national and international championships around the world.

This talk will focus on the things needed to make sports events a success for all involved with the chiropractor’s, athletes, researchers, organizers, or anyone else involved. Success is important on both a professional level in our work with the athletes, but also on a more social level. Because while we absolutely need to be professional and at our best, we also need to have fun. There is no doubt that it is so much easier to have fun if everybody knows what is expected and stick to the plans made. This will avoid huge amounts of confusion and at all sports events, whether big or small, things can sometimes be both confusing and hectic. Success is dependent on the team involved, the communications, transport, schedules, the general attitude, collaboration, et cetera. But two main points that are worth repeating is that you need to be ready for changes and don’t be late.

Who is on the team? When working at events with FICS teams can be anything from 2 to about 40 chiropractors. You will be working with chiropractors at all levels of experience. It could be University graduated chiropractor’s like myself at one point, or doctors who have worked at numerous events for FICS. Some might be team chiropractors for professional teams back home, or they may have been working for a team or country at multiple Olympics, and World Cups. As part of the team you may also see students and people involved in research who are aiming to publish articles about our work in International Journal. Research is ever more important for future involvement at high level sports events, and they are therefore very valuable team members. We generally try to put together a team of people with mixed levels of experience. You almost always meet multiple nationalities from a variety of different chiropractic schools and therefore with different approaches to chiropractic treatment. This is why working at games is such a great learning opportunity, no matter your previous level of experience. At no point in my years of working with FICS have I met any Prima donnas that did not want to share their knowledge and who were not willing to learn from others. The team is not only the FICS chiropractors. When we are working at events, we are part of a much larger team. This team is everyone from support and technical staff to the medical professions. At some events, you may be the only people person with any medical training at all. And at others you will find emergency staff, physiotherapists, and medical doctors and perhaps also other chiropractors working for a specific team or sport.

All these people are equally important, and we must work together. We are not there to compete with them or to prove ourselves better than them. You are not there to compete with your teammates either. We are there for the athletes only. And you must at all times do what is best for them. So, if you think someone is better equipped to handle a problem than you are, then refer the athlete or as a minimum ask for advice. Everybody will respect this and appreciate it, too, whether health care professional or athlete. Directly related to this, then you are not allowed to self-promote during games. It is, of course, OK to let people know where you work, if they ask. And they can then choose to come look you up afterwards. But patrolling the arena, handing out business cards, and acting pushy toward coaches or athletes is unacceptable. If a federation or country representative or similar approaches you and asks for further assistance, then refer the contact to the Chef De Mission. FICS with then negotiate the contract and in general make sure that you’ll be involved in further events with the federation, if you wish to be.  For the various games and sports events to be a success, it is absolutely vital that we are able to communicate. This is especially true at large events that may involve up to 40 chiropractors and often also support staff from the organizing committee. These could be drivers, technicians, hotel staff, etc. If you are selected for an event, communication will start long before the actual event. For this purpose, we normally use email to pass on information to the selected chiropractors. It is so important that you read all these emails carefully because they may contain a request for various information. This information could be anything from passport and flight details, clothing size, dietary wishes, et cetera. Sometimes a deadline for providing this information can be very short and failure to reply on time can ultimately cost you your seat at the game. This is, for example, if we don’t have the information needed to complete your accreditation on time.

In the emails you will also find all the practical information that you need. This could be information about hotels, event dates, venues, et cetera. We know from experience that this information is sometimes not available until quite late in the process. But we’ll, of course, make sure that it gets to you as soon as possible. We are aware that you will need this information for your planning of time away from the clinic, flight times, et cetera. But things can change, and sometimes they will change multiple times and with next to no notice. Please be prepared for this. During the actual games you will still receive emails, but we tend to use social media apps quite a lot. This could be WhatsApp, Messenger, Facebook, etc., and this will be used for the daily ongoing communication from us to you and back. We generally set up two accounts one that is for work-related messages only and another one for the more social.   Using social media apps can sometimes be a challenge though because depending on your location there may not be any internet connection at all. This could be a general problem for the region of the country that you are in or perhaps just because your treatment area is in an area where there is no Wi-Fi. Or it could even be like the Asian games in Turkmenistan, where all social apps were blocked by the government itself. Especially at the larger events, we generally have a meeting every evening where we talk about what is happened at the various venues and let everyone know when and where they are to be working the next day. These meetings are important, and they are mandatory. The only acceptable reason not to attend is when the competition at your venue of the day did not finish in time for you to make it back. In that case, make sure that someone lets you know what was discussed during the meeting.

Sometimes there will be hand-outs worth reading or information posted in the hotel lobby or at other relevant locations. At the various venues, we always try to have at least one person with a working phone. But again, that depends on the region, and countries, and this may not always be possible. Why this much talk about communication? Because things change constantly. We need to be able to adapt accordingly. Communication helps avoid unpleasant surprises and makes everything much more fun and rewarding for everyone involved.  Then there is transport. For the most part, you need to arrange your own transport to the event, but once you are there, any work-related transport will be taken care of by the organizers. There is one main thing when it comes to transport, and it is simple. Do not be late. If transport has been arranged from the hotel to the venue, then you must be there on time, every time. It is a logistical nightmare to arrange transport of 40 people to a dozen different venues spread out all over the city. If one car or bus gets delayed, then the entire schedule may collapse. For that same reason, if you decide to make your own way to the venue, you must let us know so that we do not waste time waiting for you. If you should miss your transport, it is your own responsibility, at own cost, to make it to the venue as soon as absolutely possible. While at the games, you are of course, very much allowed to have fun, and I am sure you will have fun, and we encourage you to have fun. But we need you to be ready and fit for work the next day, no matter how early your shift might start. No shows are not acceptable, and it may lead to accreditation being pulled. This has happened before, and it may happen again, so this is not something to be taken lightly. The transport available at an event is whatever we have been able to get the organizers to provide for us. Over the years, this has been every single means of transport you can imagine, cars, trucks, buses, public transport, private chauffeurs, free taxis, bicycles, or our own two feet. Sometimes we get everything we need, and at other times, it has been far from ideal.

When the transport situation is not ideal, be aware that this could mean that you end up at your venue long before the competition starts, or that you get picked up long after everyone else has left. Just remember, we have not arranged this to annoy you, but because it was the only way to make things work. Most of the time, there will be only one transport to and from your venue that day. You must make sure that you bring everything you need. This includes tables, provisions, iceboxes, paperwork, and perhaps even a lunch pack. If you do run out of something, let us know. We thrive on visiting the different venues daily, and we will try to bring you what you need. Then one last thing on transport, again, you must be ready for things to change, so keep your channels of communication open. Then there are schedules. Schedules are really, really important because these are the ones that will tell you everything you need to know about when to work, where to work, who to work with, how to get there. It is no surprise that you must be on time, and you must be ready for changes; and if you think that schedules changes often and in weird ways, then please remember that a lot of the information used to make the schedules may not be available to us until the very last minute. In multidisciplinary events, we often ask the doctors to let us know if they would like to work at certain sports, certain venues or work with certain other doctors. Asking this is not a promise that they will happen. But it is a promise that we will make it happen if we can, but when we select the teams for certain sports, there are many different things to consider, and it will not be possible to fulfil everybody’s wishes. But throughout the games, your welcome and to make requests and we will see what we can do. Sports chiropractors being who they are, we hardly ever have problems with attitude and mindset.  99.9 percent of the time I have only ever met doctors who were positive and fully focused and doing what is best for the athletes, and of course, this is what we need. There is no doubt that working at games can be frustrating at times. But this is part of the fun and part of the challenge.

One of the hardest challenges can be working with the other health care professionals present since they may not look at things the same way you do. They may not even know what a chiropractor is and what we can do. But no matter how much you disagree, you must still be professional. Do not argue. Do not be visibly upset. Stay calm at all times and explain your point of view to the people involved. Please always remember that you represent our profession. Oftentimes you will work in countries that has no tradition or knowledge of chiropractic, and in some countries, we may not even be legally allowed to practice at the event without a special permission from the authorities. Because of this, and a multitude of other reasons of course, we need to show everyone else involved that chiropractic medicine is a safe and efficient form of treatment. That it is carried out by knowledgeable health care professionals that are willing to cooperate and do not come barging in trying to be heroes and take over everything. If you do have issues with someone or something, please talk to the Chef De Mission and we will handle things from there. Being professional is also about how you look and act in general. Because again, you represent our profession and you represent FICS. By all means, do go and have fun but please, no drunken escapades in a FICS uniform, showing up the next day dirty, hangover, and unfit for work. Most of what there is to say about collaboration has already been said. But most of it is also worth repeating. We need to work together. No matter your level of experience, we all have something worthwhile to offer in both a professional and on social level. We are there for the athletes, not to bolster your ego or to show other health care professionals and/or your colleagues how awesome you are. Do your job. Do it well. and do it with a smile and willingness to cooperate and share your knowledge. Both athletes and professionals will start going to you all on their own. The staff at the venues and other vendor arenas are important, too.

Remember that most of them will be volunteers just like you. They are the ones that help you find your treatment area at the venue; they will help you with tons of practical stuff. It can be small, but important stuff like getting chairs, dustbins, finding a freezer for ice, putting up signs, bringing lunchboxes and drinking water and 100 other little things that will make everything nicer, easier, and more efficient. When arriving at a new arena, go find the venue manager and let him or her know that you are there and what you need and who you are. Just do not expect him or any other volunteers to be there for you only. They all have a gazillion other things to do, so give them a fair chance. On the other hand, if there are things that you need and that you know are a part of what should be provided for you, then inform the Chef De Mission, and we will take it from there. So why get a sports chiropractic certificate? A certificate opens so many doors, and this is both on a professional, personal, and social level. Working as a sports chiropractor is so much fun, and when I signed up for my first seminar with FICS, I never imagined that it would take me to so many places to meet so many people. I now have friends worldwide in both the chiropractor

profession and within the world of sports. I have seen places that I have never even heard of and I have worked sideline to a multitude of sports. Some of these sports were well known, and some were brand new to me. But no matter which sport or country, the number of smiles and helpful people that I have met is absolutely dumbfounding. No matter if the sports discipline is big and well known or a tiny niche sport only played in a few countries, the people involved are full of enthusiasm and love of their sport. They will be ever grateful for you to volunteer your time and experience to help them achieve their goals, so every event, whether big or small is a treasure trove of new and old friends spiced up with professional, social, and cultural experiences. What more can you wish for?


ICSC10 _Working at International Sporting Events - Webinar

Download English Transcript: ICSC10 _FICS and the World of Sport_Part 2

ICSC International Sports Chiro Module 10
ICSC10 _Working at International Sporting Events 
Instructor Christine Foss & Jon Wilhelm
Video Lesson: 33:50

Dr Foss: Dr. Jon Wilhelm is one of my favorited sports chiropractors who has done a multitude of high-level events, and low-level events. Today we will be giving you the opportunity to listen to some of Dr Wilhelm experiences, some of his wisdom and insight being a sports chiropractor internationally, which may help accelerate your success or avoid some of the pitfalls of being a sports chiropractor whilst working at an event.   Before we started this lecture, I was talking with Jon about some of the mistakes we both have made.

Dr. Wilhelm: When Christine asked me to do this lecture, I was excited about this. I have had some wonderful experiences with FICS and being a sports chiropractor and I am happy to share, and hope what I have to say is helpful to you all.

Dr Foss: Now, A little bit more about Jon’s background. He has travelled with Team USA to a multitude of events, Bobsled, track and field and Olympics with Team USA. He has travelled internationally and a multitude of consulting work with athletes from all over the globe.  He has a lot of insight and wisdom, and he has done a great job at navigating his career and is a good model for us to look forward and appreciate.

Dr. Wilhelm: I am looking around for who the person is that you are talking about. But in all seriousness, it has been a wonderful journey and wonderful ride and I want to acknowledge all of us here whether you are in this class listening to Module 10, and people like Christine and myself stand on the shoulders of those who have worked hard before us. No matter what stage you are within your career, you need to remember the people who have created these opportunities for you. There were times that chiropractors could not be at events, had to sneak in the back door of events and athletes had to advocate for us and still, they would not let us come. The wonderful experiences, the people I have met, the places I have gone to, athletes I have helped, and I think Christine would probably feel the same way, those things are special but they are not from our own doing alone and so we carry the torch, and we pass it on. As you sit here and listen to this and if you are a student, it makes tingles go up my back just thinking about the path chiropractic has come, and I hope it does for you too. I am happy to be here.

Dr Foss: Yes, you are right, Jon, that is something which is really significant, and we should think about that we are here because of the people before us. Then also, we must think about the athletes that have asked us to be there. They have stood up for chiropractors and a lot of times it is not the administrators or the heads of any sporting federations asking us to be there. It is the athletes speaking up and that is something to be said for our treatment methods and the way the athletes are feeling under our hands, as well as the time and energy that we are putting into the helping them. Well done to all the chiropractors out there on the ground doing good work. Jon, tell us a little bit about your 1st travel experience and what that was like and how you got that opportunity.

Dr. Wilhelm: Great question. I was 6 or 7 years into practice and unlike many students that know the end from the start, I was just happy to be a chiropractor working in Bozeman, Montana, that is where I grew up.  I came back, hung my sign on the door and I was working. I was at a Kinesio Taping seminar and Dr. David Parish, who was teaching the seminar got up and started giving a little bit of his background and he talked about how he had worked with the Paralympic team and the Pan American games. I remember sitting there, just this small-town chiropractor from Montana going, “Wow, you can do that?” I had no idea. Most of the students in their chairs are ahead of where I was, but I caught him on a break and asked him about it. Don’t be afraid to go out of your shell and talk to these people that have done these events, because they want to help you and share. I sat down with him on a break, and he said, “Well, you can go do a volunteer rotation at the Olympic Training Center in the US.” That is the road to work with Olympic sport often is to get the qualifications to get certified to do the background checks and there is this whole list of things you need to go through. Anyway, I started on that road and 2 and a half years later, there I was. It was 2013, and I was at the Olympic Training Center, and I thought Christine honestly, to this day, I still remember my thoughts. I did not think, “Oh, if this happens well, then what happens with this?” I just thought, “Oh, my goodness, there is a triathlete, and there is a weightlifter and there is a wrestler.” and “I know that person from TV.” They tell you, “Do not be a fan and do not ask for autographs.” Of course, we were professional, but I got home from that event and, like I said I thought I would just go back to work. A few days after that, I got a message from one of the athletes. We could not exchange phone numbers, we could not ask him for any personal information, but there was Twitter in 2013 and I had followed a bunch on Twitter, they had seen me following them. Anyway, they reached out and said, “We really liked what you did, we think you will be great.”, and he was a Bobsledder. He had been a previous gold medallist as a Brakeman, they are the pushers and he said, “We really like you to come on board with us to the World Cup tour. Would you like to?”

I remember dropping my phone and saying yes. Just like Christine was saying earlier, the athlete advocated. He said, “Well, hang on. I know what to do.” He was on his way to his 3rd Olympics; he was one of the leaders of the team. He sent a letter to the head medical director and the director of sports and a bunch of important people in the USA Bobsled skeleton and said, “We want Jon Wilhelm, I have done this enough, he has got what we need.” That fellow, of course, is really good to me and then I got really scared, like, do I have what they need?  But after a few months, I was on my first trip. It was not an international trip because we went to Canada, but it was a North American trip. I went up to Calgary and worked a World Cup for Bobsled. This is the year right before the Sochi Olympics, so as they were leading into Sochi, that was December and then the Olympics would have been in February.  Then, we went down to Park City, so we do 2 stops, I was with the team for 2 weeks and I was beside myself excited about how great it was. That was my first trip. During that time, I remember getting my hands wet, getting my hands dirty, and working with what I knew, but I also watched really closely for what the athletes liked and needed that I could not provide. I remember taking mental notes on that. I was okay to tell them that I did not know something or could not do something, which I think is a mistake and we might get to that later. That some newer younger or people trying to make their way, they try to do more act more than they are. I took notes of what I wear I was deficient. Then that next summer, that next year, I filled the gaps. That was my first trip with them, and the next year, they took me over to Europe and I did my first Intercontinental overseas trip with them, but yes, that is my little story on how I got into it.

Dr Foss: That is exciting. You alluded to it a little bit, tell us a little bit about some of the errors you made early on that if you could help somebody avoid, what would they be?

Dr. Wilhelm: Well, I already touched on it a little bit, Christine. I think you do need to operate with confidence in what you know, but certainly do not purport to be more than what you are, do not try to do more than what you’re qualified for, and really fit in as part of the team. Our team consisted of an orthopedic surgeon, several athletic trainers, and one physical therapist, and I was the chiropractor.  Even though my skills overlapped sometimes with what the athletic trainer did, they could do the taping, I could do the taping. They could do soft tissue work, I could do soft tissue work. There were areas where they have shown and I have shown and it was not anymore about my ego or my resume, it was about what we could do for the athlete working together. I would say, one of the biggest mistakes I see is people try to either go too fast into the process and they miss something important because they are just trying to climb the ladder or they try to do things that they should not be doing because they are not qualified or are unsure of. Sometimes, you are going to go into a situation, you just got to do your best. It does not mean you need to hold back and not do what is best for that athlete but do not step on somebody else’s toes that are more qualified than you. We are humble enough to learn from them. I think that is really important. Those are a couple of the little things. Yes, mistakes? I made tons of mistakes, Christine. Do you know what I mean? But nothing big enough where they did not invite me back. I think you must be confident, careful, and considerate, all at the same time. It is really a balance and the chiropractors that excel at this have this social awareness where they understand the circumstances around them, where they fit, and they are willing to fit into that mould until they are asked to do more.

Dr Foss:  Great, that is great insight because thinking about the different roles you have been in, you had to be different things. If you are with a group like traveling with a physical therapist and athletic trainer, maybe your role is different than when you are by yourself or maybe with a team.

Dr. Wilhelm: Yes, absolutely, Christine. There are times if I am on contract with an athlete and I am working with him at a training camp for a week or 2. I may be everything right into them, I am doing everything with them, doing rehab and doing soft tissue work, I am doing assessments, movement analysis, functional screens, all sorts of things.  There are other times when I have a very specific role within that team and we appreciate communicating with each other but there are times I have to step back even when I think I might do something better or in my own mind, may feel more qualified after you have proven myself. It is okay to take that step back and be part of the team and then realize if they fumbled the ball and they need you to carry it next time and maybe sometimes they would not ever, but you must be okay with that in working in a team. You do not have to be the Michael Jordan all the time, sometimes, you got to pull down the rebounds and be Dennis Rodman, that is it.

Dr Foss:  Going along those lines, what skills do you think are the most important for a sports chiropractor to attain early on? What would you say should be their foundational skills? Things that you cannot travel or go without.

Dr. Wilhelm: I think that the skill that will move you forward the most is your ability to communicate and that takes time to develop, and I think if you rush that, if you are new in practice and you never give a good report of findings or have a rapport with your own patients, you will really struggle with an elite athlete population, with interacting with coaches and other providers. I always say my answer for this is 100% communication, your ability to communicate to let the athletes know and to understand, so communication is a two-way street. Most of it is listening not always talking. I think that is number 1 and then I am always a proponent and I have told students that have asked me this or other chiropractors that want to do similar things. Something that I have learned along the way is what you know, gets you to the first door and usually opens it. So, for instance, these modules get you a certificate, once you test and learn those, that will open some doors for you. That is what you knew. Then the relationships you have, you could say, who you know, but really the late relationships you can foster, open the remainder of the doors because, at a certain point, you get where everybody is really smart and really good and has a lot of initials behind their names. The thing that separates is typically personality and your ability to communicate.  So those would be the things, Christine, I would say that are really important, both of those.

Dr Foss: You know what? I am surprised you said that but in reflecting on it, you are 100% accurate and even thinking about the smartest doctors that maybe the valedictorians of the class, they did not have the ability to communicate to be successful in practice and I think that carries over as you said, just having that ability, if you do not have it in practice to communicate with an athlete is just another level higher than that, too so I think you are exactly right.

Dr. Wilhelm: Thank you, Christine. Yes, I mean there could be lots of answers about which techniques and things like that.

Dr. Foss: Tell us then, when you travel with the team, what do you pack in your kit? What is your go-to items that are in your travel kit?

Dr. Wilhelm: Yes, that is a great question. I wish I knew this from the start because, on the first trip, I probably took way too much, a whole extra suitcase with all these things I did not need. I have pared it down to a little low pro camera bag. By the way, here is a little tip, I love those camera bags because they are really sturdy, they are made to protect expensive camera equipment. I have a little bag that works with the backpacks, got a rain fly on it, and l will always use it to carry my IT instrument assisted tool, whether it is a Graston tool, or a factor tool, or the other tools you may carry. I have cups in there because like decompression of myofascial techniques, I have floss bands in there, I have my dry needles with my electric stim pointer and the clips with the portable stim unit in there as well. I carry an assortment of tapes. Now, I do not carry 30 rolls of each because it is just not viable. Most of the teams I am with, they have totes, they have some things with them, but if I am in a situation, I like to have the tools with me that I like. I carry 2-inch and 3-inch dynamic tape, both in the regular and in the strong black color. I carry kinesiology tape, I like rock tape, nothing against any of the other tapes. Katie makes a good one, all these other ones make good ones, too, but I like rock tape, the best for me. Then, I always carry a little bit of bass and Leuko tape for rigid taping if I have to do an SPRT, or a tadpole, or something like that. What else do I have in my kit? Usually 2 tools. Yes, that is the majority of the tools that I bring with me, those are the base in my kit. You might see another 1 or 2 things that are more specific sport-dependent, but I feel like that gets me most of what I need.  My best tool is my hands.  I think for a chiropractor means hand. If I feel like if I lost my kit, I would still be okay because I have my hands.

But I like having those other things. Certainly, where I can and where I need it, if it is not there, I like to carry my own portable table. There is a comfort with that, it is the right size, sturdiness, and height. Christine and I were in Austria together, and I brought a table, and Christine had a table assigned to her. Christine’s comments were, “this monstrosity of a terrible table” but my table was good as it was my own. We still laugh about that experience to this day. I am going to track it down and give it to Christine as a holiday gift, which I am still going to try to do. But I like the chiro lux table, a portable table. It was the Astra light before, that one has gone with me around the world, several times to lots of different countries. If I need something a little more rigid, I use an arson table. Those are my choices; there are lots of good choices that are better sports chiropractors than me may use something else, but those are what I like.

Dr Foss: Tell us about when you travel with the team. What does your day look like? You are assigned a team. Rather than talking about a large event, let us talk about a regular event. What is your schedule,  what can they expect because they are travelling out with a team for the first time?

Dr. Wilhelm: Yes, really great question because I did not know this when I went in for my first trip. I showed up at the airport in Calgary for that very first assignment, and I did not even know who I was supposed to meet. It was terrible communication like I got there having to catch somebody out of the corner of my eye I recognized and latched onto them, but that is a really good question, Christine. Number 1, expect to work. Now, there are different levels of that. Sometimes, you are surprised in the assignments are easy and you have a half day off here and there and it is not too demanding. More often, you are at an event, and you are up early, whether you are an early riser or not, that does not matter because there is breakfast to eat, transportation to go somewhere, and training to happen, typically. Sometimes the days are long, where you are eating lunch out or you are packing something with you, preparing for a second training session. Maybe you have mixed groups, and the females are going and then the males after that, and then get ready for treatments where those may be in the morning, those may be an afternoon, often in the evening.

Most athletes like to get their treatments in the evening before they go to bed, which can mean you treat after dinner from 6 P.M. until 8 P.M. or it could be until midnight. There have been a lot of days where I have started up at 6:00 and the last treatment at 11:30 P.M. No, fortunately, they are not all like that; it is not a prison sentence, but understand that you are going to work and usually that work is a lot more than the remuneration you are going to get, or often, you are doing it for free to move sports chiropractic forward, move your relationship forward. A normal day would be to get up, have a morning training session, have an afternoon training session, or lift or whatever, it is different with different athletes and sports, of course, and then evening treatments until who knows when usually about 10 P.M. There are long days, we always say that the days are long, but the weeks are fast when you are on tour because seems like you are up, and up, and up, and go, go, go, but then you look back and two weeks flew by just like that.

Dr Foss: When you are travelling with a team, you are going to all the practices and all the lifts with them so you are in full contact with that team for the day, is that how you have found it works for you?

Dr. Wilhelm: Typically, so yes however sometimes, it varies. If they have a sprint coach and if you are splitting assignments with another provider, say an athletic trainer, you will divide up those duties, and we will have to do them all, but sometimes, you do them. A full schedule would include all of those things. There may be days where you just go to morning training, you do not go to the lift or the sprint session and then you will do treatments in the evening. I will also be clear, and this is if we go back to the mistakes I have seen providers make, do not expect that you are going to be in the Czech Republic and you get two days off to explore Prague, just as an example.

Sometimes, it works out really nice and you have a half-day or a day to enjoy the sights and some of the neat things around you, I have had some of those experiences. I have had more experiences where I go to a lovely place and did not get to see anything like that. You just see the venue and the hotel, the training center, the hotel, and back and forth, but you still get the experience of driving to a place, going to the airport and seeing the beauty around you and interacting with the people and eating the food and all those experiences.  Sometimes, you get that day off where you can go explore and enjoy but don’t go with that expectation and never ask for that. Nothing upsets the providers that have proven themselves and given their time more than another provider who is new that comes in and says, “When do we get to ski for a day?” Do not be that person. It is just not the etiquette; it does not represent you or the profession well. You are not there for vacation; you are there for the athletes and for the teams that you are with. That is something I have learned along the way, not because I asked for that, I never did, thank goodness but I saw people make that mistake.

Dr Foss: Can you compare that to working at a large-scale event like the Olympics? What was that experience like in contrast to travelling with the team internationally?

Dr. Wilhelm:  First, it is like the greatest thing ever, and I have been fortunate to work at World Sport Games, The World Games but the Olympic games, it is just everything times 10. You are more hours at training, there is more interaction, there is more stimulus all around you, and you are wanting to soak in the experience so you are staying up later to grab an hour or two where you can explore this or go out, and go outside the village, or see things that even in the cafeteria or wherever you are at and interact with new people.  I would say the demands when I was at the Olympic games in Pyeongchang in South Korea, a couple of years ago, were all the more. We worked more hours, there were more days where I had less sleep even than when I was on World Cup tour or doing these other big events, but you did not feel it because there was so much excitement in the air. It was not like, you are crying because you were too tired, but there are more demands and there are more demands, just mentally. I would say physically, it is about the same. There might be a few more hours of training or a few more assignments but mentally, there is more load on everybody. There is more stress on everybody and if you can have that awareness and be a person that is a giver at that point, not sucking from the team, or the athletes, or the coaches. Because look, I have said this before, be somebody that you would want to travel with. If you’re, “I am cold, I don’t like the food, I am hungry, I am so tired.”, and then you are telling this to athletes, any negativity, even though if I might be honest, which you are sometimes cold, tired, hungry, ready for a nap, and want to go home.  Even at great events, if you are just saying that and putting that energy out there, that takes away something from somebody. So if you can understand that and be just the opposite where you are like, “Wow,  we are ready to go. It is 6:00 A.M. and let us get some coffee.” I mean, people like that, being somebody you would want to travel with, I think is a really important thing.

Dr Foss:: Do you think everybody is liking the 6 A.M. pep talk, though?

Dr. Wilhelm: No, that is actually a really good point, Christine, because there are certain athletes you would never say that to. That is in general. I would say err on the side of that energy rather than moving down to breakfast and saying, “I slept terrible. I am so tired; do we have to go to training today?” I would say it in general, you have that social awareness of who you can fire up and who you cannot. But yes, that is not for everybody, that super energy bit, but some it is and that fires them up, too, so you understand who that is, that is part of your job and give what they need to them.

Dr Foss:  Yes, that is a great device. Is there some advice you can give to a young new doctor or even a doctor that is just getting into treating athletes on how to connect with a team? How would you say even if it is somebody in their town or locally, what would you say would be the steps that you would do retrospectively to try to start securing your career being a sports chiropractor?

Dr. Wilhelm: Do not be afraid to start from the bottom up and I did that. Often, we think, “I got to get in with that NTAA school that is down the road.”, but really you might start with a small high school, that is what I did to get my requirements to work at the training center, going back to that after I talked with Dr. Parrish at the seminar, I volunteered for small Amsterdam, Montana. This is a Class C school in Montana and they graduate about 40 in their graduating class and that is the team I volunteered with, but I was their everything. I was in the training room twice a week, I was a sideline for volleyball, basketball, all sorts of different sports, track, and field. I travelled with them.

One of the teams won a state championship in class C. I mean, that was huge for them, and I was part of that. How had I secured that? I talk to people, I was not afraid to go talk to the athletic director or to know that, oh, this patient is a potato farmer, but he knows all the people there so maybe he can leverage that and help me with that. I would say do not assume you have to start at the top and have a gleaming resume right away. Be okay with being at the ground floor level, you will probably get better experiences where you do not have your hands in your pockets as much. You have your hands on people when you are willing to start from a lower level. Pay your dues, and then when you finally get to touch an Olympian or the highest-level athletes, you have seen that thing 50, 100, or 1000 times and you are confident with it rather than, “I shot up the ladder, but I do not know what I am doing.”, and then you maybe flub your opportunity. I would say that you can do it and get in on the ground floor, just by talking to people and not being afraid. Somebody told me once, “Do not be afraid to make the ask.”, and that resonated with me. So do not be afraid to get yourself out there and make the ask, usually, your patients know somebody who knows.

Dr Foss: One final question. We have heard a lot in the media about doctor-patient relationships and problems; how would you or what is your advice to best navigate that? Setting boundaries on your time to treat until 11:00 or 12:00 at night and trying to be flexible with the team, trying to be there for the athletes but also trying to set professional boundaries. Sometimes, when you are travelling with the team, you are with them for two weeks, and then you are all immersed. What would be your advice in that instance?

Dr. Wilhelm: Yes, this is a really important question because this is something that, when you travel with a team, you really do have to learn to navigate and it is also a changing playing field where the rules are changing, the etiquette is changing, something, maybe that was acceptable like treating out of your own hotel room in 2013, absolutely, is not now. Make sure that you are aware of what the standards are in the country you are treating for safe sport or in whatever country you are in and also the expectations of those athletes. I have been at events where a female athlete was treated outside. For instance, when we were in Poland at the World games, and working track and field, and you go to assess a shoulder and maybe, a female Italian athlete, who is maybe has a different expectation of privacy, just wants to take her shirt right off and that would not happen, usually with our American athletes. You have to be able to stop that from happening and let them know your boundaries as a provider as well.  I think the important thing is navigating about that again. Have an awareness of what the expectation is, what the rules are, what the law says, listen. Then, you should let that guide you but deeper than that, you should have an integrity within yourself. We are professionals. We say an oath to not harm, and I think if we put somebody in a compromising situation, an athlete, especially a youth athlete, that harms them. So, avoid the appearance of impropriety, communicate well, obviously, have treatments that are viewable and interruptible, so an open door, a number of people in there. I have navigated this a lot because I have worked with USA Gymnastics, USA  Track and Field, Bobsled Skeleton, and obviously, there are different etiquettes between each of those and then, there are times on the road internationally and I may be working with a female speed skater, just one-on-one at a training camp and so I have to keep the similar boundaries and ask them what their expectations are. But beyond what they communicate, I have to hold my own compass. Each student that is watching this has to have personal integrity as a professional and be able to hold their own arrow on their own compass and not deviate from that because you are not just holding that for yourself, it is most important that you do that for yourself, but you are holding it for the rest of us, too.

They are going to put, “Chiropractor does something.” you know what I mean? or “Sports chiropractor does something inappropriate.” So, that represents us all. I think that is the most important thing that I have learned through all of that and you will get put in some situations where you just have to be in touch with your own integrity, not question that have resolved about that and it is not like every day is uncomfortable with that. It is just now, especially in our time, in our society, you must have an awareness about that. But you can still have fun and be professional. You can still have a great time and navigate these things, but there is a time to really know where you are centering your core, and before you ever get on the road with the team, you should know what that is.

Dr Foss: I think that is great advice, Jon. Understanding that there are cultural differences of privacy as you alluded to is something, as you start to travel internationally, seeing, you know, some cultures are, they do have a different expectation of privacy and understanding that culture before you travel, is important. Knowing where you are going know what people accept – socially acceptable and what is not socially acceptable is something may be worthwhile to investigate before you travel somewhere and have a hard time.

Dr. Wilhelm: Do a little homework. If I know I am going to a new country, so I am selected to go to the World Sport games in Italy, one of the first things that we did with FICS, I tried to study and learn how to say, “Can you lay face up? Face down? Turn right. Turn left.” I thought about the things that I would say so I tried to learn it in the native tongue. Now, we ran into 25 different languages so that worked for just Italian. I think what you are talking about, just that social awareness, whether it is with boundaries and privacy issues with communication, or with expectations, have an understanding of the sport you are going to work and not that you have to have deep knowledge. You are going to learn more than more you do but have a basic understanding of how to navigate those situations and you will do so much better and you will have more fun because you are less stressed. I love to have fun, but I do my research before I get there, too, which allows some stress to go away.

Dr Foss: Yes.  Well, those are all my questions, Jon and I just want to say thank you so much for coming and helping all the students navigate the water and, hopefully, avoid some of the errors that our predecessors and we also made, as we were starting out on this, trying to give them a foothold as we elevate our profession, and that is really the whole concept here. Thank you for being so great, for what you do and for being a good model for sports chiropractors internationally. I appreciate it.

Dr. Wilhelm: Well, thank you, Christine. I really appreciate that, and I want to say to all the students, look at what you are getting into, I think the best profession in the world and especially in the specialty of sports chiropractic, you are going to be able to see and do some wonderful things to help athletes achieve that there is nothing to me better than that. You are really in the right place. I want to thank you, Christine. You said at the start that I was one of your favourite sports chiropractors. Well, I do not want this to seem disingenuous, but you really are not only one of my favourite people, and you are a great mentor for these students to follow. There are lots of good mentors out there so if I can be helpful to any of you students, please search me out, I would be happy to help you. I am happy to do this, and I hope it was helpful in some way.