Physiotherapy in Adaptive Alpine racing teams

I'd like to share a little story with you about how I got the opportunity to travel with an adaptive alpine racing team. Once upon a time there was a lovely elderly lady with a sore ankle who booked in with me on a Wednesday morning because her usual Physiotherapist was not working that particular day. There are few people who come into your life and in minutes know exactly who you are as a person without you explaining yourself. Joan was one of them. She saw me for exactly who I was. 

Every Wednesday morning I looked forward to seeing Joan and sharing stories about adventures, trips to the snow and finding out about all the places she’d travelled in the world… and of course getting the physiotherapy treatment done too. Until one day, when Joan asked if I had ever considered working with a winter sports team? Never before had I seriously considered I'd be able to work in that role, but the idea of combining my love for physiotherapy, travel, and snow sounded pretty cool.

Because of that day, Joan introduced me to her son, who introduced me to the Olympic Winter Institute of Australia (OWIA). Because of that day, I received an invitation to attend the OWIA annual skills update weekend for their physiotherapy network. It was held at Jindabyne in late 2014. I loved meeting everyone in the network and hearing about their work backgrounds and experiences. It was intense and eye-opening to learn about the role as a first aid responder and how physiotherapists work with winter-sport athletes, specifically border cross, moguls, aerials and short track. I left that weekend feeling inspired by the physiotherapists I had met and hoping that I might get an opportunity to work in that role one day.

Time passed and in February 2015 my husband and I moved to San Francisco and my life took on a whole new adventure. Living in a new city, trying to navigate the re-qualification process, working as a Pilates instructor, volunteering where I could and continuing to write for this blog. The dream of being an OWIA physio still in the back of my mind, but the endeavours of settling into a new home taking up most of my time. Until one day, I received a phone call asking if I would like to be the physiotherapist for the Australian and New Zealand Para Alpine teams as they travelled to Aspen for the IPC Winter World Cup Finals. Of course I said yes. After several months of being excited and looking forward to the experience of working as a Physiotherapist again and experiencing a completely new job opportunity, I found myself in Aspen, Colorado for an amazing two-week adventure.

There are so many roles a Physiotherapist can work in, and never before had I experience working as a musculoskeletal/sports physio in an adaptive team. The aim of this blog is for me to share some of that experience with you.

What is the IPC Classification?

There are 3 classes of impairments.

  1. Visual impairment B1-B3 (also referred to as blinkeys)
  2. Physical impairment - Standing LW1 - LW9/2
  3. Physical impairment - Sitting LW10/1 - LW12/2 (also referred to as wheelies)

These classes allow for a factor system i.e. time handicap to be allocated to each athlete depending on their disability. In the para-olympics there are 6 categories of disability:

  1. Amputees
  2. Cerebral palsy
  3. Intellectual Disability
  4. Visually impaired
  5. Spinal Injuries
  6. Les Autres - their disability doesn’t come under the other 5

Visually impaired (Blinkeys):

All athletes follow a guide down the course. It is truely incredible to witness the trust and leadership these teams display as the athlete follows a guide a full speed through a race course, staying in close pursuit of their guide and listening to commands on when to turn around each gate. 

Standing classes LW1 -LW9

  • Leg impairments LW1 - LW4
  • Arm impairments LW5/7 - LW6/8
  • Leg and arm impairments LW9

These can include athletes with acquired and congenital limb deficiency, cerebral palsy, spina bifida, nerve damage and les autres.

Sitting (Wheelies) LW10, LW11, LW12.  

All sit-skiers have an impairment affecting their legs. They are allocated different sport classes depending on their sitting balance, which is very important for acceleration and balancing during the races. Sit-skiers have disabilities rating from acquired leg deficiencies, spina bifida, spinal injuries, and les autres. 

Class LW 10: Skiers in this sport class have no or minimal trunk stability, for example due to spinal cord injuries or spina bifida. They therefore rely mainly on their arms to manoeuvre the sit-ski.

Class LW 11: Skiers have good abilities in their upper trunk, but very limited control in their lower trunk and hips, as it would be the case for skiers with lower spinal cord injuries.

Class LW 12: This sport class includes skiers with normal or only slightly decreased trunk function and leg impairments.

Photo of Mitch competing in the Super-G final at Aspen. Photo credit to  Bryan Myss

Photo of Mitch competing in the Super-G final at Aspen. Photo credit to Bryan Myss

Meet the amazing athletes I had the privilege of working with - Mitch Gourley from Australia and Adam Hall and Corey Peters from New Zealand. All of which are incredible skiers and competed in the Sochi Paralympic games in 2014. 

Mitch Gourley

Mitch Gourley, aged 24 years, began skiing when he was 8 years old and racing competitively from the age of 15. Mitch falls into the LW 6/8-2 class (standing category) of the IPC. Mitch, Adam and Corey have all shared about about their experience of the role of Physiotherapy in helping them train and compete. 

"For me, physio is most important during big training blocks for maintenance of little niggles that tend to flare up under the big loads and heightened fatigue of living at high altitudes and training heavily. Meanwhile, the importance of physio while racing tends to vary for me depending on how badly I've crashed that year!

Usually, if my off-snow prep has been solid and disruption free, I shouldn't need too much work during races. Minor bits and pieces for 'GS back', 'DH neck' and my angry left shin that usually wants to fall off by around late January, but nothing major. This only tends to change with acute episodes, generally resulting from crashes!

In addition there is also non-physio specific physio work on the hill is something fairly unique that is also important to us as athletes. Clicking athletes in, receiving/relaying course reports, facilitating warm ups in cold and awkward environments etc." (Mitch)

Adam Hall

Adam from New Zealand also competes in the standing category. His classification is LW1 from spina bifida. Adam has been competing professionally for many years...

"I am just finishing up my 12th back to back competitive season. 24 winters all up in a row. Physiotherapy has played a big role in my career to date and will continue for the rest of my performance-career both on and off the snow. As an athlete with a "so called disability", I think it plays a even more crucial role in the area of Physiotherapy/treatment. I believe it is a very unique situation and there seems to always be something going on, which needs maintenance. I know my body is complicated and like a puzzle and when you don't have full sensation and movement then certain things become more important. I have found that such things as ongoing maintenance wether it be massage-flush stretching, Pilates, having a good warm up/activation routine, have all played a big roll in not just keeping my body in tip top shape, but has payed dividends with on-snow results.

Physio's have a big job to do and cover a diversity of different things. Keeping athletes in top shape, getting rid of niggles, keeping you at the top of your game when something doesn't go to plan. As the athlete also taking away as much knowledge as I can to self-treat as many things as possible has also helped me be more self-sufficient in locations when we don't have the luxury of having such a professional on board with a team.

I often find that a lot of physio's I have worked with have come from the sport arena as well and understand the basic pressures and demand sports can have, and I find the majority will help keep you cool headed when it matters most. All in all over the years Physiotherapy in general has kept me in the game this long at the highest level and will continue moving forward." (Adam)

Corey Peters

Corey Peters, 32 years old, suffered a spinal cord injury in 2009. Remarkably, Corey began sit-skiing in August 2011 during the NZ winder season and rapidly progressed to win a silver medal in the 2014 winter Olympic Games in Sochi.  

Corey's IPC Classification is LW12-1 which means that he has muscles below the injury that still function which can assist him with skiing, such as hip control. 

"Physio plays a huge role in my performance on and off the snow. Because I use my arms and shoulders so much throughout my day to day training and activities there is a tendency for everything to get tight, restricting movement through my upper thoracic/shoulder region. Regular physio sessions help to release these tight areas given me back my range of motion, which in turn allow me to be dynamic while skiing." (Corey)

What my days were like

One thing that I was encouraged to do by many others who’d experienced this working life before is to make time for myself. So each morning I tried to go for a run or walk, in the freezing cold, just to start the day fresh. It was beautiful. Colorado is so stunning and watching the sun rise of the mountains while breathing in the fresh cold air was just spectacular.

  1. Make sure I packed everything I needed for the day.
  2. Check the forecast and dress appropriately.
  3. Have breakfast and make lunches.
  4. Drive athletes and myself to the mountain. 
  5. Assist in any way I could throughout the training or competition. For me this included helping warm up athletes or tend to any injuries before course inspection.
  6. The race – be on stand-by as a first aid responder but also be there to help athletes prepare for their race. Some days all I did was make sure they stayed hydrated, while on other days I acted as a wind block to keep them sheltered from the cold wind while they waited in their speed suits.
  7. Help pack up and drive home.
  8. Physio treatment time...
  9. Notes and dinner.
  10. Go to bed, sleep and repeat.

This is just a brief overview of the routine that I fell into and that worked for me and my team. I’m sure everyone has their own experiences. One contribution I found valuable for the team was helping with meal prep. Especially when the athletes are tired from racing, just simple things like making lunches and helping cook dinner can go a long way. The bonus is that I love cooking, so it was a great way for me to relax at the end of the day, while knowing that everyone was eating well and looking after their nutrition and hydration.

It’s different to being in a clinic. In many ways you are bound by a schedule and yet there is no restriction on time. If people crash or the course becomes damaged, things get delayed and you just have to go along with it. What specific treatment athletes require each day varies and some days its important to make time just to recovery and rest. One significant change in my physiotherapy role was being with the athlete for large proportions of the day, which you might imagine can change the conversations and interactions you have with them. A great tip given to me before the trip was to give them space. By this I mean not actively watch them all day - it is just too much. So switching between these roles as physiotherapist, driver, and team mate was important to establish so that I didn't overcrowd their personal space. 

lessons learnt

There are three points that I'd like to share with you, which I took away from this experience and will impact my future role as a physiotherapist. 

The person in front of you is the most valuable source of information.

This is a belief I've held for a long time now but reinforced from this experienced. I've never raced or been a winter athlete before and came into the experience with little knowledge about the physical requirements and demands of the sport. There are four races: slalom, giant slalom, downhill, and super-G. Each course structure varies and the way the skiers perform varies too. I was so grateful that each athlete took the time to tell me about how each race effected their body and what they need to achieve to compete well. They provided me with invaluable information I needed to help them get ready for performance. Just another reminder that the person in front of you holds the most valuable information you need to know about their body and what help they need from you.  

Health, wellbeing and performance extends beyond physical injury and pain.

As you would have gathered from what Corey, Mitch and Adam shared above, the role of the Physio is quite diverse. Traveling with an athlete is vastly different to treating them for a 20-30 minute session in clinic. You have this unique opportunity to observe their entire day and see how this may impact injury, pain, and performance. Sleep hygiene, nutrition, hydration, allocating time to recovery, rest, treatment, and competition are all things that need to be carefully balanced to get the most out of each day. And I really enjoyed being present for all of it, feeling like I was able to influence much more than just function, pain or range of movement. 

The power of the mind should never be underestimated.

I was blown away but the mental clarity, determination and commitment each of my athletes possessed. What they do everyday is do far removed from my profession. Each day they look at a race course, carefully study it and memorise it, and commit to racing it as fast as they possibly can. There is this fine line between going so fast that you crash and get injured, and taking it a bit slower and coming last. The time that separates the top athletes is often tenths or hundredths of a second so every little bit counts. That skill, that lack of fear, or ability to control fear, is not something I personally have and it was really inspiring to watch these guys compete and see them in action doing something that they love. Often you’d hear coaches say at the starting line “don’t brake” or “get after it” and then the chase begins. Certainly in this profession, risk/reward is really high and I’m so proud of how these athletes performed and what they achieved. Such strong individuals. It was truly incredible to be around them for 2 weeks, learn about their sport, learn about what this profession means to them, and be reminded that we have to chase our dreams and get up everyday with the mindset that you if you want something, you have to work for it.

I returned from my trip grateful for this amazing experience, to be in a world I’d never seen before and to be offered that opportunity by SSA and OWIA. Inspired more than ever, from the enjoyment I experienced, to go after my license and to keep studying what needs to be studied. Reminded that I love helping people and I love what I do. And most of all, open minded to the idea that working in an adaptive program is a very challenging and rewarding job and hoping that I get another opportunity to work with those athletes again.