This week I had the pleasure of interviewing Dr. Massimo Testa. Dr. Testa is one of the most experienced cycling team physicians and coaches in the US as well as co-author of training manual Faster, Better, Stronger: Your Exercise Bible, for a Leaner, Healthier Body in Just 12 Weeks
In this interview we get a glimps of how this national team physician ensures his athletes succeed while staying healthy, and his advice for the sport. First, we need to understand how Dr. Testa got his start:
Q. How did you first become a team physician?
A. That’s actually an interesting story. In the early 1980s, I was finishing my fellowship in sports medicine to become a team physician at the University Pavia, Italy. Unlike the US, in a sports medicine training focuses more on exercise physiology and less musculoskeletal issues. Additionally, all athletes are considered “employees” so they are required by law to have an overseeing physician in order to do their job. I loved cycling and was doing a special research in health risks associated with being a full-time professional cyclist. I was also seeing hundreds of youth athletes for their sport physicals and injuries. Obviously very busy. In 1985, for the first time in history, an American team called 7-11 came to race in Italy. They were the only team in Europe without a physician and this was against UCI rules, so I was assigned to them because of my research interest. They were very grateful and only expected me to come to the race and fix them up if they got injured. This is not how I trained or how things were done. I watched the team warm up, race, and saw them through the recovery, giving advice or medical help as needed. They liked this so they asked me to be their team doctor, the first one they had. I visited the US that year, started to understand how American teams operated. In Italy, many times the physician is also the team coach. This has advantages and as you can imagine some serious draw backs as that balance between medical help and medical manipulation gets shaky. I never agreed with that.
So for the next 6 years, I was the physician for Team 7-11, then the team became Motorolla and I was again with them for another 5 years. After that I took a short break from American teams and was the team physician for Mapei, the largest European team during the late 1990s. At that time, Dr. Eric Haiden – rider on the Team 7-11 in the 1980s and now orthopedic surgeon, invited me to start a sports performance lab at UC Davis in Sacramento, CA. I came for one year but stayed for 7 at UC Davis. After that, I moved to Utah and just never left. During the past 10 years, I’ve been working with the USA Cycling as the national team physician and more recently as the chief medical officer for team BMC.
Q. That is an incredible amount of knowledge and experience. What makes you so successful at what you do?
A. First of all, I love the sport and I’m a big fan. Athletes are a great population to work with. They are all Type A personality, which means they demand a lot out of me, but that also means they are committed, compliant, and motivated. I owe a lot to my initial training in fellowship, there I learned a lot about applied physiology and pathophysiology of exercise. I understand what happens to a body during exercise, I believe in the process, and feel we should be prescribing it as physicians. I know what happens to a hypertensive patient during exercise, know what will be safer for them and what will make them better. We learned to do all the tests, the echocardiograms, stress electrocardiograms, tilt table tests, pulmonary function tests, and so I can couple those with physiologic processes and easy measurements to know what is happening in my athlete’s body. Also, to be really in-tune with what happens during training and racing, I’m there for the training and racing. I travel with the team 180 days a year. This way the athletes are comfortable telling me about the small changes they experience and I can “see” when they are over-training by their numbers even when I’m not there. I monitor their physiology, their weight, lactate response, power output, training intensity, heart rate to name a few to pick up early signs of fatigue and over training. Because of our close relationship, the athletes and the team trust me to make these calls and change the training and racing plans accordingly.
Q. How do you navigate that difficult conversation with the athlete, when you think they are too sick to race?
A. Well, first of all we as physicians have to know the rules and have strong internal discipline to guide the team and athletes to make the right decision. Previously, I guess I could have injected someone’s joint with cortisone to allow the athlete to compete, but that to me means that I am allowing a disease process to cause biological damage for a race. I tell the cyclist “you can continue racing at this point, but you’re not going to win the race and you’re not helping yourself heal for the next one.” They are smart, they understand this and with my athletes this is rarely a problem.
Q. What have you learned as a cycling team physician? What is your favorite part of the job?
A. The learning never stops, I’m always travelling and meeting people from other cultures, other physicians, and seeing new perspectives on each problem. It’s very interesting if you think about it. Each culture has it’s own focus, a stomach upset for a Spaniard and a stomach upset for an American can simply mean two different polar extremes of urgency. One can just think about it as a nuisance, while the other can give it the significance of the entire system coming to a halt. We learn to be sensitive to these issues with time.
Q. About half of American cycling teams racing in the continental United States do not have a team physician. What advice would you give the coaches and managers of those teams?
A. It is still very strange for me to think about that, even after all of these years in the US. I would recommend that these teams at least find a medical professional who can do a pre-participation questionnaire and screen athletes for significant risk factors such as familiar history of sudden cardiac death, personal history of exercise induced asthma, dizziness, fainting. There are resources in each community that the team managers should take advantage of. This can be a local clinic that would be willing to do all the physicals for a fixed fee, or a local business who is willing to sponsor a medical checkup for a team in return for some favorable publicity. I think being a team coach in the US is very hard, often coaches are the first level of medical care for athletes. Ideally all teams should have a coach, manager, and physician.
Q. This year has been a difficult one for concussions and traumatic brain injuries in cycling. What are your thoughts and practices in this area?
A. I have always been cautious with possible head trauma. In fact I pulled Dr. Eric Heiden out of his only Tour de France after he crashed and cracked his helmet. I’ve seen a few riders die from head injuries, especially in the days before helmets. No race is worth it. I like what your group has done with the concussion recommendations and use them for our team. This is a step in the right direction. Our team also has Scott Nydam, a rider who unfortunately ended his career after several concussions and an intracranial hemorrhage. He is a great advocate for the riders and makes sure he asks specific questions to elicit symptoms that a simple once over may not pick up. The entire team has to be on the same page on an issue like this.
Q. What are your biggest challenges as a team physician professionally?
A. There are a few big ones. We are lucky to have a very well-staffed team, so we can provide good support for our athletes. If a cyclist doesn’t have insurance, this becomes a huge problem. I’ve provided a huge number of free physicals and ECGs but in reality all riders should have insurance, and a medical professional who knows them. Unfortunately, cycling has the highly publicized doping risk. There are two categories here, intentional and unintentional. Athletes are sometimes taking supplements, including recovery drinks and vitamins, they don’t think to mention to me, their physician. But if they are caught the physician is always associated with that athlete, so we have to be super careful. Supplement companies are selling a myth that these products will make you faster, they’re just trying to sell their product. Though it takes time, education is the best prevention for doping. I make sure my guys know that most of the products don’t work, in addition to risk to health and career.
Q. What is your least favorite part of the job?
A. I love to travel, and I love the sport. I love Tour de France, but I’ve now been to 18 of them sitting in a car during the entire month of July. Most team docs love to ride their bike, well forget about that when you’re travelling with a team, it’s just too busy. The job has also become a lot more complicated. I used to just travel to races and make sure nothing happened. Now there are many more races in the season, biological tests, monitoring, training, keeping up with the rules, and blood tests.
Q. What advice do you have for team physicians who are just starting out? Especially those who are managing their athletes remotely?
A. Know the athlete the best you can. Have a periodical updates every 2 to 3 months. A good way to do this is a questionnaire for each cyclist to fill out, especially looking for changes in cardiac symptoms, fainting, dizziness, shortness of breath. When you don’t travel with the team, you don’t have the connection which encourages more open communication. You may not hear of the daily nagging headache or some other detail that may be important but not necessarily shared during an infrequent encounter. Depending on access to a performance lab or other metrics, going through this information with the rider, is a good way to get reconnected. This may also be a good project to do with a fellow or student.
Q. What is your favorite medical journal?
A. I like the British Journal of Sport Medicine. That’s probably my favorite overall. Now it’s easy to get articles from basically any journal so I just search for my favorite topic, and that is physiology.
Q. What is your favorite “must attend” medical meeting?
A. The American Medical Society of Sport Medicine is a great meeting. It has a good balance of sport medicine, medical performance lab, exercise testing, considerations for exercise restrictions, traditional non-surgical medical management, gait management, and family medicine.
We want to thank Dr. Max Testa for this interesting interview.