As appeared in Performance Conditioning -

Dr. Anna Abramson is a physician at UCSF who enjoys improving processes that can have a meaningful impact on the way tasks are accomplished in the medical world.  In her free time, she loves to ride her bike. She’s married to Mark Abramson, current vice chairman and past president of the Board of Directors of USA Cycling. 

PC: What is Medicine of Cycling and how/why did you start it?
Medicine of Cycling began organically. Initially it was a grass roots group of doctors and other medical professionals who wanted to improve the medical care of cyclists. The group needed a more cohesive way to interact since we came from so many different disciplines and specialties. Medicine of Cycling was cofounded in 2009 when past USA Cycling President Mark Abramson and trauma surgeon James Watkins MD became energized after a collective effort to improve care for a traveling collegiate athlete with a pelvic fracture. The complexities and success of his case seeded an idea for making a national care model for cyclists. I enjoyed hearing their ideas and thought it may be an interesting problem to tackle.
We surveyed and met with professional team physicians, owners, and managers, and realized the problem was much more complex than previously expected. We learned that about half of the professional road cycling teams, and many more mountain and amateur teams do not have a medical provider the athletes trust; many go to a non-traditional provider to manage medical problems. Most races do not have medical professionals, medical emergency plans, or evaluation standards for the most common types of injury.
After defining the problem, the solution seemed unattainable. At that point, we decided to form the Medicine of Cycling organization to improve the medical knowledge and exchange of expertise among the varied group of providers for this large and geographically dispersed group. We started by having an annual medical conference with experts in cycling related medical fields give talks, and simply give medical professionals the ability to meet and discuss their experiences. Now that we've had three conferences and have had tremendously positive feedback, we look for new opportunities and challenges to tackle towards our educational and outcome goals.

PC: You have already reached several important accomplishments which would be the most significant, impacting the sport of cycling the most?
It's hard to say what will have the greatest impact in the sport, but the two accomplishments to date that I'm most excited about are the groups work in concussion awareness and our Medical Emergencies in Cycling Course.
We have a group of 15 medical professionals including concussion experts, race and team doctors, working on improving concussion evaluation and care for cyclists in an out of races. We have both an adapted concussion consensus statement specific to our population, and a concussion card that help in the assessment of a down athlete suspected of head injury. Both are available on our website under guidelines for use. The concussion documents have been translated into several languages and are in wide use both in the US and in several other countries.
Additionally, we have an amazing group of emergency personnel who teach a hands on course called Medical Emergencies in Cycling Course annually for medical professionals who want to become more involved with races and teams locally or nationally. Drs. James Watkins and Aaron Goldberg put together a high-yield curriculum and organize the course.

PC: What on your radar for the future directions of the organization?
We have a number of goals that we have set for near term and some for longer term. I'll mention the ongoing projects and their near-term goals.
1.   Medicine of Cycling Membership - We invite everyone to support our organization and help us fund the various projects our group would like to do. Also medical providers who have attended our conference and/or hands on course can now feature their interest and support in being medical providers in their local and national community on our website. Our members will soon have a secure forum where they can discuss complicated medical care issues and share experiences to further their education and ability to manage patient care.
2.   Bike Fit Task Force headed by Curtis Cramblet DPT has started an amazing collaboration of bike fitters, manufacturers, coaches, and medical experts to define features of bike fit and demystify the process for cyclists and medical professionals.
3.   Bicycle Safety is one of my greatest commitments. I love to ride, but realize the hazards that come with the sport. We are working on improving race day safety and awareness of higher risk areas for falls and injury. This is a longer term goal.
4.   Education is often one of the most basic key interventions. Kristin Wingfield MD and I are planning a 6-week Mini-Medical School for the Public in Cycling Medicine through University of California, San Francisco. There are many other opportunities for local and national education, we are very committed to making these opportunities happen.
5. Research in cycling medicine in the US is lagging behind other countries and other sports. Research requires time, funding, and mentorship. We started having a research presentation portion to our conference with the hopes of fostering the research that is ongoing and encouraging those who have considered starting or finishing a project attain their goals. I want to clarify that the research is medical research - concussion, urological trauma, long term injury, etc.

PC: Let’s talk about the coach-cycling physician relationship. I look at it as a multi-dimensional situation. The coach may recommend a qualified physician for a specific medical issue. What is the decision making process?
At this point most cycling networking occurs on a very personal level. An athlete may have referred to a doctor who either has identified as a cycling enthusiast or has treated another cyclist in the past. In reality, sometimes this may not be the best person for the job, but this may be the person the coach trusts, and this goes a long way. This is one of the reasons why orthopedic surgeons and pediatric radiologists come to our conference and learn about primary care, asthma, and dermatology. If they ride with a team or are active in their local cycling community, they may be asked questions which are out of their practice scope but are personally trusted. This is a very complex problem and a large part of why we started MOC. We now have some providers listed on our website for all to see and seek, but for now we continue to work on education and hope our network grows large and robust for coaches and cyclists soon.

PC: The coach may be working with a non cycling savvy physician for a pre-existing condition of one of their athletes. How does the coach navigate through this to the best interest of the athlete?
One of the saddest things I hear from cyclists is "I went to a primary care because my knee hurt. She told me to stop riding so I never went back to her." Non-cycling savvy medical providers may not perceive the extreme commitment most cyclists have to the sport. It is very important to be straightforward with the medical provider, for example "If I don't ride my bike, I will get fat and depressed, so it's important for my well-being to manage the knee pain on the bike." If the provider does not understand this quality of life feedback, it's appropriate to ask for a referral to a sports medicine provider. The athlete should be encouraged to continue to seek care and not let one or even two negative interactions become an obstacle to their health maintenance.

PC: Then there’s the rehab process of diagnosis, surgery/treatment therapy and balanced reconditioning of integrating the injured area to the rest of the body to avoid re-injury. How does the coach/physician role change during this process?
This is great challenge. Rehabilitation is a frustrating and expensive process that wears down even the most fastidious athlete. Many insurances don't cover significant outpatient rehabilitation needs and disaster only plans cover none. This is the time that coaches can significantly improve the odds of an athlete returning to the sport. Depending on the injury, there are various long term consequences from inconsistent or insufficient rehabilitation. If the athlete doesn't remain off a broken bone or take contraindicated medications such as ibuprofen to get through the pain to start training early, the bone may heal more slowly or form an insufficient callous, predisposing to repeat fractures. Tendon and soft tissue injuries heal slowly, and jumping into training instead of rehabilitation early can significantly prolong the healing process and alter body symmetry to accommodate for pain or lack of flexibility that results from injury. In short, you as a coach have to stress the importance of rehab to your athletes, no one other than their mother can possibly nag them into doing the right thing as much as you.

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