As sports resume, experts warn of pitfalls
CHICAGO - As sports return one by one, uncertainty prevails.
Major League Baseball is set to resume July 23, while the National Women's Soccer League resumed Saturday. Major League Soccer returns next week from Orlando, Fla., and the NBA is scheduled to begin its games on Aug. 15 from its own Orlando "bubble," while the WNBA will start an abbreviated 22-game schedule later this month.
The best chance for athletics to sustain during the COVID-19 pandemic is for those involved to be open and willing to adjust, said Dr. Brian Cole, a sports medicine surgeon at Midwest Orthopedics at Rush University Medical Center.
"This is one situation where you can't see around every corner," Cole said. "There are a ton of blind spots. You get a curveball that's epidemiologically based where you find something else out about testing that wasn't apparent before because of all the research going on. You have to have humility and be nimble. Tomorrow brings a whole new set of circumstances."
Bringing athletes back to their training facilities and arenas carries a host of issues leagues must be prepared to tackle _ and not just on how to limit the spread of coronavirus. From mental health issues to nutrition to an uptick in injuries caused by a layoff from elite-level workouts, the potential problems are plentiful.
"The other thing I think people forget about is the psychological stress of this," said Cole, who serves as head team physician for the Chicago Bulls and team physician for the White Sox and the Chicago Dogs. "People are quick to conclude, 'Well, these athletes get paid a ton of money and they'll be fine. The rest of the world will suffer.' There's no question there's an immense amount of suffering people are going through. Athletes, these are young people who are not often well equipped to handle the psychological stress. They may not be worried about themselves but they're worried about the impact they may have on their immediate family and their parents. Independent of how much money you make, you can't account for the psychological component of isolation, depression, anxiety."
Another difficulty will be warding off a rash of injuries.
While there's no blueprint for returning to sports after quarantine, experts can rely on other long layoffs such as the 2011 NFL lockout that lasted four months and prevented players from having access to team medical staff and strength and conditioning coaches. Achilles tendon tears increased from eight per season to 12 in training camp and the preseason, according to a Journal of Orthopaedic & Sports Physical Therapy study.
After the 2011 NBA lockout, a string of ACL tears also concerned medical professionals.
"They haven't had the same strength and conditioning resources available to mimic what it's like to be in the sport," Cole said. "Then you can have overtraining. It's going to be a bit of fits and starts and it will be sports-dependent."
At Illinois, where athletes have returned in phases for voluntary workouts, football strength and conditioning coach Lou Hernandez said, like most programs, they use the best available science to guide them but there are no guarantees during a pandemic.
They work out in small groups. They practice social distancing with common sense, allowing for necessary spotting in weightlifting when needed. The program is easing players back into elite physical training to avoid injuries.
"There's nothing to reference," Hernandez said. "I can't go back into any of my diaries or notebooks to look back and say, 'Oh, I remember these adjustments.' There is no research how to come back after almost four months off. I would never want to be the university to volunteer for that study in the first place. We're really navigating in uncharted waters.
"Back in the day you're in your first workouts - I was part of it too - people were terrified the first workouts of the week," he added. "You would drive them until they were crawling out of the facilities. Those days and times have changed. Scientifically things have improved from a knowledge standpoint to preventing these issues and the actual development that's required to sustain a season that will run us into January."
Having a safety plan on paper is one thing. Enforcing it is another - especially at the college level.
The NBA's bubble model seems the safest and most ethical to many, considering the players are paid professionals. Baseball players may be at less risk because of the distance between players as they compete and because they play outside.
Logistically, college players - many of whom live in dorms and will attend class - can't be as isolated.
"I think there's a lot of guys understanding it and a lot of guys also feel when they're 19 and 20 and they're college football players, you also think you're immune to everything and anything," Hernandez said. "(It's) educating them and having them understand this is real. This is definitely something that not only can affect you but can affect your teammates when they have to go into quarantine. And then it might affect a coach who's not going to be able to help you. You don't want to be selfish. This affects the entire team."
Educating athletes with straight-forward information is vital to limiting virus outbreaks, Cole said, and something everyone should be absorbing.
"Using science and not politics to get them to understand going back to sports is a privilege at this point," he said. "We didn't have the luxury of having this conversation a month ago when we didn't have ample testing. Embrace the fact that physically distancing, a mask and proper hygiene is our best defense here. We know the primary root of transmission is respiratory. It doesn't mean you can't be with other people, but just doing it differently can have a profound impact."
The NBA suspended play _ and other leagues followed suit _ in March when Jazz player Rudy Gobert tested positive. Dozens of athletes across sports since have tested positive around the globe. In college football alone, nearly 50 programs have released information about positive cases.
The recovery process from COVID-19 isn't clear as researchers try to understand more about the virus. Gobert recently told a French magazine he still feels lingering effects of the coronavirus.
Cole said leagues have ramped up their cardiac testing and other screenings for athletes who are in recovery after research has shown the heart and other organs can suffer from coronavirus.
"If an athlete has been sick and had COVID, there are some metabolic and cardiac concerns that can become really relevant in high intensity sports," Cole said. "Oftentimes these athletes can initially feel OK and then they deteriorate. That's important to recognize. To assume this is just a respiratory problem when this virus has wreaked havoc on every organ system _ and there's lots of examples of that _ I think there are some things we're going to learn along the way when it comes to athletes who have been sick."
Cole said to expect adaptations as sports resume and doctors learn more about the virus.
Some college teams already have scaled back or suspended workouts. Some college games already have been canceled. Minor league baseball on Tuesday announced its season was suspended.
"The level of thought and intellectual energy that has gone into this has been unprecedented," Cole said. "I'm around some of the smartest people I've ever had the good fortune to be around. When you look at the intellectual resources the organizations have, this is not a political thing. It's a scientific thing. No one is saying they've got it perfectly figured out. It will be fertile ground for each sport to look at what the lessons will be as we get started. (They will) also be mindful of starts that may get stopped based on their local environment. There's a lot to be aware of."