Mick Mahy with another world record! Gold medal for the keeper and the United States. Evan Austin for the gold. Jonathan Finoff for the gold. Ladies and gentlemen, please welcome Drs. Jonathan Finoff and Thomas Hackett and world championship skier Nina O'Brien. Good morning. Good morning. We are thrilled to be here and to share with you some of our experiences with the Olympic Games and sports medicine and its role at the Olympics. And very thrilled to introduce you to an extraordinary young woman, Nina O'Brien, who will be joining us in a minute. To my left is Dr. Jonathan Finoff, who we're honored to have, who came from the Mayo system and is currently the medical director for the United States Olympic and Paralympic Committee. He's the big boss when it comes to all of the management of medicine around and in and around the Olympics and the lead up to the Olympic Games. And so thank you for joining us today. It's a pleasure. All right. Thank you. So I'm Tom Hackett. I've had the distinct pleasure of being the team physician for the U.S. ski and snowboard team now for 20 years. And what we're going to do today is share with you some of our experiences at the Olympics. And we're going to take you out of this 100 degree heat that we've been in and bring you into a little bit of a colder climate. The Olympic Games are right around the corner. So I think this is an appropriate time to talk about all things Olympic. And just before we get started, I would like to say thank you very much to Dr. Dean Taylor for having us here, to Dr. Toth, to Dr. Dickens. We are really honored to be part of what I think is one of the best AOSSM meetings I've ever been to so far. So thank you, Dr. Taylor. Thank you. So I put together a little bit of a video clip to introduce you to Nina O'Brien. And let's run that now, guys, if we can. And I'm going to. It was involving Nina O'Brien. She's the U.S. skier involved in that terrifying crash in the Giant Slalom earlier this week. After having surgery to stabilize her broken leg. She is now, thank goodness, out of the hospital. And not only that, Nina is with us live. And Nina, boy, are we happy to see your beautiful face. How are you feeling? I'm feeling so much better. Thank you for having me on. We didn't know the extent of the injuries. We saw the horrific crash and we all sent prayers up. But what did doctors say? And what's your recovery looking like? Well, I broke my tibia and fibula. And have a potential ankle injury as well. But I was able to stabilize the tibia. It was a compound fracture. So it was sticking out of my ski sock initially. I didn't look too closely at it in the moment. I was feeling a little bit sick seeing my leg like that. But I had surgery and stabilized it. And I'm feeling so much better now. ♪♪♪ Ski racing breeds some of the most badass women out there. It teaches you from a young age to be tough, to be gritty. I've never felt that after a fall. I've never been a prodigy at anything. To me, winning's always really been a process. Trying to get better and trying to learn. And trying to constantly take a look at myself. And see what can I change, how can I be better. For a lot of us in ski racing, you have many days where you're losing more than you're winning. So you've got to fall in love with that process of trying to get better. And trying to learn every day on the hill. ♪♪♪ In Beijing, I crashed at the second-to-last gate of the GS race. And ended up breaking my tib-fib. It was a compound break. So unfortunately, the bone came out of my leg. And I also fractured something in my ankle. And a partial tear of my MCL in my other knee. So it was kind of a gnarly injury. And for me, the first time I've ever been seriously injured in my career. So it's been a big learning experience. After Beijing, it was really just a lot of hours doing physical therapy for me. Went through four surgeries to date. Still have a bit of hardware, a metal rod in my leg. But all in all, I'm feeling really good. It wasn't easy every day. But for sure, I'm really grateful and feel super lucky. To have had a really awesome team of doctors, therapists, teammates, coaches. With family and friends behind me. I'm really proud of the work that I put in to get back here. To get back on snow. Just being back out there. Being with my team. And then also, mentally getting over the injury. And being in a place where I want to go fast. And that's pretty cool. I think what motivates me to put in the work. Especially when it's painful or hard. It's really probably the feelings of being on tour. And standing in the start gate. Knowing that you're about to compete for something big. Knowing that I have what it takes and some of the best speed in the world. All my good days. It's a pretty cool feeling. It's one thing to be fast in training. It's another thing to be this fast at the world championships. And Nina O'Brien isn't just fast on the upper part of the course. She is devastating the rest of the field. I like to ski with my heart. It's not always the prettiest. Sometimes it's a bit scrappy. But that's what I love about this sport. Her best finish in her career on the World Cup. I feel pretty damn lucky. Crossing the line and just hearing that roar of the crowd. Very, very special run indeed. But also just the lifestyle of being on the road. Traveling with everyone. Being in the mountains. I'm so lucky to be able to do this. And I love it. This is my world. Terrific. Without further ado. Let's have a warm AOSSM welcome for Nina O'Brien. Hi. Hi, Nina. Hi. Thank you for joining us. Have a seat, please. Thank you so much for having me. I'm excited to be here. All right. Well, we're thrilled to have you here. And Dr. Finoff and I have been thinking about this for a long time. And looking forward to asking you some questions. And sharing your journey with our audience. And maybe you can start with just telling us a little bit about where you're from. Sure. So, I grew up in San Francisco, actually. Born and raised there. Which I know when you probably think of Olympic skiing. You don't necessarily think of San Francisco as being the breeding ground for your national skiers. But, yeah. For me, that's where it all started. I was lucky enough to have two parents who actually were from Denver. So, I think, you know, raising a family in the city. They really just wanted us to know how to ski more as a life skill. So, for me, ski racing really just started as family weekends driving up to Tahoe. We would load up four kids and two dogs. My parents in the car every weekend. And drive from San Francisco about three and a half hours up to Palisades, Tahoe. That was our home mountain. And it really just started, yeah, as a way to get outside. Escape the city. And really just try and learn a life skill in terms of skiing. Did you have any influential coaches early on in your career? You know, I was pretty lucky being in Palisades, Tahoe. They hosted the Olympics. So, it was definitely around this culture and community that had a real passion for ski racing. And skiing in general. But there were a lot of Olympians around me. So, I had a few coaches there. But also role models in terms of Julia Mancuso and Travis Ganong and Darren Rolves. All these Team USA kind of stars to look up to. And I remember being a young girl when Julia won the gold medal in Torino. Her gold in the GS race. And I was up at Squaw that weekend. And just the energy that everyone had. We were all celebrating as if we were there. But we were in California. I mean, that was one of the most inspiring moments for me. I think that's probably when I thought, yeah, it would be pretty cool to be a ski racer. You know, I know your mother, Dana, is in the audience. And the audience is also full of parents and even grandparents who are in here. Who have taken their kids to countless soccer games and hockey tournaments and ski races. And maybe you can just comment a little bit about the influence your family has had on getting you going on this career. Yeah, I think the older I get, the more and more grateful I feel for my parents and all they did for me. There's no way of doing it without them. Especially a sport like skiing when I was doing those long commutes every weekend. They're what made it happen and facilitated the whole dream. But beyond the logistical aspects of driving me up to the mountain every weekend. I think they really created this love for the sport for me. By framing ski racing as not necessarily a job or putting a lot of pressure on it from the get-go. But as an activity to love. As a way to fall in love with moving your body and exercising and being in nature. And then as I got a little bit older, they did help me kind of realize. Okay, if you're going to spend your time doing this, let's really dedicate ourselves to try and do it well. But obviously that can kind of lead into pressure. But I think they really helped me keep it light and focused and let me drive my own career. When did you know that you were kind of going to go to that next level? And what did it take to make it to the U.S. Ski Team? Yeah, so pretty early on we realized that just skiing weekends. Was not exactly what all my peers who are ski racers around the world were doing. So I kind of came to this junction when I was trying to figure out where I was going to go to high school. About whether or not I wanted to take the next step and really commit to skiing full time. Or it was time to dedicate myself to something else. And so we kind of surveyed our options. And that led me to attending a ski academy high school in Berk, Berk, Vermont. It's called Berk Mountain Academy. And I would say that's really where ski racing became my own thing. And where I took the initiative over it. Because being away at a boarding school, I didn't have anyone pushing me to get up. Or really pushing me to do the workouts. I mean you can try as hard as you want when you don't have your parents around. So I think that was a pretty pivotal moment for me in terms of taking ownership over my own career. And deciding is this something I want to do. And ultimately it was. And decided to apply myself there. And is that how you knew, was it at Berk when you started getting a little better at ski racing? And a little better and realized you might be able to have a shot at it at the big show? I would say yes. But as you heard me say in the video, I truly never was a prodigy. Even through Berk, I think I was always in the mix of being a podium athlete. Or being in that top group within touch of being the best of my age in the nation. But I never believed, I don't know that I ever truly believed I would make the U.S. ski team in high school. I just kind of kept my head down. And was just focusing on okay, what's the next race? What's the next thing I need to fix? Without necessarily holding on so tightly to that bigger picture dream. But yeah, at the end of my four years there, I think one of the big milestones in my career was I was kind of a surprise winner of our national championship when I was 17 years old. And that actually ended up helping me qualify for the U.S. ski team right out of high school. And really spurred the next stage of my career. So yeah, Berk certainly got me, got me a long way. That must have been amazing. And when you went on to the World Cup circuit, you also pursued a degree at the same time at a very competitive institution at Dartmouth. What was it like to be a student athlete? I really enjoyed it. Dartmouth is one of those schools on the quarter system. And so the way I was able to balance it is I would go to school for the spring and summer quarter. And then I could fully dedicate my fall and winter to ski racing. And so it made for a pretty full calendar year in terms of activities. But I actually think that balance of having something outside of sport to focus on and to feel like I was still being productive in the off season and mentally stimulated was really helpful for me on the athletic side as well. Because of course there are moments in the winter when things aren't going well. And when you feel like that's all you're doing, it can cut really deep. And it can be really painful. So I think feeling like I had a little bit more balance going on in my life has actually been really helpful. Well, what you may not know, Nina just graduated with a degree from Dartmouth in economics and is currently interning with a private equity group. So you're sort of achieving in all levels of your life. But maybe in talking about getting onto the U.S. ski team, I think it's important to know what sort of resources you had in comparison with the really great women that you're competing against, such as the Norwegians or the Swiss or the Austrians. Maybe you can comment on how you make the logistics of that work versus some of those other nations. Yeah. I feel so lucky to have been supported by many different ski racing communities throughout the U.S. I absolutely didn't do it alone. I couldn't have done it alone. But one of the huge differences between the way our national team works versus some of these other nations is that we actually receive no government funding. So if you look at the Austrian or the Swiss athletes, they receive stipends and their entire NGB is just funded much more broadly. Whereas we really rely on our foundation and fundraising. And so I think what that ends up looking like is they can support a lot more athletes at the lower level. And so they've got these kind of bigger, broader pipelines that they're supporting. Whereas you have to fund a lot of this yourself coming up, which is a huge burden on you and your family financially. And that wasn't really the case for athletes from a lot of the other nations. They're being paid by their nation. How many of those kids were going to school at the same time as they're training? Oh, gosh. You know, it's hard to say. I don't know. I think I would imagine maybe 15% of World Cup athletes are kind of pursuing a degree while they're actively racing. And I have a lot of teammates on the U.S. ski team who have done the same thing. But in the international picture, we're certainly the minority. Have you been watching the Olympic trials and getting excited about Paris coming up? And when did you know that you made the Olympic team? Oh, my gosh. I think I watched every trials of it. I just, I love it. I mean, that hype video had me feeling emotional earlier. I get goosebumps. I don't know if any of you guys do. I think my boyfriend's in the crowd, too. And he, at some point, might have been like, how many of these trials are we watching? We're watching everything. But for me, the trials are a little bit different in ski racing in that we don't just have one set day where the team has decided. They actually look at all of your races leading into the Olympics for that, the preseason there. And I was fortunate in that in the very first race of the Olympic season, I had a ninth place, which met the objective criteria. Now, that being said, other women could have beat me in the subsequent races, and I could have been knocked out. But I did have a little bit of security going into the season, which I think, I mean, it was personally nice. And a little bit less stressful. But also helped me, you know, kind of ski more freely, I would say, into all the races leading into the games. Well, as long as we're talking about the games, I'm going to click forward a slide. And then, guys in the back, if I could go to the video now. Thank you. Here you are. With everything we just sort of discussed, we're here in the gate. And we're going to, just for the audience, we're going to run through Nina's run here. And I'm going to stop and start it a couple of times to hit her with some questions. But maybe you can start off by just saying, you know, you've had this extraordinary experience as a kid. Coming through high school, studying the whole time, grinding. And here you are at the gate. You've attained this goal, really. Getting to the start is the hard part. What's going through your mind? What's your sort of mental preparedness at this stage? My heart was beating out of my chest at this moment. I mean, I think as much as so much of the day is like any other race in terms of you wake up, you have breakfast, you look at the course, you do your warm-up. Something about it feels so different. And it feels bigger and more powerful on that Olympic morning. And I don't know if you felt those feelings at games or big championships as well. And it's a little bit hard to put your finger on it. But I just felt so much more emotion waking up that day. And I think part of it is pride. You know, I'm always representing our national team. But seeing Team USA and looking out and seeing the rings on those panels as I'm standing in the start gate right now. I mean, that feels different than any other race morning. And then there's another part where it's like I really want to rise to the occasion and be free. And, you know, you only get so many times, maybe once in my life where I'll get to feel that. Hopefully not. I'm hoping to go again. But I kind of wanted to savor that and actually enjoy that moment as well. Because I think it's pretty special. So I was a whole bundle of nerves. But I was trying to summon a bit of courage to really be free and ski with my heart and instinct, I'd say. Which you did. Here, let's run a little bit of this. I'll put it on my screen and hit it here. And here we go. Different nations at the top of the hill. And the first one is the USA with Nina O'Brien. Her advantage, 26 hundredths over Laura Gudbarami from the first run. All right, I got to stop it right there. That looks pretty steep. That looks pretty steep. What is this course like, Nina? The top of this was gnarly. I mean, right out of the gate, you say it looks steep. I think this is deceiving. It feels so much steeper than it looks here. And let me tell you, it was so icy. I mean, it looks like a clear, beautiful day. It was freezing cold in China. And they'd been working and slipping, sliding on this slope for weeks to prepare it for us. And so by the time we get up there, it was glare ice on this top pitch. A little bit hard to tell from the video. Yeah. If you look in the background of this, notice that there is no snow anywhere there except on the actual course and to a couple courses to the right. China was extraordinarily cold. They do what's called injection on these courses. And can I just have a round of hand? How many people in the audience ski or snowboard? Just a rough, right? We all know what we'd like to be on, a nice, soft, groomed slope, maybe some powder. Let me talk to you about what an injected ski slope is like. They make snow for weeks ahead of time, right? And then they rototill it. It gets rototilled, just like your garden. And then they pour about 2 million gallons of water onto the rototilled snow and then groom it. And then once it's a smooth surface, they pour another million to 2 million gallons of water on top of it to make it a surface that's rather like stainless steel almost, right? I mean, is that accurate? But that process goes on for quite a while. So it is a hard course. So let's keep going. O'Brien, well, it wasn't clean, but it was effective run one. Let's see if she can get a clean, effective run in the second run. But she sounds and seems a little wide, and she loses half the advantage. Can she clean up this run from the second run and still carry the same speed that she had? There's no such thing as a perfect run, but it's about the speed that you carry. So little mistakes can still be fast. It's a matter of where you are. Nia, what's happening here? Are you just in the zone? Are your legs burning? Are you, are you, where are you at? I mean, so when I'm standing in the start gate, I have a plan. And I like to keep it pretty simple. There are going to be a few cues, you know, attack the pitch, and then I'm really looking to be fluid on the flats, ski a direct line. So that's the plan in the gate. But so often, you get on course and everything just kind of goes blank. And you're just relying on instinct at that point. So I think, you know, subconsciously here, like, I know I want to push a little bit of context. This is my second run. I was in first, or I was in sixth place after the first run with about a half second gap to the third place position. So I knew I was kind of in the mix. And if I wanted to be on the podium, I really had to push. So here, I think, you know, every single turn, I'm just looking to try and find some speed. And you're in the green here. That means you're. Yeah, and the woman, Lara Guparami, whose time you'll see the green referencing, she ends up winning the gold medal. Make them and how you carry your speed out. 2900's gone between the intermediates, one and two. And O'Brien now fighting this hill. She's skiing some extra meters as she gets pushed off the line and reflected in the clock. And she's very wide coming into the finishing pitch. And O'Brien hasn't had a clean run. Oh, oh. That's a dramatic crash right at the last gate. And Guparami. Yeah, she's hurt herself as O'Brien. Oh, she's done it. She's done the splits as well. That's really nasty. OK. It's all fun and games until now. Dr. Finoff, where are you at this point in time? I was back in the clinic, but watching all of this on TV. So we have in the Olympic Village, we have a medical clinic for Team USA, and so it's staffed at all times, so any athlete from the variety of different sports and teams that we have there can come in and get healthcare at any time. We have the team that's deployed up on the slopes, which Tom is a part of, but we're sort of the headquarters, and if something serious happens, then we're immediately on the phone with the medical team on the slope, as well as the, in this case, Beijing Organizing Committee and our international insurance, so international SOS, to start thinking about what's going to happen after. Guys, could we go to the next slide, please, or go back to the slideshow so I can advance them? Thank you. So this is where we, the, all of the various teams, such as, whether it's USA Taekwondo or USA Skiing or USA Swimming, have their own medical staff that interact and coordinate with the United States Olympic Committee and Paralympic Committee, and that's where Dr. Finof comes into play, and so initially, we are the first responders on the slope, and on that photograph right there, that's Dr. Jeff Harrison that's rolling over there. Now, at this point in time, he was at the base of that course, but oftentimes, we might be stationed at the top of the course, and so as a team physician, we have to respond to that situation, and once the course is stabilized, we then have to get to our athlete that may need our assistance. It's a little bit of a unique situation as a sports medicine physician to manage these situations because, unlike certain other traditional sports, like if you're the team doctor for basketball team, you don't have to dribble through the paint to get to your athlete that's down on the other side of the court, right, or you don't have to do a punt return necessarily to get to the other side of the field, but for us, we actually have to do the sport. Now, I would never dream of saying I can ski like Nina can, but we have to get down these venues as well and then get to the bottom, and then there's some significant challenges sometimes with egress or actually managing the bottom of one of these courses, right, and Nina could comment on this, you know, like for Kitzbühel, for example, right, if you get injured at the bottom of the course in Austria, there might be 60,000 people around that base, and so when we respond to an injury, we actually have to stabilize someone. A helicopter comes in, long lines them. We yank them up and over the crowd to get down to the next point of egress because there's too many people there. Now, that's not necessarily the case at the Olympics where things are a little more sort of controlled, but in any event, that's one of the challenges that we face managing these injuries. So, Nina, where are you at at this point in time? I mean, obviously, I'm sure you're dazed. Well, I actually felt very aware as I was going through the crash. I remember it almost felt like it was slow motion where I was falling, and I watched I think my right knee come in and kind of thought like, oh, maybe I just tore my ACL, and then, you know, take another tumble and see my foot sideways and was pretty cognizant I definitely just broke my leg. So I was at the bottom down there knowing that I had a broken leg, which I don't know how you guys do that. For me, just seeing the foot sideways, I was like, this is enough. I don't want to look at it anymore. So I felt like I was truly just at the mercy of, you know, the first responders who thankfully they did a great job. Ski Patrol shuttled me away in a sled. I knew that I had our team doctor, Jeff Harrison, there. And so I feel like I had no option but to trust the people around me, and I was lucky to have some really great people around me in that moment. Yeah, absolutely. And a couple of different things. One is that they actually brought in really experienced ski patrol from Canada. And so that made a huge difference in terms of their ability to take care of athletes on the course there. But what did they do for pain control? Because that must have been horribly painful at that time. So in the finish right there, they did give me pain meds in the moment, which helped a lot and I think helped me calm down. And then, you know, later I had surgery, and I remember waking up from surgery with a nerve block. But after that wore off, that was it. And I don't know if that was something in China or not, but I spent the rest of the days I recovered in China for I think maybe three, four more days and flew home only on Advil and Aleve. So that was fairly uncomfortable. So just from the standpoint of as the team physician, as an orthopedic surgeon, think about some of the decision making process. And I just invite the audience to consider this that's going through your mind. She is now going to a facility in China, and we have had some, and this is true of multiple other countries or nations that we're competing in. In fact, we may have eight to 10 teams at any given week at an international setting where we're managing their care. And so we run into this with, and Dr. Finoff has even more, but we run into this with decision making algorithms on how to manage these injuries. And we have here one of our star U.S. athletes going to a facility where we may or may not know all of their capabilities or skill levels. And so there are some significant discussions that occur on how to manage these, not just in the field, because that's basic ATLS type stuff, airway, breathing, circulation, right? But that next level of stabilization exists in a foreign hospital with significant language barriers oftentimes. And so here in this case, Dr. Finoff, myself, the other staff who are sort of a little well-versed in managing sports trauma like this, had to make some decisions with the host nation on what was in Nina's best interest. Could you just comment, Dr. Finoff, on that? Yeah, absolutely. So a few different things. When you're in a different country, they have different rules about whether you can or cannot travel in the ambulance with that individual. Thankfully, in this case, they did allow one of our medical staff to transport with Nina, which makes a big difference. Another thing, in the cold environment, our main form of, in any environment, our main form of communication is through a cell phone. But in a cold environment, those cell phone batteries die quickly. And so one of the first things that needed to happen is they needed to get a portable battery pack to Jeff so that he could continue to communicate with the rest of the team on Nina's condition. From a USOPC standpoint, we're interfacing with the Beijing Organizing Committee and that hospital in terms of receiving her, what care is going to be rendered, working with the NGB medical team to make sure that the right care is being done there, because we're thinking about long-term. What do we need to do? Which in this case was stabilize and transport. And so we're starting to talk to international SOS to arrange for an air ambulance to get her home. But in the case of COVID and China, we could not actually do any type of air ambulance or medical transport because they wouldn't allow any foreign planes coming into their airspace. And if anybody was allowed to come into their airspace and they got out of the plane, they would have to quarantine for two weeks. So they couldn't actually do that. So now we're trying to think of how do we get her home on a commercial airline with medical escort. Here's the x-ray. And so this was the first thing we got. And we do a lot of communication through texting when our athletic trainers or one of Nina's teammates perhaps may be taking pictures of the x-rays in the emergency room and then sending to one of us if we're on site or oftentimes when we're not on site. And this is something that I get at all hours of the day and night throughout the year as our athletes are training. And to Dr. Finoff's point, we've had athletes in certain Asian countries in the past that had real difficulties with transport because of not being able to fly through Chinese airspace or Russian airspace, not being able to fly at night, having to get the State Department involved to do some political jockeying and coordination with the counterparts within that host nation. So this is just one of the challenges that comes up with managing our athletes in these situations. So this was an open fracture and you can see it's a distal tibia fracture. And so our recommendation to the local medical crew was that we put an external fixator on this and wash it out. And that's what was done. And so here's Nina going in for that procedure. And what we noticed in China was there's a lot of photos being taken by everybody around us. Everybody wanted to take pics. Right. Isn't that right? Oh, man. The hospital. I mean, they were so kind to me. And I was so grateful. They they really everyone took wonderful care of me. And we did take a lot of photos at the end, partially because I don't think it's every day you're in a hospital with everyone, you know, fully kitted out in COVID uniforms. It felt kind of crazy. But but yeah, no, I I was in good hands there. Yeah. Well, we'll jump. This is this is what you received. And then we did find that that X fix you did fly home with. And we then had to redo it. Right. And there were some opportunities for improvement on the placement of that external fixator. And I think with an open fracture, it was prudent to clean it again. But before we even kind of get into that, tell me, what was the flight like home? Long. Yeah. I mean, I'm telling you, I was truly on Advil. And I think it had been four days out of surgery. And the way the flight patterns worked is, I think my flight out of Beijing took off at three in the morning. And we weren't sure exactly how the processing leaving the airport would go. So I arrived at the airport at 6 p.m. And so for, you know, whatever, eight hours that was, I was simply sitting in this airport with my X fix leg, just resting on a duffel bag trying to elevate. So that was fairly uncomfortable. But I ended up flying business class from Beijing to Tokyo, and then finally making my way back to the US. And I mean, all the airline staff, they took great care of me. I did have several teammates who were pushing me around in the wheelchair. I had a medical companion and one of our physical therapists. And I also had Randy Viola, one of the Stedman docs on my flight, traveling with me as well, which gave me a ton of confidence, just given my situation, knowing that I had someone experienced there with me. So Nina, you got home. She was able to come here to the University of Colorado and have the X fix redone. And then about a week later, I came home from China, and we rendezvoused up in Vail. And we sort of fixed this definitively. And then it was, you started the hard work, right? Yeah. Started the hard work. And so can you guys run that one? So you started this pathway, I mean, what's it like? I'm sure there were some significant challenges on seeing your Olympic plans end up a little bit differently than you expected. But what was this stage like now? Well, so this was my first significant injury. And I really had no idea what to expect. The first real hurdle that we faced was just trying to get my ankle to bend and flex. And that was so much harder than I had thought it was going to be. I think probably initially, post-op, I was thinking, all right, I've got to build my quad strength. I've got to get the bone to heal. Let's get the hamstring and glute going. But it ended up being all of these really small muscles in my shin and my calf. And getting my foot to simply move and relax and get that proprioception back, that actually ended up being the real challenge for me in this rehab. So I spent a ton of time stretching, trying to strengthen that ankle. And I eventually, I mean, now we're pretty equal if it's got full flexion in both, which I'm proud of. That's awesome. That's awesome. What was the most difficult part of that transition phase while you were going through rehab? I think on the mental side, part of it is watching the rest of your teammates and competitors continue to race for the rest of the season while everything feels like everything truly has come to a hard stop for you. And so that was challenging. And then there was also, I had a very structured rehab plan with all these stages and criteria to progress from one stage to the next, lined out. And initially, I found that so overwhelming. In order to return to snow, the US ski team has some criteria you have to meet, including passing certain strength thresholds. I had to be at 90% of my previous best strength. And so sitting there in the days following surgery, thinking, how am I possibly going to get back to 90% of my best before this ever happened, was really difficult. But I think that's where having the right group of people around you who can kind of just help frame your thinking on that one step at a time process was so important for me. And I was lucky to have a really wonderful physical therapist here in Denver that I worked with. And obviously, we were in touch throughout the whole process. But yeah, it's really the team that I think got me through those stages. Speaking of that team, Dr. Finoff, can you comment on some of the mental health resources that are available to some of our athletes? Because I know that's been a big item that you've championed over the years with the USOPC. And it's obviously such a critical component of recovery. Yeah, so we had a really strong, so I've been in my role for 4 and 1⁄2 years. And so prior to my arrival, there was a very strong sports psychology group within the USOPC. So they were really focused on mental performance as opposed to clinical mental health. But unfortunately, within our athlete population, not only has mental health become more prominent in terms of our awareness, there have been some really tragic deaths over the years within the Olympic and Paralympic communities. And so that was a really high priority for me. So when I arrived, some of the changes that we made are all of our sports performance, mental performance staff, we made sure that all of them were dually certified as clinical mental health providers as well as sports psychologists. So they can do both in the whole spectrum. And we've gone from only having five up to 18, so we have a lot of mental health providers. We made sure that our elite athlete health insurance has 100 percent coverage for all mental health appointments. We set up a registry of mental health providers all around the country that have elite athlete experience. We got a relationship with Headspace so people can do mindfulness work and self-education. We also started doing mental health first aid education for all coaches and athletes and offering that for free to everybody. So we know that, you know, if somebody is mentally fit and they're doing really well from a psychological standpoint, they're going to be far more successful in life and in sport. And so we've really emphasized that at the USOPC. That's remarkable. Well, Nina, let's get to the next slide. Here we go. And I'm going to hit that to play. Here we are. This is your first time back on snow, I think. Is that right? Or one of them? Exactly. Yeah. Tell us where you are. So here I'm at an indoor skiing facility in Belgium. I don't know. I would imagine most of you probably haven't seen indoor skiing before. But there are a few of these facilities that exist throughout the world. And I ended up here. And I thought this was actually a really productive place to return to snow just because it's probably the most controlled environment I could get into. I mean, you're taking weather variability out of the equation. You're taking snow variability out. And at the bottom of this slope here, I can walk inside and just take my boots off. So this was a really perfect place for me to sort of just test how I was feeling. And you can't see it in the video, but I had the biggest smile on my face. I was just so happy to be back on snow. I think I had a lot of anxiety coming into returning to snow about what it would feel like and whether this leg would know how to ski or if my skiing would still feel like, you know, what it did in the Olympics. Those sensations I remembered. And it was really wild to me to just, you know, almost from the very first turns, I was able to kind of relax and exhale and be like, oh, my gosh, my skiing, still my skiing. And that is what amazes me about the body. Like that muscle memory absolutely was there for me. And thanks to you for fixing me up so that I could do it. Wait, this story isn't over yet, so let's let's keep going. We've we've got the skiing here. But think about all of you all in the room about about hardware, right, and removing hardware or leaving it in and your decision making algorithm on that. And let me share with you something about ski racers is there's a myth or maybe it's not a myth, but there's an idea in the ski racing world right now that rods need to come out or you won't have that same feel. Right. We might call it a modulus mismatch between the rod and the bone and something's just not quite right. And so so we elected to take the rod out. Yes, we did. How do you guys like this picture right here? Anybody see that? So Nina was doing great, coming back like a champ, rod was out, no big deal. And then. Broke again through the same fracture site, so we got to experience another intramedullary nail together, and we fixed that and maybe we're yet now. So so we've been through a little bit of a journey here with this. Yeah. So so round two is still in. We've got the rod back in. That's not coming out, by the way. No, I think we're going to keep this one for a while forever. Yeah. Yeah, that was I mean, it's been kind of a crazy journey. So as you mentioned, I skied a full comeback season with the rod in and actually had a really successful season. So you did. Yeah. So in my very first comeback race, one of the kind of thresholds for ski racing is qualifying for the second run. Everybody does a first run, but only the top 30 after the first run get to move on to the second run. And in my first comeback race, I made it into that second run. I don't remember exactly where I placed somewhere in the 20s, but for me, that was a huge success. And I think I probably did it off of sheer willpower alone, because from there, I do think I I struggled a little bit in the middle of that season. And I think part of that I physically felt really good. But I think maybe there was almost this subconscious mental block where I wasn't quite ready to let go and, you know, be free with my body and ski off of instinct. Part of me still wanted to control everything. And so that was challenging. But I think there was kind of no way around that. But through and I was lucky to get through it halfway through the season in time for the World Championships, which I qualified for and was actually on our team event. It's a four person team. I was part of Team USA and helped our team win the gold medal there. And that is like maybe the highlight of my career to date and something I'm really proud to have been a part of. So that season was a huge success. But I did have this nagging thought that the rod was not totally comfortable. So we took it out after that season. I felt awesome. And about a year ago, exactly, I was in New Zealand at a training camp and I straddled a slalom gate, which means that my ski, instead of going around it, hit it dead on. And I just instantly my stomach dropped because I felt this pain in the bottom of my leg again. Turns out we had that little fracture in there. So now I have a new rod and I feel awesome and I'm really excited. I'm actually headed back to New Zealand in a few weeks. And so we'll try this thing again. That's great. That rod's not coming out. So, you know, this is a photo here. That's the good Dr. Finoff with a colleague on the left. That's me on the right in the black. And really, it's a joy to be part of these games. And I've got a couple of pics of just some of the infrastructure that Dr. Finoff has and is organizing. I thought, John, maybe you could comment a little bit about your, you know, Paris is coming up in a couple of weeks. I know you're going over there next week, is it? Yeah, I go over there next week. We already are doing our daily coordination calls with all the functional leads. We have a bunch of people on the ground already, not just in sports medicine, but across the board with security and games operations development. It's just so many different people there. But we bring from a medical standpoint about 200 medical staff, close to 50 of them are physicians, close to 20 of them are mental health professionals. We bring 20 cargo pallets of medical supplies over there for the summer games. It's three times the size of the winter games. Back up a sec. Did you say 20 pallets? Twenty. When did you send those over? So they have to go by. Exactly. They don't go by air. They go by freight. And so shipping. So it's three months in advance and all of it you have to do. There's just so much logistics beforehand. You have to go through all of the customs of importation and exportation of all of your medical supplies. We have to get medical licensure for all of our staff so that they can practice in a foreign country. Now it is a limited medical practice, but it's still all the hoops you have to jump through to get that medical licensure interfacing with the Paris organizing committee, setting up all of our medical clinics. We have one in Paris, Lille, Marseille, Chatereau, Tahiti. There's multiple different places where Team USA is going to be living, training and competing. So we have to have that medical infrastructure in place. So we're in the heat of it right now. Speaking of heat, I read that the Paris Olympic Committee decided not to put air conditioning in the Olympic Village. Yeah. Well, so there was a lot of there's a huge push. Sports is not very environmentally friendly. People are traveling all over the world in jets and they're bringing, you know, for waxing skis with fluorocarbons and all sorts of different things. It's it's a pretty big deal. And so the Olympic and Paralympic Committee want to be carbon neutral. And so one of the things that they're that they decided in Paris is they weren't going to have air conditioning. But of course, Paris is hot and humid in the summer and heat illness is real. So there's a bit of pushback, us being one of the countries that really pushed back and they did allow us to bring in air conditioning. And so Team USA has air conditioning. I think the Olympic Village is a is a wonderful place and a challenging place to live when you're getting ready for sport. Maybe you can comment Nina a little bit on your experience in the Olympic Village and what it was like. Yeah. I mean, it's just exciting to be there. Something you've dreamed about since you were a kid or at least I had. And then you end up being, you know, in this village with all these different athletes from different nations, which is pretty fun. So many different sports as well. It's not often we get to cross over with our U.S. bobsled team, let alone, you know, the international bobsled community. So that was a lot of fun. Our housing in and of itself, I would kind of relate it to a college dorm style where, you know, you're bunking in with your teammates, but they totally before we arrived, Team USA set us up with all sorts of care packages and you show up to your uniform. I mean, it kind of feels like Christmas showing up, which is pretty fun. Yeah. Tell us about I've been very fortunate to to go through that process and go through what's called athlete processing. And I know many of the people in the room have as well, where you essentially go down what's like going through a supermarket with literally with a shopping cart, just receiving all the gear and the trinkets and the shoes and the jackets and having the polo people measure you. But give us a little sense of that and what that was like for you. Well, so actually I was already in Europe and had to leave directly from Europe to China. So I missed the processing, which I was so bummed about because I see all these photos and it looked fun. But I mean, one thing I was shocked about is that any teammates who had previously been to games, you know, we're talking about what do I pack? What do I bring? They were like, bring nothing. Bring as little as you can. You're only going to wear the gear they give you over there. And that ended up being totally true. I mean, they our sponsors set us up with so much stuff and it is so fun to try it all on and really feel like you are Team USA when you, you know, put on that jacket with the flag on the back. It's pretty special. Yeah. Yeah, absolutely. Amazing. And I just kind of wanted to transition from a little bit on the training of becoming a physician for the ski team or for the U.S. Olympic Committee and for the USOPC. And, you know, we could pick Dr. Finoff's brain all day here on all of the logistics and planning that's going into it. But I thought we might talk about a little bit about maybe as a recruiting play to see if anybody in the audience is ever sort of interested in this. But some of these events that we cover are not necessarily in a place like Paris or even a place like Beijing. And I just throw this up as as an example of one of the events that I've covered before where you're really sort of out there on your own and you may actually be pretty far away from resources, from advanced medical care. And so we actually do some training. And I just thought I'd throw this in just as a matter of interest. Can you guys click on that video to get that guy rolling? This is a course that we started years ago that Dr. Finoff has been involved with that Dr. Stedman originally started. And if that guy's not starting, I'll just talk through it. We have a course we've called them. Oh, here we go. Medical Emergencies and Skiing and Snowboarding, which is about managing yourself in these environments. There's the good Dr. Finoff there. And we do a couple of days of didactic lecturing and then ATLS style training in the in the hotel in a setting like this. And then after we've done that, we take people out into the field and actually go up and practice these situations in the steepest, coldest, darkest part of the mountain we can find with our medical professionals to try to get people ready for this type of environment. And it's a unique facet, I think, of sports medicine management to be doing this type of first responder training in an environment like this. And really, I just wanted to share this video in part for this ending part right here. That's Dr. Viola, who came back with with Nina from the Olympics. And there's Dr. Stedman, really, who started it all, who we all miss very much. But Dr. Finoff, maybe you can talk about the preparation for becoming an Olympic physician and what that entails. Absolutely. If you could advance it a couple of slides. So a couple of things. I mean, number one, there are multiple ways of getting involved in Team USA. So one is through the national governing bodies. And there are 54 different national governing bodies. So they really have the full spectrum of sport, whether you're interested in equestrian or modern pentathlon or track and field swimming, skiing, all of these different sports, they all need medical personnel. And so if you scan that QR code, it takes you to the USOPC website. And there are links at that location for all of the different NGBs who are looking for medical professionals to work with their national governing body. In addition, there's opportunity to work directly with the U.S. Olympic and Paralympic Committee, where you come and you spend a couple of weeks at one of our training centers taking care of all the athletes who are there, which in and of itself is a lot of fun. But you also get integrated into our team. You meet with the athletes and the NGB medical staff who happen to be there at the training center at the time that you're rotating. And those are really good entry points into the Olympic and Paralympic movement. And of course, if you do a good job, the athletes like you, the staff like you, you're available, as I'm sure all of you are. Then you work your way up through the system and eventually hopefully go to the Olympic or Paralympic Games. So actually, within the USOPC, we do a very similar thing to the Mass Course. We mimicked it after the Mass Course. We think it's such a good way of training people to be on the road and ready to take care of athletes. But we try to make it broader. So it's looking at both winter and summer Olympic and Paralympic. So we might have a sled hockey scenario where we'll have actually a sled hockey athlete in their sled mimicking having a traumatic injury and autonomic dysreflexia and a bunch of different things all happening at once and doing an assessment as a team. And as Dean knows, Dean Taylor, we really focus on leadership and you need to work as a team. And we trade off having different people lead the team. Because when we finish up that course, we want you ready to be able to lead in the field. So I'd encourage all of you who are interested in working with Team USA athletes to scan that code and take advantage of the opportunity. Thank you. Well, Nia, we're wrapping it up here. So you've graduated from Dartmouth. You're working for a private equity firm. You're going to New Zealand in two weeks to start skiing again. What's the plan? What's the plan going forward here? The plan is to keep doing the ski racing thing while I can. No, I I feel so grateful that I'm still in a position, you know, physically in terms of my body and athletically, mentally where I I love the sport as much as I ever have. So I really want to go for it these next few years, hopefully make it to Milan in two years. But in the meantime, yeah, I know I'll be training hard and I'm actually I'm so excited to watch the rest of our team in Paris. I'm jealous you'll get to be there. Well, that's terrific. I might just open it up if any if there's any questions from the audience for for Nina or Dr. Finoff or myself. And I know we're at time, and so maybe one or two questions, if anybody does have any. Yep, right in the back there. There's the microphone just up there. Yeah, take your time. Thank you all for a great session. My name is Alex Galant. I'm from NYU. I've actually had the honor of covering some of the events. We were in Zagreb together. I remember that. Yeah. Thank you. Likewise. So how do you feel about the coverage when the physicians are not your regular physicians like Dr. Hackett, Dr. Finoff? How do you build a relationship with the physicians that's only there for a brief period of time covering the event? Well, one of the cool things when new physicians step in on the road like you did, Alex, is we actually get to spend a lot of time together off the hill as well. So when we're having team dinners in Croatia, like when Alex was there, everyone's getting to know each other. We're all sitting around the table together. And, you know, I didn't know too much about Alex before he showed up, but you end up, you know, learning about each other's families, asking him about his career, talking about us and our interests both in and out of sport. So I think that's a pretty good way to build that connection and trust. And it's also a ton of fun. We love having new people join our group. It helps keep the energy fresh throughout a long season. And I had no idea we'd be reconnected here today, but that's one of the best parts of it as well. We're always looking for great docs to join us on the road, so please reach out to us. Dr. Taylor. Tom, John, Nina, I'm like John Fagan, I always get the last word. And like I said at the last Game Changer, you guys are national treasures, both in sport for the United States of America and in sports medicine. And for you to take the time and come here and Nina to share that story, I'm sure that that opens some some wounds to do so. But it helps us understand better of how we can take care of our athletes better. So on behalf of the AOSSM, I want to thank all of you for a tremendous session. Thank you. Thank you. Thank you. That was awesome. Thank you. Thanks, everybody.

Nina O'Brien

Jonathan T. Finnoff, DO, FACSM, FAMSSM, AMSSM

Thomas R. Hackett, MD

sports medicine

Olympic skiing

Jonathan Finoff

Thomas Hackett

Beijing Olympics

rehabilitation

USOPC

mental health

Milan Olympics