It isn’t particularly controversial to say the Olympic and Paralympic Games showcase the pinnacle of athletic achievement. For a few short weeks, we’re privileged to witness the world’s elite athletes perform at the very edge of their physical and mental capacities — that is, the edge of human possibility. Thus, the Games are at once an unimaginably high-stakes competition and a life-affirming vision of how, when judiciously combined, innate talent and cultivated perseverance propel us to new heights.
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But behind the breathtaking feats and moving medal ceremonies, critical support systems are whirring away. For Team USA, that includes the United States Olympic and Paralympic Committee (USOPC), and in particular the USOPC’s sports medicine arm. Headed by Chief Medical Officer Jonathan Finnoff, D.O., FACSM, this dedicated corps of physicians, certified professionals, researchers and mental health providers ensures the nation’s top athletes are in peak condition when it’s time to perform on the world stage.
Finnoff himself is not only the USOPC’s chief medical officer (CMO) but also clinical professor of physical medicine and rehabilitation at the University of Colorado Anschutz Medical Campus. An accomplished mountain bike racer — he’s trained alongside Olympians and competed in the World Cup Circuit — Finnoff earned his Doctorate of Osteopathic Medicine from the University of New England in 1995, completed his residency at the University of Utah Medical Center in 1999 and pursued a sports medicine fellowship at the Mayo Clinic College of Medicine in 2000. He became an ACSM fellow in 2012 and was also named Most Valuable Section Editor by the ACSM journal Current Sports Medicine Reports in 2019.
Finnoff first got involved with the Olympic movement in 2002 when the Winter Games came to Salt Lake City, where he’d been working as the head team physician for Utah State University’s D-I athletics program. He was initially brought on as the director of the Salt Lake Olympic Organizing Committee’s athlete clinic at the Soldier Hollow cross-country and biathlon complex, after which he became the venue medical officer for the Paralympic Games, charged not only with athlete health and safety but that of visitors and staff as well.
It was during this time he met the head team physician for the U.S. cross-country ski team. Soon after, he joined the US Ski and Snowboard Association’s medical pool. He eventually became the head team physician for the U.S. Nordic combined team (“combined” referring to the fact that the competition includes both ski jumping and cross-country skiing), attending both the Sochi and Pyeongchang Winter Games in that role.
In 2019, Finnoff applied for the USOPC’s CMO position. His selection was announced in January 2020, and his first day was March 2, 2020, just as the COVID-19 situation was shifting into high gear. But covering everything said shift entailed would require a whole article in and of itself.
Rather, here’s a brief sketch of the CMO role as it stands today: Finnoff oversees a team of roughly 60, including an in-house research and data science unit; an International Olympic Committee-recognized organization called the U.S. Coalition for the Prevention of Injury and Illness in Sport; and a functional area known as Athlete Health Care, which provides about 1,400 high-level competitors with health insurance. He also manages the USOPC’s Medical Network, leads the USOPC’s three medical clinics and serves as the chief medical officer for the Team USA delegation at the Olympic and Paralympic Games.
Finnoff wears a lot of hats.
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For U.S. Olympians and Paralympians, medical care is nothing if not a collaborative effort. Each sport has its own national governing body, or “NGB,” which oversees much of its respective athletes’ training and treatment. The USOPC sports medicine team steps in during the Games themselves, working in tandem with the individual NGBs, but it also provides year-round services to all of Team USA athletes, particularly at the committee’s three facilities in Chula Vista, California; Colorado Springs, Colorado; and Lake Placid, New York.
Amongst those services is the careful study of longitudinal athlete data. Per Finnoff:
“We have really robust data for the Games because all of the athletes are there; all the providers from the various NGBs are using our electronic medical record.”
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But outside of the Games, athletes’ medical records remain with their respective NGBs, which makes needful information more difficult to track. Finnoff and his team are working to change that.
“We want all of Team USA — all of the NGBs and the USOPC — on the same electronic medical record platform so we can collect data over a much longer time,” he says.
But even with current limitations, what do the data reveal?
The most common issues athletes present with seem, at face value, almost banal: respiratory, dermatologic and gastrointestinal illnesses and conditions. But each can take a toll on performance, and some can lead to rather severe outcomes, notably skin ulceration and severe respiratory infections. As for acute injuries, they differ between Olympians and Paralympians. The former tend to injure portions of their lower extremities: the knee, foot and ankle. The latter more often experience shoulder issues. The distinction makes perfect sense when you consider that most Olympians are using their lower bodies for propulsion and support, whereas a fair number of Paralympians are relying on their upper body to manipulate a wheelchair or other assistive device.
Treatment and support strategies differ between the two cohorts as well.
“They’re really quite different,” Finnoff says. “In general, while any of our athletes, just like the general population, can have both physical and mental health conditions, the Olympic athletes tend to be relatively young, healthy individuals. A lot of our Paralympic athletes have underlying medical conditions and comorbidities that create much more acuity in their medical condition.”
As alluded to above, of particular concern for Paralympians are skin ulcers and respiratory infections. Athletes with impaired spinal function may not immediately notice an ulcer forming because they can’t feel it; in a worst-case scenario, the ulcer might even reach the bone. And some spinal injuries and neurological conditions make breathing more difficult. Combine that with an acute illness, and things can get dicey.
“They get sick, and they get way sicker because they’re functioning at a lower respiratory level,” Finnoff says. “We have to have more medical supplies and broader medical infrastructure from a knowledge standpoint — medical skills standpoint — for our Paralympic athletes.”
But physical health isn’t the only challenge elite athletes face. Mental health has become a subject du jour in the public discourse, and it affects Olympians and Paralympians as much as anyone else.
Perhaps more. Competing at such a high level — and often at a young age — puts intense pressure on an athlete, sometimes with extreme consequences.
“Frankly, there have been some tragedies,” Finnoff says.
In response, he and his team spearheaded a program, now four years old, to address athlete mental health not just in the traditional sense of scoreboard-focused sports psychology but in a manner that addresses athletes’ overall mental well-being.
The USOPC staffs dually certified sports psychologists and clinical mental health providers at its training centers, provides a 24/7 hotline athletes can use to find mental health services anywhere in the world, and has partnered with eHome Counseling Group, which offers a virtual mental health platform for those who can’t fit in a face-to-face session with a USOPC specialist. The USOPC also sends an increasing number of mental health practitioners on the road with athletes, trains staff and competitors alike in mental health first aid and provides athletes with the Headspace self-help and wellness app to fill in any gaps that remain.
“We have developed what I believe is a world-leading psychological services program with multifaceted resources for the athletes,” Finnoff says.
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As the Games approach, the USOPC shifts into high gear, bringing a combined medical team of NGB and USOPC sports medicine professionals to the host city. To do that, they have to get a lot of ducks in a row:
“At gametime, we have quite a robust medical team,” Finnoff says. “One-hundred and fifty to 200 medical providers at the Olympics, and for the Paralympics, between 50 and 70, depending on the delegation size and winter versus summer.”
And they need to place those team members strategically.
“We set up clinics in all of the base villages,” Finnoff says. “So when you think of the Paris Games, most people think about the Paris Village — that’s one village. There’s also a village in Tahiti, Lille, Marseille, Versailles, Châteauroux. There’s a whole bunch of different villages, so we make sure we have supplies and staffing based on the size of the delegation and the particular medical needs of that sport and those individuals.”
They also need to integrate themselves into the host city’s medical infrastructure. The USOPC’s physicians and specialists will be able to provide care, but only up to a point — depending on the supplies they have available, as well as the status of each team member’s licensure in the host country, they may need to send athletes to the host’s medical system. For the Paris Games, that’s the Paris Organizing Committee Medical System. And if an athlete experiences a critical medical emergency, USOPC’s travel insurance partner, International SOS, provides services up to and including air ambulance flights back to the United States.
Then there’s the language issue. Providing medical care in a multinational setting requires skilled translators.
“Most of the time, in each of the different functional areas, teams will recruit people who speak the language,” Finnoff says. “That includes the medical team, security team, operations team, etc. So we do have several of our medical staff who speak French. We also have a language line, so at any time you can call, put your phone on speaker and have a translator right there.”
Further, for each Games, the USOPC team must tally up the supplies it will need far in advance of the actual events.
“It’s roughly 20 shipping pallets that we send over from a medical standpoint,” Finnoff says. “So we have to plan all the customs and importation and then exportation. All of this is not air freight; it’s shipping freight. It goes three to four months prior to the Games.”
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But for Finnoff, all the preparation and complication are more than worth it. Because of his unique window into the world of athletic training and recovery, the Games present him with perhaps an even richer experience than that of the average viewer. He’s seen champions at some of their lowest moments. Thus, the heights of their accomplishment are even loftier by contrast.
“We take care of a lot of athletes through the clinics at the Olympic and Paralympic training centers, and so we get to know a lot of them,” Finnoff says. “And since we’re not on the road and with them at competitions, I know them when they’re injured or ill or have mental health difficulties. So seeing them overcome those difficulties and then being in Paris and seeing them perform and achieve their goals — that brings the greatest satisfaction to me.”
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If you too would like to work with Team USA athletes, Finnoff has some advice:
“One of the things you need to do early on is decide that sports medicine is what you want to do, because you really do need to get that extra training,” he says. “Whether that’s a board certification and fellowship in sports medicine or, if you’re a physical therapist, getting SCS certified and doing a sports medicine residency as a P.T.”
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For those who’ve already earned the necessary credentials, Finnoff suggests working first in recreational athletics, then collegiate competition and with professional teams. From there, the next step would be to throw your hat in the ring with either an NGB or the USOPC itself.
“The NGBs are actually an easier way of getting involved,” Finnoff offers, “because there are a lot of them, and they need coverage at multiple levels. And if you do really well at the national level, you go to the international level and eventually go to the Games.”
If you’d like to get involved sooner, though, there’s an avenue for that too: the USOPC Sports Medicine Volunteer Program. Whether you’re a physician, a physical therapist or an athletic trainer, there’s room for you to share your expertise with Team USA. (Not to mention that “USOPC” looks pretty good on a sports medicine résumé.)
“If people are interested in applying for the volunteer program at the USOPC,” Finnoff says, “it is No. 1 a fantastic experience. You get to work with all the athletes who are at the training center, and that is a variety. A lot of them are living and training there, but a lot of them are coming in for camps, and so it’s variable at different times what you will see. But if you apply for the volunteer program, you come, you have this great experience, and then it also opens the door for you to be working with the USOPC and NGBs at future events.”
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So as you’re watching the Paris Games, remember the physicians, athletic trainers and physical therapists working behind the scenes to make it all possible.
Maybe by the next Games, you could be one of them.