James Gladstone, MD, an orthopedic sports medicine surgeon at The Mount Sinai Hospital in New York and the Medical Advisor to the U.S. Davis Cup team
After a long and punishing summer hardcourt season, the world’s best tennis players are preparing to descend on Flushing Meadows in New York for a chance to win the US Open. To ensure that players are well cared for throughout the two-week tournament, a team of Mount Sinai doctors and sports medicine experts will be there, using the latest medical advances and technology to provide world-class care for the athletes.
In this Q&A, James Gladstone, MD, Chief of Sports Medicine at the Icahn School of Medicine at Mount Sinai in New York and the Medical Advisor to the U.S. Davis Cup team, explains what it’s like to treat elite athletes during a major championship and what tennis enthusiasts can learn from their favorite player’s preparations for a big tournament.
What kind of medical care does Mount Sinai provide for athletes during the tournament?
We have a really good, comprehensive setup for athletes in which a team of sports medicine specialists are present at any given time. We also have portable X-ray and ultrasound machines for on-the-spot diagnosis.
In addition, within the Mount Sinai Health System, we have every specialty on call at a moment’s notice. If a player has a problem with her eye, we can bring in an ophthalmologist; if someone is having trouble with his throat, we will get an ENT specialist.
What type of injuries are you usually treating?
Mainly we treat acute injuries—something that has just happened on the court, like a twisted ankle or heat exhaustion. For soft tissue injuries, like sprains or strains of the muscle or tendon, the ultrasound can be a great tool. You get a good sense of what is going on quickly.
Unfortunately, players do not have a lot of recovery time. They typically have only a day off between matches. As quickly as possible, you have to figure out how serious the injury is and whether you can get the player back to the tennis court. Is this something for which the player can take pain relievers, apply some heat or ice, do some stretching, and be okay? Or is it more serious? There are definitely cases in which we have to send players for an MRI to get a diagnosis immediately.
Often we see players who have had nagging injuries over the course of a few months. Either they want to be reassured that they are okay and can keep pushing through, or they just played a match or had a practice and the injury is causing more pain than usual.
What additional staff supports the Mount Sinai sports medicine team?
Trainers and physiotherapists are onsite and many of them travel with the men’s and women’s tour. This is a huge asset because, from a medical point of view, the trainers really know the players. For example, if I am treating a player’s injury, the trainer will be able to tell me, “Well, the player was in Germany a few weeks before and had a similar issue and this is how it was treated and it helped a lot.” There is a lot of backup. On top of that, massage therapists are onsite to maintain the player’s muscles and flexibility. Many players will have massage treatments after every match.
What is your experience of being at the US Open? How different is it to treat athletes at the tournament as opposed to in your office?
At the Open, the atmosphere is electric. Early on in the tournament it can be very busy; there is a constant stream of players with minor ailments. This is usually when we will send people to get MRIs if we need immediate answers, as they have the whole tournament ahead of them. The athlete’s physician or the tour physiotherapists can always access those scans and discuss the results with us.
One big difference is that in my office at The Mount Sinai Hospital, I have some additional tools. For example, I use an in-office arthroscope. This device is approximately a fifth as large as the arthroscope used in the operating room. It has a digital camera that is inserted into a joint in the same way an injection is given and provides much of the information that you get in the operating room. In many cases it can take the place of an MRI, and it can be done on the spot in the office. X-rays, MRIs, and ultrasounds have a lot of value, but sometimes it is best to actually see a problem.
I do not bring this device to the US Open. While it is minimally invasive, players have such little time between play. I would not want to take a chance that using the device would cause soreness that would interfere with play.
Finally, as players head to New York from tune-up events throughout North America, what are they doing to prepare for the final Grand Slam event of the season? What can a weekend warrior do to emulate how the pros get ready for a new tournament?
Leading up to the tournament, players will want to maintain their hydration, nutrition, and sleep. They also will work with their trainers to maintain conditioning on three different levels: flexibility, strength, and agility.
For amateur athletes, I stress the importance of this kind of preparation and maintenance. One big difference: Amateur athletes are not travelling or battling jet lag, which adds a whole other component of complexity to their preparation and disruption to their biorhythms.