Tokyo Olympics and Paralympics – PediaCast 496

Show Notes


  • Dr Jonathan Napolitano and Ashley Davidson visit the studio as we consider the Summer Olympic and Paralympic Games in Tokyo. We explore the impact of a pandemic on athlete training and performance… and examine the path that leads from student athlete to Olympian. We hope you can join us!


  • Tokyo Summer Olympic Games
  • Tokyo Paralympic Games
  • Adaptive Sports Medicine




Announcer 1: This is PediaCast.




Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.


Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.


It's Episode 496 for July 28th, 2021. We're calling this one "Tokyo Olympics and Paralympics". I want to welcome all of you to the program.


So, the 2020 Summer Olympic Games in Tokyo are finally underway after a solid year of delay, courtesy of the COVID-19 pandemic. And they promised to be an Olympics unlike any other in recent history. Today, we're going to consider the Tokyo Olympics and an event that will follow on its heels, the Tokyo Paralympics, which features competitions among athletes challenged by physical disabilities from many countries around the globe.




Now, you may be wondering why is a pediatric podcast highlighting the Olympic games? Now, the answer is simple, every single athlete in the Summer Games was a student at one point in their past. And many were student athletes who lived at home with their parents and families. And you, the PediaCast listener may have a student athlete in your home or perhaps you will have a student athlete in your home at some point in the future.


And you may be wondering how the athletes currently on your television and computer screens made it from competing at the school or local level to the world stage that is the Olympics. Your children may have Olympic aspirations or perhaps they don't really care, but you do.




So, what's involved in ramping up training and competition to an elite level? Are these realistic dreams for you and your child? And what are the benefits of such an endeavor and what are the possible consequences? We'll consider the answers to these questions for both the able-bodied athlete and those challenged by disabilities.


We'll also consider this summer's Olympic and Paralympic Games with a big picture view. What was it like training for the games during a worldwide pandemic? How are these games different from the perspective of the athletes? And what does it mean to leave family and friends and fans back home?


To help us explore the Summer Olympics and Paralympics, we have two terrific studio guests joining us this week. Dr. Jonathan Napolitano is a sports medicine physician at Nationwide Children's Hospital and Ashley Davidson is a certified athletic trainer, also from Nationwide Children's.




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So, let's take a quick break. We'll get our expert guests connected to the studio. And then we will be back to talk about the games of the 32nd Olympiad and the Paralympics that follow. It's all coming up right after this.




Dr. Mike Patrick: Dr. Jonathan Napolitano is a sport medicine physician at Nationwide Children's Hospital and an assistant professor of Physical Medicine and Rehabilitation at the Ohio State University College of Medicine. He also serves as director of our Adaptive Sports Medicine Program which supports athletes challenged by physical disabilities.


Ashley Davidson is a certified athletic trainer with the Sports Medicine Program and Functional Rehabilitation at Nationwide Children's Hospital. Like Dr. Napolitano, she has a passion for supporting student athletes and their families.




Of course, every Olympian and Paralympian begin their athletic career as a student athlete. And since this is Olympic season and you're listening to a pediatric podcast, we thought it helpful to talk about the Olympics and Paralympics through the lens of families with kids who may aspire to compete in these games.


So, let's give a warm PediaCast welcome to our guests, Dr. Jonathan Napolitano, and Ashley Davidson, thank you both so much for joining us today.


Ashley Davidson: Thank you. Glad to be here.


Dr. Jonathan Napolitano: Thanks, Mike. I'm looking forward to it.


Dr. Mike Patrick: Yeah, absolutely. I thought a good place to start would be, you know, we're just a few days into the Olympics games. And I just wanted to see what you Olympic-watching experience has been so far this Olympic season.




So, Ashley, what has that looked like for you? You've been glued to your television and watching during all of your free hours? Or is this something that you're just kind of tuning into peripherally?


Ashley Davidson: Oh no, I'm probably been staying up a little bit too late as I should watching it because with that being in Tokyo and the time change, the primetime starts at 8:00. So, I've been definitely glued to my TV from like 8:00 to about 11. I mean, you too?


Dr. Mike Patrick: Yeah, same at our house, it's on pretty constantly in the background. What about you, Jonathan?


Dr. Jonathan Napolitano: Yeah, we're joking with my sister and brother-in-law recently. My wife and I don't use our television often. But every four years, in this case, I guess five years, yeah, it is on. And I've been looking at other applications to see what I can see digitally that's not on the network televisions. But yeah, I'm a big Olympics fan, both in the Winter and the Summer.




Dr. Mike Patrick: So far, what have your favorite things been to watch, Ashley?


Ashley Davidson: So, I'm big with gymnastics and I watch the soccer and volleyball and swimming. I mean, I enjoy the majority. I like to view other sports, especially that are new this year, like skate boarding's on there now. So, I watched that a few times, just to kind of get a different aspect of what they're doing. But I'd say that gymnastics, soccer, volleyball, and swimming are my big ones that I tune in for and catch up with.


Dr. Mike Patrick: The skateboarding, I've been sort of glued to that a little bit, because they fall so often.




Dr. Mike Patrick: They fall more often that they don't fall. And I'm thinking like how are they just getting up and moving on? I would be scraped up all over and holding my leg or an arm. And they just pop up and they're ready to go. They're pretty tough, right?


Ashley Davidson: Definitely.


Dr. Mike Patrick: And Jonathan, what have you been watching so far?


Dr. Jonathan Napolitano: Yeah, tough in skate boarding. But I was amazed yesterday, watching the highlights. I didn't watch it live, but the highlight from surfing, also a first-time event.




They were out there in what looked like, I'm not sure when it made landfall, but it looked like a pretty rough tropical storm or a hurricane come in. But that was really awesome to see. But I agree, looking at safety as a sports medicine doctor is always on my radar.


You know, Mike, as I watch the Olympics, being a sports medicine physician but also a fan of sports, I'm really drawn to team sports throughout the year. But every four years, the things that draw me into the Olympics most is really the individual athletes and the ability to kind of excel in that.


I'm not a huge tennis or golf fan at the professional level, but my biggest guilty pleasure for the Olympics is swimming. I think. Michael Phelps drew us all into that. But I love a relay race and I've even enjoyed watching the whole 1500-meter race with Katie Ledecky the other night.


So, swimming's my favorite but that's also just because what's been on. If you ask me again at the end of the Olympics, I'll probably tell you track and field.




Dr. Mike Patrick: Yeah, yeah, it's whatever was just there. Speaking of the surfboard, it was so rough condition that someone, their surfboard broke in half right there in the middle of competing. That's pretty amazing.


So, it's really been fantastic. And as I think back through my own life in watching the Olympics, I mean there are critical points in time that you have memories for. And Mary Lou Retton, that perfect vault that she did, I remember watching that on television as it happened. And it's so wonderful that this is an event that the whole global community can come together and actually cooperate and all be involved in. And these little pieces of memories just go on with us for the rest of our lives. So, it's quite an amazing event, really.


Dr. Jonathan Napolitano: I was watching those apps on the Peacock app; they have like Olympic history. Because early on in the games, I'm already ready but there was not a lot of events on. So, they had some older kind of replays. And yeah, they replayed the American victories and stuff like that.




But I really got drawn into there's a race I think four years ago in Rio, where there's a qualifying heat for men's swimming, a 100-meter. And all of the other qualifier got disqualified.


So, there's one man in the pool and he was, I believe, from Equatorial Guinea. He's the first swimmer on his team to ever make the Olympics. And his entire country does not have a swimming pool of the size of the Olympics. So, he trained in a little hotel pool. He saw the Olympic pool and never swim that far. And he struggled to finish the race but the whole arena was behind him. So, I love all those stories as well.


Dr. Mike Patrick: Yeah, those are really amazing. This year in particular has been tough for the athletes. And Ashley, as an athletic trainer, how has the pandemic impacted the training regimen that these athletes would normally do to prepare for these games. It must be quite a bit different, right, or no?




Ashley Davidson: Oh, definitely. I feel like when everything shut down last year and a lot of things are put on hold, it impeded with a lot of these athlete's normal training regiments, where maybe they need that team-like atmosphere to motivate themselves to get out there and continue to work hard and train. But then, with that rest, they just lost a lot of conditioning.


And so I feel like depending on how they continued to push their things, whether they cross-trained, if they weren't able to be involved in more of like a team sport atmosphere, it definitely impacted as far as overuse or different type of injuries that you can see, or just overall mental aspect of that training as well.




Dr. Mike Patrick: So, both physical and mental. And as we think about the mental aspects of this, the pandemic has really affected all of us in terms of mental health. And of course, then, when that get spotlighted on a global level, you really do see that. And we'll talk about it more as we move on.


But just as one example, I think Simone Biles really is that picture of what the pandemic and training in the Olympics and that spotlight and the pressure and what that does to someone's mental health. And she's so brave to step out and say, "Hey, this is a problem and I need to take care of myself."


And I just really salute her, and I think she's continuing to be a fabulous role model in the way that she has respond to the stress of the Olympics. But again, we'll talk more about overall physical and mental aspects of Olympic competition as we move forward.


What about participating in these games, Jonathan? What challenges does the pandemic bring to the athletes?




Dr. Jonathan Napolitano: Yeah, I think as Ashley actually highlighted the challenges with preparation, but also in getting to the games. I mean Team USA's basketball team had some changes because of recent positive tests. The golf team has had eliminated certain competitors based on recent COVID-19 positivities. So, I think this was not only an issue back in 2019 – 2020 as they were preparing, but all the way up until the end.


The challenge now that these athletes are dealing with, and I see various of levels of it as I'm watching this on TV but preparing and performing without fans. So, to be able to at your best in an empty stadium is kind of an eerie feeling. So, I couldn't imagine that as an athlete.




But also, the support from their families and parents, I mean, I'm hearing a lot of stories about new moms who are Olympians, who were leaving their family behind or the parents who had supported these kids all the way. You're going across the world to compete. And as I have highlighted earlier, oftentimes in an individual sport, to do so without your support group is a whole added challenge to these games that we've not really seen before.


Dr. Mike Patrick: Absolutely. You mentioned that there's no fans there in the stand. And from the viewing standpoint, it's a little odd that it almost seems normal now. As I'm watching it, it's like not all that unusual that you're watching beach volleyball and there's just empty seats all around. But for the players and the participants, really, they do feed off of the cheering, right? I mean that really is a big difference for them.




Dr. Jonathan Napolitano: You hear a lot about that with the NBA I think last year. But yeah, there's so much pressure on yourself and to see how a crowd can motivate you to kind of give you superhuman, supernatural things to really push yourself further than even a human is able to push themselves. Again, I don't envy it.


Dr. Mike Patrick: Yeah, no doubt. Then, there's COVID and the concern that you could perhaps get COVID from another player. And I know they're doing lot of testing.


And some would say well, these are young healthy folks. And those who are the most at risk tend to be older than those with chronic illnesses. And yet, we do know that you can have heart inflammation and heart issues after COVID. And so that must really weigh on the minds of these athletes too because that could stop an athletic career pretty quickly, right?




Dr. Jonathan Napolitano: Yeah, absolutely. It's a really good question. Thanks for bringing it up. This was something we were really fearful about as we were just learning about the virus last summer. But it is something that is seen as a kind of a chronic long-term effect of COVID and inflammation of the heart called myocarditis.


And it is the reason why we can have long-term effects of this and really why protecting an athlete individual is important. Yes, an athlete is eliminated from play to protect the others after a positive test but it's also making sure that they are able to safely return to such a high level without respiratory or cardiac impairment. So, heart or lung impairments afterwards is something that we see.


Luckily, it's pretty rare but it's serious when it does happen. That's been seen in collegiate athletes, professional athletes. So even at this high level, it's something that we all look out for and it's something that we have kept an eye on our high school athletes here in town.




Dr. Mike Patrick: Yeah, absolutely. Ashley, a lot of kids, as they're watching the Olympics may start to think, "Hey, that looks really fun. It's something that I would really like to do." So, a child or a student athlete who really is interested in pursuing things to that kind of level, how does one get from being a student athlete to being an Olympian?


Ashley Davidson: That's a great question. And honestly, I was thinking the same thing when I was… I mean, they showed all these commercials of how this big platform and how that might motivate some of these kids. Or like saying that's something they could achieve one day.


So, I've never personally competed on that kind of level. So, I wouldn't know the proper steps, but just from watching the interviews from the athletes here recently, either just after the competition or even sitting down on a true interview, just telling about all the sacrifices that were made to get there.




So just from what I've learned and seen, it's just a lot of dedication and sacrifice and a lot of training that goes into it. And it normally starts at a young age, but I don't think that's always the case. It just might be something that inspire them or allow them the opportunity to be able to train at that level and get to where they're wanting to go.


But then also, because it does put in so much work that they're going to need to that type of level. Also, the importance to knowing how to have those recovery days or cross train or proper nutrition just to help feel their body because they're going to be putting through a lot of different measures. And if they're not keeping up and aware of what their body and mind and everything is going through, then I don't know that you can achieve that level. You just have to have a lot of support and resources to be able to go through that.




Dr. Mike Patrick: It seems like everything's got to come together. You have to have that natural talent. You have to have the dedication. You have to avoid injury. You've got to work in that sports life balance. You got to have good coaching. You've got to have support of parents. You probably have to have some finances in order to pay for coaching at that level.


So, when you think about all those factors that go into it, Jonathan, is this a realistic dream for most kids? On the one hand, you don't want to just tell your kids, "No, this is not something that's going to be possible for you. You come from a normal family." I mean, how do you support a child and yet keep things realistic?


Dr. Jonathan Napolitano: I think you put two very tough words together. You said realistic and then you said dream. And I don't think dreams need to be realistic. I think if you have the passion and a drive to do something, as long as that passion is alive and that fire is alive, I think a parent can support that and get behind their child, to make sure they have that support to do that, to be active, to be doing what they want to do.




But also, where that pressure lies is, does that change? When that passion goes away or that drive goes away, that passion is not automatically transferred to the parent. And then it becomes the parent's dream, the parent's passion, and drive.


Because that becomes a very challenging aspect where not only do we set up for physical injuries because we're pushed past the fun stage and free play stage and the ability to kind of regulate ourselves. But then we're also at risk of some of those mental health concerns about burnout or really pressure to achieve beyond your own goals can become a real challenge.




Dr. Mike Patrick: Yeah, absolutely. One of the things I know in speaking with sports medicine physicians on this podcast through the years is this idea of sports specialization. In that you're more likely to see injuries if you're just involved in one sport.


Speak a little bit to how a kid may really have an interest in a particular sport or a particular position. But from the parent's viewpoint, how can you encourage your kids to be involved in other sporting activities that maybe use different sets of muscles?


Dr. Jonathan Napolitano: This is really fascinating research that has been done over the past ten years or so that really isolates the risk of this pressure and push to really excel in one sport. Sports specialization just as a field is talking about the risk of injury and overuse injury specifically when the athletes dedicate it to one sport.




As you just hinted at, the advantage of diversity in sport is really muscle diversity. If we do the same motion over and over and over again, you become an overhead thrower or a runner who is doing a straight line running on a track or something like that, you put your body at risk of injuring those same muscles that are doing that same repetitive activity, without the corresponding neuromuscular control and balance of developing muscles outside of that activity. That actually as small as it is play a big role in maturing and supporting that other sport.


One of my favorite slides outside of the literature that we read, but our previous slides, the football coach Irving Myers, when you look at his list of recruits of athletes, 99.9% of all recruits through there were playing multiple sports all the way through  high school. And those were kids who were going on with big dreams and aspirations, too.




So, the sports specialization, how do you reduce the risk of overuse injuries? They try to pare it down the best they can. The clues that they look at is, is there a single sport that athletes are giving up or walking away from other sports in order to pursue that one sport? Where they've eliminated free play and they're going from practice to practice on this one sport.


If that sport is played year-round, greater than eight months out of the year, those risk of injuries go up. So as I educate patients in the clinic, when you've become this good that you're on multiple teams year round, when you get back to your next season, or you have that transition from one season to the other and the parent say "Well, this starts up immediately after," you tell that coach who is going to support you that, "I'm not available this first month of the season."




And if you think about it, the amount of participation and the level that you're at, that coach should be pretty supportive of that. And having you as the season progresses, you don't need to be conditioned with the other athletes who may not have been playing a lot.


So really finding two to four months of breaks between repetitive sport is not as hard as people think it may be. And there are other very simplified and incurred measurement that we've seen, but when we look at the research, if you play this single sports more hours per week than your age, you have an increased risk of injury.


So, kind of a complicated thought, but if you narrow it down, that means that a 12-year-old should not be playing Little League baseball more than 12 hours per week. So that really seems pretty daunting and easy to do but you'd be surprised, some of these dedicated specialized athletes who are going through private tutoring or homeschooling because they're pursuing their athletic dreams year-round, that really sets those up for injury.




Dr. Mike Patrick: Absolutely. So that is one way in which parents can support an athlete, a student athlete's dreams, really by encouraging them to get proper rest, not to overdo things. Because once you get injured and now you have maybe a long rehabilitation process, its kind of does put a damper on things. And you may lose interest because of that injury.


So, we can keep kids healthy and continued to have fun and diversified. That even though they may have a talent for a particular sport or even a particular position within the sport, they're going to get there hopefully better with less injuries by really being diversified and free play and other sports and all of these things, as you mentioned.


As we think about proper technique and training and avoiding injury, what is the role of sports medicine, both doctors and athletic trainers in supporting athletes? Do you wait until there's an injury to see a sports medicine doctor? Or can sports medicine be involved really right from the ground level in helping and supporting these athletes and their families? What do you think, Jonathan?




Dr. Jonathan Napolitano: It's a good question. When I see patients in clinic, it's almost exclusively that they're there for a reason, some type of injury. But oftentimes, that injury is not the bad scary injury that they're afraid of. What we do in their assessment is we talk about that injury as a near miss, because what we look at is, we look at their functional ability and we determine where these muscle imbalances may lie.


So for example, a soccer player who turns and cuts really quickly and feel some pain in their knee, and they've heard about all the other people on their team who torn their ACLs and they're afraid that they tore it, I can do a test and that determine if that happened to them or not. But then I go through different tests to look at how they're squatting and balancing and controlling their body.




And we have some certain markers that say if you don't have that neuromuscular control to control your knee motion, that you're at risk for those injuries.


So, there's certainly things to think about, there's information out there when we think about soccer specifically or ACLs specifically. That's where most of the research lies and there's prevention programs for that. I don't think it needs to be directly with the sports medicine physician but there's lots of athletic training opportunities, strength and conditioning coaches who are certified in this.


And honestly, the movement for the ACLs in the International FIFA Program from Youth to Professional is with coaches as well. So, coaches should be educated on this too, to make sure they're doing the right things to support it.




But it doesn't have to just be how you're moving in sport. What I've seen a lot this past year is with less activity, less sports, more virtual school, less walking around. We have other certain imbalances, as I'm sitting here in this office doing this interview. I've seen my reflection of my shoulders rounding forward.


And so as I do that, whether I'm typing or texting or doing these things in my posture in one direction, and then if I start playing summer softball or summer baseball, I start overhead throwing, I have this imbalance in my muscles. Where the front of my shoulders are tight and dominant and the back of my shoulders, the posture and balance to control where my shoulders and place is weaker.


Sorry to run on about this, but there's a lot that can be done kind of beforehand to really see how do we function at our best to maximize our abilities but also minimize our injuries.


Dr. Mike Patrick: And Ashley, athletic trainers are often in the schools on the sidelines, really where the athletes are training and participating. And so, I would suspect that your role in injury prevention is really significant. Tell us a little bit about that.




Ashley Davidson: Yeah, so the athletic trainers are great resources to be able to use out of middle schools or the high schools, just to kind of be that frontline to see what might be happening, kind of keep tabs on how they're feeling or little injuries or tweaks here and there.


But then, when they do have those injuries, or maybe just a pain or ache that's not going away, and they're sent to or referred to a sports medicine physician and then get seen or send up to see me in clinic, with functional rehab, then like how what Dr. Napolitano was saying, we look at a lot of those functional movements. Because a lot of the times, these injuries, especially with the rest from COVID is all overuse for mechanics starting things up too soon when they've been resting for too long.




I mean, I've seen the injuries before, but it seems like it's more of those explosive movements from too much rest and poor mobility and strengthening. And there's just been a lot more strains, apophysitis, things that I've had in the past. But I feel like those are my top-level injuries that I'm treating and doing rehabilitation for that I haven't had that high of percentage of that type of injuries.


So, it's funny how the dynamics of the pandemic, like what Dr. Napolitano is saying, little things that you don't think about, like posture and sitting. And then once they are upright and doing more physical activity, they are conditioned back into that sport where they should, but they're also excited to be back in that atmosphere, but their bodies are not there.


So being an athletic trainer, that's where I have to come in and step in and try to get them that coordination back on point, working on those mechanics. Because in all these kids, they're not aware of their body yet. They don't understand that this is happening in this, either sports specific or could just be daily activities. So just teaching them, educating them, giving those visual cues to see what's going on for them to carry over while they get back to that sport.




Dr. Mike Patrick: So, what I'm hearing is rest is really important but not too much rest. And then, once you're done resting, you got to ramp things up slowly. And you're not going to be quite as conditioned as you were at the beginning of the rest.

And the pandemic really represented a big long, like year-long rest for these athletes. And so, it does kind of make sense that there's going to be more injuries as they're excited to get back out there. But their bodies are just not quite conditioned to do that yet.


Do you think that the same thing has been experienced by the Olympians? Did the pandemic affect their conditioning? And what has really been the cost of training at the Olympic level for these athletes, Ashley?




Ashley Davidson: Great question. I think that just from hearing some of the interviews again with the athletes, those Olympians, that they've been having, I heard they go both ways. Some of them said that that off-season getting that extra year allow them to critique and perfect a few different things and work on a few different strengthening programs.


But then, on the other hand, I heard a few athletes that felt like they were at that peak, at that prime, and then at that year off. I mean it hits different. Nobody has experienced this before. So, they had that mental influence that kind of change things for them. Nobody's been through this type of rest or break and knew how to properly progress or perform. So, they were just doing what they knew how to do.




And I feel like being that Olympian, they already have that mentality to continue to train and work out on their own. But it's also a different type of atmosphere, like what we were talking about before, you don't have the camaraderie of fans. That build up to those games and then they got put on hold, you don't know what that person is going to go through during that year.


So, if they have that focus and drive to continue on and adapt with those changes, then I think they were able to be successful with that year. But everybody's life changed.


Dr. Jonathan Napolitano: As we were in the height of this pandemic, March and April and May of last year, the opportunity to do a lot of extra CME or lectures. And I heard a colleague of mine and the director of the US Olympic and Paralympic Committee, Medical Director, Dr. Finnoff, and he talked about the policies that they had for getting the athletes back at the training facilities.




So, when you watch the opening ceremonies, you saw these videos of people doing home workouts and trying to adapt things the best they could. But there is a rigorous plan to slowly and safely get people back into the training facilities.


So, there is definitely a down time and then a ramp up. But they've been training at full level for over a year, from last summer to this summer unless they have another hiccup int he way with the COVID positivity or something like that. But the athletes got creative for ways to keep training.


Dr. Mike Patrick: Absolutely. One of the costs to, again, the pandemic which I alluded to at the beginning of this interview was with Simone Biles and the mental health aspects of being an Olympian.


Ashley, how do you use that example, while you're working with student athletes, to sort of bring out, to talk about this and to identify which student athletes may be burning out? Or the pressure is really getting to them and it's affecting them from a mental health aspect. How do you identify those athletes and then get them the help that they need?




Ashley Davidson: I think that the way that this all happen, I mean to be on that type of the platform, I know with the past year, we've seen the importance of what mental health is for a lot of these kids, are just being involved or being around peers and just having that shutdown. So I think that Simone's very brave for what she's done and has just brought more of that awareness for these kids to show them, you know what, it's a big part of your life right now, but there's so many other factors that go into it.


So, having that maturity and just realizing how much of your mental aspect goes into controlling your body. I mean, when she was going through those practices and you could tell, like those practice routines. And she just tell that she was not mentally in it and how that was affecting what she was doing physically.




And so just being able to educate these athletes within clinic and rehab. I mean, we try to tell them so many things, but obviously, I'm only so much. I'm not at that on that level. Or I am not that celebrity. They're not going to listen to me as much.


But I mean, she's a role model to so many kids already. But now even more so with what she's now really taking the time to step back and realizing there's so much more to what's going on than the high level of competition that she's within. And she can use that to bring light and support and awareness for what is really important to make sure that she's overall healthy.


Dr. Mike Patrick: So from a parent and coaching point of view, if you have  student athlete who is performing at a particular level and they're pretty consistent in doing that, if there is a change in their performance, certainly could be from a physical injury, but we really do have to think about the mental health aspect of this.




And so, when you do see a change, maybe start talking about it. Or even beforehand, if things are going well, say "Hey, if things start not going well, that could be a sign of a mental health issue. And I'm here to talk about that." And just to sort of normalize these conversations.


And then Jonathan, once you do identify a student athlete who is having issues related to mental through the Sports Medicine Program at Nationwide Children's, do you have resources that student athletes can call upon to help them out when they are having anxiety performance issues?


Dr. Jonathan Napolitano: To answer your question, simply yes. The scope of this is so big and it's so exciting to have brought forward instead of swept under the rag.


As Ashley just hinted at, this can go from "What is the mental benefit from participating in these athletics?" to "This is truly the drive that keeps that person going." And if that's the case, then injuries or things that pull him away from it becomes a mental health concern.




So that's probably the most recent, not most recent, but the most common thing that I see in clinic. Because as I mentioned, most of the time, I see patients, that's because they're coming in with an injury. And so, in that case, if we start to identify mental health concerns, depression about, "Oh, I'm missing this," or "I'm never going to be the same or what am I if I'm not an athlete?" Those are important things that we have, yes, here at Nationwide Children's, but also a number of community partners as well that can provide that in our clinics.


While none of us are experts, all of us can be on guard for looking at the trait you mentioned, parents and coaches, primary care physicians, athletic trainers, sports medicine physicians.




Yeah, our goal is to direct them to the appropriate experts in psychology and behavioral health. But starting those conversations and making them normal is really the key and may in many times be enough to let that athlete know that they have that support and their feelings are normal and appropriate. It can help them already get some relief and some improvement.


So, don't be fearful of it. I don't have direct references to give you right now, but it's an entire field of athlete psychology. And then in that performance aspect as you were just talking about, yes, to see how is your mental impacting that, that's huge thing. There are many professional athletes who have psychologists who work with them for that specific reason, is how can you prefer to be at your best at all times, not just physically but also mentally. Because that's a huge toll on an individual.




Dr. Mike Patrick: Absolutely. I want to end our talk about the Olympics and then we're going to transition and talk about the Paralympics here. But we have really talked about some of the negative aspects, both physically and mentally, of training at the level of an Olympian. Actually, there are lots of rewards though, too. And not just at the level of an Olympian, even participating in high school and community sports, there are a lot of rewards to training for sports participation. What are some of those rewards that you can expect students and families to experience?


Ashley Davidson: Yeah, I mean, I think a lot of the times that people just get involved with any type of that physical activity for participation is that… So if it's like a team-involved sport is just that team camaraderie, just that hard work and working towards something together and just achieving great things and just building up that type of relationship that way, and just having that type of foundation to really build upon. I mean, that's rewarding.




There's always the importance or there's that competitive drive to win and I think that's what keeps kids going and continues to have that success. But everybody measures success at a different way. So obviously, once you're on that Olympic type level, you're going and you're competing against the best in the world, you're creating legacies. You're being a role model. You're influencing.


So, there's all these types of rewards and it's just making sure you continue to do so in a positive light because you're on the biggest platform. You're having so many people watching you. So, it's rewarding but just making sure that you're staying with that proper type of path to be able to be influenced in that positive light.




Dr. Mike Patrick: Absolutely. All right let's kind of transition over and talk about the Paralympics. Jonathan, give us a little bit of background on the Paralympics. Where did they come from?


I know NBC is planning on having like 1,500 hours of coverage after the Olympics are over and the Paralympic starts, which I think is more than they've ever done before. So, there's going to be a lot more awareness. And so, some folks may think this is a new thing, but it isn't. It's really steep in history. Tell us a little bit about that.


Dr. Jonathan Napolitano: Not only just in history, but really interesting history, too. So, the term, even just in the term Paralympics, a lot of people have come up with the understanding that the Paralympic is the paraplegic Olympic for someone who has a decreased sensation and motor control or spinal cord injury as an Olympian.




But it's far beyond that. The term paralympic just comes from the root word 'para' which means alongside or beside. So, it's developed alongside the Olympics, or participation along the Olympics. Because the participation and as you'll see here, if you're tuning in for the Paralympics which I encourage everybody to do, there are multiple disability groups included.


There are those people with spinal cord injuries as we just alluded to, but those with limb loss or amputations, cerebral palsy or other brain injuries and neurologic injuries. There's those with visual impairments. There are visually impaired specific sports.


Ashley is a big soccer fan. And here in Columbus, we have a team. Here in Columbus, we call it as Blind Soccer as the program, but in the Olympics, it's called Football Five Aside. And these athletes with visual impairments are playing on a soccer pitch with blindfolds on and the soccer ball has bells in it. So, they are following their other senses. It is an incredible sport.




So visual impairment, the fifth group of injury is intellectual disabilities. So those with cognitive impairments or learning challenges have eligibility in certain Olympic sports. And then, if you’re watching the Olympics and the opening ceremony, you how everything's announced in both English and French. French is the official language of the Olympics.


So, the last category of athletes is called Les Autres or it means 'The Others'.  So really, anybody else who doesn't fit in to that group can be one of those six disability groups in the Paralympics. Each sport has specific qualifications, as to who is eligible but it's a pretty broad scope.


As far as the history, the first evidence of international participation in those with disabilities was after World War II in England, at the Louis Stokes Institute of Veterans Rehab. They started a veteran's games where veterans from across Europe were competing internationally in disability-related sports, so wheelchair sports and otherwise.




The inaugural Paralympics were in 1960 in Rome. The first year they had it, they have 400 athletes, 23 different nations that first year, which was exciting. The first Winter Olympics went for another 16 years. So, 1976, that was hosted.


And then, up until 1988, those were a completely different bid. Meaning that, so the Paralympic could be hosted by some country in some year, and the Olympics not really parallel or alongside or beside the Olympic at all. It was a whole different bid.


So in 1988, in Seoul, South Korea, that was the first time that Olympic Committee and Paralympic Committee said this, you need to apply to host both events and prepare your Olympic venues to be accessible, which was helpful not only for athletes but also spectators in the world as a whole.




So, you talk about here the increase in coverage has grown. The athlete participation has grown. I don't have the data for the upcoming participation here in Tokyo. But in Rio in 2016, there were over 4,000 athletes from a 159 different nation and 22 different sports. So just as they've added skateboarding and surfing to the Olympics, they're always adding new Paralympic sports.


Yeah, it will be available on a lot of NBC networks. So, we're really excited about that.


Dr. Mike Patrick: Yeah, I'm really excited to watch. It's going to be August 24th through September 5th. And again, NBC's covering it, much like they're covering the Olympic Games. Just some of the events, you had mentioned a few also, archery, cycling, equestrian, goalball, power lifting, rowing, sitting volleyball, or swimming competitions, wheelchair basketball, fencing, rugby, tennis. I mean, just really lots of different sporting events for folks who are challenged by disabilities.




Now, this then brings up in terms of training for these games. And we should mention that Paralympics, of course, this is the big Paralympics. But really, this is also happening at local and community levels too, where folks challenged by disabilities are competing in sporting events. So even student athletes are involved in these activities. And so, what unique challenges does training and then also having these disabilities impact students and their families?


Dr. Jonathan Napolitano: I think the biggest challenge in every athlete who I've met in this field is just connecting and realizing not only that these opportunities exist, but also that they too either can be or an athlete.




We are conducting a big research study here in Central Ohio about kids and adults with disabilities who are participating in sports and our preliminary results show that overwhelmingly over 99% of our participants when asked the question, "Are you an athlete?" they say yes.


So now that we're watching the Paralympics on TV, now that we see these commercials that's showing the grit and determination and the aptitude and ability of these athletes, I hope that the public can see and identify these participants as athletes as well, and not an individual with a disability as first. But as an individual, and whether that's an athlete, whether that's an employee, whether that's a classmate.


The challenges, so finding the groups is a challenge. One great resource I know, Dr. Mike, you have an audience nationally and internationally. So, Team USA website has a number of different links to local Paralympic committees, and not just committees, but organizations. So, youth groups that support Paralympics here in Columbus, Ohio, Columbus Recreation and Parks, The Adaptive Sports Connection, Ohio Sled Hockey. We have a lot of different sports.




But then also, this is advancing within our schools as well. So now the Ohio State Athletic Association was not the first in the country, but they are among the first that had supported athletes with disabilities competing at the high school level as well.


So, we have a seated track and field division. So those who are not able to run track for various reasons, it could be an amputation, it could be a neurologic condition, they can compete at a wheelchair level. That has grown immensely. And we have athletes competing from all over the state in the state tournament.




They recently, the past two years, have had a swimming division as well. So, the freestyle and back stroke has a special division for those with limited ability or disability.


And so, it can kind of explore it on a bunch of different levels. And as our awareness of it grows, so did the opportunities for the athletes.


Again, international audience, the Move United is really an excellent organization that really provides some of these resources they put out. A lot of stuff during the pandemic, how can athletes train at home with limited abilities. But also, now, they're connecting them to other organizations across the country and across the world.




Dr. Mike Patrick: Yeah, and we'll put links in the show notes over at for this episode, 496, to Move United, also Team USA, the International Paralympic Committee. So, lots of resources there for folks who want to learn more over at the website, in the show notes at


Ashley, from a parent standpoint, how can parents who have kids that are challenged by disabilities, how can they inspire and support their kids to get involved in athletics?


Ashley Davidson: Yeah, I actually go with what Jonathan, Dr. Napolitano, was just talking about, with the feeling that connection with a group or just knowing the resources out there, which I think has grown really well, especially within the area of Columbus that we live in right now. I feel like that's really started to take off somewhat, which is nice. But obviously, if you're not living in this area, you have to might do a little more research to find that out.




But just being that advocate for your kids, like knowing what their passions are and just knowing how to properly support them and put them on that path if that's something that they want to pursue. But then listening to them and knowing their comfort level within it.


But I feel like just seeing other kids that might be in the same type of situation and knowing or just having that type or support of just that relationship to build, to see what they've gone through and knowing that some things are possible. Because there's so many parents that I've talked to within Adaptive Sports Medicine, if I'm doing rehabilitation for a patient, a lot of the parents don't know a lot of the programs I'm trying to help get them involved or other resources.


So, I'm trying to help improve their injuries or just different type of support that I can give them. But then educate them with resources for once they are no longer within my care to then go out and continue to be active and pursue whatever type or dreams or passions that may have.




Dr. Mike Patrick: You've mentioned adaptive sports medicine. Jonathan, what exactly is adaptive sports medicine and what role does it play in helping kids with disabilities?


Dr. Jonathan Napolitano: You asked that question earlier about the role of a sports medicine doctor with athletes beforehand. We do that best really in our Adaptive Sports Medicine Program, where we look at individuals who not only are coming with injuries but those who may be looking to be involved in athletics. And we can do an assessment and kind of see, number one, personally what interest do they have, but also what are their abilities, their limitations and how can we prepare someone for participation in sport and connect them.


To answer your question, what is adaptive sports medicine, it's truly just the mix of sports medicine, so training and conditioning for athletics with the adaptive sports which are a focus on the functional ability with the knowledge of the physical limitation and accommodation for such. So, it's kind of a mix of the two of those.




So, in Adaptive Sports Medicine, basically, it's an awareness of what the underlying diagnosis or impairment may be but a focus well away from that, and the focus being on the ability and functional ability. And so, keeping those both in focus at all times but the priority is straight. So that the priority is a return the field, return to play to make sure that athletes remain active, as we've talked about all the benefits of staying on the field and being involved in the stuff.


Dr. Mike Patrick: We take a deep dive into adaptive sports medicine in Episode 434 of PediaCast. And I'll put a link to that episode in the show notes as well. So, for folks who are interested in learning more about adaptive sports medicine and what their role is and sort of the unique…




Because we could talk, and we did talk for an hour on this topic, in terms of specific challenges and specific management and treatment plans and conditioning and rehabilitation of injuries and all these things. And we did discuss those in detail. Again, Episode 434 on Adaptive Sports Medicine. And again, I'll put a link in the show notes over at


Ashley, I would suspect that the cost of training and participation and the rewards of being involved at like a Paralympic level are the same that's experienced by the traditional Olympians, correct?


Ashley Davidson: I would say I mean really pretty closely related to that, but just with having different limitations or different things they might have to overcome. There's obviously things that they might need to be more aware of, depending on their level of injury or what type of thing that they're facing.




So, any type of kid or individual or with some type of either spinal cord of injury or amputation, they obviously have to be a little bit more aware of skin issues. So, all those training hours, they have to really be mindful of what they're putting their body through and taking breaks and just doing checks on things like that. But hopefully, at that point where they're at, they know all those types of things to be aware of. So just knowing the importance of that.


So, I think that that will be like the biggest difference as far as the cost with the higher level of training at that level with the Paralympics. But I would say that the rewards and everything are just the same, especially now with all the resources and opportunities that they are getting to compete at that type of a level.




Dr. Mike Patrick: I mean, really overcoming their disability by competing. And not only with others but really competing against yourself and succeeding and setting a goal and making it. For all of us, whether it's sports and not sports, when we set a goal for ourselves and make it, that's really exciting and then maybe time to step it up and put another goal in there. And we're always working and striving to better ourselves.


Jonathan, I feel like you want to discuss something.


Dr. Jonathan Napolitano: Yeah. I feel like a research on this has been interesting to look at, both the benefits but also the barriers to those. Additional cost we've identified is an addition to access, the equipment can somewhat be daunting. To combat that, there are a number of grants available to help athletes pursue the necessary equipment they would need to compete. So that helps with that.


Other benefits outside of this is we see those who participate in adaptive sports with disabilities have higher self-worth, employment in the community, self-identified, more independence with activities of daily living. So, the benefits in this group are similar but yet elevated to a whole another level.




As you were just talking about, setting different goals. If you can win a gold medal at this stage, you pretty much determine that you can do anything you set your mind to. So that allows and opens doors for athletes across abilities. And so, the way to promote this is really extremely helpful for the community as a whole.


Dr. Mike Patrick: Absolutely. I want to wrap up with just talking about the Athletic Training Program and the Sports Medicine Program at Nationwide Children's Hospital because it's really grown over the years and just support so many student athletes and their families.


Ashley, tell us about the athletic trainers at Nationwide Children's and what you guys do.




Ashley Davidson: Yeah, sure. So, I have now been here for five years, so I have kind of learned as I go as well. But we have a lot of great outreach athletic trainers within the high schools. I can't even keep up with how many contracted schools that we have anymore, but I know that we have several around the surrounding areas, just to be there to support the student athletes and then get them in to be seen by a sports medicine physician here within Nationwide Children's Hospital when that is needed for their care.


But then also, like what I do when on a day-to-day basis within functional rehabilitation, so I'm here within the clinic, seeing all those student athletes that had become injured within their school. They might need a little bit more one-on-one time to get them recouped and rehab from their injuries that has been referred from the sports medicine physicians just like Dr. Napolitano.




And then, we also offer other types of programs, such as Play Strong for those kids and individuals who might need a little bit more support becoming physically active. Maybe they don't like that type of, like that big team atmosphere. They just need ideas of what to do at home. Or maybe they don't have the support from family to be as active. So just giving them those tools and resources and education just to keep them active and use exercise as medicine in that way.


Dr. Mike Patrick: One really cool thing that you guys have done in the past and that has been put on hold because of the pandemic, but I think you're looking forward to doing in again in 2022 hopefully, and that is the Athletic Training Workshop, which is designed for high school students who are interested in the field of going into athletic training as a career.


And it's a workshop that introduces students to the field of athletic training, gives them enhanced knowledge of the common injuries you're likely to see and how those are managed, functional rehab activities, really hands-on labs, and lectures. It really sounds like a day of fun for students who may be interested in learning more about athletic training as a career.




So, I'll put a link in the show notes to that as well. Again, it's on hold until at least 2022. But once that gets going, that's going to be exciting.


Ashley Davidson: Correct, yeah. It's always been a really a good turnout. And I know that there's a lot of good support. And the kids always have fun because it's usually held within the Lesterville Gym which the location that I work at. So, I can always see that they're having fun and I kind have to revamp what I'm doing that day. But it's good to see the turnout.


And Nationwide Children's, those athletic trainers that put on that workshop, they do a great job. And the kids always have a lot of fun.


Dr. Mike Patrick: And then Jonathan, give us a big picture overview of Sports Medicine at Nationwide Children's. You guys do so many great things. Give us a little sample.


Dr. Jonathan Napolitano: Thanks, Dr. Mike. You know, as Ashley was saying, it just keeps growing. So, we have nine doctors in our department from various backgrounds, from pediatrics to family medicine. In my background in physical medicine and rehab, we see student athletes of various ages.




And athlete or not, we use the term very loosely. We see students with various involvement in sports. And just looking at their muscular skeletal injuries, but also looking at their head injury from sport as well, concussion. You have a number of shows and discussions on that as well.


We see patients all across the city, from Marysville to Canal Winchester. Our website is very robust with the ability not only learn more about reasons to see somebody but also what to look out for and how to even schedule those appointments. We have a lot of updates there.


The programs continue to expand into smaller niches as well. And so, one of the things is you introduce me a director of Adaptive Sports Medicine Program which we talked about a little bit, where we are seeing athletes from various abilities and disabilities within our traditional sports medicine clinic.




So that person is in the waiting room with the quarter back at their football and the head cheerleader and the number one swimmer on the relay team. So, everybody's together in that waiting room because they're all athletes. And we see them with my background again underlying disabilities, but really what the focus in our clinic is on their functional abilities, getting them connected. And as you said, you'll link to that other episode that we talked about that.


But those are the big programs that I'm involved in. We are advancing our ultrasound diagnostic and interventional testing which we talked about recently. We have new golf rehab programs. We have tons of different specialized programs within Sports Medicines. Lots of providers all over the city and we keep growing.




Dr. Mike Patrick: And we'll put a link to Sports Medicine at Nationwide Children's and Adaptive Sports Medicine in the show notes as well, along with all those other links that we've been talking about. You'll find it all over at


So, Dr. Jonathan Napolitano, sports medicine physician, and Ashley Davidson, certified athletic trainer both from Nationwide Children's Hospital, thanks once again so much for stopping by and chatting.


Ashley Davidson: Thanks, Dr. Mike. Always a pressure to be here.


Dr. Jonathan Napolitano: Thank you, Dr. Mike. We've really enjoyed it. Enjoy those Olympics. Go USA!






Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.


Also, thanks to our guests this week, Dr. Jonathan Napolitano, sports medicine physician at Nationwide Children's, and Ashley Davidson, certified athletic trainer, also from Nationwide Children's Hospital.


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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.






Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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