This is an excerpt from Behind the Scenes at the Tour de France, a feature in the July/August edition of Bicycling which is on sale now – the team doctor’s view is supplemented by insights from Gary Blem, Chris Froome and Team Israel Premier Tech’s mechanic, and SA Tour legend Daryl Impey.

Adrian Rotunno is the Medical Director at the UAE Team Emirates professional cycling outfit that’s won the last two Tours de France with Tadej Pogačar, and a whole lot more top-level races across the world (he’s also a clinical partner at Cape Sports Medicine medical practice). Unsurprisingly, the Tour de France is as hectic for the staff as it is for the riders – if not more. 

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“A typical day starts with a 5.30am wake-up for a sanity run (if possible). Then the daily barrage starts: possible random anti-doping controls, breakfast shovel, morning rider ward rounds, a furious pack-up and onto the bus to the start, pre-race war-room meeting, attending to rider medical needs prior to the start, a white-knuckle ride in the car behind the race or in the bus to the finish, anti-doping testing at the finish, hopefully a podium ceremony (!), back on the bus, attend to acute medical problems on the bus, transfer back to the next hotel, rider evening ward rounds, race debrief, final rider ward round, staff dinner shovel (by 11pm, if you’re lucky) – and finally, bed. Rinse and repeat for three weeks. Oh, and be on call 24-7…”

What The Doctor Sees!

Rotunno’s first Grand Tour was an eye-opener. “The sheer level of difficulty of a three-week GT was more than I thought. You can’t quite comprehend what these athletes endure, day after day, unless you’re in the thick of it. 

“With the pressures of expected personal and team performance and sponsors weighing on their shoulders, riders have to be physically – and especially, mentally – strong, to not only survive but perform. It’s ultra-high-intensity racing, every day, for 21 days. There’s no other sport or race that puts a body through its paces like a Grand Tour.” 

“With the high-velocity nature of the sport, and cobwebs for clothing, traumatic injuries are mostly what we deal with.”

The medical staff are always busy. “With the high-velocity nature of the sport, and cobwebs for clothing, traumatic injuries are mostly what we deal with on a Grand Tour. We have permanent wound-dressing stations on the bus and in the hotels – making sure wounds stay clean and healthy so the rider can perform the next day is crucial. 

“Of course, when the dreaded saddle sores strike, it can be extremely disabling for the rider. With fractures and concussions, obviously we withdraw the rider and manage as necessary. There are also overuse injuries that can flare up and need to be managed on a daily basis. And it’s not only riders we need to care for; the staff get sick too. 

“In summary, being prepared for anything is key when it comes to the daily medical battleground of a GT.” 

Covid Protocols

“And we need to be flexible… here’s an example: suturing is part of a doctor’s daily grind, but suturing – or tailoring – bib shorts, from a moving vehicle in the middle of a stage, after a crash, is slightly out of the norm! One of our guys crashed, and ripped up his bibs so badly that pretty much most of his nether regions would have been exposed on television. I managed to stitch it all up to get him to the finish line mostly censored.

“As three weeks of racing is taxing on the immune system, acute illnesses are always a concern, and even more so when still in a pandemic. Immunity typically takes a hit after five to eight days of hard racing; this is the dangerous period, when opportunistic viruses can settle in, causing illness and race withdrawal. 

Prior to the start of the race, I’m generally the drill sergeant seen at the entrance to the bus, with hand sanitiser and a bag of masks at the ready.

“Also, ensuring that illnesses don’t go viral among the team and staff is a daily battle. We have strict hygiene and illness-prevention protocols for the team – and these were in place prior to the pandemic. Covid-19 has certainly added several layers onto those. Prior to the start of the race, I’m generally the drill sergeant seen at the entrance to the bus, with hand sanitiser and a bag of masks at the ready. 

“And with fan interaction, there’s always the risk of a pathogen being transferred. We try to run defence for our riders when engaging with fans and journalists, as one small infection can disrupt an entire team’s GT campaign. We also have room-sanitisation procedures at every hotel, so that by the time the riders and staff arrive at the next hotel, their rooms have been sanitised. 

“Masks have proven their worth in the pandemic; and in fact, we’ve seen far fewer other typical respiratory infections over the last two years, because of them. We will certainly be keeping them in use going forward.” 

 

Top Tour-Doctor Tips

Dr Adrian Rotunno, Medical Director at UAE Team Emirates, has one piece of advice for us non-Tourists.

It’s tempting to try to be these guys. The truth is, we just can’t. We don’t have the genetics, the time, the support or the drive. They spend all day on their bikes, so they’re conditioned and trained to perform at that level. We have jobs and other responsibilities to contend with. So don’t be too harsh on yourself. As we’ve seen, cycling can be a stressful sport; but bike riding is supposed to be fun, with the added benefit of keeping you strong, fit and healthy. The one thing we can learn, and implement easily: fuel properly for all your rides. Your body – and performance – will thank you.

 

Read the rest of this article in the July/August edition of Bicycling South Africa.

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