Ed Ryan, Director of Medical Services at USTA Player Development, joins the podcast to talk about his role at the National Campus and how the athletic medicine team works to support the players. The episode tackles what players go through psychologically after an injury and/or surgery and what goes into a successful return to play.


J: Welcome to the compete like a champion podcast. You're here with Dr. Larry Lauer, mental skill specialist, and coach Johnny Parkes with USTA player development. Today we've got a special guest in the studio, Ed Ryan, director of medical services at the USTA national campus. Ed, welcome to the podcast. Thank you.

L: Welcome Ed. Glad to have you on here.

E: Thank you, Dr. Lauer.

L: This is going to be good.

J: I appreciate you being here.

L: We're going to pick his brain today.

J: Absolutely. Well today we thought a great thing would be to talk about recovering from injury. Um, but before we get into that, Ed would you mind sort of maybe given us a, um, a sort of brief background into, into your experiences, what you've done so far and how you came to be director of medical services at the national campus?

E: Well, I'm an athletic trainer by education and training and most of my career has been in Olympic sport that lasted 21 years as an employee of the us Olympic committee, now known as the US Olympic and Paralympic committee. Following that I worked, uh, with USA basketball, uh, leading their medical services for primarily the national team's activities. And then how I ended up here at the national campus was really, uh, as a favor to two old friends from my Olympic time. Uh, Dr. Jim Anders and Dr. Dave Joyner who asked me to come down here and help out with the partnership between Nemours children's hospital, the Andrews Institute and the USTA.

J: Awesome. Well, we appreciate you, uh, you doing that cause we've enjoyed having you around and providing your experiences and expertise to all our players. Um, so Ed, as we get into this, would you mind giving us an overview of maybe some of your philosophy within the realm of athletic training and, and maybe what that means with return to play protocols, things like that with, with athletes recovering from injury? Sure.

E: Well, I think when we look at the services that are provided to the competitive athlete, in particular, the elite performing competitive athlete, one of the things that we need to keep in mind is that players have to compete on demand. Uh, they don't get to call in sick. They don't get to show up late. If they're scheduled to compete at a specific time, then they have to be there and be ready to go. In order to do that, the services that are provided around athletes also needed to be delivered on demand in order to meet their schedule as well as their coach's schedule. So one of the things that is critical when delivering those services is understanding that players, when they're seeking care from myself or our team, uh, they typically are not too enthusiastic about coming in to see us because that means that they're not capable of doing what they want to do, how they want to do it, when they want to do it. So we need to make sure that, provide a positive experience for them. And our philosophy really is to, that something positive has to happen to an athlete every time they walk in to see one of our staff's assistance. And again, keeping in mind that what the demands are for them, I think helps us to do that. Uh, the last thing is, you know, as a medical or an allied medical professional, uh, sometimes we get confused when we talk about what is good care and what is good care for the performing athlete. And good care can be rendered at a lot of places like a hospital or clinic, et cetera. Good care for a performing athlete has to consider, uh, the athletes demands of their sport, the, that are physical, the emotional, mental demands of their sport, what they're going through, what their mindset may be when they come in to seek our care. Um, because we want to promote an environment or an atmosphere where they are receiving services, receiving care, and that they believe that they're receiving care that contributes to their improvement and enhancement.

L: So, and I was curious, you mentioned, I guess a goal for your staff is to have it be positive when the players come in, right? And yet a lot of times when they come in, it's not for a positive reason. Is that possible? And how do you see that happening? I'm sure there's different ways, but how does, how does your staff make sure that even someone's dealing with something like an injury or something chronic that's going on and isn't necessarily getting better yet? How do they turn that into a positive with the athletes?

E: Well, we tried to share the burden of their injury. While compartmentalization isn't always good. Sometimes when an athlete is dealing with an injury or something that's limiting their ability to perform, compartmentalizing that aspect and being shared by one of our team and as a partner to help them get better, that's where we try to turn it into a positive so that they can leave that day, that session believing that they've done something to contribute to their recovery or to their improvement.

L: And when you say compartmentalizing, it makes me think that in some ways you're specifying what the injured area is, but also there's a lot of you that is healthy and what you can be doing on that as well.

E: Exactly. And that particularly for players who are, who have suffered an illness or an injury that keeps them out of the game for a long period of time, we really need to focus on what they can do as opposed to what they can't do.

L: I mean that's a good point because that, you know, you need some optimism, you know in the training room obviously cause it could probably pretty pretty negative in there if you're just talking about what's wrong with everyone.

E: Right. And again, for the long term reconditioning athlete, oftentimes it's an opportunity for them to improve on other aspects of their game besides the area that is injured, ill, or whatever.

L: Am I, am I jumping here ahead here, Johnny or not carrying on with this? This is just curious to me because you know, Ed, you had tons of experience over the years working with injured athletes and healthy athletes, but what kind of, I don't want to make this about necessarily stable traits, but what kind of characteristics, you know of, of the person or what kinds of people are able to do that in a way where they can take on a serious injury along rehab, along return to play and, and manage that well? What have you seen from your experience, what really helps people to be able to go through that journey and come out the other side better?

E: My experience has been, again, unique and that it primarily has dealt with high performing individuals. And to that end, they're all competitors. So as we can channel and funnel their competitive juices towards getting better than they don't leave anything unturned or any stone unturned, uh, with regard to their recovery, we should a, a goal for rehab and, and uh, actually treatment is that when, uh, if an athlete is not able to participate, it should be part of our goal to ensure that when they go back to participation and when they're fully released, they should be returning at a higher level of capability than they were when they first got injured. Because if you think about it and, and I think tennis is a great example because you don't have people running into each other and in the game of tennis necessarily. But most of the stresses that are, that cause injury in tennis are intrinsic. So if that repetitive load that caused an injury is something that they are going to have to withstand when they return to the game and they had a particular level of capability prior to their injury but they still got injured, perhaps that level wasn't adequate for them to perform at the highest level.

L: Well it sounds like, JP, that a lot of what Ed's talking about in this positive approach to things. I love it cause I think it, it motivates people, uh, through the rehab. But it sounds like you'd have to work closely with strength and conditioning to make sure that you're getting this done.

E: Oh absolutely. And I've partnered with strength and conditioning professionals throughout my career. And one of the things that truly is a benefit here, at the national campus is the geography by virtue of the fact that we office together we are adjacent or embedded within the player development gym that fosters and promotes partnership. There is regular discussion about players, what their capabilities are, perhaps if they have any limitations. Uh, not only with the S&C team but also with the tennis coaches.

J: That's a good point. I mean the linkage with the tennis coaches too. So if we were to give an example of a, say like a shoulder injury, what might be some ways that you communicate with that, with the tennis coach when they start going back out and call it? What are some strategies that you might say to the tennis coach to ensure that they're not overloading the shoulder but just doing enough so that it's, you know, helping them return to play. What might be some strategies you would give based off maybe a shoulder injury to give to the coach?

E: Well, that's a great question. It's been a period of learning for myself and our team because we've learned that some players and tennis coaches when given some some guidelines as to what to do on court in order to minimize or mitigate any excessive stresses to to the shoulder, some of them, when we use a time-based constraint, their philosophy is to hit as many balls as they can within that window of time and others. And in that incidence I should say, then we have to give a numerical value for the number of balls that they should hit. Others. We know that we've had some players who only hit the ball as hard as they can all the time. And in that instance, rather than try to change their tennis stroke, which is certainly beyond my capability, then we have to work on limiting the volume because they are going to hit as hard as they can every single time. The bracket strikes the ball. So working, figuring out what works best with that individual player and that individual coach. So often times I will ask the coach or our team will ask the coach, is this a player who hits the ball as hard as they can every single time, whether it's forehand, backhand, volley, serve, whatever it is. And then we know that we have to work on limiting volume, et cetera. And you know, to be perfectly honest, one of the biggest challenges that we have is determining with strength and conditioning with the tennis coach is what is the correct load. And I always reflect back on a good friend of mine always said, you know that one workout will never make an athlete but one workout can break an athlete. So if our athlete is going through a return to play and you allow them to do too much, then that may set them back. So we never want to push that envelope too hard when they're going through return to play. The last point I will make is that there's only one thing, one parameter that can be changed at a time.

L: That's a great point. Can you explain that a little bit more?

E: Sure. So we only have so many parameters that we can modify in training, and I use the term training specifically because you know when we talk about rehab that that connotates or indicates that rehabilitation is a different philosophy. It's a different modality than exercises. The body responds to stress the same way, whether it's in a rehabilitation or reconditioning setting or whether it's in a training setting. So if we're reconditioning athletes to return to play, we're really training them. But you can modify their volume of work. You're going to modify their intensity of work, and you can modify the rest period between the bouts of exercise. You can modify the rest period between the individual exercises, et cetera. But you only want to change one of those at a time. So where we have gotten into trouble, not only here in tennis but in my experience, has been when we've tried to modify too many of those at the same time. So we increase the volume, think about it from this perspective that if we start a player off at 15 minutes on court and the goal is to hit 50 balls, then if we progress them to 30 minutes on court, we have increased the time by 100% and that's not very gradual. It will also indicate that if we can hit 50 balls in 15 minutes, that we would hit a hundred balls in 30 minutes. Again, not very gradual. So we need to be able to modify whether it's the volume or the intensity. And as I mentioned before, some players just go as hard as they can all the time and then it's hard to modify their intensity. So sometimes we just, we have to modulate, you know, we have a day that's 40 minutes today and it's 20 minutes tomorrow and then it might be followed by a rest day. And then repeat that and then we start to look at back to back consecutive day activities and then we start to transition more into the typical tennis training schedule, which is two tennis's a day. So again, when we look at the two tennis's a day or any increase, we always need to look at how much are we increasing.

L: This sounds like a, a bit of a complex, uh, decision making process, right? Cause there's a lot of different things to look at and determine which, which variable to change, right? Which, which one to ramp up or ramp down. Or a lot of our listeners are coaches, players, parents who don't have access to someone like you, but they're working with a physician or a doctor somewhere. How can they take what you're saying and in a good way apply it because I, you know, I want to listeners to be like, okay, so I like all I can only change one variable, but how, how are they going to know and what can they do? Obviously most of them aren't, aren't doctors, and they're certainly not athletic trainers. And so what, what can they do?

E: Well, probably the biggest thing is, is, is gradual progression. They need to start at the beginning, as elementary as it may sound. The beginning is truly that. So when we're talking about a player who has not been on court, who has not been striking a ball, we're talking about starting off with the gradual progression balls, starting off with foam balls, red, orange dot. I never get those in order.

J: That's in order.

L: He nailed it.

E: And then, uh, and then, uh, before they get to yellow. Um, so that's one way to progress. But that doesn't mean that you start off with a foam ball and you cannot just because it's a foam ball, you can do 200 forehands or you start off with a foam ball and you're, you do 20. And that sounds like it's very little, but that 20 is more than they've done perhaps in weeks.

J: So what are the, some of the, I don't know, we touched a little bit on it that, but what are the, some, some of the maybe common flaws you see with athletes when in this rehab phase? For me the major injuries or minor injuries. So you talked a little bit about, you know what I was coming to mind, Dara, is you probably sometimes have some athletes that when you ask them how that feeling, how that doing, some of them may or may not maybe give the whole picture because they're so keen to just get back out there. But you might have some on the flip side that a may be on the two precautious sides, that it's almost hindering the efficiency of that time to come back to play. So what are some of those barriers that you see or maybe common flaws isn't the right word when, when going through this process?

E: Well, I think motivation is probably one of the big things in, in viewing their process to achieve a goal. And their goal would be to return to the game. Part of part of our plan in reconditioning, uh, a player would be to ensure that we're not giving them a plan or an exercise regimen that they're gonna follow for the next three weeks. That is very monotonous. So we want to change that up with the overall objective of that phase of their reconditioning and mind so that there's some variety in that. So we want to try to prevent monotony. We, we also need to that if they're taken out of the game, that there's a grieving period that they're, they're going through and we want to refocus their, their time and their energy into their reconditioning as to how to address the loss that they're suffering by working towards returning to the game. Probably the last thing, and this is in my opinion, the most important is throughout this entire process we need to promote through them and with them confidence and confidence that what they are doing will be able to demonstrate progression and progression is not in reconditioning. Progression is not linear. There is a, there is an improvement and then there's plateau and there's improvement and there's plateau. And that's just like any other conditioning aspect. We just don't keep beginning getting better every single day. So by stressing them, and again, you probably one of the, a big challenge in some reconditioning athletes is getting them to understand that stress is really important to their reconditioning and return to the game. Physical stress. If you lie on the couch and watch TV, eventually something will stop hurting. But you won't be very good at playing tennis. So when you go to a return and put a racket back in your hand, that will not be very successful. So development of, of confidence, trying to maintain their motivation and keeping them focused on what their end goal is.

L: I think that's great and think about the, uh, the perspective. I remember, um, you know, someone who was at Michigan state and she had a serious knee injury, um, ACL, I don't remember all that she had done, but she was out of well able to do much, um, for a long time. And she talked about how she used that as an opportunity to learn from the experience. And she's a sports psychology professional now and she used it as an opportunity to understand what the athletes she was working with were going through when they were returning to play and having surgery and going through rehab and, and tried to turn it and have a different perspective. And that really helped me when I had my shoulder surgery because I went into that surgery saying, okay, I never had, I mean I had appendectomy when I was 17 but not a major surgery where I was going to do lengthy rehab. It was a first time and I went with a positive attitude of I can learn a lot about what the athletes are going through through this experience and, and what it takes. And I actually, you know, this is going to sound weird JP, but I enjoyed the experience actually really enjoyed.

J: You're sick, Larry.

L: I am sick but I well yeah, when it's time to be done in my rehab I asked for more so cause I enjoyed it so much. But this idea of taking off those small incremental goals towards something bigger I think is pretty motivating and important for the players.

E: Absolutely. Probably another point to this and something that is probably more along your line of work, Larry, is understanding that achievement of a goal is also a stressor. When somebody is working for weeks, months to return to the game and they get to return to the game, is it going to be what they expected?

L: That's where, you know, your discussion earlier about being better, sorry, JP, it's got me fired up here. [inaudible] me to your discussion about how to get better in other ways and also strengthening the, either that area or the areas around the injury. Um, so that the athlete feels more confident when they come back. More capable of taking on the stress. I think there's the athletes deal with, uh, the, the worry and concerns about area and as it strong will maintain. Right. And we have to, we have to deal with that. But they also deal with, well everybody else has been playing and I haven't been and they've gotten better and I haven't, but we can say no actually you have, it just hasn't been the whole time with a racket in your hands or hitting balls, but you have gotten better and the, and then there's the whole idea of being patient and, and working your way back and not expecting amazing results as well when you return to play. You may get them to, there may be a honeymoon period, but you may not, you know, I don't want to be negative. I want to be optimistic, but at the same time we need to be patient with ourselves.

E: Absolutely.

L: Sorry JP.

J: No. So I'm just thinking here about that the mindset of the athlete goes through, I know, again, I want to use myself too much as an example. Hey, but I always try to approach it as another challenge. I think we talk a lot on the podcast about having resilient competitors and athletes that are able to, to be adaptable. Right? And, and you know, within that, when you do get an injury, and the thing that I like about your philosophy here at is, you know, we want to tell them what they can do. There's times where you go in the gym, you have certain parameters, okay. And, and you go, okay, well if I do this exercise, I'm not staying within the parameters I'm giving. So I'm gonna figure out what else I can do in order to, in order to get the work in that I want to do. So it now starts to get you thinking and, and almost like figuring out how you're going to achieve the body of work you want to do given those parameters. So becomes now a challenge to be able to step up and figure out what you can do in order to get from A to B. And so rather than just sort of going, okay, well I know I can't do this and I can't do that and I can't, you know that that's a negative phrasing, right? And so say that you can't do something is, is to, is to take a negative stance on, on, on, on that aspect. You know, by always providing that positive, well you can do this, so go figure out how you can do it. You know, I think that's a really important outlook I think from an athlete in their approach to to return into play or going through rehab.

L: Yeah, exactly. And I think it's important for the people around the athlete is, well as ed and I both speak a lot to the athletes who are injured and returning to play, that it's nice when they have people around them who are positive and and talking about the things that they are developing versus, you know, you're broken and you just need to heal. Well guess what? I mean obviously the healing process has to happen, but you can get better in other ways and that can get people excited. Cause I see athletes changing technical things then that they would never touch when they're in a competitive season or maybe even a preseason because they just, it's too worrisome to actually deal with this technical thing. So the opportunities there are definitely the opportunities, right? And when you, when you go through one of these lengthy journeys through rehab or as you call training.

E: Exactly.

J: I want to switch folks. I know we're running out of time so I just got one. One more thing on my mind here.

L: I got a lot, so... Get it out.

J: When we talk about the importance of rest and recovery, I think especially in the tennis world, we have a pretty loaded daily schedule for most of our athletes they spend a lot of time on court than they have the off court. Now if you factor in some minor injuries that they have to take care of that before and after practices too. What is the importance of that daily rest and recovery to maintain sort of a, to maintain their health physically or mentally. And maybe what are some tips that you can give to the listeners for daily rest and recovery?

E: You know, the whole concept of rest and recovery has gained a lot of uh, interest and enthusiasm of late. It's primarily been driven by things that plug into the wall. Things that beep, buzz, light up, et cetera. When in fact, the best strategies for approaching recovery from exercise day after day or the simple things and that's sleep, what you've put in your body as fuel and what you put in your body is hydration. And those three things really are the key to rest and recovery. So a highly motivated training athlete needs a lot of sleep and that's usually in the form of uh, you know, eight hours, maybe a nap during the day. Those things aren't luxuries for an athlete, bare essentials for an athlete, they're not nice to have, they're needed to have. They need to put quality fuel in their body and they need to program their fueling around their life and their training so that they're putting the appropriate type of fuel, high nutrient value fuel in surrounding their training so that they have the energy to do their training. And then second, they need to apply or put in the amount of protein so that they can rebuild tissue that they're breaking down. Because as we know, the body gets better by a breakdown build up process. It's not just build up, build up, build up. What they drink and when they drink it, that's also important so that they're prepared for optimal performance in a training bout as well as a competitive session. But again, I think if there was one thing that you could put your finger on that would significantly affect somebody's recovery, you, it would be sleep. And that means put down the electronics 30 to 60 minutes before it's time to go to bed and leave them down and put her in a different room. Things like that. Don't watch TV.

J: I would imagine that's a virtual impossibility for some people. But, uh...

L: It is challenging. Just when you have kids and that's like the one time you have to watch your favorite show right when they're in bed. So yeah, that, that's a challenge. But it's, it's important, especially if you're a high performing athlete or you desire to be one. Um, you have to make certain small adaptations or sacrifices, right? I mean to, to be your best. So, um, I mean thing that's a big part of what we talk about in his podcasts are all the things that athletes must do that allows them to be competing like champions and not all those things are easy or fun, you know, but they're good for you.

E: Absolutely. I view the population that we're fortunate to work with is, uh, they're, they're all motor geniuses. Okay. They can do things with their body that most people dream about trying to do with their body, but it comes with a price and they have to do all the preparation work in order to execute where people are going to watch them execute. When I come to work in the morning, if I have an upset stomach or I don't, didn't get a good night's sleep, I can probably be pretty effective doing my job. If I have a match today and it's center court at the US open, maybe I don't want to have a poor night's sleep the night before. Maybe I want to make sure that my stomach, I didn't catch some stomach virus by eating, uh, you know, a hotdog in front of the hotel.

L: Nothing against that guy. But, but Ed's probably not eating that meat out there. The street meat.

E: Right.

J: Awesome. I know we're wrapping up on time here Larry, but you've got one more thing.

L: Not just, I don't know when we're going to get Ed back here. So, you know, we're going to, as long as he has more time. No, I think it's interesting. One thing is that because tennis is an independent sport, it seems like your team is able to spend a lot of time with the injured athletes who are rehabbing and give them a lot of attention. But if you're working in a team sport, sometimes you might not see those athletes, they might be going somewhere else to get help. Right. So how is, how is it different in tennis and how is that, I think it's a positive thing coming out of this being an individual sport in terms of they aren't seen as you know stay, you know, cause we hear like coaches sometimes, "Ah, stay away from the other ones. We don't want them to get injured too." Kind of this nonsense sometimes that I hope coaches don't do much anymore. But it seems like tennis in some ways is very healthy that way.

E: Well I agree. I think the, the individual nature requires that it'd be entirely focused then that individual player needs to be focused on what they need to achieve on that day in order to continue to get better. Who is a team sport in basketball, but uh, coach used to always say if you're going to be here, be all here. So in order to, to get them engaged in that, the same thing is true with our team and the support around that player. Again, you'd have to be all there. We have to be able to give them our best if we're going to expect their best. Having worked in both team and individual sports, I am familiar with the scenario that you mentioned where coaches say, well, you're broke, I don't want to, don't come back until you're fixed. And I used to, uh, in that scenario, I used to always take um, part of their reconditioning time and do it while practice was going on in the gym or in the venue in order to create that association and that connection between a player who's returning to the game and the rest of the players who are playing the game. And I think that that creates a healthy supportive environment, but it also educates the other teammates what somebody is going through in order to get back.

L: I think sometimes the coaches have, I hope it doesn't happen much anymore, but this concern that, well, they see that athlete and as a distraction and they start thinking about getting injured and all those things, some of that nonsense. But I think it is healthy for them to see what their teammate's going through and can be inspiring.

E: Absolutely.

L: I've got one more, Johnny, sorry. So as we think about this, Ed, and players are coming back, a big part of what has to happen is playing points or playing matches in practice. And what is your philosophy on what you need to see for an athlete in practice competitively to then to be able to say that person's ready to go and, and play a tournament?

E: That's a great question Larry. And it's one that, uh, I didn't know the answer to when I started here, but having great tennis minds around here, like there are early on Ola Malmqvist came to me and asked me that exact question. My initial response to him was, what is the goal for a player to enter a tournament? And he said, well, it should be to win. So I said, so help me to figure out what that looks like in order to prepare a player who is recovering from being away from the game duty injury or illness. What do they need to be able to achieve before you could say they could go enter a tournament in order to win. So we came up with the goal of 10 sets in five days and we want to be able to see that player, whatever combination that is, whether it's some days it's two, some days it's three, but to be able to accomplish and in a five day period, 10 sets that are highly competitive and that that would be a metric that would indicate whether or not that player would be capable of entering a tournament. And that's, again, that's really Ola's concept that I just stole.

L: Well, all credit to both of you. It makes so much sense that you know that sometimes it hits us or like, wow, I wish I would have known that before. But also the listeners have to keep in mind that that's very much based on the, the level of the player, what the expectations are, right? So let's say a child is coming back from an injury, but they're playing maybe on the weekend and they have to play two, three times a day. But they're playing over a two, three day span. Right, Johnny? So they're, right, I mean they're, what you would expect from them will be different.

E: Exactly. But I think it's all on having an understanding and doing a needs analysis of what the competitive environment will demand of the player and then creating the structure to prepare them adequately. Because in the absence of that, you're preparing players to participate, not to compete.

L: Great point. And we always need to know why we're doing what we're doing. It always comes back to why, you know, what, what's the reason that you're going to go play? And if it makes sense then let's do it, but if you're not ready then, and I think that's a concept that we, we all embrace around here is that you want to be ready and, and that's from all aspects, physical, mental, emotional and considering all facets of the player.

E: Right.

J: I'm pleased I didn't cut you off there, Larry. Cause that was a awesome last question. Unless you've got another two or three.

L: I don't want to, I don't want to mess it up. I'm, I always had questions for ed, but usually ones that refer to me, but I, yeah.

J: It's been some great content.

E: If I could add, we always like to end a players session on a positive note.

L: We like to end these podcasts on a positive note to.

J: Awesome. Well, Ed, thank you so much for your time. We greatly appreciate the services you and your team provide for the players and uh, you know, we enjoy our time with you and appreciate our, our connections together. So thank you very much for taking the time to be on the podcast and Dr. Larry for some, uh, some stinging questions.

L: Well, I knew he was ready for my, we've talked about a lot of this stuff before, but, uh, very good stuff Ed, so thank you.

E: Oh, it's a pleasure. Anytime.

L: We'll take you up on that.

E: Okay.

L: Anytime.

J: Well that's it for today's episode of compete like a champion. That's been recovering from injury with Ed Ryan, director of medical services at USTA national campus. If you're a player out there and you're going through injury and experiencing some tough times, don't be afraid to reach out to us. You can get our contact information on our our USTA website, If there's any advice that you need, you can reach us through that. Until next time, Dr. Larry, Ed, we're clocking out.