By Olivia Trani

Behind every athlete performing on an international level, there is a network of health professionals whose mission is to ensure their safety and wellbeing during competitions.

Mary Caldwell, D.O., a physician specializing in sports medicine and physical medicine at VCU Health, personally knows how important this network is for the adaptive sports community, where physicians also need to navigate unique medical concerns that can arise due to physical disabilities and visual impairments.

While caring for patients at VCU Health, Caldwell has served as a physician for the U.S. Soccer Federation's Extended National Teams for more than 4 years. These teams play other versions of soccer, including beach, futsal, and cerebral palsy. Most recently, Caldwell was the team doctor for the U.S. Men’s National Cerebral Palsy Soccer Team while they competed – ultimately winning a bronze medal – in the 2023 Parapan American Games. She has also served as a physician for the U.S. Men’s National Futsal team for other international tournaments.

“I'm here to help our athletes perform at the best of their abilities in their sport, but I'm also out here to make sure they’re safe at the end of the day,” said Caldwell, who is also an associate professor in the VCU School of Medicine’s Department of Physical Medicine and Rehabilitation.

In the final days of the Paris 2024 Paralympic Games, we spoke with Caldwell to learn more about how team doctors help keep adaptive athletes healthy when they compete on an international stage.

What are your responsibilities as a physician for a national team when they compete at international events?

As a physician for a national team, I’m a part of the larger medical team, sharing responsibility with the U.S. Olympic & Paralympic Committee. There is a whole team of health professionals that make these international trips successful for athletes, keeping them safe and allowing them to perform to the best of their ability for their country.

We are there to help take care of any medical issues that could come up day or night. We have to be prepared to take care of anything from small cuts and minor sprains to broken bones and traumatic injuries. We also manage any medical issues that might occur outside of matches, such as respiratory illnesses like COVID-19 and skin infections. If someone on the team has a history of diabetes, seizures or blood pressure issues, we treat all of this, which is especially important for athletes that have had strokes, brain injuries, or cerebral palsy.

Mary Caldwell, D.O., was part of the medical team when the U.S. competed and won third in the 2023 Parapan American Games. Head team coach Stuart Sharp (right) with Caldwell, assistant coaches, and members of the medical team. (Contributed photo)

How is providing care to adaptive athletes different from providing care to other athletes? What kind of unique medical issues do you have to look out for?

I actually had the opportunity to help write a book on this topic, Adaptive Sports Medicine: A Clinical Guide, with multiple mentors and team physicians. We teamed up with sports medicine experts to put together a guide that covers clinical and safety concerns for taking care of adaptive athletes. We have successfully published two editions now to help train future providers in caring for adaptive athletes and teaching them how the sport may have different rules, positions, and which abilities can qualify to participate in that sport.

Adaptive athletes may use a wheelchair or bracing, or they may have a spinal cord injury or a brain injury where their body has a different way to function regarding the neuromuscular system. This could set the athlete up for temperature dysregulation, more complex wounds, higher fracture risk, seizures, clotting disorders, etc. The sports medicine physician must be a “jack of all trades” so to say when anticipating and treating medical issues.

While these impairments may not be immediately visible, cerebral palsy can impact balance, coordination and muscle function. How can these impairments influence the kind of preventative care athletes undergo before an event? How does it affect their participation?

Before a player attends an international event like the Paralympics or the Parapan American Games, they undergo a physical exam and are given an independent medical classification based on their abilities. These classifications are important because teams are required to have a mix of athletes with different classifications playing at the same time.

One example specific to cerebral palsy soccer is some athletes may experience spasticity that causes their muscles to tighten and spasm when they run. Others may have minimal spasticity on exam and would classify as a different level player. This classification process varies per sport and per disability.

As physicians, we also take these medical classifications into consideration when we are treating our athletes. I have to know each player’s ability and the medical issues they are dealing with because it helps us prepare for what kinds of injuries we should be watching out for.

What is something you want others to better understand about the adaptive sports community?

I think that probably one of the most important things is not seeing these athletes for their disability, but rather seeing them for who they are. They just have different abilities and they will dominate you in their sport. The fact that they are under a different bracket is just a title, and they are just as competitive and amazing at their art as the athletes competing in the Olympics. They have worked really hard to get to where they are, and they should be seen and appreciated as such. It’s an honor that I have the privilege to work next to them.

Also, there are great opportunities locally in Richmond for anyone, at any age, who wants to get involved in adaptive sports. For example, Sportable is an adaptive sports club in Central Virginia where I’ve worked as a medical consultant. The club hosts more than 20 sports for over 500 athletes. Those interested in opportunities with U.S. Soccer Extended National Teams can reach out via email at extendedNT@ussoccer.org.