Dr. Scott A. Rodeo, Sports Medicine Surgeon at Hospital for Special Surgery, is the head team physician for the Giants, a role he assumed in 2015 after having been associate team physician since 2000. Dr. Rodeo works closely with Ronnie Barnes, Vice President of Medical Services, in helping to organize and implement a comprehensive medical team. Dr. James Kinderknecht is a Sports Physician at Hospital for Special Surgery and an Associate Team Physician with the Giants. In this Q&A, both doctors discuss the unique challenges of playing in the high altitude of Denver, Colorado.
Q: Dr. Rodeo, what do you specifically do to help prep players for the high-altitude conditions awaiting them in Denver?
We just let the players know that at that altitude the air is essentially "thinner" and they may feel it when they are out there running. Our athletes that have the sickle-cell trait may have a slightly increased risk of a problem at that altitude. So we make sure we alert those players and watch those players carefully as well.
Q: What can players do on their own to help them adjust?
One of the main things is maintaining hydration. It's important to stay hydrated and be aware that dehydration may exacerbate any adverse effects of altitude. We ask our players to report any symptoms early on. Symptoms may include muscle fatigue or cramping - things like that. So we ask that they have a sense of what's happening and be tuned into it so they can let us know.
Q: What are some good tips on helping to acclimate more quickly?
The best thing for athletes that are going to play in altitude that don't have a chance to acclimate is to hydrate. Maintaining good nutrition and rest is important too, but hydration is key. Training in the altitude can be very beneficial if you go for an extended period of time. Positive physiological adaptations occur when you train at the lower oxygen concentration at the altitude.
Q: Have you seen any issues crop up with football players in the past when they play in these conditions?
Yes, athletes have felt it. Athletes will definitely feel the reduced, thinner air with running. So a running back - when you make a long run, may feel a lot of variability between individuals.
Q: How about the recovery aspect?
They will recover as normal. They will fly back down to sea level so if you are acclimated to that altitude and you fly back down to sea level, you will feel great, kind of super-charged.
Q: How about the timing? How long does it usually take to adjust? Football players don't have a week to adjust...
If you can't spend a week there to acclimate the best thing to do is get there right before the event. The biggest problem is if you're there for a couple of days. If you are there for a couple days, two or three days, that's where you have a problem. The best bet is to get there a week early, which isn't practical, or get there as close to game time within that day.
Q: Dr. Kinderknecht, what are some of the concerns about the altitude for an athlete, in a football sense and other athletes?
Our big concern is there is so much individual variation to people's response to exercise in altitude. It even relates to some people not feeling good at altitude. Some people are just able to tolerate it a lot better than others and so that individual variation is hard to predict until someone has experienced being at altitude.
Q: Because of the variation from athlete to athlete, how can you offer your expertise on a case by case basis?
I think most people can relate to that in that some people do just fine and some people really just struggle. Based on that, that's the one variable that we can't really factor in. Probably the variable that we can control the most is hydration so if you're hydrated you do better at exercise or being at altitude in general. So we tend to make sure people are doing things that don't dehydrate themselves and then really maintain hydration.
Q: Can you dive deeper into the acclimation process. How difficult is it really?
The real issue with acclimation to altitude is that it really takes about a week. That process starts about 24-to-48 hours. It's in that window when you're acclimatizing, that you will typically have the most issues. Days 2 and 3 are the biggest struggle when you go to altitude. So really, your two strategies are get there a week ahead of time and really go slow the first two or three days, and then progress as the week goes on towards your normal training. So we typically tell people to cut back on their training 10% or so early on. If you don't stay a week, then your goal is to get in and get out. In that case, you really want to close that gap very close to the time of that event which is ideally under 24 hours.