Ep 198: Careers in sports medicine, with Dr Ciara Burgi

[00:00:00] The American Academy of Sports Physical Therapy and JOSPT are joining forces to bring you the second virtual sports PT conference on Saturday, the 2nd of November.

[00:00:09] This is the premier online event for people interested in sports injury rehabilitation in 2024.

[00:00:16] The three main blocks of content cover assessing and managing fear of re-injury, how approaches to pain monitoring have evolved, plus the latest in wearables and how to get the most out of wearables in your sports rehabilitation practice.

[00:00:28] You'll hear from world-leaning clinician scientists, including Drs Terri Czemuleski, Laurie Mishner, Karin Silbernagle, Liz Welsent and Rich Willey.

[00:00:38] There's something for everyone at the virtual sports PT conference so that you're in the best position to help the patients and athletes you work with.

[00:00:46] Join us on Saturday, the 2nd of November. Register now by following the link in the show notes and take advantage of the opportunity to earn up to 3.7 credits towards your continuing education.

[00:01:02] Hello and welcome to JOSPT Insights, the podcast that aims to help you translate quality research to quality practice.

[00:01:10] I'm Claire Ardern, the editor in chief of the Journal of Orthopaedic and Sports Physical Therapy. It's great to have you listening today.

[00:01:20] If you ever wanted to peek into what leadership in high-level sports looks like through the eyes of a physical therapist, look no further than Dr. Sierra Berge.

[00:01:27] Dr. Berge is the director of health and performance for the WNBA team, the Las Vegas Aces.

[00:01:32] And prior to the Aces, Dr. Berge worked for the NFL team, the Houston Texans, where she spent the past two years as the return to performance lead.

[00:01:39] As director of health and performance for the Aces, she and her team are tasked with building a modern, cutting-edge, high-performance team, co-creating systems and processes to maximize the athlete experience, athlete health, and preparedness and athlete development with the mission of continuing to elevate the championship standard.

[00:01:54] My name is Dan Chapman, owner of Summit Physical Therapy and Performance in Baltimore, Maryland.

[00:01:59] And I'm Chelsea Kuman, a physical therapist and athletic trainer at Stanford University Athletics.

[00:02:04] Sierra Berge, thank you so much for joining us on JOSPT Insights today.

[00:02:08] You're welcome. Thanks for having me.

[00:02:09] So you were with the Houston Texans.

[00:02:11] Yep.

[00:02:11] And you were the return to performance lead for the team. Is that right?

[00:02:14] Yes.

[00:02:15] And then in April of 2024, you shifted into director of health and performance for the Las Vegas Aces.

[00:02:20] We would imagine you're coming into a position where you want to assess kind of where the team is at.

[00:02:26] And then you probably also want to figure out where you want the team to be and then build a bridge to get them from A to B.

[00:02:33] And we would love to hear about how you decide where you want the team to be and how you kind of build that road to get there.

[00:02:39] I think that that's probably one of the main reasons why I took this job is because there's so much potential for curiosity and creativity within the WNBA right now.

[00:02:50] History is not a barrier because there isn't a lot of history, right?

[00:02:53] Where you think about MLB, NFL, like there's history as being a barrier to change at times and there isn't a lot of history here.

[00:03:00] You know, there's a massive amount of funding coming towards women's sports at this time and funding allows you to be able to do things.

[00:03:06] And so it's time to like professionalize women's sport in the way that it deserves to be.

[00:03:11] And so that's a big reason why I took this job.

[00:03:14] I think it's been a challenging year.

[00:03:16] The entire medical staff is brand new.

[00:03:18] So not only are we new to the athletes, we're also new to each other.

[00:03:23] And so you don't have any working rhythm with each other.

[00:03:25] No one has any historical knowledge of the athletes or the coaches or the front office or how the organization runs.

[00:03:30] So it has been a big year of discovery and learning and listening.

[00:03:36] And I think we haven't made yet massive changes and not yet been who I think we can be.

[00:03:42] But that's because you have to come in and build buy-in and build relationships.

[00:03:46] And so these women have had multiple medical providers throughout their career being overseas, being here.

[00:03:52] So a lot of them kind of know what they like and know what they want.

[00:03:55] And so you don't come in and assert your own ideas too quickly because you have to build buy-in and build relationships.

[00:04:00] Same thing with the coaching staff.

[00:04:01] Have to learn how they function and what they know and what they don't know and what information they need.

[00:04:06] So it's really been like a massive year of listening and learning and figuring out where we want to assert ourselves in the future and figuring out how to assert ourselves in small ways now and figuring out how to work with each other.

[00:04:19] So, yeah, I don't think you, I mean, you can dig a hole super fast if you don't have good relationship with people.

[00:04:24] And so we'll get to all of those exciting things and data-informed things in the future.

[00:04:29] But it's been a big year of like listening and learning and slowly asserting.

[00:04:34] I feel like we've had so many Sports Corner episodes where the people, like the biggest takeaway is like you have to listen to all the stakeholders.

[00:04:43] Like your communication isn't so important and like getting everybody on board and buy-in.

[00:04:47] So now you're saying that exact thing.

[00:04:49] So thank you.

[00:04:50] At your level though, how do you view that balance between the stakeholders, athlete, other clinicians, coaching staff?

[00:04:59] I mean, I think it's all about being really curious and listening to each other, right?

[00:05:03] And so like having conversations about open conversations and open dialogue about what different providers, like all three of our medical staff are new, myself included.

[00:05:14] So like we all treat a little bit differently.

[00:05:16] Like how do we want to come at this as a cohesive unit?

[00:05:19] What is the front office expecting?

[00:05:20] What are the coaching staff expecting?

[00:05:22] So it's just like really being super curious and then sitting down and having a dialogue and figuring out what that middle ground is.

[00:05:29] I mean, yeah, it sounds like cliche, but really like great communication and great relationships are going to get you further than anything else, especially in this world.

[00:05:37] So it's really just been like, okay, you're really used to doing it this way.

[00:05:42] What do you like about that?

[00:05:43] What do you not like about that?

[00:05:45] What's worked for you in the past?

[00:05:46] Like just pounding them with curiosity, the front office and the athletes and the coaching staff and figuring out really what their needs are.

[00:05:55] Are they attached to a certain way because that's the only way they've ever done it?

[00:05:58] Are they open to something new?

[00:05:59] Are they not open to something new?

[00:06:00] So it's really just being like super, super curious with all of them and trying to figure out what the middle ground is.

[00:06:07] So Duke, you were working with both men's and women's sports at the college level and then you're with the Texans at the professional men's level.

[00:06:14] I'm curious to know the differences at working with like a professional level men's, professional level women's, especially as a woman in a leadership role for both of them.

[00:06:23] That's like a very unique experience.

[00:06:25] Do you notice any differences or is it whatever?

[00:06:29] I'm listening and I'm learning and I'm curious and it doesn't matter.

[00:06:33] I would say yes and no.

[00:06:34] I think like athlete population wise, it doesn't matter that much.

[00:06:39] They're all very similar.

[00:06:40] I find the professional men's team and this women's team to be honestly not all that different to me.

[00:06:46] They're really, really good human beings.

[00:06:48] They're really, really good professionals.

[00:06:50] They're not what we perceive in the media like some of the best people I've ever met.

[00:06:54] And it's like a blessing to be around them every day.

[00:06:56] And they're really interesting and they have really diverse lives and they have families and have other interests outside.

[00:07:03] So like it's a really, really cool population.

[00:07:05] Like they're really interesting people.

[00:07:07] At the college level, I love the athletes too.

[00:07:09] It's just like a little bit more homogeneous of a population where they just all left their parents and are all kind of in the same, like same four year age range.

[00:07:17] Where here we have women who are 22 all the way up to women who are 37.

[00:07:22] And so there's like a large age range here.

[00:07:24] Same thing at the Texans.

[00:07:25] There's a large age range.

[00:07:26] Those are a lot of people in different life stages.

[00:07:27] I would say as far as like a leadership position, there's so much history in the big four sports, right?

[00:07:34] There's just more historic structure.

[00:07:37] And so change is harder when you're in probably the NBA, the NFL, the NHL or MLB, right?

[00:07:44] Just because there's history there.

[00:07:45] And so I think that this is working in this or the WNBA or working in a WNBA organization.

[00:07:51] Like there's a little bit more freedom and openness to new ideas and change.

[00:07:57] I know that you're like, listen, you're like, I just freaking started here.

[00:08:01] Okay.

[00:08:01] Give me a second.

[00:08:02] But I am curious about like what you're excited to start looking at metrics wise, because I feel like, okay.

[00:08:07] And also correct me if I'm wrong, at your level, you are the person who's deciding what the heck, or at least having a large say in what the heck you want to start looking at.

[00:08:18] And I think that's such a big thing right now with force plates are more accessible and handheld dynamometers are more accessible and fancier and connecting to apps.

[00:08:25] And now we have data sets and all this stuff.

[00:08:27] I feel like it's just so much more accessible to even just like the outpatient clinician.

[00:08:32] I'm curious to know what you're excited about metrics wise and picking up.

[00:08:36] I think we've started to collect some baseline data.

[00:08:39] We have Kinexon, which is like a GPS, basically monitoring tool that they have during practices.

[00:08:45] And then there's another company that does it during games just because the WNBA has a contract with another company.

[00:08:51] We have force plates.

[00:08:52] I would say the large challenge here that I was unprepared for or unaware of is just the intensity and density of our game and travel schedule.

[00:09:01] Like there are a lot of times where we would have, I mean, we have what, eight games in 16 days.

[00:09:09] So we're literally playing every other day and it doesn't, sometimes we're home, sometimes we're away.

[00:09:13] So it's like, I was unprepared for that.

[00:09:17] I think we've practiced maybe twice since August 15th.

[00:09:24] Again, because like we're either playing or we're not playing.

[00:09:28] Every other day we've played so many games in the last month.

[00:09:31] And so it's interesting, we are interested in quantifying, yes, physical load, but also travel load and schedule load and getting back at 2 a.m.

[00:09:44] and then playing the next day, right?

[00:09:47] So there's like so many different things that we need to quantify.

[00:09:50] And so, yes, like force plates matter.

[00:09:53] We have to think about, is that something we can test at home?

[00:09:55] And is that worth testing on the road?

[00:09:56] What's the consistency?

[00:09:58] If you're going to collect data, you want to collect high quality data.

[00:10:00] And so what is the common denominator?

[00:10:04] Do we go every single game day?

[00:10:06] Like these are types of things that we're starting to question and think about how we want to collect data and make meaning.

[00:10:11] Yeah, the biggest priorities are figuring out how to quantify, yes, the physical load, but just that intensity and density of our schedule and the mental stress of things as well.

[00:10:22] We had four athletes, well, actually six athletes that represented various countries at the Olympics.

[00:10:27] And so like that's a big mental stressor.

[00:10:30] We were the WNBA champions the last two years.

[00:10:32] So we're trying to three-peat this year.

[00:10:34] That's a mental stressor, right?

[00:10:36] There's so many different things to quantify outside of the like myopic world of force plates and GPS monitoring that it's like there's so many other stressors for this team besides physical.

[00:10:49] And I think that all three of us new to the medical staff were sort of unprepared for that density and intensity of the schedule.

[00:10:56] And like the NFL is very predictable.

[00:10:58] Every Monday is the same.

[00:10:59] Every Tuesday is the same.

[00:11:00] You always play on Sunday.

[00:11:02] You get used to it, right?

[00:11:03] And so here it's just very, very different.

[00:11:05] I feel like with a schedule that dense, it's got to be incredibly challenging to do anything other than optimize for recovery, right?

[00:11:15] Yeah.

[00:11:15] How are you supposed to build within season?

[00:11:18] Right.

[00:11:18] No, you don't.

[00:11:19] With a schedule that's like that.

[00:11:22] I mean, that's wild.

[00:11:23] Yeah, it's really wild.

[00:11:25] And I'll give like tons of credit to our strength coach, Jeremiah, for creating the culture of lifting after games.

[00:11:31] And so the girls always lift after games.

[00:11:34] That way we keep our highs high.

[00:11:36] So that way our next day, which is an off day, the lows are low.

[00:11:39] And then we probably play the next day again.

[00:11:41] And so, I mean, credit to him for like creating that culture and the girls buying into it.

[00:11:46] But really, like, yeah, we're just trying to not deteriorate really over the course of the season.

[00:11:51] There is not building that happens largely.

[00:11:54] And then the other thing would just be keeping our low minute players prepared to play, which, again, I think we do a good job of just with extra longer workouts on game days and things like that.

[00:12:05] So we do a good job of that.

[00:12:06] But that's the other thing important, too, because knock on wood, but you never know when someone's going to go down.

[00:12:11] And so you need to have those low minute players ready to roll and step into a bigger role.

[00:12:15] But really, we're just trying to keep up given the intensity and density of the schedule.

[00:12:21] I don't think I realized.

[00:12:21] I think I guess I knew that.

[00:12:23] I just didn't think about it.

[00:12:24] It makes me sound silly.

[00:12:25] But holy cow, that is you really are just like holding it together.

[00:12:28] So that makes the preseason then so or like the offseason, I guess, is so important.

[00:12:34] Yeah, I mean, our preseason is 10 days.

[00:12:37] So it's barely a preseason.

[00:12:38] And then the offseason, it really depends.

[00:12:41] Like the culture is shifting in the WNBA for less people to go play overseas.

[00:12:45] But in order for them to make money, most of them go play overseas.

[00:12:48] There's a decent number of women who are just playing all year round because they leave the U.S. season and they leave the WNBA season and then go play overseas and then get two weeks and start with us again.

[00:13:00] And so at times, there's not really a developmental period for a lot of them, which is super challenging.

[00:13:06] But that's what they've had to do to make a living, to be honest with you.

[00:13:10] Well, hopefully that continues to change.

[00:13:12] As yeah, I mean, it's just we're in such an interesting point.

[00:13:16] And yeah, for sure.

[00:13:17] Women's sports, but also like just specifically the WNBA right now.

[00:13:20] Yes, you gave a shout out to your sports performance coach, your strength coach for like the culture of lifting afterwards.

[00:13:25] What's your role in establishing how we manage our time with the schedule and the demands in that?

[00:13:33] This year, we've largely stuck to the schedule and things that were set before we all arrived.

[00:13:40] Thing that having more influence on that when we can might be something that we'll do next year.

[00:13:46] So, right, like as soon as our game schedule comes out, let's sit down and look at should we stay at a city the night after the game or should we fly home?

[00:13:53] Right. And so starting to look at what are smart flight times that are going to maximize our recovery for me?

[00:13:58] And I don't do anything physical on the court.

[00:14:01] I'm buried for two days when I get home at 2 a.m.

[00:14:03] You know what I mean? And so like, let alone our athletes that are playing.

[00:14:05] And so next year, now that we have more buy in with coaches, with athletes, with front office, I think as a staff, we hope to influence scheduling when we can.

[00:14:14] Right. Control our controllables.

[00:14:16] We can't control game time, but we can't control when we fly.

[00:14:19] We can maybe control when we practice.

[00:14:21] And so the goal would be to have a little bit more influence there next year.

[00:14:25] So Stanford just went to the ACC all of last year.

[00:14:29] Every single meeting, con ed that we did as a department or anything was all about that freaking schedule.

[00:14:34] We brought in sleep experts.

[00:14:36] We brought in whatever.

[00:14:37] We had third party companies come in and tell us about their products, about how they could, you could adjust over.

[00:14:41] It was, and it's all we did.

[00:14:42] But the sleep, the sleep experts were fascinating to listen to.

[00:14:45] Yeah, like a circadian rhythm expert from the app Time Shifter, which is actually pretty cool to look into.

[00:14:50] Lay people can use the Time Shifter app to change time zones when they're flying at least three time zones away.

[00:14:56] I talked to the chief scientist for that, and he's done a lot of circadian rhythm shifting type work with teams and things like that to try to shift your peak performance time to when you're playing and everything like that.

[00:15:08] It's super interesting stuff.

[00:15:10] People who are listening to this and want to follow in your footsteps, what kind of advice do you have to students or new grads that say, you know, I want to do what Sierra is doing?

[00:15:20] I think like for me, it's all been about relationships and opportunities just coming up at the time.

[00:15:26] I didn't graduate PT school and be like, I must work in professional sports.

[00:15:30] I didn't even have that as a goal.

[00:15:32] And it's still not necessarily a goal.

[00:15:34] It's just sort of where I've landed, right?

[00:15:36] I don't know.

[00:15:36] I think people get really, really focused on what they perceive is a goal or where they perceive they want to be and forget to dive in really deep where you are.

[00:15:44] So do a really great job if you decide to do a I did a residency.

[00:15:48] I'm not saying everybody should.

[00:15:50] I did a great job there and dove in really deep and wasn't looking to go somewhere else specifically after that.

[00:15:56] And then eventually life took me other places, right?

[00:15:59] It took me back to Duke for fellowship.

[00:16:01] But like all of the jobs that I've gotten have come because of relationships that I've had.

[00:16:07] If I apply for a job with the Houston Texans, there's probably 150 or 200 applications for that job, right?

[00:16:13] I didn't apply for that job.

[00:16:15] I got that job through a mutual connection that said, hey, you should interview Sierra, right?

[00:16:20] And so same thing with the job with the aces.

[00:16:22] It's through a mutual connection that knows the person that was in my previous position.

[00:16:27] And so I think it's all about relationships and just trusting that life always works itself out, even when you're in tough times.

[00:16:34] Invest super deeply in relationships and the place wherever you are and don't look to the future too much.

[00:16:40] Because those people that you invest in deeply wherever you're at are going to fight for you in the future to get something.

[00:16:46] But if you just develop superficial relationships with them, then they won't fight for you in the future.

[00:16:52] I'm going to cut out that recording and just play it to myself once a day.

[00:16:58] That's absolutely phenomenal.

[00:17:00] It's your own special mantra.

[00:17:01] I think that also goes against a lot of blood.

[00:17:03] But I feel like people who are doing fellowships and residencies and deep in that world about my goal is to be at this level.

[00:17:10] And then it's like, I got to get the right mentor to do it.

[00:17:12] I got to meet this person because that's the person that's going to get me in.

[00:17:15] And it's not always how it goes.

[00:17:18] And if you look at my resume, I look like a giant box checker, right?

[00:17:21] I did a D&D and then I did a manual therapy fellowship.

[00:17:25] And then I did a Division I athletics fellowship.

[00:17:27] And then I look like a box checker.

[00:17:29] But the truth is, those things sort of just came up and I was like, oh, maybe I'll do that.

[00:17:34] Like, I must do this list of things to get to where I want to go.

[00:17:38] It's not how I approached it.

[00:17:39] Again, to each their own.

[00:17:40] But it just was like, oh, okay, I'll do that.

[00:17:44] Valuable insight is be patient and invest in those relationships.

[00:17:48] I think that's a solid take.

[00:17:49] For sure.

[00:17:50] Sarah, is there anything else that you want the listeners to know about leading at the high level, taking on that responsibility?

[00:17:54] I think we spend so much time trying to hone our craft and be really good physical therapists or whatever, right?

[00:18:04] Like really honing your craft.

[00:18:05] And I think what's going to dictate your success in higher level sport?

[00:18:10] Yes, you have to be good at your job, but you have to be really good at relationship and really good at communication and really good with people.

[00:18:16] I think you can always learn new skills from a craft perspective, but it's tough to learn how to not be a bad person, right?

[00:18:26] Relationships and listening and communication is going to get you further and being phenomenal at that than really being perfect at your craft because you can always learn forever.

[00:18:37] But I think that that's the undervalued part of everything is really being great with people.

[00:18:43] Sarah, that's phenomenal.

[00:18:44] Thank you so much for sharing your expertise and your advice with our listeners and best of luck in these playoffs.

[00:18:51] Let's go.

[00:18:51] Trying to 3P.

[00:18:52] Dr. Berge, thank you so much for joining us on JOSPT Insights for this chat.

[00:18:57] You're welcome.

[00:18:57] Thanks for having me.

[00:18:58] We want to wish the Las Vegas Aces the best of luck in going for their 3P.

[00:19:02] And as always, we want to thank you for listening to JOSPT Insights.

[00:19:09] Thanks for listening to this episode of JOSPT Insights.

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