Olympic Games: “We can almost control the athlete” (Pr. Johan Bellemans)

Professor Johan Bellemans heads the medical team supporting Belgian athletes at the Paris Olympic Games. He himself participated in the 1992 Barcelona Olympics as a sailor.

Together with his brother Dirk, he took part in the regatta in a 470, a two-seater boat. Four years later, their sister Ingrid, also a sailor, qualified for the Atlanta Games. “If I had to choose between sailing and medicine back then, I would definitely have chosen sailing. This dynamic and the fact of wanting to measure yourself against others constitute a fantastic life project. Sailing taught me the sacrifices necessary to get to the top. In medicine too, I have always had this inner motivation: I always want to improve,” he said about this three years ago.

In 2014, as an orthopedic surgeon in Leuven, Johan Bellemans co-founded GRIT, the Belgian Sports Clinic, and is chief physician of the Belgian Olympic and Interfederal Committee (COIB).

How will the medical team with which you are going to the Games be made up?

This composition is not a simple exercise. We normally leave with 10 doctors, 26 physiotherapists and three psychologists. They are distributed between the different federations. Some support more endurance sports or technical sports, while others focus on combat sports. My job is to make sure we have a well-rounded team. They are all sports doctors, including two orthopedists and three physical doctors, who each have their own expertise in general medicine and gynecology, as the female athlete is increasingly recognized as a type of athlete in her own right. I have been a doctor within the COIB for almost 20 years and we have evolved towards a more professional and permanent council. We also now have more consistent and comprehensive coverage of our athletes. Online we can get very detailed advice on every conceivable problem.

Thanks to Panega, among others, your medical communication platform.

With this closed medical record, we can communicate with the entire medical staff and determine strategy. Such a platform was absolutely necessary. Before, an athlete was followed by many doctors: his own doctor, that of the federation, the club… Often, communication was poor, which is very irritating for a coach and an athlete. I changed that: we communicate behind the scenes about policy, but with the coach and the athlete there must be a unified message. This has significantly improved our relationships with coaches and athletes.

What lessons do you learn from the Tokyo Games?

One of the most important changes after Tokyo is the prevention of infections following Covid. We realized that we had moved from reactive medicine to proactive medicine. Previously, medical staff would strive to get an injured person back to competition as quickly as possible; today, it’s about ensuring that athletes arrive at the starting line in perfect condition. The success of the medical team at the Games is determined by the number of athletes ready to perform, not by how quickly an athlete is brought back from injury. Rehabilitation methods are now quite well known internationally. This time is the busiest and most dangerous for us, because if something happens now, it will be difficult to be ready in time. But in the medium term, we are exactly where we wanted to be. Generally speaking, we are in better medical shape than before Tokyo and Rio.

The figures published in the media vary from 18% injured in Beijing to 10% in London, 6% in Rio and 4.8% in Tokyo. Will the figures be even lower in Paris?

No, this is the lower limit. The baseline injury rate is about one in 20 athletes. That’s our goal.

Avoiding hamstring injuries is one of the main points. For what ?

This is linked to the carbon plates that equip the shoes. They give a spring effect, which has made it possible to break several records. In Tokyo, we established with many countries that this was indeed a problem. We have worked hard on this topic over the past three years. I think we are ready. We had to adapt training methods because the kinematics of the race change. Hamstring prevention is completely different than it was five years ago, by intentionally training and strengthening certain structures. There is more preventative training.

What do you think about the use of oxygen tanks, a practice that is becoming more and more common in sport?

With each edition of the Games, some medical problems appear. Like Covid in Tokyo and new rehabilitation techniques in Rio, everything related to oxygen will play an important role in Paris. Many countries are working on this subject. For example, for hypoxia (rooms poor in oxygen, for better production of rapid muscles, editor’s note) and hyperoxia (rooms rich in oxygen, for faster recovery of soft tissues, editor’s note). It is often the coaches and physiotherapists who are at the origin of these choices. As doctors we are not always satisfied, but the impact of the new methods is so great for endurance and sprint performance that there is no turning back. We have to evolve with this as a medical staff and keep the health of the athlete in mind. As doctors, we view athletic performance as the result of training and a healthy lifestyle, but it is much more than that. Here, it’s an artificial technique with which I personally have a little more difficulty. The IOC prohibits the installation of such boxes in the Olympic village. A number of countries had requested it, just to show how it works.

How do you think this artificial technique will evolve?

In endurance sports, based on physiology, this is something that concerns me. I’m not a big fan of heavy endurance sports. I make a distinction between physiology-based and skill-based sports. The danger lies in the former, because knowledge of physiology has advanced so much that we can almost control the athlete. It takes away some of the charm of the sport. Today, we can almost predict who will win the Tour. They have become almost theoretical models. In the discipline of endurance, we are evolving into a sport where results have become very controllable. If something is not allowed in races but is allowed on the training ground, you can say, as a doctor, that you are against it, but that’s not how it works. We need to understand what is happening, what the metrics are showing and how this is implemented in training. The same goes for ketones and other energy substances. I remember heated discussions in Rio between medical staff and physiotherapists. Are we going to allow our athletes to use ketones? We were one of the very first countries to do so. We then agreed that medical staff had a right of veto to refuse certain artificial substances at any time, as is the case today for oxygen tanks.