Building the PLL Bubble

Dr. Catherine Logan

Catherine Logan

Injury Prevention

00:10:50

How an Upstart Professional Lacrosse League Created a COVID-19 Free Championship Series

Ty Warner (Midfield, Whipsnakes LC) takes on Choas Attackman Connor Fields
Photo courtesy of the Premier Lacrosse League media team

In 2019, the Premier Lacrosse League (PLL) entered the world’s stage. The league launched a tour-based model and offered higher player compensation, player equity, health insurance, and a major media rights deal with NBC Sports Group.

In the months prior to the inaugural game at Gillette Stadium, I was brought on as the PLL’s Head League Physician, charged with overseeing care of the players comprising the league’s six teams. I, together with Mike Giunta, DPT, built the medical team protocols from the ground up – from physicals to on-field emergency care – with the added challenge of players residing throughout the U.S. and Canada. In a touring league, the city-based team concept does not exist, and players often have a 9 to 5 Monday through Friday.

After a successful first season and the addition of an expansion team, the PLL planned a second season traveling the country in a dozen or so cities. We all know what happened next – COVID-19 changed our lives forever. In subsequent weeks, the PLL formed our COVID-19 Committee with a singular goal – creating a safe and successful return to play. The plan centered around a 20-game Championship Series in a fanless, quarantine bubble. Here is where the real work began.

Developing the COVID-19 Committee

The following months included a growing list of decisions to be made, with each decision setting off a list of new questions. As an upstart league, the PLL advantage is agility, youth and energy. However, as an upstart league, we also run lean. Legacy leagues, such as the NBA, NFL and MLB, have the luxury of bigger budgets, large staff rosters, endless resources and an army of interns. In time, it is clear size and youth are an advantage.

Paul Rabil, Atlas LC Midfield and PLL Co-founder
Photo courtesy of the Premier Lacrosse League media team

The PLL was co-founded by the Rabil brothers. Lacrosse superstar, Paul, and his brother, Mike, a former Dartmouth football player, serial entrepreneur and investor. The Premier Lacrosse League is backed by an investment group composed of Joe Tsai Sports, Brett Jefferson Holdings, The Raine Group, Creative Artists Agency (CAA), and other top investors in sports and media. The brothers often espouse the phrase “operate like an owner,” a call to action essential to the early success of the league.

I, an Orthopaedic Sports Medicine surgeon, led the PLL COVID-19 Committee with our General Counsel, Rob Sanzillo. Our committee included three additional physicians I hand selected for their diversity of experience and expertise (Dr. Sandra Nelson, Infectious Disease; Dr. Jennifer Knepper, Internal Medicine; and Dr. David Kuppersmith, Internal Medicine). PLL COO, Andrew Sinnenberg, the Head of PLL Academy, Rachael DeCecco, and healthcare investor, Oliver Marti, rounded out the committee. Subsequent Friday evenings were dedicated to fast-paced, decision-heavy Google Meets, ending with a list of tasks to tackle before our next meeting. The main objective: building a comprehensive, safe COVID-19 Return to Play Operations Plan, a document that eventually surpassed 100 pages.

Andrew Sinnenberg, Rachael DeCecco, Catherine Logan and Rob Sanzillo at Zions Bank Stadium

We debated the pros and cons of several bubble locations, taking into account the ever-changing COVID-19 maps, as well as the site’s proximity to COVID-19 testing labs, to player homes (how many would drive versus fly commercial), as well as the available housing options. Would we house players in a dormitory? Are there private bathrooms? Is there access to laundry facilities? Air conditioning? Would we allow take-out? At the venue, where will teams watch film? Shower? Engage in recovery and training? How would they transport from hotel to venue, and with whom may they travel?

Courtney Ellis and Rachael DeCecco preparing for athlete arrivals

Our committee members would have spin off discussions throughout the week to inform the decision-making process. Essential to this process was Courtney Ellis, Manager, Events and Product at Premier Lacrosse League. Described by writer Katie Baker in a Ringer article as a “logistical mastermind,” there is no better way to describe Courtney, who was tasked with implementing the fine points of these decisions.

We chose to hold the Championship Series at Zions Bank Stadium in Salt Lake City, Utah which offered state-of-the-art facilities of the Real Salt Lake Training Academy. The series took place over three weeks; week one included seven teams competing in a 14-game group play format to determine seeding, followed by a single-elimination round and a championship game to crown the 2020 PLL Champion. 

Establishing Bubble Buy In

In the lead up to Championship Series, we considered how best to educate players and staff on the ins and outs of our COVID-19 protocol. Ultimately, we decided to proceed with all-league virtual town hall, followed by individual virtual meetings with each team to facilitate Q&A. My role in these meetings was to relay the seriousness of the pandemic and the importance of following protocol. A group of young men such as these, to no fault of their own, often feel invincible, making this task particularly challenging.

Professional athletes rose to the top through discipline, and I chose to engage this trait… plus a healthy dose of the reality other leagues were facing. In the weeks leading up to our town hall, teams from the MLS and NWSL were excluded from their bubble tournaments due to COVID-19 outbreaks.

As a sports surgeon, the difference I see in high achievers is their ability to not only be disciplined, but to do this repeatedly once the boredom of a routine sets in. In closing, I simply asked the players to do two things: Maintain your discipline. Fight Complacency.

The following day I was interviewed by a sports writer who had already spoken to multiple PLL players that morning. She specifically inquired about what I said during the town hall talk. She relayed players had been texting each another during the call, all with the same theme – we cannot let that be us. With the July 4th holiday weekend approaching, I was happy to hear the message was received.

Expansion team, Waterdogs LC, practicing during Mini-camp
Photo courtesy of the Premier Lacrosse League media team

The Pre-Travel Countdown

Twelve days prior to travel, we began daily symptom and temperature surveillance, as well as our first round of COVID-19 testing 72 hours pre-departure. Any positive symptoms were reported to me, and I contacted them directly to better understand context.

The PLL office worked tirelessly to coordinate the delivery of COVID-19 saliva tests to players, coaches, staff and affiliates. Each individual then underwent testing via a telemedicine session with myself or Drs. Knepper, Nelson and Kuppersmith. Those who had a known, previous COVID-19 positive test were required to undergo formal cardiology work-up in addition to our standard physical.

Rob Sanzillo, General Counsel & SVP, Lacrosse Operations at the PLL prepping for a round of COVID-19 saliva testing

Entering the Bubble

Upon arrival, we again performed saliva tests, followed by a quarantine period until tests resulted. Tests were administered at designated intervals or if symptoms were present. Not one individual in the bubble tested positive at any timepoint.

Now in the bubble, the traditional role of team physician came into play. As any team physician knows, when deployed to a 24/7 work environment, caring from anything from on-field trauma to a migraine to a UTI is fair game. Expected blisters from new cleats, lacerations and musculoskeletal injuries are the norm. As the only physician living in a bubble for approximately 300, one must be prepared for everything. I kept medical kits at the venue, my hotel room and my backpack stocked full of the necessities.

Our medical team consisted of myself and our team of physical therapists and athletic trainers. Mike Giunta, physical therapist and CEO at Evolution Physical Therapy, and I performed a national search to select a skilled team of athletic trainers and physical therapists. We selected the top clinicians in their respective field, committed to caring for these athletes around the clock. They were tasked with managing injuries in a complex setting that entailed athletes pushing themselves to their limits.

PLL Medical Team
Morgan Baxter, ATC, Adam Thomas, PT/ATC, Jessie Ku, ATC, Camille Lu, ATC, Jack Malafronte, PT/ATC, Mishaal Amjad, ATC, Mike Giunta, PT, Catherine Logan, MD, Nicole Warren, ATC
Nicole Warren (Lead athletic trainer for Chaos LC) and myself tending to an athlete during Championship Series play
Photo courtesy of the Premier Lacrosse League media team

Each PLL team had a dedicated athletic trainer, responsible for not only on-field care, but post play recovery and treatments. In a compressed scheduled such as this series, quick turn around between games was not uncommon. Our athletic trainers and physical therapists performed treatments at the facility and our hotel, logging long hours to keep players in peak shape. The facility’s expansive training center enabled team-based workouts, and the ability to conduct mobility, strength training, recovery and yoga sessions led by our athletic trainers and therapists. Normatec provided an extensive array of tools and equipment, essential to the recovery of our players.

Kyle Bernlohr and Matt Rambo recovering post-play
Photo courtesy of the Premier Lacrosse League media team

The previous season I had carefully taken epidemiologic data on the injuries sustained by players with respect to multiple factors such as age, position, and field surface. With this understanding, I created a plan to best care for expected injuries while maintaining a safe bubble. We partnered with neurologist, Dr. Jeffrey Kutcher to develop and employ our Brain Health Protocol. He and his team worked with our players placed on protocol via telemedicine. Micro-C Imaging enabled me to take radiographs safely and efficiently on site with their mobile fluoroscopy technology. If antibiotics were needed, a contactless drop off was organized with a local pharmacy. These tactics proved both efficient and effective.

Assessing injuries inside the bubble

Maintaining our Discipline

When things are working well it is easy to get comfortable, but the difference in achieving bubble success is fighting complacency. To assist in this process, we instituted the concept of Social Captains – members of the bubble we knew could succeed in the role of ensuring smaller groups under their purview followed protocol. Our social groups included teams and their coaches, the equipment staff, media, referees, operations, and talent to name a few. Empowering Social Captains to be accountable played a large role in our bubble success. Similar to the operating room, I encouraged everyone to speak up, call one another out and be accountable for keeping us all safe.

Growing the Game

Between COVID-19 policy development and the fast-paced nature of a 20-game Championship Series, the league did not neglect one of its most important missions – growing the game. Each PLL team was linked to a non-profit partner focused on encouraging youth programming development.

Jules Heningburg addressing his team, the Redwoods LC
Photo courtesy of the Premier Lacrosse League media team

Partners included: Harlem Lacrosse, Charm City Lacrosse, City Lax, OWLS Lacrosse and others, with players launching social media campaigns to fundraise for these organizations. Additionally, leaders within the league have emerged to further the conversation on improving inclusion and diversity in the game of lacrosse.

Chatting with Ty Warner, PLL Whipsnake and Harvard Medical Student

The PLL Difference

Just as players reflect on their play, I too reflected on my experience within the Championship Series bubble. We were able to bring lacrosse back safely and successfully, and on the biggest stage the lacrosse world has ever experienced.

Every run I took leading up to the series was my time to anticipate risk, problem solve and develop solutions. Our committee had run endless scenarios, worked through potential challenges and outlined a meticulous plan of action. While not a novel lesson, but a confirmation – Preparation is King. Upon arrival, it was time to execute.

The PLL difference is pride in our own personal accountability. In a league of our size, we know the success of the series is on each of our shoulders, and we know how important the person standing next to us is in their respective role. We have faith in one another to get our job done, and to call upon each other when assistance is needed. As we have been charged, we operate like owners.

About the Author:

Catherine A. Logan, MD, MBA, MSPT is a sports medicine Orthopaedic Surgeon and writer. Based in Denver, CO, she is an attending at Rose Medical Center. Dr. Logan is the Head League Physician for Premier Lacrosse League (PLL) member of the team physician pool for the US Ski & Snowboard teams each year. Dr. Logan completed her Orthopaedic Surgery residency at the Harvard Combined Orthopaedic Residency Program and her Sports Medicine Fellowship training at the prestigious Steadman Philippon Research Institute/The Steadman Clinic in Vail, CO. Logan is also on the board of The Chill Foundation.