Return to Sports during COVID-19

Catherine Logan

September 7th, 2020

First published in AOSSM STOP


In 2019, the Premier Lacrosse League (PLL) transformed the professional lacrosse world, launching a new tour-based model which offered higher player compensation, player equity, health insurance, and a major media rights deal with NBC Sports Group. After a successful first season, the PLL planned a second season traveling the country. In the setting of the COVID-19 pandemic, the PLL formed a committee to create a safe and successful return to play.

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. Agility, it turns out, is our advantage.

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 brothers often espouse the phrase “operate like an owner,” a call to action essential to the early success of the
league. In developing a successful return to play, here are my six recommendations for success:

Recommendation #1: Develop a Multi-disciplinary Team

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 selected for their
diversity of experience and expertise (Drs. 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 a 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. While our backgrounds differed, our goal was the same – to build a comprehensive, safe COVID-19 Return to Play Operations Plan, a document that eventually surpassed 100 pages.

Recommendation #2: Understand Local Guidelines

Given the novel nature of COVID-19, local standards are a moving target. Members of the committee must keep abreast of these changing federal, state and local guidelines as new scientific findings inform protocol. At a minimum, standards should be developed in several categories, including but not limited to:

• Social distancing
• Personal protective equipment (PPE)
• COVID-19 testing requirements
• Sanitation and cleaning protocols
• Pre-participation physicals
• Symptoms surveillance
• Competition day protocols/Emergency action plan
• COVID-19 illness protocols
• Injury and heat illness protocols

Our committee 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?

Recommendation #3: Establish Buy In

In the lead up to Championship Series, we considered how best to educate players, coaches 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, along with 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.

Recommendation #4: Planning is Everything

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. Those who had a known, previous COVID-19 positive test was required to undergo formal cardiology work-up in addition to our standard physical.

Recommendation #5: It is Better to Anticipate than React

Upon arrival, we performed COVID-19 tests, with additional testing at designated intervals or if symptoms were present. Not one individual in the bubble tested positive at any time point. Now in the bubble, the traditional role of team physician came into play. 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.

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 in a bubble. We partnered with neurologist to develop and employ our Brain Health 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.

Recommendation #6: Stay the Course

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. 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.

Lessons Learned

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. In the months leading up to the bubble, I spent each of my evening runs thinking through the complex challenges we faced. I thought through anticipated risks and worked through solutions. Our committee had run endless scenarios, addressed potential challenges and outlined a meticulous plan of action. While not a novel lesson, but a confirmation – preparation is king.

Application to Youth Sports

The COVID-19 pandemic has presented clinicians and the sports community with unique challenges that affect all levels of sport, from youth to professional. Recommendations regarding resumption of high intensity exercise and competitive athletics requires careful planning and is best performed in a multi-disciplinary manner. Once the planning is done, it is
time to execute your vision. Stay vigilant and agile and be ready for new guidelines or scientific progress to affect your protocol.

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 Colorado Sports Medicine & Orthopaedics 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.