Search for tag: "athlete"

Interviewer: Travis Nolan is an athletic trainer that works for the University of Utah Health Orthopedic Center and also works with high school athletes here in the valley. And the question today is if an athlete gets a fracture, should you always go get that x-rayed? Now, I threw on a trick word there, Travis. I said "always," right?

Travis: Yes, yeah, yeah.

Interviewer: So maybe not always. But first of all, you were saying that you've got stories of people who got a fracture, didn't get it x-rayed, didn't get it taken care of, and then it really impacted them later in their life. Give me an example of how that might happen.

Travis: I ended up coming in over this summer just to do some check-up on the school I work at and things like that, and this athlete pops in my room. And he wasn't really thinking about it much. He was doing some lifting and just experiencing some slight pain in his wrist. And he's like, "Hey, man. Is this normal? I took a little follow-on a couple of weeks ago." He actually did ended up going to see somebody. He was instructed to come back in if it wasn't getting better, and the athlete didn't do that. And so after evaluating it, I was pretty concerned for a fracture still present in his wrist.

And so we sent him back in. And I guess, long story short, since that second referral, getting him back into a doctor again, he has actually had four different surgeries on his wrist trying to restore normal function and trying to properly heal the bone that broke. And so he ended up breaking his scaphoid bone. And for those that have broken it or know about that bone, I'm sure they know the complications that can come from breaking that bone, and then it not healing properly because that bone can lose blood supply. And when that happens, it's called necrosis. And so part of that bone can sort of die off. He, to this day, still has trouble playing athletics. It has affected him in class, in school, writing, typing, so many aspects of his life, carrying things, lifting a backpack. And so he is definitely one of my big advocates when I have to tell other athletes to go get an x-ray, and he'll back me on that a lot of the time, so yeah.

Interviewer: So, for young high school athletes, are there some fractures that tend to occur more often that if it does occur, that is definitely a reason you want to go see somebody, ask for an x-ray? What are those kind of common fractures that could really give you problems down the road if you don't take care of them almost immediately?

Travis: Yeah, the ankle. So whether or not it's from twisting your ankle, getting it caught up in a pile, or if you're a basketball athlete, very common to come down on top of somebody's foot after you jump up into the air, and then any kind of fracture around the ankle bone. So whether it's a small chip off your tibia or fibula, those are sort of common when it comes to spraining your ankle. And most of the time, why doctors recommend x-rays for ankle sprain is because you can get . . . whether it's a small piece of your ligament sort of pulls off a little piece of bone, that's a common area to fracture as well.

The other area of the body that is another big one to go get checked out is called the base of your fifth metatarsal. So that's on the outside of your foot there. And that's a special bone because it's sort of just like the one on our wrist where if we don't catch it in time, it can also go through that sort of necrosis. And it's called a dancer's fracture, actually, because it happens in dance quite frequently. And so that's one of those areas where if you do have pain on the outside of your foot sort of near the . . . we call it the base of our fifth metatarsal. If you have pain in that location, that's a very important one to go get evaluated and x-rayed because it can go through that necrosis process.

And then also, they actually are seen quite often in the military. They're called marcher's fracture. So it's at second or third metatarsal in your foot, and that's the same thing. It's going to be those repetitive stress motions. So whether it's marching, running, jumping, that's another very common area in athletics or the sports world to see a fracture in.

Interviewer: So I noticed that these common fractures in athletics that you believe should be x-rayed seem to be around the wrists, ankles, and the feet, the smaller bone.

Travis: Yeah.

Interviewer: Yeah. So those are the ones that if you don't get them looked at, x-rayed, follow your doctor's instructions can really kind of mess things up in the future for you not only in athletics, but in regular life as well. And I'd imagine a lot of those you don't even know that there's a fracture. You probably . . . just pain. You thought maybe just strained something or sprained something. Is that accurate?

Travis: When athletes have a bigger emotional response, it's pretty easy to convince someone, like, "Hey, we should go get an x-ray on this," like, "You're in a lot of pain right now." It's more time those athletes that they're able to tolerate it. They're sort of pushing through it, they're playing with it still, or they come in and they're, like, "Dude, this is something I can deal with." And you have to have that conversation and you have to educate them on, "Hey, look. It's not about you missing a couple of games." This is about your long-term health, especially for those important areas, whether it's the scaphoid, the base of the fifth. There are some areas in your body where if you don't get them checked out and treated properly, they will cause long-term complications. You will have to get multiple surgeries on them in order to try restore normal function in your body.

Interviewer: And if the athlete is experiencing that, how much time do they have to go get the x-ray? Now, I know at University of Utah Health, we have a walk-in orthopedic center, which is great because you could just walk in, tell somebody what's going on, and they could do an x-ray right there. If they need to have a couple of days in order to arrange that, did you have a couple of days to do that or you really want to get it checked sooner than later?

Travis: Yeah. So can you wait overnight? Sure. Should you wait the entire weekend and then maybe go get it checked out on Monday? Those are some things that I probably wouldn't recommend unless you've been advised and it's already been evaluated by somebody, but make sure you're getting evaluated by a professional that can give you recommendations on, "Hey, this is one of those high-risk areas and this is why I would go get an x-ray tonight instead of waiting over the weekend."

updated: December 8, 2022
originally published: March 3, 2021

Dr. Miller: You've torn your ACL. Is that a game changer for the young athlete? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. "The Specialists," with Dr. Tom Miller, is on the Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller, and I'm here with Dr. Travis Maak. Travis is a professor of orthopedic surgery in the Department of Orthopedics here at the University of Utah. Travis, got a young athlete who's playing football, hears a pop, falls down the ground, torn his ACL. Is that it, you no longer play football, or what can you do?

Dr. Maak: Absolutely not. I think, obviously, no one wants to get injured at any point in their sporting career and it is extremely psychologically impactful for the athlete when they injure themselves. And the first gut reaction is, "I'm never going to get up. I'm never going to play sports. I'm never going to be the athlete I was before."

Dr. Miller: Pretty traumatic emotionally for the young and talented athlete, I'm sure.

Dr. Maak: It absolutely is and, in fact, as an area of expertise, sports psychology is a growing area, because it really is a hard thing to recover from.

Dr. Miller: Let's talk about the first piece of this, which would be the diagnosis of an ACL tear. How do you do that and how are you assured that the patient actually has an ACL tear?

Dr. Maak: The way to differentiate between an ACL and everything else is fairly straightforward. If you fall, you twist, you feel a pop, and your knee swells right away, and you can't walk off the field...

Dr. Miller: You know you got it. Something's going on.

Dr. Maak: It's a good chance.

Dr. Miller: Well, how do you definitively diagnose that? Is that the coach on the sideline or the trainer, or do you think that that belongs to a specialist, such as yourself in sports medicine?

Dr. Maak: Well, I'll tell you, actually, trainers are fairly good for the most part. There's an example, the Lachman exam, where you test the knee instability. That being said, right out of the gates, when the knee is extremely swollen, the athlete's in pain, it's really hard to diagnose it. So generally speaking, if there's a concern of any sort that there might be an ACL, a referral to a specialist is probably the best answer.

Dr. Miller: Now, treatment or therapy doesn't begin until that swelling is reduced or is eliminated. Is that correct?

Dr. Maak: That is correct.

Dr. Miller: We think the first thing, athletes, they want to get it repaired right away, and the assumption is that, "I've got to go to the ED," and then the surgeon comes down and operates on him, like as if it's a terrible fracture. But that's not true. You want things to cool down.

Dr. Maak: You're 100% right. In fact, we know now that operating for an ACL when a knee is extremely swollen and stiff, all it does is make the knee continue to be swollen and stiff. And so we let things calm down with therapy. And once the knee is back to moving appropriately, that's when you fix it.

Dr. Miller: Well, the million-dollar question and the question that I've been asked by patients is, do we have to have the ACL repaired? Do I have to have the ACL repaired once we know that it's torn?

Dr. Maak: It is 100% the million-dollar question. Fortunately, we have some statistics behind this. So looking at all of these different types of repairs, reconstructions that we've done, we've learned the following things. Number one is if you're extremely young, and by that, I mean under the age of 18, you cannot have a kid do activity modification.

No matter what you do to try, they are going to run, they are going to jump, and you can try, even if you're a parent, you know quickly it's not going to happen. So in those patients, they actually have a higher risk of other injuries to their knee if they don't have an ACL because they will not modify their activity. So in the 18 and younger, most of us will recommend surgery for them almost across the board.

When you get above that, in the 20, 30, 40-year old range, the question then becomes, can you modify your activities, and do you need an ACL at all? And actually, there's fairly good evidence to suggest that a third of patients actually don't need an ACL.

Dr. Miller: How would you determine if a patient didn't actually need their ACL for the types of activities they're interested in doing, such as running, tennis? I imagine if they're going to play basketball or running sports like soccer, they probably would need their ACL in almost all cases. But maybe, that's wrong.

Dr. Maak: Sure. So, Tom, that's a really good question. If we could do that, if we could identify who the individual was that didn't need their ACL, we would be winning the game. And unfortunately, we can't. So a third of people don't need it to do anything, including rotational activities. So I saw one of the players who actually used to be on the women's national Olympic soccer team for the US and she actually was diagnosed as having no ACL, and the reason it was diagnosed is they got an MRI because her knee hurt.

Dr. Miller: No ACL.

Dr. Maak: No ACL. And she actually had to see four separate orthopedic surgeons, all of whom had to tell her she did not need her ACL fixed before she could return to playing high-level soccer, at that level. That being said, she'd torn it years ago, and her knee was totally stable. So there are some people, it's about a third, that don't need it. A third of people need it to do rotational activities. So to your point, that's soccer, that's pivoting sports like tennis, especially singles, you can run without an ACL, that's generally fine if you're in that group. Then there is a third of people that need it for everything, and that is walking down the stairs and saying hi to your friend. That is turning, stepping.

Dr. Miller: Walking, stepping off a curb, get away, we fall down.

Dr. Maak: Basically, exactly. And those people need it for everything. To answer your question, can you figure it out for yourself? The answer is yes. And generally speaking, if you're tending towards saying, "Hey, you know what, I'm okay giving up these activities," and this is what I tell my patients. If you take those numbers, about two-thirds of people need it, if they're not going to modify their activities. So if they're going to go back to playing basketball, tennis, bump skiing, things like that, there are good odds you're going to need your ACL.

Dr. Miller: Well, that begs the question. So you let the swelling recover, you let that inflammation calm down, and then, do you allow them to go back and play their sport to see if they can manage it without the ACL, or do you recommend that they proceed with surgery?

Dr. Maak: For me, it is very patient dependent. So in terms of the statistics, what I would tell you is, and what I tell my patients, is if there is a good chance they're going to retry to return to rotational activities, and they're somewhere between the ages of 20 and 50, then my recommendation is unless they're absolutely against surgery, they probably fix it.

Because if you don't fix your ACL and you return to rotational activities and you need it, what you end up doing is risking further injury to your knee, and that is mainly the meniscus. We know that if you tear your meniscus, your risk of arthritis down the road is much higher than if you didn’t, and we're not talking about the ACL, we're talking about the meniscus.

Dr. Miller: So for the patient who rips that ACL, now you've repaired it, what is the time to return to activities? Is it a month, is it two months, is it six months, is it a year?

Dr. Maak: Sure.

Dr. Miller: I mean, some time ago, I believe, it was like a year before you can get back on the field. Things have changed since then.

Dr. Maak: Well, to some degree. So the devil's in the details, actually. And I think what you mean by return to activity, it can vary depending on the person. So you can walk within two to three weeks. If that's, if your activity is walking your dog around the block, number one, you probably shouldn't get your ACL fixed if that's all you want to do, but number two, you can definitely do that. If you're talking about rotational activities like basketball, football, baseball, high-level tennis, anything of that nature, you're looking about six to nine months.

Dr. Miller: Now, let's say that this individual has heard that pop, they had swelling in the knee, where do they go first to have that evaluated? Should they come and see an orthopedic surgeon? Should they go to a sports physician? Should they just end up going to their family practitioner? What do you recommend?

Dr. Maak: I would say all three of those, yes. The truth of the matter is, at this point, the vast majority of individuals, number one, should have a family practitioner as a doctor. So if you don't have a doctor, my plug here is please go get one. That being said, if someone you are familiar with, go ahead and get evaluated. I would say just about everyone is comfortable diagnosing an ACL.

Dr. Miller: To summarize, then, if you have that pop, and you have swelling, you might have pulled, ripped out that ACL, a chance of that. Secondly, if you're about 18 years old or under, you recommend that that be repaired surgically. If you're older, it might depend. You said a third of the people that have complete ACL tears may not actually need that ACL and time will tell. And it also depends on the type of activity that they're going to engage in as well. And then, finally, once you have the surgery, it depends on what you plan to do with that knee again in terms of how quickly you'll get back into that activity. Would that be fair?

Dr. Maak: That is fair. And the other thing I would say is one of the hardest things about tearing your ACL is the idea that you'll never return to what you wanted to do the way you were before. And I can, fortunately, say that there's very good evidence, that in fact, you will be able to do that. And the idea and the reason that I do the job that I do is to get people back doing all of the high-level activities at the level they were training in before as quickly as we can. So your life is not over, your career is not over, you will be fine.

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Interviewer: Olympians are some of the strongest, fastest, hardest-working athletes in the world, pushing their bodies to the limit. But what's it like for a doctor who takes care of them? That's coming up next, on The Scope.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: I'm here with Dr. Willick, and he is a sports medicine physician at the U. He's worked with the international Olympic and Paralympic medical communities and has worked with some athletes himself. When you're working with an athlete, what kind of considerations do you have to take in when compared to, you know, just someone that hurt their leg when they're hiking, or something like that?

Dr. Willick: One special consideration with any athlete who might get tested for doping is that we have to make absolutely, 100% certain we don't make any mistakes when prescribing medications. So for every single medication that we prescribe with an athlete, we always check, double check, and triple check whether or not it is on the prohibited list to make sure the athlete doesn't inadvertently get into trouble. It turns out that a lot of anti-doping violations are actually mistakes made by healthcare providers unknowingly prescribing a prohibited substance to an athlete when they shouldn't.

Another important consideration when you're taking care of elite athletes is, what is their training and competition and travel schedules. We often have Olympic and Paralympic athletes come to clinic who may only be in town for three days. They may be in between one World Cup event and the world championships, for example. Sometimes you have to prearrange things to get a lot done in a short period of time. You have to know when their next major competition is, because that's going to affect your workup and your rehabilitation protocols. For a recreational athlete, for example a hiker, we often have more time for the workup and rehabilitation.

Interviewer: So, with these extraordinarily driven athletes and things like that, what is it like when, you know, maybe they're injured, or, do you ever come up to a situation where they want to compete, and they're going to compete, and it's against what you want, what's best for them? You're saying, "Hey, I'm your doctor, no, you shouldn't be doing this"? Do you ever run into those types of things, or, how do you deal with those?

Dr. Willick: The short answer to your question is yes, of course. We run into that with recreational athletes as well as the world's best athletes. People want to do their sport, they want to continue being active, they want to compete. Every case is taken individually. There are times when it might be okay for an athlete to compete with a particular injury, knowing that maybe it'll give them a setback, but if they have one chance to compete in the Olympics, sometimes they just have to go for it.

And that's very different than if you have one chance to compete in the next 5K that's being run in town, knowing that there's going to be another 5K a week later and another 5K a week after that or a month after that. But often, there's only one opportunity to actually compete in the Olympic or Paralympic Games and the fact of the matter is, that can be reflected in the medical decision-making. However, if it is truly unsafe or unwise for the athlete to compete, we absolutely have that discussion with the athlete, along with their coach, sometimes with their family and other members of the team.

Interviewer: So coming up, we have all these people sitting down, watching the athletes, right, and cheering for their country, their favorite athletes, watching their favorite sports and stuff like that. What is something you would want the viewers, our American listeners who are sitting and supporting their country, to know about these athletes? What is something that they should appreciate and know about these athletes?

Dr. Willick: The viewer should appreciate the thousands of hours of hard work the athletes have put in to be on TV at the Olympic or Paralympic Games for a few seconds, or a few minutes, or maybe an hour. Thousands of hours of strength training, and flexibility training, and motor skills training, and meeting with a sports nutritionist, trying to regulate their sleep, meeting with a sports psychologist, and the dozens or hundreds of support staff behind every athlete. From all the specialists, to the coaches, to the coaches they had in their earlier days, and yes, even the medical staff supporting that athlete.

Interviewer: So you'll be watching?

Dr. Willick: I will be watching, yes.

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Dr. Miller: Your coach tells you you have a groin pull. Is that really what it is? We're going to talk about that next on Scope Radio.

I'm Dr. Tom Miller and I'm here with Dr. Travis Maak, an orthopedic surgeon here at the University of Utah and he's in the Department of Orthopedics. Travis specializes in sports medicine. Travis, talk a little bit about that whole issue around groin pain. Is there such a thing as a pulled groin muscle or is that something else?

Dr. Maak: It could be and many athletes are very used to this type of injury and being told by their trainer or their coach that you bent down or you were running and just kind of exploded off the blocks if you're a running athlete. And all of a sudden, you have pain in your groin and you're told you pulled your groin and you need to take a little bit of time off, stretch it, out walk it off, take some anti-inflammatories like Aleve, ibuprofen, Advil and when the pain goes away, you get back doing what you were doing.

Yes, there are muscles, to your point, that you can literally pull in your groin. Those are called the adductor muscles. They are on the inside of your hip. Frankly, multiple groin pulls are not common.

Dr. Miller: They're not common?

Dr. Maak: They're not common.

Dr. Miller: Contrary to what everybody hears.

Dr. Maak: That is true.

Dr. Miller: We always talk about a groin pull. For the audience, I think that a groin pull is pain on the inside of your upper leg towards the pelvis, right?

Dr. Maak: That is correct.

Dr. Miller: If it's not a pulled muscle, then what is it?

Dr. Maak: Well, a person who's prone to groin pulls and has a history of playing sports from their childhood and being told they pulled their groin, they pulled their groin, they pulled their groin and it never seems to get . . . it will go away temporarily, but then it comes back. One of the other diagnoses, which can cause this, is something called femoral acetabular impingement or FAI.

Dr. Miller: That's a big word. What does it mean? What does that look like?

Dr. Maak: So the femur, that's the thigh bone

Dr. Miller: That's the big bone in the thigh?

Dr. Maak: That's the big hole in the thigh. Acetabulum, that's the socket or the ball and the socket of the joint. So the ball is the femur, the socket is the acetabulum. Just the two bones of the hip joint. And then impingement is a fancy word for the two bones hit together.

Dr. Miller: They rub?

Dr. Maak: They rub.

Dr. Miller: When they rub, they cause pain.

Dr. Maak: That's exactly right.

Dr. Miller: Are certain people predisposed to this problem?

Dr. Maak: They are. It tends to be a Northern European type of injury or at least the way the bones are shaped. Although it can happen in any type of ethnicity or group of population. Interestingly, we also have some evidence that specific sports put people at risk for this.

Dr. Miller: Do tell, which ones?

Dr. Maak: Lacrosse tends to be a fairly high incidence of sport, football, hockey.

Dr. Miller: Now, why lacrosse as opposed to basketball or soccer?

Dr. Maak: Interesting question. We believe it has to do with the rotation with the stick. Part of this, there's a current theory that this has to do with the growth plate of the hip and small growth plate injuries that occur over time can make your hip shaped a little differently.

Dr. Miller: So if this happens, you have this pain, this discomfort. How is one reliably to separate this out from actually a pulled muscle or tendon versus you know this is a problem with the hip joint.

Dr. Maak: Sure. So the history is actually fairly classic here. So while the initial acute stabbing pain of a pulled groin can happen quickly, particularly when you're exploding off the blocks or you twister you get tackled, and then it goes away within a few days and basically you return to normal. With FAI, there's typically a subtle, continued discomfort, particularly when you sit for long periods of time. If you find yourself going to the weight gym and your coach says, get down, get deep and squat this weight and every time you find yourself not going . . .

Dr. Miller: Get discomfort.

Dr. Maak: Right.

Dr. Miller: What do you do then? What are the treatments?

Dr. Maak: Well, the first treatment is physical therapy so athletic trainers are very good at this. Many physical therapists are as well. As long as you have the diagnosis, going and learning how to lift a little bit differently, avoiding deep squatting exercises and strengthening the muscles around the hip as well as a little an-inflammatory, like Aleve, ibuprofen, Advil can help you. When those fail, sometimes other interventions can help you.

Dr. Miller: How often is this a game changer for the young athlete?

Dr. Maak: So I can tell you is if this ultimately gets diagnosed in the athlete finds himself limiting their athletic participation because they're groin hurts when it's treated, the beautiful thing, while no one wants to get surgery, if it ends up getting surgery . . . and the surgery is basically to make the ball of the hip round again, it's done with a camera. It's minimally invasive and three little, tiny poke holes. And you go in and basically reshape the ball to make it round again. It's curative, it does not return and effectively, they return to their sports at a higher level without pain.

Dr. Miller: One of the things you started out with is the potential to have this problem misdiagnosed. So what would be your recommendation be to an athlete that has groin pain?

Dr. Maak: The first thing is probably to not worry about it initially. If it's a first time you're told by your trainer that you have a groin pull, odds are you probably did. That being said, if it continues to happen and you have a one or two or three or even four groin pulls that keep happening, my recommendation would be to go get an X-ray of your hip. It's nothing fancier than a simple X-ray of your hip and you can diagnose this problem.

Dr. Miller: They could very well do that through their primary care physician?

Dr. Maak: Absolutely.

Dr. Miller: So, in summary, this groin pain may not actually be a groin pain, it could be an impingement in the actual hip joint itself and that that ought to be checked out if you have repetitive groin pains.

Dr. Maak: That's exactly right.

updated: March 9, 2022
originally published: August 9, 2016

Interviewer: Pressure, whether you're an elite athlete or speaking in public, it can be a killer. Tips to deal with it next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: No matter who you are you deal with pressure, and if you deal with pressure a little bit better, your life might be better. We're going to find out some tips from Nicole Detling. She's a sports psychologist and has worked with Olympic athletes, most recently the U.S. ski team's freestyle aerialists in Sochi. She's also a visiting faculty member in the Exercise and Sports Science Psychology program at the University of Utah. Let's talk about pressure for a second.

Nicole Detling: Sure.

Interviewer: What is pressure? Let's get that definition out because I don't think a lot of people think about what exactly that means.

Nicole Detling: Sure. I think we all feel pressure to a degree almost every day of our lives. Probably what would be a better term for most of us out there is stress. I can't think of a single person I've ever met who hasn't experienced stress on a daily basis. But I would say if we think of stress or pressure, it's more of when you feel that your resources do not match the demands that you are under so whether you have this big project that's due at work and you don't feel you have enough time to complete it, something like that would be stress or pressure where you're under a situation that you have to perform and you just don't feel like you're able to do it the way you want it to be done.

Interviewer: So for Olympic athletes for example, the jump or the trick, whatever they're going to try is something that they're not completely confident with.

Nicole Detling: Maybe not, or they just feel that, "Gosh, I've only done this a couple of times. I'm confident that I can compete it when I don't have all these cameras on me and all these expectations, but gosh, I'm in this situation and all these other things are happening." The pressure can be increased.

Interviewer: So it's a lot like if I'm relaxed and just talking to somebody I'm passionate about, the words flow so easily and my thoughts come out so coherently, but when it's in front of a room of 500 people, all of a sudden I'm a different person. That's pressure.

Nicole Detling: That's pressure, and typically the situation's the same, right? You could give that speech, and you can nail it when no one's watching. It's the exact same speech when there's 500 people there so the difference between those two situations is how your mind perceives that situation. That's where pressure comes from. It's typically something that we create in our minds in response to a situation.

Interviewer: Alright, so now let's talk about this in real terms. So whether I'm an Olympic athlete or giving that presentation, are my strategies going to be the same?

Nicole Detling: You're strategies will be very similar. Yes, absolutely. The things that I teach Olympic athletes are the exact same things that anybody out there can use when they're dealing with stress and pressure.

Interviewer: Cool, OK, well give me so tips how I can nail that presentation that I know I can do anyway.

Nicole Detling: Sure, well I will say the Number 1 source of confidence is preparation so if you're giving that speech, it's probably best that you practice that speech many, many times prior to going into that situation. Practice it by yourself. Practice it in front of friends and family, friendly audiences so to speak, and maybe increase the number of people you're practicing it to each time you practice it so you get a little bit more comfortable. If you step on that stage and you feel like you have put the time in and you are ready, you're more likely to not feel as much pressure in that situation and be able to really nail that performance.

Interviewer: How important is it that I do it in front of other people? Because I feel funny doing that, right?

Nicole Detling: Sure, you do, but you're going to feel funny in front of 500 people if you don't practice.

Interviewer: OK, so you've really... That's an important step is what you're telling me.

Nicole Detling: Sure, it's an important step, absolutely, and it may not be for everyone, not everyone needs to do that, but that would be a good idea for someone who does feel a lot of pressure if they are speaking in front of 500 people.

Interviewer: Do your due diligence that way. What else could I do? What other things could I employ?

Nicole Detling: There's a lot of different exercises that I'll teach an athlete in terms of the thought processes that they have going on in their head. So something athletes hear me say all the time is, "I don't care who you are or what sport you do, how good you are if you look for reasons to fail, you will find them." So in that situation you can look for, "Oh my gosh, what are these people going to think about me. Are they going to know more than I do? What if I sound like an idiot?" Yeah, sure you can find those reasons, but on the other hand, if you look for reasons to succeed, you will find those reasons as well. So in that situation, the speech situation, you can also think, "I have put my time in. I know my material. They asked me to give this speech because I have something to offer. They believe I have something to offer." And so thinking about it in terms of just reframing the thoughts in your mind from looking for reasons to fail to looking for reasons to success, that's one strategy.

Interviewer: OK.

Nicole Detling: Another strategy would be using deep breathing techniques, anything that will help deal with the butterflies in your stomach and just kind of calming your body down. Something I say a lot to is, "You have to control yourself first before you have a chance to control your performance." And for many people, that pressure is going to cause anxiety. So the anxiety feelings may be you have to pee 20 times before you perform, sweaty palms, butterflies in your stomach, things like that, and when you feel uncomfortable, you might feel out of control. Imagine how good you would feel if your body felt comfortable and you felt in control of your performance. What would that do for your confidence?

Interviewer: Yeah.

Nicole Detling: So if you do deep breathing techniques or some kind of a meditation prior to going out in that situation, you get your body under control, it's easier to get your mind under control.

Interviewer: So when I was watching the Olympics, I noticed a lot of the athletes listen to music beforehand. Is that their way of taking their mind out of the moment, relaxing themselves?

Nicole Detling: Yeah, and that's actually another strategy is to use distraction, use a deliberate type of distraction, and music can be a great deliberate distraction. So if you have a particular kind of music that you listen to that just helps you feel calm and relaxed and comfortable then absolutely, listening to that music prior to going onstage and performing could be really beneficial for you to get your body under control and then it's easier, as I said before, to get your mind under control.

Interviewer: That seems counter-intuitive that I would want to distract myself from what I was about to do. I would think I'd want to really think about it and make sure I've got my steps down but not so helpful.

Nicole Detling: Well, you know, it depends on the person. Everybody's different so for some people, absolutely not, that would not be helpful at all. For other people, it would be incredibly helpful so part of this whole process is knowing what works for you, and one way to find that is you can find any performance in your life, and sport is one performance, but we perform all day long, every day in everything that we're doing. We perform at our jobs. We perform driving to and from our jobs, some of us better than others. We perform as parents. We perform as spouses. We perform in every aspect of life so think back to a time when you feel that you were performing exceptionally well regardless of what that performance was.

Interviewer: Like that great parenting moment where you really felt you explained something to your children, and they got it, and...

Nicole Detling: Exactly, it clicked. It worked. You got the result you were looking for, and then rewind the tape just a little bit further and say, "Where was my mindset before that? What was I doing? Was I really thinking about what I was going to say and what I wanted to happen? Or was I in the car listening to the radio, and I got home and it clicked?" Right? So what are some of those scenarios where you've had performance in the past, and if you look at many of those scenarios, you'll be able to find trends, and what you did prior to a good performance, that will help you determine some ideas going forward for what may help you in those situations deal with that pressure and stress.

Interviewer: Alright, I'm sure we could talk about this for hours.

Nicole Detling: Easily.

Interviewer: We've got to wrap it up though. Is there a final thought that you have for our audience when it comes to this topic?

Nicole Detling: Probably, knowing yourself. Finding what you need and then finding the tools that are necessary in order for you to really get what you need out of each experience so that you can perform your best every single time you perform.

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