The Tour de France is intense. The pinnacle of many pro cyclists’ careers, let alone seasons, the race attracts the world’s attention unlike any other event in the WorldTour calendar. This pressure isn’t solely felt amongst the riders, though. Behind each eight-strong team lies a group of support staff whose job is to make sure they’re able to get to Paris in one piece, while also juggling sponsors, media and fans.
“We've got staff members who don't like it – it's too high-strung. But I kind of like it,” says EF Education-EasyPost’s director of medicine and sports science, Dr Kevin Sprouse. “I'm board-certified and practice both emergency and sports medicine, so compared to my time in the ER, the Tour de France seems pretty benign in terms of stress load.”
He has “between 15-20” Grand Tours and nine Tours de France under his belt during his 12 years with the team, proving it’s clearly a situation he thrives in. But aside from the obvious (responding to a crash), what does a team race doctor actually fill their days with? From assessing rider’s metrics before the racing has even got underway to being on hand at all hours if they have any niggles or queries, Dr Sprouse shares the average Tour de France for a team doctor…
EF Education-EasyPost have two team doctors during a Grand Tour; each will do a two-week stint, swapping positions and trading notes on the first rest day. In addition to the first nine stages of racing, the first block includes the week before the first stage is even underway and is used by the doctors to assess the health of the riders.
“There's a lot of catching up with the riders on how they're doing – How do they feel? Are they fresh? Are they tired? We'll then use metrics from the laboratory, [wearable fitness tracker] Whoop, and training files to get a combination of subjective and objective assessments that we can compare. We want to see that there's concordance between the two – they say they're fresh, they look fresh, the metrics are there. If they're diametrically opposed, then we have to step back.”
“I don't think there's often a conscious decision to hide an illness but typically there's a bit of a pressure to say, ‘I feel great, I'm riding great’, and what happens is they downplay.” Riders would occasionally turn up with head colds or sniffles, but “in the Covid world, people take that a bit more seriously so we haven't seen as much of that in the last two years.”
Red flags for Dr Sprouse include less than ideal blood test results (“levels of testosterone, cortisol, haemoglobin, hematocrit, vitamin D, iron”) and retrospective trends such as heart rate variability, resting heart rate, and sleep. “We want to make sure that all those things are in a good place before the race. You don't want to start in a hole because it's hard to dig out of.”
Ultimately, the decision of whether a rider will start the Tour is taken by the team’s head director, Charlie Wegelius, but “he’s very good at seeking input from everyone involved”.
Life on the road
While the Tour coverage only lasts for between four-to-five hours a day, the shift of the team doctor often extends beyond three times that.
After waking at 6am, Dr Sprouse makes a coffee, reads and goes for a run “so that I can have a little time to myself”. From 7:30am, he’s on hand in case anti-doping testers arrive at the hotel unannounced: “Having done it for years, you know that's when they're coming so they can get the cortisol levels at a certain time. I want to be there because that's one of my roles is to chaperone the rider through that process, even though they're perfectly comfortable doing it.”
Assuming there’s no random control, he’ll have breakfast with the other staff and linger as the riders come down so he can check in with how they’re feeling. He’ll collect urine samples from outside their rooms to check hydration status to see if they need to drink a little extra. He also goes through each rider’s Whoop dashboard to make sure they’re getting enough sleep and not “staying up too late watching Netflix or calling friends on WhatsApp” before gathering up his bags and medical kit.
Dr Sprouse carries two medical bags – a big case on the bus and a smaller one in the car – and is prepared for anything that can come up. “In [my small bag], I’ve got a little bit of everything – electrolytes, an inhaler for any rider that has asthma, medication in case somebody’s got a sour stomach, paracetamol, stuff to clean and bandage a wound, even stuff to do stitches and staples.”
For the vast majority of stages, he’ll be in one of the two team cars, and will occasionally be dropped off to do the first bottle feed “for utilisation of staff”. “I actually kind of like it. You're sometimes in a mountainous scene. It's a nice place to eat a sandwich, wait for the riders, and hop back in the car through to the finish.”If there are no incidents on the road or doping control at the finish line, he’ll get back on the bus at the end of the stage and do a quick check on the riders as they transfer to that night’s hotel. Most of the niggles are “probably the same thing that any recreational rider has experienced when they ramp up their training volume”, such as neck, lower back, and knee pain. “I would wager there's not a single rider who goes through a Grand Tour who doesn't struggle with a couple of days with one of those. It’s just a little bit of inflammation that flares for a day or two and then it's good again.”
After dinner, it’s a case of making the rounds – ”stopping by rider’s rooms and seeing if any concerns came up during the day” – before bedding down himself between 10-11pm. “My family is usually back home in the US, so that's the time I get back and do face time with kids and talk to my wife.”
Even if there isn’t a serious incident that requires a hospital visit, his days are long and require him to always be on call. While he’s not riding 160km-plus stages day after day, there’s still a build-up of fatigue that could affect his performance. How does he cope?
“I've been very big on the idea that, as staff, we have to take care of ourselves to be able to give our best to the riders and the job that we have to do. You now see more of the staff taking personal time during the day. If we're in a beautiful mountain town, I may go for a hike or sit by a river. Sometimes we're in an industrial park on the outskirts of some industrial city, so then I maybe go for a run or sit and read a book. It sounds very zen but it's just getting outside and being away for a minute and it's really worthwhile.”
When there is a crash in the peloton, riders will often brush themselves down and continue, albeit with the loss of some lycra and the addition of some road rash. But on more serious falls, Dr Sprouse will be on hand to provide medical attention.
“If it occurs in the peloton, and we're right behind them [in a team car] then [we’ll be at the scene in] 30 seconds or a minute depending on our location. I'll quickly assess them and figure out if they're good to get back on the bike – frequently they are.”
The initial distinction he makes on the road is “is this injury dangerous?”. “A lot of injuries are just painful and if they want to ride through it. We'll support them with appropriate pain medications – some paracetamol, some Advil [ibuprofen] – and tape it appropriately and do everything we can to keep them in the game.”
He believes that road cyclists inherently “have probably the highest suffer threshold of any sport”. He points to Lawson Craddock’s 2018 ride as a case in point. “On the first day, he crashed pretty badly, fractured his [shoulder blade], and rode the entire Tour. It was a good injury – he was pretty beat up.”
But what if he determines that the injury is dangerous? “There’s no discussion – that’s it, they’re out”. Concussion is a common example but “can be a bit of a hard sell” because it’s not that visible, while other, smaller injuries that affect bike handling can spell the end of a rider’s Tour. “There may be an injury to a hand that’s not that impressive, but we determine that the rider couldn’t break if he needed to, so we’re not putting him in the peloton with everyone else.”
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