The Physical Therapist’s Role in High-Level Cross-Country Ski Competition and Training (hint: it’s not just PT!)

I am thrilled to introduce a new series of guest posts from Runners’ Edge Alaska, a full-service sports physical therapy business in Anchorage. This is, to be clear, sponsored content; Runners’ Edge will be writing the posts, which I will edit for house style and little else, and has paid me for this exposure. I deeply appreciate their support of this site.

But this is also really good and helpful content, from a business that I think the world of. Runners’ Edge Alaska has put me back together and helped me stay active as I pursue my Masters athlete dreams. Runners’ Edge has helped my septuagenarian mother maintain bone health and overall strength and mobility as she moves into her 70s, let alone still be out skiing with her granddaughters (and/or son). When my mother and I skied the Tour of Anchorage 25km classic together last Sunday, we both owed our ability to participate in the “race” to the folks at Runners’ Edge.

Runners’ Edge has worked with probably any Alaska-based cross-country skier you can think of, and, due to their frequent presence on the World Cup as a team PT, most of the non-Alaskans as well. You know that famous team photo from Pyeongchang in 2018 with Kikkan and Jessie celebrating their gold medal (above)? Runners’ Edge is in that. The 2022 version from Beijing with Jessie celebrating silver, plus a lot of folks in N95s (below)? Runners’ Edge is there, too, this time holding a plush Bing Dwen Dwen giant panda mascot draped in a garland of faux gold laurel leaves. The U.S. Ski Team can get effectively anyone they want to serve as a PT at global championships; they want Runners’ Edge there.

So you should listen to them when they talk about strength, mobility, nutrition, or other topics of interest to cross-country skiers of all ages. Stay tuned. And check them out if you are broken — or, especially, if you would like help with the prehab that will keep you from becoming broken in the first place. If you would be interested in seasonal upcoming posts on, say, foot care for nordic skiers or how to ease the transition from skiing to running, then don’t touch that dial. In the interim, you can also follow them on Instagram for tips, tricks, balance and strengthening drills, and more.

— Gavin Kentch

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The Physical Therapist’s Role in High-Level Cross-Country Ski Competition and Training (hint: it is not just physical therapy!)

By Zuzana Rogers, PT, ScD, SCS, COMT

IOC Diploma in Sports Physical Therapy

Physiotherapist for the U.S. National Cross Country Ski Team

As a private practice clinician working with high-level cross-country ski athletes, I receive an interesting number of questions regarding “what does a physical therapist do during training and competition?” Many people are surprised to learn that my role is not just managing injuries or doing massage. It is so, so much more than that!

I have been working with the U.S. Cross Country National Ski Team since 2013. It has always been voluntary work; I call it my “hobby job.” Maybe that is why it’s so rewarding and I am motivated to put 100% into it. I have been involved in many high-level competitions such as the Winter Olympics in PyeongChang in 2018, Beijing in 2022, five World Championships, and numerous World Cup races and domestic competition. As different as those events are, they also share some similarities.

Let me share my experiences as a physical therapist — and how my role varies — during training and race days.

Training day:

Athletes try to match their training schedules to competition times. Competitions can start early in the morning or late in the afternoon — we have some competitions starting at 7 p.m. under artificial lights! So I adjust my schedule to work with athletes’ training times.

The athletes that are dealing with an injury or a tweak start with a quick check-in and treatment, possibly taping, to allow them to train optimally. Communication with coaches is very important; if a lingering injury requires training adjustments, training objectives still need to be fulfilled. We work together to keep athletes progressing to peak on time and to prevent detraining. This is especially important in endurance sports.

I usually join our athletes during on-snow training and/or gym sessions, and I am available to answer any questions or help the coaches adjust the session to match athlete needs. One of the most rewarding elements of these sessions is putting my movement assessment skills into practice. It’s incredibly rewarding to use knowledge of movement biomechanics to help coaches and athletes perfect ski technique. Yes, the role of a PT is also performance enhancement!!

After training, I check in with the athletes and provide physical therapy and recovery massage/bodywork to get them ready for the next day. The athletes are then able to absorb more training load and to train optimally and with good recovery. Overall, I spend 8-10 hours doing the combination of PT, massage, and training session coverage each day. Repeat the next day.

Again, communication with the coaches, the team doctor, and — of course — our athletes is the key!

Competition day:

Athletes start to arrive at competition venues several hours before each event. Their prep routines involve ski testing with coaches and techs, as well as extensive warm-ups. If anyone is dealing with a tweak or an injury, I will address it pre-race at the venue or sometimes even before we leave the hotel. Otherwise, I stay in the background unless needed until close to the start.

My duties usually involve start and/ or finish oversight; getting athletes ready for the start including clothes, bibs, keeping track of time and their starting position, making sure they have everything, and occasionally cutting the sleeves off their race suits and soaking them in water if the race day gets too hot (yes, winter athletes tend to overheat when the weather is above 30° F and sunny).

We also manage feeds, giving course reports to the coaches, and cheering our lungs out. 

During sprint days (these involve qualifications and repeated heats), I set my massage table up somewhere close the finish or in the athletes’ area for recovery massage/bodywork for the athletes that advance in the competition. Get this… an athlete that ultimately advances to a sprint final must complete four all-out legs, each approximately two to three minutes long. They are most definitely spent afterwards.

When we podium (yay!), my job is to take care of the athletes and their belongings. I make sure they are fed, hydrated, and have dry clothes. There is always a lot of “action” for the athletes — anti-doping control, interviews, and similar activities.

This is also when I check in with all our athletes, prepping for the PT/recovery bodywork that will be needed when we get back at the hotel. Massage and bodywork during the competition also involves calming the nervous system so the athletes can get restful sleep at night. During high-level competition, we often have a massage therapist on staff as well. This is a lifesaver for me, especially when we have larger teams with different or staggered competition times. 

Being a physical therapist and traveling with the U.S. Cross Country Ski Team has been an incredibly rewarding experience. I get to share my knowledge and experience as a PT, and I have been able to contribute to the recently growing success of American skiing. It also keeps me eager to learn and perfect my craft. Very little in sports medicine is black or white, and new knowledge is constantly emerging. There is so much that we still don’t know. So we as sports physical therapists have to keep our minds open and always learn. 

Finally, I’ll leave you with the most important points of all: The athletes always come first, and communication between the athletes, coaches, and medical staff is paramount. Even in an individual sport, it really does take a village to succeed!