If you google "cycling doctor" you are met with a wall of doping allegations, and shady behaviour. But the modern generation of doctors are looking to shake those connections. Ineos' Dirk Tenner was a successful track and field athlete before shifting his focus to medicine. A specialist in orthopaedics he is the first man the riders see when they break a bone.

This conversation sees Bobby and Jens pressing him on everything from the best way to fix a collarbone to carbon monoxide's use in the peloton and learn why you should never drive a friend to hospital with a concussion.

This podcast is available in audio form wherever you get your podcasts and ad free on the Odd Tandem Patreon page.

Follow us on social media just search for @OddTandem on Twitter, Facebook, TikTok and Instagram.

Hello everyone, and welcome

to another episode of The Odd Tandem.

2

You know, we've been doing this a while

and we've had riders, sponsors, mechanics.

3

We even had a cook once.

4

We've never had a team

doctor on the podcast.

5

So we sat down with Dirk

Tanner of Ineos Grenadiers today,

6

and he gave us quite a few little tidbits

of information

7

that I think the viewers and the listeners

are really going to enjoy.

8

Jensie, you’ve actually known Dirk

for a while because he's German.

9

Tell us a little bit more about him.

10

Well, he's,

first of all, is a huge cycling fan

11

and really impressive, is also that

12

in the tour of Poland,

during the horrible crash

13

of Fabio Jakobsen,

he was more or less the first responder.

14

He was the first race team doctor there,

15

basically trying to,

you know, help Fabio to survive

16

and help him to go into hospital

with the helicopter.

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And another impressive thing

he actually mentioned in our podcast

18

is from the 206 bones we have in our body.

19

He operated more than 100 of them.

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How impressive is that?

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Yeah, and the

22

coolest thing is

that he's so passionate about the sport.

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I don't think you could having

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a job like that on the road

150 days a year or whatever.

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So sit back and relax

and listen to our great conversation

26

with Dirk Tenner from Ineos Grenadiers.

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Welcome to the odd Tandem.

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Hey guys. Thank you for the invitation.

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And I'm very proud to be,

on this one tonight.

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Yeah, this is going to be neat

because we've never had a team

31

doctor, especially at the World

tour level on the podcast.

32

So this is going to be fun

and hopefully very educational

33

for our viewers and listeners.

34

And maybe remind Jens

and I about what it used to be like when

35

you just had a doctor

36

on the other end of the phone

the whole time, you never saw a bill.

37

They did all the paperwork.

It was nice and simple, right?

38

But before we get started,

let's talk about your background,

39

your educational background,

and then your perhaps sporting background.

40

Yeah.

41

Well, I,

I started well, my my my first, my

42

my sport background

is I'm originally from track and field.

43

I used to be on the junior national team

for quite a while,

44

and I stopped, being a track, track

and field athlete

45

when I started my, my medical school,

46

yeah, I had some some,

47

some meetings with

48

doctors when I was really young,

with, knee issues.

49

And from this moment

on, for me was like my,

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my, that was my all through my career.

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That was my my, my main sentence.

52

I always wanted to do it

better than they did it on my body.

53

So that was my reason

why I started my medical career.

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So I went through, started in, in Mainz

55

at the university and,

after finishing medical school,

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I did one year at the University of Utah,

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for some sport medical specialisation,

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further ran through, my,

orthopedic residency and now.

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And, now I'm, a doctor for,

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sport trauma and orthopedic surgery.

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So before we really go into more of your

career, let's, ease up a little bit.

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We have four quick fire questions.

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You pick a short answer.

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Let's start easy.

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We know that you have a dog

or you have multiple dogs.

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So what do you choose?

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Walking the dogs or taking a bike? Right.

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walking the dogs.

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after work. Yeah.

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What do you prefer?

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A lazy day with nothing to do at all

or busy day full of work?

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busy day full of work,

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a broken collarbone, surgery or not?

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on a cyclist.

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Always surgery.

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And what is easier to fix?

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A football injury?

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Soccer.

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Football or a cycling injury?

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A cycling injury.

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Awesome. Thank you.

82

So you're coming

from the world of football.

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What attracted you

to the world of cycling?

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Because when you're a team doctor

for a World

85

Tour team, you absolutely have to live

and breathe that sport.

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So what is it about cycling that excites

you the most?

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I think, cycling is

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a really, honest and true sport,

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that the athletes, they,

they are full passion for this sport.

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They, they, they work hard daily and,

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even when they're injured

92

in a race, first

they don't think about giving up.

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They try to complete their,

their race at this stage, all the, or,

94

a whole tour.

95

I was working little,

before I started my career in cycling.

96

I, I worked for for soccer and,

I found out,

97

you know, like, like,

some even professional soccer players,

98

they love to have their time off,

even with small,

99

small injuries, just to,

I would say just to relax a little bit.

100

So then I guess,

101

the next question would be what impresses

you most about the cyclist?

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I guess you or gave

half of that answer right

103

now, but yeah,

what is the difference there?

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First, the difference is,

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just if you if you compare the payment

of, of a soccer player, even a focus,

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especially in Germany,

even especially when they play

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only third like a Germany,

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I would probably say that more,

they they'd still,

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get a higher payment than most of, well,

to ride us when they start their career.

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and if you come in as,

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as, neo pro,

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you you

you literally have to rip off your ass to,

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to, to stay in this team, to work

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hard as hell, to, go out for training.

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Doesn't matter

what kind of weather outside is.

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and you do have to do this daily,

and you travel a lot.

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You are away from home like

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150 days per year.

119

And at the end,

your outcome is still first years,

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like, okay, I just,

I'm just in balance, on my bank.

121

and, I really love passion

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for sports, and, that's the most thing.

123

What really impresses

me on, on, on bike riders.

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Yeah, you're absolutely right.

125

I really now that I'm out of the sport,

I realize how tough cyclists are,

126

you know, especially watching,

you know, a footballer get kicked in the

127

in the shin guards and roll around

like he just broke his leg in ten pieces.

128

And then you see a rider crash

in a very high speed

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and just, you know, gets up

and gets on with it, right?

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No crying, no rolling around.

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No, no drama.

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They just get back on the bike.

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If you if you know,

if you know what I mean.

134

Yeah. I mean they go

they jump on the bike.

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they, they,

they even don't, check their body.

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The first thing they check is

if the it's the bike. All right.

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The first thing

what they what they are shouting for into,

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into the phones is get me the spare bike.

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And then maybe after whatever

five, ten, 15 kms,

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they probably come back

and asking you, hey, doc,

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can I have maybe, a painkiller cause

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my shoulder hurts or my

my knee hurts a little bit, but that's it.

143

But you said that you were on the road,

like 150 days with with the team.

144

how do you balance that

with your clinical practice?

145

I know it's less.

146

I mean, I'm, I'm,

I would say I'm on the road at the moment

147

between 70 and 80 days per, per year.

148

so, I'm in the lucky position

that I'm head of the department.

149

nobody's asking me

how many days I'm really away,

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but I, that probably also shows

my passion.

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I mean, I spent my holidays for,

for covering, races or training camps.

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Honestly, I'd probably have one week.

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Really? Vacation per year? Where?

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I don't go to a race

and just spend time with my family.

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The rest of the year.

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I spent all my free time

for covering, races

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and helping, my riders

or even other riders to, to compete.

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Well, so let's, let's,

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let's get a little bit off of a system

of an order into this.

160

we both go to of Germany tomorrow, right?

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That starts on Wednesday in Germany.

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I with my kinder joy of moving program

and up there as a team doctor.

163

Right.

164

So as I understood,

you had a team doctor call tonight.

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What can you tell us about that?

166

What are the topics?

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How do you prepare the race, how

to prepare your travel?

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You check if for every rider’s healthy

and then once you enter race,

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you check every right

like one by one before the race starts.

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How do we have to imagine this?

171

Okay.

172

We have like, like,

so we this sesaon is really hard.

173

We have like a weekly, meeting

with all our team doctors at Ineos,

174

and just discussing all riders

through, like, especially the,

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the riders were injured

or having, a problem.

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medical side.

177

so tonight we were just discussing

178

in general, but,

what we do, like a week ahead of a race,

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we are, like, creating already

or teams or WhatsApp groups.

180

then calling the riders.

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is everybody okay? any any problem?

182

before the race

where we have to be aware of or,

183

where we have to jump in, asking

if they have,

184

their personal medications

with them at the moment.

185

We also started again with doing,

lateral flow tests before,

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flying in, just because of,

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like, again, increasing,

188

cases of acute respiratory infections.

189

so as we saw at the, for example, at,

190

the Giro, like, like,

quite a lot of, Covid infections.

191

and then when I arrived tomorrow

at the hotel, well, as soon as all

192

riders arrive, I have like,

193

it's, like, personal talk with everybody.

194

Just, usually it's just a small,

talk through.

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I mean, how are you?

How were the last days?

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and that that's normally.

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That's it.

198

because if they arrive, we we were,

199

they should be healthy.

200

And, then we start the preparation

already for the first stage.

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and, what we do,

we have, like, a medical check,

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like, every day,

when we are in the races.

203

so we start the day

before the race with the,

204

daily morning, medical checkup.

205

Okay, so that's during the race.

206

But when we were racing,

we always had a kind of medical checkup

207

during, like,

the first training camp of the year.

208

And, you know,

there's been a lot of riders,

209

suffering from arrhythmia issues.

210

So can you explain to our viewers

and our listeners a little bit about

211

those medical checks, what they're for,

what you're actually looking for?

212

Yeah.

213

I mean, we have we also have,

one medical check even before,

214

any of of the riders

come to the first training camp.

215

So we usually have our, medical, train

or medical camp in, in November.

216

oh. And, for example,

we had our medical camp last year

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in Manchester, where every rider,

is flying in, and we do like,

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a general checkup of each rider,

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which is not that I see a rider.

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It's like a circus. I'm just.

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I'm just an orthopedic trauma surgeon, so,

I'm.

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I cannot,

see any details in an EKG checkup.

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So we have, like,

several disciplines on this day,

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and, the rider has, like, a list way

has to run through.

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So we, we have, like, sports medicine,

orthopedic check.

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we have a dentist.

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We have, a cardiologist.

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we have a radiologist.

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So we are we able to do an MRI?

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or, an X-ray, X-ray scan, what else?

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head. Neck.

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ears. doctor.

233

we do, a DEXA scan

just to measure bone density.

234

We have a, pulmonologist

to check the lung.

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So literally, we go all the disciplines.

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And at the end, if we have any,

237

pathology,

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pathology, we we could do further

checkups.

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So, when the rider leaves from this,

from this,

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medical camp, we,

we are aware of any any,

241

possible problems,

we could have during the season.

242

And we tried to solve some of these,

these problems before the season start,

243

so that for each rider,

244

that takes a whole day.

245

I can imagine it takes a whole day.

246

So when you say you're an auto pair

orthopedic

247

trauma surgeon,

is that the word you used? Yes.

248

to make it easy for our viewers

and listeners.

249

You're you're a doctor.

You're a bone doctor, right?

250

So, yes.

251

What they call

you up, let's say, now in the welter span

252

you had Jhonatan

Narváez crashing yesterday.

253

What did call you up?

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What do you think about it. Yes.

255

And you look at the

256

at the TV, at the video,

how he crashed or they sent you X-rays.

257

How do you give your expertise for,

because you're not there, right? Yes.

258

But maybe no spectators

think that's crazy.

259

But, if I'm in the hospital.

260

Not now.

261

Between two races,

when I'm in the hospital.

262

And, for example,

in, in the surgery theater

263

and most of my surgeries,

I do, arthroscopic,

264

usually after

265

my big screen where a where

see the joint from inside.

266

But I usually have an iPad with,

with, Discovery Plus, for example.

267

And watch having the race live,

next to the screen.

268

So, it's, it's, it's kind of weird.

269

And probably people think, hey,

you should go to or what do you do?

270

So these are my docs.

They're they're always with me.

271

and so, and sometimes many people think

272

that's kind of strange and you should

concentrate on what he's doing.

273

But I know what I'm doing, and it's just,

you know, that that that I'm aware of.

274

If somebody crashes, that I can replay it

and and, call the doctor

275

who is at the race,

or usually they call me after the race

276

and they set me X race, as you said, I'm

the only, bone doctor on this team.

277

so I usually the first one

who's giving, comments on this and

278

giving, ideas about,

further treatments or

279

how and where we have to do what.

280

I had to Google this

because I didn't know.

281

But there are 206 bones in the human body.

282

how many of those bones do

283

you think you've operated on

or how to deal with?

284

Out of those 206?

285

So, I

286

definitely don't do surgeries

on, on on spines.

287

so the spine is out of my,

288

of a lot of my real expertise, but,

289

I mean, to count now how how many bones

290

I do all fancy stuff on extremities.

291

but I'm, I would say

especially with, with,

292

with cyclists, I do most of the stuff

upper extremity and big bones.

293

in our hospital where I work,

we have one, guy who is.

294

He's, he's a genius

in, foot and for foot surgery, so I would

295

I always would forward these surgeries to

to my colleague.

296

The things you really have to know

where you're good and

297

or where you're really good at a

where you just average yet.

298

So, out.

299

And for me,

it's important to get the best outcome.

300

So, if I know somebody who's better

301

in this, I would always forward it

to another one. So.

302

But you'd think you would have

303

operate 100 bones out of the 200

possible bones in a human body.

304

Half and half?

305

Yeah. For sure. Wow.

306

Alrighty

then. Let's go further down this road.

307

What is the biggest metal piece

you ever put into a human body in surgery?

308

Or, I mean, the

309

the intermediary rods used for femur

fractures.

310

That can be really long.

311

So like 36, 38cm long, seven millimeter

312

thick, screws, or even bigger.

313

if you if you do,

if you operate on a femoral neck

314

fracture,

I mean, the the screws are used there.

315

Yeah, I would say bigger as big or,

sometimes bigger than a thumb.

316

I have been

317

retired for quite a while

now, and two months ago,

318

I broke my collarbone

and I had to have an operation.

319

It was the first time ever

that I broke my collarbone.

320

So I never really felt

like a real cyclist.

321

Because, you know, Yancy,

how many times did you break yours?

322

Three. Three.

323

So, Dirk, in your experience with riders,

what is the most times

324

that a single individual

has broken their collarbone?

325

I had an, South African rider

who broke his collarbone.

326

Let me think at least five times,

and I think

327

I did four times surgery on him,

328

and I think was twice

where I first had to,

329

take the plate out

and then put a new one in it.

330

So my, my, my first, surgery.

331

Oh, sorry.

332

My, my first collarbone to bone was,

it's like, broken but still in place.

333

So give me that.

334

what's the German word for this?

335

That it, not like a rucksack.

336

Like I think you would bend it

to put my shoulders back

337

and up to the bone

would be straighten out.

338

That worked really nice,

339

but it took a long time until I actually

could use some power on that shoulder.

340

And that's the problem.

341

Yeah.

342

The other two times

I had surgery, there's obviously a risk.

343

Well, there's tiny, tiny, tiny risk.

344

You just not survive it.

345

I mean, it's almost zero,

but it it it exists.

346

but you can move.

347

You can train three days after. Right?

348

But there's the correct action.

349

So you always have to, balance that out,

don't you?

350

Yeah.

351

But I mean, on a professional cyclist,

there's for me no option because, I mean,

352

if you use just,

the one you describe, like

353

this rucksack, bandage, for sure.

354

You couldn't ride properly for 6

to 8 weeks.

355

I mean, this is like,

the all the really conservative

356

style of, orthopedic trauma

treatment of a collarbone.

357

The for me, the, the the the the

358

the right one

is to have like a rigid, stable,

359

reduction, of this of, of this bone

360

because then, as you said,

you can start training three, four days

361

after the surgery and I had riders,

leading out their, their,

362

their sprint, ten days after the surgery

on a on an important race.

363

Oh, yeah.

364

Yeah.

365

so Jens and I, we have this text thread

with some of our buddies from CSC

366

and two of the guys broke their collarbone

seven times during their career.

367

Christian Van de Velde and Stuart O'Grady.

368

That that blew me away.

369

So, yeah, it's it's pretty crazy.

370

But another question that came up

371

just this weekend, honestly,

I had some friends come down from Toronto

372

and we were out on a little ride and,

373

5 or 6 of us made the turn,

and then we realized that three guys

374

were behind us.

375

So we kind of stopped and whistled like,

hey, we're this way.

376

We're this way.

377

And the guy in the front

slammed on the brakes

378

to try to make the turn,

and the guy in back of them crashed.

379

so road rash, right?

380

Like, can you give some tips

to our viewers and listeners?

381

The best way to deal with with Road

Rash these days is it

382

is it keep it dry or keep it wet?

383

Is it to always have a bandage on it?

384

what is the new way of dealing

with, road rash?

385

Because I think it's always

been debatable.

386

Yeah.

387

I mean, I think there's no really no,

no way to treat it.

388

the road rash.

389

I mean, as soon as it dries up, it's

getting really uncomfortable to cross it.

390

It breaks all the time.

391

It starts getting like,

it's it's painful again.

392

So what I, I mean, for the first days

when it's, like, really,

393

really fresh, I try to, to keep it a close

394

so that we don't risk,

and any superficial infection.

395

But as soon as it dries out, I always,

396

pull, a small layer of just normal

397

classic Vaseline

on the, on the, on the road rash

398

so that it that it stays,

I can call it, moist, Correct.

399

A little bit moist.

400

So then it will it will heal up easily

401

a little bit, peel off day by day,

and it's gone pretty quickly.

402

Okay.

403

Then once you had to crash in a road race,

you come back to your hotel or team bus,

404

whatever. How many times? Bobby. Right.

405

Did we hurt ourselves

by like, with the brush, rubbing it clean?

406

Is that still the way to go?

407

Ask that in less painful way.

408

Because from what I understand,

it is super crucial.

409

Important

to rather suffer for two minutes more,

410

but keep it clean and stop

any infection, right?

411

Is that still the way to go? Correct.

412

We still have these these brushes

and these sponges, with Betadine.

413

And so as soon as the rider comes in,

414

I will, I will pass them,

into the, into the shower.

415

I will pass them one of these brushes,

416

and they, they stop cleaning it,

cleaning it out, and then we dress it.

417

So that's still the way how you do it.

418

I mean, I mean, for sure.

419

I mean, if you crash on the road, you're,

You have to expect that there are, like,

420

all kind of bacterias, inside the wound.

421

There's still some small stones,

maybe some, but whatever.

422

pieces of glass or whatever.

423

So, Yeah, for sure.

424

You you, that's still the way we do it,

but we use, like, sterile

425

sponges to to clean them up.

426

Yeah.

427

Your your dog sound like they're trying

to get your attention right now.

428

No no no. That's okay.

429

That's you maybe be hungry.

They want food.

430

No no no.

431

He's just she's just a little bit bored

probably.

432

And we'll try to play

with, with his friend.

433

but that's okay.

434

Can you tell me a little bit

about the concussion protocol?

435

Because we've, you know,

that's become a big thing

436

that didn't exist, really, when Jens and I

were racing for the most part.

437

But what does a rider have to go

through during that concussion protocol?

438

And are you the one that actually does it?

439

Yeah.

440

I mean, if a rider crashes

and crashes on his head,

441

we do like a an on road

directly assessment.

442

So we, we start asking them,

like like really, really,

443

simple questions

like, hey, what day is it today?

444

well, on which race are we at the moment?

445

Can you tell me

which kilometer are you in?

446

what's what's the time about? And,

447

so that's how we start.

448

So if we, if we see something is is weird.

449

Not really. Right.

450

We take him out of the rate,

out of the race immediately.

451

And to do further assessments in the bus.

452

so, for example, we, from Ineos,

we also do in the medical check.

453

pre-season, we have

it's called a new reflect system.

454

So we would, a rider uses, a Google

and we do some, we,

455

we do some tests

on, on, on eye movement.

456

and so we have this as a baseline and

we have, these, these systems in our bus.

457

And we can immediately can test them

when they come back to the bus.

458

So, so then we, we, we have,

we it's called a set.

459

set six test.

460

So where we go through, we do some,

some, some, tests just to remind numbers

461

and to, to, to give them, to, to to to

tell them again.

462

Tell us again which,

which numbers we have to we just ask them

463

we do balance tests,

all this and, if we're still not

464

100% sure, they all go to,

465

they all go through a CT

scan to exclude an acute,

466

cerebral, bleeding.

467

so I guess you also train your team

member team stuff, was it?

468

Right,

this when you ask to sport directors,

469

everybody who was in a car at a race?

470

yes.

471

Explain a little bit about that.

472

And resulting in the question you have,

473

the the doctor or one of the team

doctor of Team Ineos Grenadiers.

474

Would be a mechanic

allowed to stop Geraint Thomas

475

after a crash from keep racing

or would then Geraint Thomas

476

as a former tour de France winner go

no it's my decision, I keep going.

477

Or can the mechanic see no Geraint

I can see you're not good.

478

You have to stop now.

479

all,

480

team members who are, in,

on race service,

481

they have to go through, a first,

482

first, responder, program.

483

So they all know what they have

to do in a race or, in a training camp,

484

if a rider, is suffering from an injury

485

or suffering from a crash

or from a head injury or whatever.

486

So they basically know

what they have to do.

487

And, I mean, that's not an easy question.

488

What you were asking,

I mean, but I know, but the thing is,

489

we are in the good position that,

490

it's in our policy that in a race,

491

the race doctor has to be in car number

one or number two.

492

So normally the doctor is doing the first

assessment on the race if, for example,

493

whatever, you're in the second car

and stuck behind, wherever, behind.

494

If you do Roubaix -

stuck behind the police, you can't go.

495

You don't come through. And,

496

the, the, the DS or the mechanic is,

497

with, with,

with G, for example, for sure.

498

They would call me immediately

and tell me about symptoms.

499

And I would then, take the decision

to, to take him out of the race.

500

So and he has to follow this.

501

I mean, we had like last year,

we had discussions with a rider at Torino

502

where he was not happy to leave the race,

503

and the final decision was made

by the doctor.

504

And, then we stopped him from from,

further racing.

505

I'm sorry.

506

I'm going to pick your brain here because

back to that ride over the weekend.

507

and then having suffered a minor

508

concussion myself two months ago

when I fell off my gravel bike.

509

what are the symptoms

that we can look for?

510

What should we educate ourselves on?

511

That we can help either.

512

Actually, if you're concussed, you

probably can't help yourself.

513

But if you're one of your friends

or teammates you're riding with,

514

what are some of the things

that our viewers and listeners can learn

515

about the concussion protocol

and what to look out for?

516

I mean, probably the first thing, is to

517

I mean, the first thing is if you

518

if you see your friend, crashing,

519

do a quick assessment before you take off,

for example, a helmet.

520

Helmet. So, is he awake? Can you breathe?

521

How is the circulation?

522

So this is something what you easily

can do into the first seconds.

523

So is he awake.

524

Can you breathe?

525

And, check his pulse.

526

That's the.

527

These are the first three things

you always should do.

528

this is helmet broken.

529

The next thing, is he,

complaining about, So, neck pain.

530

So then, for short, don't move him.

531

Call directly.

532

an, an ambulance.

533

But, so then start asking questions.

534

Where are you?

535

where are you?

536

who's riding with you?

537

What time is it into an hour. About,

538

where do you live?

539

What is your name?

What is your date of birth?

540

So these are easy questions

you can go through into,

541

like the first 2 or 3 minutes.

542

further, I mean, concussion

543

symptoms can be really,

really, widespread.

544

It's so from,

545

just easy

546

having a headache, vision problems.

547

vomiting, nausea.

548

Dizziness. Right.

549

Dizziness. Dizziness. Yeah.

550

So, it's really,

really like like, widespread it.

551

Where are you?

552

but usually these

are the typical symptoms.

553

And if that happens to a friend of yours,

554

then you just tell him or her,

hey, just sit there.

555

I call somebody in a car and we drive.

556

You're not riding.

557

We drive direct to hospital. Right? Okay.

558

I would always probably call an ambulance

559

before driving your mate.

560

with a private car to a hospital.

561

It's, The thing is, it takes.

562

It takes a time to to get a normal car.

563

yeah.

564

There there are no professional,

paramedics around you.

565

So if some if, if your if this person has

566

a brain bleeding, it can turn

567

into a life threatening situation

into minutes.

568

And, for sure, if you call.

569

I mean, in Germany, if you call it,

an ambulance, they usually,

570

they're usually at the, at the accident

inside, inside five minutes.

571

And then, everybody is for sure

572

happy with having professional help.

573

Well, thank you for that because,

574

I learned a few things there.

575

We try to do is pretty much everything

that you mentioned.

576

But we did wind up

577

just calling our friend, and,

he came over and picked him up in the car,

578

but we had pretty much assessed that,

the concussion wasn't a big deal.

579

but you mentioned

you mentioned that the doctor

580

has to be in either

the first or second car.

581

I've driven those cars.

582

I don't like being a passenger in one.

583

How is it free. Are you?

584

I crammed in the back

between a mechanic and his toolbox.

585

Or are you in the front?

586

Nice, nice and comfortable with, like,

a baguette and, can of coke in your hand?

587

Yes, I was sitting in the front, but,

I mean, if you have a

588

if you have a mechanic in your back

who's, one 190 tall, it's not, it's not,

589

a really comfortable position

for, for six hours in the racecar.

590

But I really love sitting in the car.

591

It's, I mean, I hate being in the bus

and waiting for more riders, so,

592

I'm happy that that we have this policy

that, the the,

593

the doctor has to be in the car

and it's always a little,

594

also a little bit for me, like being a

little bit like seconds in the first car.

595

So, I

596

believe that a lot of it

is just waiting and watching.

597

And then you have these absolute

chaotic moments when a crash happens.

598

Right?

599

So, for example, yes, we all have

we have seen the tour de France.

600

You probably have been

in these big, massive pileups.

601

So you come to a crash,

602

you see, hey, crash, in the peloton

or whatever, 15, 20 riders On the ground.

603

So you run how and when

and how do you decide?

604

Who do I help first?

605

My right has the one that screams the most

606

to one where I can see

his leg is obviously broken.

607

How do you decide?

608

20 people in pain on the ground.

609

Who do you help first?

610

honestly,

I help the person who was injured.

611

most.

612

So, and, but that that's

how it should be.

613

I mean, if I come to, to the crash,

see my riders,

614

just have some road crashes

and they're already standing

615

next to the bike and changing

by changing wheel or whatever.

616

But I see another one in the ditch

somewhere not moving at all.

617

Or like, as you said, like,

like a fractured leg or whatever.

618

For sure. I would help them first.

619

I mean, that's,

that's how medical ethics should be.

620

so and the thing is,

621

on WorldTour races,

we have a lot of doctors in the car,

622

so, usually I can

I can take care of my of my riders first.

623

But I had, moments in my, in my,

624

in my cycling career where I definitely,

helped another rider first.

625

Were you

626

actually in the team car during pays

Basque this year, when that awful

627

crash happened and took out

so many of the tour de France favorites?

628

No, I was not there.

629

But as I said at the beginning,

630

I watched it, on my ipad

while I was doing surgery.

631

Okay, so, I guess I know where Bobby's

next question is going to go.

632

How do you think the recovery

of Jonas Vingegaard worked out?

633

Did you think it was possible for him

after the severe injuries?

634

He had to come back and be podium material

for the tour de France?

635

Yeah, I think that's that's the the the,

636

the the the model.

637

the way of, of, medical support,

I mean, it's not that we,

638

we start the, the recovery

639

a week later,

640

we start immediately

after, after an accident.

641

So as soon as we, as soon as we have

an idea of what the society of of the

642

of the accident we know, so that we,

we immediately start, planning.

643

We start where he where he has,

where he can undergo,

644

a surgery properly.

645

And what next steps we have to do,

how we can start, recover, recovery.

646

Who is in charge of where does he do it?

647

I think, this was the for sure,

on the same level.

648

Like we

649

and, nowadays,

I mean, a collarbone is an s s.

650

It's not a big deal.

651

anymore and, broken.

652

ribs.

653

I mean, we, I would say 99.9% in

you don't do a surgery on a broken rib,

654

but, as long as you don't

655

have, a punctured lung, you,

656

you still come back pretty quickly.

657

I mean, probably

658

you guys had, broken ribs

and you started training, even with pain.

659

And it was quite okay, and for sure.

660

Jonas, was not on the same level.

661

Like like like like last year,

what we saw on, on on each stage.

662

But, I mean, he performed super well,

so, Yeah,

663

but the thing is, we are really, really

664

has, I think, as quickly

you have like, a really, really clear

665

plan for, for recovery

as quick as you come back nowadays.

666

I mean, it's

not that only you it's not not only the

667

medical side, it's, it's also nutrition.

668

and,

the conference calls with the coaches

669

and then having, like, a whole set up

where people are like three, 4 or 5

670

different people are involved to, to, to,

to start training as early as possible.

671

Again,

672

I've really

appreciated that sort of support.

673

And I, I've seen it through other teams

where,

674

you know, the rider when he crashes, it's

not only a physical injury,

675

it's a psychological injury.

676

And then like you said,

if all these people put together a plan

677

and make that rider feel fully

supported, like,

678

you know, takes away

the anxiety, the panic a little bit.

679

So, very, very I, I'm

680

sure the riders are very,

thankful of that, but I have a question.

681

You know, during the tour de France,

there was a story it was kind of a brief

682

story about the re breathing carbon

683

monoxide, device to improve performance.

684

And some of the big teams,

actually admitted to using that is.

685

What is the purpose of that?

686

well, we don't use it.

687

so, as I said, I'm, I'm an orthopedic.

688

the thing is, if you if you breathe

689

back, carbon monoxide,

690

you you it's it's awful.

691

I mean, it's poisonous.

692

I mean, you

you you really, destroy your,

693

part of your,

or you destroy your hemoglobin.

694

So you you increase for sure.

695

Then the the,

696

that,

that the, the body tries to, to rebuild,

697

more more blood when you, when you,

when you destroy healthy blood.

698

But, I'm not an expert really on this,

699

so I, I would go no,

700

probably into a little bit of a gray zone

to, to explain.

701

is this the right?

702

Well, for me

personally, I think it's it's not,

703

a healthy way to, to increase,

704

your your your,

your physical, outcome on the race

705

because you, you really going

the way that you,

706

that you, choose, a poison gas,

707

like highly poison gas, to to increase.

708

your, your cyclist function.

709

a little bit an easier question here.

710

You used to work in football,

right, Remco Evenepoel,

711

he was a footballer until,

I believe the age of 18.

712

Primoz Roglic was a ski jumper and,

a young German rider.

713

Florian Lipowitz with team,

Red bull Bora-Hansgrohe

714

he did biathlon, skiing and shooting.

715

Do you think these are absolute

exceptions, or you think we will see

716

more and more people coming across

to cycling from other sports?

717

I mean, that's how it is,

what teams are doing.

718

I mean, we are looking,

not only into junior races

719

and tried to find the,

the new, the new today or the new Jonas,

720

the riders, age of 16 or whatever.

721

So, for sure we're looking more into

other, endurance sports.

722

so, for sure now we're looking into.

723

Well, I think I think football is really,

724

exceptional,

but but looking into whatever running

725

triathlon, I mean, we have

we have Cameron Wirth in our team as a

726

triathlete,

727

but also like, looking into winter sports.

728

ice skating.

729

For me, ice

skating is definitely one of the sports.

730

You have to you have to look in.

731

I mean, you guys in the US ?

732

Eric Heiden is, probably

one of the best speed skaters, ever.

733

And he was

he was really good, pro pro cyclist.

734

Later.

735

and that's, another modern way to find

736

new talents, for for cycling.

737

So when you're home from the races

in your practice,

738

are you actually still paying attention

to the races?

739

Like yesterday

I had the tour de France farm on my TV,

740

and I had the Vuelta

on streaming on my phone,

741

and I was just like, I have nothing to do

with either of those races.

742

But like, as a bike fan, I.

743

I had to watch both of them.

744

Are you are you the same

or are you just too busy with your

745

your practice that you have to

just read it on?

746

the hot sheets? The results?

747

No, no, no.

748

Well, wow.

749

Yeah. I love to follow all kind of sports.

750

when when you see me, at the

751

Olympics, I left to watch, like,

all kind of other sports.

752

So I'm really interested into.

753

I'm really widespread

in what I'm interested.

754

Probably not playing chess. but,

755

but the thing is for sure,

when I see different sports and sometimes,

756

I think I see a talent

757

a lot, sometimes just to ride,

to a performance group to say, hey,

758

this could be could be somebody to,

who's who could be interesting.

759

So, yeah.

760

and that's how it should be.

761

I mean,

762

if you were really following sports,

763

your your eyes should be always wide

open and,

764

try to find, decent talent.

765

And, we we often hear

that at the tour de France, for example.

766

For sure. Maybe other races.

767

Well, the UCI has an x ray truck

at the finish line.

768

Right?

769

So, riders

after crash the fight through the stage.

770

You finish the stage.

771

How often is it actually used in reality?

772

By riders or by teams

to x ray to take the chance to take x rays

773

right at the finish line?

774

Oh, pretty

often, I mean, it's the best thing to do.

775

I mean, it's, it's

776

much easier to get an x ray

just after the race at the x ray truck.

777

instead of going to a hospital

somewhere in the middle of France,

778

where you cannot expect

779

that, you find, a really

780

a surgeon

who is really interested into cycling,

781

and you can end up waiting three,

4 or 5 hours

782

for, for, for, get an x ray.

783

So that really saves us time.

784

And also,

785

recovery for the next day.

786

I mean, if we know. Okay.

787

The riders. Okay. No fracture.

788

we could go back to the hotel.

789

He can go to to his to the physio,

seeing the

790

the one of the carriers

after and being ready for the next day.

791

Instead of sitting like, 4 or 5, six hours

on a wooden

792

chair into,

small hospital in the middle of nowhere.

793

I mean, probably

you guys have had this experience before.

794

Yep. That was that was not fun at all.

795

But, I know you're an orthopedic doctor,

796

but I think I would be a little remiss

797

not to address the elephant in the room

a little bit.

798

You know, in the past,

cycling doctors have had a bad reputation.

799

you know,

you have just recently joined the sport.

800

do you did that concern you at all

801

with having that moniker of,

you know, team doctor?

802

And do you feel any sort of responsibility

to ensure that the sport is viewed

803

differently now than when it was?

804

Absolutely.

805

I mean, you know, I start I started and

806

and cycling with Milran in 2008.

807

So when I came up with the possibility,

joining,

808

a Pro Tour team at this time,

everybody was shaking.

809

their head I had to

I had to sign papers in my hospital.

810

so in kms of I'm

811

involved into any kind of illegal stuff,

I would have, I would have,

812

I would have, to leave my my,

my job immediately.

813

So, Yeah, I mean, the

814

it's still sometimes, you know,

that people, when you go to a party,

815

for example, and,

they, then they, they ask you questions.

816

Hey, your your in cycling,

this sport is not clean.

817

I mean, I always, I what I can tell from,

818

from my perspective is it's the, it's,

it has turned

819

to probably one of the cleanest sports,

at all.

820

because there's no other sport

with so many control.

821

that would alter daily to weekly.

822

I'm sure no

soccer player has so many doping controls.

823

then, top pro cyclist

824

has, in, in one month.

825

so comparing,

a soccer player, in one year,

826

I what about what I always say is,

there's no sport in the world.

827

We can we can earn money,

828

without any cheaters, for sure.

829

So, from my perspective,

I just can say what we do.

830

What I do is 100%, inside the rules,

831

and, Yeah, that's how it is.

832

So, probably

my job is the easier questions here today.

833

If you would have the magic power

and you could change one thing and cycling

834

just like that, maybe on a medical side

or what would you change?

835

What do you think that needs to be?

836

better.

837

Different helmets or whatever.

838

Head, neck protection.

839

you know.

840

All riders where a jersey where, you know,

like, the downhill ski as a jersey,

841

it blows up into a, like a bubble

to protect the riders when they crash.

842

Whatever. Anything like that.

843

Yeah.

844

I mean, I, I start

845

literally I started thinking about that,

a few weeks ago

846

and,

you know, the thing is, I at the moment

847

I see the most crashes on downhills

at the moment.

848

So and from,

I started thinking about that

849

and what I would probably think

I would start thinking about from UCI

850

side would be to restrict the, the,

851

the chainrings,

because nowadays, I mean, we nowadays,

852

we see riders, descending

853

with a 60 or 62, chainring.

854

So when you go down with the, with 60, 60,

11, you can still pedal,

855

at the speed of 80, where with a 54-11,

856

you cannot pedal anymore with 70.

857

So we would definitely restrict

the, the, the,

858

the downhill speeds a little bit.

859

And that probably could

cause less severe injuries.

860

Yeah.

861

just yesterday or two days ago

862

in the tour of Spain time trial,

one of your guys,

863

Josh Tarling, used a 68 front chainring,

a 68 tooth ring.

864

Like.

865

I mean, I had a 54, and then,

866

I used a 56 from time to time,

and that felt big.

867

Now that's just like,

kind of common practice,

868

but that's that's that's.

869

But I see this

I see the, not, individual time trials.

870

I don't see the, too much risk

because you are alone on the road

871

and you can really, really, get, corner

by your own, if there are downhills.

872

and I think the, the size

of the chainrings on TT bikes

873

is more about aerodynamics, but,

even in on road races nowadays,

874

if you go through, through the paddock

before a race, you see, like,

875

I mean 50 fours

probably nowadays small chainring.

876

Yeah.

877

It's 56 and up and or teams using Sram.

878

They got the ten sprocket, the ten.

879

Yeah.

880

So 54-10 that is enormous.

881

Like you said, he can pedal at 80km

an hour to accelerate even further. Yes.

882

And that's my biggest fear.

883

I mean if you if you I mean bus country,

it was a downer where they crashed.

884

It was not and usually the crashes

you see on flat roads, I mean.

885

Yeah. Okay.

886

There are some, some, some,

but bad injuries.

887

But also, I mean,

the speed has increased so much.

888

I mean, nowadays

889

if you see the, the, the timetables

on, on, in the, in the race books,

890

we are normally way faster than the faster

split nowadays.

891

Like it just to the, at the welter stage

because we talked about it

892

just slowest average day

plan was 41 kms an hour.

893

43-45 probably back in our days

it was 38-40

894

and 40-42 was the fastest or whatever,

36-38 or 40.

895

So yeah, you're right.

896

It changed a lot over

the last, let's say ten years or 15 years.

897

I have one last

898

question, because I was always,

a little curious about this,

899

because when there's not a five alarm fire

that you have to put out right

900

when it's all the riders are healthy,

no one crashes.

901

What other responsibilities

do you have at the race?

902

Do you can you just go into your room

903

and watch Netflix

or are you doing other things or,

904

you know, other than fixing,

right, or broken riders?

905

No, I mean, I mean, after the race,

it's still like the same day.

906

It's the days when you guys were riding.

907

Why? We we go through the rooms.

908

Just asking everybody. Is everything okay?

909

but that's that's it.

910

I mean, we cannot do any recovery

like we did a year before, but,

911

you know, we are,

912

I'm part of the team,

so if I, if there's really,

913

really nothing to do for me,

I really like to help out.

914

I like to help the farers

915

or I help them with cleaning the car

or filling up the car.

916

even, I mean, helping a mechanic

917

to whatever to change something

or to clean.

918

It's always fun

for me to learn from others.

919

Okay, my last

920

question would be, every time

when the rider finishes stage a race,

921

do you have a different colored

bottle of drink?

922

What is in that special drink?

923

Carbohydrates. Vitamins? Minerals?

924

What's in them? Protein shakes.

925

I mean, the colors. probably, call spy.

926

but just by the flavor,

I mean, no one likes, strawberry.

927

The next one likes more lemon or whatever

all the other one likes.

928

Just what? just clear.

929

but it's more or less like, it's,

930

everything to recover muscle.

931

So, amino acids,

932

protein shakes, as we all know, like,

933

the first half hour is

the most important hour to, to to recover.

934

So in this half, this golden 30 minutes,

935

we try to, try to recover

with, with these

936

drinks, plus, directly with, with fruit.

937

So, yeah, but the color is

938

can be everything.

939

Well, Dirk, thank you so much

for coming on the Odd tandem today.

940

I hope our viewers and our listeners

learned some things I know I did.

941

Good luck to you and your team

at the upcoming tour of Germany.

942

You know, my buddy down here

won that race a couple times.

943

So, I know he he's looking forward

to seeing it, but, Yeah.

944

Thanks again for giving us your time

in between the the medical call

945

and taking off for another

another bike race.

946

A was a pleasure for me,

to be on this call.

947

And,

Yancey was always a pain, to listen to.

948

I remember the I remember once, maybe.

949

N0, you remember that,

the last really long, tour of Germany

950

we had when we started in Kitzbühel,

and there was one stage where

951

the race was quiet, everybody was happy,

and then the Jensie attacked again.

952

And you just hear about a tour through,

the, the, the, the the microphones.

953

Oh, no. No,

he attacked again. No. We race again.

954

That is through my hometown. mate

955

well, I could never win a sprint,

so I had to do something different.

956

Right. I would love to be in sprint. but.

957

Yeah. Hey, Dirk

It was so cool to catch up.

958

And I see you in two days.

959

Somewhere around the start line, I guess.

960

Thanks again for being our guest tonight.

961

Thank you.

962

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keep hitting, subscribe and click the bell

963

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964

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965

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