Trainer Talk with....Dr. Steve Augustine
(10/4/07)
By Tim Crytser


 

 

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Dr. Augustine driving the Asterisk Mule

Virtual Trainer: Steve, tell me a little about your background in Motocross and how you became involved the Asterisk Mobile Medic Unit.
Dr. Steve Augustine: Well, as a kid I grew up around motorcycles, my father made it a family affair. I am originally from the Ford City / Kittanning, PA area, where Broc Hepler is from. We used to ride there as kids with my mom and dad. Yes, that’s right my mom used to ride dirt bikes. What a women, she was a pioneer for the WMA. When I was young, we moved to Cleveland, but we would still go back to Kittanning to visit relatives and ride there. There are a lot of strip mines in that area, so we would go ride on them a lot. I have an older and younger brother, and we would pack a lunch and go to the strip mines to ride all day. My older brother started racing MX around age 13, his first race was at Steel City and I started racing MX as well back in Ohio when I was 9. Throughout high school I got more into traditional stick and ball sports and drifted away from MX a bit, but I never really stopped riding. When I was playing high school and college football, it was really looked down upon to ride a motorcycle during the season, especially if you got hurt. So that was a conflict for me. I didn’t let the coaches know and still rode my bike, but I didn’t race as much. I didn’t want to chance getting hurt and losing my scholarship. The workout you get from riding is unmatched; it was my form of cross training. Once I got out of college football, I got back into riding and started competing in the GNCC’s and the National Hare Scramble Series during medical school whenever my nose wasn’t stuck in a book. I never really was able to pursue racing the way I wanted to because of academic commitments. Medical school is a huge commitment and takes up a lot of time, and it’s not like you have spare time to travel, train and go race a lot. But, I did get to race a lot of local events wherever I was living during my medical training, so I was always around bikes one way or another. You make choices in life and mine was to pursue sports medicine surgery, fortunately, I have been able to combine both things I am passionate about into a career – motorcycles and sports medicine. I enjoy all types of riding from trails to MX. When I was in Denver for my internship I was able to ride a lot of the trail system in Colorado during off time. Once I moved from there to Philadelphia for my orthopedic surgery residency, I started doing the East Coast Enduro Association events and local MX stuff. One perk about traveling so much is that I’ve been fortunate enough to have met a lot of great people and ridden different tracks and trails across the country.

When I was in Philly doing my residency, I trained with the doctors that cared for the Philadelphia Eagles, Flyers and the 76’ers. When I was spending time with these doctors, I saw the void that existed in professional MX and SX and I got to see how things were done on the professional side of sports medicine. Coming from that sports background as an athlete and a physician, when I would go to a MX race I noticed there were never any Doctors or Athletic Trainers there to provide on site care that was always present at other professional sports events and even at the high school level. From a Sports Medicine perspective, on site care is essential to the athletes at the event being able to participate with more confidence knowing that if they get hurt there is a competent medical staff available to maybe patch them up and get them back out participating. So from experience, I saw a void that existed. I decided that I wanted to develop some sort of Sports Medicine program for professional MX and SX athletes. At that time, I was visiting my younger brother in Arizona when Jimmy Button got hurt; I guess that was 2000. Well, when he got hurt I stopped by to see his father and see how Jimmy was doing. I was telling him about what I was trying to do and that I thought motorcycle racing and motorsports, specifically MX and SX, Enduros, and Hare Scrambles needed an onsite medical team. I ended up talking to Bobby Moore. He had been talking to Bob Walker after Jimmy’s accident and they were floating around this idea of Road 2 Recovery which is a foundation setup to help injured riders. At that time, there wasn’t really anything setup to help these guys if they did get seriously hurt. I proposed my idea to Bob and he thought it was a great idea and in lines with what Road 2 Recovery was trying to do for the sport so he thought I should start going to the races and pushing the idea.

About a year before that I had met with Jim Castillo from Innovation Sports the Cti knee brace company at a sports med meeting. I proposed the idea to him and at about the same time Dr. Bodner was out in California doing the same thing, he and Castillo got together and started the Supercross side of the program. At the same time Bobby Moore said lets get you to the Motocross races. So that year Bodnar through the support of Cti covered the SX races and I, with the support of Road 2 Recovery covered the outdoor Nationals. So that was the beginning. We would literally show up at the races with our medical bags and that was it. That was 2001. The next year Bodnar and I made the commitment that we were going to cover every single SX and MX race and create the program.

From there, Tom Carson from Asterisk really made it all gel together. The program took off and from there it has just grown every year. Initially, we added the original 5 th wheel Asterisk Mobile Medical Center that we took to all the races to work out of. That really improved our ability to care for the athletes. Tom Carson really came through and helped with the organization and funding for our travel expenses. Then we added athletic trainer Eddie Casillas to the team, who has been a tremendous addition and also made sure we had a nurse at every event. By proving the programs worth, we now have a lot of industry support and have been able to move into a larger semi unit, and all the stuff that is necessary to put together an on site medical project like this. Having an x-ray machine available, I think is one of the biggest things that has made a difference in the level of care we can provide. For instance, if a racer hurts his wrist and isn’t sure if he has broken it or not, before he would either have to try and tough it out not knowing or go wait in the local hospital emergency room and probably miss the rest of the day. Now we can x-ray it at the track and determine if it is safe or not for him to continue to ride that day. Often times it may just be a sprain and he can continue on and tough it out that day knowing it is not broken. That alone is priceless and worth having the program. It takes a lot of money to do this and a lot of people from the sport have really come to the table like the OEM’s, Live Nation, and the AMA. The budget for an operation like this is very big. It is a great program and everyone in the sport benefits from it.

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The Asterisk Mobile Medic Unit brings a professional look to Motocross racing complete with a fully equipped semi and Mule

So before you guys came on the scene, what level of care did the Professional riders get at a National?
Basically the same type of care that you might get at a local race. A local ambulance crew that, while they are trained in emergency situations, usually aren’t used to dealing with athletes or SX/MX for that matter. I don’t want to make light of their importance. The paramedics and EMS guys, they do a good job, but most of them are not used to dealing with athletes at this level. Sports medicine is a unique skill. In MX/SX you are dealing mostly with musculoskeletal sports injuries that these guys just are not used to dealing with. One good thing that has happened with our program is that a lot of the EMS crews have improved as a result of us being there. It’s really a team effort. We couldn’t do it without them and we bring to the table the level of care and expertise that we can in terms of Sports Medicine. Prior to the Asterisk program the level of care that was provided was really poor. You would literally have the ambulance crew waiting in the ambulance until someone got hurt on the track and then they would respond. Thankfully, those days are gone and the crews that we work with now are really pretty good. We have improved the level of care tremendously.

I’m not sure the general public understands just how important onsite medical care is. I mean, it not just about making sure these guys are ok, it’s also about how quickly you can get them back out there.
It’s good for the sport all around. Good onsite medical care can mean the difference between a guy being able to compete immediately or missing races because he didn’t get proper medical care. We are able to evaluate and treat them and make decisions on whether it is safe to compete or not. That means a lot to the spectators as well. People pay good money to see their heroes out there competing and that is what we are trying to make sure happens. Not that the athlete is sitting in an ER waiting for an X-ray instead of riding the main. It’s our ultimate plan to have a medical team of not only Bodnar, Eddie and myself but a group of paramedics and well trained support staff that is consistent. In other words, instead of every time we go to a race and deal with inexperienced and different EMS crews from race to race we would have our medical team. Sometimes the EMS crews assigned to a race may have no interest what-so-ever in the sport and know nothing about the sport, might even be the first time they have ever seen a motorcycle race period. That makes it more difficult on us. Ideally what we would like to have in the future is a pool of say 20 well trained paramedics, familiar with motorsports medicine that we can choose from so that we can have 6 of those 20 at each race. That would ensure consistency with protocols and ensure that we can all work as a team.

The Asterisk Mobile Medic Unit was at the Motocross de Nations this year. What type of challenges did you guys come up against with that being an International event?
Well, that event was a huge undertaking. Dr. Bodnar and Tom Carson really did a great job working with the FIM and planning that event. There are so many protocols and requirements to meet FIM standards from mandatory staffing of 3 crew members at 7 posts located around the track, certain amount of doctors and paramedics, certain amount of ambulances and on track vehicles (mules/quads/ambulances) to having to have white uniforms only. There is a ginormous amount of pre-event planning that goes into something like that, not only in terms of coordinating over 25 medical crew members but making sure there is enough medical equipment and that it is all functional. We are used to dealing with pre-event planning at regular races but it is easier because we typically over the years go back to the same locations and have our program down pat. At that event everything is under the FIM microscope. As far as it being an International event the language barrier was obviously a bit of a problem but not too bad. Luckily, Eddie speaks Spanish which came in handy. We transported at least 10 riders off the track on the mule, fortunately because of the Asterisk program we were able to avoid many transfers to the hospital, that without our program those athletes would have to have gone to the hospital for care and potentially missed the event. We were well prepared if anything more serious happened. We had the helicopter on call, and hospitals around the area were on call and had been contacted prior to the race weekend in case of something really serious. Motocross and Supercross events get the same level of care, but the planning for the MXDN was much more involved and started at least 6 months in advance.

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The rest of the crew consists of Trainer Eddie Casillas (left), Dr. Bodnar (right) and a nurse

Do any other Countries offer similar services to professional riders like you all do?
Not sure. I think the big difference with our program is probably in the fact that we have a consistent, experienced core team of people that attend the races year after year as well as the fact that we have such a great mobile medical center.

So what the rest of the World saw at the MXDN as far as the medical care is concerned had to pretty impressed.
Well, I think they had to be, our program is top notch and we work hard to make it that way.

Let’s talk briefly about the football player, Kevin Everett who had a severe spinal cord injury in a game on September 12, and they gave him a cool saline solution to cool his body and prevent further injury to his spine. Is that a medical technology that could be applied to MX racing and do you think it will ever get to us?
It is certainly something that would be beneficial to not only the management of an injured motocross athlete but to anyone with a spinal cord injury anywhere. To be able to institute that technique could potentially have a huge impact on the outcomes of people with spinal cord injuries. While it looks promising, there is still a lot of research that still needs to be done to prove it is truly beneficial. But, with that said, and I don’t want to be a pessimist, but it is going to take a lot of time and money to train front line people like paramedics on the technique because a procedure like that needs to be applied as soon as possible, those are the front line people who need to be familiar with it. It will take years to get something like that instituted to the level of when a treatment like that is available and commonplace to someone in, say a car accident. There is an educational process that is necessary for medical care givers across the country to be able to apply the technique that will take time to institute. If it proves to be valid, then it is something that is going to happen, but it will not be something that happens over night.

It seems in the motocross industry when someone gets seriously hurt there is an instant cry for more safety, versus other sports where more research gets done on the treatment, like the case of the Kevin Everett.
I don’t have any football data as to the number of spinal cord injuries they encounter versus motocross, but since the Asterisk Medic unit has been in place I have compiled injury data from all of the practices and races at the events that we have worked from 2001 to 2005. This is just at the MX and SX races and does not include practices during the week. So I looked at all the data we had and broke it down into body parts and the type of injuries we saw. And when you look at the data over those 139 events and look at each injury we saw, we saw that upper extremity injuries accounted for 32% of all injuries for example. That covers everything from clavicle fractures, to shoulder dislocations, wrist injuries, etc. I did the same thing for lower extremity injuries and then looked at the spine. And when you look at the data between those years, we had two spinal cord injuries that resulted in paralysis. Now, that doesn’t account for guys like Ernesto Fonseca who got hurt while practicing during the week. So in those 139 weekends of SX and MX racing, we only saw two catastrophic spinal cord injuries. That’s a lot of exposure with only two permanent spinal cord injuries being sustained. However, there were also 10 spinal fractures that did not result in paralysis. So when you look at it statistically, only 2% of all injuries we saw during that time period were spine related. And of those less than 20% resulted in permanent paralysis. So while it is certainly one of the worst injuries encountered, it certainly is not the most prevalent. And like I said I don’t have the data on the number of spinal cord injuries in the NFL, but I would imagine it is comparable to MX. The NFL has a lot of tangible money which is really the driving force behind innovative treatment research such as at the Miami Project. But there are some really good things happening in MX too, like the fund raiser that was just done in conjunction with Oakley where David Bailey and I believe Davey Coombs were there supporting stem cell research at UC Irvine. There is that, plus the Wings of Life Spinal Cord Research Foundation that was just announced at the MXDN. So there is some money being invested into research like this for MX. On the prevention side of things there is of course the Leatt brace. The areas of injury research need to be addressed equally, both prevention and treatment.

So what is your opinion on the Leatt Brace? Is this a no-brainer piece of safety equipment that everyone should be wearing?
When you look at what is available out there; it is by far the best thing we have to offer in terms of potentially preventing spinal injuries, specifically of the cervical spine. It is probably the one biggest impact innovations to hit the MX industry in recent years. When you look at the research that Dr. Leatt has done, and I have talked with him at length about it several times, it is very thorough and complete. A few years ago he sent me a prototype brace and I evaluated it and reviewed the testing he had performed and think it is definitely valid and the product worthwhile. I think he has proven that it will reduce certain motions in the spine during crashes. It’s not going to prevent all injuries and they do not claim that it will prevent you from getting paralyzed but I do believe it has merit and I recommend it strongly. It is definitely a step in the right direction. I have studied his research and consider it a no-brainer to wear one. I wear one all the time now and I highly recommend other people to wear one. I really commend Dr. Leatt on the amount of time and effort he has put into the research and development of the brace. One other thing that I would like to say about the Leatt brace is in regard to clavicle fractures. It is my personal and medical opinion that the brace does not cause clavicle fractures. I think clavicle fractures are going to happen whether it is worn or not. The only real way to answer that question is to look at the data before and after people started using the brace. If the number of clavicle fractures increases then you can start to say that maybe the brace is responsible, but until then I don’t see how the brace can be increasing the risk of that type of fracture. The clavicle breaks simply because it is the weakest link. The helmet does not cause it, the Leatt brace does not cause it; it is simply too much force going through the arm.

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Scott Brady received some personal attention from Dr. Augustine in the form of a phone call just for as asking a question on the Virtual Trainer "Ask the Trainer" section.  Now that's service!

 photo: Courtesy Scott Brady

The last thing I want to touch on before I let you go is your involvement with the Virtual Trainer website. Believe it or not, the VT website is 100% voluntary on my part and I do it to help people out. I have tried my best to do much like you and Dr. Bodnar have done with the Asterisk Mobile Medic Unit and fill a void that I felt existed in good, credible training advice for MX. My main goal with the VT website is to be the place to go for all MX training related advice ad information. With that, contained within the VT website is an expert panel that is available 24-7 to answer any and all questions. We have Doctors like you, a nutritionist, a physical therapist, top trainers in the sport, and more. Talk a little about your experience as a panel member and how you have helped people who have emailed in.
I think that from a Doctors perspective, what you have done with the expert panel is huge. As far as value added you would have to ask the people who have written in and asked questions and how much they appreciate the service. But as a resource available to people out there, and its free, I think it’s great. For people to have someone to turn to within the sport when the Doctor or therapist that they are seeing may not be in tune with MX is of great value. To have a place to turn to and get your questions answered gives you a comfort zone that is very important in the treatment of an injury. Like just recently, two readers emailed in a question that both just happen to be about tibia/fibula fractures. One was a teenager who was having some nerve damage issues and the other was a 40 year old who had some questions regarding diet and nutrition and ways to keep the weight off while he was laid-up for the next three months. For those people to have a resource to go to, ask a question and then get a personal phone call from me to talk to them about their situation is invaluable. Not everyone gets a phone call, but I thought their injuries were serious enough to warrant talking to them directly. The young boy was having nerve issues related to the injury and I talked to his parents and confirmed what their Doctor was telling them. It’s the whole second opinion thing to get comfortable with a diagnosis and treatment and to get that from other people who get motocross is huge. Being able to go to a source like Virtual Trainer where people understand the sport is probably the biggest asset that the Expert Panel offers to viewers.

Well Steve, thanks for your time.  I know you are a very busy man, so I'll let you go.
No problem, Tim anytime!

That's it for now. Until next time, good luck with your training and, as always, VT can be reached anytime at crytset@comcast.net . In addition, be sure and check out the Racer X Virtual Trainer archive section , your complete one-stop information zone for motocross fitness.

Have a Question? Check Out the Virtual Trainer Expert Forum !

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