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Published on:

23rd Aug 2024

Dirk Tenner: The cycling team doctor changing perceptions about the sport.

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.

Transcript
Speaker:

Hello everyone, and welcome

to another episode of The Odd Tandem.

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You know, we've been doing this a while

and we've had riders, sponsors, mechanics.

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We even had a cook once.

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We've never had a team

doctor on the podcast.

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So we sat down with Dirk

Tanner of Ineos Grenadiers today,

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and he gave us quite a few little tidbits

of information

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that I think the viewers and the listeners

are really going to enjoy.

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Jensie, you’ve actually known Dirk

for a while because he's German.

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Tell us a little bit more about him.

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Well, he's,

first of all, is a huge cycling fan

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and really impressive, is also that

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in the tour of Poland,

during the horrible crash

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of Fabio Jakobsen,

he was more or less the first responder.

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He was the first race team doctor there,

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basically trying to,

you know, help Fabio to survive

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and help him to go into hospital

with the helicopter.

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And another impressive thing

he actually mentioned in our podcast

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is from the 206 bones we have in our body.

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He operated more than 100 of them.

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How impressive is that?

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Yeah, and the

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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

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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

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doctor, especially at the World

tour level on the podcast.

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So this is going to be fun

and hopefully very educational

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for our viewers and listeners.

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And maybe remind Jens

and I about what it used to be like when

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you just had a doctor

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on the other end of the phone

the whole time, you never saw a bill.

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They did all the paperwork.

It was nice and simple, right?

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But before we get started,

let's talk about your background,

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your educational background,

and then your perhaps sporting background.

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Yeah.

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Well, I,

I started well, my my my first, my

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my sport background

is I'm originally from track and field.

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I used to be on the junior national team

for quite a while,

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and I stopped, being a track, track

and field athlete

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when I started my, my medical school,

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yeah, I had some some,

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some meetings with

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doctors when I was really young,

with, knee issues.

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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.

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I always wanted to do it

better than they did it on my body.

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So that was my reason

why I started my medical career.

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So I went through, started in, in Mainz

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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.

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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

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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

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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,

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a whole tour.

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I was working little,

before I started my career in cycling.

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I, I worked for for soccer and,

I found out,

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you know, like, like,

some even professional soccer players,

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they love to have their time off,

even with small,

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small injuries, just to,

I would say just to relax a little bit.

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So then I guess,

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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

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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.

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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.

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and, I really love passion

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

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What really impresses

me on, on, on bike riders.

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Yeah, you're absolutely right.

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

I realize how tough cyclists are,

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you know, especially watching,

you know, a footballer get kicked in the

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in the shin guards and roll around

like he just broke his leg in ten pieces.

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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.

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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.

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But you said that you were on the road,

like 150 days with with the team.

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how do you balance that

with your clinical practice?

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I know it's less.

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I mean, I'm, I'm,

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

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between 70 and 80 days per, per year.

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so, I'm in the lucky position

that I'm head of the department.

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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.

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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.

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Right.

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So as I understood,

you had a team doctor call tonight.

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What can you tell us about that?

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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?

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Okay.

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We have like, like,

so we this sesaon is really hard.

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We have like a weekly, meeting

with all our team doctors at Ineos,

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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.

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so tonight we were just discussing

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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.

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then calling the riders.

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is everybody okay? any any problem?

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before the race

where we have to be aware of or,

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where we have to jump in, asking

if they have,

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their personal medications

with them at the moment.

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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,

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cases of acute respiratory infections.

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

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the Giro, like, like,

quite a lot of, Covid infections.

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and then when I arrived tomorrow

at the hotel, well, as soon as all

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riders arrive, I have like,

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it's, like, personal talk with everybody.

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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.

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because if they arrive, we we were,

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they should be healthy.

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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.

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so we start the day

before the race with the,

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daily morning, medical checkup.

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Okay, so that's during the race.

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But when we were racing,

we always had a kind of medical checkup

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during, like,

the first training camp of the year.

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And, you know,

there's been a lot of riders,

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suffering from arrhythmia issues.

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So can you explain to our viewers

and our listeners a little bit about

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those medical checks, what they're for,

what you're actually looking for?

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Yeah.

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I mean, we have we also have,

one medical check even before,

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any of of the riders

come to the first training camp.

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So we usually have our, medical, train

or medical camp in, in November.

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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.

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we do, a DEXA scan

just to measure bone density.

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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,

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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,

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possible problems,

we could have during the season.

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And we tried to solve some of these,

these problems before the season start,

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so that for each rider,

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that takes a whole day.

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I can imagine it takes a whole day.

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So when you say you're an auto pair

orthopedic

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trauma surgeon,

is that the word you used? Yes.

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to make it easy for our viewers

and listeners.

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You're you're a doctor.

You're a bone doctor, right?

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So, yes.

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What they call

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

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you had Jhonatan

Narváez crashing yesterday.

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What did call you up?

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What do you think about it. Yes.

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And you look at the

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at the TV, at the video,

how he crashed or they sent you X-rays.

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How do you give your expertise for,

because you're not there, right? Yes.

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But maybe no spectators

think that's crazy.

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But, if I'm in the hospital.

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Not now.

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Between two races,

when I'm in the hospital.

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And, for example,

in, in the surgery theater

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and most of my surgeries,

I do, arthroscopic,

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usually after

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my big screen where a where

see the joint from inside.

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But I usually have an iPad with,

with, Discovery Plus, for example.

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And watch having the race live,

next to the screen.

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

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And probably people think, hey,

you should go to or what do you do?

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So these are my docs.

They're they're always with me.

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and so, and sometimes many people think

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that's kind of strange and you should

concentrate on what he's doing.

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

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

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If somebody crashes, that I can replay it

and and, call the doctor

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who is at the race,

or usually they call me after the race

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

the only, bone doctor on this team.

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so I usually the first one

who's giving, comments on this and

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giving, ideas about,

further treatments or

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how and where we have to do what.

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I had to Google this

because I didn't know.

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But there are 206 bones in the human body.

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how many of those bones do

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you think you've operated on

or how to deal with?

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Out of those 206?

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So, I

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definitely don't do surgeries

on, on on spines.

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so the spine is out of my,

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of a lot of my real expertise, but,

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I mean, to count now how how many bones

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I do all fancy stuff on extremities.

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but I'm, I would say

especially with, with,

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with cyclists, I do most of the stuff

upper extremity and big bones.

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in our hospital where I work,

we have one, guy who is.

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He's, he's a genius

in, foot and for foot surgery, so I would

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I always would forward these surgeries to

to my colleague.

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The things you really have to know

where you're good and

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or where you're really good at a

where you just average yet.

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So, out.

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And for me,

it's important to get the best outcome.

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So, if I know somebody who's better

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in this, I would always forward it

to another one. So.

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But you'd think you would have

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operate 100 bones out of the 200

possible bones in a human body.

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Half and half?

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Yeah. For sure. Wow.

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Alrighty

then. Let's go further down this road.

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What is the biggest metal piece

you ever put into a human body in surgery?

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Or, I mean, the

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the intermediary rods used for femur

fractures.

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That can be really long.

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So like 36, 38cm long, seven millimeter

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thick, screws, or even bigger.

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if you if you do,

if you operate on a femoral neck

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fracture,

I mean, the the screws are used there.

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Yeah, I would say bigger as big or,

sometimes bigger than a thumb.

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I have been

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retired for quite a while

now, and two months ago,

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I broke my collarbone

and I had to have an operation.

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It was the first time ever

that I broke my collarbone.

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So I never really felt

like a real cyclist.

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Because, you know, Yancy,

how many times did you break yours?

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Three. Three.

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So, Dirk, in your experience with riders,

what is the most times

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that a single individual

has broken their collarbone?

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I had an, South African rider

who broke his collarbone.

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Let me think at least five times,

and I think

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I did four times surgery on him,

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and I think was twice

where I first had to,

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take the plate out

and then put a new one in it.

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So my, my, my first, surgery.

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Oh, sorry.

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My, my first collarbone to bone was,

it's like, broken but still in place.

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So give me that.

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what's the German word for this?

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That it, not like a rucksack.

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Like I think you would bend it

to put my shoulders back

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and up to the bone

would be straighten out.

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That worked really nice,

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but it took a long time until I actually

could use some power on that shoulder.

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And that's the problem.

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Yeah.

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The other two times

I had surgery, there's obviously a risk.

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

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You just not survive it.

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I mean, it's almost zero,

but it it it exists.

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but you can move.

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You can train three days after. Right?

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But there's the correct action.

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So you always have to, balance that out,

don't you?

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Yeah.

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But I mean, on a professional cyclist,

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

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if you use just,

the one you describe, like

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this rucksack, bandage, for sure.

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You couldn't ride properly for 6

to 8 weeks.

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I mean, this is like,

the all the really conservative

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style of, orthopedic trauma

treatment of a collarbone.

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The for me, the, the the the the

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the right one

is to have like a rigid, stable,

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reduction, of this of, of this bone

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because then, as you said,

you can start training three, four days

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after the surgery and I had riders,

leading out their, their,

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their sprint, ten days after the surgery

on a on an important race.

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Oh, yeah.

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Yeah.

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so Jens and I, we have this text thread

with some of our buddies from CSC

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and two of the guys broke their collarbone

seven times during their career.

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Christian Van de Velde and Stuart O'Grady.

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That that blew me away.

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

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But another question that came up

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just this weekend, honestly,

I had some friends come down from Toronto

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and we were out on a little ride and,

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5 or 6 of us made the turn,

and then we realized that three guys

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were behind us.

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So we kind of stopped and whistled like,

hey, we're this way.

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We're this way.

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And the guy in the front

slammed on the brakes

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to try to make the turn,

and the guy in back of them crashed.

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so road rash, right?

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Like, can you give some tips

to our viewers and listeners?

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The best way to deal with with Road

Rash these days is it

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is it keep it dry or keep it wet?

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Is it to always have a bandage on it?

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what is the new way of dealing

with, road rash?

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Because I think it's always

been debatable.

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Yeah.

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

no way to treat it.

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the road rash.

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

getting really uncomfortable to cross it.

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It breaks all the time.

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It starts getting like,

it's it's painful again.

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So what I, I mean, for the first days

when it's, like, really,

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

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so that we don't risk,

and any superficial infection.

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But as soon as it dries out, I always,

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pull, a small layer of just normal

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classic Vaseline

on the, on the, on the road rash

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so that it that it stays,

I can call it, moist, Correct.

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A little bit moist.

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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

:

Please remember,

keep hitting, subscribe and click the bell

963

:

icon so you can never miss

an episode of the podcast.

964

:

Keep dropping your questions for us

in the comments and check our description

965

:

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About the Podcast

The Odd Tandem Cycling Podcast with Bobby Julich and Jens Voigt
Bobby Julich and Jens Voigt on all things cycling
Bobby Julich and Jens Voigt are back with a brand new cycling podcast. Speaking to the biggest names in the professional peloton and sharing their wisdom from their own careers.