As team physician for the US Men’s National Soccer Team, Dr. Gerhardt’s position has called on him to travel the world, bringing him “from the snow covered fields in Germany to 110° temperatures in Mexico City.”

This past October, Dr. Gerhardt was with the team for the CONCACAF Final closer to home, at the Pasadena Rose Bowl. After an exhilarating US vs. Mexico match, Dr. Gerhardt spoke with us about his experience as team physician for the USMNT.

How long have you been working with the USMNT?

I’ve been the USMNT team physician for twelve years. Dr. Bert Mandelbaum, who has cared for the team for over twenty-five years, recruited me to the medical team shortly after my Sports Medicine Fellowship. I’ve worked with the team through three world cups, with three different head coaches, and with many of the best players to ever don an American jersey. It has been a real honor to help care for these athletes and to help this team be successful.

Treatment of USMNT is high profile. When an injury occurs, there is pressure for return-to-play, consideration of media coverage, etc. Talk about the added pressure and how you handle it.

The athlete’s health and safety is always first priority. There are certainly extrinsic pressures that loom over medical decisions, both on and off the pitch, but the doctor-athlete relationship is of the utmost importance. Always. Without this trust and this relationship, the best interests of the team and athlete will eventually be compromised.

Open and honest communication between all parties - the athlete, the coaching staff, management, agents, and other members of the medical team is critical in maintaining a strong sports medicine program. When communication is good between all parties, it makes hard decisions much easier.

What other challenges, if any, are specific to treating the USMNT?

One of the challenges unique to the USMNT, and all national teams, is that these athletes only come together intermittently and usually for brief periods of time. Each player has commitments to fulfill with their respective professional teams, scattered all over the world. The national team coach is sensitive to the players’ time and keeps them only for a short duration to train with the US team.

Players are constantly coming and going, so I have just brief periods of time to assess the health and fitness of the players. While many of the athletes are fit enough to compete, it’s not uncommon for them to be struggling with minor ailments, which need to be monitored and factored in to their ability to compete effectively for our team. The best way to manage these situations, again, is to communicate with the player, the trainers, and the coaches to make sure the athletes are optimally prepared to compete at the highest levels come game time with the USMNT.

In the week leading up to a big match like the CONCACAF Final, what are the top three points of preventative care you would advise to soccer players to ensure they’re in top shape come game time?

Fitness is always the most important factor as soccer is a grueling and intense test of endurance, particularly when played in hot and humid conditions. Most of these athletes already come in to camp with a solid base of fitness, so training is geared toward maintenance of the fitness base while also ensuring that the players are not “overworked” and fatigued going into the match.

Programs may vary from player to player, depending on variables of whether the athlete is coming off injury or perhaps is coming off a grueling stretch of games with their professional team. These factors are discussed with the coaching staff going into a USMNT camp and workouts can be individualized and tailored to a large degree depending on the situation and how long our players are in camp leading up to the game.

Nutrition, hydration, and acclimatization to the local environment are the other three most important factors to optimal performance. Our coaching staff and medical staff put these factors at a premium when preparing our athletes for a game like the CONCACAF Final. The team travels with a full time chef who is focused on optimal nutritional performance for the soccer athlete. Hydration is monitored with daily urine checks leading right up to game time and any deficiencies are corrected. Acclimatization to the local conditions is also important. Practices leading up to game time are conducted at times that best replicate the conditions when the match will be played. Acclimatization is critical particularly when conditions are expected to be extreme such as high humidity, extreme temperatures, and high altitude.

What are the top three injuries you see on the field and what is the most important factor for treatment?

The most common injuries in the soccer athlete involve muscle strains, ligament tears, and joint sprains. Specifically, hamstring muscle strains, ankle sprains and medial collateral ligament strains of the knee.

These injuries can range in severity and, since the athlete is only with the USMNT camp for a brief period, it is critical that the injury is evaluated by the medical staff and that appropriate diagnostic tests be arranged. We can then quickly decide whether this is an injury that the athlete will recover from quickly and if the athlete will be able to compete or not.

I am available 24 hours a day and 7 days week for these athletes and have set up a medical program such that x-rays, MRIs, ultrasound machines, and other necessary diagnostic tools are immediately available to our team. That being said, these resources become harder to arrange if the game is played in a country such as Nigeria where technology may not be readily available. For this reason, we travel with a complete set of medical gear including a portable ultrasound so that detailed information about an injury can still be assessed and decisions can be made.

How has playing soccer competitively yourself given you insight in to soccer-related injuries?

Having played soccer for many years, I understand the nature of the game, the injuries, and the importance of certain situations, bringing an extra layer of insight to our medical program. Having first-hand understanding of the requirements of the players to be able to compete at a high level helps make decisions in high-pressure situations easier.

I have developed relationships with many of these players and coaches over the years and with that comes a sense of trust and understanding. They know that I am here to help in any way I can to help keep this team healthy and fit. In many ways, this team feels like a big family – which is a nice feeling when we are half way around the world in tough conditions.

What was the most memorable part of the CONCACAF Finals match?

US v. Mexico games are always special because of the intensity and history as neighboring soccer countries. This game had all the intensity and importance as any game we have played. It almost reminded me of a World Cup atmosphere, which was fostered by the stakes being high. Qualifying for the Confederations Cup is a huge reward that both teams wanted badly.

For me, the highlight of the match was watching Bobby Wood enter the match late in the game and quickly making his mark by scoring a beautiful tying goal. This made the game 2-2 and at this point we really were pressing the Mexican team, nearly scoring again on a couple of occasions. Just when we thought the game would surely go in to overtime, the Mexican striker scored a world-class goal to close us out. It was a heartbreaking loss, but a game I will never forget.

Now, it’s time to reset and focus on the next challenge, which is qualifying for the 2018 World Cup. Those games start this fall and the team is already setting its sights on this process.