This physician and surgeon has been instrumental in carrying on the Justin Sportsmedicine Team’s goals of caring for rodeo competitors.
Tandy Freeman, MD, has never ridden a bronc or bull, but his presence at numerous rodeos every year is essential. As medical director of the Justin Sportsmedicine Team, he makes sure competitors stay healthy and are treated promptly for the inevitable injuries that occur in the sport.
Freeman completed his undergraduate work at Baylor University in Waco, Texas, and received his medical degree from UT Southwestern Medical Center in Dallas, Texas. It was during his residency in Dallas that he met J. Pat Evans, MD, who co-founded the Justin Sportsmedicine program in 1981. Evans was the team physician for the Dallas Cowboys from 1970 to 1989, and the Dallas Mavericks from 1980 to 1992, and saw the need for organized care for rodeo cowboys. They developed a lasting friendship, and Freeman was the logical choice to take over the program when Evans retired.
Taking care of rodeo contestants—whose livelihoods are not supported by million-dollar contracts and endorsements, and whose paychecks depend on their ability to compete— offers different challenges than those faced at most medical practices. But Freeman enjoys the challenges and rewards of working with athletes, not only treating their injuries but also teaching them to better care for themselves.
“One of our goals all along has been to educate the rodeo athlete about their injuries, about how to prevent them if at all possible, and how to take care of themselves when they are hurt,” he says.
How did you get involved with rodeo? I went to junior high and high school in Junction, Texas. While my family was not involved in ranching, it was a ranching community. I did not have any experience in rodeo other than the fact that when I was in high school there were communities nearby where I grew up that would have a little weekend rodeo during the summertime. There was always a dance after the rodeo and that was a good place to go for fun.
When I was doing my training as a resident I had a six-week rotation working with Pat Evans, an orthopedic surgeon in Dallas. He became my orthopedic surgery mentor. I really had an appreciation for the way he related to and dealt with his patients. He’s an extremely good diagnostician. We got to be friends outside of the office and hospital setting. He was getting close to retirement about the time I was getting started. Because of the Justin Sportsmedicine program, he was interested in having somebody step into his practice that he thought would relate well to the rodeo athletes and would take care of them.
When he did start taking me to some events, it appeared that it would work out. A big part of my early involvement was really motivated by wanting the program to continue, because it’s something that he had put a lot of blood, sweat and tears into. I wanted to see that it not only survived, but that it improved and grew.
What’s the role of the Justin Sportsmedicine Team? How has it changed through the years? When they started the program, there really wasn’t organized medical care for rodeo athletes. Quite honestly, most rodeo athletes went to the doctor only if they were more or less forced to. The joke is that before the program started, rodeo sports medicine was basically a bottle of aspirin and a six-pack of beer, and if that didn’t work you doubled up on the beer!
The original goal of the program was to bring state-of-the-art physician and athletic training services to the rodeo cowboy, and that remains our goal. When it started, it covered 10 rodeos and the National Finals Rodeo. It was Dr. Evans and one athletic trainer. Now the program covers 120 rodeos a year. We’ve got a staff of athletic trainers, most of whom also have other jobs. The number of program managers—athletic trainers who either bring the truck and mobile training room to the event or stay at the training room at an event and are on the road—is between six and nine. The executive director is Mike Rich. He is based out of Gilbert, Arizona. He is an athletic trainer who also has physical therapy centers that he owns and manages. Throughout the country, wherever we have events, we have local athletic trainers and physicians who volunteer to work those events and help take care of the athletes. With 120 events, we have hundreds that help out. Justin pays for everything that is done at the rodeo arena.
They pay for the athletic trainers who travel for our program, they pay their expenses, for their time, for the trucks and trailers, the gas … if we use it in the training room, Justin has paid for it. That’s the only way the program functions. Rodeo cowboys don’t pay anything. The communities don’t pay anything. PRCA doesn’t pay anything.
What are some of the challenges with this program? We cover 120 events, but the PRCA has somewhere in the neighborhood of 700 events [annually]. We can’t cover everything because of budgetary constraints. I guess if people bought a lot more cowboy boots we’d be able to expand the program some! But it would take a lot of cowboy boots.
The fact that there are about five times as many events that we don’t cover as we do cover, it does create some logistical issues in terms of continuity of care. A guy who gets hurt at an event is likely to be headed down the road to compete at an event where there aren’t Justin Sportsmedicine personnel. That creates some logistical issues. We teach them what they need to know about whether they need to be off or not, which may or may not sink in, but also teach them how to do the things we do for them in the training room—how to tape a knee or ankle or elbow or whatever might be an issue, and giving them physical therapy-type rehabilitation activities they can do when they’re going down the road. We’re doing things to try to help them optimize their physical status so they can be more competitive.
Some athletes probably only go to the rodeos where the Justin program is at; we’re at most of the top 100 rodeos in the country. That means that the guys who are really out there on the road and making a living rodeoing tend to be at those same rodeos. But we have a lot of guys who just compete in a given circuit, or compete part of the year. We take care of them just the same as we do the ones that are in the top 30 or the ones destined to head for the NFR.
How does sports medicine in rodeo compare to other sports? Every sport has unique demands on the athletes and has injuries that are common to that sport or unique to that sport or rare in other sports. Rodeo has its own unique aspects. In rodeo you’ve got an athlete who’s competing against an animal athlete that is bigger, stronger and faster. There aren’t any other sports where you’ve got an individual competing more or less against an opponent that is 10 times their size, like you do in bull riding. It’s a mismatch that doesn’t happen in other sports.
There are a lot of injuries we take care of that are the rodeo version of what happens in other sports. The surgical treatment for a torn ACL [anterior cruciate ligament] is the same whether you did it playing football or jumping off a pick-up man’s horse. But there are differences between those, in that in some aspects of rodeo you can compete with a torn ACL, whereas if you’re playing in the NBA you’re going to have a really hard time doing what you need to do if you have an ACL-deficient knee. In [other sports], a guy tears his ACL and he’ll be having surgery in a short period of time afterward, have rehab and be back playing during the next season. In rodeo, a guy may tear his ACL and if it’s not going to interfere with his ability to compete, he may forgo surgery. In that case, we teach him what to do in terms of rehab, how to tape the knee or whether we prefer to get him in a brace. In some events, like saddle bronc riding, the traditional ACL brace doesn’t work, so you have to teach a guy how to tape and use a brace to supplement it. That’s something you won’t see in any other sport.
Rodeo has multiple disciplines, and that’s different than a lot of other sports. Injuries have different effects. An ACL tear in a tie-down roper is not the same as it is in a bull rider. You have to look at them differently in terms of how you manage them.
In rodeo we do see a lot more high-energy trauma than you see in most other sports. Again, you’ve got a 1,500-pound or 1,750-pound bull, or a bronc, you’ve got a lot more energy involved in the injuries, so there are differences. But it’s still a matter of taking care of athletes and getting them back in competition as soon as it’s safely possible.
How do you deal with patients who want, or perhaps financially need, to compete when they should rest and heal from an injury? The first thing that the athlete has to be realistic about, and the physician needs to be aware of, is are you really going to be competitive given the injury you have? If a guy is not going to be competitive and actually have a chance at winning given his injury, you have to sit down and talk to him about that. You say, “You can go out and get on with the injury that you have, but that doesn’t mean you’re going to be able to ride. You’ve got to be able to stay on and you’ve got to be able to be competitive to actually win. If you don’t win, you’re just pouring money down the hole.”
When a guy’s got an injury that maybe he ought to get fixed, but he can still be competitive with it, then we do what we can to protect him. But it’s got to make sense from the standpoint of him not significantly increasing his risk of having something worse happen to him. At the same time, he’s got to be competitive. You have to balance those things. Some of that is easier for me to do now that I’ve been doing this for over 20 years than it was back when I was brand new at it. You learn along the way what guys can and cannot do, what things are a problem, and it starts to make more sense. Now I can look at an 18-year-old bull rider and say, “Look, I’ve been doing this longer than you’ve been alive, so you might want to hold on just a minute. If you want to be riding 15 years from now, let’s talk about what you might need to do.”
What are the most common injuries in rodeo? The most common injury in bull riding and rodeo in general is concussion. About 15 percent of the injuries we treat in the PBR are concussions. Beyond that, we treat every known common injury that you see in sports— ACL tears, muscle strains and tears, ligament injuries, joint injuries. And unfortunately we treat a lot of the same things you see in motor vehicle accidents, like spine injuries, liver lacerations, spleen ruptures, inter-abdominal injuries and rib fractures.
But by and large the most common orthopedic surgical problem is the knee. The most common surgical problem in the shoulder is instability—a shoulder that is dislocated. About a third of the injuries involve the upper extremity, about a third involve the lower extremity, and about a third involve the head and neck, and back.
Do the contestants you’ve seen for years take your advice differently than some of the younger cowboys? The guys who have been around any at all pay a little more attention. But the thing is, the Justin Sportsmedicine program is now 35 years old, and it’s not just me but other folks in the program who have years of experience devoted to rodeo, and not rodeo as a sideline.
Plus, over time things have changed. Back when it was a bottle of aspirin and a six-pack, part of the reason was if they went to a physician with an injury, the physician would tell them they needed to stop riding bulls or stop steer wrestling. [The physicians] didn’t really understand how important it was for the cowboys, or even what the sport was all about.
Now we’ve got physicians all around the country, and a guy can go in and he gets listened to like any other athlete, and the first words out of the doctor’s mouth aren’t, “you need to quit doing what you’re doing.” They’re seeing somebody they know who is going to help them get back to what they do as quickly as they can and as safely as possible.
Is there more emphasis now on training and injury prevention than there used to be, and do contestants take it more seriously? That’s a yes and no question. Yes, injury prevention is an important part of what the program is about and an important part of what the PBR sports medicine program is about. When I talk about trainers, I’m talking about athletic trainers; they’re not the guys who show you how to lift weights at the gym. They’re certified medical providers. They have college degrees from four-year colleges, some of them have master’s degrees, and they’re board-certified athletic trainers, licensed to practice. Injury prevention is a big part of what they do. They teach guys how to prepare before they get on in terms of warming up and stretching, and when they have had injuries, provide them with rehab protocols and for those that are interested, also helping them in terms of things like exercise programs.
Some guys are really dedicated to it and spend a lot of time training to be prepared for their event. They realize that being physically fit may help them compete better. And some guys’ idea of training is to go out and get on some practice bulls. Beyond that they don’t do a whole lot. From that standpoint some of these guys haven’t changed that much.
Have you seen attitudes change on helmets and safety vests? The vests came along just before I started or about the same time. [Bull rider] Lane Frost had died in 1989; Cody Lambert had a vest in 1993 or 1994. By the late 1990s everybody had them. PBR had a rule that they had to wear them. Most of the rest of the PRCA guys were wearing them by the time I was spending a lot of time at this. Vests have made a big difference, I believe, and I think the numbers bear that out in terms of reducing major inter-abdominal and chest injuries.
As far as helmets are concerned, right now probably two-thirds of the bull riders wear helmets. When I first came around nobody wore a helmet. The young guys don’t know any different. Most of them had to wear them when they were in high school or college. And it’s a good thing. It doesn’t do anything in terms of preventing concussions, because concussions are by and large the result of what happens inside the skull and not what happens outside the skull. Where it does make a difference is in terms of facial fractures, because helmets have a facemask and that prevents a lot of fractures.
Although it’s been proven in football, there aren’t enough numbers to be able to prove it in rodeo, but it probably decreases the risk of major head injuries, like skull fractures and intracranial bleeds. I’ve seen more than one guy manage to avoid a head injury because he was wearing a helmet, and I’m pretty sure that at the very least he would have spent a lot of time in the intensive care unit and probably not riding any bulls anymore if he hadn’t been wearing a helmet.
Are there improvements that can be made in sports medicine as it pertains to rodeo? Sports medicine is a multi-billion-dollar industry. Trying to find ways to make things better, whether it’s surgical or innovations in training techniques or injury prevention, there is something going on all the time. In terms of rodeo, it’s about adapting things from other sports. Research takes money, and money tends to go where money is going to be made. While we think of rodeo as a big sport, it’s not the NFL, it’s not the NBA. Research money tends to go places where there are lots of competitors and lots of money to be made. Rodeo is still kind of a small sport.
Fortunately there have been some people who have been able to look at it as a niche market, so there are some helmets out there that are designed specifically for rodeo and bull riding. We’d like to see better equipment in terms of helmets, and the people who are involved in doing that are getting as much encouragement as we can give them, but they don’t have people lining up to give them money to build those helmets.
There’s probably a lot more money spent on developing things for the horses than there are for the cowboys, particularly in barrel racing, tie-down roping and team roping. There’s a lot of money spent on those animals. But we try to do what we can do with what we’ve got.
This article was originally published in the December 2016 issue of Western Horseman.