SPORT Medical Monitoring in High-Performance Race Car Driving

Dr. Mayer has been working with Porsche for 20 years. He is an orthopaedic surgeon and the medical director of the University Outpatient Clinic in Potsdam, where he runs the sports medicine centre. We sat down with Dr. Mayer as he supported the Porsche team before Le Mans 2021, and asked him what it takes to keep the world’s fastest drivers running like a new engine.

Let’s start with you giving us a general overview of your role. What is the main purpose of having a doctor on a racing team?

Besides onsite treatment and consulting at the race track our main focus is centered on all-year general health monitoring of the drivers. At least twice a year they come to our clinic where all the basic health checks are done, musculoskeletal, cardiology, run through diagnostics and some exercises – whatever is necessary to monitor and maintain their general health. Based on that we try to prevent injuries, or anything that could restrict their driving. The drivers are educated to deal with any common issues for drivers, like for example, strain on the lower back and the neck, or the effects of flying and traveling so much. In addition, we also run a fitness program with them. Running, cycling, strength training, sensory motor control of the core and the extremities. In all these areas we’ve developed scientifically-based programs that we’ve been running with Porsche for nearly 20 years.

How many doctors are there working with Porsche? 

We are a big team. There are eight physios worldwide, three doctors, and two athletic coaches consulting the factory drivers and the teams. We all share information and findings among each other regularly and try to be at as many races as possible. We have different experts in the field, including Dr. Lindemann, an ENT (ear, nose, and throat) specialist and Dr. Cassel, another orthopaedic surgeon. One of the most frequent reasons drivers are not suitable for racing is infections of the respiratory or gastrointestinal system. Therefore prevention of these infections besides musculoskeletal complaints is the main issue for us doctors.

How closely do you work with the drivers throughout the year? 

We normally see them in November or December after the running season, so then if they need any special treatment, or even surgery, they have Christmas and the beginning of the year to recover. This is also an important period for basic training, when they can exercise a bit more to improve their basic health for the whole season, so when they’re on the road they just have to maintain it. Besides health issues our coaches and trainers work with them in person three or four times a year. In addition there are online sessions regarding physical training as well as medical consulting. The most important thing however is to educate the athletes, so that the drivers know what they have to do themselves.

Are there any specific exercises for drivers? 

I would say there are a number of key things, in each field. We’ve developed some programs for maximising stability and agility while they’re sitting in the car, keeping the legs coordinated. Even if they’re strapped into personalised seats that are moulded to their bodies, they still have to stabilise themselves, engage their cores. That’s why they do a lot of core strength exercises related to strength testing in that area. Furthermore, we put a lot of effort on spine stability and motor control, because we see a lot of mostly overuse injuries due to G-forces and vibrations in the lower back and neck. 

Are back and neck injuries the most common for drivers? 

Yes, we see a lot of issues in this area since external forces in the car are mostly sudden and unpredictable perturbations – sudden reactions when the body has to compensate for pretty high external loads. If these situations occur a lot over 24 hours, when it’s repetitive, muscles get tired, and the risk of uncompensated loads and overuse is greater. However, compensation can be optimised through specifically tailored training programs. We also see some cardiovascular and metabolic loading conditions due to the amount of time they’re in the car, as well as due to fluid loss, if they’re in a hot climate. Therefore, another focus of our health monitoring is to improve their general basic endurance capacity. If your basic level is pretty good, you recover better, your immune system is addressed, the better you sleep, and the better your body can tolerate anything troubling that comes along. Monitoring body weight while maintaining calorie and energy uptake is also an issue, so we focus on a balanced diet with them.

What diet do drivers have? What is your role in terms of their nutrition, and is it different for each driver? 

One goal is to adapt the diet to the individual needs of the drivers. We take their usual eating and sleeping habits into account, measure anthropometrics regularly and then tailor a program to their specific needs. Twice a year they get specific recommendations from our nutrition specialist. What the drivers need is, on one hand, related to their work in the car, and on the other hand, it’s quite dependent on the exercise they do outside of the car. Athletes need to eat carbohydrates in relation to their energy requirements in the training regimen, however, if they’re not burning all the carbohydrates, bodyweight will increase, which is not welcome in race car driving. So most importantly we educate them on how to balance carbohydrates, protein, and fats – what we call the macronutrients.

So you don’t tell drivers exactly what they should eat? 

Since the drivers are on the road most of the year they have to know what they should eat and drink by themselves. When we’re at a training camp we might go into more detail and help them in practice or even tell the hotel about dietary requirements, but we don’t do that regularly at the racetrack. Based on regular education, the drivers have to make their own choices at the buffet, but we consult them onsite whenever possible. The system runs pretty well taking into account that some drivers don’t have to worry that much about what they eat if their diet is balanced, whereas, others are more sensitive in terms of fluid loss, gastrointestinal problems, or other dietary requirements.

Are there any particular vitamins or supplements that drivers should take?

When your macronutrients are fine and balanced and enough fluid is consumed, then your vitamin levels are usually good too. If you have a balanced diet there’s normally no need for supplements as well. It’s preferable to get all the nutrients you need from your regular diet. So we try to educate drivers on what a balanced diet is, and how to deal with things like replacing lost fluids when they are somewhere in the world where it’s very hot. They have to replace fluids as well as electrolytes and stay hydrated. Nevertheless, if there is an evident and diagnosed medical reason for it we take supplementation into account.

Are there different dietary requirements for different kinds of races? Endurance races, for example?

Yes, carbohydrate intake may be dependent on the race, but mainly it’s dependent on what they do off the track in terms of general exercise. They consume and burn more carbohydrates when they’re running and cycling than when they’re in the car.

Is there a difference in the way older and younger drivers use the information you give them?

We are lucky to have been able to work with Porsche for 20 years and develop a consistent program. Since most of the drivers have been team members for several years, they have acquired more medical knowledge and experience with training. The younger ones also push hard to improve themselves, so they listen to every recommendation. Working with them from the beginning of their careers is great fun, very interesting but also demanding.

And do you just deal with physical health? How do drivers manage their mental health? 

We’re the physical guys so we don’t have that much knowledge in this field, but there has been mental health training for the drivers as well. There are excellent mental health specialists that work with them. The goal of the medical team is that whenever they need to drive, there are no physical restrictions. That’s our thing.

How does your work with drivers compare with other sports? Do drivers have to keep themselves fit and healthy in the same way as other athletes? 

We work with a lot of athletes in different sports, including national teams and Olympic athletes. Even if the specific demands in race car driving are different from other types of sports, the drivers have to keep themselves fit and healthy as professional athletes taking sport-specific, as well as medical issues in high-performance sports, into account. One example is to prevent repetitive infections by exercising, diet, and basic hygiene – not just due to Covid, but all the time, especially when travelling around the world.

Have you had to deal with a driver needing a lot of rehabilitative work after a big impact?

We have had some accidents over the years, but mostly ones that require the usual musculoskeletal rehabilitation. We saw some fractures, elbow and knee fractures, even spine fractures. In these cases, they get differentiated medical care just like regular athletic patients, and they have to go through a sophisticated rehab program with specialists.

We’re speaking to you now in the Porsche garage at Le Mans. Is there any specific thing that you need to do with the drivers before a race like this? 

Le Mans is a long week and a long race! Usually, all drivers were examined on the first day by physiotherapists and one of us doctors. So we can see whatever we can do to get them in the best condition possible before the first practice session, and then we try to maintain it. In addition, full health checks are usually scheduled one or two weeks before Le Mans. If there are any deficits we might react and help the drivers.

Over the past 20 years, what significant developments have you seen in your field? 

Overall medical care and consultation in race car driving got more differentiated and professionalized. Since race car drivers are professional athletes, medical monitoring increased in relevance. Furthermore, drivers are in the car a lot more. They have really tough schedules, they’re traveling a lot, and have to meet a lot of different commitments. The need to stay as healthy and fit as possible has therefore increased over the years. They really behave as professional athletes like in any other type of sport.

As much as we wanted to hear more about cardio and carbs, we had to close there. Dr. Mayer is definitely the kind of calm, knowledgeable influence you want on your team – especially if you’re pushing yourself to the edge of endurance. We had renewed admiration for race car drivers after speaking to him, and we’ll be thinking about his advice the next time we watch a race – or sit in the driver’s seat…