At the beginning of August, Duke football players were getting ready for practice by focusing on where the playbook told them to block and run when a player called an athletic trainer complaining of bad body aches.
Robert "Hap" Zarzour, then the head athletic trainer for football, took the player to the Student Health Center, where tests confirmed he had the 2009 H1N1 flu virus, known as swine flu. Several weeks before Duke's home season opener, more than a dozen players were diagnosed with swine flu symptoms.
Lucky for them, they had Duke on their side. And for the season kick-off in September, all the starters were on field.
"The care for the team was incredible," said senior quarterback Thaddeus Lewis, a captain. "It was a difficult situation, especially given the timing of it all with preseason camp going on. We always hear that we're lucky to be at Duke. where the medical staff is the best in the country, and that's definitely right."
From the tackling on football fields in the fall to rowing on Durham's Lake Michie in the spring, Duke athletes rely on the team behind the team -- the dozens of full-time athletic trainers, doctors, rehabilitation specialists and sports medicine fellows at Duke -- to keep them healthy on and off the field.
"It's all about being a part of something bigger than yourself," said
Dr. Jeff Bytomski, the head medical team physician for Duke Athletics. "When these teams try to win championships, everyone has a role to play -- from the strength trainers to nutritionists to us."
When football players started coming down with H1N1, the virus could have spread quickly, affecting more than just a dozen players.
But Zarzour and other members of the training staff held meetings throughout the summer, working preemptively to aggressively treat any potential outbreak.
From the first day on campus, doctors and trainers educated coaches and players on techniques to stay healthy like washing hands often and reporting any health problems. The head medical team physician for Athletics set up a twice-a-day clinic where players went for health evaluations to check for fever and flu-like symptoms or to learn more about H1N1.
When players showed symptoms, the medical staff isolated them from practice and kept them in separate living quarters so others didn't get sick. By Duke's first game against the University of Richmond on Sept. 5, the team had beat the flu bug.
"It could've been terrible, but because it was such a team effort, things were manageable since everyone was doing their part -- from the people cleaning the buildings we work in to our physicians," said Zarzour, now director of athletic training. "We were getting calls from other schools around the country asking us what we did and what they could do to prevent a spread of swine flu."
But responding to seasonal viruses isn't the only care the staffs from athletics and sports medicine provide to Duke teams.
Acting as the frontline of injury prevention, athletic trainers like Kristi Hall often work 10 to 12 hours a day -- and that doesn't count game days. Hall, who works with the rowing and fencing teams, is one of 11 trainers who typically care for two teams and handles anything from a sprained ankle to rehabilitation.
Unlike football, where players are more likely to suffer unexpected and serious injuries, Hall focuses more on preventing chronic injuries such as tendinitis or inflammation of a joint or muscle, which are likely to happen to rowers and fencers.
When she came to Duke in 2006, Hall implemented a preventative habilitation program with her teams that was created by physical therapists at Duke. The program runs athletes through tests to check muscle and joint strength and flexibility before a season starts to find potential injury problems. By finding problems early, Hall makes sure athletes strengthen weaker joints like a knee, so they don't get injured later.
"You don't want to just react to injuries," said Hall, who cares for more than 70 student-athletes. "You want to make sure you're doing everything you can to prevent them."
Members of the Duke rowing team commonly work out their aches with team athletic trainer Kristi Hall.
Since Hall became the first full-time trainer for the rowing team, head coach Robyn Horner said her team has had the healthiest period in more than a decade because rowers have been able to avoid recurring injuries like tendinitis, and players also healed more quickly when hurt. That presence has helped keep the Blue Devils one of the top rowing teams in the Atlantic Coast Conference.
"Having Kristi on our staff has been absolutely pivotal," Horner said. "As a coach, I have all sorts of things to worry about, but when it comes to the medical side, I know I don't have to worry about anything. It's a good peace of mind."
When there's a case Hall can't handle, other members of the training and sports medicine staff can step in.
On a daily basis, Dr. Jeff Bytomski, head medical team physician for Duke Athletics, visits with up to 20 athletes from various teams at Duke. He helps them with anything from treatment for a common cold to understanding an MRI exam or an echocardiogram, which uses sound waves to create a picture of a heart. He also helped to educate and treat football players, while responding to last summer's swine flu outbreak.
"Handling the swine flu was a perfect example of how we're all working together to build something great," Bytomski said. "Everyone has their own little part in working toward the big picture of keeping all these students healthy."
That includes Claude T. Moorman III, director for Duke Sports Medicine and head team physician, who previously held that title with the NFL's Baltimore Ravens. Moorman said the work being done by trainers and physicians at Duke is like a space program. The university, he explained, has some of the best care providers in the country who try new techniques to keep student-athletes healthy -- like using new radiology scans to discover potential injuries or introducing oral strips that release electrolytes to athletes, allowing them to better hydrate and avoid cramping.
"The beauty of being at Duke isn't just having the capability to care for some of the country's best student-athletes, but helping them stay healthy and become better at what they love," Moorman said. "There's nothing that happens on or off the field we can't handle."