The Continuum — Methodology

I have spent half my life in gyms, on fields, in the basement of a Brooklyn apartment turned into a training room, and on operating tables where people I love have been put back together after the body that carried them through every great moment of their life decided, on a Tuesday, in the eleventh minute of a friendly match, to stop being trustworthy.

Every time, the moment after the injury looks the same. The athlete is on the ground. The parent is already on the phone. The coach is doing what coaches do, which is hold the space and look brave for everyone else. And the people who actually know what to do next — the surgeon, the physical therapist, the athletic trainer, the sports-medicine doctor, the family practitioner who will sign the form to get the kid back to school — are not yet in the room. Most of them will never meet each other. They will work, very hard, on different parts of the same athlete. And when they hand off, they will hand off through the parent, who is by then exhausted, and who is the least equipped of any of them to be the project manager of a year-long recovery.

This is the failure that the Continuum exists to fix.

The mistake of the moment

When something goes wrong, the instinct is to think about the wrong thing. Everyone talks about the surgery. The surgery is the smallest part of it. The surgery is one day; the recovery is a year; the prevention of the next one is the rest of an athletic life.

We organize our systems around the visible event — the tear, the break, the diagnosis — because the visible event is the part we can charge for, the part we can put on a clinic schedule, the part that has a code in the billing system. So we have an enormous infrastructure for the visible event, and almost nothing for the year that follows, and even less for the years that precede.

This is true in adult sports medicine. It is catastrophically true in youth sports. Because in youth sports, the people who will pay for the visible event are also the people we are counting on to coordinate the year that follows. We are asking a parent to be a project manager for something they have never project-managed before, on a schedule no one will explain to them, with a vocabulary no one will translate for them, with stakes that include whether their kid will play soccer in college.

It is, I have come to think, the single hardest job in American family life. And we have given that family no tools.

The picture

We have spent the last several years building, with quiet relentless attention, a different way to do this. We call it the Continuum because it is exactly that — a continuous thread of attention that follows an athlete from before the injury, through it, and back out to performance and beyond. There are nine phases. Each phase has objective criteria that have to be met before the next phase begins. Each phase has specialists who are responsible for it. Each phase produces information that is useful to everyone else.

What makes the Continuum a Continuum and not just a list of phases is the picture. There is one shared picture of an athlete that lives at the center of all of it. Every specialist who touches the athlete sees the same picture. The surgeon sees what the PT has been seeing. The PT sees what the athletic trainer has been seeing. The coach sees the parts that matter to a coach. The parent sees everything. The athlete sees themselves.

No one sees what they shouldn't. We have spent more time on the permission structure than on almost anything else. Sensitive things stay private by default. The mental-health screen, the eating-disorder screen, the crisis indicators — those are opt-in, never visible to coaches by default, never available to anyone the family hasn't explicitly allowed in. The picture is shared, but it is shared exactly the way the family decides.

Why this is what we are athletes for

Every founder story has a version of the moment that made them do it. Mine was a blood test I almost didn't take, that came back with numbers I almost didn't survive, that led to a year I almost didn't recover from. I came out of that year understanding that being an athlete is not what you do on Saturday in front of a crowd. Being an athlete is what you do on Monday morning when you would rather not.

The Continuum is built for the Monday morning. It is built for the family that is exhausted and still has to figure out what to do for the next nine months. It is built for the PT who hates the part of her job where she has to translate her own work into language a parent will understand and a coach will respect, because that translation is not what she went to school for, but it is what makes her care actually land. It is built for the coach who lost a player to an ACL tear and has spent every practice since wondering what he missed. It is built for the surgeon who knows that the operation went well and also knows that the operation is not what determines whether the kid plays again.

It is built, finally, for the athlete. Who is, in this whole story, the only person who has not had a tool of their own.

What the Continuum is not

It is not a clinic. We do not practice medicine. We refer to people who do.

It is not a curriculum. We do not replace what coaches know about coaching.

It is not a database. The picture is the point, not the storage.

It is not, despite how we sometimes talk about it, a single piece of software. It is a way of seeing an athlete that we have written into software because that is how things scale.

What it costs

For the 100,000 Girls campaign, the Continuum is free. We chose this because we think the cost of inaction is so much greater than the cost of building this for the people we are building it for. For families who participate in a school pilot, the Continuum is also free. For everyone else, eventually, we will charge what it is worth and not a penny more — and we will subsidize through our foundation arm the families for whom what it is worth is more than they can pay.

What we need from you

If you are a family, register. If you are a clinician, talk to us. If you are a school, talk to us. If you are an investor, talk to us. If you are someone who has been in this work for twenty years and has opinions about what we have wrong, please tell us. We are nowhere near done.

You can leave a sport. You cannot leave being an athlete. The body that carried you here is the same body that will carry you somewhere next. The Continuum is how we make sure it does.

We are athletes for life. This is how we live that.

— Tomas