Redefining Care

April 22, 2015

Recently, several innovative sports medicine clinics have opened, their offerings as unique as their facilities. In this multi-author article, we provide a peek inside three of them.

The following article appears in the April 2015 issue of Training & Conditioning.

By Aaron Hellem

Aaron Hellem, PT, DPT, CSCS, is a Physical Therapist at Mayo Clinic Sports Medicine at Mayo Clinic Square in Minneapolis. He can be reached at:

At most sports medicine clinics, it’s unlikely that a high school athlete can be treated by the same physicians and physical therapists who work with Andrew Wiggins, the number one pick in the 2014 NBA Draft, or Maya Moore, a two-time WNBA champion. But at the newly opened Mayo Clinic Sports Medicine Center at Mayo Clinic Square, it’s a reality.

Opened to the public in October 2014, Mayo Clinic Square provides a unique sports medicine experience. As the medical provider for the Minnesota Timberwolves and Minnesota Lynx, Mayo Clinic Square houses the teams’ practice courts inside its facility, which are scheduled for completion in the spring. Once the Timberwolves and Lynx move in, patients at the center can receive treatment while the squads battle during practice next door.

Located a few stories above the bustling streets of downtown Minneapolis, Mayo Clinic Square’s creation was a combination of need and opportunity. Every year, tens of thousands of patients in need of sports medicine were making the nearly 90-mile trip from the Minneapolis/St. Paul metro area to our Rochester, Minn., location. Many expressed a desire for a Mayo Clinic option closer to home.

In 2014, the perfect location became available. At 22,000 square feet, it provided us with enough space to build a sports medicine facility, and being in the center of the city helps us better serve the broader Twin Cities population. Plus, the space is connected to Target Center, home of the Timberwolves and Lynx, providing easy access for the teams.

Mayo Clinic Square differs from a traditional sports medicine facility in a number of ways. The most significant is that it takes the Mayo Clinic’s famous model of integrated medicine and applies it to athletes. Integrated medicine ensures all individuals who visit the clinic benefit from a group of providers, including physiatrists, orthopedic surgeons, physical therapists, athletic trainers, musculoskeletal radiologists, radiology nurses and technicians, performance coaches, dietitians, and support staff. Involving our whole team allows us to gather multiple perspectives and discuss how to reach the best solution for each athlete.

Our integrated approach to athlete treatment covers everything from pre-practice nutrition to surgical reconstruction. The center offers a variety of sports medicine services, such as injury diagnosis, regenerative medicine, physical therapy, strength and conditioning, and sports dietetics. The clinic also provides 13 different sport-specific performance programs for athletes of every age and ability. These consist of a two-hour appointment with a physical therapist that includes a musculo-skeletal evaluation, a 2-D video analysis of movement mechanics, and a tailored home exercise program.

One of the best ways to see our integrated approach in action is by observing our partnership with the Timberwolves and Lynx. Being connected to their shared arena, along with the practice courts, corporate offices, and sports medicine facilities located in the Mayo Clinic Square complex, means all of the athletes’ needs can be met in one location.

We believe our partnership can serve as a model for other NBA and WNBA teams because it is mutually beneficial. The Timberwolves and Lynx have direct access to our sports medicine and performance services, while we are able to utilize the teams’ marketing platforms to raise awareness about wellness issues.

Aside from our comprehensive take on sports medicine, Mayo Clinic Sports Medicine also differentiates itself from other facilities by offering services to our patients through collaboration with EXOS (formerly Athletes’ Performance), a leader in integrated performance training. The EXOS team includes certified strength and conditioning specialists and a registered dietitian who is certified in sports dietetics. EXOS coaches are housed within our center and see athletes referred by our providers.

EXOS’s services are buoyed by the center’s state-of-the-art equipment. We have areas dedicated for video analysis of baseball/softball players, runners, and golfers. There are 45 yards of turf space for functional work, and an Alter-G treadmill flanks the turf that can be used to off-load an athlete returning from injury.

All athletes who work with EXOS go through an initial evaluation to assess their readiness, fitness level, and movement quality. They then work with a performance specialist to create a game plan based on the results of their assessment. The EXOS coaches tailor each training regimen to the athlete’s specific sport, position, physical strengths and weaknesses, and attitude.

EXOS maximizes athletic performance by optimizing its four pillars: Movement, Mindset, Nutrition, and Recovery. While all athletes have goals, EXOS coaches delve into their psyche to find out what drives them.

The sports dietitian provides individualized plans customized to meet the needs of each athlete based on their performance and nutrition goals. In addition, the sports dietitian operates a nutrition bar just outside the training space, where pre- and post-training fuel is available to enhance performance.

Lastly, recovery is integrated into EXOS’s training twice a week. Techniques are employed to apply a regenerative stimulus to the athlete’s system, including massage therapy, hydrotherapy, proprioceptive neuromuscular facilitation, active isolated stretching, whole-body vibration, light calisthenics, movement technical work, and metabolic-oriented resistance training.

The important thing to note about EXOS’s four pillars is their relationship to each other. Segregating any of them from the group will lead to less-than-optimal results for the athlete. The elegance of the system is watching the pieces come together.

Though we just opened Mayo Clinic Sports Medicine in October 2014, we look forward to our facility’s continued development. We are excited to grow our relationship with the Timberwolves, Lynx, and broader downtown community, providing world-class patient care to athletes of all ages and types for years to come.


Prevention First

By Corey Dawkins

Corey Dawkins, ATC, is an Injury Prevention Specialist at the Micheli Center for Sports Injury Prevention in Waltham, Mass. He can be reached at:

Nearly 20 years ago, Lyle Micheli, MD, an orthopedic surgeon from the Sports Medicine Division of Boston Children’s Hospital, decided to review the department’s original charter from 1974. He noted that, despite it being a goal laid out in the document, little was being done in the clinic to prevent injuries. It was then that he came up with the idea for a training center dedicated exclusively to injury prevention.

After years of planning, fundraising, and construction, Dr. Micheli and his team have made that dream a reality. The Micheli Center for Sports Injury Prevention broke ground in October 2012 and opened to the public in April 2013, becoming one of the only centers in the world that conducts research on sports injury prevention and works directly with clients to keep injuries at bay.

Since then, the Micheli Center has taken Benjamin Franklin’s adage, “An ounce of prevention is worth a pound of cure,” to heart. All too often, it takes a serious injury for athletes to treat prevention seriously. The Micheli Center is a pioneering force in reversing this trend by offering athletes evidence-based strategies to minimize their risk of injury, keep past problems from recurring, and improve sports performance.

Located in Waltham, Mass., on the campus of Boston Children’s, the Micheli Center is staffed by a unique mix of clinicians, researchers, and administrative staff. Patients work primarily with our Injury Prevention Specialists and Fitness Specialists. Injury Prevention Specialists are knowledgeable in athletic training, exercise science, and kinesiology and craft individualized prevention prescriptions for athletes. Fitness Specialists, who have additional expertise in the fields of personal training and strength and conditioning, work with athletes to fulfill these programs.

The Micheli Center’s flagship offering is its Injury Prevention Evaluation (IPE), a three-hour examination that provides each athlete with a personalized plan for lowering their injury risk. To create the framework for the IPE, our clinicians researched athletes from 40 different sports. The researchers recorded common injury risk factors, measurements to determine if an athlete falls within a safe range for participation, and prevention strategies for the identified risk factors, collecting an average of 300 data points per subject. Our lead software developer then used the findings to create a program called Sports Injury Prevention Prescription (SIPRx), which analyzes the data to determine an athlete’s injury risk profile and suggests preventative or corrective exercises.

When athletes arrive for an IPE, they first complete a pre-evaluation questionnaire that asks about their injury, sports, and training histories, as well as general lifestyle habits. Next, an Injury Prevention Specialist collects measurements of their strength, range of motion, cardiovascular endurance, flexibility, balance, and functional movement.

SIPRx compares all of this information with published research on sports injuries, which is then reviewed by one of our sports medicine physicians to see what injuries the athlete is at risk for. Once completed, the physician will decide on the best injury prevention prescription.

To complete the athlete’s visit, the Injury Prevention Specialist goes over the regimen with them. It will typically consist of stretches and strength and conditioning exercises, several of which the Injury Prevention Specialist will teach the athlete. We encourage athletes to return every three months to repeat their IPE and periodically follow up to inquire about their sports, participation levels, and any recent injuries.

Besides the IPE, we offer several other services. Runners are some of our most frequent clients. We offer a quick-start running program for healthy runners and a gait-retraining program for the injured population. Both of these focus on improving strength and flexibility deficits and achieving an ideal gait.

We also provide services to address common sports injuries, such as ACL tears and concussions. Our ACL injury prevention program focuses on athletes who have strength, flexibility, proprioceptive, or neuromuscular control deficits that increase their risk of an ACL injury. Athletes who have already undergone reconstruction can participate in our return-to-play program. For concussions, we offer prevention and return-to-play services.

In addition, we now offer 3-D motion analysis for golfers and baseball pitchers. During their first visit, pitching or golf-specific strength and flexibility measurements are taken. Then, 50 specialized markers are placed on the athlete, which are used to track their swing or delivery motion to identify areas where breakdowns occur. The athlete returns in a week or two to review their mechanical inefficiencies and injury risk factors. They are also given an exercise prescription to address any weaknesses or imbalances seen in the motion analysis.

While we do not treat acute injuries, we do introduce corrective exercises with injured athletes to keep future issues at bay. If a trainee has a lower-body injury, for instance, we will use seated upper-extremity movements or non-weight-bearing core exercises to arrive at our treatment goals without aggravating the injury. We might also utilize cross-education strengthening exercises on their healthy leg to attain gains without stressing the injured side.

Beyond our focus on injury prevention, the Micheli Center separates itself from traditional sports medicine centers by focusing on active research of sports injuries, including those resulting from poor gait patterns, ACL prevention strategies, performance artist injuries, concussion prevention, and rotational injuries. We seek to advance the field of sports medicine by revealing current injury patterns and risk factors while developing new methods, strategies, and technologies for preventing future ones.

When the Micheli Center first opened, most trainees were referred from the Sports Medicine Division at Boston Children’s after an injury. Since our goal is prevention, we’ve made a strong push into the community to educate parents, coaches, and other health care professionals about our offerings.

We hold seminars at the Micheli Center and throughout the area that focus on ways to decrease the risk of key injuries. Additionally, we’ve spread the word about our services at athletic events in the community, including tournaments, coaches’ clinics, and track and field meets.

Early on, it was challenging to convince athletes that injury prevention was necessary for their short- and long-term well-being. As we gathered data and repeated measurements, however, athletes saw improvements to their health, which started to change their minds. They became more enthusiastic when they realized our programs would help them in their sport. As a result, we have seen an increase in our word-of-mouth and partner referrals.

In the future, we hope to continue our growth by making our services more affordable for clients. Since insurance companies usually do not cover injury prevention treatments, we do not currently accept medical insurance. We’re striving to develop sufficient research to validate our injury prevention model so that insurance companies will cover our offerings.

Until then, we believe it is important for everyone in the community to have access to the center if they need it, so we keep consumer costs low by relying on philanthropy and grant funding. We also established a scholarship fund to offset our costs for families that are in financial need.

Since we opened to the public two years ago, the results of our prevention plans have been excellent. Although data analysis and research is an ongoing process, we have seen the desired results with our return-to-running and gait-retraining programs. Athletes have shown improved mechanics and decreased the negative forces exerted on their lower bodies. Clients have also noted that as they improved their running efficiency through their work with us, they decreased their 5K and 10K times.

By obtaining positive results, the Micheli Center is leading the way in changing attitudes about injury prevention. No longer is it something to focus on only after a major injury. Instead, athletes are recognizing that injury prevention is an important factor in their long-term success. Moving forward, we hope to continue to change perceptions about injury prevention and make it a larger focus in the health care system.


New to the Club

By Meghan Fulton

Meghan Fulton, MA, ATC, is Head Athletic Trainer for Sport Clubs at the University of North Carolina. She can be reached at:

Across college campuses, thousands of athletes have little or no access to sports medicine care. Because they play for club sports teams, athletic trainers don’t cover their practices and games, and they must find their own treatment for any injuries.

In 2008, the University of North Carolina set out to change this. By starting a Sport Clubs Athletic Training department, it joined a small, but growing, number of schools that provide medical coverage exclusively for club athletics.

The department was the brainchild of Jason Halsey, Associate Director of Programs for UNC Campus Recreation. When he arrived in 2008, the school wasn’t providing any athletic training services to club athletes. But with more than 1,500 club participants competing in 50 different sports—from ballroom dancing to tae kwon do to rugby—Halsey quickly recognized the importance of providing medical coverage for this population.

He worked with the director of campus recreation, the chair of exercise and sport science (EXSS), and the director of UNC Sports Medicine to create the Sport Clubs Athletic Training department. It is part of the Sports Medicine Department within Campus Health Services. All UNC athletic trainers, including those working with varsity athletics, are employees of Campus Health and are supervised by its physicians.

A hallmark of the Campus Health system is that it offers open access to all students, regardless of athletic status. The physicians and orthopedic surgeons providing care to UNC varsity athletes also have a responsibility to recreational athletes and the general student population. This extends to athletic trainers on staff as well, who are required to spend one half-day a week in the campus’s physical therapy clinic.

In 2010, I was hired to be the second Head Athletic Trainer for UNC sport clubs. I work on a nine-month contract during the academic year. Currently, I’m assisted by two certified graduate student athletic trainers and several undergraduate athletic training students from the EXSS department.

My staff and I offer sport club athletes a wide variety of athletic training services, starting with coverage for evening practices. Graduate athletic training students in EXSS rotate to keep our athletic training facility open Monday through Thursday until 11 p.m. and on Sundays from 2 p.m. to 10 p.m. During these hours, they provide on-call and triage coverage. This model is mutually beneficial—injured club athletes get the immediate care they need, and the graduate students get to fine-tune their athletic training skills.

We also provide on-field athletic training coverage of home sport club events, such as rugby matches, soccer games, and swim meets. But with only three certified athletic trainers available to cover so many activities, this is easier said than done.

To make event coverage more manageable, Halsey and I created a tier system that designates each club sport as low, moderate, or high risk based on the NATA’s recommendations and guidelines for appropriate medical coverage, which takes into account factors like participation numbers and injury rates. High-risk sports include rugby, ice hockey, and Ultimate Frisbee.

Moderate-risk sports include women’s lacrosse, field hockey, and water polo, while tennis, baseball, racquetball, and dance are considered low risk.

A member of the Sport Clubs Athletic Training staff is always on site for a high-risk club event and usually attends moderate-risk competitions. We typically aren’t present for low-risk activities but remain on campus and on call in case there is an emergency.

Besides incorporating coverage for practices and games into the new department, Halsey felt it was important for athletes to be able to meet individually with a member of the Sport Clubs Athletic Training staff for injury assessment, treatment, rehabilitation, and prevention. In order to control the flow of patients, appointments, rather than open hours, were necessary. Appointments are available Monday through Friday and are held in the same athletic training room utilized by the varsity athletic department. In fact, it’s not uncommon for a club athlete to be completing rehab exercises right next to a varsity player.

Offering appointments is well-received, and we average close to 400 per semester. However, shortly after I joined the Sport Clubs Athletic Training staff, I recognized that club athletes needed more immediate access to athletic trainers after weekend road contests.

To meet this need, I established an injury clinic for them on Monday afternoons in the campus health center. These visits are similar to a triage clinic/injury check. They are quick, 15-minute assessments and result in referrals only—no rehab or treatment is offered. The early and collaborative management of ACL tears, ankle sprains, muscle strains, and concussions at the Monday clinic has led to improved outcomes for sport club athletes.

So far, we’ve had a great deal of success in treating club athletes through our department. However, we face a unique blend of challenges that we approach with a mix of flexibility, empathy, and creativity.

Many of the issues we face center on the logistics of providing coverage. Although the department has a staff of three certified athletic trainers, reasonable coverage hours can be difficult on weekends when there are many tournaments occurring simultaneously. I have a per diem budget that allows me to hire additional part-time athletic training services when needed, but we still aren’t always able to provide full coverage for events.

One way we’ve learned to manage is by bringing Campus Recreation employees and sport club participants up to date on emergency protocols. For instance, the Campus Recreation department hires a select number of sport club supervisors annually. Each supervisor is first aid, CPR, and AED certified, and I hold a training session for them focused on risk and emergency management. Supervisors have a specific role in the sport clubs emergency action plan and are trained to provide immediate first aid should an athletic trainer not be on site at an event. They also serve as our eyes and ears at low-risk competitions.

Additionally, each of our club teams are required to have at least two members with current first aid, CPR, and AED certification. I lead a separate risk management training session at the start of each academic year for these athletes, which covers emergency action plans, AED locations, inclement weather policies, concussion recognition and referral, and immediate injury management.

Other challenges relate to the administrative side of sport clubs. My staff and I are often at the mercy of student-run organizations when it comes to scheduling. Many clubs do not have coaches or administrators helping with game and tournament scheduling or field reservations, so it’s up to the team presidents and captains to work out logistics.

This makes it essential to have good communication between the clubs, Halsey, and my athletic training staff. In addition, Halsey and I have weekly meetings to discuss our upcoming obligations.

One area that I thought would be challenging but has worked out smoothly is return-to-play decision making. Should my staff or I think it is not safe for an athlete to participate in their sport, I communicate with the club presidents and Halsey. Once the athlete is listed as out, Halsey’s staff ensures they do not participate, and there are steep penalties should an athlete play against our recommendation.

Overall, I find my role as a sports club athletic trainer to be clinically challenging and rewarding. The large variety of athletes and injuries keep my staff and I on our toes, and I have seen many athletes through post-operative care, return to play, concussions, and emergent injuries. I pride myself on helping these individuals continue to participate in their sport while teaching them about the role of an athletic trainer.

Athletic training programs for sports clubs are becoming more prominent across the country as campuses recognize the important role they can play. While the Sport Clubs Athletic Training department at UNC is unique in its operation, the foundations of the program can extend to any campus.


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