Aug 17, 2016
Open For Business

Unique sports medicine clinics are popping up across the country, and Marshall University is leading the way with a pair of innovative new facilities. Take a look inside both in this two-part article.

This article first appeared in the July/August 2016 issue of Training & Conditioning.

Despite offering similar services, it’s rare to find two sports medicine clinics that are exactly alike. In fact, these facilities can be just as diverse as the patients they serve.

Some stand out more than others, however, due to a unique approach. Whether it’s their organizational structure, treatment methods, or location, clinics that try something new redefine care and expand the reaches of sports medicine.

Marshall University is home to two such facilities. While one takes a comprehensive approach to care and the other addresses an underserved population, both are pushing the field forward by thinking outside the box.


By Tom Belmaggio

Tom Belmaggio, MS, ATC, CSCS, is Sports Medicine Program Coordinator for the Marshall University Sports Medicine Institute. He previously spent eight years as the school’s Head Athletic Trainer. He can be reached at: [email protected].

Although its doors opened in July 2015, the building blocks for the Marshall University Sports Medicine Institute (MSMI) were first laid 12 years before. At that time, Charles Giangarra, MD, Chief of Orthopedic Sports Medicine in Marshall Health’s Joan C. Edwards School of Medicine and Team Physician for Marshall athletics, had grown tired of shuttling injured athletes from one facility for imaging, to another for treatment, and then to a third for rehab. He wanted to create a comprehensive sports medicine center on campus that could treat patients from diagnosis through return to play.

Since few, if any, clinics like this existed at the time, the idea was groundbreaking in and of itself. However, what truly set Dr. Giangarra’s plan apart was his desire to go beyond the Marshall campus and open the facility to the active population of surrounding Huntington, W.Va. By providing advanced care to both Thundering Herd student-athletes and the general public, Dr. Giangarra hoped to make Marshall a nationwide leader in sports medicine.

To turn his vision into a reality, Dr. Giangarra knew he would need some help. So he banded together Marshall Health, Marshall athletics, Marshall Orthopaedics, and Cabell Huntington Hospital to get the ball rolling.

Over the next decade, we gradually checked off all the boxes required to get the MSMI off the ground. To start, it needed funding. The school acquired private donations for the MSMI through the Marshall University Vision Campaign that were then matched by the West Virginia Research Trust Fund’s “Bucks for Brains” initiative, which supports research and infrastructure aimed at improving economic development, health care, and job growth in the state. With funding secured, the MSMI was slated to be the final piece of the Chris Cline Athletic Complex, a 108,000-square-foot facility that houses a track, indoor practice facility, student-athlete academic center, and athletics hall of fame.

Next, we got all the equipment needed to treat patients under one roof. Using a combination of funds raised by Marshall athletics and budgeted by Cabell Huntington Hospital and Marshall Health, we acquired an X-ray machine, Fluoroscan, and the tools to perform platelet-rich-plasma injections. We also bought plunge tanks and an underwater treadmill for the planned hydrotherapy room and purchased an anti-gravity treadmill, thermostim machine, laser technology, active compression and cold therapy system, balance system, sports simulator, and compression boots to put in the treatment rooms.

As construction progressed and we got closer to completing the MSMI, we realized it was time to make athletes on and off campus aware of our new clinic. However, we were concerned about getting the public to buy in to the benefits of having all sports medicine services under one roof. After all, our competitors had been staples in the community for years, so we had to convince patients to try our facility.

We did this by rolling out a major marketing campaign before the MSMI opened. Branding it “the region’s game changer,” we shot a series of commercials to spread the word.

Our promotional efforts paid off, and we’ve had a steady stream of patients since we opened our doors. True to Dr. Giangarra’s vision, the 22,000-square-foot MSMI is staffed by a comprehensive team of orthopedic surgeons, family practice physicians, pediatric physicians, pediatric neurologists, athletic trainers, physical therapists, massage therapists, chiropractors, nurses, nutritionists, sports psychologists, and strength and conditioning coaches.

Marshall athletes have access to their own athletic training room within the MSMI, and our physical therapists work with the athletic department’s sports medicine staff to treat them. The public can see physicians from Marshall Orthopaedics and physical therapists from Cabell Huntington Hospital. Each group shares the MSMI’s technology, equipment, and hydrotherapy room.

To ensure we have the greatest impact possible, we offer patients access in a variety of ways. Besides making an appointment, they can visit our walk-in clinic from 9 a.m. to 3 p.m., Monday through Friday. Marshall students can receive treatment Monday through Friday at a free walk-in clinic inside the campus rec center. The MSMI also provides outreach athletic training to five local high schools and holds a free Saturday morning clinic from August 1 to June 1.

Beyond offering comprehensive sports medicine care, the MSMI specializes in concussion management and performance training. We hold a concussion clinic every Wednesday, during which a physician, neurologist, and psychologist provide comprehensive baseline and follow-up concussion testing. In addition, the MSMI formed the Marshall Concussion Consortium, a group of regional medical practitioners who regularly meet at our facility to discuss concussion care.

Through a partnership with STACK Sports Performance, we also offer elite training and testing to increase patients’ explosive power, speed, agility, and quickness. A “Bridge Program” features post-rehabilitation training in collaboration with the MSMI’s physical therapists, as well. Although these services are used primarily by the general public, we do work with Marshall athletes who are preparing for their professional playing careers.

Throughout the MSMI’s first year of operation, the biggest lesson I’ve learned is the importance of communication. Other schools looking to start a similar sports medicine institute must know that it won’t work if there are any turf wars. There needs to be open communication among all parties, and everyone from providers, to professionals, to clerical staff needs to be on the same page.

Before the MSMI, Marshall University didn’t have the means to be a leader in sports medicine. Now that we do, we’re eager to develop standards of comprehensive care that others can adopt. Regardless of whether our patients are Marshall athletes or weekend warriors, we know our services have come together to elevate their treatment to the next level.


By Dr. Mark Timmons

Mark Timmons, PhD, ATC, is an Assistant Professor of Athletic Training in Marshall University’s College of Health Professions. He can be reached at: [email protected].

The patients seen at our clinic practice daily and perform in highly competitive environments. They often suffer musculoskeletal injuries, which can sideline them for weeks or months. When these injuries start to severely hamper performance, the patients may be forced to retire. Sounds like I’m talking about athletes, doesn’t it? I’m actually referring to the musicians, dancers, and actors who receive treatment through the Center for Wellness in the Arts (CWA) at Marshall University.

Performing artists have unique health and wellness needs dictated by their creative pursuits. However, this population has long been underserved by medical professionals due to a lack of understanding surrounding the mechanisms of their injuries.

In the summer of 2014, two faculty members from Marshall’s College of Arts and Media (CAM) set out to change this. Nicole Perrone, Associate Professor of Acting and Movement, and Henning Vauth, DMA, Assistant Professor of Piano and Coordinator of Keyboard Studies, both experienced injuries and other health issues during their performing careers, and they didn’t want their students to develop similar problems.

For this reason, they reached out to me and other instructors from the College of Health Professions (COHP) to brainstorm how to bring quality medical care to performing artists. Because my colleagues and I immediately saw the overlap between treating artists and athletes, we were happy to collaborate.

From there, we started to lay the groundwork for what would become the CWA. We envisioned a comprehensive, multidisciplinary program exclusively for performing artists. It would stand out by offering services in the fields of athletic training, nutrition, communication disorders (speech and hearing), psychology, and exercise science.

We wanted the CWA to be about more than treatment, however. It also had to contribute to the academic and professional development of the students and faculty of the CAM and COHP. Therefore, we established three pillars to guide our planning of the program: education, clinical services, and research.

Once we had a pretty good idea of what we wanted the CWA to be and do, our next priority was finding a space to provide services. Since we received no extra funding for the CWA, we had to use existing sites on campus. We quickly determined that consults for nutrition, communication disorders, psychology, and exercise science could be provided at the COHP’s existing clinics and labs.

For our dedicated athletic training facility, we initially wanted to use the athletic department’s athletic training rooms. Unfortunately, they were already at full capacity, so that was a no-go. We turned next to the teaching laboratory used by the Athletic Training Program in the School of Kinesiology. It was equipped with several treatment tables, e-stim and ultrasound machines, and tons of other rehab tools. The School of Kinesiology agreed to let us use the space from 4 to 6 p.m., Monday through Friday, as that time frame would not interfere with classes using the lab.

After finding a site for the CWA’s athletic training clinic, we shifted our focus to staffing. While licensed audiologists, dietitians, clinical psychologists, and exercise scientists from the COHP were willing to offer their services as needed, we wanted the CWA to have its own dedicated athletic trainer. It couldn’t just be any athletic trainer, however. Because we didn’t have a budget to fund a full-time position, we needed a graduate athletic training student. He or she also had to have experience working with performing artists and a desire to continue on that path.

The candidate we ultimately chose, Elliot Smithson, ATC, had spent time treating performing artists at Walt Disney World in Orlando, Fla., and he expressed an interest in pursuing an athletic training career with this population. Once on board, he began graduate studies at Marshall and recently completed his master’s degree in athletic training.

With the logistics of the CWA wrapped up, we prepared to launch the program at the beginning of the fall 2014 semester. To spread the word to Marshall’s performing arts community, we included announcements about the CWA in pre-semester meetings with the CAM and COHP faculty. Students were informed via presentations made during the Music 101 course (which is taken by all freshman music majors), entry-level theater classes, and at theater preproduction organizational meetings. Our involved CAM instructors also distributed educational materials about performance anxiety, hearing and vocal health, and pre-performance warm-ups in their classes and explained how the CWA could address these issues. Furthering our cause to a broader audience, we announced the CWA’s opening on Marshall’s website and created a Facebook page and Twitter account for the program.

Our final promotional step was inviting Eckart Altenmuller, MD, PhD, to Marshall for a series of academic lectures to the COHP, CAM, School of Medicine, and Department of Orthopaedics. Combining his skills as a trained neurophysiologist and classical flutist, Dr. Altenmuller serves as Director of the Institute of Music Physiology and Musicians’ Medicine in Hanover, Germany. We planned his lectures to coincide with the opening of the CWA and advertised both events across campus.

The CWA officially kicked off in October 2014. Afterward, our faculty from nutrition, communication disorders, psychology, and exercise science wasted no time meeting with students as needed.

As for athletic training, music and acting students used the clinic in equal numbers. Most of the injuries we treated were categorized as muscle/tendinous strains, with a few ligamentous sprains, and we saw a number of chronic hand and arm injuries-likely associated with the playing of musical instruments. Elliot provided the majority of the athletic training services, and I assisted when it was busy and provided faculty mentorship.

In addition to the services provided in the clinic, Elliot attended rehearsals for several of the music and theater shows. During these times, he led physical warm-up sessions and provided injury evaluation and treatment for performers who couldn’t make it to the scheduled clinic hours.

Any patients seen by Elliot who needed further evaluation by a physician were referred to the Marshall Sports Medicine Institute or the patient’s personal physician. Emergency cases were transported to Cabell Huntington Hospital and followed up through the Marshall Student Health Center.

During the CWA’s first year, 299 contacts occurred in the athletic training clinic. Ninety-seven of those were initial evaluations and treatments, while the remaining 202 were follow-up visits. This ratio suggests that most of the patients returned to the clinic at least once, which we were thrilled to see.

Although the user statistics for the first year were encouraging, we expected them to be higher. When we analyzed the data, it revealed we were struggling to get consistent visits at the athletic training clinic. Usage would spike when we held an information session about the facility, but then attendance would decrease over time. One contributing factor to this was our location, which is not near the CAM. The future success of our program will depend on our ability to better inform performing arts students of our services. Data for the athletic training clinic’s second year is currently under analysis, but we think we expanded our total number of contacts.

Another challenge we faced in our inaugural year was the lack of knowledge performing artists had about athletic trainers. Most athletes know what we are and what we do, but our CAM students were completely in the dark about what we could offer.

This was very obvious when the issue of concussions arose. By now, most athletic organizations have concussion protocols, but that’s not the case in the world of performing arts. For example, a CAM student received a blow to the head in a rehearsal soon after the CWA started. Elliot diagnosed the student with a concussion, and we had to explain return-to-activity and return-to-learn plans to all involved.

Beyond all our clinical offerings, the CWA fulfilled our research pillar by fostering an investigative collaboration between the COHP and CAM. When we started, the CAM faculty had questions about injuries sustained by performing artists. Over the past two years, the COHP faculty has been searching for the answers while broadening their own horizons.

For instance, at the 2015 Performing Arts Medical Association meeting, Elliot and I presented the results of a study investigating the subacromial space and the supraspinatus tendon in violin players. We found that the arm postures common to playing the violin result in a reduced width of the subacromial space, which has been associated with the development of rotator cuff disease. I have been investigating the relationship between arm motion and shoulder injury for years, but the CWA allowed me to expand my line of research and better understand the mechanisms leading to musculoskeletal shoulder pain.

Other topics under investigation in the CWA include the effects of endurance exercise on dance performance, strength and proprioceptive training on stage combat performance, voice training on singing and stage performance, and the treatment and quantification of performance anxiety in stage actors. These are all in the early stages of data collection.

Since its founding, a lot of people have asked me about the secret to the CWA’s success. For starters, I think the strong collegial relationship between the administrators and faculties of the CAM and COHP has helped the program to flourish. The lack of a budget forced us to pool our resources and concentrate on doing what we could with what we had. Besides using the athletic training teaching lab for our athletic training clinic, the exercise science faculty employed techniques normally used in improving athletic performance to enhance the exercise tolerance of stage performers, while the School of Communication Disorders used hearing screenings for music students to create a learning experience for audiology students.

The absence of a typical hierarchical organizational structure also allowed each discipline within the CWA to grow according to the desire of the involved faculty. This permitted professors to provide services that were unique to the disciplines of the CAM students.

Other schools that are thinking of starting a similar health and wellness program for performing artists are welcome to follow our model. But before doing so, they should first assess their campus’ need for the service, as well as their capacity to provide it. Lastly, they should understand that undertaking something as broad as the CWA is a collaborative effort, and everyone involved should participate according to their strengths.

Despite its occasional obstacles, the CWA has reached its goal of providing much needed medical care for performing arts students, and we hope it continues to grow. Athletes are already accustomed to working with athletic trainers and will seek assistance for their injuries. As the CWA becomes more established, we expect Marshall performing artists to develop the same relationship with the athletic training profession.

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