LOUISVILLE/BARDSTOWN “You can provide sports medicine care from many different vantage points,” says Darryl Kaelin, MD, medical director of Frazier Rehab Institute, part of KentuckyOne Health, and chief of the division of Physical Medicine & Rehabilitation (PM&R) for University of Louisville (UofL) Physicians. The key to KentuckyOne Health/UofL Sports Medicine is the collaboration of a diverse network of services that creates a holistic approach to sports medicine care for pediatric to geriatric athletes.
At the center of the collaboration is a trio of medical specialties – primary care sports medicine, orthopedics, and PM&R. The KentuckyOne/UofL team includes 18 physicians from all three sports medicine-related specialties and across locations from Louisville to Bardstown. In addition, the program follows a performance team model, which includes providers from any specialty that can help keep an athlete from being sidelined. This is where KentuckyOne Health’s large network adds immeasurable value to the program. From emergency medicine physicians to cardiologists and mental health professionals to sports nutritionists, an athlete’s health is covered from every angle.
KentuckyOne Health/UofL Sports Medicine focuses on four main components of sports medicine care: education, prevention, treatment, and rehab. It is important to note that two of these categories are about wellness, not just reactionary medicine. KentuckyOne’s educational programming includes road race training, concussion management, and sports nutrition. Prevention programs include: function movement screening, golf swing analysis and training, and sports performance programs.
The Home Team: Primary Care Sports Medicine
Primary care sports medicine providers are the gatekeepers of the program. Often the first practitioners in the system to see patients, they serve to funnel patients to the appropriate specialist when needed.
KentuckyOne Health is the official healthcare provider for UofL Cardinal Athletics. “We serve as the primary care and sports medicine physicians for UofL athletes as part of that partnership,” says Jessica Stumbo, MD, an internal medicine/ pediatrics specialist with UofL Physicians and program director for the UofL Primary Care Sports Medicine Fellowship.
As a med/peds physician fellowship-trained in primary care sports medicine, Stumbo says, “When athletes come to campus, we see all their medical problems, not just their sports injuries.” That means taking care of coughs, colds, rashes, and female issues, in addition to sports injuries and musculoskeletal problems. Her training in primary care allows her to evaluate sports medicine issues from a deeper perspective, always asking – Is there an underlying medical issue contributing to this injury or illness?
Stumbo practices at the program’s primary clinic at Cardinal Station, along with colleagues Jennifer Daily, MD, and Jonathan Becker, MD, who also provide leadership to the fellowship program. Stumbo’s clinic time is split between seeing primary care and sports medicine patients. While the partnership with Cardinal Athletics creates a unique population of Division I collegiate athletes, she also sees sports medicine patients of any age from the community.
Sports medicine services that Stumbo and her colleagues provide include: chronic exertional compartment syndrome testing for exertional leg pain; concussion management; female triad management; stress fracture management; fatigue and under-performing athlete evaluation; treatment of exercise-induced asthma or shortness of breath from non-asthma causes, such as vocal cord dysfunction; musculoskeletal ultrasound for diagnostic purposes and injection guidance; and prolotherapy for chronic tendon issues, which increases healing by injecting a special solution to irritate the area and increase blood flow.
Stumbo is well-acquainted with the sports medicine fellowship because she was a fellow at UofL from 2007–2008. The fellowship is a one-year program with fellows rotating with various orthopedic surgeons in the community, as well as through the UofL athletic training rooms, including covering athletic events, and through the sports medicine clinic. While fellows are not trained in surgery, Stumbo says, “They still get that aspect, so they have a more comprehensive view of sports medicine and how injuries are handled.”
The Relief Pitcher: Orthopedic Shoulder & Elbow Care
Specializing in orthopedic care for the shoulder and elbow allows Kevin Harreld, MD, orthopedic surgeon with KentuckyOne Health Orthopedic Associates, the opportunity to employ aspects from every area of orthopedics and see patients of all ages – from 10 and 11 year-old little league pitchers, to high school athletes, to adult weekend warriors, to octogenarians. “I had several fractures as a child. We had a neighborhood orthopedic surgeon I got to know really well, and that led me into orthopedics,” he says.
Harreld, who is from Owensboro, has been with KentuckyOne Health since 2011. His training includes medical school at UofL, residency at Wake Forest University in North Carolina, and a one-year shoulder and elbow fellowship at Florida Orthopedic Institute in Tampa. He is one of three orthopedic surgeons in his practice at Sts. Mary and Elizabeth Hospital, which also includes Todd Hockenbury, MD – foot and ankle care, and Navin Kilambi, MD, – knee, shoulder, and elbow treatment.
One area of growing concern is an epidemic of overuse in little league baseball players, among other athletes, who play one sport year round. “The number of Tommy John surgeries has gone up exponentially since 2000,” says Harreld.
Platelet rich plasma (PRP) is one non-surgical treatment Harreld uses in acute and chronic sports injuries. By injecting the patient’s own platelets, containing growth factors, into injury areas, PRP can speed recovery in both non-surgical and surgical patients.
Arthroscopy plays a major role in Harreld’s surgical practice. Beyond rotator cuff tears, the technique is also being used to address cartilage issues, such as osteochondritis dissecans (OCD) lesions in the elbow. “People are beginning to push the frontiers of what we can do through the scope in terms of elbow surgery as well,” he says. While not necessarily just for athletes, Harreld does perform reverse total shoulder replacement.
Underlining the importance of the continuum of care, a supervisor from Frazier Rehab sees patients in tandem with Harreld in the office one day a week. “That’s been a tremendous help to both of us and to the patients because he’s here when they come back for post-op follow-up … I think working very closely with a therapist is key to maximizing outcomes.”
Other KentuckyOne Health Orthopedic Associates physicians who specialize in shoulder repairs include Andrew Duffee, MD, and Greg Rennirt, MD, both of whom man solo sports medicine/orthopedics offices as part of the KentuckyOne network. Duffee also performs knee arthroscopy and arthroplasty, meniscus repair, ACL reconstruction, trigger finger release, and carpal tunnel release. In addition to shoulders, Rennirt’s practice emphasizes knee repairs.
Extra Innings: Joint issues in an aging population
Jeffrey Stimac, MD, orthopedic surgeon with KentuckyOne Health Orthopedic Associates, knew he wanted to go into orthopedics in high school, when he shadowed an orthopedic surgeon.
Stimac, who is approaching his two year anniversary with KentuckyOne, attended Tulane University Medical School in New Orleans, did an orthopedic surgery residency at UofL, and a fellowship in adult reconstruction and joint replacement at the Hospital for Special Surgery in New York.
His practice includes six physicians, who do a mix of sports medicine and joint replacement, and has locations on the Jewish Hospital downtown and Jewish Northeast campuses. Other physicians in the practice include: David Caborn, MD, who specializes in knee and sports surgery; Arthur Malkani, MD, complex joint cases; Paul McKee, MD, non-surgical orthopedics and UofL baseball team physician; Raymond Shea, MD, UofL football; and Edward Tillett, MD, UofL football.
Stimac’s areas of interest include joint replacement, anterior approach total hip replacement, complex primary hip replacement, revision hip and knee replacement, and treating infected joint replacements. He treats mostly adults over age 50. Because he does revisions and infected joints, he sees patients from a wide geographic area.
Stimac estimates 95 percent of his primary hip replacements are done with the anterior approach. A trending technique, he notes, “It probably accounts for 15 to 20 percent of hip replacements in the US. I think that number continues to grow.” Contraindications to the anterior approach include revision surgery for previous posterior approach surgery, significant hip dysplasia, significant defects within the acetabulum, or previous trauma or surgical incisions.
Another general orthopedist who is part of the KentuckyOne network is Thomas Loeb, MD, who specializes in partial and total knee replacements in a solo practice as part of KentuckyOne Health Orthopedic Associates.
The Team “Captain”: Military experience informs sports medicine treatment
UofL is not the only area college benefitting from the expertise of KentuckyOne Health Sports Medicine. In Bardstown, Mark Duber, DO, orthopedic surgeon with KentuckyOne Health Orthopedic Associates, serves as team physician for St. Catharine College, a partnership that has flourished under Duber’s one-year tenure. “It started as an open door policy, now we are on campus evaluating athletes two times a month and involved at sporting events as backup,” says Duber. Working closely with the athletic trainers, he provides next-day care and evaluation for injuries.
Duber grew up in Cleveland with a lot of athletic interests. “I looked at orthopedics as kind of the complete spectrum that relates to the musculoskeletal system,” he says. He went to medical school at Kirksville College of Osteopathic Medicine (KCOM) in Missouri on a US Army scholarship and did his residency in orthopedic surgery at Cleveland Clinic. He fulfilled his scholarship requirements with four years of active duty service at Fort Knox, specializing in sports medicine. “We treat every troop like an athlete … based on the type of work they’re doing, especially with deployment and anything else related to military activity,” Duber says.
Upon completion of his military service, Duber settled in Bardstown at Flaget Memorial Hospital, part of KentuckyOne Health. It is a high-volume practice that treats patients from age four to 90. “I engage in big city orthopedic surgery with excellent results and rehabilitation with a small town feel,” he says.
Fifty percent of his practice is sports medicine, including covering athletes from the four area high schools, as well as grade school athletes. The other 50 percent is devoted to fracture care, degenerative conditions, and degenerative sports medicine.
An ageless issue, concussion treatment has undergone diverse changes over the last decade. With Duber’s military service, “I got to see firsthand a lot of the changes that were happening in evaluation and treatment because of the traumatic brain injuries we were seeing with roadside bombs and other types of injuries,” he says.
Duber also notes the evolution of techniques for the anterior cruciate ligament (ACL), particularly graft selection and anatomic reconstruction. “If positioned correctly, you have a much lower failure rate of ACL over the long haul and a much better return to sport without any type of disability than we had with non-anatomic reconstruction,” he says. Graft selection is also just as critical. The use of allografts has been shown to be less effective in the athletic population for long-term outcomes. Duber uses only autografts in athletes and has learned which type of tissue gives the best results.
Off the Bench: Rehab for a quicker recovery
Effective surgery is important for sports medicine injuries, but effective rehab may be just as important to recovery. Frazier Rehab has over 20 outpatient clinics throughout the community contributing the KentuckyOne’s continuum of care. Frazier’s physical therapists work closely with physicians to ensure the best possible treatment plan for patients.
Kaelin and his PM&R colleagues head the rehab component for Frazier. Michael Weaver, DO, a sports medicine fellowship-trained rehab specialist, is the point person for rehab care of sports medicine injuries, while Kaelin specializes in neurologic injuries, such as concussions and spinal cord issues. “We tend to provide very distinct and specific prescriptions for therapy, in addition to using medications and treatments like injections, ultrasound, electrical stimulation, etc. Therapists are a big part of the team in giving correct guidance,” says Kaelin.
Kaelin cautions that not all therapy programs are alike. “Because we are the provider for UofL, we are using state-of-the-art techniques in helping [all our athletes] recover. So, those include things like reduced weight-bearing treadmills that allow people to get back to running and jogging without putting their full weight down, aquatic exercise, electrical stimulation to help muscles recover quicker, and some unique injections, including PRP and ultrasound-guided injections to insure we’re putting medications where they need to be without injuring other tissues,” he says.
Concussions are also an issue being emphasized in rehab. In addition, KentuckyOne Sports Medicine is highlighting injury prevention by providing functional movement screens for athletes to evaluate flexibility and muscle balance to assess injury risk.
From prevention to injury assessment, to treatment, to recovery and return to sport, KentuckyOne Health/UofL Sports Medicine’s immense network of professionals has covered all the bases, making athletes of all ages and all levels in Kentucky part of the winning team.
MEDICAL MANAGEMENT AND COMMUNITY OUTREACH PARTNERSHIPS
KentuckyOne Health/UofL Sports Medicine provides medical management to area events, as well as athletic training services to community schools.
MEDICAL MANAGEMENT:
► JCPS Cross Country Championships
► UofL Football
► PGA Championship and Senior PGA
► Ryder Cup
► Triple Crown of Running
► Louisville Sports Commission
Urban Bourbon Half Marathon
Cross Country Classic
Kids Finish First
NCAA DII National Championship Fall Festival
ATHLETIC TRAINER COVERAGE:
► Area high schools: Doss, Manual, PRR Bullitt East (all sports)
► UofL Rugby
► St. Catharine College (all sports)
SPEAKER INVOLVEMENT:
► Traumatic Brain Injury Symposium—KentuckyOne Health (Frazier Rehab and UL Physicians)