LOUISVILLE In a world dominated by 24-hour sports channels, pro-athlete endorsed products, and an increasing pressure to compete at a younger and younger age, it is hard to escape the influence sports has on our lives, for boys and girls, men and women. This is particularly evident in Kentucky, where red and blue are not just colors but ways of life. Sports medicine, then, as a specialty seems self-evident. But in truth, it is often misunderstood and underrepresented in the community. The physicians of Baptist Health Sports Medicine are hoping to change that.
The Truth About Primary Care Sports Medicine
Baptist Health Sports Medicine is a full-service sports medicine program that includes sports medicine specialists, orthopedic surgeons, physical therapists, athletic trainers, and more to meet the comprehensive needs of patients. “Really what we’ve tried to create is a whole system of treating any patient who walks in the door the way you would treat a professional athlete,” says Mark Puckett, MD, primary care sports medicine physician with Baptist Health Medical Group Family & Sports Medicine at Baptist Health Eastpoint. “You have a whole team that works on everything from start to finish. Somebody is doing injury prevention or strength training with a coach somewhere, and they get screened by physical therapy to identify things early on. If we don’t identify things early or an acute injury happens, we address it from a surgical or non-surgical standpoint and then address every aspect of puzzle.”
Perhaps the gatekeepers of this program are the sports medicine specialists. Physicians trained in family medicine, internal medicine, pediatrics, emergency medicine, or physical medicine and rehabilitation, sports medicine specialists pursue an additional accredited fellowship in sports medicine. With a board that is only about 25 years old, sports medicine is one of the youngest medical specialties. Different from orthopedic surgeons, sports medicine specialists are trained in non-surgical techniques.
Baptist Health Medical Group Family & Sports Medicine at Baptist Health Eastpoint employs three full-time primary care sports medicine specialists – Puckett, Christopher Pitcock, MD, and Michael Hughes, DO. Their primary care background brings a unique perspective to their care of patients.
As primary care providers, each physician can and does see patients who are solely primary care, as well as those who are sports medicine patients. “One of the things that makes us a little different than routine primary care is that not all primary care physicians are comfortable with musculoskeletal problems,” says Pitcock. “They may have an idea that a patient doesn’t necessarily need surgery, but I think we are a good first stop.”
Hughes believes the primary care background gives them a better understanding of the whole patient. “Because we’re primary care physicians, if somebody’s blood pressure is sky high and we’re thinking about a cortisone injection, the first thought to me is, ‘Well, let’s try to get this under control,’” he says.
Occasionally, patients will come to them convinced they have a bone or joint problem when it’s really a medication side effect. “We deal with these medicines routinely, and we deal with the bone and joint things routinely,” says Puckett. “Sometimes it allows us to see the intersection between their medicine and their orthopedics, and merge them together well.”
A Penchant for Puzzles, Putting Hands on Patients, and Perceptible Results
A Louisville native, Puckett attended medical school at the University of Louisville (U of L) and attended residency and fellowship at Self Regional Healthcare in Greenwood, S.C., in family medicine and primary care sports medicine, respectively “As I was going through training, I recognized that I really enjoyed the hands-on problem-solving aspect, just the nature of figuring out the puzzle of folks with a lot of musculoskeletal problems,” says Puckett. He joined Baptist Health when the sports medicine program began in 2012.
Hailing from a small town in south central Kentucky, Pitcock attended the University of Kentucky for a degree in pharmacy and worked for a year in that field before pursuing his medical degree at U of L. Pitcock also attended U of L for his family medicine residency around the time the primary care sports medicine specialty got its start. He received his sports medicine certification in 1999 and joined Baptist Health in 2011.
“People who I treat for their blood pressure or heart disease or diabetes, I know I’m getting them better. It’s just they can’t feel it, they can’t see it right away. If we’re doing all their screening exams and we find a colon polyp, I know we’ve prevented that one case of colon cancer, which is very gratifying. But there’s something gratifying also about people who have overused something, torn something, broken something and helping them heal without a surgery. They can see the improvement, they can feel the improvement, they know they feel better,” says Pitcock.
Also from Louisville, Hughes received a master’s in physiology at U of L and earned his Doctor of Osteopathic Medicine degree at West Virginia School of Osteopathic Medicine. He attended residency at Floyd Medical Center in Rome, Ga., and a sports medicine fellowship at U of L. He is the newest member of the team, having joined Baptist Health a year ago.
“I played baseball in college, and I had an injury that may have been partly my fault for not managing well as a patient. But that was the start of seeing how can I help somebody in the future,” says Hughes. “Throughout medical school, I enjoyed the challenge of just laying hands on people and trying to diagnose that way. I have had a lot of patients who come in here and say, ‘I didn’t even have a doctor touch me before.’ I value the art of a good physical exam.”
Surgery is Rarely the Answer
Those patients represent a wide range of ages, athletes, and conditions. Athletes include those ages 10 and up, from high school, college, and professional sports to recreational athletes and weekend warriors. The variety of patients and presentations is a large part of the appeal to this group of physicians. “Recently, I did a viscosupplementation injection on a 97-year-old woman for knee arthritis and my very next patient was a 12-year-old girl who had stress fracture in her pelvis,” illustrates Pitcock.
With an estimated 80–90 percent of conditions being non-operative, sport medicine physicians must have a breadth of tools at their disposal. Baptist Health Sports Medicine offers treatments including everything from braces and casting to gait analysis to injections to osteopathic manipulative treatment (OMT). With on-site X-rays, physicians can diagnose and treat trauma such as sprains and fractures.
Injections include corticosteroids for inflammation, viscosupplementation, and platelet-rich plasma (PRP). With viscosupplementation, a gel-like substance is injected into joints to act as a lubricant and shock absorber for the treatment of arthritis. For longer-term conditions with structural damage that need help healing, physicians turn to PRP, “which is using somebody’s own blood cells to generate healing of the structure that may have a partial tear or chronic scarring or chronic weakness,” says Puckett.
To relieve muscle tightness and restore flexibility and range of motion, Hughes has introduced OMT to the practice. “One thing I do that I think has been a good benefit to our patient population is osteopathic manipulative treatment. It is basically laying hands on a patient and treating as indicated, head to toe,” he says.
Another diagnostic tool is musculoskeletal ultrasound, which provides real-time soft tissue imaging. Often it can save patients the radiation exposure and cost of having a MRI. Plus, the physicians also use it for ultrasound guidance on certain procedures, much like an interventional radiologist.
In the 10 percent of cases where surgery is warranted, these physicians have a group of orthopedic surgeons they work with closely.
From Treatment Room to Turf
Sports medicine is one of those specialties that extends far beyond the clinic. “We try to provide the community with as much knowledge as we can to exercise safely and be as healthy as they can,” says Pitcock. That includes a variety of activities such as affiliation with 28 area high schools and three middle schools, providing athletic training services and on-field support, as well as educational programs such as an annual female athlete seminar.
Maybe its largest community partnership is that with the Louisville City Football Club, the city’s professional soccer team, providing athletic training, home game support, injury prevention, and injury treatment.
Baptist Health is also committed to helping all athletes prevent injuries, optimize healing, and simply rise to the next level. That is why they partnered with four former U of L football players turned professional athletes – Deion Branch, Breno Giacomini, Chris Redman, and Eric Wood – in the Baptist Health Performance Training Program and facility. With 17,000 square feet, it is the largest training facility in the city outside of U of L’s campus. Whether a high school or college athlete is doing off-season training to get stronger or needs additional attention after an injury, Baptist Health’s trainers have experience training Division 1 level athletes and getting athletes to the next level. With on-site Baptist Health physical therapy and access to sports medicine physicians, it is another resource in Baptist Health’s comprehensive sports medicine program.
Team Players
One misconception these physicians encounter is confusion from primary care providers unfamiliar with their specialty, asking why they would refer to a potentially competing primary care provider. The doctors of Baptist Health Medical Group Family & Sports Medicine emphasize they treat such patients like any other specialist would, encouraging them to maintain a long-term relationship with their own primary care provider.
Hughes jokes that his own mother warned him about returning patients. “My parents are both physicians here in town. They are both family doctors. Early on in my time here my mom called me up and said, ‘I’ve got a patient that I think has a stress fracture. She’s one of my favorite patients and she’s going to continue seeing me for primary care. But she’ll come out to you and you take care of her stress fracture and then send her back,’” he says.
Pitcock says he and Puckett are actually closed to new primary care patients, but regardless, their real focus is sports medicine. “If some other primary care physician sends a patient to us, we are not looking to take anybody’s primary care patient. Sports medicine is what we like to do. Sports medicine is what we want to do.”
And they’ll treat you like a pro while doing it.