Sports Medicine for All Athletes with Harris Slone, M.D. and Mike Barr

The MUSC Health Sports Medicine Team provides leading edge care for athletes and weekend warriors of all ages and abilities. The program is also the official sports medicine provider for several professional and high school sports teams. In this episode hear more details about MUSC health sports medicine from Dr. Harris Sloan and Mike Barr.

"There's a lot of sports medicine doctors out there who take care of athletes, but I think we offer the only soup to nuts sports medicine service, whether that's concussion management, taking care of athlete, nutrition issues, or endocrinology issues, injuries that happened to the face or head all the way through, head-to-toe comprehensive care of the athlete."
- Harris Slone, M.D.

Topics covered in this show

• The Sports Medicine program at MUSC Health is a comprehensive and well-rounded group that includes pediatricians, specialists, orthopedic surgeons, endocrinologists, and physical therapists.
• The Sports Medicine Team at MUSC Health offers comprehensive care of active people ages six to 96.
• Common injuries treated in the Sports Medicine program at MUSC Health are knee injuries, like ACL or meniscus tears, early arthritis, shoulder injuries, like rotator cuff tears, and trauma such as fractures and concussions.
• The Sports Medicine Team at MUSC Health utilizes cutting-edge innovations like minimally invasive surgery for faster recoveries.
• Patients seen by the Sports Medicine Team at MUSC Health include professional teams, AAU basketball, academy soccer and club teams, amateur adult rugby and roller derby teams, and the College of Charleston club sports.
• The Sports Medicine program at MUSC Health relies on a team that works together to care for patients, has frequent communication, and coordinates with physicians and surgeons.

Transcript

Erin Spain: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. The MUSC Health Sports Medicine Team provides leading edge care for athletes and weekend warriors of all ages and abilities.

The program is also the official sports medicine provider for several professional and high school sports teams. Today, we'll hear more details about MUSC health sports medicine from Dr. Harris Sloan and Mike Barr. Dr. Sloan, welcome to the show.

Dr. Slone: Thanks for having me.

Erin Spain: Tell me about this program and what services are provided.

[00:00:47] Dr. Slone: We have really the only comprehensive sports medicine program in the area. There's a lot of sports medicine doctors out there who take care of athletes. But I think we offer the only soup to nuts sports medicine service, whether that's concussion management, taking care of athlete, nutrition issues, or endocrinology issues, injuries that happened to the face or head all the way through, head-to-toe comprehensive care of the athlete.

I think what's unique is we all work together and we work together a lot. And so we have very open lines of communication between the subspecialty groups, which helps tremendously. So if I'm helping getting an athlete back on one of our teams from a concussion, or they're seeing one of our doctors for a recent head and neck injury, that communication line is very open and we collaborate to get people back on the field as quickly as past.

We take care of 15 high schools, we take care of three pro teams, we cover major pro tennis events when they come to town. We've got a great group of surgical and non-surgical doctors here at MUSC. We have a fantastic group of rehabilitation specialists. We're the ones on the frontline doing the research.

And I really don't think there's a better place to go in the region.

[00:01:49] Erin Spain: Talk a little more broadly about the services provided.

[00:01:52] Dr. Slone: So our frontline consists of our emergency medicine group and the orthopedic group. And within the orthopedic group, we have all of the subspecialties included. So a lot of our athletes are pediatric patients.

And so a lot of our pediatric docs participate in care of our athletes. We obviously have the sports medicine group within the sports medicine proper. We have the operative and non-operative specialists. So we have numerous non-operative sports medicine specialists within our group. And even the doctors who do orthopedic surgery treat a lot of patients non-operatively.

So we're not only doing surgery. And then we have a conglomerate of athletic trainers who work with our athletes on the field, who are a part of our sports medicine team. We have physical therapists who specialize in rehabilitation of the athlete, and then we have our complimentary services outside of the MSK for the musculoskeletal group.

And that includes our endocrinology team, our facial and plastics team, our hand surgery team. And so we really, again, just have the most comprehensive and well-rounded group of people taking care of athletes.

[00:02:50] Erin Spain: It's a goal to get people back on the field as quickly as possible. That is a philosophy that really applies in sports medicine because time is of the essence for a lot of these folks.
Tell me about that.

[00:03:01] Dr. Slone: Patients always want to know how quickly can I get back. And as a sports medicine doctor, that's really my priority, but I always tell them my job is to get you back as safely and as quickly as possible, so in that order. Because a lot of times athletes feel really good maybe after a knee surgery, but they just need a little bit more time until they're ready.
So we have a lot of assessment tools that we use regularly to help us to know when athletes are going to be safe, to go back to sports. And obviously sometimes that's really quick and sometimes it takes several months or a year. And it just depends on the injury and our care is always individualized.

[00:03:32] Erin Spain: Who do you see in the clinic? What's the range of patients that you see over the course of a year, and the typical injuries?

[00:03:38] Dr. Slone: So I see patients of all ages. I see patients as young as six or seven sometimes, and patients who are 86 or 87. And an athlete is a very variable term, or an athlete means different things to different people.

And so it's not just care of the athlete. I think probably sports medicine is better described as here of the active individual. So what is active for one person or what is an athlete for another person might be very different.

[00:04:02] Erin Spain: What's it like for you to see your patients make a recovery and get back to their favorite sports or activities?

[00:04:08] Dr. Slone: We always think about the surgery as being the hardest part, but a lot of times it's really the recovery that is the hardest part, or where most of the work goes into. And that's the stuff that the patient does. So seeing the sort of return on their investment during their rehabilitation is always very rewarding.

[00:04:23] Erin Spain: Just name out some of these typical injuries that you see, that are common, that come through.

[00:04:27] Dr. Slone: I see a lot of knee injuries, whether that's a knee ligament injury, like an ACL tear or a MCL tear. I see a lot of meniscus tears. I treat a lot of patients with cartilage injuries or early arthritis. So we do a lot of, sort of, joint preservation and joint salvage surgery.

I see a lot of shoulder injuries. The common children injuries are usually rotator cuff tears, shoulder dislocation, labral tears, shoulder instability. And then I do see trauma. So I see fractures, whether they're sustained during sport or sustained just from a fall. But I would say the vast majority of my practice probably is comprised of shoulder and knee injuries.

[00:05:03] Erin Spain: You mentioned ACL injuries and ACL construction is an area of clinical research for you. Now, this includes tears and re-tears. Tell me about this injury, and what about it keeps you looking for more answers, through research?

[00:05:18] Dr. Slone: We see a lot of ACL patients and we're seeing more and more of them. And I really enjoy taking care of ACL patients. The number of young people who are participating in sports has really increased dramatically over the last couple of decades in the United States. And as a result, we're seeing more and more ACL tears, and we're seeing them at a younger age.
We know women sustain ACL injuries at a higher rate than the guys.

The ACL is one of the most studied things in orthopedics. And there's still so much that we really don't know, and there are so many choices, there are so many techniques when it comes to ACL reconstruction, and we're way better now than we ever were. But there's still a long way to go, both with treating ACL tears, and I think preventing ACL re-tears, or preventing ACL tears from happening in the first place.

[00:06:02] Erin Spain: You mentioned that women seem to be at higher risk of ACL injuries. Why is that?

[00:06:07] Dr. Slone: The short answer is it's probably multifactorial. We know that there's neuromuscular things that occur when. women land from a jump , versus when men land from a jump, and some of them might be that women tend to have a little bit of a wider pelvis. They tend to land with their knee and a little bit more extension. They tend to be a little bit more knock-kneed where guys tend to be a little bit more bow-legged. So that definitely predisposes them to having ACL tears.

It's been hypothesized that women ACL's are smaller than male ACL's to start with. And so they're more likely to re-tear what's called the notch., so an area in the knee where the ACL sits might be a little bit smaller. So there's a lot of things that have been studied and identified as potential reasons that women have an increased incidence of ACL tears, but the short answer is it's probably multifactorial.

[00:06:50] Erin Spain: MUSC Health Sports Medicine actually has a special focus on female athletes. Tell me about some of the unique aspects of women in sports and how MUSC Health is meeting the needs of these female athletes.

[00:07:02] Dr. Slone: We have to approach the female athlete very differently than we approach the male athlete, because we have to understand some of their neuromuscular factors about their recovery.

We have to understand what predisposes them to some different injuries than a lot of the male athletes that we see. We're learning more and more about injuries sustained in the female athlete. I think there's still a lot to learn, but they're a fun group of patients to treat.

[00:07:24] Erin Spain: Your team is nationally recognized as innovative leaders in sports medicine. Tell me about this approach and some of the innovations being used.

[00:07:33] Dr. Slone: We are always looking at new techniques. We're always studying the best available evidence and utilizing whatever that might be. We published several techniques in the last few years about treating common injuries differently, through minimally invasive techniques, using new instrumentation to do things through smaller incisions with faster recoveries.

One example of that for us has been quadriceps tendon ACL reconstruction. It's a graph that's been around for a long time,but really not been used. And I would say over the last three to four years, the number of quad ACL reconstructions has increased dramatically in the United States., as people are recognizing that this is a really good graph to use ratio reconstruction.

It's a graph that I've been using since 2013, 2014, and a lot of the data that has come out of MUSC about quad tendon graphs, we worked very closely with some of our colleagues at Emory University to help publish a lot of this research. But it's been really fun to see what's happened as we've published more and more research, and then people are picking up on this nationally.

We partner with the Clemson Bioengineering Group in terms of some of our basic science and biomechanical research. I'm participating in a study right now, looking at ways to preserve bone and cartilage grafts to allow us to transplant these in patients a little bit easier, and overcome some of the hurdles that are associated with bone and cartilage transplantation and graph preservation.

It's just a really fun thing to investigate, and I think it's very rewarding personally. And I think that at MUSC, we're making a big difference in terms of the research that we're doing nationally.

[00:09:01] Erin Spain: Why should someone consider MUSC Health Sports Medicine as their first choice? What is it that sets MUSC Health Sports Medicine apart?

[00:09:10] Dr. Slone: Number one, I just think you're going to get evidence-based care, which is so important in 2022. You're not going to get something that doesn't have evidence to support the use when you come to MUSC. We have a team of experts who really see some of the more complex stuff in the Southeast. We're a tertiary or quaternary referral center, so while we see the sort of worst of the worst, in terms of injuries or surgical complications, we also can treat the common and routine injuries very well, and we do it all the time. We have an indications conference, which is one of my favorite parts of my job, where we review the images and the surgical plan with other orthopedic surgeons and the radiologists.

We do it every Wednesday. We did it this morning and I think it's a great time to say, Hey, I have his really tough case, what would you do in this case? And sometimes I talk to my colleagues and I ended up changing my plan a little bit or tweaking the way I might do things. And it's very helpful to just have an extra set of eyes sometimes to say, yeah, this is exactly what I would do, or I think you could do it this way, but you could also try and you know, use this anchor, try this differently.

And sometimes it just, it's really helpful to get another opinion when approaching a difficult, especially for the difficult surgical problems.

[00:10:17] Erin Spain: What's your philosophy when it comes to treating patients?

[00:10:21] Dr. Slone: I think number one, if I can treat you without a surgery, I'm going to try. And many, many sports injuries, thankfully don't require surgery. If we can treat you conservatively, or if we think that non-surgical interventions are likely to help then that's what we try first. And I think the athlete, or the patient, should be a big part of the decision-making process. So a lot of times during my office visits with patients, I'm presenting them options and I'm explaining the advantages and the disadvantages of each option because there's not always a right or wrong answer.
If I can have a patient help to choose their treatment plan, then that's always preferable. And my ultimate goal is to get them back on the field, or back to their job, or back to doing whatever they want to do as quickly and as safely as possible, or as safely and as quickly as possible in that order.

There's some times where I think it's my job to present the options to the patient and say, which of these do you want to do? And here's one option and here's another option. And there's other times to say, hey, you know what? We really need to do your ACL reconstruction and here's the reason why. And so it just kind depends, again all of our care is individualized, but at the end of the day, we always try and do what we think is best for our patients.

[00:11:27] Erin Spain: What do you do to optimize your health and live well?
I think.

[00:11:31] Dr. Slone: it's super important to obviously eat healthy, stay hydrated. You got to find time for yourself. You got to get a good seven or eight hours of sleep. And then whatever physical activity you enjoy, setting aside time to have some physical activity. preferably every day.
It can be surfing. It could be bike riding. It could be playing pickleball. And I find joy in doing all those things. I really like riding my bike or skateboarding with my kids. You just try and find some time to set aside, to be physically fit. I think it really helps when you come back to work that you're refreshed, invigorated, and ready to take on the challenges of your job and family life.

[00:12:05] Erin Spain: Now let's shift gears and talk about the work MUSC Health Sports Medicine Team does as the official sports medicine providers for local teams and events. Mike Barr is a physical therapist and the sports medicine manager at MUSC Health. He joins me with details.
Welcome Mike.

[00:12:24] Mike Barr: Thank you for having me today.

[00:12:25] Erin Spain: Tell me about your role. What are some of your responsibilities as a sports medicine manager here at MUSC Health Sports Medicine?

[00:12:33] Mike Barr: I oversee all of our day-to-day operations for our outreach sports medicine team. So that includes all of our athletic trainers, that are stationed in local high schools, as well as with our professional teams. As well as then the event coverage that we take care of, plus the college of Charleston, additional club sports, and club and recreational teams. The other side of it is I deal with the bigger picture of our program of continual growth and how we can bring services of MUSC Health to local communities throughout the Charleston, and really the overall state of South Carolina.

[00:13:07] Erin Spain: So how many people are we talking here? How many physicians, physical therapists, other staff members are out there in the community working with these local teams?

[00:13:16] Mike Barr: We currently have 18 athletic trainers that work specifically in the outreach setting. So they are based with our high schools and our professional teams, the colleges, as well as all the recreational teams.

And then we have additional sports-medicine-specific orthopedic surgeons. As well as sports-medicine-specific primary care sports physicians. So it's a really, a big multidisciplinary team that combines for coverage with all of our events.

[00:13:42] Erin Spain: So those 18 individuals, you mentioned, the athletic trainers, what are they doing on a day-to-day basis?

[00:13:47] Mike Barr: They are with their teams, their assigned teams, basically all the time. So if a team is practicing, if they're lifting, if they have a game, if it's home, if it's away. It does not matter if it's in Charleston for the Charleston Battery or they're playing in California, our athletic trainers are there with that team.
They are fully embedded and really are members of the individual teams and schools they take care of.

[00:14:11] Erin Spain: You mentioned the Charleston Battery. Tell me about some of the local professional teams that you're working with and just a range of sports that you all are covering.

[00:14:22] Mike Barr: We take care of all of the professional sports in the Charleston area.

That includes the Charleston Battery, the Charleston River Dogs, which is a professional baseball team, part of the Tampa Bay Minor League organization. The South Carolina Stingrays, which is part of the Washington Capitals Minor League organization, as well as the WTA tennis event that's over at the new Credit One Charleston Stadium on Daniel island.

We take care of all athletes of all ages, from Youth AAU basketball teams, to academy soccer and club teams, all the way up through adult amateur leagues, rugby teams, roller derby, as well as the College of Charleston and all their clubs sports. So our athletic trainers are with every College of Charleston club game.

The other day, there was a club hockey game. We have an athletic trainer who's providing support for that team.

[00:15:12] Erin Spain: Why is it so important to build these relationships and offer the MUSC Health Sports Medicine expertise to folks in the community who are participating in sports?

[00:15:22] Mike Barr: There's a common theme out there in the sports world. it's called athletic trainers for all. And that's really having a medical provider on site with every sports team. Injuries happen from minor bumps and bruises, sprains, and strains to more major injuries like tears and broken bones, but also the even greater picture of concussions, cardiac issues. And a lot of times there are games going on and the only person out there is a coach who may have first aid or CPR certifications, but they don't have true medical expertise and their job is to focus on coaching. The job of our athletic trainers is to be there and look out for the health and wellness of every athlete on the field. It doesn't matter if it's that little bump or bruise, or if it's a major cardiac event, our athletic trainers are trained for emergency management as well as then continued management.
So if somebody has an injury, they can rehab them onsite. They can work with them on taping and splinting to help get them back in the game or facilitate their overall recovery.

[00:16:26] Erin Spain: Tell me about the quality of the trainers, physicians, the whole sports medicine team, that's able to take care of these athletes.

[00:16:35] Mike Barr: We pride ourselves on being the most experienced team of athletic trainers around. We have members of our team. who've been athletic trainers for 35 plus years, 10 plus years, to those who are a couple of years out of school. And so we set up mentor programs where our newer grads, our newer team members, have a peer partner or a mentor that's been with our team for a long time, as well as been in the field for a long time. So that way, they can work together on how to deal with the athletes and not just be out on their own. They really have that backup person to go to for every little thing that comes up. It also helps our more experienced athletic trainers to have some of those newer people share some of their experiences with them.

So they're continuing to learn from each other, and that teamwork it's, even though it's one athletic trainer with one team, they really do work as a comprehensive team together. So that puts us in a different category. In addition to that, our sports med physicians and orthopedic sports med orthopedic surgeons are easily accessible to our athletic trainers. A day doesn't go by where one of our ATs doesn't talk to a physician about an athlete. This is going really well, I just wanted to update you. Or where you've run into a little snag. here's what's going on. What do you think? And let's put some heads together on how we can get them over these obstacles.

[00:17:55] Erin Spain: For more information on this podcast, check out, Advance.MUSCHealth.org.