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Bouncing Back

By Leslie Hill
August 2012

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Vanderbilt University basketball player Christina Foggie, the top scorer, male or female, at her New Jersey high school and the top-rated recruit, came into her freshman season in 2010 doing all it took to make plays, taking the inevitable bumps and elbows from her opponents.

At the sixth game of the season at Bowling Green State University in Ohio, the Commodores trailed by 12 at the half, but brought it within three points with 14 minutes to go. With nine minutes to go, Foggie’s season took an unimaginable turn.

Hit by a screen on defense, she fell to the hardwood and was knocked unconscious. As the packed court went silent, Vanderbilt athletic trainer Michele Loftis immediately rushed to assist Foggie, who appeared to have a seizure. Loftis called for a spine board as a precautionary measure.

Back in Nashville, Alex Diamond, D.O., MPH, assistant professor of Orthopaedic Surgery and Rehabilitation and Pediatrics and the women’s basketball team physician, knew it was bad news when he saw Loftis’ phone number appear on his cell phone. As Loftis rode in the ambulance with Foggie, Diamond called ahead to the hospital to request tests and scans, and then consulted with physicians as the results came in.

Safety is the No. 1 concern, but must be balanced with not holding a player back unnecessarily, says Alex Diamond, MPH, D.O., the Vanderbilt women’s basketball team physician. Photo by John Russell.

Safety is the No. 1 concern, but must be balanced with not holding a player back unnecessarily, says Alex Diamond, MPH, D.O., the Vanderbilt women’s basketball team physician. Photo by John Russell.

With the possibility of spine fracture or brain bleed, the concussion diagnosis was a relief but still had major implications for Foggie, both as an athlete and a scholar. The Vanderbilt Sports Medicine division would play a key role in returning her to the court and the classroom.

Striking a Balance
The Vanderbilt Sports Medicine division and its team of physicians, nurses, athletic trainers and physical therapists care not just for college athletes like Foggie, but for anyone seeking an active lifestyle, from ultra-marathoners to backyard gardeners. Knee and shoulder injuries are the most common, but treatment is also given for injured ankles, hips, hands, necks, backs and concussions.

With six clinics throughout Middle Tennessee and Western Kentucky, Vanderbilt Sports Medicine reaches a large portion of the general population. They also care for all high school athletes in Davidson and Williamson counties, Vanderbilt and Belmont University athletes, the Nashville Sounds baseball team and Nashville Predators hockey team.

“We’re busy. We start most days of the week with educational conferences, see patients in the clinic during the day and then cover sports teams in the evening and on weekends. We’re a very busy practice, but it makes us good and makes us one of the leading Sports Medicine divisions in the country,” Diamond said.

Sports Medicine is about finding the balance between ensuring athletes’ health and letting them do what they love.

“Safety is our first concern no matter who you are or what team you’re on,” Diamond said, “but we don’t want to make the opposite mistake of being too conservative and holding players back. This is their passion and what they’ve worked their whole life for. It’s a balancing act to know what is best for them.”

One of the most important new resources is the Vanderbilt Sports Concussion Center, a joint venture between the Vanderbilt Orthopaedics Institute and Vanderbilt Neurosciences Institute, to give the same state-of-the-art concussion care to all athletes, from grade school to the pros.
A return from a concussion is a deliberately slow process because coming back too fast can worsen symptoms, and another concussion before the brain is healed can be devastating.

“A brain injury is like any other injury in that it needs time to heal,” Diamond said. “An athlete first has to tolerate school and regular life, and then we’ll slowly step them back into activity.”

For Foggie, this meant sitting on the sidelines. Her concussion was just the first of several incidents in a year plagued by injury. With another concussion in January during practice and an ankle that kept locking up, trainer Michele Loftis constantly had her eye on Foggie.

“She’s one of those kids you joke about keeping in a bubble. I always saw her after practice with something wrong,” Loftis said. “It was hard to see her on the sidelines because I could tell she wanted to be in. She’s a tough kid.”

Indeed, ‘aggressive’ is a commonly used word to describe Foggie, who felt the after effects of her injury for several months. “I wasn’t sure if I would ever get back to normal, not just for sports but for everyday life. I played the rest of the season but never felt right,” she said.

In the off-season last summer, Foggie’s headaches and short-term memory loss finally lifted and she had arthroscopic surgery to clear some scar tissue in her ankle that had built up from repeated sprains, the non-invasive procedure requiring just a few days of rehab.

Finally feeling healthy going into her sophomore season last fall, Foggie was determined to play in every game but never expected the amazing success she would have. She led the Southeastern Conference in scoring, averaging 17.9 points per game and was named First Team All-SEC by the Associated Press.

Game Changer
The 20-year history of Vanderbilt Sports Medicine is a story of growth. When Kurt Spindler, M.D., director of Vanderbilt Sports Medicine, arrived in 1991, he was just the second faculty member in the department with about 1,100 annual patient visits. Today there are 14 faculty, more than 40,000 annual visits and $1.5 million in research funding.

Under the direction of Kurt Spindler, M.D., the Sports Medicine division has 40,000 annual visits and $1.5 million in research funding. Photo by Joe Howell.

Under the direction of Kurt Spindler, M.D., the Sports Medicine division has 40,000 annual visits and $1.5 million in research funding. Photo by Joe Howell.

The Sports Medicine field has also changed rapidly, with technical innovations keeping more athletes in the game. In the 1980s, an ACL tear was a career-ending injury, but today, with advances in minimally-invasive arthroscopic surgery, athletes are back in a matter of months.
Spindler, Kenneth D. Schermerhorn Professor of Orthopaedics and Rehabilitation, points to arthroscopy and the MRI as major game-changers in the specialty.

“Arthroscopy dramatically changed Sports Medicine because you could get into the joint and get to the issue with lower morbidity, which means the patient gets back faster,” he said. “The MRI has allowed us to appreciate damage that we couldn’t detect on plain X-rays or even on physical exam. Physical exam of patients can lead you in the right direction, but especially in the shoulder, it’s not reliable to differentiate between which anatomic structure is torn. MRI lets you be positive about the injury.”

But Spindler says Sports Medicine physicians always have to respect the biological clock.

“There is a timeframe for healing of tissues, whether it’s muscle, tendon or bone. People want a quick fix but things don’t always heal quickly. We just put everything in position to heal, and it’s up to biology to do the rest.”

Spindler experienced first-hand the limits of the early years of Sports Medicine when he tore a muscle during a high school football game in 1975, and it led to swelling that cut off a nerve in his leg. He asked his orthopaedic surgeon what he needed to do to play football again, and when he completed those steps, the doctor still said he couldn’t play.

“I was 17 years old, pretty wild at that age, and my father thought I was going to strangle the doctor, but I was calm. I said, ‘Thank you, I’ll send you my clippings.’”

Spindler decided to make a career of keeping athletes on the field and has built a Sports Medicine division at Vanderbilt that values research and innovation.

“One of the things we’re most proud of is we have trained a lot of the future NIH researchers and received the highest research awards,” Spindler said. “If you asked everybody in the country who is the best in clinical outcomes sports medicine research, I think we would be named in everyone’s pool.”

There are four major multi-center clinical studies currently under way, three of which are NIH-funded (see sidebar on next page).

“These studies are designed to guide clinical practice, and there are no equal studies to these in the world,” Spindler said. “They set up predictive models, so if your son or daughter tears their ACL and you want to know their prognosis after it gets fixed, we can predict that. It really is individualized or personalized medicine.”

The Trusted Trainers
Michelle Johnson, A.T.C., often feels like a second mom to the hundreds of athletes she cares for at John Overton High School. As the school’s sole athletic trainer, she spends every afternoon rehabilitating injured students, taping ankles and icing sore shoulders. During games, she paces the sidelines, ready to offer medical care or motivation.

Community outreach is a primary mission of Vanderbilt Sports Medicine. Athletic trainers like Michelle Johnson are stationed at every public high school in Davidson and Williamson counties. Photo by Joe Howell.

Community outreach is a primary mission of Vanderbilt Sports Medicine. Athletic trainers like Michelle Johnson are stationed at every public high school in Davidson and Williamson counties. Photo by Joe Howell.

Athletic trainers like Johnson, employed by Vanderbilt Sports Medicine, are stationed at every public high school in Davidson and Williamson counties and some private schools – 27 in all – at no cost to the school district.

“Less than half of the high schools in America have athletic trainers, and we’re fortunate that Vanderbilt is willing to provide that community support,” said Mitch Bellamy, A.T.C., assistant director of Sports Medicine. “Today’s kids are all bigger, stronger and faster, and the collisions are more violent. There’s no question we’re seeing more injuries and those injuries can affect them for the rest of their lives.”

There are about 3.5 million injuries each year in the United States to children 14 and under playing sports, and high school athletes have about 2 million injuries per year. About 8 percent of children drop out of sports each year because of an injury, missing out on the valuable lessons of teamwork, confidence, achieving goals and dealing with setbacks. As athletes specialize in one sport at ever younger ages, overuse injuries are more and more common.

Johnson is there to keep them on the field. Because she sees the students every day, she knows when to tell them to walk it off and she can observe how they’re recovering after a concussion. She also knows when to joke playfully about a player’s mistake or when to have a more serious talk to get their head back in the game.

“Years ago we didn’t have this luxury,” said Overton High School head baseball coach Mike Morrison, “and it’s hard to believe how we functioned without it. If a kid says he doesn’t feel quite right, it’s easy to say who he should go see. She’s available anytime, and it’s great to have someone who can diagnose and knows what to do. Coaches don’t have a clue about sports medicine. We just say ‘put some ice on it.’”

Johnson’s players have her cell phone number, know where her training room is and are quick with high fives and hugs whenever they see her. They know she is available to them at all times.

After ensuring the safety of the athletes, her next most important role is to communicate with parents. At the high school level, they make all the calls about whether their child participates, and Johnson ensures they have all the information they need.

At the collegiate level at Vanderbilt, the Sports Medicine athletic trainers and physicians are given sole discretion about whether players participate.

“We feel very fortunate that we’re at a place that has this outstanding medical center that has a great specialty in sports medicine, and it’s just a few steps away from our athletic department,” said David Williams, vice chancellor for University Affairs and director of Athletics. “I feel as comfortable as I can sending our students out onto the field because I know the people we have in Sports Medicine are the best in the business and they’re going to make the best decisions for the child.”

At all levels, from high school to college to professional, Diamond says athletic trainers are a key part of the equation.

“They’re like a Swiss army knife. They can handle pretty much everything you throw out at them. They also know the athletes, from being there every day, and there’s a great dynamic of back and forth between physicians and athletic trainers. It’s a two-way street and an open door and we constantly are talking and updating. We trust each other, so that allows us to take better care of our athletes.”

Christina Foggie heads into her junior year and the 2012-2013 season in good health and high spirits. She said she couldn’t have done it without Loftis and Diamond and the Vanderbilt Sports Medicine program.

“I’ve spent so much time with Michele and Dr. D., and I love them because they have all our best interests at heart. They did a great job getting me back to health and keeping me in every game. It’s about health first, rather than wins,” she said.





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