Clinical training focuses on the evaluation and management of sports-related injuries and musculoskeletal problems that adversely affect a patient's ability to participate in exercise or maintain general fitness. Although the clinical focus is musculoskeletal, all aspects of a general sports medicine practice are encountered, such as exercise physiology, pulmonology, psychology, and other medical aspects of sports. In general, these patients are seen at Mayo Clinic Square, Monday through Friday from 8 a.m. to 5 p.m.

Throughout the year, you will rotate with sports medicine physicians from a variety of backgrounds, including PM&R, pediatrics, emergency medicine, and orthopedic surgery. During the first several months of the fellowship, you work only under the direct supervision of consultants and are introduced to the procedures of the Sports Medicine practice and Mayo Clinic in general. You evaluate the patients of the consultant with whom you are rotating. The consultant reviews the history and physical exam findings and staffs the patient with the fellow.

As you progress in clinical competency, you begin your own continuity clinic two half days each week, working under indirect supervision with immediate consultant availability. The clinic schedule and types of procedures are progressed during the year based on your clinical competency. This facilitates the advancement of your clinical skills under a model of progressive supervision.

You receive instruction on sports injury history-taking; physical exam findings and techniques; use and interpretation of appropriate diagnostic imaging and related testing; formation of comprehensive management strategies; and therapeutic injections with ultrasound guidance. Throughout the remainder of the year, you are given progressive responsibilities based on your clinical performance.

The sports medicine staff members instruct and assist you in developing differential diagnoses as well as sport- and patient-specific treatment plans for common complaints and injuries.

Aspects covered in the treatment plan include:

• Indications for operative and nonoperative treatment of injuries
• Appropriate use of modalities and scientific rationale
• Exercise prescription
  • Endurance
  • Strength
  • Coordination
  • Flexibility
• Evaluation and management of sports concussions
• Principles of functional progression
  • Treatment plan modification
  • Return-to-play criteria
• Prescription of various orthoses
• Use of ultrasound for diagnosing sports medicine conditions
• Compartment pressure testing
• Appropriate use of diagnostic and therapeutic injections pertinent to sports-related injury
• Ultrasound-guided procedures
  • Peripheral joint and bursa injections
  • Perineural injections and blocks
  • Percutaneous mechanical neo-vessel and nerve ablation (tendon scraping)
  • Percutaneous needle tenotomy
  • Percutaneous tenotomy and fasciotomy using the Tenex device
  • Releases, such as carpal tunnel release and fascial release
  • Platelet-rich plasma injection
  • Bone marrow aspirate concentre (BMAC) injections
  • Micro fragmented adipose tissue injections
• Indications for specialty consult (sports psychology, nutrition, surgical specialties, etc.)

You also participate in:

• Coverage of training rooms and basketball games for the Minnesota Timberwolves (NBA) and Minnesota Lynx (WNBA)
• Game coverage and spring training experience with the Minnesota Twins (MLB)
• Training room for the James Sewell Ballet
• Training room and event coverage for the University of Northwestern, North Central University, and Crown College
• Coverage of Minnesota State High School League games/tournaments
• Adaptive athlete sports coverage
• Local mass participation events
• The annual Med City Marathon and Twin Cities Marathon
• Pre-participation examinations for high school, college, and professional athletes

Clinical training also includes specific clinical learning experiences with Mayo Clinic Square physical therapy, athletic training, and sports performance staff. During these experiences, you observe and participate in patient evaluation, movement analysis, and therapeutic exercise prescription.