The focus of the fellowship clinical training is on the evaluation and management of sports-related injuries and musculoskeletal problems that adversely affect a patient's ability to compete, 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, neurology, endocrinology, cardiology, and other medical aspects of sports. In general, these patients are seen in Sports Medicine from 8 a.m. to 5 p.m., Monday through Friday.

Throughout the year, you 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 primarily under the direct supervision of sports medicine attendings and are introduced to clinic and procedural flow with gradually increasing autonomy. You evaluate patients independently and with the attending physician with whom you are rotating.

As you progress in clinical competency, you will receive increasing autonomy beginning your own independent continuity clinic two half-days each week, working under the indirect supervision of an attending physician. 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 autonomy.

You receive instruction on sports injury history-taking, physical exam findings and techniques, the use and interpretation of appropriate diagnostic imaging, and related testing and procedures. 

The PM&R and orthopedic 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
• Evaluation and management of concussions as part of the Mayo Clinic Sports Medicine concussion program
• Appropriate use of modalities and scientific rationale
• Prescription of targeted stretching techniques
• Prescription of specific strengthening techniques:
  • Isometric, isotonic, isokinetic, and more
  • Concentric and eccentric
  • Open kinetic chain and closed kinetic chain
• Proprioceptive and neuromuscular control retraining
• Principles of functional progression:
  • Treatment plan modification
  • Return-to-play criteria
• Indications for additional objective testing, such as KT2000, Cybex, and gait analysis
• Prescription of various orthoses
• Use of ultrasound for diagnosis of musculoskeletal and sports medicine conditions
• Compartment pressure testing
• Extracorporeal shockwave therapy (focused shockwave and radial pressure wave) 
• Appropriate use of diagnostic and therapeutic injections pertinent to sports-related injury
• Ultrasound-guided procedures:
  • Peripheral joint and bursa injections
  • Perineural injections and blocks
  • Calcific tendon barbotage
  • Mechanical neo-vessel and nerve ablation (tendon scraping)
  • Needle tenotomy
  • Ultrasonic tendon and fascia debridement (Tenex)
  • Soft tissue releases (adductor, compartment, fasciotomy, trigger finger, carpal tunnel)
  • Platelet-rich plasma preparation
  • Bone marrow aspiration and preparation of bone marrow concentrate
  • Microfragmented adipose tissue harvest/preparation

You learn the appropriate indications for consulting specialists in sports psychology (and through this interaction, the psychological impact of sports injuries), neuropsychology, brain injury, sports nutrition, as well as other medical and surgical specialists.

You also participate in:

• Weekly Rochester Community and Technical College training room coverage
• Rochester Community and Technical College football coverage
• Local high school football and hockey coverage
• Multiple-team local tournaments
• National and regional sporting events that regularly occur in Rochester
• The annual Med City Marathon and Health Human Race
• Pre-participation examinations of local high school students, Rochester Community and Technical College students, Major League Baseball, and Rochester FC athletes
• High school wrestling weight certification, skin examinations, and tournament coverage
• Rochester FC game coverage and training room (men’s and women’s)
• Austin Bruins and Rochester Grizzlies hockey coverage (if interested)
• Training camp and practice coverage during the United States Olympic & Paralympic Committee rotation (if interested)

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