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Back in the Game

Sentara RMH Orthopedics Helps Athletes Play On

From weekend warriors to elite professionals, the team at Sentara RMH Orthopedics and Sports Medicine has a wide range of expertise to help athletes of all skill levels—like the three featured here—recover from challenging injuries and get back to the sports they love.

Returning a Tennis Pro to the Courts

Emily Harman has played competitive tennis at a high level for most of her life, but a series of injuries was keeping her career in check. Looking for a nonsurgical solution to help get her back on the court, the Petersburg, W.Va., native recently turned to the caregivers at Sentara RMH Orthopedics and Sports Medicine.

Following her graduation from Syracuse University, Harman played professional tennis from 2012 to 2015, but struggled with knee pain due to several issues, including partial tearing of the patellar tendon, incomplete bone fusion at the tibial tubercle and deep infrapatellar bursitis.

“I could play, but it was painful,” Harman says. “And the pain made it very difficult for me to train at the level I needed in order to compete.”

Ranked as high as No. 232 in the world in doubles tennis and No. 966 in singles during her career, Harman tried to work through the pain with help from trainers on the tennis circuit. She experienced some relief from physical therapy, but the pain still made competitive play challenging. Hearing about Harman’s problems, her cousin, who was working at Sentara RMH, recommended that Harman come in to see orthopedic physician Benjamin I. Mwanika, DO.

“Dr. Ben was great,” Harman says, “and I connected with him immediately. He understood my position as a professional athlete and knew this was very important for my career and my confidence.”

After evaluating Harman’s condition carefully, Dr. Mwanika administered platelet-rich plasma (PRP) injections in a procedure intended to help speed the healing in her knee. As part of the procedure, a small amount of Harman’s blood was placed in a centrifuge to separate the platelets from the rest of the blood, and the concentrated platelets were then injected, under ultrasound guidance, into three locations in her knee.

A relatively recent advance in orthopedics and sports medicine, PRP injections have been used to treat well-known professional athletes such as Stephen Curry, Rafael Nadal and Hines Ward. The procedure has been in use since the 1980s, according to Dr. Mwanika, when it was first used for cardiac procedures, but it is now used successfully in numerous other fields, including orthopedics, cosmetic surgery and dentistry.

Since Harman had previously received a PRP injection in her shoulder while at Syracuse, she had confidence in the technique’s effectiveness. Within two weeks of receiving the treatment, she says she experienced “massive improvements” with her knee. She then underwent physical therapy to help get her flexibility back and reduce swelling.

“After the injections, it took about three months to get full strength back in the knee,” notes Harman. “But I was able to do everything I could do before my injuries, and I had the confidence to go out and compete again.”

With her knee at “100 percent,” according to Harman, she went back to playing pro tennis during the first half of 2015, winning a doubles tournament on tour during that time. Later that summer, she accepted a position as assistant women’s tennis coach at West Virginia University, where she is also studying for a master’s degree in health sciences and considering pursuing a medical degree.

“The knee has held up great,” she says. “It’s maybe even stronger than it was before. PRP certainly helped my healing process, and I would encourage athletes who are good candidates for the procedure to give it a try. As an athlete, you want the best in sports medicine care, and I would definitely advise anyone in need of nonsurgical treatment to consult with Dr. Mwanika.”

Getting a Weekend Warrior Ready to Race Again

David Gillette really enjoys pushing himself physically. For instance, while many people would consider running a 5K race to be a significant event, Gillette got “bored” with those races and decided to challenge himself on a whole new level.

That drive led him to obstacle course races like the Spartan Race and Tough Mudder, events during which participants not only run but also attempt to complete physical challenges, such as climbing walls, crawling under barbed wire and carrying heavy objects. The races Gillette participates in are as long as 13 miles and contain 25-35 obstacles. “I needed a change of scenery, and the obstacles motivated me,” Gillette says.

But Gillette, 44, had to take a break from racing and training recently when he broke his hand. “I was just doing everyday tasks when it happened—I wish I had a better story,” he jokes.

Gillette had what Sentara RMH Orthopedics and Sports Medicine physician Thomas Weber, MD, refers to as a “boxer’s fracture” on his knuckle, as well as a laceration on top of the fracture. Rather than immediately recommending surgery to repair the hand, Sentara RMH physicians decided to investigate the wound first to see if surgery was necessary. They determined the bone could in fact heal without surgery, so they put Gillette’s hand in a splint for two weeks, then Dr. Weber removed the stitches and fitted him with a fiberglass cast for an additional two weeks.

The injury to Gillette’s dominant right hand forced him to find new ways to carry out basic tasks and perform his duties as office manager at James Madison University’s Counseling Center.

“Typing turned into peck typing with my left hand, and writing turned into kindergarten letters,” he recalls. Gillette also learned to keep his shoes loosely tied so he could slip them on and off easily.

A personal trainer in his spare time, Gillette found it challenging during his recovery to model exercises and correct his clients’ form. “I could describe to my clients how to perform certain exercises, but I couldn’t show them,” he says. “I had to give very detailed instructions.”

At the time of this writing, six weeks after the fracture, Gillette estimates he is 85 percent recovered and is looking forward to the Civilian Military Combine, a military-grade race at Fort Hamilton in Brooklyn, N.Y., on the weekend of the September 11 anniversary. “Each day I can see a bit of progress with my hand,” he notes.

Putting a Standout Football Player Back on the Field

For Jeremy Pultz, a football injury during his junior year of high school proved to be somewhat of a mixed blessing, leading to the discovery of a serious knee condition—and, ultimately, relief from years of persistent pain.

In September 2015, Jeremy, the first-string center on the Harrisonburg High School football team, took a hard hit on the field. Trainers thought he might possibly have a tear to his anterior cruciate ligament (ACL), one of the major ligaments that help stabilize the knee, so he went to see Sentara RMH Orthopedics and Sports Medicine surgeon Chad Muxlow, DO. Surprisingly, X-rays didn’t show an ACL tear, but they did reveal that Pultz had a serious issue, known as an osteochondral defect, in both knees. Dr. Muxlow then ordered a magnetic resonance imaging scan to evaluate the extent of the defect.

Caused by a disruption of the blood supply to the bone beneath the cartilage in a defined area of both knees, the defect had resulted in extensive damage to the bone. The reason for the blood supply disruption is not fully understood, according to Dr. Muxlow, but it may have been caused by repetitive stress or trauma to the bone over time.

Pultz had been complaining about knee pain for years, but his mother, Robin Crespo, reasonably assumed it was caused by Osgood-Schlatter disease, an inflammation of the knee ligament, with which her son had been diagnosed as a child.

Pultz, who is also an aspiring competitive powerlifter, says it was a relief to finally have a diagnosis.

“The pain was really tough, but my body got so used to it that I didn’t really notice,” he says. “I used to joke with Mom that I had ‘old man’ knees, and it turned out to be true.”

Pultz’s right knee was far more damaged than the left, so Dr. Muxlow first performed a bone graft on the left knee, which likely would hold up better under the stress of surgery.

“When it came time to do the procedure, I really wasn’t nervous at all,” Pultz recalls. “Dr. Muxlow explained everything he was going to do, and I was grateful to have one of the best doctors I could possibly have for my particular situation.”

After 10 weeks of crutches and physical therapy, Pultz was ready for surgery on his right knee, which Dr. Muxlow performed on Dec. 31, 2015.

The damage to the right knee was so extensive that Dr. Muxlow couldn’t do a bone graft. Instead, Pultz underwent a microfracture procedure, a type of arthroscopic surgery in which small fractures or holes in the bone are made in order to prompt stem cells to form new cartilage and stimulate healing. It’s a procedure that has been performed on many big-name basketball stars and other professional athletes.

“The surgeries went fine,” Crespo says. “Because Jeremy had surgery on both knees and was undergoing continuous rehab, he spent from October until the end of March on crutches, except for one week between the surgeries.”

While the left knee repair should last a lifetime, Dr. Muxlow says Pultz may potentially need further cartilage surgery on his right knee down the line, since he is a very active athlete. “The cartilage that heals in after microfracture surgery is a type of scar tissue cartilage that isn’t as durable as the cartilage we’re born with,” he explains.

A sample of Jeremy’s healthy cartilage is currently being grown at a cartilage bank—which is similar in concept to a blood bank—for any potential future surgeries, Crespo says.

She adds that Dr. Muxlow and his physician assistant, Ryan Chico, PA-C, did everything possible to get her son moving again.

“They’re athletes themselves, so they understood,” she says. “They really communicated with Jeremy as an athlete and a kid. They were just awesome.”

Following his surgeries, Pultz was named captain of the Harrisonburg High football team for his senior year, and he hopes to continue to play football in college. He also broke the Harrisonburg High School squat lift record just eight weeks after completing his rehab. He says he experiences very little pain these days, but he does play football with knee braces, for the sake of his own confidence.

“I’m doing really great,” he says. “This is the best I’ve ever been, thanks to the surgeries. I was used to not being at my best due to my physical situation, and the surgeries have really changed my whole life.”

To contact Sentara RMH Orthopedics and Sports Medicine, call 540-689-5500.

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