The days of sports medicine being a service line that simply addresses the repair of injury and return to play are going…going…gone. Instead, the specialty today is tinged with notes of wellness and holistic care, with just as much attention paid to proper training and prevention as treating the average ankle sprain.

Programs include the usual suspects of orthopedics and rehabilitation alongside newcomers like sports psychology, nutrition, and even research initiatives and technology to measure and analyze data points to better address the causes of injury or secrets to peak performance.

Philosophically, care delivery isn’t too different than the average acute care project, but the unique twist of adding elements that essentially bring patients to a facility for a purpose other than receiving healthcare services is a new one, says Michael Wiggins, senior vice president and administrator of Children’s Health at Plano in Plano, Texas. “Being able to integrate function into a care delivery model has been different for me from an owner’s perspective.”

It’s a model that’s catching on, too, as care centers are popping up everywhere from urban downtowns to community MOBs, serving Little League players and weekend warriors all the way up to professional athletes. Despite these projects’ inherent differences, the programs gaining strength all come in answer to growing demand, provide a menu of services that provide whole-person care, and offer providers the possibility of a swelling revenue stream.

Beyond the basics
A few years ago, Children’s Medical Center Plano in Plano, Texas, part of the Children’s Health System of Texas, started considering some impressive figures, including statistics that 30 million children across the country are participating in some form of organized sports and that 3.5 million children under the age of 14 will be treated for some type of sports-related injury in a given year. But it wasn’t necessarily a focus on treating those injuries that spurred a response; it was preventing them. “That was a foundation to all of our discussions—that it’s not just about dealing with injuries,” Wiggins says.

Children’s partnered with the Andrews Institute for Orthopaedics & Sports Medicine, based in Gulf Breeze, Fla., to establish the Children’s Health Andrews Institute within a new four-story MOB on the Plano campus, scheduled to open in the third quarter of 2017, where the prevention of injuries and long-term conditions is a big piece of its mission.

It’s an effort already established for adult patients in Rochester, Minn., in the 21,000-square-foot Mayo Clinic Sports Medicine Center that opened in 2014 inside the Dan Abraham Healthy Living Center. “What Mayo was doing and what we’re starting to hear our clients talk about is this alignment or overlap between healing and injury repair with wellness and performance,” says Pete Smith, president and CEO of BWBR and the principal on the project (Saint Paul, Minn.).

This bridging between healthcare and healthy living has struck a chord, with professional sports teams seeking top performance from their athletes all the way down to the average Joann who’d like to have her golf swing analyzed to achieve a better game and prevent future damage if that swing isn’t exactly up to par.

The results seen so far are frontrunners to the wellness push starting to be explored in healthcare, and for good reason, too—there’s cash flow, particularly in partnerships with collegiate or professional teams. “There’s an economic reason [providers] can do these things versus if they were trying to convince you or I to spend some dollars staying healthy. We usually don’t go to the doctor until we need to, but this concept is, ‘What if you go before you need to so you never need to?’” Smith says.


The lineup
This modern approach to sports medicine relies on the critical component of holistic care, meaning that programs that must be accommodated within built environments are varied and complex.

For the Mayo Clinic project, a sports medicine program had long been located within the basement of an existing campus building and finally found a new home in the Dan Abraham space, a wellness center originally built for employees and where the 2014 expansion also added outreach to the broader community. The move allowed the program to partner with human performance group Exos for athletic training and continue to treat patients including NHL hockey players, Olympic weight-lifting athletes, and pros and amateurs alike across basketball, volleyball, baseball, golf, and track.

“They wanted a clinical element, as well, so that if somebody did have an injury or was doing some rehabilitation, or perhaps there was suspicion [of an injury] after they started checking their performance, they wanted to be able to walk across the hall and check that out,” Smith says.

So in this case, the program called for exam rooms, rehab space, and training areas for all of those above-mentioned sports.

Likewise, in Brookhaven, Ga., Emory Healthcare and the Atlanta Hawks Basketball Club are partnering to build a training and sports medicine facility to serve as the NBA team’s training facility as well as home to Emory’s sports medicine program. It’s currently in schematic design, with HOK at the helm, and is scheduled to open in late 2017.

Of the 90,000-square-foot facility, about 30,000 square feet will be home to Emory’s treatment and training programs, with its entire roster of sports medicine staff making their home there. The building not only has to support the training and treatment of the Hawks but a general patient population and P3, an athletic performance and injury prevention intelligence provider—all alongside three basic components of exam suites, high-end radiology, and rehabilitation and physical therapy.

The addition of science to the equation through P3 is a new one, and Hideaki Taguchi, senior project designer for HOK sports, recreation, and entertainment (Kansas City), sees it as a growing trend. That’s due partly to Major League Baseball, specifically, sparking interest in the use of analytics to enhance performance, a move that’s now being translated across sports and medicine.

“[Professional athletes] have reached a performance peak based on the traditional training aspect and started looking at science and numbers to gain an edge in their performance,” he says. This ability to gather metrics will be an important part of the holistic approach to care at the Hawks facility, helping to identify mechanical issues via motion capture technology or using force plates to recognize where adjustments might be needed in a person’s jump or gait, adds Paul Whitson, regional leader of healthcare and senior vice president of HOK’s healthcare practice (St. Louis).

Additionally, the Emory/Hawks program will bring in support for nutrition and relaxation, stressing the importance of recovery. “That rhythm and the rest side of the training I see as a newer, stronger trend,” Taguchi says.


Building blocks
For HOK, organizing those different elements at the Hawks facility first meant accommodating the sports medicine practice currently housed within Emory’s spine and orthopedic center. Answering projected growth, the clinical plan uses a modular approach to exam rooms that allows modules to be added over time or reassigned depending on patient volume.

Additionally, the clients requested a clear separation between the Hawks population and traditional patients. “This has been an architectural planning challenge,” Taguchi says. And few examples exist, with some including partnership locations between the Minnesota Timberwolves and Mayo Clinic and Cleveland Cavaliers and Cleveland Clinic. Although ownership expressed a desire to separate the pros from the amateurs, there’s an emotional element that the provider didn’t want to lose, either: for example, a young athlete coming into the facility and being inspired by who else is treated there.

The solution is separate entrances for the public and the Hawks, with the team largely kept out of site, while the facility overall represents a unique colocation that offers plenty of seductive branding, Whitson says. To that end, one exception to the separation is a window into a basketball court in the two-story public lobby, with design elements largely obscuring a view inside but providing peeks of movement and glimpses of players. “It’s more complex than it sounds,” Whitson says, comparing the project to acute care work. “I found this to be more challenging just because of the way these two entities are sharing this one building and how to make it really synergistic.”

At the Children’s Health Andrews Institute, there are no pro athletes who have to be accommodated, but the design is still aspirational. “It’s very similar to what you provide the adult athletic population in terms of the types of services and facilities,” says Chad Gilliland, senior director, Andrews Institute. “The facility itself very much mimics [facilities] where high-level athletes train. If you had less than that, you really wouldn’t get kids’ attention.”

Organizationally, that’s meant creating a continuum of care with a surgery center, orthopedics, physical therapy, and a highly visible athletic performance training gym and athletic fields that boost that aspirational note. “When you’re coming in with an injury, you’re seeing the kids who have gone through the recovery process and are back out playing sports. So there’s a lot of play and inspiration with what the patients and families are seeing,” says Beth Carroll, principal and architect with Page, which is designing the project.


Everyone at the table
Regardless of patient base and whether the biggest star walking into a facility is LeBron James or the kid next door, designers recommend using a multidisciplinary approach to planning, bringing in all those disparate specialties and caregivers to hash out what a building really needs to be.

“Because of the process of care, the surgeons are very connected with the physical therapists and the strength and conditioning specialists about how that delivery of care is going to be received by the patient. So when we were going through the design process, we had several meetings where they were all at the table discussing this,” Carroll says of the Children’s project.

Whitson agrees: “Working in orthopedics, especially, there are so many specialized components to it that you really have to start with listening and trying to understand how this particular provider delivers care different from anyone else.” Another key is unlocking a willingness to change. “Because of their expertise and confidence, [caregivers] think the way they’ve been doing this for 20 years is absolutely the right way. That might be true, but we don’t know … just talking about it can make everybody realize there’s a way of doing things better,” Taguchi adds.

Solving that challenge requires consideration of the patient experience, as well—for example, the more casual nature of physical therapy compared to the more technical side of radiology. “Understanding the different qualities and experiences associated with the different program elements and being able to stitch that together, I think for sports medicine that’s the real conceptual design framework,” Taguchi says.
Well ahead
As sports medicine continues to evolve like healthcare in general—focusing on preventing illness rather than treating it—the projects that have come to fruition or are in progress serve as valuable case studies for all. “Healthcare is moving in that direction with population health and wellness initiatives that are out there. Sports medicine gives it a good model to emulate over time. When you’re treating a knee, you’re not just treating a knee—you’re treating a whole person back to a recovery state that allows them to return to activity,” Gilliland says.

When the topic of wellness comes up, Smith recommends working with sports medicine clients to truly define the project goal. “Is it wellness and performance and keeping people from being injured, or is it just wellness because it’s a popular word?” Smith says.

And delivering on these goals in the built environment means more than service lines—it’s about an integration of elements that are inextricable from the design and not just layered on top, from rooftop gardens to walking trails to opportunities for lots of natural light. “It’s completely integrated into the overall approach to the design and execution,” Whitson says. In fact, for the Emory/Hawks project, the goal isn’t sports medicine; it’s sports spa. “That’s been a big push from the client side,” he says, “that people coming to this facility don’t experience stress. It’s very calming. It’s very easy to understand what you’re supposed to do and where you’re supposed to go.”

In the meantime, Whitson urges design firms to consider internal collaboration to brace for the trend. “As part of our practice in Kansas City, there are people who do nothing but wellness design, so that’s where we’re finding we’re breaking interesting new ground,” he says of the integration of healthcare, sports, and wellness studios. “That’s going to inform the larger healthcare practice.”

Jennifer Kovacs Silvis is executive editor of Healthcare Design. She can be reached at