UnityPoint Clinic Sports Medicine - United Medical Park

Caleb Peters, a freshman at Waterloo East High, had long dreamt of sharing the baseball field with his older brother. Brayden was a senior, and his final baseball season was just a few months away.

However, Caleb’s hopes were in jeopardy. The 15-year-old had battled the pain of a torn labrum since a wrestling injury in seventh grade, and physical therapy had only resolved so much. He didn’t want to risk reinjury yet assumed any surgical procedure would sideline him for baseball season.

Peters was referred to UnityPoint Clinic orthopedic and sports medicine surgeon Rafael Serrano, MD, who affirmed the original diagnosis. What followed wasn’t a recommendation, life advice or even an assumption. It was a question that got to the heart of the matter.

Dr. Serrano asked Peters, “What do you want?”

Peters wanted to play sports again–specifically, to wrestle and play baseball with his brother, all without pain or the fear of reinjury.

That’s all Dr. Serrano needed to hear. He performed a left shoulder scope with labral repair in December 2022. By spring–with help from his team of Alexa Ginther, ARNP, and Caylee Miller, RN–Peters was back on the field starring for East as a shortstop and starting pitcher. He finished the season as honorable mention all-conference and All-Metro, while finishing among the Trojans’ leaders at the plate (RBIs) and on the mound (strikeouts).

“I have nothing but gratitude every time I step on the field,” Caleb says. “Without Dr. Serrano, I’d be missing out on playing baseball with my older brother. For years, we talked about how awesome this would be.”

Surgery wasn’t the only option for Caleb. Physical therapy could have helped him attempt to manage the pain and avoid surgery. However, he would still face the risk of re-injury and physical limitations.

The shoulder is a ball-and-socket joint that’s inherently unstable because of its shallow socket. The labrum, a soft rim of cartilage, helps accommodate the head of the upper arm bone, but it can be torn with a traumatic injury or overuse.

“Caleb’s injury isn’t one of those where surgery is mandatory for activities of daily life,” explains Dr. Serrano. “But if he wanted to return to competitive sports, the only way to fully go back and play without pain and further damage to the labrum was with surgery.”

“I was worried Dr. Serrano would tell me I wouldn’t be able to wrestle anymore,” Caleb says. “The first time I met him, even the way he checked out my arm was different. He was very complete in everything. No one at this point had even moved my arm and shoulder the way he did. Yeah, it hurt. It hurt really bad.”

“The first thing he asked me was, ‘What do you want? Do you want to compete in sports again? Is your plan to wrestle, play football or baseball again?’ Of course, without even thinking, I answered yes!”

Caleb’s family also had input about how his high school career could play out.

“It was hard to watch Caleb go through what he did for about two years,” said his mother, Meghan. “We have absolutely no regrets, and we’re completely astounded by the outcome we’ve seen.”

“Dr. Serrano himself called to check in on Caleb to see how he was handling the first couple of days after surgery,” recalled Dominic, Caleb’s father. “This meant a lot to us. It showed he had truly invested in our child. We cannot thank him and his staff enough for all they did.”

The surgery did require Caleb to miss wrestling season, but his seamless recovery preserved the plans he and Brayden had about sharing the baseball diamond.

“If I said I wasn't upset about missing the wrestling season because of this, I would be lying,” says Caleb. “This was hard on both of us. So, to be able to play baseball together is awesome.”

Golf isn’t typically considered a team game. Goals related to longer drives and lower scores are usually achieved by overcoming obstacles inside your own head.

For Fred Abraham, his goals were much different – he simply wanted to enjoy the game again. And his limitations were mostly physical.

He found a teammate in physical therapist Tristan Boaldin, who took the time to fully understand Abraham’s condition, amplify his mental drive, provide motivation as needed and work toward goals to improve quality of life.

“One of the great things that happened is he worked so hard with me it inspired me to work harder myself,” Abraham said. “I reached the stage where I was focused less on the exercise and more on not disappointing Tristan.”

Abraham’s ailments centered around his hip. He endured four surgeries in eight months before opting for a total hip replacement. It took a toll, and he relied on a walker most days to get around due to atrophy of the muscles around his hip joint. He took a recommendation to visit Boaldin at UnityPoint Clinic Orthopedics – United Medical Park for physical therapy to find a path to recovery.

Upon their first meeting, Abraham felt a sense of comfort and connection. When therapy began, there was clear progress, but it wasn’t without setbacks. He injured his back doing work around the house, which meant some alterations were made to his therapy plan while the end goals remained the same.

“We never resumed any exercises that might possibly cause problems for my back,” Abraham said. “That was insightful on his part – he was not going to take a chance that while we were strengthening my hip, we would cause another problem.”

From Boaldin’s point of view, he modified exercises targeting the hip, core and back musculature as well as the intensity and specific movements to prevent setbacks. The issues Boaldin identified initially included altered gait, difficulty with balance and decreased range of motion that affected daily activities.

Steady progress was made, and Abraham no longer needed his walker. He graduated to unaided walking over short distances and returned to walking nine holes on the golf course with the help of a four-point cane. Before long, he was able to put away the cane.

All this just seemed to click and come together for Abraham, which became a lasting impression.

“We had humorous discussion as I was doing my exercises, and I found that if I focused on our conversations, I was not totally aware of what I was doing and I was getting stronger without knowing it,” he said. “All the while, Tristan was carefully watching me as I went through the program.”

In addition to playing golf, Abraham has achieved his goal of taking 10,000 steps a day – an impressive total for anyone.

“Fred was very motivated to improve. He was specific about his goals and also realistic about the amount of effort required to achieve them,” Boaldin said. “He was also very good at communicating his needs to allow me to modify my plan as needed. The progress made by Fred is truly remarkable!”

What’s remarkable to Abraham is how much trust was given to the process and the careful planning that was required. Setbacks that could have put everything on hold ended up as small obstacles.

“I was impressed by how well Tristan listened and how well he remembered all of my issues,” Abraham said. “He had the ability to recognize how much I could and, more importantly, how much I couldn’t do. Anytime a particular exercise was simply too difficult, we eased up a little. But only for a while. He had a long-term plan for me and we stuck to it."

Photo courtesy of Stephanie Lyn Photography

Hilman was working toward his future and had responsibilities on the ice, so he chose to continue playing. His symptoms came and went until they finally reached a crescendo at the end of this 2022-23 season with the Waterloo Black Hawks.

Eventually, it become too much. Hilman was sent to Rafael Serrano, MD, at UnityPoint Clinic Orthopedics in Waterloo. A sports medicine expert, Dr. Serrano also serves as the team’s orthopedic surgeon.

Hilman had suffered several dislocations between both of his shoulders over the course of a year. With Dr. Serrano’s help, he managed the pain and helped the Black Hawks finish a strong season.

Finally, Hilman had his labrum arthroscopically repaired in each shoulder. He then did three months of physical therapy, which beat the original timeline. With help from the Black Hawks’ athletic trainer Todd Klein and strength and conditioning coach Spenser Popinga, Hilman was back on the ice for the Black Hawks by October without any lingering issues. Through last week, the forward had a healthy total of 10 goals and five assists.

Surgery went well, but that wasn’t what made the biggest impression on Hilman. Instead, it was Dr. Serrano’s flexibility to help him finish the season.

“Towards the end of last year, I knew something was really wrong, but we had a really good team, and we were going to make a good playoff push,” Hilman says. “I wanted to be a part of that. So, I didn’t want to do surgery and miss out. (Dr. Serrano) was like, ‘You’re not going to make it much worse, and we can give you an injection to get through the year.’

“I was super impressed with how willing he was to work with me. He understands that I’m an athlete, he gets it. He used to work with the Penguins and Steelers and stuff, too, so he’s kind of been there and knows you can push your body a bit more when you’re younger and you heal a little quicker.”

When the season ended, Hilman had surgery the next day, and the second shoulder was repaired six weeks later. He then ramped up with three months of meticulous physical therapy aimed at regaining range of motion and increasing strength. He started with skating, then began hitting a puck before joining his teammates for non-contact practice.

“He is a true athlete,” Dr. Serrano says. “He worked really hard to get back. He was able to cut down, in a safe manner, every single phase of his rehab to return to play sooner. We had aimed for four months after the second surgery. It ended up being three.”

“I’m thankful for Dr. Serrano for just being a phenomenal human,” Hilman says. “He’s a great surgeon, too. My shoulder has never felt better. But the big thing is he’s just such an approachable guy. He’s at our games telling us to see him between periods, was always checking up on how I’m doing, asking about the family.”

“In our sports medicine clinic, we take care of every single part of the puzzle,” Dr. Serrano says. “We understand the importance of prompt diagnosis, a treatment plan and execution of that plan to safely bring the athlete to their pre-injury level as quickly and safe as possible.”

"I would like to leave a 5-star review for Dr. (Rafael) Serrano and his team in regards to the care my daughter, Saela Steege, received. After her second knee injury, we were told to seek tertiary care. 'The damage is severe and her case too complex to be handled locally.'

"And then this incredible surgeon came into our lives.

"Tonight – 13 months after he repaired her knee – he showed up to support and cheer her on at her basketball game. Tertiary care is right here!

"We are blessed with the winning team! Incredibly thankful to Dr. Serrano and crew at UnityPoint Sports Medicine and Orthopedics, and Justin Trainor and staff at Performance Rehab Physical & Occupational Therapy."

– Katie Steege, of Fredericksburg