© 2011 McGraw-Hill Higher Education. All rights reserved. History of Athletic Training and the Sports Medicine Team William E. Prentice

Athletic trainers specialize in preventing, recognizing, managing and rehabilitating injuries Function as a member of a health care team which also incorporates and involves a number of medical specialties Provide a critical link between the medical community and physically active individuals

© 2011 McGraw-Hill Higher Education. All rights reserved. Historical Perspective Early History ◦Evidence suggests that coaches, physicians & therapists existed in Greek and Roman civilizations ◦Assisted athletes in reaching top performance ◦Worked with athletes such as gladiators ◦Athletic trainers came into existence in the late 19 th century in intercollegiate & interscholastic sports ◦Early treatments involved rubs, counter-irritants, home remedies and poultices

Evolution of Contemporary Athletic Trainer Traditional setting of practice included colleges and secondary schools ◦Dealing exclusively with an athletic population Today certified athletic trainers (ATC) work in a variety of settings and with a variety of patient populations ◦Professional sports ◦Hospitals ◦Clinics ◦Industrial settings ◦Military ◦Sales ◦Physician extenders

© 2011 McGraw-Hill Higher Education. All rights reserved. Rapid evolution of the profession following WW I ◦Athletic trainers became specialists in preventing and managing injuries ◦Dr. S.E. Bilik wrote, The Trainer’s Bible (1917) ◦The Cramer brothers developed a line of liniments to treat ankle sprains (1920’s) and followed the publication The First Aider (1932) ◦In the 1930’s the NATA started to come into existence but then disappeared during WW II ◦In 1950 the NATA was reorganized and it has continued to flourish and expand

With the evolution of the profession a number of milestones have been achieved ◦Recognition of Acts as healthcare providers ◦Increased diversity of practice settings ◦Passage of practice acts ◦Third party reimbursement for athletic trainers ◦Constant revision and reform of athletic training education

© 2011 McGraw-Hill Higher Education. All rights reserved. Changing Face of Athletic Training Profession Role of the athletic trainer is more in line, today, as a health care provider ◦40% of athletic trainers are employed in clinics, hospitals, industrial and occupational settings ◦Also involved in NASCAR, performing arts, military, NASA, medical equipment & sales, law enforcement, and the US government Has resulted in changes in athletic training education

Athletic trainers do not just provide medical care to athletes or those just injured during physical activity Becoming more aligned as a clinical health care profession ◦Requires terminology changes ◦Patients and clients vs. athletes ◦Athletic clinic or facility vs. athletic training room ◦Athletic trainers – NOT TRAINERS!!

© 2011 McGraw-Hill Higher Education. All rights reserved. Sports Medicine and Athletic Training Broad field of medical practices related to physical activity and sport Involves a number of specialties involving active populations Typically classified as relating to performance enhancement or injury care and management

Practice of Medicine Human Performance Injury Management Exercise Physiology Biomechanics Sport Psychology Strength Conditioning Sports Physical Therapy Athletic Training Personal Fitness Trainers Sports Massage Sports Podiatry/ Orthotists Sports Dentistry

Growth of Professional Sports Medicine Organizations International Federation of Sports Medicine (1928) American Academy of Family Physicians (1947) National Athletic Trainers Association (1950) American College of Sports Medicine (1954) American Orthopaedic Society for Sports Medicine (1972) National Strength and Conditioning Association (1978) American Academy of Pediatrics, Sports Committee (1979) Sports Physical Therapy Section of APTA (1981) NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (1985) National Academy of Sports Medicine (1987)

National Athletic Trainers’ Association To enhance the quality of health care for athletes and those engaged in physical activity, and to advance the profession of athletic training through education and research in the prevention, evaluation, management and rehabilitation of injuries The NATA now has 32,000 members

Sports Medicine Journals A variety of publications exist, providing excellent resources to the sports medicine community ◦Journal of Athletic Training ◦Journal of Sports Rehabilitation ◦International Journal of Sports Medicine ◦Physician and Sports Medicine ◦Clinics in Sports Medicine ◦American Journal of Sports Medicine ◦Sports Health ◦Athletic Therapy Today ◦Training & Conditioning ◦Athletic Training & Sports Health Care

© 2011 McGraw-Hill Higher Education. All rights reserved. June AMA officially recognized athletic training as an allied health care profession

© 2011 McGraw-Hill Higher Education. All rights reserved. Employment Settings for the Athletic Trainer Employment opportunities are becoming increasingly diverse ◦Dramatic transformation since 1950 ◦Due largely to the efforts of the NATA Started out primarily in the collegiate setting, progressed to high schools and now, 30% are found primarily in hospital and clinic settings

Settings include: ◦Clinics and hospitals ◦Physician extenders ◦Industrial/Occupational settings ◦Corporate settings ◦Colleges or Universities ◦Secondary schools ◦School districts ◦Professional sports ◦Amateur/Recreational/Youth sports ◦Performing arts ◦Military & Law enforcement ◦Health & fitness clubs

© 2011 McGraw-Hill Higher Education. All rights reserved. Treating Physically Active Populations Consists of athletic, recreational or competitive activities Requires physical skills and utilizes strength, power, endurance, speed, flexibility, range of motion and agility

© 2011 McGraw-Hill Higher Education. All rights reserved. Roles & Responsibilities of the Athletic Trainer Charged with injury prevention and health care provision for an injured patient Athletic trainer deals with the patient and injury from its inception until the athlete returns to full competition

© 2011 McGraw-Hill Higher Education. All rights reserved. Roles and Responsibilities: Board of Certification Domains 1. Prevention 2. Clinical evaluation and diagnosis 3. Immediate care 4. Treatment, rehabilitation and reconditioning 5. Health care administration 6. Professional responsibilities

© 2011 McGraw-Hill Higher Education. All rights reserved. Prevention ◦Ensure safe environment ◦Conduct pre-participation physicals ◦Develop training and conditioning programs ◦Select and fit protective equipment properly ◦Explaining important diet and lifestyle choices ◦Ensure appropriate medication use while discouraging substance abuse

© 2011 McGraw-Hill Higher Education. All rights reserved. Clinical Evaluation and Diagnosis ◦Recognize nature and extent of injury ◦Involves both on and off-field evaluation skills and techniques ◦Understand pathology of injuries and illnesses ◦Referring to medical care ◦Referring to supportive services Immediate Care ◦Administration of appropriate first aid and emergency medical care (CPR, AED) ◦Activation of emergency action plans (EAP)

© 2011 McGraw-Hill Higher Education. All rights reserved. Treatment, Rehabilitation, Reconditioning ◦Design preventative training systems ◦Rehabilitation program design ◦Supervising rehabilitation programs ◦Incorporation of therapeutic modalities and exercise ◦Offering psychosocial intervention Organization & Administration ◦Record keeping ◦Ordering supplies and equipment ◦Establishing policies and procedures ◦Supervising personnel

© 2011 McGraw-Hill Higher Education. All rights reserved. Professional Responsibilities ◦Athletic trainer as educator ◦Athletic trainer and continuing education ◦Athletic trainers as counselor ◦Athletic trainers as researcher ◦Incorporation of evidence based medicine and participating and acquisition of evidence for efficacy of patient care

The athletic trainer, physician and coaches must be aware and inform parents of Health Insurance Portability and Accountability Act (HIPAA) ◦Regulates dissemination of health information ◦Protects patient’s privacy and limits the people who could gain access to medical records

© 2011 McGraw-Hill Higher Education. All rights reserved. The Athletic Trainer and the Team Physician Athletic trainer works under direct supervision of physician Physician assumes a number of roles ◦Serves to advise and supervise ATC Physician and the athletic trainer must be able to work together ◦Have similar philosophical opinions regarding injury management ◦Helps to minimize discrepancies and inconsistencies

© 2011 McGraw-Hill Higher Education. All rights reserved. The Athletic Trainer and the Physician The physician is responsible for compiling medical histories and conducting physical exams ◦Pre-participation screening Diagnosing injury Deciding on disqualifications ◦Decisions regarding athlete’s ability to participate based on medical knowledge and psychophysiological demands of sport Attending practice and games Commitment to sports and athlete

© 2011 McGraw-Hill Higher Education. All rights reserved. The Athletic Trainer and the Coach Must understand specific role of all individuals involved with the team Coach must clearly understand the limits of their ability to function as a health care provider in their respective state Directly responsible for injury prevention ◦Athlete must go through appropriate conditioning program

© 2011 McGraw-Hill Higher Education. All rights reserved. The Athletic Trainer and the Coach Coach must be aware of risks associated with sport Provide appropriate training and equipment Should be certified in CPR and first aid Must have thorough knowledge of skills, techniques and environmental factors associated with sport Develop good working relationships with staff, including athletic trainers ◦Must be a cooperative relationship

© 2011 McGraw-Hill Higher Education. All rights reserved. Referring the Patient to Other Personnel The athletic trainer must be aware of available medical and non-medical personnel ◦Patient may require special treatment outside of the “traditional” sports medicine team Must be aware of community based services and various insurance plans ◦Typically the athletic trainer and team physician will consult on the particular matter and refer accordingly

Exercise Physiologist Biomechanist Nutritionist Sport Psychologist Coaches Strength & Conditioning Specialist Social Worker Neurologist Emergency Medical Technician Physicians Dentist Podiatrist Nurse Physicians Assistant Physical Therapist Occupational Therapist Massage Therapist Ophthalmologist Dermatologist Gynecologist Support Health Services & Personnel

Accredited Athletic Training Education Programs Entry-level athletic training education programs ◦In 2009, 357 undergraduate programs, 19 entry-level master’s programs Advanced graduate athletic training education programs ◦Designed for individuals that are already certified ATs

© 2011 McGraw-Hill Higher Education. All rights reserved. Athletic Training Education Competencies ◦ Risk management ◦ Pathology of injuries and illnesses ◦ Orthopedic clinical examination & diagnosis ◦ Acute care ◦ Pharmacological aspects of injury and illness ◦ Therapeutic modalities ◦ Conditioning & rehabilitative exercise ◦ General medical conditions and disabilities ◦ Nutritional aspects of injury and illnesses ◦ Psychosocial intervention and referral ◦ Health care administration ◦ Professional development & responsibilities

© 2011 McGraw-Hill Higher Education. All rights reserved. Foundational Behaviors of Professional Practice ◦“People” components of the profession ◦Recognizing the primary focus of practice should be the patient ◦Understanding that competent health care requires a team approach ◦Being aware of legal elements of practice ◦Practicing ethically ◦Advancing the knowledge base in athletic training ◦Appreciate cultural diversity ◦Being an advocate and model for the AT profession

Requirements for Certification as an Athletic Trainer Must have extensive background in formal academic preparation and supervised practical experience Guidelines are set by the Board of Certification (BOC)

Upon meeting the educational guidelines applicants are eligible to sit for the examination Examination is computer based Exam assesses the 6 domains ◦Prevention ◦Evaluation and diagnosis ◦Immediate care ◦Treatment, rehabilitation & reconditioning ◦Organization and administration ◦Professional responsibility

Upon passing the certification examination = BOC certified as an athletic trainer ◦Credential of ATC BOC certification is a prerequisite for licensure in most states

Continuing Education Requirements Ensure ongoing professional growth and involvement Requirements that must be met to remain certified ◦50 CEUs every 2 years ◦10 must be Evidence Based

© 2011 McGraw-Hill Higher Education. All rights reserved. CEUs are awarded for: ◦Attending symposiums, workshops, seminars ◦Serving as a speaker or panelist ◦Certification exam model ◦Participating in the USOC program ◦Authoring a research article; authoring/editing a textbook ◦Completing post-graduate work All certified athletic trainers must demonstrate proof of current CPR/AED certification

State Regulation of the Athletic Trainer During the early-1970s NATA realized the necessity of obtaining some type of official recognition by other medical allied health organizations of the athletic trainer as a health care professional Laws and statutes specifically governing the practice of athletic training were nonexistent in virtually every state

© 2011 McGraw-Hill Higher Education. All rights reserved. State Level Regulation ◦ Licensure ◦ Limits practice of athletic training to those who have met minimal requirements established by a state licensing board ◦ Limits the number of individuals who can perform functions related to athletic training as dictated by the practice act ◦ Most restrictive of all forms of regulation ◦ Certification ◦ Does not restrict using the title of athletic trainer to those certified by the state ◦ Can restrict performance of athletic training functions to only those individuals who are certified ◦ Registration ◦ Before an individual can practice athletic training he or she must register in that state ◦ Individual has paid a fee for being placed on an existing list of practitioners but says nothing about competency ◦ Exemption ◦ State recognizes that an athletic trainer performs similar functions to other licensed professions (e.g. physical therapy), yet still allows them to practice athletic training despite the fact that they do not comply with the practice acts of other regulated professions

© 2011 McGraw-Hill Higher Education. All rights reserved. Evidence Based Medicine The integration of the best available research with clinical expertise and patient values ◦Is there evidence to support what we’re doing ◦Have I seen what we’re doing work before ◦How does the patient feel about what we’re doing

© 2011 McGraw-Hill Higher Education. All rights reserved. Levels of Research 1.Systematic Reviews 2.Clinical Trials 3.Observational Studies 4.Case reports 5.Expert Opinion