1. Putting Together a Sports Medicine Team and Defining Their Roles Chapter 1

2. Overview Sports medicine incorporates many areas of concentration. The term Sports Medicine refers to a broad field of medical practice related to physical activity and sport. The field of sports medicine encompasses, under its “umbrella”, a number of more specialized aspects dealing with the physically active or athletic populations relating to Performance Enhancement or Injury Care and Management.

3. Areas of specialization

4. The American College of Sports Medicine …has defined sports medicine as multidisciplinary, including the physiological, biomechanical, psychological, and pathological phenomena associated with exercise and sport. Physiological –the functions and activities of living organisms and their parts, including all physical and chemical processes. Biomechanical – the study of the action of external and internal forces on the living body, especially on the skeletal system. Psychological – anything affecting the mind, especially as a function of awareness, feeling, or motivation. Pathological – caused by or involving disease.

5. The Sports Medicine team The Coach The Athletic Trainer Team Physician These individuals must work together and know their roles in order to create an environment that is optimal for the athlete.

6. The Coach The coach’s role is to take responsibility for preparing the athletes skill level and to ensure that the athlete is conditioned properly. In addition, the coach must make sure all protective equipment is properly worn and maintained.

7. The Athletic Trainer The Athletic Trainer should be a highly educated and well- trained professional who is responsible for the overall health and safety of the athlete. The Athletic trainer must be certified and should comply with state regulatory laws governing their practice. As in any profession, the athletic trainer must follow the highest standards of conduct.

8. The Team Physician The team physician may come from a variety of specializations. The role of the team physician can vary depending on the willingness to commit time to a specific sports program. Some of the responsibilities of the team physician may include preparticipation physicals, diagnostics of injuries and illness, educating the athletic training staff, providing coverage for scrimmages and practices, and counseling the athlete about any related health matter.

9. In an Ideal World Coaches could concentrate their efforts on coaching. Athletic trainers could assume total responsibility for the health needs of the athlete. BUT… Budget constraints do not allow for every coach to have an athletic trainer. Coaches are force to assume responsibility for the health care of their athletes.

10. Sports Medicine Organization Goals To upgrade the field by devising and maintaining a set of professional standards, including a code of ethics. To bring together professionally competent individuals to exchange ideas, stimulate research, and promote critical thinking. To give individuals and opportunity to work as a group with a singleness of purpose, thereby making it possible for them to achieve objectives that, separately, they could not accomplish.

11. What is an Athletic Trainer? The terms Training and Athletic Training are often confused. Training = to Coach or Teacher Athletic Training = a field within the allied health professions that is concerned with Prevention, Management, Evaluation, and Rehabilitation of injuries related to physical activity.

12. Trainers - Certified Athletic Trainer - Personal Fitness Trainers - Strength and Conditioning Coaches Trainer refers to someone who trains dogs, horses, ect… A Certified Athletic Trainer (certified by the Board of Certification) is a highly educated allied health care professional who is a credentialed specialist in athletic training. These individuals hold the credential ATC. Personal Fitness Trainers develop fitness and wellness. Strength and Conditioning Coaches enhance conditioning and performance typically at the pro & collegiate level.

13. NATA The National Trainers’ Association is the professional organization to which most Athletic Trainers belong to. There are many professional organizations that are dedicated to achieving health and safety in sports. They can be found on page 5 in your text book.

14. The Relationship Among the Coach, Athletic Trainer, Physician and Athlete The major concern of everyone on the sports medicine team should always be the athlete. All decisions made by the physician, coach, and athletic trainer ultimately affect the athlete. The coach must defer and should always support the decision of the medical staff in any matter regarding health care for the athlete.

15. The Relationship Among the Coach, Athletic Trainer, Physician and Athlete This is not to say that the coach should not be involved in the decision making process. For example, during the time the athlete is rehabilitating an injury, there may be drills or technical instruction sessions that the athlete can participate in that will not aggravate the existing problem. Thus the coach, the athletic trainer, and the team physician should be able to negotiate what the athlete can and cannot do safely in the course of a practice. Athletes are frequently caught in the middle between coaches who tell them to do one thing and medical staff who tell them something else. Close communication between the coach and the athletic trainer is essential.

16. The Relationship Among the Coach, Athletic Trainer, Physician and Athlete The injured athlete must always be informed and made aware of the why, how and when factors that collectively dictate the course of an injury rehabilitation program. Bothe the coach and athletic trainer should make it a priority to educate student athletes about injury prevention and management. Athletes should learn about techniques of training and conditioning that may reduce the likelihood of injury.

17. The Importance of Family in the Sports Medicine Team In the high school setting, the coach, the athletic trainer, and the physician must also take the time to explain to and inform to the parents about injury management and prevention. With an athlete of secondary school age, the parents decision regarding health care must be of primary consideration. Many parents will insist that their child be seen by their family physician rather than by the individual who may be designated as the team physician.

18. The Importance of Family in the Sports Medicine Team The opinion of the family physician must be respected even if the individual has little or no experience with injuries related to sports. The coach, athletic trainer, and team physician must make certain that the athlete and family are familiar with the Health Insurance Portability and Accountability Act (HIPAA), which regulates how individuals who have health information about an athlete can share that information with others and not be in violation of the privacy rule. HIPAA protects a patient’s privacy and limits the number of people who can gain access to the athletes medical records.

19. Responsibilities of the Coach It is the responsibility of the coach to clearly understand the limits of their ability to function as a health care provider in the state where they are employed. The coach is directly responsible for preventing injuries by seeing that athletes have undergone a preventive injury condition program. The coach must ensure that sports equipment, especially protective equipment, is of the highest quality and properly fitted. The coach must also make sure that protective equipment is properly maintained.

20. Responsibilities of the Coach All coaches, both head and assistants, must be certified in cardiopulmonary resuscitation (CPR) by either American Red Cross, the American Heart Association, or the National Safety council. Coaches should also be certified in First Aid by the American Red Cross or the National Safety Council. Obtaining these certifications is important, not having these can have some negative legal impact on the coach and their employer. When a sports program or a specific sport is without an athletic trainer, the coach often takes over this role.

21. Roles and Responsibilities of the Athletic Trainer The athletic trainer is the one individuals who deal with the athlete from the time of the initial injury, throughout the period of rehabilitation, until the athlete’s complete, unrestricted return to practice or competition. The athletic trainer is most directly responsible for all phases of health care in the athletic environment, including preventing injuries from occurring, providing initial first aid and injury management, evaluating injuries (only physicians can diagnose injury), and designing and supervising a timely and effective program of rehabilitation.

22. Qualifications to Look for When Choosing an Athletic Trainer The athletic trainer must be knowledgeable and competent in a variety of sports medicine specialties if he or she is to be effective in preventing and treating injuries to the athlete. The Board of Certification has established specific requirements that must be met for an individual to become certified as an athletic trainer. Once these requirements for certification have been met, and the individual passes a certification exam, that person earns the credential ATC.

23. Risk Management and Injury Prevention One major responsibility of the athletic trainer is to make the competitive environment as safe as possible by… Ensuring appropriate training and conditioning of the athlete Monitoring environmental conditions to warrant safe participation Selecting properly fitted, and maintaining protective equipment Explaining the importance of proper nutrition Using medication appropriately

24. Recognition, Evaluation, and Assessment of Injuries The athletic trainer must be skilled in recognizing the nature and extent if an injury through competency in injury evaluation. The athletic trainer must be able to efficiently and accurately evaluate injuries. The information obtained in the initial evaluation may be critical later on when swelling, pain, and guarding mask some of the functional signs of injury. The athletic trainer is responsible for referring the athlete to appropriate medical care or support services.

25. Immediate Care of Injuries and Illness Once the initial on-the-field assessment is done the athletic trainer then must assume responsibility for administering appropriate first aid to the injured athlete and for making correct decisions in the management of acute injury.

26. Treatment, Rehabilitation, and Reconditioning The athletic trainer must work closely with and under the supervision of the team physician with respect to designing rehabilitation and reconditioning protocols that make use of appropriate rehabilitative equipment, manual (hands on) therapy techniques, or therapeutic modalities. The athletic trainer should then assume the responsibility of overseeing the rehabilitative process ultimatley returning the athlete to full activity.

27. Health Care Administration The athletic trainer is responsible for the organization and administration of the athletic training program, including the maintenance of health and injury records for each athlete, the requisition and inventory of necessary supplies and equipment, the submission of insurance information to the insurance companies, the supervision of assistant or student athletic trainers, and the establishment of policies and procedures for day-to-day operation of the athletic training program.

28. Professional Development and Responsibility Athletic trainers shall respect the rights, welfare and dignity of all individuals. Athletic trainers shall comply with the laws and regulations governing the practice of athletic training. Athletic trainers shall accepts the responsibility for the exercise of sound judgement. Athletic trainers shall maintain and promote high standards in the provision of services. Athletic trainers shall not engage in conduct that constitutes a conflict of interest or adversely reflects on the profession.

29. Responsibilities of the Team Physician The athletic trainer works primarily under the supervision of the team physician, who is ultimately responsible for directing the total health care of an athlete.

30. The Relationship with the Athletic Trainer and Physician The physician should be a supervisor and a advisor to the athletic trainer and coach. The athletic trainer should be given flexibility to function independently in the decision making process and must often act without the advice or direction of the physician.

31. Compiling Medical Histories The team physician should be responsible for compiling medical histories and conducting physical examinations for the athlete, both of which can provide critical information that may reduce the possibility of injury.

32. Diagnosing Injury The team physician should assume responsibility for diagnosing an injury and should be keenly aware of the program of rehabilitation as designed by the athletic trainer following the diagnosis. The athletic trainer should be capable of doing an accurate initial evaluation following acute injury.

33. Diagnosing Injury The physician had been trained specifically to diagnose injuries and make recommendations to the coach and the athletic trainer for treatment based on that diagnosis. Since it is likely that the athlete may see a physician with the athletic trainer being present, it is a good idea to have the physician provide a written diagnosis. The athletic trainer should have a sound background in injury rehabilitation and must be the one to design and supervise and effective rehabilitation scheme.

34. Deciding on Disqualification The physician should determine when an athlete should be disqualified from competition on medical grounds and must have the final say in when an injured athlete may return to activity. Any decision to allow an athlete to resume activity should be based on recommendations from the athletic trainer. The athletic trainer most often has the advantage of knowing the injured athletes well, how they respond to injury, how they move and how hard to push to return them safely to activity.

35. Deciding on Disqualification The athletic trainer may also know about special protective equipment that will allow the athlete to continue play. The physicians judgement must be based not only on medical knowledge but also on knowledge of the psycho- physiological demands of a particular sport.

36. Other Members of the Sports Medicine Team School Nurse Physicians: Orthopedist, Neurologist, Internist, Family Medicine Physician, Ophthalmologist, Pediatrician, Psychiatrist, Dermatologist, Gynecologist, Osteopath Dentist Podiatrist Physicians Assistant Strength and Conditioning Coach Sports Psychologist Sports Physical Therapist

37. Other Members of the Sports Medicine Team Sports Chiropractor Orthoptist/Prosthetist Exercise Physiologist Nutritionists Sports Message Therapists Emergency Medical Specialist (EMS) Equipment Personnel Referees