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Athletic Training: Are We Doing Sports Medicine Wrong?

I have been doing Athletic Training for the better part of a decade now and in my experience I have encountered people from all across the country. I've encountered coaches, parents, personal trainers, physical therapists, physicians, and athletes and the one thing they all have in common, when it comes to Athletic Trainers, none of them have absoultely any clue what we do . Regardless of age or level of involvement there is a consistent level of ignorance to what it is that we do. How is this possible? How can an Athletic Trainer be at an institution for 10 years and the people that saw this individual "work" everyday still knows nothing about the services they provide? I have been pondering this for a while and now I wonder is Sports Medicine being done wrong by the Athletic Trainer?

This question has to be asked in my humble opinion as I run into athletes in my clinic and I hear stories that flat out make me mad. I am proud of what I do and to hear athletes consistently say that they go to the Athletic Training facility and their Athletic Trainer says something like:

-"I am hungry so I'm going to lunch I can't give you treatment"

-"I am going to go workout so I dont have time for you"

-"I'm tired so im just going to give you a bag of ice"

-"I don't know, so I don't know what to tell you"

As an Athletic Trainer I feel ashamed hearing the stories like that. How dare we want better wages or to be treated like qualified healthcare professionals when there are so many Athletic Trainers that don't do their job. Shame on us, complaining about our jobs and that nobody understands us, or that we work so hard.

We are supposed to be there for injury prevention, how often are we as a collective group doing it right?
-Are we taking objective measurements during pre-participation screenings to find dysfunction?
-Are we working together with our coaching staff or strength and conditioning coaches to:
-include stretches and resistance exercises that will prevent specific injuries based on the sport
-watch the occasional strength and conditioning session to ensure the athlete is doing the exercise correctly
-take data throughout the year to ensure that the programs you implemented are working

We are supposed to be first responders, are we doing this right?
-Are we even going to practices?
-Are we paying attention at practice?
-Are we intervening when something is unsafe?

We are supposed to be clinicians, are we doing this right?
-Do we even do an evaluation before administering treatment?
-Do we prescribe exercises that are appropriate?
-Do we use our manual skils at all?
-Do we take daily SOAP notes ?
-Are we collaborating with physical therapists who see our athletes so that they are getting well rounded care?

We are supposed to be professionals, are we doing this right?
-Are we following HIPAA laws?
-Are we following OSHA standards?
-Are we dressing like a professional?
-Do we carry ourselves like we are healthcare providers?
-Do we go to seminars and conventions to learn or just to hang out?

We are supposed to be Athletic Trainers, are we even doing this at all? If all we are doing is taping and icing its no wonder we aren't respected by anyone. There is no doubt in my mind that nothing for our profession is going to change if we as a collective group don't step our game up. There is no point in going to a masters, changing the name of our profession, or changing laws if; athletes can't even go into the Athletic Training facility and get an injury evaluated, athletes can't get QUALITY treatment for injuries, or an athlete gets hurt during practice and their Athletic Trainer is busy watching Netflix or went home cause its a few minutes away. I am unapologetic as I write this discussion because I don't understand how the ego of the Athletic Trainer got so big that we forgot to care for our athletes.

Why are we doing Sports Medicine wrong?
Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES

Comments

  • edited September 2015
    While I agree 100% with what is in your comment, I do not feel that we should be abused as healthcare workers in regards to our time and life away from athletic training. This is especially true in the collegiate setting where coaches seem to always want to schedule everything ALL day long to include prior to 7:00 am (and sometimes prior to 6:00 am), through a lunch hour and into the evening (past 6:00 or even 7:00 pm). When do we take care of ourselves? I am the first to want to be there for my athletes, but I also want to be there for myself and for my family.

    I have taken the "appointment" approach to healthcare, making sure that my student-athletes schedule an appointment time that works for both of us when it isn't a pre- or post-practice situation. I am always around for those times. This allows for me to get done the "other" aspects of athletic training administration and allows me to carve out a little "me" time as well. At the same time, it teaches the student-athlete time management and life lessons, as they are held to the appointment times I make with them. If they miss an appointment without letting me know, their coach knows about it and corrects the behavior. This also prepares them for life after athletics...you have to schedule appointments with healthcare providers when you don't have an athletic training room to go to.

    While we look to gain respect in the healthcare profession, I think we also need to get away from the "firehouse" mentality of athletic training, that is, being in the athletic training room 17 (or more) hours a day "just in case" a student-athlete needs to be seen. There are other ways to practice athletic training that aren't "wrong."

    Eric Frederick, MS, ATC, LAT
    Director of Sports Medicine
    Murray State University
  • Eric

    I absolutely 100% agree that there does need to be a better work life balance for the Athletic Trainer is most settings. Sometimes it is going to come with the territory, in the case of professional sports since their demands are much higher and it would be very difficult, but not impossible, to sub Athletic Trainers in and out as they would have a difficult time finding the same consistency of care. In the case of the highshool Athletic Trainer in many instances, not necessarily all, there are many who work a normal 35-40 hour work week and still find a way to approach Athletic Training like it's a hang out and get annoyed when asked to do something as simple as their job. I'm not even talking about having to fill water up, I'm talking about estabishing a simple presence of a qualified healthcare professional is at the institution they work at.

    The most basic problem I am addressing in this post is until we shift to medical models and adjust the entire practice of Athletic Training, lets actually practice healthcare. I am all for the Athletic Trainer not livig at their school or stadium or respective facility. I get frustrated with the Athletic Trainers who toss ice bags at their athletes like candy, the Athletic Trainers who ignore athletes who need treatment, the Athletic Trainer who has a normal work week and decideds to not bother peeking out at practice or blatanty goes home during a practice schedule because they couldn't be bothered to do something so menial, and I don't agree with the Athletic Trainers who's egos are so big they think they "deserve" to be treated like a god/goddess of sports medicine when they do all of the afformentioned things that make Athletic Training look like a joke. We won't ever get any respect until we respect ourselves.

    The idea of "wrong" isn't me , as an individual, trying to say Athletic Training has to be done my way. It's just the approach that there are certain things that are within our job title and scope of practice that we are obligated to do yet, there are many of those in our profession who choose not to do many of these things and its hurting us as a group. Then we wonder why we are in the position we are in. Not because you Eric, the invidual Athletic Trainer who does what he is supposed to be doing its because we as a group don't hold the plethora of bad Athletic Trainers accountable for their actions.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • edited September 2015
    Agreed. Sadly, there isn't much we can do about the plethora of bad "apples" that make us look bad and it is hard for us to hold them accountable as we can't actually see what it going on. It amazes me that these individuals are able to keep a job. Maybe it goes back to the administrators and coaches don't know what it is "supposed to look like" and they don't know any better in order to go find someone to do the job justice. Not sure how to approach this problem. Suggestions?
  • My thoughts on that are that we hold our colleagues accountable by setting standards for them. Many of us work for a company that employs a number of Athletic Trainers. We all know who these Athletic Trainers are in our company, everyone has at least one , sometimes two or three. This is where establishing protocols at company meetings is addressed so that everyone is on the same page and the bare minimums are set in stone and once they are established either that "bad apple" does their job or is reprimanded and if it continues then they will be replaced by someone who will do job right. By doing this I think it can help the coaches and administrators that don't know any better about what an Athletic Trainer is supposed to do can learn more about what they are really supposed to be getting from the company. Because just like you said these coaches and adminstrators have this idea that if the Athletic Trainer is around and they tape a few people or give them some ice the job is being done so it's easy to fly under the radar. And in the instance of the schools with two Athletic Trainers and one is the "bad apple" and the other Athletic Trainer is on top of their game the Athletic Trainer that is doin what they are supposed to be doing will often not blow the whistle because they have to work with this person and they dont want to ruin the work relationship so it is "easier" to say nothing and have to carry more weight than to say something and potentially upset the other person. Getting rid of the "I dont want to rock the boat" makes us just as responsible as that Athletic Trainer that catches up on Orange is the New Black at work instead of providing care to their athletes.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • "...we as a group don't hold the plethora of bad Athletic Trainers accountable for their actions." And when those of us do hold other ATs accountable, we are told "we shouldn't be bashing other ATs, we need to support one another." I can't support an AT who is too lazy/in a hurry to leave to open their packed away kit after a game in order to find a sling for an athlete who dislocated a shoulder, or one who tells an athlete with LBP due to a herniated disc to "keep stretching and go to a chiropractor."

    I've met more than my share of ATs who I don't want representing my profession, and staying quiet about it isn't going to help anything. In fact, staying quiet about it makes my job that much more difficult. Have had several collegiate athletes tell me they initially didn't want to tell me about their injuries because of the bad experiences they had with their high school ATs.

    Completely agree that we as a profession need to hold one another accountable if we expect to gain respect as a profession.
  • Rachel

    Thats just a shame to hear athletes say things like that. I think its so different for us as a profession to get a bad review or misconception from an athlete because they will carry it from highschool to college to their professional career/adult life. Whereas, in the case of physical therapists a patient will just go to a different clinic. Athletes don't have the luxury of going that route. They are stuck with the same Athletic Trainer for 4 years usually. So four years of a tainted perception of Athletic Training, think about how damaging that is to a profession they could potentially endure a full decade of bad Athletic Training if they have bad Athletic Trainers at two schools from 7th grade until they are done with college. That image of Athletic Training has such a wide ripple effect its early impossible to change that perception. So now you have an athlete who doesn't get the treatment they need/deserve for several years, they tell other athletes not to see Athletic Trainers, they tell their parents, they tell physical therapists, and once they are adults and have kids of their own they remember these experiences with Athletic Training. So why should the colleague of the bad Athletic Trainer sit idley by?

    Rahel, as an Athletic Trainer who has experienced this ripple effect how have you overcame it ?

    AND

    How do you think you correct it within a companies system?
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Wow! There is a lot I could comment on this topic and in fact I just deleted a great deal of my own thoughts. But I will say:

    I agree. I myself have been in that "bad apple" category - at least I'm putting myself there and I have noticed it was when I felt unfulfilled being in AT - we all have the AT slump at times - or at least I'm going to say we do. But I was called out by a fellow co-worker and that brought me back to do the job I was given to do - to the best of my ability. It's a biblical principle: As iron sharpens iron; so one man sharpen another. Proverbs 27:17. I think we can do this in a constructive way.

    Since the BOC has introduced EBP ceu's and the lectures on that aspect itself has led me to change the way I do things. I now try to do the outcome based pain scales when I evaluate athletes. I want to become more data-based in my approach and see if what I am doing is actually working. In my SOAP notes I am being more detailed than normal, having seen some of the notes our supervising sports med physician and our ortho surgeons write.

    During a lecture sometime in the last two years, the speaker, who was an AT, stated something I'll never forget and made me want to definitely be known more as a health professional and it was the statement that athletic trainers are probably the only health professionals more known for their social media - such as setting up a FB page for their school, or a twitter account or Instagram.

    Just this year, my football team traveled to a site where the host school had an AT and a grad student AT and we had some small talk and their contribution to the conversation was how they created AT meme's all week "because you can't find any good ones online." I was glad I traveled with my team knowing that at least one person would be out there caring for them!
  • I believe it is not always the fault of the AT in certain situations. Consider this for a moment (think high school setting):
    What about the school that has coaches who do not care what the AT says?
    They do not respect the AT, their athletes learn the disrespect from them.
    When the AT has treatment times set up and no one cares to acknowledge them.
    When the AT suggests/prescribes rehab to help the athlete heal and the coach does not enforce it to the athlete so they never show up.
    When the AT has 1 "short day" a week that is only 11 hours long, and the other 4-5 days are 12+ hours.
    When the AT has a room full of athletes to look at, at one time, by themselves (with 5 mins before all practices begin) and a coach/AC/(your boss) brings in "their" athlete who you need to look at in this exact moment and fix right now before everyone else.
    When the AT has a "ATR" that measures out to be 12'x8' with 2 taping tables, a sink, a small ice machine, and a cupboard because that's all that fits.
    When the AT cannot do any adequate treatment/evals because they do not have space or supplies to perform their duties to their own expectations, let alone others.
    And finally, when there are all these issues, but the AT's boss causes most of the problems, and the AD at the school doesn't want to bother himself with any of the "drama" or problems, and the principle's hand's are tied because the athletic department oversees the AT and coaches, and when the athletic department turns a blind eye to all the issues, to the point of going through multiple athletic trainers in multiple years and still not caring to see any problems.

    I know this situation very well and do not know how to do anything about it besides trying to do the best I can with what I have. I know this is an outlier to the general situations you are probably thinking of, but any AT in this type of situation can fight and fight to be more than a "bad apple" but to someone who doesn't know the situation, who sees them give out ice and think they "deserve" better, they just fall into a certain category.

    I'm not trying to say you are wrong, I do know the type of people you are talking about, but I just wanted to write this to bring up the point that it is not always the AT's fault that a certain perception is being given off.
  • Rachel,

    I think that's awesome that you had a "change of heart" and decided that you'd take a different approach to Athletic Training. It can be easy to fall into a slump and fly under the radar because of little or no expectations from the coaching staff or repeated incidence of being disrespected. So kudos to you for not letting it keep you down.

    Alyssa,

    You bring up a very valid point about how many times we have everything and everyone going against us. It makes it nearly impossible to be a "good Athletic Trainer ". However, let's look at those situations from a positive perspective or how to combat some of these instances. This is something I try to teach interns whenever I have them ; objective data and evidence will take you a long way. What I mean by this is not an simple task but if done with diligence and patience it can better your situation and yourself as a professional.

    Consider the coach that doesn't listen or care to.

    -when he makes life difficult try to send gentle reminders regarding athletes not coming in for treatment through email with your Athletic Director cc'd to them so if they are not getting the outcomes they desire there is a paper trail with both your daily sign in sheet and repetitive emails to the staff.

    -many times coaches don't care to understand or out of innocent ignorance don't understand why athletes need treatment. This is where data comes into play. By keeping accurate records of injuries it's easy to show coaching staff how many injuries have been sustained, what part of the season they occurred in, how often the athlete received treatment or didn't receive treatment due to missed appointments, and what was the prevalence in contact vs non-contact acute vs. Chronic, and area of the body affected. If a coaching staff or administration can't see the value after you have shown this much information it is no longer in your hands. You have done everything in your power.

    -adding pre-participation movement screens to the information above to demonstrate what athletes are at risk. And creating programs, which I know many coaches would scoff at and not follow, that will decrease the likelihood of injuries. Then correlating your pre-participation data with real world data to see if your predictions of high risk injuries came to fruition can be a valuable asset in the fight to help your athletes and show your worth.

    More often than not we are outgunned, misunderstood, underfunded, and understaffed but there are still many opportunities to gather information this way we can defend ourselves, create better situations for our athletes and future Athletic Trainers, and potentially having good enough data to submit to board members, state committees, or presenting it as research to change our flawed system.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Audric,

    I would to love to utilize movement screens and tried to get funding with grants that were unsuccessful. I would also like to know when athletes are injured when I'm not there but the problems with gathering information is finding resources and ways to document that are easy when you are constantly on the go or when you don't see athletes daily.

    I cover 5 high schools total but am at 2 almost every day Mon-Friday. While I can be really busy running around, I've found that the coaches, parents, and ADs really appreciate everything I do. I listen to the athletes and try to make a plan or at least am able to make reasonable modifications to what they are doing. While communication isn't always the greatest when it comes to letting me know when practice times are and when games are cancelled or moved, I've learned to work around it by taking over the communication.

    It is not always about doing everything for an athlete but working together with the healthcare system, I work with some great doctors and PTs that help me to take care of my athletes. If an athlete can give me the time to fully evaluate their problem, I can either give them a plan of attack or refer them to the right kind of healthcare professional.

    No matter how overwhelmed we may get as professionals it is about creating a balance. If you are understaffed, then utilize your other resources. At the high school level with how spread out I am, running rehab programs is not feasible but that doesn't mean that I don't try to give them some exercises and stretches or help them. If an athlete is willing to make time for me to work with them then I will be there, even if I am running late. As professionals we need to stand by what we say we are going to do. If you tell someone you will be in the ATR or at practice, you need to be there. If they tell you they will meet with you at a time and don't show or are late without letting you know, that is on them. I told a kid he wasn't cleared for sports by the PT or the DR and showed up at his non school sponsored practice to make sure he was practicing because I told him I would check. Following up and showing that you care go a long way when you are stretched thin as well as show that you mean what you say.

    You can not work somewhere and just expect everyone to respect you and trust what you tell them. I started at my current job almost a year ago and am considerably more busy now that everyone knows me and what I can do for them. While I am still working on creating more organization in the chaos, I don't mind taking the time to make things better. I hear all the time that I do considerably more than the person before me. While high school athletics wasn't my original plan, I don't think they deserve less that the DI college athletes I used to work with just because I don't have the same resources.

    Unfortunately, some high school athletic trainers end up there because they didn't get the job they wanted and they take it out on the athletes. Instead of working to make things better or easier on themselves, they become "bad apples" and go through the motions to get paid. I would love to cover practices and try to make it to some, but am spread out between multiple schools so I find it hard to understand how someone who covers one school can't find the time to be at practice. I create my own schedule, during preseason that meant 13+ hr days but when things slow down and I can make it work then I'll only work 7-8hrs days. My boss says "work hard, play hard", when you don't need to be at work don't be but when you have stuff that needs to be done work to complete it to the best you can. As athletic trainers we need to value our time and make sure to have "me time" but also need to work hard and create better situations for ourselves. This means not being available all the time and making the people we work with/for respect our time and what we do for them.
  • Audric:

    I have practiced this profession for 45 years. While I agree that some people have no idea what we do, more people today know than we I started. Some of this is our own fault with identity. How we solve this is not an easy task and "we" must be our own advocates.
    I too have heard the excuses for not treating or examining people. Athletic Trainers cannot be there 24/7 /365 for every athlete. Athletic Training should be your job not your life. Unfortunately we all fall into the trap of helping people to a fault. That being said there should be a professional way to redirect people to meet your schedule and their needs.
    As far as "I don't know what to tell you" When in doubt refer to MD.

    You can never go wrong by doing right.
  • Holly

    I apologize for the late response. Now you are in a different situation than the "typical" Athletic Training scenario. Being on the go like you are makes it difficult to do certain things for your athletes. This is more for the Athletic Trainer who has a permanent residence in a school or team. When that Athletic Trainer doesn't treat the profession like a healthcare profession instead they see themselves like a coach, the Athletic Trainer who doesn't advocate for their Injured athletes, or the Athletic Trainer who simply doesn't care. This is sports medicine at its worst when people approach Athletic Training in such a way that it demeans the Athletic Training profession and does more harm to those we are supposed to help.

    Mike
    We definitely need to be our own advocates. I definitely think that our work life balance should be better BUT that require a completely different approach to how we do coverage. We shouldn't have to refer in my opinion if we modeled Athletic Training in a different way but most importantly got away from working for PT companies. We are literally marketers to these companies which further pro creates a system of low value Athletic Trainers.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • I agree there are bad apples and that we need to speak up. I live in Texas where the battle is VERY real, particularly since we are the "lone star state" that allows LAT and not BOC. I cringe watching some "AT's" attempt to provide care and am having a VERY hard time with the overall lack of care for our state "professionals" doing things the right way. Some AREN'T EVEN LICENSED and practicing! It's sickening and there's no good way to report it with our licensure being moved to a different governing department within the state! Also, many of the AD's don't care and some non-school admins don't even know to check! It's very difficult to speak up and also not appear to be a "know-it-all" or "BOC snob" when you see someone refer to a doctor because they are too busy to do a 3-5 minute ankle evaluation or spend 20minutes writing a HEP and want to say something.

    Audric, I completely disagree about referring. While I also see the "lazy" AT's who want to put ice on it and refer to a chiropractor or PT, I also see many AT's (even really good ones) trying to treat something that should be referred. Having worked in a PT clinic with PT's and OT/CHT's I will be the first to refer to a CHT (even though I have very good experience working alongside an amazing one). Likewise, while I have plenty of manual therapy and mobilization experience, there are times when I value the one-on-one time a PT (or AT working in a PT clinic) can provide that the 1v1,000 HS AT cannot provide. AT's not referring simply because they want to do it themselves (when they cannot) is what perpetuates the rift. Yes, we can be valued for being therapists as well, but absolutely not referring isn't going to help that fire nor is it good practice for our patients. Sometimes a specialist is needed, whether that's a surgeon, GP, PT, OT, AT, chiropractor, whatever!

    All great discussion from everyone though! :smile:
  • Meghan

    Thanks for joining the discussion. Now while I do agree with what you said about referrals I want to clarify the idea of "not referring". I am talking about a scenario where Athletic Training has a completely different approach to doing coverage. It is in no way possible to provide adequate rehab on an athlete when you are outnumbered 1 to 500. However, if Athletic Training were structured in such a way that there are more Athletic Trainers on staff, there are different specialty Athletic Trainers ( first responder type, clinical type, sports performance type, etc...), and we had a certain level of collaboration when it came to treating the athletes then the Athletic Trainer(s) would not have to work as many hours, pump out referrals to meet a quota, could give more athletes that one on one care that they need, and can cover sports more effeciently. This outside the box concept is kind of a fairy tale for most people but it is certainly doable if you get the right people on board with it. And get away from the terrible status quo that has been established.
    Now there are plenty of situations that still require a referral to other specialtie but just because someone is a PT does not mean they should be referred to. I have encountered just as many unqualified PT's as I have unqualified Athletic Trainers. A title doesn't necessarily mean that they will provide better care to our athletes. With that being said I definitely think that care can be given as a team effort when AT's, PT'S , OT's, and chiripractors all work toward the best interest of the patient. This is an awesome thing actually when done appropriately. The patient gets amazing results in these scenarios. But that is a hard thing to do for some people when money and egos get involved. Patient care comes first and foremost to me. I am just presenting the thought of a world where we as a profession step up our game so that the people we provide services to benefit from our efforts then we can be justly rewarded whether its recognition or an upgrade in pay.
    Im just dreaming of a better world for Athletic Training :smile:
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
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