A Letter to Athletic Trainers
Every year around March I post something related to our wonderful profession, 2014 will be no different. The time has come to stop whining about how you are addressed and be more concerned about how well you do your job. Do you know what your job is? Are you fully aware of your skill set? If I asked one hundred AT’s this question, I am sure all would say yes but I’ll bet the majority of them still treat injuries like it is 1991…taping ankles and stretching hamstrings. I am far from being the best but I have learned a few things over my 15 + years in the profession and it frightens me when I look at my twitter feed, the concern is not about being a better AT but being recognized as more than just a trainer. This has been a topic of discussion for years and I am sure it will continue to be for more to come but how about taking a different approach. How about actually going out there and helping individuals get better through proper technique learned from reading research and discussions with individuals who know how to fix problems instead of placing bandaids on injuries? Taping ankles does not prevent ankle sprains, you can teach a monkey to tape an ankle, fill a water cooler, and drive a gator.
Our skill set is very unique within the realm of allied health care but yet we do not take full advantage of it. We complain about lack of respect, job availability, and pay but we do nothing to separate ourselves and show our true worth. It amazes me that in a profession where applied techniques should rule, they do not and we lean more on the latest modalities, etc. I need a Hivamat, cold laser, Normatec, the old faithful e-stim and ultrasound. These devices have their place with acute issues but the majority of cases we manage are a result of overuse. I was fortunate enough to attend a great ATEP program which promoted independent thought, I was even more fortunate to work in pro sports for several years and learn from some of the best in the business. Both experiences helped shape the AT I am today but they also take the back seat to me understanding what my job description is and what I need to do to ensure that I make every effort to excel at it everyday. For those who may need it, here is a reminder as listed on the NATA’s website and in this document:
Athletic trainers (ATs) are healthcare professionals who collaborate with physicians. The services provided by ATs comprise prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.
- Recreational, amateur, and professional athletes
- Individuals who have suffered musculoskeletal injuries
- Those seeking strength, conditioning, fitness, and performance enhancement
- Others delegated by the physician
Athletic trainers deliver rehabilitation services under a physician’s guidelines.
Guidelines are general directions and descriptions that lead to the final outcome, thereby allowing the athletic trainer to rely on clinical decision making in constructing the rehabilitation protocol. Protocol are rigid step-by-step instructions that are common in technical fields and do not allow flexibility and/or clinical decision making.
Athletic trainers function under a physician’s direction.
The terms "direction" and "supervision" mean two different things. Most importantly, supervision may require the on-site physical presence of the physician and that the physician examines each and every patient treated by an athletic trainer. Direction, on the other hand, requires contact and interaction, but not necessarily physical presence.
Lets break this down:
“Athletic trainers (ATs) are healthcare professionals who collaborate with physicians.”
If you operate independently this is more important than anything, you must establish a relationship with a physician, preferably an orthopedic. It validates your existence and if you are good at what you do you will get referrals. Without a physician it will be difficult to use many of your skills legally. Thank goodness for state licensure.
The services provided by ATs comprise prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.
What is prevention? In my opinion for the AT, it should be defined as: reducing the risk of sport-related injury through early diagnosis and treatment; and recognition of limitations and rehabilitation potential. This definition encompasses everything but emergency care and certain medical conditions and if followed properly, truly reduces chance of injury. The key phrase in NATA’s definition of an AT though is “therapeutic intervention and rehabilitation of injuries”. Therapeutic intervention in my eyes is hands on care to achieve a desired outcome. Does taping an ankle fall within those guidelines? In my humble opinion, no, but measuring ankle dorsiflexion, assessing rear foot angle, and testing hip strength does (there's a lot of research on correlation between hip strength and ankle instability). Another example would be the unwritten rule of stretching hamstrings because a patient/client says they feel “tight” without proper assessment. More often than not, the hamstrings are synergistically dominant due to an anterior pelvic tilt and reciprocal inhibition of the glutes. This may cause one to say their hamstrings “feel tight” which they are, but they are elongated under tension as a result of misalignment of the pelvis, not short and contracted. In this case, it is more appropriate to stretch the hip flexors and activate the glutes. It is this type of evaluation that prevents injury; early diagnosis and recognition of the musculoskeletal warning signs, in other words, therapeutic intervention.
- Recreational, amateur, and professional athletes
- Individuals who have suffered musculoskeletal injuries
- Those seeking strength, conditioning, fitness, and performance enhancement
- Others delegated by the physician
As an athletic trainer you may be in either of the settings listed above, respect only comes to those that earn it. If you work with athletes and they are always in front of you with the same issue, there is something you are doing incorrectly. My patients range in age from 11 - 81 years and compete at levels from recreational to professional. The approach taken to treating those musculoskeletal injuries does not differ because of age, setting, or level of competition. For those individuals in a strength & conditioning/fitness/performance enhancement role, if you are not the busiest individual in your place of practice something is wrong. You have the skills to not only address fitness, but to also deal with any musculoskeletal issues…use that to your advantage. Assess your clients as if you are in the athletic training room and then put them on a plan to move better, their performance will increase. You may say, but I do this….do you really, or do you just tell people you do? If you properly diagnose and follow appropriate protocol, not diverting because you are bored with it or you think they have progressed when they have not, then great! But most do not fall within this category. A colleague recently posted a blog on sticking with your plan, it is worth a read. Click here.
I choose a soft science for my graduate education because I felt it would make me better at rehabilitation and I must say it does. We get so wrapped up in returning an individual to playing status that we overlook one of our main responsibilities which is to protect the athlete. If you do not fix the problem and only bandaid it, you are not protecting the athlete, you are just adding to the problem. There is substantial research out there to back this, I wrote a short blog on it a while back, it can be found here.
The ability to work under the direction of a physician is a great responsibility, one that must not be taken lightly. There are too many individuals who worked too hard to get this profession to its current level for it to be compromised by individuals who are just lazy and want everything handed to them. As I stated in the beginning, I do not claim to know it all and I never will simply because I learn something new everyday. Every patient is an opportunity for me to learn something different about how the musculoskeletal system works from a functional perspective. If you do not have a comprehensive understanding of functional anatomy, get on that ASAP! There was a huge factor left out of your A & P class that most overlook. The cadaver was prone or supine on a table, the class did not address how everything changes once the kinetic chain closes. You have to open your mind to a different way of thinking, you have the knowledge, just apply it!
Yusuf Boyd, M.S., ATC, LAT, CES, PES, CKTP
BIOMechaniks: Train the Mind and the Body will Follow
Posted on February 26, 2014 | Permalink
