Transcript The Sports Medicine Team

Principles of Athletic Training
14th Edition
William E. Prentice
© 2011 McGraw-Hill Higher Education. All rights reserved.
Principles of Athletic Training
th
14 Edition
PowerPoint Presentations
Damian Goderich, MA, Physical
Education, USF
© 2011 McGraw-Hill Higher Education. All rights reserved.
Chapter 1: The Athletic
Trainer as a Health Care
Provider
© 2011 McGraw-Hill Higher Education. All rights reserved.
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What is an ATHLETIC
TRAINER?
Are they a doctor?
Can they prescribe medicine?
Are they a coach?
Where can they work?
Do you have to go to school to be an
athletic trainer?
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• 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
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Historical Perspective
• Early History
– Evidence suggests that coaches,
physicians & therapists existed in Greek
and Roman civilizations
• Assisted athletes in reaching top performance
– Athletic trainers came into existence in the
late 19th century in intercollegiate &
interscholastic sports
– Early treatments involved rubs, counterirritants, home remedies and poultices
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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, the military, equipment sales,
physician extenders
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• 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
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• 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
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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
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• 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!!
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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
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Human
Performance
Injury
Management
Exercise Physiology
Practice of Medicine
Biomechanics
Sport Psychology
Athletic Training
Strength Conditioning
Sports Massage
Personal Fitness
Trainers
Sports Podiatry/
Orthotists
Sports Physical Therapy
Sports Dentistry
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Growth of Professional Sports
Medicine Organizations
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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)
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International Federation of
Sports Medicine
• Federation Internationale de Medecine
Sportive (FIMS)
• Principal purpose to promote the study and
development of sports medicine throughout
the world
• Made up of national sports medicine
associations of over 100 countries
• Organization includes many disciplines that
are concerned with physically active
individuals
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American Academy of Family
Physicians
• To promote and maintain high quality
standards for family doctors who are
providing continuing comprehensive
health care to the public
• It is a medical association of more than
93,000 members
• Many team physicians are members of
this organization
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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
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Figure 1-1
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American College of Sports
Medicine
• Patterned after FIMS (Umbrella Organization)
• Interested in the study of all aspects of sports
• Membership composed of medical doctors,
doctors of philosophy, physical educators,
athletic trainers, coaches, exercise
physiologists, biomechanists, and others
interested in sports
• >20,000 members
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American Orthopaedic Society
for Sports Medicine
• To encourage and support scientific research
in orthopaedic sports medicine and to
develop methods for safer, more productive
and enjoyable fitness programs and sports
participation
• Members receive specialized training in
sports medicine, surgical procedures, injury
prevention and rehabilitation
• 1,200 members are orthopaedic surgeons
and allied health professionals
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National Strength and
Conditioning Association
• To facilitate a professional exchange of ideas in
strength development as it relates to the improvement
of athletic performance and fitness and to enhance,
enlighten, and advance the field of strength and
conditioning
• 30,000 strength and conditioning coaches, personal
trainers, exercise physiologists, athletic trainers,
researchers, educators, sport coaches, physical
therapists, business owners, exercise instructors and
fitness directors
• Accredited certification programs
– Certified Strength and Conditioning Specialist, (CSCS)
– NSCA Certified Personal Trainer (NSCA-CPT)
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American Academy of
Pediatrics, Sports Committee
• Dedicated to providing the general
pediatrician and pediatric sub-specialist with
an understanding of the basic principles of
sports medicine and fitness and providing a
forum for the discussion of related issues
• To educate all physicians, especially
pediatricians, about the special needs of
children who participate in sports
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American Physical Therapy Association,
Sports Physical Therapy Section
• To provide a forum to establish collegial relations between
physical therapists, physical therapist assistants, and
physical therapy students interested in sports physical
therapy
• Promotes prevention, recognition, treatment and
rehabilitation of injuries in an athletic and physically active
population
• Provides educational opportunities through sponsorship
of continuing education programs and publications
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NCAA Committee on Competitive
Safeguards and Medical Aspects of
Sports
• Collects and develops pertinent information
regarding desirable training methods,
prevention and treatment of sports injuries,
and utilization of sound safety measures
• Disseminates information and adopts
recommended policies and guidelines
designed to further the above objectives
• Supervises drug-education and drug-testing
programs
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National Academy of Sports
Medicine
• Founded by physicians, physical therapists
and fitness professionals
• Focuses on the development, refinement and
implementation of educational programs for
fitness, performance and sports medicine
professionals
• Offer a variety of certifications (fitness and
performance)
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Other Health Related
Organizations
• Various aspects of health related
professions have also become involved
– Dentistry, podiatry, chiropractic medicine
• National, state and local organizations
have also emerged
– Focus on athletic health and safety
• All bodies have worked towards the
reduction of injury and illness in sport
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Sports Medicine Journals
• A variety of publications exist, providing
excellent resources to the sports medicine
community
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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
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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
are now 30% are found primarily in
hospital and clinic settings
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• Settings include:
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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
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Figure 1-3
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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
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• The Adolescent Athlete
– Focuses on organized competition
– A number of sociological issues are
involved
• How old or when should a child begin training?
– Skeletal maturity presents some
challenges with respect to healthcare
– Physically and emotional adolescents can
not be managed the same way as adults
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• The Aging Athlete
– Physiological and performance capability
changes overtime
• Function will increase and decrease depending
on point in lifecycle
• May be the result of both biological and
sociological effects
– High levels of physiological function can be
maintained through an active lifestyle
• The impact on long-term health benefits have
been documented
– Beginning an exercise program
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– Exercise program should be gradual and
progressive as long as no unusual signs or
symptoms develop
– Individuals over age 40 should have a
physical and exercise testing before
engaging in an exercise program
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• Occupational Athlete
– Occupational, industrial or worker “athlete”
are involved in strenuous, demanding or
repetitive physical activity
• May result in accidents and injury
– Involves
• Instruction on ergonomic techniques to avoid
injury associated with physical demand of job
responsibilities
• Intervention when injuries arise
– Correcting mechanics, faulty postures, strength
deficits, lack of flexibility
• Injury prevention is still critical
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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
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Roles and Responsibilities:
Board of Certification Domains
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Prevention
Clinical evaluation and diagnosis
Immediate care
Treatment, rehabilitation and
reconditioning
• Health care administration
• Professional responsibilities
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• 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
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• Clinical Evaluation & 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)
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• Treatment, Rehabilitation Reconditioning
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Design preventative training systems
Rehabilitation program design
Supervising rehabilitation programs
Incorporation of therapeutic modalities and
exercise
– Offering psychosocial intervention
• Organization & Administration
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Record keeping
Ordering supplies and equipment
Establishing policies and procedures
Supervising personnel
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• Professional Responsibilities
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Athletic trainer as educator
Athletic trainer and continuing education
Athletic trainers as counselor
Athletic trainers as researcher
• Incorporation of evidence medicine and
participating and acquisition of evidence for
efficacy of patient care
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Personal Qualities of the
Athletic Trainer
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Stamina and the ability to adapt
Empathy
Sense of humor
Communication
Intellectual curiosity
Ethical practice
Professional memberships
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Athletic Trainer and
the Athlete
• Major concern on the part of the ATC
should be the injured patient
• All decisions impact the patient
• The injured patient must always be
informed
– Be made aware of the how, when and why
that dictates the course of injury
rehabilitation
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• The patient must be educated about
injury prevention and management
• Instructions should be provided
regarding training and conditioning
• Inform the patient to listen to his/her
body in order to prevent injuries
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Athletic Trainer and Parents
• Athletic trainers must keep parents
informed, particularly in the secondary
school setting
– Injury management and prevention
• The parents decision regarding
healthcare must be a primary
consideration
• Insurance plans may dictate care
– Selection of physician
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• 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
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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
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• 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
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• Potentially serve as the academic
program medical director
– Coordinates and guides medical aspects of
program
– Provides input into educational content and
provides programmatic instruction
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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
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• 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
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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
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Support Health Services &
Personnel
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Physicians
Dentist
Podiatrist
Nurse
Physicians Assistant
Physical Therapist
Occupational Therapist
Massage Therapist
Ophthalmologist
Dermatologist
Gynecologist
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Exercise Physiologist
Biomechanist
Nutritionist
Sport Psychologist
Coaches
Strength & Conditioning
Specialist
• Social Worker
• Neurologist
• Emergency Medical
Technician
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Recognition and Accreditation of
the Athletic Trainer as an Allied
Health Professional
• June 1990- AMA officially recognized athletic
training as an allied health profession
• Committee on Allied Health Education and
Accreditation (CAHEA) was charged with
responsibility of developing essentials and
guidelines for academic programs to use in
preparation of individuals for entry into
profession through the Joint Review Committee
on Athletic Training (JRC-AT)
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• June 1994-CAHEA dissolved and replaced
immediately by Commission on Accreditation
of Allied Health Education Programs
(CAAHEP)
– Recognized as an accreditation agency for
allied health education programs by the
U.S. Department of Education
• Entry level college and university athletic
training education programs at both
undergraduate and graduate levels were
accredited by CAAHEP through 2005
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• In 2003, JRC-AT became an independent
accrediting agency
– JRC-AT would accredit athletic training
education programs without involvement of
CAAHEP
– JRC-AT officially became the Committee for
Accreditation of Athletic Training Education
(CAATE) in 2006
– CAATE was officially recognized by CHEA in
2007
• CHEA is a private nonprofit national organization that
coordinates accreditation activity in the United States
• Recognition by CHEA puts CAATE on the same level as
other national accreditors, such as CAAHEP
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• Effects of CHEA accreditation are not
limited to educational aspects
• In the future, this recognition may
potentially affect regulatory legislation, the
practice of athletic training in nontraditional
settings, and insurance considerations
• Recognition will continue to be a positive
step in the development of the athletic
training profession
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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
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Education Council
• In 1997 the Education Council was
established to dictate the course of the
educational preparation for the athletic
training student
• Focus has shifted to competency based
education at the entry level
• Education Council has significantly expanded
and reorganized the clinical competencies
and proficiencies
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Athletic Training Education
Competencies
• Twelve Content Areas
– Risk management
– Pathology of injuries and illnesses
– Orthopedic clinical examination & diagnosis
– Acute care
– Pharmacological aspects of injury and illness
– Therapeutic modalities
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Athletic Training Education
Competencies
– Conditioning & rehabilitative exercise
– General medical conditions and disabilities
– Nutritional aspects of injury and illnesses
– Psychosocial intervention and referral
– Health care administration
– Professional development &
responsibilities
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• 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
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Post-Professional Athletic
Training Education Programs
• 15 programs are certified by the NATA
Graduate Education Committee
• Designed to enhance academic and
clinical preparation of already certified
athletic trainers
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Specialty Certifications
• NATA is in the process of developing
specialty certifications
– Further enhance professional development
– Aid in expanding scope of practice
• Specialty certifications build on entry
level knowledge
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• Purpose
– To provide the athletic trainer with
advanced clinical practice credential that
demonstrates attainment of knowledge and
skills that will enhance patient care,
enhance health-related patient quality of
life, and optimize clinical outcomes in
specialized areas of athletic training
practice
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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)
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• Upon meeting the educational
guidelines applicants are eligible to sit
for the examination
• Examination is computer based
• Exam assesses the 6 domains
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Prevention
Evaluation and diagnosis
Immediate care
Treatment, rehabilitation & reconditioning
Organization and administration
Professional responsibility
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• Upon passing the certification
examination = BOC certified as an
athletic trainer
– Credential of ATC
• BOC certification is a prerequisite for
licensure in most states
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Continuing Education
Requirements
• Ensure ongoing professional growth
and involvement
• Requirements that must be met to
remain certified
– 75 CEUs over the course of three years
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• Purpose:
– To encourage athletic trainers to obtain
current professional development information
– To explore new knowledge in specific areas
– To master new athletic training related skills
and techniques
– To expand approaches to effective athletic
training
– To further develop professional judgment
– To conduct professional practice in an ethical
and appropriate manner
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• 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
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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
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• Athletic trainers in many individual states
organized efforts to secure recognition by
seeking some type of regulation of the
athletic trainer by state licensing
agencies
• To date 47 of the 50 states have enacted
some type of regulatory statute
governing the practice of athletic training
• Rules and regulations governing the
practice of athletic training vary
tremendously from state to state
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• Regulation may be in the form of:
– 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
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– 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
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– 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
• Legislation regulating the practice of
athletic training has been positive and to
some extent protects the athletic trainer
from litigation
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Future Directions for the
Athletic Trainer
• Will be determined by the efforts of the
NATA and its membership
– Ongoing re-evaluation, revision and reform of
athletic training education
– Further recognition of CAATE by CHEA will
further enhance credibility
– Athletic trainers must continue to actively seek
third party reimbursement for athletic training
services
– Standardization of state practice acts
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– Athletic trainers will seek specialty
certifications
• Expanding breadth and scope of practice
– Increase in secondary school employment of
athletic trainers
– Increase in recognition of athletic trainers as
physician extender
– Potential for expansion in the military, industry,
and fitness/wellness settings
– With general population aging = increased
opportunity to work with aging physically
active individuals
– Continue to enhance visibility through
research and scholarly publication
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– Continue to be available for local and
community meetings to discuss health care
of the athlete
– Increase recognition and presence
internationally
– Most importantly, continue to focus efforts
on injury prevention and to provide high
quality health care to physically active
individuals regardless of the setting in
which the injury occurs
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