Clinical and Health Affairs
Certified Athletic Trainers
By Lori Glover, M.H.A., M.S., A.T.C.
Abstract
Certified athletic trainers optimize people’s ability to participate in athletics or activities of work and life. Athletic training encompasses the prevention, examination and assessment, treatment, and rehabilitation of emergent, acute, subacute, and chronic neuromusculoskeletal conditions. Certified athletic trainers play a key role in health care delivery today, and that role is expected to evolve and grow in the future. This article describes what certified athletic trainers do, outlines their educational and certification requirements, and describes the ways they work in different settings—from the sidelines to industry to medical clinics.
The Centers for Disease Control and Prevention estimated that 7.2 million high school students participated in organized sports during the 2005-06 school year.1 Playing organized sports is generally considered positive, as it promotes a physically active lifestyle, weight management, improved self-esteem, and increased strength, endurance, and flexibility. According to the National Federation of State High School Associations, students who participate in sports or other physical activities also tend to have higher grade-point averages, better attendance records, lower dropout rates, and fewer discipline problems than students in general.2 However, those who participate in sports are at risk for injury. An estimated 1.4 million injuries occurred among high school sports participants during practices and competitions during the 2005-06 school year.1
When employed in the school setting, certified athletic trainers will be the first health care providers to see an injured athlete, as they are often on the sidelines during games and practices. They are the ones who run onto the football field when a player goes down. Like EMTs, certified athletic trainers manage acute trauma and life-threatening conditions. Unlike EMTs, they also are trained to determine whether a participant is fit to return to play. (They are among the few health care professionals trained in the assessment and management of concussion.) Like physical and occupational therapists, athletic trainers rehabilitate patients with musculoskeletal injuries. But they also have expertise in nutrition and an understanding of the socioeconomic effects of returning to a sport or activity. Certified athletic trainers can identify comorbidities such as depression, addiction, or eating disorders that may occur in the population they serve and work with other practitioners to manage them. In addition, they educate patients on how to prevent injuries and stay healthy.
According to the Board of Certification for athletic trainers, there are more than 36,000 certified athletic trainers worldwide. In the United States, all states but California and Hawaii regulate the practice of athletic trainers. Certified athletic trainers work in a variety of settings including high schools, colleges, and universities. They also work with professional sports teams, performing arts organizations, and branches of the military. Increasingly, they are working in fitness centers, occupational settings, and as members of health care teams in clinics, hospitals, and rehabilitation centers. This article outlines the educational and certification requirements for certified athletic trainers and describes some of the ways they work with sports teams and other organizations.
Qualifications of a Certified Athletic Trainer
Athletic training is a unique and relatively young profession. In 1950, a group of 200 athletic trainers gathered in Kansas City to establish professional standards and discuss the future of athletic training. The National Athletic Trainers’ Association (NATA) was formed shortly thereafter. In 1956, the NATA Board of Directors authorized a committee to study avenues through which the professionalism of athletic training could be enhanced.3 Since 1989, athletic trainers have been certified by an independent national board, the Board of Certification, which develops and delivers the certification examination for people entering the field.
Certified athletic trainers are trained in five areas: injury/illness prevention and wellness, clinical evaluation and diagnosis, immediate and emergency care, treatment and rehabilitation, and organizational and professional health and well-being. All must hold at least a bachelor’s degree from an education program that is accredited by the Commission on Accreditation of Athletic Training Education. Nearly 70 percent of athletic trainers have a master’s or doctoral degree in athletic training or a related area.4 According to the National Athletic Trainers’ Association, educational programs must include training in the following areas:
- Risk management and injury prevention,
- Pathology of injuries and illnesses,
- Orthopedic clinical examination and diagnosis,
- General medical conditions and disabilities,
- Acute care of injuries and illnesses,
- Therapeutic modalities,
- Conditioning and rehabilitative exercise,
- Pharmacology,
- Psychosocial intervention and referral,
- Nutritional aspects of injuries and illnesses,
- Health care administration, and
- Professional development and responsibilities. 4
Minnesota is one of 47 states that regulate the practice of certified athletic trainers. This is done by the Minnesota Board of Medical Practice (BMP) in accordance with the Minnesota Athletic Trainers Act of 1993. The BMP regulates more than 650 certified athletic trainers in Minnesota. To retain certification in Minnesota, athletic trainers must obtain 75 hours of continuing education every three years and adhere to the standards of professional practice outlined in the NATA’s Code of Ethical Conduct.
Certified athletic trainers work closely with physicians. In Minnesota, the BMP requires athletic trainers to establish a relationship with a supervising physician. The physician and athletic trainer must sign a form each year that outlines the specific clinical duties that the supervising physician allows the athletic trainer to perform. The supervising or “primary physician” may by law allow the athletic trainer to evaluate and treat patients up to 30 days without being seen by a physician. Examples of injuries typically managed by athletic trainers alone are strains and sprains where imaging is not indicated. Physicians and athletic trainers also may add other competencies such as suturing, starting IVs, or performing other medical duties to the protocol form based on the didactic and practical training the athletic trainer has received.
What Certified Athletic Trainers Do
Where Athletic Trainers Work
According to a survey by the Minnesota Athletic Trainers’ Association, nearly 55% of all Minnesota high schools utilize the services of certified athletic trainers for their athletic programs. All of Minnesota’s professional sports teams, colleges, and universities as well as the National Sports Center in Blaine, the Minnesota Youth Soccer Association, Minnesota Youth Athletic Services, the Minnesota State High School League, and Special Olympics-Minnesota employ at least one certified athletic trainer. In these settings, athletic trainers provide care to athletes on a day-to-day basis, evaluating new injuries as well as on-going ones, and managing illnesses and chronic conditions. They also tape and brace athletes before practices and competitions, provide on-site rehabilitation of injuries, and decide when an injured athlete is ready to return to play. In addition, the athletic trainer acts as the “eyes, ears, and hands” of members of the health care team who cannot be on site. They coordinate care with other providers, and manage communication with coaches, parents, and other off-site health care professionals.
Athletic trainers are also being employed by industry. Recent studies have demonstrated that the services of athletic trainers save money for employers and improve quality of life for patients.5 For each dollar invested in preventive care, employers gained up to a $7 return on investment, according to one NATA survey.5 Today, more than half of all athletic trainers work outside of the athletic setting.5 In Minnesota, companies such as United Parcel Service, Delta Airlines, and Frito Lay have discovered the value of athletic trainers, as they can educate workers about proper movement patterns, look for opportunities to prevent injuries, and manage injuries that may occur.
Athletic trainers also work in rehabilitation facilities and medical clinics. Employment in physician offices is a relatively new phenomenon (clinics in Minnesota began employing them about 15 years ago). Those who work in clinics serve as physician extenders and most often work with orthopedic patients. They are responsible for triaging patients, taking patient histories, performing evaluations, providing instruction on exercise prescriptions, aiding with rehabilitation, and doing general patient education and other tasks including casting/bracing and injection preparation. This allows the physicians to spend more of their time caring for patients with complex needs and performing the work that only they can do. In clinics that employ certified athletic trainers, the patient benefits by having extended one-on-one time with a medical provider who can answer questions and provide direction on how to prevent and care for injuries.
Conclusion
Certified athletic trainers play a role not only in keeping athletes in the game, but also in helping workers prevent and recover from job-related injuries. They have a role in a reformed health care system, as they provide high-value care and support to physicians who can then devote more of their time to patients with more complex needs. Their role is likely to expand as health care providers in the United States increasingly recommend safe physical activity for prevention of obesity and many other chronic diseases. As the role of the athletic trainer becomes better understood, demand for these health care providers is expected to increase and their skills will be used in new ways to benefit patients who are athletes as well as those who are not. MM
Lori Glover is community sports medicine director for the Institute for Athletic Medicine, part of Fairview Health Services.
References
1. Centers for Disease Control and Prevention. Sports-related injuries among high school athletes—United States 2005-06 school year. Morbid Mortal Wkly Rept. 2006;55(38):1037-40. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5538a1.htm. Accesed November 4, 2010.
2. National Federation of State High School Associations. Benefits of High School Activities. Available at: www.iahsaa.org/resource_center/Character_Sportsmanship_Safety/Benefit_of_Activities_Handout.pdf. Accessed November 4, 2010.
3. Delforge GD, Behnke RS. The history and evolution of athletic training education in the United States. J Ath Train. 1999;34(1):53-61.
4. National Athletic Trainers’ Association. Athletic Training. Available at: www.nata.org/athletic-training. Accessed November 4, 2010.
5. National Athletic Trainers’ Association. The FACTS about Athletic Trainers. : Available at: www.nata.org/sites/default/files/AT_Facts.pdf. Accessed November 4, 2010.