Playing Games

Casey Kirk (i) and Dave Litzke (r)  Casey Kirk (i) and Dave Litzke (r)

When Reggie Brown of the Detroit Lions was tackled in a game against the New York Jets on December 21, 1997, it appeared to be just another good hit. That is until he didn’t get up. Immediately, Kent Falb, the team’s head athletic trainer, ran out onto the field to determine what was wrong. Unfortunately, the impact displaced Brown’s first and second vertebrae, but it was impossible diagnose that on the field. All Falb knew at the time was that Brown was struggling for every breath. But it was Falb’s quick-thinking reaction along with the help of team doctors that helped to stabilize Brown and prepare him for transport to the nearest trauma center.

While the public may automatically associate athletic trainers, also referred to as sports therapists, with professional athletic teams, their expertise reaches far beyond the playing fields of the NFL, NBA, NHL or MLB. It’s an allied health specialty that’s gaining respect among school districts, sporting clubs, hospitals, physicians, and even in the field of industrial manufacturing.

In fact, the profession has been experiencing significant growth for nearly 30 years. Membership in the National Athletic Trainer Association (NATA), the profession’s leading organization, has grown more than 520% since 1974. Its most recent statistics reveal that membership topped the 28,000 mark in 2001.

And it’s a specialty that continues to create new jobs for sports medicine graduates. In fact, NATA forecasts continued job growth of at least 2,600 more jobs by 2005, and another 7,000 jobs by 2010.

The Fundamentals

In some ways, athletic trainers assume many of the same responsibilities as triage nurses—they’re usually the first ones on the scene and in charge of making split-second assessments. “The trainer is the first-line soldier, working in the trenches with the athletes,” comments Dale Baker, the Smith and Nephew chair for director of education at the American Sports Medicine Institute, based in Birmingham, Ala.

As in Brown’s case, Falb was able to gauge the urgency of the situation and prioritize the initial treatment steps. In less traumatic cases, trainers determine whether or not an athlete’s injury is severe enough to warrant transportation to the hospital. If not, they treat the injury on site and follow up with a rehabilitation plan.

“We’re trained to splint a fracture, perform cardiopulmonary resuscitation (CPR), assess injuries and illnesses, and rehab an injury,” states Laura Harris, PhD, ATC, assistant professor of athletic training at Ohio State University, School of Allied Medical

Professionals in Columbus.

But trainers also work in preventative capacities, such as strength training, conditioning, exercise instruction and overall health maintenance. “Athletes are expected to do a job and the trainer is trying to get them back to work as soon as possible,” notes Michael Mandich, ATC, an independent consultant based in Lewisville, Texas.

Because their responsibilities cover such a wide spectrum of health care tasks, athletic trainers and sports therapists are typically required to have a four-year degree that includes classes in anatomy, physiology, psychology, nutrition and conditioning. Employers also require a variety of certifications, namely athletic trainer certified (ATC), CPR and first aid. Additional certifications focus on specific areas within the profession, and requirements vary depending on the needs of the job.

Of course, to practice at the professional sports level, trainers must have several years of experience and usually an advanced degree. Even at the collegiate level, the competition for positions is extremely stiff, and a master’s degree can be a deciding factor.

“Most trainers recognize the need for advanced education in order to be competitive. It’s difficult to make it to Division I, II or even III without a graduate degree, and it’s especially difficult to get into the professional level,” asserts Harris. “It doesn’t necessarily matter what your degree is in, but it proves you’re someone who has challenged your critical thinking skills.”

Unlike physical or occupational therapists (PTs and OTs, respectively), not all states mandate athletic trainers be licensed. However, 43 states currently demand some form of regulation, from licensure to registration, and the average starting salary hovers around $28,000.

Game Plan

Almost without fail, an individual’s introduction to sports medicine comes from sustaining an injury while playing a sport. “I would say about 98% of us in the profession were injured as an athlete and had to be treated by a trainer. We didn’t know about [the field] until a trainer took care of us,” says Harris, a former gymnast.

Of course, there is that small percentage that simply saw sports medicine as a way to stay directly connected to sports without becoming a professional athlete or coach. Mandich is one example: “Growing up in Green Bay, Wis., I always wanted to work for the Packers. I knew I was never going to play for the team, so I thought the closest I could get would be to become a trainer,” he says.

While Mandich hasn’t landed that dream job with an NFL team yet, he has been able to expand his skills through various positions. Since graduating from the University of Wisconsin at La Crosse in 1997, he has worked at PT clinics, hospitals, and with a number of school districts. “I especially like working with kids because it’s challenging work and always changing. You never do the same thing two days in a row,” he comments.

Little League

Many athletic trainers start off their careers treating high schools athletes, getting them in shape, and prepping them to compete at the more advanced collegiate level. Unfortunately, there are very few individual schools that can afford to hire a trainer to solely attend to students’ needs. Rather, school districts usually contract with local clinics or hospitals to have staff trainers work with the schools on a part-time basis. These specialists split their time between patients and students. “I like being part of the fast-paced environment during the day and working at a high school in the evenings,” Mandich says.

“In more rural environments, some of the education budgets are not as lucrative, and schools may have to hire a trainer to service the entire district instead of one trainer per school,” notes Harris. “At the high school level, trainers are more often used in the game settings for emergency medical situation rather than for their rehab or prevention skills.”

Yet another sport medicine career path is teaching. In this scenario, individuals are in the classroom during the day and on the field or court after school. “However, that’s a job with a high amount of burnout because they are there from early in the morning to late at night,” states Harris. “Typically after five to seven years, many trainers find a spouse or start a family and want better hours.”

Neither the health care nor the educational communities overlook the importance of having certified trainers to support young athletes. Recent studies have shown that too many children are insufficiently trained and, therefore, sustain unnecessary injuries. According to U.S. News & World Report, there is an alarming rise in the number of overuse injuries among children, such as persistent heel problems among young soccer players.

Complicating matters is the fact that many youth teams are coached by parents or sports enthusiasts who may know about the sport’s fundamentals but aren’t necessarily trained in the finer aspects of conditioning. Without a balanced approach to practices, weight training, and overall conditioning, children are at risk for injuring themselves or, at the extreme, causing permanent damage. Additionally, the medical community has expressed concerns about undiagnosed concussions, particularly among football and soccer players.

With more than 30 million children playing on school or recreation-league teams, it’s no wonder that there’s a growing call for change. More organizations and schools are recognizing the importance of appropriate training and, where budgets allow, are seeking the expertise of professional athletic trainers. Even the American Academy of Pediatricians has publicly advocated the use of ATCs for high school sports. Therefore, industry analysts believe this is a work setting that will continue to grow for entry-level sports medicine grads.

The Practice Arena

For those who prefer treating a broader range of people, doctors’ offices, PT clinics and hospitals also offer interesting career options. In these settings, the ATC works along side PTs, OTs, doctors and nurses as part of the health care team. Additionally, patients vary in age, race and socioeconomic backgrounds. Specialists may see professional and collegiate athletes, weekend enthusiasts, children, and even the elderly—all of whom may have suffered an injury or require additional training in order to avoid further complications. Says Mandich, “Athletic training is a very interdisciplinary approach. You’re still treating an active population, they’re just not all athletes.”

Regardless of the environment, sports therapists are required to function under the supervision of a physician and are often the link between patients and the rest of their health care team.

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“We work with the primary health care team that consists of the patient, parents if a minor, coaches and physician. Then there is the secondary team, which consists of a rolodex of consultants, such as PTs, exercise physiologists, nutritionists, psychologists, social workers, school nurses and chiropractors,” explains Harris. “Our co-workers run the gamut of the health care professions.”

Additionally, trainers in the clinical setting assume more of a rehab perspective, including exercise prescriptions and patient education. In a time of heightened cost-consciousness, ATCs have proven to be a valuable asset. The NATA reports that physicians have indicated a higher rate of reimbursement when employing trainers. Additionally, ATCs free up doctors’ time to see more patients while continuing to cater to an individual’s needs.

As the population ages, industry analysts anticipate a significant increase in the need for sports therapists in the clinical arena. As people grow older, they become more susceptible to activity-related injuries. Therefore, there will be a greater demand for specialists who can help individuals return to their daily life, which includes instruction on how to prevent further injuries.

Another promising development for ATCs is the recent changes in insurance policies that now agree to reimburse providers for sports medicine treatments. “The list of companies that will reimburse trainers is growing, whereas PTs have been billing for their services forever. In terms of reimbursement, trainers have been undervalued and underutilized,” says Mandich.

“As we gain more progress toward reimbursement—and the number of potential services that are covered by reimbursements—we will also see salaries increase,” adds Harris.

The Professional Team

Perhaps the most promising employment environment for ATCs is nowhere near a football stadium, ice rink or hospital. Rather, it’s within the walls of high-rise office buildings and manufacturing plants. Corporate America has taken notice of the benefits of being physically fit, including the financial results. At its most basic, active employees are less likely to use up sick days and make fewer medical claims against insurance policies—they even add to high company morale.

Although most evidence is anecdotal, more and more companies are encouraging employees to exercise and maintain healthy lifestyles by providing workout facilities, discounts to private gyms, and even perks like free movie tickets to those who prove to be physically active. But back in 1985, Honda of America Manufacturing (HAM) simply wanted to give its employees and their families a place to exercise, get in shape and enjoy recreational activities. That’s when the automotive manufacturer opened its first Wellness Center in Marysville, Ohio.

Now, nearly 20 years later, HAM boasts three Wellness Centers, each with degreed professionals on staff to assist employees with their physical needs.

“Each center promotes wellness with education. There is nutrition information from a registered dietician, and associates can discuss their wellness concerns and have one-on-one consultations for issues like stress management. The centers’ program departments plan recreational activities, such as intramural leagues and holiday parties. The aquatics departments run the pools, swimming lessons and aqua aerobics. The fitness departments’ staff have the capabilities to help individuals with any from training—from a marathon to body building,” explains Dave Litzke, the coordinator for the Marysville center.

While the centers are designed to accommodate individual needs, their staffs also help HAM employees recuperate from injuries, whether suffered on the job or during their off time. “Injured athletes need to return to playing at the same level of competence in the shortest period of time—that is what the athletic trainer does. A lot of those same treatments also work on other workers and athletes, including the weekend warrior,” notes Baker.

“Nowadays, larger organizations are recognizing athletic trainers as entities that are viable options to help offset or deter health care costs,” adds Casey Kirk, coordinator at one of HAM’s Wellness Centers.

Athletic trainers are particularly valuable in the industrial environment where assembly workers are expected to do heavy, monotonous functions that can lead to workplace injuries, if the workers are not properly conditioned.

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“When you look at the volume and repetition of movement an associate does in a fast-paced manufacturing environment, the amount of trauma on the body equates or supercedes that of an athlete. Upon their gaining employment at Honda, some people may not have the baseline physical condition that’s required,” explains Kirk. “Associates who work in these facilities need a high level of conditioning.”

Both Litzke and Kirk agree that it’s satisfying to help people not only obtain better performance on the job, but to also enhance their lives as a whole by becoming physically fit. “We work with a diverse group of people in very different ways. In the morning we could be working with a senior citizen, in the evening we could be working with mom who just had a child, and at night it could be helping a high school athlete,” explains Kirk.

Keeping Score

In order for athletic trainers to be effective with their clients, regardless of the setting, a holistic approach is required. Lifestyle, motivations and health care goals are all taken into consideration. “Most of the time, you’re not dealing with sick people but people with health care problems nonetheless. You have address the whole person in treatment,” advises Baker.

And it’s this complete approach that places sports therapists in a unique position within the allied health field. Their broad knowledge, multiple applications, and adaptability to numerous environments make them an asset.

Indeed, it was Kent Falb’s expertise that helped Detroit Lion Reggie Brown not only survive that tumultuous tackle, but allowed him to make a remarkable recovery. Less than a month later, Brown was jogging and doing other prescribed exercises on his way back to a fully functional life and a winning athletic career.