1. Chapter 1: The Sports Medicine Team

2. Sports Medicine Where Have We Been? Where Are We Now?
Where Are We Going?

3. Where Have We Been? Trainers associated with Greek & Roman Periods.
Increase in sports activities during the Renaissance.
Late 19th century AT’s involved with intercollegiate athletics in the US.
Rub downs, home remedies, lack of technical knowledge.
After WWI AT’s viewed as specialized in preventing and managing athletic injuries.
1950 NATA founded in Kansas City
1980’s Athletic Training Program content for bachelor’s degree.
1980’s development of NATABOC for board certification, ATC’s.
Recognized by the AMA as a allied health care provider.

4. Where Are We Now?
40% of ATC’s work outside of school athletic settings.
JRC-AT/CAAHEP programs developed
ATC’s allowed to bill insurance companies using CPT codes in 2002.
2004 End of internship programs
ATC’s regulated and licensed healthcare providers
ATC’s provide the same or better outcomes as others, including PT’s.
ATC’s demonstrate high patient satisfaction ratings.
30,000+ NATA members

5. Where Are We Going? 2005 17,110 projected ATC jobs
Continued research to develop new techniques for injury prevention, management, and rehabilitation.

6. What Is Sports Medicine ?

7. Sports Medicine Human Performance Management Injury
Exercise Physiology
Practice of Medicine
Biomechanics
Sports Physical Therapy
Sport Psychology
Athletic Training
Sports Nutrition
Sports Massage

8. Goals of Professional Sports Medicine Organizations
Develop professional standards & code of ethics
Exchange of professional knowledge, stimulate research, & promote critical thinking.
Ability to work as a group with a singleness of purpose to achieve objectives that could not be accomplished separately.

9. The Players on the Sports Medicine Team
Physicians
Dentist
Podiatrist
Nurse
Physicians Assistant
Physical Therapist
Athletic Trainer
Massage Therapist
Exercise Physiologist
Biomechanist
Nutritionist
Sport Psychologist
Coaches
Strength & Conditioning Specialist
Social Worker

10. The Primary Players on the Sports Medicine Team

11. Physician
Coach
Athlete
Athletic Trainer

12. Historical Development of Sports Medicine Organizations
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)

13. Historical Development of Sports Medicine Organizations
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)

14. Historical Development of Sports Medicine Organizations
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)

15. Historical Development of Sports Medicine Organizations
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)

16. International Federation of Sports Medicine (FIMS)
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 is multidisciplinary, including many disciplines that are concerned with physically active individuals

17. American Academy of Family Physicians (AAFP)
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

18. American Orthopaedic Society for Sports Medicine (AOSSM)
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

19. National Strength and Conditioning Association (NSCA)
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
14,500 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)

20. American Academy of Pediatrics, Sports Committee
Dedicated to providing the general pediatrician and pediatric subspecialist 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

21. 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

22. American College of Sports Medicine (ACSM)
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
18,000 members

23. Sports Physical Therapy Section of APTA
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

24. Sports Physical Therapy Section of APTA
Promotes the role of the sports physical therapist to other health professionals
Supports research to further establish the scientific basis for sports physical therapy
Offers certification as a sports physical therapist (SCS)
Approximately 9,000 members
Many sports physical therapists are also certified athletic trainers

25. National Athletic Trainers Association (NATA)
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 28,000 members

26. AMA Recognition of Athletic Training
June 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)

27. AMA Recognition of Athletic Training
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 are now accredited by CAAHEP

28. AMA Recognition of Athletic Training
Effects of CAAHEP 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

29. National Athletic Trainers Association Board of Certification (NATABOC)
In 1999 the NATABOC completed the latest Role Delineation Study, which redefined the profession of athletic training
Study designed to examine the primary tasks performed by the entry level athletic trainer and the knowledge and skills required to perform each task

30. Role Delineation Study Performance Domains
Prevention of athletic injuries
Recognition, evaluation and assessment of injuries
Immediate care of injuries
Treatment, rehabilitation and reconditioning of athletic injuries
Health care administration
Professional development and responsibility

31. Education Council
In 1998 the Education Council was established to dictate the course of the educational preparation for the student athletic trainer
Focus has shifted to competency based education at the entry level
Education Council has significantly expanded and reorganized the clinical competencies and proficiencies

32. Athletic Training Educational Competencies (1999)
Twelve Content Areas
Acute care of injury and illness
Assessment and evaluation
General medical conditions and disabilities
Health care administration
Nutritional aspects of injury and illnesses
Pathology of illness and injuries

33. Athletic Training Educational Competencies (1999)
Pharmacological aspects of injury and illnesses
Professional development and responsibility
Psychosocial intervention and referral
Risk management and injury prevention
Therapeutic exercise
Therapeutic modalities

34. NATABOC vs. Education Council
The NATABOC defines the minimum knowledge base that an entry level athletic trainer should possess to be able to work in the profession while the Education Council was charged with determining the competencies that should be taught in accredited educational programs
There is overlap between Performance Domains and Competencies

35. Certification Requirements
Candidates for certification must meet NATABOC established requirements
For students graduating in 2003 and beyond, NATABOC no longer requires clinical hours
CAAHEP accredited programs must develop and implement a clinical instruction plan according to 2001 Standards and Guidelines to ensure that students meet all AT educational competencies and clinical proficiencies in academic courses with measurable outcomes

36. Certification Requirements
Accreditation process will be concerned with the quality of experiences and student outcomes and knowledge rather the number of hours accrued
As of January, 2004 the internship route to certification will no longer be accepted
All candidates for certification will have to meet CAAHEP requirements
Successful completion of all parts of the certification exam will earn the credential of ATC

37. CAAHEP Accredited Programs
Currently 134 institutions offer entry level athletic training education programs accredited by CAAHEP
174 are in the process of seeking CAAHEP accreditation
13 graduate programs in athletic training approved by the Education Council Post-Certification Graduate Education Committee

38. Employment Settings for Athletic Trainers
Secondary Schools
1995 NATA adopted a position statement supporting hiring athletic trainers in secondary schools
1998 AMA adopted policy calling for ATC’s to be employed in all high school athletic programs
~ 30,000 public high schools in U.S.
Between 20-25% of high schools have ATC’s
School Districts
ATC floats between several schools in same district

39. Employment Settings for Athletic Trainers
College and Universities
Number of ATC’s varies considerably
Extent of coverage varies
2000 Task Force published Recommendations and Guidelines for Appropriate Medical Coverage for Intercollegiate Athletics
Based on a mathematical model created by a number of variables
Professional Teams
~ 5% of employed ATC’s

40. Employment Settings for Athletic Trainers
Sports Medicine Clinics
The largest % of employed ATC’s found in this setting
Work in the clinic in AM and in high school in PM
Industrial and Corporate Settings
ATC’s oversee fitness, injury rehabilitation, and work-hardening programs
Understanding of workplace ergonomics is essential

41. 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

42. State Regulation of the Athletic Trainer
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 40 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

43. State Regulation of the Athletic Trainer
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

44. State Regulation of the Athletic Trainer
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

45. State Regulation of the Athletic Trainer
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

46. List of Regulated States
Alabama (L) Kansas (R) North Carolina (L)
Arkansas (L) Kentucky (C) North Dakota (L)
Arizona (E) Louisiana (C) Ohio (L)
Colorado (E) Massachusetts (L) Oklahoma (L)
Connecticut (E) Maine (L) Oregon (R)
Delaware (L) Minnesota (R) Pennsylvania (C)
Florida (L) Mississippi (L) Rhode Island (L)
Georgia (L) Missouri (R) South Carolina (C)
Hawaii (E) Nebraska (L) South Dakota (L)
Idaho (R) New Hampshire (C) Tennessee (C)
Illinois (L) New Jersey (R) Texas (L)
Indiana (L) New Mexico (L) Vermont (C)
Iowa (L) New York (C) Virginia (C)
Wisconsin (C)

47. Reimbursement for Athletic Training Services
During the past 40 years the insurance industry has undergone a significant evolutionary process
Health care reform initiated in the 1990’s has focused on the concept of managed care in which costs of a health care providers medical care are closely monitored and scrutinized by insurance carriers
Managed care involves a prearranged system for delivering health care that is designed to control cost while continuing to provide quality care

48. Reimbursement for Athletic Training Services
Third-party reimbursement - primary mechanism of payment for medical services in the United States
Health care professionals are reimbursed by the policy holder's insurance company for services performed
To cut pay-out costs, many insurance companies limit where and how often an individual can go for care and what services will be paid for

49. Reimbursement for Athletic Training Services
Unless ATC is also a licensed physical therapist, it is difficult to obtain third-party reimbursement for health care services provided
State regulation of the ATC has, to date, helped little with obtaining reimbursement
In general, insurance companies have not been willing to cover services provided by the ATC
Securing third-party reimbursement must be a priority, especially for the clinical ATC

50. Reimbursement for Athletic Training Services
1995- NATA established Reimbursement Advisory Group to monitor managed care changes and to help ATC secure a place as a health care provider
1996- NATA initiated the Athletic Training Outcomes Assessment project designed to present supporting data to measure results of interventions which involve athletic training procedures

51. Reimbursement for Athletic Training Services
Athletic Trainers must bill insurance companies according to the Current Procedural Terminology (CPT) codes published by AMA
In 1999, the American Hospital Association approved a new uniform billing code (UB Code) to be used specifically for provide athletic training services

52. Athletic Trainer vs. Physical Therapist Wars
It is not unusual to find a physical therapist interested in sports and athletics working toward certification as an athletic trainer
A certified athletic trainer interested in working with patients outside of the athletic population may work toward licensure as a physical therapist

53. Athletic Trainer vs. Physical Therapist Wars
Historically, the relationship between athletic trainers and physical therapists has been less than cooperative
There has been failure to clarify the roles of each group in injury rehabilitation
Academic preparation is similar
Individual who holds a dual credential is more marketable

54. Future Directions Increase effort to enhance visibility
By making themselves available for local and community meetings to discuss athletic health care
Through research efforts and scholarly publication
Continue reorganize and refine educational programs for student athletic trainers
Continue to seek and strengthen state regulation of the practice of athletic training

55. Future Directions
Increase efforts to create job opportunities particularly in secondary schools, colleges and universities, and corporate and industrial settings
Increase effort in seeking third-party reimbursement for services provided
Continue efforts in injury prevention and in providing appropriate, high-quality health care