1. © 2011 McGraw-Hill Higher Education. All rights reserved. Principles of Athletic Training 14 th Edition William E. Prentice

2. © 2011 McGraw-Hill Higher Education. All rights reserved. Principles of Athletic Training 14 th Edition PowerPoint Presentations Jason Scibek, PhD, ATC Duquesne University

3. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 1: The Athletic Trainer as a Health Care Provider

4. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

5. © 2011 McGraw-Hill Higher Education. All rights reserved. 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 19 th century in intercollegiate & interscholastic sports –Early treatments involved rubs, counter- irritants, home remedies and poultices

6. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

7. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

8. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

9. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

10. © 2011 McGraw-Hill Higher Education. All rights reserved. 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!!

11. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

12. © 2011 McGraw-Hill Higher Education. All rights reserved. Practice of Medicine Human Performance Injury Management Exercise Physiology Biomechanics Sport Psychology Strength Conditioning Sports Physical Therapy Athletic Training Personal Fitness Trainers Sports Massage Sports Podiatry/ Orthotists Sports Dentistry

13. © 2011 McGraw-Hill Higher Education. All rights reserved. Growth of Professional 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) National Academy of Sports Medicine (1987)

14. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

15. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

16. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

17. © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 1-1

18. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

19. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

20. © 2011 McGraw-Hill Higher Education. All rights reserved. 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)

21. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

22. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

23. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

24. © 2011 McGraw-Hill Higher Education. All rights reserved. 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)

25. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

26. © 2011 McGraw-Hill Higher Education. All rights reserved. Sports Medicine Journals A variety of publications exist, providing excellent resources to the sports medicine community –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

27. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

28. © 2011 McGraw-Hill Higher Education. All rights reserved. Settings include: –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

29. © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 1-3

30. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

31. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

32. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

33. © 2011 McGraw-Hill Higher Education. All rights reserved. –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

34. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

35. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

36. © 2011 McGraw-Hill Higher Education. All rights reserved. Roles and Responsibilities: Board of Certification Domains Prevention Clinical evaluation and diagnosis Immediate care Treatment, rehabilitation and reconditioning Health care administration Professional responsibilities

37. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

38. © 2011 McGraw-Hill Higher Education. All rights reserved. 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)

39. © 2011 McGraw-Hill Higher Education. All rights reserved. Treatment, Rehabilitation Reconditioning –Design preventative training systems –Rehabilitation program design –Supervising rehabilitation programs –Incorporation of therapeutic modalities and exercise –Offering psychosocial intervention Organization & Administration –Record keeping –Ordering supplies and equipment –Establishing policies and procedures –Supervising personnel

40. © 2011 McGraw-Hill Higher Education. All rights reserved. Professional Responsibilities –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

41. © 2011 McGraw-Hill Higher Education. All rights reserved. Personal Qualities of the Athletic Trainer Stamina and the ability to adapt Empathy Sense of humor Communication Intellectual curiosity Ethical practice Professional memberships

42. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

43. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

44. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

45. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

46. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

47. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

48. © 2011 McGraw-Hill Higher Education. All rights reserved. Potentially serve as the academic program medical director –Coordinates and guides medical aspects of program –Provides input into educational content and provides programmatic instruction

49. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

50. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

51. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

52. © 2011 McGraw-Hill Higher Education. All rights reserved. Exercise Physiologist Biomechanist Nutritionist Sport Psychologist Coaches Strength & Conditioning Specialist Social Worker Neurologist Emergency Medical Technician Physicians Dentist Podiatrist Nurse Physicians Assistant Physical Therapist Occupational Therapist Massage Therapist Ophthalmologist Dermatologist Gynecologist Support Health Services & Personnel

53. © 2011 McGraw-Hill Higher Education. All rights reserved. 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)

54. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

55. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

56. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

57. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

58. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

59. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

60. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

61. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

62. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

63. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

64. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

65. © 2011 McGraw-Hill Higher Education. All rights reserved. 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)

66. © 2011 McGraw-Hill Higher Education. All rights reserved. Upon meeting the educational guidelines applicants are eligible to sit for the examination Examination is computer based Exam assesses the 6 domains –Prevention –Evaluation and diagnosis –Immediate care –Treatment, rehabilitation & reconditioning –Organization and administration –Professional responsibility

67. © 2011 McGraw-Hill Higher Education. All rights reserved. Upon passing the certification examination = BOC certified as an athletic trainer –Credential of ATC BOC certification is a prerequisite for licensure in most states

68. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

69. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

70. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

71. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

72. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

73. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

74. © 2011 McGraw-Hill Higher Education. All rights reserved. –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

75. © 2011 McGraw-Hill Higher Education. All rights reserved. –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

76. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

77. © 2011 McGraw-Hill Higher Education. All rights reserved. –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

78. © 2011 McGraw-Hill Higher Education. All rights reserved. –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