1. Principles of Athletic Training 14th Edition
William E. Prentice

2. Principles of Athletic Training 14th Edition PowerPoint Presentations
Damian Goderich, MA, Physical Education, USF

3. Chapter 1: The Athletic Trainer as a Health Care Provider

4. 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?

5. 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

6. 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, counter-irritants, home remedies and poultices

7. 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

8. 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

9. 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

10. 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

11. Becoming more aligned as a clinical health care profession
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!!

12. 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

13. Sports Medicine Human Performance Management Injury
Exercise Physiology
Practice of Medicine
Athletic Training
Biomechanics
Sport Psychology
Sports Physical Therapy
Strength Conditioning
Sports Massage
Personal Fitness Trainers
Sports Podiatry/ Orthotists
Sports Dentistry

14. 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)

15. 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

16. 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

17. 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

18. Figure 1-1

19. 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

20. 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

21. 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)

22. 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

23. 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

24. 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

25. 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)

26. 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

27. 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

28. 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

29. 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

30. Figure 1-3

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. Roles and Responsibilities: Board of Certification Domains
Prevention
Clinical evaluation and diagnosis
Immediate care
Treatment, rehabilitation and reconditioning
Health care administration
Professional responsibilities

38. 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

39. 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)

40. 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

41. 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

42. Personal Qualities of the Athletic Trainer
Stamina and the ability to adapt
Empathy
Sense of humor
Communication
Intellectual curiosity
Ethical practice
Professional memberships

43. 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

44. 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

45. 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

46. 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

47. 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

48. Deciding on disqualifications
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

49. Potentially serve as the academic program medical director
Coordinates and guides medical aspects of program
Provides input into educational content and provides programmatic instruction

50. 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

51. 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

52. 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

53. Support Health Services & Personnel
Physicians
Dentist
Podiatrist
Nurse
Physicians Assistant
Physical Therapist
Occupational Therapist
Massage Therapist
Ophthalmologist
Dermatologist
Gynecologist
Exercise Physiologist
Biomechanist
Nutritionist
Sport Psychologist
Coaches
Strength & Conditioning Specialist
Social Worker
Neurologist
Emergency Medical Technician

54. Recognition and Accreditation of the Athletic Trainer as an Allied Health Professional
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)

55. 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

56. 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

57. 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

58. 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

59. 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

60. 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

61. 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

62. 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

63. 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

64. 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

65. 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

66. 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)

67. Examination is computer based Exam assesses the 6 domains
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

68. BOC certification is a prerequisite for licensure in most states
Upon passing the certification examination = BOC certified as an athletic trainer
Credential of ATC
BOC certification is a prerequisite for licensure in most states

69. 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

70. 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

71. 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

72. 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

73. 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

74. 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

75. Certification Registration
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

76. 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

77. 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

78. 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

79. 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