The Sports Medicine Team

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					Chapter 1: The Sports
  Medicine Team
         Sports Medicine
• Where Have We Been?
• Where Are We Now?
• Where Are We Going?
           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
• Rub downs, home remedies, lack of technical knowledge.
• After WWI AT’s viewed as specialized in preventing and managing
  athletic injuries.
• 1950 NATA (National Athletic Trainers Association) 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 an allied health care provider.
         Where Are We Now?
• 40% of ATC’s work outside of school athletic
• 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
      Where Are We Going?

• 2010 21,525 projected ATC jobs
• 2015 25,400 projected ATC jobs
• Continued research to develop new
  techniques for injury prevention,
  management, and rehabilitation.
           What’s the Difference?
Athletic First Responder          Certified Athletic Trainer

Certified in CPR/First Aid        Holds a degree in Sports
                                    Medicine/Athletic Training
Completes 40 hours of
  continuing education each       Certified by the NATABOC
  year in injury                     (exam)
                                  (National Athletic Training
                                     Association Board of
May have additional                  Certification)
  certifications/degrees in the
  field of sports
                                  Licensed in the State for which
  medicine/athletic training
                                     they work
        Human          Injury
      Performance     Management

Exercise Physiology    Practice of Medicine

Biomechanics           Sports Physical Therapy

Sport Psychology       Athletic Training

Sports Nutrition

Sports Massage
  Goals of Professional Sports Medicine
• 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
     The Players on the Sports
         Medicine Team
•   Physicians               • Exercise Physiologist
•   Dentist                  • Biomechanist
•   Podiatrist               • Nutritionist
•   Nurse                    • Sport Psychologist
•   Physicians Assistant     • Coaches
•   Physical Therapist       • Strength & Conditioning
•   Athletic Trainer           Specialist
•   Adult First Responders   • Social Worker
•   Massage Therapist
The Primary Players on the
  Sports Medicine Team
    American College of Sports
       Medicine (ACSM)

• Patterned after FIMS (Umbrella
• Interested in the study of all aspects of
• Membership = individuals in the medical
  field, and those interested in sports
• 18,000 members
  Sports Physical Therapy Section of

• Promotes the role of the sports
  physical therapist to other health
• Supports research to further establish
  the scientific basis for sports physical
• Offers certification as a sports physical
  therapist (SCS)
• Approximately 9,000 members
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 28,000 members
AMA Recognition of Athletic Training

• June 1991- AMA officially recognized
  athletic training as an allied health
• 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)
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
National Athletic Trainers Association
 Board of Certification (NATABOC)

• In 1999 the NATABOC completed the
  latest Role Delineation Study, which
  redefined the profession of athletic
• Study designed to examine the
  primary tasks performed by the entry
  level athletic trainer and the
  knowledge and skills required to
  perform each task
  Athletic Training Educational
      Competencies (1999)

• Twelve Content Areas
 – Acute care of injury and illness
 – Assessment and evaluation
 – General medical conditions and
 – Health care administration
 – Nutritional aspects of injury and illnesses
 – Pathology of illness and injuries
Athletic Training Educational
    Competencies (1999)
– Pharmacological aspects of injury and
– Professional development and
– Psychosocial intervention and referral
– Risk management and injury prevention
– Therapeutic exercise
– Therapeutic modalities
    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
     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
  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
      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
  – ~ 30,000 public high schools in U.S.
  – Between 20-25% of high schools have ATC’s
• School Districts
     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
      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
• Industrial and Corporate Settings
  – ATC’s oversee fitness, injury rehabilitation,
    and work-hardening programs
  – Understanding of workplace ergonomics is
 State Regulation of the Athletic
• 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
  State Regulation of the Athletic
• 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
 State Regulation of the Athletic
• 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
State Regulation of the Athletic
– 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
– Registration
  • Before an individual can practice athletic
    training he or she must register in that state
         List of Regulated States
        L: Licensure C: Certification R: Registration
•   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)
    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
    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
    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
• A certified athletic trainer interested in
  working with patients outside of the
  athletic population may work toward
  licensure as a physical therapist
    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
• Academic preparation is similar
• Individual who holds a dual credential is
  more marketable
           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
• Continue reorganize and refine
  educational programs for student athletic
• Continue to seek and strengthen state
           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