1.11: Athletic Training

Learning Objectives

1. Evaluate the role of an athletic trainer on a sport team.
2. Understand different methods of muscle recovery.
3. Describe CTE.

Do you love sports and the sports environment? Maybe you grew up as an athlete and do not want to move away from that lifestyle. Athletic training could be for you!

Athletic training is a section of kinesiology but also a job title. Athletic trainers are healthcare professionals usually working with an athletic sports team or school. Athletic trainers can provide services including “prevention, examination, diagnosis, treatment, and rehabilitation of emergent, acute or chronic injuries and medical conditions” (1). Athletic trainers can work in elite-level sports including the Olympics, professional sports, and college athletics, but there are also job opportunities in high schools and youth sports programs. Depending on the circumstances, you as an athletic trainer could be working solo or as part of a team and will be working closely with coaches, strength and conditioning trainers, and possible data analytics.

Athletic trainers are front-line medical workers, working with athletes. Often athletic trainers work and operate in the “training room” which is a healthcare facility with highly specialized medical technology in the athletic facilities. The goal of an athletic trainer is to keep their athletes healthy and able to participate in sporting competitions. Keeping athletes healthy and able to perform at their best is critical to the success of elite-level teams, and athletic trainers are valued as a key part of that function. Overall health also includes recovering from a player getting sick, not just physical injury.

When an athlete gets hurt during a game or practice the athletic trainer is the first to rush out, assess, diagnose, and start treatment of the injury. This process is multifaceted because consideration needs to be made if the athlete can safely return to the current game, or if the athlete is out of competition for a longer timeline, and how to start treatment immediately. There can be a lot of pressure from the athlete and coach to clear a player for return to competition immediately, especially when the outcome of the game could depend on it.

Ultimately your role as an athletic trainer is to protect the long-term health of your athletes, even if that means a lost game or missed playoff opportunity.

Consider contact sports like rugby, American football, or ice hockey (the three sports with the highest incidence of concussions) and how important the role of an athletic trainer is to protect the athletes; short and long-term health. There is a danger of soft and hard (bone or teeth) tissue injury in all sports and physical activity, but head (brain) injuries are especially dangerous. Different sports and leagues will have variations of concussion protocol but there will be some common aspects of agreed-upon rules and procedures to follow a head impact which will include:

The NFL concussion test protocol consists of several steps designed to identify and evaluate players who may have suffered a concussion. The protocol is designed to be comprehensive and includes a range of tests and assessments to help determine whether a player is ready to return to play.

The protocol includes the following steps:

1. Baseline testing: Before the start of the season, all players undergo baseline testing, which includes cognitive and physical tests, to establish a player's normal functioning in various areas.
2. Sideline evaluation: If a player is suspected of having a concussion during a game or practice, they are immediately removed from play and evaluated on the sidelines by medical personnel. The evaluation includes a series of questions, physical tests, and a check of vital signs.
3. Concussion assessment: If a concussion is suspected, the player undergoes a more comprehensive concussion assessment, which includes a series of cognitive and physical tests. The test evaluates memory, concentration, balance, and coordination.

   Cognitive tests: These tests are designed to evaluate different aspects of brain function, such as memory, attention, and reaction time. Some of the most common cognitive tests used in the assessment of concussion include the SCAT5 (Sport Concussion Assessment Tool), ImPACT (Immediate Post- Concussion Assessment and Cognitive Testing), and King-Devick test.

   Balance and coordination tests: These tests are used to evaluate a player's ability to maintain balance and coordination, which can be affected by concussion. Some of the most common balance and coordination tests used in the assessment of concussion include the BESS (Balance Error Scoring System) and tandem gait test.

   Symptom evaluation: Symptoms such as headaches, dizziness, nausea, and sensitivity to light or noise are commonly associated with concussion. A medical professional will ask about the presence of these symptoms, and evaluate their severity and duration.

   Physical examination: An athletic trainer will evaluate a player's physical condition, including coordination, strength, reflexes, and vision, to identify any signs of concussion.

   Neurological examination: An athletic trainer may perform a neurological examination to assess a player's brain function, including reflexes, vision, and hearing.

4. Return-to-play protocol: Once a player is diagnosed with a concussion, they are subject to a return-to-play protocol before they can return to the field. This involves a gradual increase in physical activity and monitoring for symptoms. The protocol includes five stages, each of which must be completed before a player can progress to the next stage. The stages are:
   • Rest and recovery
   • Light aerobic exercise
   • Sport-specific exercise
   • Non-contact drills
   • Full-contact practice
5. Medical clearance: Before a player can return to the field, they must be cleared by the team's medical staff including athletic trainers. This includes a final assessment of the player's symptoms, cognitive and physical testing, and medical imaging if necessary.

You can view the NFL’s full protocol here

Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease associated with repeated physical head trauma. CTE is found in many athletes that participated in contact sports or fighting sports like boxing and military veterans. CTE was first known as “punch drunk syndrome” in boxers almost 100 years ago. In the last 20 years, awareness and research on CTE have increased. CTE usually onsets years after the athlete leaves play and starts slowly with symptoms including short-term memory loss, frequent mood swings, and more than normal confusion or disorientation. Symptoms can escalate to slurred speech, memory problems, and depression. CTE can increase the risk of developing Alzheimer’s, Parkinson’s, and suicide rates. A Hall of Fame NFL player Junior Seau committed suicide by shooting himself in the chest so his brain could be studied for CTE and hopefully advance the safety protocols and protective equipment for future athletes.

Critical Thinking

An infamous story about how competition and physical health can come to battle in sports was showcased in the 1985 NFL season. Hall of Fame player Ronnie Lott was a critical part of his team's defense, and near the end of the regular season, Ronnie injured his pinky and would require surgery, ending his playing time for the season. Rather than sit out for the rest of the season and risk his team missing playoffs, Ronnie had half of his pinky amputated. He was cleared to play for the following game. Unfortunately, his team still lost, and Ronnie has publicly stated that he regrets his choice.

How would you handle the pressure of an athlete, coach, or parent of an athlete insisting that they need to go back into the game to impress the college scout/win the game/make it to the playoffs when you have deemed it dangerous for their health to return to the competition?

Dealing with injuries inherently means an athletic trainer will be placed in a situation to be potentially exposed to another person's blood or bodily fluids, which can transmit disease. Following safety and blood exposure plans is critical for an athletic trainer's personal health. Using gloves, masks, and other personal protective equipment at all times when needed is important.

One of the reasons that personal trainers, athletic trainers, and physical therapists are commonly confused for being the same job is that each of these professionals will work one on one with a client/athlete to create a customized plan to reach their goals.

In athletic training, you will design a unique rehabilitation program for each athlete consisting of different recovery methods and rehabilitative training including:

Physical training using resistance bands, focused unilateral lifts, and agility exercises all targeted on the recovery of an athlete's injury.

These unique training combined with preventive measures during sporting practice or games including specialized warm-up procedures and athletic taping for support and limiting range of motion are crucial aspects of an athletic trainer's expertise to help their athletes recover and return to play as fast as safely possible.

If you end up specializing in athletic taping you will be required to learn and practice many different taping procedures, here is a video on an ankle being taped.

Critical Thinking

What do you do when you have sore muscles? Why?

Let's take a deeper look into some of these recovery methods.

Ice has been used for centuries to help reduce inflammation (swelling) and pain of soft tissue injuries. Ice has also been a common treatment for post-exercise recovery to reduce muscular soreness. Typically, ice is either applied locally in a bag and secured to the body with plastic for 10-20 minutes. Keeping ice directly on the skin for prolonged times can cause tissue damage or frostbite. Ice baths have also been popular in recent years with a large tub of cold water and ice used to submerge a person's entire body. Recent research calls into question the effectiveness of cold therapy, so time will tell if ice remains in the athletic training tool kit.

Heat is generally used to loosen up tight or injured muscles and accelerate the “warm up” process prior to all-out competition. Heat can also increase blood flow to an area, increasing healing. Ice has shown better results at reducing swelling due to injury if used immediately compared to heat treatment which may be better for older injuries.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive therapy that uses electrical impulses to alleviate pain. It involves applying electrodes to the skin over the area of pain or along the path of the affected nerves, which are then connected to a small, battery-operated device. The device delivers low-voltage electrical currents that stimulate the nerves and muscles in the affected area.

The exact mechanism of how TENS works is not completely understood, but it is believed to work by stimulating the production of endorphins, which are the body's natural painkillers. TENS may also work by blocking pain signals from reaching the brain or by stimulating the release of other neurotransmitters that can help reduce pain.

TENS is commonly used to treat various types of pain, including back pain, neck pain, joint pain, muscle pain, and nerve pain. It is often used as a complementary therapy in combination with other pain management techniques, such as physical therapy, medications, and relaxation techniques.

TENS is generally considered safe when used as directed by a healthcare professional, although it may not be suitable for everyone, such as individuals with pacemakers or certain other medical conditions. Side effects are usually mild and may include skin irritation, muscle twitching, or headache.

Myofascial release is a manual therapy technique that is used to treat muscle pain, stiffness, and dysfunction. It involves applying sustained pressure to specific areas of the body to release tension in the fascia, which is the connective tissue that surrounds and supports muscles, bones, and organs.

The goal of myofascial release is to restore mobility and function to the affected area by reducing the restrictions and adhesions in the fascia. This is achieved by applying gentle, sustained pressure to the affected area for a period, typically several minutes.

Myofascial release can be performed using a variety of techniques, including manual pressure, stretching, and massage. Objects like foam rollers or lacrosse balls are also commonly used to apply targeted physical pressure.

Other muscle recovery techniques like scraping, acupuncture, and cupping have shown poor to mixed results and are not widely practiced.

While likely a requirement for all careers in kinesiology, staying up to date on a CPR/First Aid/AED certification is crucial for the emergency response care provided by an athletic trainer.

AED is an acronym for Automated External Defibrillator, and this is a tool that can deliver an external electric shock to an individual with an irregular heartbeat or a stopped heart. All modern AEDs have audio directions to assist with use during an emergency.

The American Red Cross classes can be booked here. First Aid covers the treatment of physical trauma to the body including cuts, burns, and electric shock.

Taking a CPR class is critical for your full understanding and ability to act quickly in an emergency but a basic overview of what you would learn in a certification class is included.

CPR is an acronym for Cardiopulmonary Resuscitation and combines chest compressions and rescue breathing. CPR would be administered on someone that is not breathing normally (or at all) or whose heart has stopped.

Figure 1. Proper Hand Placement for CPR. "CPR" by Anna Chruscik is licensed under CC BY-SA 4.0

Personal Protective Equipment (PPE) is important for athletic trainers because it helps to minimize their risk of injury and exposure to potentially harmful substances while performing their job duties. Athletic trainers’ job requires them to be in close proximity to their clients, which increases their risk of injury and exposure to infectious agents.

Some of the common PPE used by athletic trainers include gloves, face masks, eye protection, gowns, and shoe covers. These protective items can help to prevent the spread of infectious diseases such as COVID-19, hepatitis and other viruses.

Athletic trainers are responsible for the health and wellbeing of their clients, and their own health is equally important. By using appropriate PPE, they can protect themselves and their clients from potential harm and ensure that they can continue to provide the highest level of care possible.

Blood transfusions were considered risky procedures until Karl Landsteiner, an Austrian biologist, and physician, discovered the major human blood groups in 1900. Antigens are organic substances that the body does not recognize as part of its own tissue and trigger an immune response. Antigens can be large proteins or other organic molecules such as carbohydrates, lipids, and nucleic acids. When incompatible blood is infused, erythrocytes with foreign antigens appear in the bloodstream and trigger an immune response. Antibodies, or immunoglobulins, produced by certain B lymphocytes called plasma cells attach to the antigens on the plasma membranes of the infused erythrocytes. IgM antibodies, which are large, can cause direct destruction of incompatible red blood cells by activating a group of plasma proteins called complement. This type of RBC destruction is called intravascular hemolysis and results in an acute hemolytic transfusion reaction that can be fatal with as little as 10 mL of incompatible red blood cells.

The ABO blood group name is made up of three letters, but the ABO blood typing system is concerned with only two antigens - A and B. These antigens are carbohydrate-based, and their presence or absence on the surface of red blood cells is determined by genetics. Blood type A is designated for people whose erythrocytes have only A antigens on their surfaces, while blood type B is for those with only B antigens. Blood type AB is for people who have both A and B antigens on their erythrocytes, while blood type O is for those who have neither A nor B antigens.

The Rh blood group is categorized based on the presence or absence of a second erythrocyte antigen known as Rh, which was first discovered in rhesus macaque, a type of primate that is used in research because of its similarity to humans. Although many Rh antigens have been identified, the D antigen is the most clinically significant.

Individuals who have the Rh D antigen on their erythrocytes, which accounts for about 85 percent of Americans, are classified as Rh positive (Rh+), while those who lack it are Rh negative (Rh-). It's important to note that the Rh group is distinct from the ABO group, which means that individuals may or may not have Rh antigen on their RBCs, regardless of their ABO blood type. When determining a patient's blood type, the Rh group is indicated by adding positive or negative to the ABO type. For example, A positive (A+) refers to ABO group A blood with the Rh(D) antigen present, while AB negative (AB-) refers to ABO group AB blood without the Rh(D) antigen.

To avoid transfusion reactions, it is best to transfuse only matching blood types; that is, a type B+ recipient should ideally receive blood only from a type B+ donor.

A person with O-negative blood can donate to all other blood types safely and a person with AB-positive blood can receive blood from all other blood types.

While blood transfusions are out of the realm of an athletic trainer it is important to remember how unique and different each person is. A treatment or technique that was successful with one person may not be successful with everyone else.

Figure 2. A chart of different possible blood types. "Blood Types" by Anna Chruscik is licensed under CC BY-SA 4.0

A career in athletic training will require a Masters degree in kinesiology or athletic training and an accumulation of clinical hours as well as passing a board certification exam.

In Chapter 12 we will cover physical therapy, like athletic training but not the same.