Chapter 1: The Sports
Medicine Team
Sports Medicine
• Where Have We Been?
• Where Are We Now?
• Where Are We Going?
Where Have We Been?
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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 (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
settings.
• 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.
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
year in injury
prevention/management
May have additional
certifications/degrees in the
field of sports
medicine/athletic training
Certified by the NATABOC
(exam)
(National Athletic Training
Association Board of
Certification)
Licensed in the State for which
they work
Human
Performance
Injury
Management
Exercise Physiology
Practice of Medicine
Biomechanics
Sports Physical Therapy
Sport Psychology
Athletic Training
Sports Nutrition
Sports Massage
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.
The Players on the Sports
Medicine Team
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Physicians
Dentist
Podiatrist
Nurse
Physicians Assistant
Physical Therapist
Athletic Trainer
Adult First Responders
Massage Therapist
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Exercise Physiologist
Biomechanist
Nutritionist
Sport Psychologist
Coaches
Strength & Conditioning
Specialist
• Social Worker
The Primary Players on the
Sports Medicine Team
American College of Sports
Medicine (ACSM)
• Patterned after FIMS (Umbrella
Organization)
• Interested in the study of all aspects of
sports
• Membership = individuals in the medical
field, and those interested in sports
medicine
• 18,000 members
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
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
AMA Recognition of Athletic Training
• June 1991- 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)
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
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
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
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
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 PostCertification Graduate Education
Committee
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
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
PM
• Industrial and Corporate Settings
– ATC’s oversee fitness, injury rehabilitation,
and work-hardening programs
– Understanding of workplace ergonomics is
essential
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
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
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
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
List of Regulated States
L: Licensure C: Certification R: Registration
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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
trainer
• 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
rehabilitation
• 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
publication
• Continue reorganize and refine
educational programs for student athletic
trainers
• 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