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Title: Arnheim

Arnheims Principles of Athletic Training 12th
  • William E. Prentice Daniel D. Arnheim

Arnheims Principles of Athletic Training 12th
EditionPowerPoint Presentations
  • Jason Scibek ATC
  • University of Michigan

Chapter 1 The Athletic Trainer and the Sports
Medicine Team
Sports Medicine
  • Broad field of medical practices related to
    physical activity and sport
  • Involves a number of specialties involving active
  • Typically classified as relating to performance
    enhancement or injury care and management


Sports Medicine
Human Performance
Injury Management
Practice of Medicine
Exercise Physiology
Sports Physical Therapy
Sport Psychology
Athletic Training
Sports Nutrition
Sports Massage
Sports Medicine
  • Where have we been?
  • Where are we now?
  • Where are we going?

Sports Medicine Athletic Training
  • 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
  • Professional sports, hospitals, clinics,
    industrial settings, the military, equipment
    sales, physician extenders

  • With the evolution of the profession a number of
    milestones have been achieved
  • Recognition of ATCs 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

Growth of Professional Sports Medicine
  • International Federation of Sports Medicine
  • American Academy of Family Physicians (1947)
  • National Athletic Trainers Association (1950)
  • American College of Sports Medicine (1954)
  • American Orthopaedic Society for Sports Medicine
  • National Strength and Conditioning Association
  • American Academy of Pediatrics, Sports Committee
  • Sports Physical Therapy Section of APTA (1981)
  • NCAA Committee on Competitive Safeguards and
    Medical Aspects of Sports (1985)

International Federation of Sports Medicine
  • Federation Internationale de Medecine Sportive
  • Principal purpose to promote the study and
    development of sports medicine throughout the
  • Made up of national sports medicine associations
    of over 100 countries
  • Organization is multidisciplinary, including many
    disciplines that are concerned with physically
    active individuals

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
  • Many team physicians are members of this

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 30,000 members

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
  • 18,000 members

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

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
  • 14,500 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,
  • NSCA Certified Personal Trainer (NSCA-CPT)

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

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

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

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
  • Offer a variety of certifications (fitness and

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
  • Focus on athletic health and safety
  • All bodies have worked towards the reduction of
    injury and illness in sport

Sports Medicine Journals
  • A variety of publications exist, providing
    excellent resources to the sports medicine
  • 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
  • Numerous journals are available

The Athletic Trainer
  • Charged with injury prevention and health care
    provision for the athlete
  • Athletic trainer deals with the athlete and
    injury from its inception until the athlete
    returns to full competition

Roles and Responsibilities Performance Domains
  • Prevention of athletic injuries
  • Clinical evaluation and diagnosis
  • Immediate care of injuries
  • Treatment, rehabilitation and reconditioning of
    athletic injuries
  • Health care administration
  • Professional responsibilities

Education Council
  • In 1998 the Education Council was established to
    dictate the course of the educational preparation
    for the student athletic trainer
  • Focus has shifted to competency based education
    at the entry level
  • Education Council has significantly expanded and
    reorganized the clinical competencies and

Athletic Training Education Competencies
  • Twelve Content Areas
  • Risk management
  • Pathology of injuries and illnesses
  • Assessment and evaluation
  • Acute care
  • Pharmacological aspects of injury and illness
  • Therapeutic modalities

Athletic Training Education Competencies
  • Therapeutic exercise
  • General medical conditions and disabilities
  • Nutritional aspects of injury and illnesses
  • Psychosocial intervention and referral
  • Organization and administration
  • Professional responsibilities

Personal Qualities of the Athletic Trainer
  • Stamina and the ability to adapt
  • Empathy
  • Sense of humor
  • Communication
  • Intellectual curiosity
  • Ethical practice

Athletic Trainer and the Athlete
  • Major concern on the part of the ATC should be
    the athlete
  • All decisions impact the athlete
  • The injured athlete must always be informed
  • Be made aware of the how, when and why that
    dictates the course of injury rehabilitation

  • The athlete must be educated about injury
    prevention and management
  • Instructions should be provided regarding
    training and conditioning
  • Inform the athlete to listen to his/her body in
    order to prevent injuries

Athletic Trainer and Parents
  • ATC 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

  • ATC, physician and coaches must be aware and
    inform parents of Health Insurance Portability
    and Accountability Act (HIPAA)
  • Regulates dissemination of health information
  • Protects patients privacy and limits the people
    who could gain access to medical records

Responsibilities of 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 ATC must be able to work together
  • Have similar philosophical opinions regarding
    injury management
  • Helps to minimize discrepancies and

Roles and Responsibilities
  • Compiling medical histories and conducting
    physical exams
  • Pre-participation screening
  • Diagnosing injury
  • Deciding on disqualifications
  • Decisions regarding athletes ability to
    participate based on medical knowledge and
    psychophysiological demands of sport

  • Attending practice and games
  • Commitment to sports and athlete
  • Potentially serve as the academic program medical
  • Coordinates and guides medical aspects of program
  • Provides input into educational content and
    provides programmatic instruction

Responsibilities of 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 healthcare provider in
    their respective state
  • Directly responsible for injury prevention
  • Athlete must go through appropriate conditioning

  • Coach must be aware of risks associated with
  • Provide appropriate training and equipment
  • Must have knowledge of 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

Referring the Athlete to Other Personnel
  • ATC must be aware of available medical and
    non-medical personnel
  • Athlete may require special treatment outside of
    the traditional sports medicine team
  • Must be aware of community based services and
    various insurance plans
  • Typically the ATC and team physician will consult
    on the particular matter and refer accordingly

The Players on the Sports Medicine Team
  • Physicians
  • Dentist
  • Podiatrist
  • Nurse
  • Physicians Assistant
  • Physical Therapist
  • Athletic Trainer
  • Massage Therapist
  • Ophthalmologist
  • Dermatologist
  • Gynecologist
  • Exercise Physiologist
  • Biomechanist
  • Nutritionist
  • Sport Psychologist
  • Coaches
  • Strength Conditioning Specialist
  • Social Worker
  • Neurologist
  • Osteopath
  • Psychiatrist

Employment Settings for the Athletic Trainer
  • Employment opportunities are becoming
    increasingly diverse
  • Dramatic transformation since 1950
  • Due largely in part to the efforts of the NATA
  • Started out primarily in the collegiate setting,
    progressed to high schools and are now found
    primarily in hospital and clinic settings

  • Settings include
  • Secondary schools
  • Colleges and universities
  • Professional teams
  • Sports medicine clinics
  • Corporate/Industrial settings
  • Military
  • Physician extenders
  • Medical supply equipment sales
  • Research
  • Administration

Treating the Physically Active
  • Consists of athletic, recreational or competitive
  • Requires physical skills and utilizes strength,
    power, endurance, speed, flexibility, range of
    motion and agility

  • 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

  • The Aging Athlete
  • Physiological and performance capability changes
  • 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
  • beginning an exercise program

  • 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

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)

  • 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 now accredited by CAAHEP

  • In 2003, JRC-AT became an independent accrediting
  • JRC-AT would accredit athletic training education
    programs without involvement of CAAHEP
  • JRC-AT will seek affiliation with CHEA once it is
    fully independent
  • CHEA is a private nonprofit national organization
    that coordinates accreditation activity in the
    United States
  • Recognition by CHEA will put JRC-AT on the same
    level as other national accreditors, such as
  • CAAHEP accreditation will be discontinued in
    2006 JRC-AT will begin in 2007

  • Effects of CAAHEP 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

Accredited Athletic Training Education Programs
  • Entry-level athletic training education programs
  • Undergraduate and graduate
  • Advanced graduate athletic training education
  • Designed for individuals that are already
    certified ATCs

Specialty Certifications
  • NATA is in the process of developing specialty
  • Further enhance professional development
  • Aid in expanding scope of practice
  • Specialty certifications build on entry level

  • Seven proposed areas
  • Business practice, medical care management,
    occupational health, wellness, pediatric/adolescen
    t health, adult/geriatric health, special health
  • Candidates will have to complete experiential
    requirements and pass a standardized examination

Requirements for Certification as an Athletic
  • Must have extensive background in formal academic
    preparation and supervised practical experience
  • Guidelines are set by the National Athletic
    Trainers Association Board of Certification

  • Upon meeting the educational guidelines
    applicants are eligible to sit for the
  • Examination consist of the following
  • Written portion
  • Practical portion
  • Written simulation
  • Exam assesses the 6 domains
  • Prevention of injuries
  • Evaluation and diagnosis
  • Immediate care of injuries
  • Treatment, rehabilitation reconditioning
  • Organization and administration
  • Professional responsibility

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

Continuing Education Requirements
  • Ensure ongoing professional growth and
  • Requirements that must be met to remain certified
  • 80 CEUs over the course of three years

  • Purpose
  • To encourage ATC to obtain current professional
    development information
  • To explore new knowledge in specific areas
  • To master new athletic training related skill and
  • To expand approaches to effective athletic
  • To further develop professional judgement
  • To conduct professional practice in an ethical
    and appropriate manner

  • 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
  • Completing post-graduate work
  • Obtaining CPR and first aid certification

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

  • 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

  • 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

  • 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
  • Individual has paid a fee for being placed on an
    existing list of practitioners but says nothing
    about competency

  • 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

Physical Therapist and Athletic Trainers
  • 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

  • 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

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
  • JRC-AT will become an accrediting agency
  • Third party billing will gradually become the
    rule not the exception for ATCs
  • Standardization of state practice acts
  • ATCs will seek specialty certifications
  • Expanding breadth and scope of practice

  • Increase in secondary school employment of ATCs
  • Increase in recognition of ATC as a physician
  • Potential for expansion in the military,
    industry, and fitness/wellness settings
  • With general population aging increased
    opportunity to work with aging physically active
  • Continue to enhance visibility through research
    and scholarly publication

  • Continue to be available for local and community
    meetings to discuss healthcare of the athlete
  • Increase recognition and presence internationally
  • Most importantly, continue to focus efforts on
    injury prevention and to provided high quality
    healthcare to physically active individuals who
    are injured while participating in sport