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Use of athletic trainers on the rise in high schools

Aided by athletic trainers, high schools are stepping up to limit sports concussions

LAS VEGAS — Chatting with a co-passenger on her flight here, Diana Miller mentioned she was a high school athletic trainer. Professional experience prepared her for the response.

“Gym teacher?” said the guy in the window seat.

Miller, who is responsible for about 700 student athletes every year at Robert E. Lee High School in Springfield, Va., took it in stride. She also gets mistaken for a personal fitness trainer and a physical therapist.

Her associate, Justin Blankenbecler, says, “We get, ‘Oh, you work in the weight room.’ … If I didn’t know anything about it, and I heard ‘athletic trainer,’ I would think somebody that trains an athlete. And it’s not really what we’re doing.”

In all but two states, California and Alaska, athletic trainers are licensed as health care professionals.

Their actual jobs are injury prevention, treatment and rehabilitation in sports — all prime topics this week at the annual meeting of the National Athletic Trainers’ Association (NATA). It’s a health care profession in which they can go in a blink from dealing with nicks and bruises to responding to concussions, blown out knees and heat stroke.

NATA will release preliminary survey data today showing improvement in the percentage of U.S. high schools serviced by athletic trainers. In past years, the group estimated that only about 40% of high schools had “access” to full-time or part-time athletic trainers.

Amid a continuing campaign to expand that, NATA also will present a report on preventing sudden death in high school athletes. Leading causes include head and neck injuries, heat stroke, cardiac arrest and complications from exertion for athletes who have the sickle cell blood trait. The Youth Sports Safety Alliance has released a list of 40 fatalities in high school and youth sports in 2012, most heart-related.

Athletic trainers are certified by an independent board, which requires at least a four-year degree in athletic training and passing of a proficiency test. There are more than 43,000 certified athletic trainers nationally, according to the board. About 31,000 are NATA members, and about 10,000 of them are here this week.

Decades ago, athletic trainers battled a stereotype as being ankle tapers and keepers of the water coolers. Amid raised awareness about concussions and other health concerns, they have been thrust into more specialized duties in front lines of sports medicine.

They assess concussions on the field and later administer neurocognitive tests to assist in return-to-play decisions. They assist in specialized rehab following surgeries of all sorts. They preach awareness of heat-related illness and more recently evolving issues such as staph infections.

“It’s just been drastic changes over the years,” says NATA president Jim Thornton, in his 24th year as head athletic trainer at Clarion (Pa.) University.

“We are involved in every aspect of sports medicine … everything from kinesiology and biomechanics (science of human movement) to exercise physiology, injury prevention, rehabilitation, reconditioning, post-surgical rehabilitation. … The whole nine yards.”

By any name not the same

Beyond sports at all levels, athletic trainers work in industry, sports medicine clinics, with the military and in roles with performance groups such as the Rockettes and Cirque due Soleil. At Clarion, Thornton has a student doing an internship with NASA. “She’s in Cape Canaveral right now,” he says.

Just don’t refer to them simply as “trainers.” If somebody in the media does that, they’ll hear from a NATA representative. They don’t want to be confused with some of the “trainers” implicated in cases such as the baseball drug investigations.

“Terminology and nomenclature are very important to us because there are all kinds of trainers out there today. … The ‘athletic trainer’ is actually a term used in state and federal law to describe our profession,” Thornton says. “Those other professions are not regulated.”

But the name has been the topic of internal debate.

“Some of our members get frustrated because they feel like ‘athletic trainer’ isn’t a very good description of what we do. To tell you the truth, our scope is so wide and so broad … there isn’t a name out there really that does a very good job of it at all,” says Thornton.

“We’ve had investigations of our nomenclature and name. … We investigated and weighed in on 50 or 60 different names. Everything from ’emergency medical staff’ to ‘athletic therapist.’ … Nothing is significantly better than athletic trainer.”

In Fairfax County (Va.) Public Schools, for example, all 25 high schools have a fulltime athletic trainer and an associate who also teaches. At Robert E. Lee, Miller is fulltime; Blankenbecler is the associate and a biology teacher.

Miller, 34, has an undergraduate degree in athletic training and a master’s in athletic administration. Blankenbecler has an undergraduate degree in athletic training and a master’s in education.

Coaches ‘more supportive’ of trainers’ input

Thornton says an athletic trainer can be put to the test at any moment, such as with incidents of “sickling” triggered by exertion in athletes with the sickle cell blood trait.

“The symptoms for sickling and for heat illness are similar, and knowing the difference between the two is critical because the treatments for the two are completely different,” says Thornton.

“If you take a kid that’s got the sickling and just put them in an ice bath to cool him down, you’re wasting valuable time that should be used getting him to a hospital to get that taken care of. … Knowing the difference between the two, knowing the fact that the kid has a history and tested positive for sickling trait, that’s significant information.”‘

Blankenbecler says that in Fairfax County athletes are asked during the pre-participation physicals whether they have the trait or a family history of it. “Our best bet is to get as accurate a history as possible,” he says, noting that can lead to a reduced work load and extra rest periods for such athletes on hot days.

There are, however, limits to what athletic trainers can do.

“No injections, no stitches, no medications,” says Miller. “And we can’t order X-rays and MRIs and those kind of things.”

But both make decisions on whether an athlete is concussed and should be removed from play. Miller says coaches have become more supportive of those decisions in recent years, compared to some in the past who were “skeptical” when she removed an athlete from competition.

Blankenbecler says all Lee athletes are given baseline computerized tests of brain function. After a concussion, one gauge of when players can return is whether they can score normally on the baseline test. “If they’re showing any symptoms, we hold them out,” says Blankenbecler.

Miller, in her eighth year at Lee, says, “Our ability to prevent injuries is something that has grown since I’ve been in Fairfax County. It’s pushing prevention and education on certain things and rehabilitation — instead of solely taping.”

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