Principles of Athletic

th
Training 14 Edition
William E. Prentice

2011 McGraw-Hill Higher Education. All rights reserved.

Principles of Athletic
Training 14th Edition
PowerPoint Presentations
Jason Scibek, PhD, ATC
Duquesne University
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Chapter 1: The Athletic

Trainer as a Health Care
Provider

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 Athletic trainers specialize in

preventing, recognizing, managing
and rehabilitating injuries
Function as a member of a health
care team which also incorporates
and involves a number of medical
specialties
Provide a critical link between the
medical community and physically
active individuals
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Historical Perspective
Early History
Evidence suggests that coaches,
physicians & therapists existed in
Greek and Roman civilizations
Assisted athletes in reaching top
performance

Athletic trainers came into existence

in the late 19th century in
intercollegiate & interscholastic sports
Early treatments involved rubs,
counter-irritants, home remedies and
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Evolution of Contemporary
Athletic Trainer
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 and with
a variety of patient populations
Professional sports, hospitals, clinics,
industrial settings, the military,
equipment sales, physician extenders

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 Rapid evolution of the profession

following WW I
Athletic trainers became specialists in
preventing and managing injuries
Dr. S.E. Bilik wrote, The Trainers Bible
(1917)
The Cramer brothers developed a line of
liniments to treat ankle sprains (1920s)
and followed the publication The First
Aider (1932)
In the 1930s the NATA started to come
into existence but then disappeared
during WW II
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 With the evolution of the

profession a number of milestones
have been achieved
Recognition of Acts 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 education
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Changing Face of Athletic

Training Profession
Role of the athletic trainer is more in
line, today, as a health care provider
40% of athletic trainers are employed
in clinics, hospitals, industrial and
occupational settings
Also involved in NASCAR, performing
arts, military, NASA, medical
equipment & sales, law enforcement,
and the US government
Has resulted in changes in athletic
training education

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 Athletic trainers do not just provide

medical care to athletes or those
just injured during physical activity
Becoming more aligned as a
clinical health care profession
Requires terminology changes
Patients and clients vs. athletes
Athletic clinic or facility vs. athletic
training room
Athletic trainers NOT TRAINERS!!

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Sports Medicine and

Athletic Training
Broad field of medical practices
related to physical activity and
sport
Involves a number of specialties
involving active populations
Typically classified as relating to
performance enhancement or
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Human
Performance

Injury
Management

Exercise Physiology

Practice of Medicine

Biomechanics
Sport Psychology

Athletic Training
Sports Physical Therapy

Strength Conditioning

Sports Massage

Personal Fitness
Trainers

Sports Podiatry/
Orthotists
Sports Dentistry
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Growth of Professional Sports

Medicine Organizations

International Federation of Sports Medicine (1928)

American Academy of Family Physicians (1947)
National Athletic Trainers Association (1950)
American College of Sports Medicine (1954)
American Orthopaedic Society for Sports Medicine
(1972)
National Strength and Conditioning Association
(1978)
American Academy of Pediatrics, Sports Committee
(1979)
Sports Physical Therapy Section of APTA (1981)
NCAA Committee on Competitive Safeguards and
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International Federation of
Sports Medicine
Federation Internationale de Medecine
Sportive (FIMS)
Principal purpose to promote the study
and development of sports medicine
throughout the world
Made up of national sports medicine
associations of over 100 countries
Organization includes many disciplines
that are concerned with physically
active individuals
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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 members
Many team physicians are
members of this organization

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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 32,000 members
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Figure 1-1
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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
>20,000 members
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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
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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
30,000 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,
(CSCS)
NSCA Certified Personal Trainer
(NSCA-CPT)
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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
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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
publications
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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 drugtesting programs

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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
professionals
Offer a variety of certifications (fitness
and performance)

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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 emerged
Focus on athletic health and safety

All bodies have worked towards the

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Sports Medicine Journals

A variety of publications exist, providing
excellent resources to the sports medicine
community

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
Sports Health
Athletic Therapy Today
Training & Conditioning
Athletic Training & Sports Health Care
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Employment Settings for

the Athletic Trainer
Employment opportunities are
becoming increasingly diverse
Dramatic transformation since 1950
Due largely to the efforts of the NATA

Started out primarily in the

collegiate setting, progressed to
high schools and are now 30% are
found primarily in hospital and clinic
settings
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 Settings include:

Clinics and hospitals

Physician extenders
Industrial/Occupational settings
Corporate settings
Colleges or Universities
Secondary schools
School districts
Professional sports
Amateur/Recreational/Youth sports
Performing arts
Military & Law enforcement
Health & fitness clubs
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Figure 1-3

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Treating Physically Active

Populations
Consists of athletic, recreational or
competitive activities
Requires physical skills and utilizes
strength, power, endurance,
speed, flexibility, range of motion
and agility

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 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
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 The Aging Athlete

Physiological and performance
capability changes overtime
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 documented

Beginning an exercise program

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 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

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 Occupational Athlete
Occupational, industrial or worker
athlete are involved in strenuous,
demanding or repetitive physical
activity
May result in accidents and injury

Involves
Instruction on ergonomic techniques to
avoid injury associated with physical
demand of job responsibilities
Intervention when injuries arise
Correcting mechanics, faulty postures,
strength deficits, lack of flexibility

Injury prevention is still critical

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Roles & Responsibilities of

the Athletic Trainer
Charged with injury prevention and
health care provision for an injured
patient
Athletic trainer deals with the
patient and injury from its
inception until the athlete returns
to full competition
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Roles and Responsibilities:

Board of Certification
Domains

Prevention
Clinical evaluation and diagnosis
Immediate care
Treatment, rehabilitation and
reconditioning
Health care administration
Professional responsibilities

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 Prevention
Ensure safe environment
Conduct pre-participation physicals
Develop training and conditioning
programs
Select and fit protective equipment
properly
Explaining important diet and lifestyle
choices
Ensure appropriate medication use
while discouraging substance abuse
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 Clinical Evaluation & Diagnosis

Recognize nature and extent of injury
Involves both on and off-field
evaluation skills and techniques
Understand pathology of injuries and
illnesses
Referring to medical care
Referring to supportive services

Immediate Care
Administration of appropriate first aid
and emergency medical care (CPR,
AED)
Activation of emergency action plans
(EAP)
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 Treatment, Rehabilitation
Reconditioning
Design preventative training systems
Rehabilitation program design
Supervising rehabilitation programs
Incorporation of therapeutic
modalities and exercise
Offering psychosocial intervention

Organization & Administration

Record keeping
Ordering supplies and equipment
Establishing policies and procedures
Supervising personnel

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 Professional Responsibilities
Athletic trainer as educator
Athletic trainer and continuing
education
Athletic trainers as counselor
Athletic trainers as researcher
Incorporation of evidence medicine and
participating and acquisition of evidence
for efficacy of patient care

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Personal Qualities of the

Athletic Trainer
Stamina and the ability to adapt
Empathy
Sense of humor
Communication
Intellectual curiosity
Ethical practice
Professional memberships
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Athletic Trainer and

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

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

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Athletic Trainer and

Parents
Athletic trainers 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
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 The athletic trainer, 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
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The Athletic Trainer and

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 the athletic trainer

must be able to work together
Have similar philosophical opinions
regarding injury management
Helps to minimize discrepancies and
inconsistencies
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 The physician is responsible for

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
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 Potentially serve as the academic

program medical director
Coordinates and guides medical
aspects of program
Provides input into educational
content and provides programmatic
instruction

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The Athletic Trainer and

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 health care provider in their
respective state
Directly responsible for injury
prevention
Athlete must go through appropriate
conditioning program

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 Coach must be aware of risks

associated with sport
Provide appropriate training and
equipment
Should be certified in CPR and first
aid
Must have thorough knowledge of
skills, techniques and
environmental factors associated
with sport
Develop good working
relationships with staff, including
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Referring the Patient to

Other Personnel
The athletic trainer must be aware of
available medical and non-medical
personnel
Patient may require special treatment
outside of the traditional sports
medicine team

Must be aware of community based

services and various insurance plans
Typically the athletic trainer and team
physician will consult on the particular
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Support Health
Services & Personnel

Physicians
Dentist
Podiatrist
Nurse
Physicians Assistant
Physical Therapist
Occupational Therapist
Massage Therapist
Ophthalmologist
Dermatologist
Gynecologist

Exercise Physiologist
Biomechanist
Nutritionist
Sport Psychologist
Coaches
Strength & Conditioning
Specialist
Social Worker
Neurologist
Emergency Medical
Technician
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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)

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 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
were accredited by CAAHEP through
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 In 2003, JRC-AT became an

independent accrediting agency
JRC-AT would accredit athletic training
education programs without involvement
of CAAHEP
JRC-AT officially became the Committee for
Accreditation of Athletic Training Education
(CAATE) in 2006
CAATE was officially recognized by CHEA
in 2007
CHEA is a private nonprofit national organization
that coordinates accreditation activity in the United
States
Recognition by CHEA puts CAATE on the same level
as other national accreditors,
such as CAAHEP
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 Effects of CHEA 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 profession
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Accredited Athletic
Training Education
Programs

Entry-level athletic training

education programs

In 2009, 357 undergraduate

programs, 19 entry-level masters
programs

Advanced graduate athletic

training education programs
Designed for individuals that are
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Education Council
In 1997 the Education Council was
established to dictate the course of the
educational preparation for the athletic
training student
Focus has shifted to competency based
education at the entry level
Education Council has significantly
expanded and reorganized the clinical
competencies and proficiencies
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Athletic Training Education

Competencies
Twelve Content Areas
Risk management
Pathology of injuries and illnesses
Orthopedic clinical examination &
diagnosis
Acute care
Pharmacological aspects of injury and
illness
Therapeutic modalities
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Athletic Training Education

Competencies
Conditioning & rehabilitative exercise
General medical conditions and
disabilities
Nutritional aspects of injury and
illnesses
Psychosocial intervention and referral
Health care administration
Professional development &
responsibilities
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 Foundational Behaviors of
Professional Practice
People components of the
profession
Recognizing the primary focus of practice
should be the patient
Understanding that competent health
care requires a team approach
Being aware of legal elements of practice
Practicing ethically
Advancing the knowledge base in athletic
training
Appreciate cultural diversity
Being an advocate and model for the AT
profession
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Post-Professional Athletic
Training Education
Programs
15 programs are certified by the
NATA Graduate Education
Committee
Designed to enhance academic
and clinical preparation of already
certified athletic trainers
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Specialty Certifications
NATA is in the process of
developing specialty certifications
Further enhance professional
development
Aid in expanding scope of practice

Specialty certifications build on

entry level knowledge
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 Purpose
To provide the athletic trainer with
advanced clinical practice credential
that demonstrates attainment of
knowledge and skills that will
enhance patient care, enhance
health-related patient quality of life,
and optimize clinical outcomes in
specialized areas of athletic training
practice

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Requirements for
Certification as an Athletic
Trainer

Must have extensive background in

formal academic preparation and
supervised practical experience
Guidelines are set by the Board of
Certification (BOC)

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 Upon meeting the educational

guidelines applicants are eligible to
sit for the examination
Examination is computer based
Exam assesses the 6 domains

Prevention
Evaluation and diagnosis
Immediate care
Treatment, rehabilitation &
reconditioning
Organization and administration
Professional responsibility
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 Upon passing the certification

examination = BOC certified as an
athletic trainer
Credential of ATC

BOC certification is a prerequisite

for licensure in most states

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

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 Purpose:
To encourage athletic trainers to obtain
current professional development
information
To explore new knowledge in specific
areas
To master new athletic training related
skills and techniques
To expand approaches to effective
athletic training
To further develop professional judgment
To conduct professional practice in an
ethical and appropriate manner
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 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 textbook
Completing post-graduate work

All certified athletic trainers must

demonstrate proof of current
CPR/AED certification
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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
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 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 47 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

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 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

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

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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
Further recognition of CAATE by CHEA
will further enhance credibility
Athletic trainers must continue to
actively seek third party reimbursement
for athletic training services
Standardization of state practice acts
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 Athletic trainers will seek specialty

certifications
Expanding breadth and scope of practice

Increase in secondary school

employment of athletic trainers
Increase in recognition of athletic
trainers as physician extender
Potential for expansion in the military,
industry, and fitness/wellness settings
With general population aging =
increased opportunity to work with aging
physically active individuals
Continue to enhance visibility through
research and scholarly publication
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 Continue to be available for local and

community meetings to discuss
health care of the athlete
Increase recognition and presence
internationally
Most importantly, continue to focus
efforts on injury prevention and to
provide high quality health care to
physically active individuals
regardless of the setting in which the
injury occurs
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