Almost all athletic trainers work long hours during their seasons and sacrifice many things. Some games and practices occur very early in the morning or late at night. Football games almost always occur on Friday nights or on weekends. Availability before practice and games is also needed for evaluations and treatments. I always value their input on certain situations in regards to an athlete’s goals, demeanor or reactions in certain situations. ATs spend much more time with student athletes than the team or personal physicians and tend to know most on a more personal level. This brings up the next important role for athletic trainers, which is providing first line recognition of mental health issues or disorders. Regardless of the setting – secondary, collegiate, professional, military, or clinical – every athlete or patient is at risk to experience stressors that could lead to emotional disturbances. In a study funded by the National Institute of Mental Health, the prevalence of a broad range of mental disorders in a nationally representative sample of US adolescents (aged 13-18) was examined. One in 10 children had a serious emotional disturbance that interfered with daily activities. In addition, few affected youths received adequate mental health care. Mood disorders affected 14.3% of teens, including twice as many girls as boys. The prevalence of these disorders increased with age: a nearly 2-fold increase between age 13 to 14 years and age 17 to 18 years. One in 3 adolescents (31.9%) met the criteria for an anxiety disorder, ranging from 2.2% for generalized anxiety disorder to 19.3% for a specific phobia (4). Some teams may incorporate mental health assessments or questions into the pre-participation exams to identify at-risk athletes. There may be referrals made before the season or close monitoring may occur. It is the ATs job to speak with team physicians and mental health care providers to help the athlete improve or prevent worsening or relapse (5). Permission may be needed from a parent or guardian, which may or may not know how their child is feeling. Emergency situations with either homicidal or suicidal ideation may also occur and the AT may be the first person a student athlete shares this information with due to their relationship.

Another role that affects sports medicine physicians and student athletes directly is the AT’s role in rehabilitation. Injured athletes often report to ATs with a wide range of injuries, including concussion return to play to ACL reconstruction rehabilitation. This often occurs on a near daily basis on many occasions. Many musculoskeletal injuries undergo treatment either before, during of after practices and a wide range of recovery modalities may be performed. Many orthopedic surgeons and physical therapists will use ATs for a final graded return to play following injuries or surgeries, such as ACL reconstruction, elbow UCL reconstruction, labrum repairs, among many others. ATs also play a vital role in return to play for sport related concussions. They are most likely the medical professional that facilitates and observes the return to play process for sport related concussions. I personally use our ATs to facilitate initial and post-exertion neuropsychological testing, which helps office flow and eases the burden on other office staff. Many universities and health systems use ATs in the clinical setting to assist in rooming patients, administer testing, or cast or splint injuries. This is another emerging role for ATs that can ease the burden on health systems.

Prior reports estimate that roughly half of sports injuries are preventable and other reports estimate around half are also due to overuse (6,7). This is yet another important role for ATs that directly affects other sports medicine professionals. This is done in multiple ways including prophylactic bracing and taping, balance-training exercise programs, neuromuscular conditioning, and data-driven rule and policy changes. The NATA (National Athletic Trainers’ Association) recently published an ACL prevention statement, which recommends that a multicomponent injury-prevention training program include, at minimum, feedback on proper exercise technique for at least 3 of the following exercise types: strength, plyometrics, agility, balance, and flexibility (8). This may be implemented in many ways but including these in the warm up or cool down for practices or games is often done and ATs are critical in implementing these injury prevention programs. Other general lower extremity programs, such as FIFA 11, fall under similar circumstances. Some systems may implement newer techniques for attempts at concussion prevention such as vision training, vestibular training or neck strengthening, although no program or equipment has been shown to prevent sport related concussion (9).

I have had a great personal experience through my own training and practice working as a team with ATs. I have worked with professional, college and high school ATs and have witnessed their diversity and importance to both teams and providers. I always value their opinion on their athletes in training room and during games due to the fact that they spend much more time with their respective teams. At the University of Kentucky, ATs are used to help room patients and are assigned one or multiple teams, depending on the sport. Their AT program also requires participation in research. In my current setting with many high schools and two small colleges, we have implemented injury prevention and screening programs. ATs also fuel the walk in clinics in most areas and universities. In summary, ATs serve an extremely important role of almost all sports medicine practices and are the first line of both offense (prevention) and defense (treatment).

References

1. National Athletic Trainers’ Association. (1989). Injury toll in prep sports estimated at 1.3 million. Journal Athletic Training, 24, 360-393.

2. Comstock, R. D., PhD, Currie, D. W., MPH, & Pierpoint, L. A., MS. (n.d.). National High School Sports-Related Injury Surveillance Study 2014-2015 School Year [Scholarly project]. In UC Denver. Retrieved March 8, 2016, from http://www.ucdenver.edu/academics/colleges/PublicHealth/research/ResearchProjects/piper/projects/RIO/Documents/Original Report_ 2014_15.pdf

3. “A Safer Approach to Sport.” https://www.atyourownrisk.org/reduce-your-risk/. National Athletic Trainers’ Association. 2019.

4. Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–989.

5. Gourlay, L., & Barnum, M. (2011). Recognizing psychological disorders, part 2: Referral and management. International Journal of Athletic Therapy & Training, 13-18.

6. Preserving the Future of Sport: From Prevention to Treatment of Youth Overuse Sports Injuries. AOSSM 2009 Annual Meeting Pre-Conference Program. Keystone, Colorado.

7, JS Powell, KD Barber Foss, 1999. Injury patterns in selected high school sports: a review of the 1995-1997 seasons. J Athl Train. 34: 277-84

8. Padua DA, DiStefano LJ, Hewett TE, Garrett WE, Marshall SW, Golden GM, et al. National athletic trainers’ association position statement: prevention of anterior cruciate ligament injury. J Athl Train. 2018;53:5–19.

9. Schneider DK, Grandhi RK, Bansal P, et al. Current state of concussion prevention strategies: a systematic review and meta-analysis of prospective, controlled studies. Br J Sports Med 2016.