Last week, Musi Nde discussed ways to improve interdisciplinary communication between respiratory therapists and physical therapists.
This week, two of my colleagues and former classmates, Sarah Parker and Keller Galpin, will discuss athletic training.
Sarah Parker, DPT, ATC, LAT, CSCS
Sports Resident, Duke University 2016
Keller Galpin, DPT, ATC, LAT, CSCS
What is the educational background, licensure/certification, test to become an athletic trainer? What is the difference between ATC and LAT?
Sarah: An athletic trainer is an individual who has completed at least a bachelor’s degree in athletic training. The National Athletic Trainers’ Association (NATA) has recently made the decision that all undergraduate athletic training programs would move to an entry level masters degree. The educational background incorporates all of the domains of athletic training in a classroom and clinical method. In order to become a certified athletic trainer (ATC), the individual must pass the national board of certification exam at the end of their program. Licensure is done on a state by state basis, where there is a wide difference in standards of licensing and upkeep of the credential. Many states require the athletic trainer to place LAT after their name (North Carolina), while others do not have such standards in place (Georgia). An athletic trainer is required to complete 50 CEU credits every two years to maintain certification, which 10 of the 50 being in the evidence based practice category. Athletic trainers must also have a continuous CPR/AED certification.
Keller: Athletic training education is currently in a transition to a master’s program. It originally could be done as either a 2 or 3 year program within your undergraduate degree depending on the school. An athletic trainer goes through undergraduate classes to satisfy both core classes as well as the athletic training major. The student must also complete a minimum of 20 hours a week in the clinical setting (sport or PT clinic) but most students wind up getting closer to 40+ hours a week outside of class. The athletic trainer must sit for a national board exam in order to become an ATC. An LAT is an ATC who is licensed to practice through their state of choice/residence.
What kind of setting did you or do you work in? Are there other settings athletic trainers commonly work in?
Sarah: I will be working as a resident sports physical therapist for Duke University as my first job out of PT school. This particular residency program allows me to incorporate both my education as an athletic trainer and a physical therapist. I will be providing physical therapy services in a clinic as well as providing medical coverage for games and practices. This is a very common area of practice for athletic trainers (high school, college, etc). I have several friends who are working with a myriad of diverse populations, including: the Atlanta Ballet, Cirque du Solei, and Delta Airlines. Many athletic trainers work in clinics as physician extenders and are involved heavily in family and community education. There are so many different places an athletic trainer can work! The sky is truly the limit.
Keller: I worked in a variety to settings ranging from Friday night high school football games, college football, various youth sports tournaments, and various youth sports camps. There are many settings ATC’s can be employed in such as PT clinics, sports performance centers, health and wellness centers, schools (teaching), and of course a variety of sports teams.
What does/did your typical day look like? What are some of your job duties?
Sarah: A typical day for me includes treating 5 patients in the morning, followed by a didactic course taught by some of the physical therapy staff. I then will either attend a grand rounds meeting or a lab session. Mid-afternoon, I head over to my high school where I am assigned for the fall semester. I provide rehab in their training room and coverage for practices and games. My job includes both of my favorite things about athletic training and physical therapy: rehabilitation and acute medical care.
Keller: It really depends on the setting and the season of the sport. At an in season collegiate D1 football setting, an AT will arrive at the training facility around 5:30am, if a team lifts at 6:00am, and perform any treatment that needs to be done to prepare players for their lifts. Once lifts are over, the ATC is there for post lift treatment and rehab. The majority of programs run their lifts in 3-5 lifting groups that are broken up in the morning and maybe one group going in the afternoon so the ATC must be there before and after each lift for medical and safety purposes. Then after lunch meetings begin and players come in for both long term and short term rehabs. Then around 4 practice begins and the ATC will then be present at practice making sure players are safe, healthy, hydrated, and any guys with injuries are limited/protected accordingly.
What kind of interaction do you have with physical therapists?
Sarah: I think my job is going to be quite different from most physical therapists in that I will be interacting with an athletic trainer and physical therapists every day. Most PT’s do not get to interact with athletic trainers and when they do, it is primarily in the clinical setting as opposed to on-field coverage.
Keller: It depends again on the setting. Most ATC work closely with a PT. Generally in the sports medicine world, a PT is handling the long-term rehabs and is there for guidance if needed for the ATC’s while they handle maintenance rehab.
In what ways could PT’s help to make your job easier? Or how could PT’s and athletic trainers work together more effectively to improve patient care?
Sarah: TEAMWORK. TEAMWORK. TEAMWORK. The turf wars that these two bring against each other kills me! I feel these stem from pride and a general lack of knowledge of what an athletic trainer is skilled in and what a physical therapist is skilled in. Athletic trainers DO have knowledge of rehab principles. However, the physical therapist is the movement expert. But physical therapists have a very limited background in return to play decisions and sport specific exercises. This is where putting two heads together can shine!! Use one another. Learn from one another. Don’t continue to balk at one because you think his or her education is less than yours. Physical therapists also need to be aware of their lack of knowledge regarding acute medical care. A PT is a valuable asset in assessment and examination once the athlete is on the sideline and out of danger. However, during a medical emergency on the field, the athletic trainer is the professional more skilled to handle the situation. These two professions are both so valuable and have so much to teach each other.
The patient should always come first and that’s that. Put pride aside and allow what’s best for the patient to happen.
This goes for all healthcare involved in sports medicine! Physician assistants, nutritionists, strength and conditioning specialists – all are necessary components and turf wars are getting us nowhere when our patient’s health and well-being are on the line.
Keller: I think PT’s could jump in and take down time as an opportunity to help educate ATC’s on the reason behind certain interventions and the “why’s” behind certain orthopedic injuries. The majority of the time the ATC knows what to do for specific orthopedic issues, but doesn’t know why. They may know what the injury is, but they may not always know why it occurred if it isn’t an acute injury. I believe a skilled, biomechanically inclined, sports medicine PT could step in and help educate an ATC in this area.
Was there ever a time where a PT did something to tick you off or interfere with your treatment session?
Sarah: Personally, no. However, I have friends who have had terrible horror stories of having their knowledge questioned in front of patients or being treated like a PT aide in the clinic. Most of these experiences, again, stem from general lack of understanding of the scope of practice for athletic trainers. The biggest firecracker in my gunpowder room right now is a post I recently saw on the DPT student facebook page. One individual was curious about going back to school to receive his ATC after completing his DPT. Several of the commenters clearly had NO idea what an athletic trainer is skilled to do or an SCS physical therapist for that matter. As a recent graduate DPT, an athletic trainer, and an SCS in training, I am appalled at the lack of information out there for these three professions and the blatant lack of respect for one another’s knowledge base. It makes me even more excited that Clay is making this blog post so that hopefully people can be more attuned to what their co-worker knows and has training to do!!
Keller: No, not that I’m aware of. The majority of time that I’ve been an ATC, I’ve been becoming a PT so I’m biased I guess.
Any particular story about athletic trainer and PT interaction that helped improve patient/athlete care?
Sarah: On a physical therapy rotation at the University of Georgia, I had heavy interaction with athletic trainers. Each day, we were all able to sit down and discuss progress and come up with ideas for how to advance the patient. It was fantastic to be able to put our heads together to come up with good rehab plans for these patients.
Keller: I can’t give a specific story because it would take forever to type it all out and no one wants to read all that. But there have been athletes with very difficult to diagnose, chronic orthopedic issues and the PT was able to use his ability to decipher through differential diagnoses to get to root of the issue and treat was caused it in the first place, which is most important.
Finally, if there was some sort of information that you wish the general public and PT’s knew more about in terms of athletic training that you would like to share?
Sarah: I think it’s worth sharing the domains of athletic training: injury prevention, clinical evaluation and diagnosis, immediate care, treatment, rehabilitation and reconditioning, organization and administration, and professional responsibility.
An athletic trainer is skilled in handling acute injuries and making decisions on return to play or activating emergency response. Athletic trainers are skilled in primary care of injuries- not just sports injuries! Athletic trainers have knowledge of rehab that allows them to treat not only sport injuries, but also your workplace injury or your brand new hip replacement.
Keller: ATC’s education ranges from first aid and injury prevention to sports performance and emergency medicine. ATC’s are much like the PA’s of the sports medicine world. We know a little bit about everything, but not a lot about one thing. This means ATC’s have a lot of potential within sports medicine but it needs to be tapped into by those who have more knowledge in specific areas. This means that it’s up to the Ortho docs, the PT’s, the PA’s, the surgeons, the EMT’s and any other healthcare providers who works closely with an ATC to tap into that potential and help make the ATC the most well rounded they can be. Trust me, we are way more than just a water boy and it’s time the nation starts to realize it!
Any other thoughts or advice?
Keller: ATC’s work their butts off for very little compensation or thanks. If you work closely with, or are, an athlete who has a ATC’s that works on you regularly and cares for you, go out of your way to show your appreciation. Getting up at 4:30am and going home at 10:00pm can really take its toll.
I’m very thankful that Sarah and Keller took time out of their days to write this up. Hopefully this post can play a small part in educating other clinicians about the roles of an athletic trainer and how to improve interdisciplinary communication to enhance patient care.