What is an Athletic Trainer

While both are casually referred to as “trainers”, personal trainer and athletic trainers are two very different roles. Personal trainers generally work in gyms and health clubs, helping the general public improve their level of fitness; Athletic trainers are most often found at colleges, hospitals, clinics and with professional sporting or performance organizations, helping patients or athletes recuperate from injuries and safely continue to participate in sports and physically demanding professions. Below, we’ll dive into the two professions in greater detail:

Personal Trainers

Personal trainers evaluate a person’s fitness level and then design with an exercise program to improve the individual’s health, cardiovascular endurance and body composition. They teach clients how to perform exercises properly, while creating an atmosphere of accountability. Personal trainers with additional credentialing can also education clients on how to live a healthier lifestyle, coaching them on nutrition basics and recovery strategies.

While there is no governing body for personal training, it’s highly recommended to select a personal trainer who has completed a certification program; there are several institutions that offer certifications in personal training, including the American Council on Exercise (ACE) and the National Academy of Sports Medicine (NASM). However, some people may prefer to work with a coach who has learned personal experience in fitness such as a former athlete, rather than someone who has completed a certification program. In any arrangement, it is important to start smart-

1. Check with your doctor before beginning a new fitness program

2. Opt for simple movement patterns at low to moderate weights while you are still learning to limit your risk of injury

3. Stay hydrated and take rest breaks as needed

4. Stop exercising if you feel dizzy, lightheaded, nauseated, experience chest pain, or have an unexpectedly difficult time breathing

5. Don’t do anything you’re not comfortable with

Athletic Trainers

Athletic trainers are clinicians who provide injury preventative services, emergency care, clinical diagnosis of injuries, therapeutic intervention and rehabilitation of both injuries and medical conditions. Athletic training is recognized by the American Medical Association (AMA), Health Resources Services Administration (HRSA) and the Department of Health and Human Services (HHS) as an allied health care profession. As a part of the healthcare system, athletic trainers work under the direction of a physician, and work collaboratively with physical therapists, massage therapists, and chiropractors. As part of an athletic department, they partner with the coaching and strength and conditioning staff, as well as nutrition and sport psychology teams to promote the overall health of the athlete.

Athletic trainers undergo rigorous academic and clinical training, supervised by the Commission on Accreditation of Athletic Training Education (CAATE). The current minimum entry point into the profession of athletic training is at the master’s level. Upon completion of a CAATE-accredited athletic training education program, students become eligible for national certification by successfully completing the Board of Certification, Inc. (BOC) examination. Once certified, athletic trainers are required to complete several hours of continuing education every year in an effort to ensure all professions remain current on the latest recommendations within sports medicine.

Comprehensive Care

There’s not a lot of crossover between the two occupations. This isn’t to say the roles can’t go hand in hand. After working with an athletic trainer to rehabilitate a sprained ankle, for example, an athlete may choose to enlist the help of a personal trainer to return his strength and endurance to the levels they were before the injury.

Physical TheraPT is a multi-faceted clinic, centered on patient success. By placing the individual at the hub of the system, instead of siloing by speciality, we’re able to streamline a truly comprehensive recovery. Our athletes are able to seamlessly work with the professionals they need- physical therapists, athletic trainers, massage therapists, and strength coaches- all in one place. Our athletic trainer offers:

• Urgent Injury Assessment: Streamline your recovery by seeing an athletic trainer first. With extensive orthopedic education, athletic trainers are able to quickly determine the severity of an injury, determine next-steps and make referrals to local physicians, and provide you with home care instructions

• Rehab: Apply the same proven approaches used with elite athletes to your unique situation and goals. Our expertise includes post-operative rehab, as well as rehab for both chronic and acute injuries and conditions.

• Return-to-Play Training: We offer evidence-based programs, utilizing technology like force plates, dynamometer testing, blood flow restriction training (BFR), biofeedback and motion analysis to formulate your plan. Following a comprehensive evaluation, we can problem-solve with you to optimize your movement potential.

• Injury Prevention: By using similar tools as detailed above, we are able to assess athletes and individuals before an injury occurs. Underlying movement compensations and imbalances are often evident even in healthy athletes. By prescribing corrective exercise strategies, and customized strength and conditioning programming, these vulernabilities can be targeted.

To learn more, check out these resources:

1. American Counsel on Exercise

2. National Athletic Trainers’ Association

3. National Academy of Sports Medicine

4. CT.gov

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Reactive vs Proactive Athletic Wellness

Depending on where you are in the country, preseason is underway for fall sports. No matter what level, most teams require some form of pre-participation exam. These annual appointments are designed “to screen for injuries or medical conditions that may place an athlete at risk for safe participation."¹ Regrettably, there is not a standardized exam in the US, resulting in a wide range of effectiveness. The National Athletic Trainers' Association Position Statement includes the following guidelines for designing an exam:

• Medical and Family Health History

• General Health Screening

• Cardiovascular Screening

• Neurological Screening

• Orthopedic Screening

• General Medical Screening

• Review of Medication Use

• Nutrition Assessment

• Heat- and Hydration-Related Illness Risk Factors

Considering all the areas assessed, it is important a medical physician (MDs or DOs) supervise these exams. Missing from that list however, is a Functional Movement Assessment. Both ATCs and PTs can be instrumental in helping you establish an athletic baseline.²

By evaluating basic movement patterns, any strength imbalances or compensatory strategies can quickly be identified. Check out our instagram post on the functional assessment I used with the Warriors Dance Team for the 2021-2022 preseason screens!

Your provider can review any significant findings with you, helping you understand how they may be impacting your performance. But if the findings from your assessment don’t correspond with pain, should you still address them?

Short answer: It depends. 

As clinicians, it is important to take the whole athlete and their goals into account. Understanding the demands of the sport and the anticipated load throughout the season is one piece of the puzzle. A rising high school freshman basketball player with lower extremity strength imbalance may have been fine playing at the middle school level 3-4 times per week. However, once introduced to the demands of a varsity squad- weight lifting, practices 5 times a week, and a heavier competition schedule- may no longer thrive. It is reasonable to anticipate that they will begin to experience lower extremity joint pain at some point during the season. By providing them a short home exercise protocol that addresses the imbalance, they may be able to avoid the scenario altogether.

A semi-professional golfer will expectedly present with a strength imbalance dominant to non-dominant side rotation due to the demands of their sport. Assuming their regular strength and conditioning includes bilateral rotational power and deceleration work, minimal changes may need to be made.

Ultimately, we believe that sports medicine should be proactive not reactive. While it is impossible to avoid injury in sports entirely, athletes can train more effectively based on their individual strengths and demands.

To learn more, check out these articles:

1. Wingfield K, Matheson GO, Meeuwisse WH. Preparticipation Evaluation: An Evidence-Based Review. Clin J Sport Med 2004; 14(3):109-122.

2. Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers’ Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions. Journal of Athletic Training 2014;49(1):102–120.

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Daily Foam Rolling

Myofascial release is a hands-on technique using sustained pressure to the connective tissue restrictions to relieve pain and restore motion. But does it work? Dr. Betsy Webb certainly thinks so, stating “this is one of the most common modifications I suggest to patients. Maintaining soft tissue and joint mobility is so important in preserving joint health and building strength.”

According to a systematic review conducted by Beardsley and Škarabot, myofascial release can help to increase flexibility and reduce soreness. Regular maintenance helps with joint and soft tissue extensibility and mobility, will improve tissue length and pliability and its ability to accept force and load. This allows the body to do more work with less strain overall. Methods like foam rolling, gua sha and massage can improve arterial and vascular endothelial function, or the flow of blood and lymph through the tissues. Self-myofascial release allows for consistent and cost-effective management. Athletes of all levels most commonly use a foam roller or ball of varying density.

Despite being versed on the benefits, Betsy has trouble incorporating soft tissue work. “I love working on strength and cardio work,” she laughs, “but often under prioritize mobility in my own physical fitness. I know how valuable mobility work is, yet I struggle to incorporate it into my routine.” As part of our Athlete Within Challenge, Betsy agreed to spend 10 minutes foam rolling everyday for two weeks. Here’s how it went:

As with any new habit, the most challenging part about for Betsy was adherence. “I started out really strong for the first week but then the weekend hit and falling out of my daily routine made it more challenging to stay diligent,” she says. Sound familiar?

In order to stay consistent, Betsy found three different techniques to be most helpful: routine, external accountability, and increased accessibility. “I found using an alarm worked really well. I set an alarm for 9:15 every night to remind me.” (As an added benefit, myofascial release can also help to improve parasympathetic nervous system activity, allowing us to mentally and physically calm down so our bodies can regenerate. Soft tissue work in the evening can set you up for a great night’s sleep!)

Betsy shared her goals with her fiancé, finding that having “someone to hold me accountable, who knew to remind me if I hadn’t done it for the day” helped to keep her on track. The last thing she found to be helpful? Relocating her foam roller. “I ended up putting it next to the tv,” says Webb, “so that when I would sit down to watch tv at night I would see the roller and be reminded to use it.”

So is it worth the time? After the two weeks were up Betsy’s body was thanking her. “Foam rolling is something I know I should do more of, especially for my thoracic spine, but never was able to get into a routine." Like so many of our patients, Betsy saw tremendous benefit from going back to the basics: “After the first week I felt good but not too much different, but a full two weeks really started to make a difference in how I felt from a mobility standpoint.” The true payoff for myofascial release work is in the consistency. Studies have yet to show if any of these improvements in flexibility and tissue quality have longterm effects once treatment is stopped. “I fully intend to maintain this behavior. As I saw with the two weeks, the longer I remained consistent the better I felt,” states Webb.

Our vote? Yes to myofascial release!

Looking for Dr. Betsy Webb? As of July 1st, she will be practicing in the Chicago Area!

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Back At It

To wrap up our section on lumbar disc injury, Nina and I break down some of the most common patient questions we receive. As an AT, Nina is accustom to triaging athletes in pain, helping them find confidence in their plan of care.

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SV: For the past month, we’ve been sharing the latest research on lumbar disc pathologies. As a recap, what are your top three take aways for experiencing back pain?

NS: We’ve covered a ton of information on this topic recently, looking at the impact of pregnancy as well as injury. The overall takeaway is that each individual’s experience can be different- this goes for symptoms and solutions. That’s why personalized care can have such a big impact for back pain. Similarly, there isn’t one guaranteed strategy for managing a lumbar disc injury. A combination of treatments, including soft tissue work, stability and mobility exercises, and pain management, is typically needed. Last, use this as an opportunity. For most people, an injury like a disc herniation can be a catalyst to make adjustments to their behaviors, allowing them to emerge stronger than before.

SV:  How does this differ from the type of back pain caused by pulling a muscle?

NS: Discogenic pain has a different quality; many patients report feeling sharp, electric sensations, while others complain of weakness. Nerve pain can “travel,” sending irritation down one or both legs. Muscle spasm often accompanies a disc injury- it’s a protective strategy. Muscles of the back will automatically tighten above and below the injured disc to limit movement. This tightening makes it difficult to use muscle systems, or groups of muscles designed to support compound movements, effectively.

Pulling a muscle, or overusing a muscle, can usually be correlated with a specific action or activity. You may feel tight, or restricted. This should resolve, or feel considerably better, in 72 hours if it’s just muscular.

SV: Here’s a popular combo question- do patients need to get imaging for this type of injury? How likely will they need surgery?

NS: It’s a valid question- too often, we only hear about worst case scenarios for injuries. Unless you’ve suffered a traumatic injury, like a car crash, we don’t typically recommend imaging right away. Rehab exercises and pain management will be the most productive first steps. If you eventually need surgery down the road, being as strong as possible going in will dramatically help your recovery!

Surgery makes the most sense for patients who have a high risk of complications- like if your herniation or displacement is so severe you may cause permanent damage to your spinal column- or for those who haven’t succeeded with conservative care after a number of months.

We’re big believers that patients should be the center of their plan of care, with a variety of clinicians and specialists, coaches and supporters surrounding them. Without a different perspectives, you can overlook options. Ask questions, get second options- be your best advocate!

SV: Once someone injures their back, does that mean they can never workout or play sports again?

NS: In the vast majority of cases, definitely not! Most patients are able to return fully to their previous level of activity. Like any major injury, it will take dedication and focus to recover. It’s essential to allow your body enough time to heal, and to correctly learn, or re-learn, movement patterns. Look for rehab practitioners that understand the demands of your activity, and can help get you there. Stopping at 65-75% better increases your chance of re-injury significantly.

SV: With back pain being one of the most prevalent injuries, how can someone lower their risk for injury?

NS: Regular physical activity will help to protect against a number of ailments and injuries. Particularly with the recent transition to virtual learning and working, movement is even more important, as we are naturally more sedentary in this scenario. Adding in tri-planar exercise, including linear, lateral and rotational work, can help make sure you’re prepared for whatever life throws you! If you’re new to exercise, or struggling with home exercise routines, setting up an appointment to work with a clinician or coach can give you the confidence you need to move safely.

SV: At Physical TheraPT, as many of our patients know, we love staying current on the latest innovations in exercise and rehab equipment. What’s your favorite product out there right now for back pain patients?

NS: For patients still in the early stages of recovery, I really like the biofeedback cuff. This deconstructed blood pressure cuff helps increase awareness of pelvic stability and highlights how well someone is able to maintain a braced position when you add on movement. For those who are out of pain, and show progress with more challenging exercises, the 3D strap is my favorite. Don’t be deceived by the simple nature of this piece of equipment! It adds rotational load to almost any movement pattern, allowing athletes to adapt and practice in a safe environment.

Buy on Amazon

SV: Last question- what’s your go-to strategy for pain relief with this type of injury?

NS: Finding a position of comfort that you can rest in. Back injuries can feel unrelenting- having a position that gives you some relief is critical in the beginning stages of recovery. Laying on a firm surface, resting on your back with knees bent and feet planted, referred to as Hook-Lying Position, is generally safe for most patients. Others may find relief with a bit of light traction, leaning into your elbows at a counter, or floating in a pool.

Consistent Advice for Inconsistent Times

Seemingly almost every day, this year has thrown unprecedented challenges our way. As a country, and as a community, it can feel like we simply can’t catch a break. This air of overwhelming chaos and danger can trigger feelings of distress and distraction, and impact our normal immune response, throughout coping strategies like emotional eating or alcohol consumption, or poor quality sleep. Good news, these feelings and responses are very normal. Bad news, these behaviors are correlated with an increased risk of injury.

“I don’t know if I can do this”

As athletes and performers, we each possess a deep spirit of resilience. Resilience is defined by the American Psychological Association as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress.” Each tryout, audition, tie breaker, performance and championship game has reinforced that spirit. We have each gone through challenge, and emerged stronger.

Brené Brown reminds us in her 2015 book, Rising Strong, that resilient leaders all show three key attributes:

First, they recognize the central role that relationships and story play in culture and strategy, and they stay curious about their own emotions, thoughts, and behaviors. Second, they understand and stay curious about how emotions, thoughts, and behaviors are connected in the people they lead, and how those factors affect relationships and perception. And, third, they have the ability and willingness to lean in to discomfort and vulnerability.

During these unprecedented times, we find ourselves rebounding more frequently. Today’s challenges require near moment-to-moment adaptation. While we may feel sensitive and vulnerable, athletes and performers are robust. Driven by challenge, each of us have demonstrated incredibly grit and perseverance to reach the position we are at today, overcoming injuries and obstacles. It’s important to acknowledge any feelings of distress, but equally important to have an arsenal of resources to continue moving forward in a healthy fashion. We’ve pulled together our favorites from the author / coach duo behind The Growth Equation, as well as the mental health professions at IADMS:

Practice compassion, for yourself and others

Each new 2020 challenge has shown value of human compassion. If you’re feeling overwhelmed, look to ways you can help someone or look for ways someone else has helped you recently. Being kind to yourself when things don’t go as planned is essential, too!

Stop resisting what’s happening

We’ve all been there. But wishing this wasn’t happening isn’t going to help the situation or your mental state. Focus on what your next three tasks are, and keep cycling through your day.

Focus on what you can control

Rather than worrying about the uncontrollable, put your energy towards productive action. If your league now requires mask usage for competition, build a schedule that allows you to gradually build up tolerance to it while exercising.

Think adaptation, not change

“Change is something that happens to you. Adaptation is something that you are in conversation with.” Stulberg’s view returns control to the individual, and the tasks at hand. What is non-negotiable for you, your family, or your team? Start with these, and work backwards to find to solutions that suit your current challenges. Maintaining an openness to new experiences can help to keep you on track- what opportunities has this scenario brought you?

Practice positivity and gratitude

With so much bad news floating around, it’s easy to get lost in it. When you noticed a persistent negative thought, try to reframe it. For example, maybe you still can’t take that trip you’ve been longing for, but airlines and tourism industries are working hard to provide rapid test options.

If you find yourself getting worked up, try what Stulberg refers to as the 4 P's: pause, process, plan, proceed. This quick exercise allows you to acknowledge whatever is coming up for you, and choose a response that best suits our ever-changing environment.

Finally, tap into memories that remind you why it’s all worth it. The view at the summit, that game winning shot, the performance where everything just clicked. Visualization can help to reignite feelings of purpose.

Use Routines to Anchor you

Some days, internal strategies just won’t be enough. These are the days to lean heavy on your routine lifesavers. Block off 15m breaks to take a walk around the block, schedule tech-free time at the beginning and end of your day, pre-order that instagram worth salad + juice combo. Learn what helps you be your best self on bad days. After all, “creativity resides at the heart of human resilience. Even though adversity will always exist within the human condition, embracing the creative resources within us allows us to not only endure but to prevail.” -Creativity, Trauma, and Resilience by Paula Thomson and S. Victoria Jaque.

To learn more about the connection between stress and injury, check out this article.