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

Image Credit

How intense does massage really need to be?

When it comes to massage therapy, many people wonder how intense the pressure needs to be to achieve the best results. There is a common misconception that the deeper and harder the pressure, the more effective the massage. However, the relationship between pressure and therapeutic outcome is more nuanced. Let’s explore the difference between deep pressure and deep tissue massage, why excessive pressure can be counterproductive, and how to find the optimal level of pressure for your needs.

Too Much Pressure?

One key aspect of effective massage therapy is understanding that getting muscles to release isn't about forcing them into submission. When a massage therapist applies pressure, sensory receptors in the skin and muscles send signals to the brain. These signals can help the brain to recognize tension, slowly convincing it to relax the muscles.

While other physiological effects also contribute to reduced tension in the body, putting the brain into a parasympathetic state is key to maximizing the benefits of massage. This means that excessive pressure is actually counterproductive, causing the body to go into a protective mode and tightening up the muscles even more in response to pain or perceived threat. Even worse, too much pressure can cause bruising, inflammation, or further injury.

Finding the Optimal Pressure

The goal of massage therapy is to promote relaxation and facilitate muscle release, not to cause pain. While a certain level of discomfort might be expected, particularly when working on tight or knotted areas, the sensation should be more of a "hurts so good" feeling rather than outright pain.

The optimal pressure during a massage varies from person to person and even from one area of the body to another. What feels good for one person might be too intense or too light for another. The "hurts so good" sensation is often an indicator that the right amount of pressure is being applied. This feeling suggests that the pressure is sufficient to address the muscle tension without causing excessive pain.

Take Control of Your Experience

To get the most out of your massage therapy session, there are several things you can do to help facilitate muscle release:

1. Stay in Communication

Always communicate with your massage therapist about the pressure being applied. No massage therapist, no matter how experienced, can know exactly what you are feeling. Your feedback is essential to ensure the pressure is just right.

2. Avoid Tensing Up

Try to keep your own muscles from tensing during the massage. Tension in the muscles can counteract the effects of the massage and make it harder for the therapist to work effectively.

3. Breathe Deeply

Make sure not to hold your breath. Deep, steady breathing can help to relax your muscles and enhance the therapeutic effects of the massage. When an especially tender or tight area is being worked on, focus on taking deep breaths to help the muscles release.

4. Relax Your Mind

Mental relaxation is just as important as physical relaxation. Try to let go of any stress or anxiety you may be holding onto. A calm mind can help facilitate muscle relaxation.

Effective muscle release involves communicating with the brain through slow and deliberate touch. The right amount of pressure to accomplish this is different from person to person and won’t even be consistent throughout your entire massage. Let go of any preconceived notions about how light or deep a massage needs to be. By finding a balance that promotes relaxation and healing without causing unnecessary pain, and by communicating with your massage therapist, you’ll be surprised at how much more benefit you can get out of each massage!

---

To learn more, check out these articles:

Journal of Bodywork and Movement Therapies

Deep tissue massage: What are we talking about?

National Library of Medicine

Brain Activity Underlying Muscle Relaxation

The mechanisms of massage and effects on performance, muscle recovery and injury prevention

The Value of Sports Massage for Athletes of Every Level

Sports massage is a specialized therapy designed to cater to athletes and active individuals. It offers a range of benefits from enhancing performance to improving overall well-being. Here are five reasons why you should consider incorporating sports massage into your routine:

1. Increased Flexibility and Freedom of Movement

Flexibility is key to optimal performance in many sports. Techniques used in sports massage work to stretch and lengthen the muscles, break down adhesions, and improve elasticity. In addition to an increasing flexibility, these techniques also free up restrictions within normal range of motion. These benefits can help your muscles and joints function optimally, giving you a competitive edge.

2. Accelerated Recovery and Reduced Muscle Soreness

One of the primary benefits of sports massage is its ability to speed up the recovery process. After intense physical activity, muscles often experience micro-tears, leading to soreness and stiffness. Sports massage promotes the flow of oxygen and nutrients to the affected areas, facilitating faster repair and reducing delayed onset muscle soreness (DOMS). By helping your muscles recover more quickly, sports massage allows you to return to your training regimen sooner and with less discomfort. This accelerated recovery is essential for athletes who need to maintain a rigorous training schedule without prolonged downtime.

3. Relief from Chronic Pain

The very nature of sport is to perform the same actions over and over and, as such, many athletes suffer from chronic pain due to repetitive use injuries. Focusing on the root causes of pain and addressing muscle tightness, trigger points, and adhesions, sports massage helps to reduce chronic pain from these injuries. This reduction in pain combined with an increase in circulation from the massage itself encourages healing, leading to increased performance.

4. Injury Prevention

Preventing injuries is crucial for anyone engaged in regular physical activity. Sports massage helps to maintain optimal muscle function by addressing muscle imbalances and tightness. These issues can lead to strain or overuse injuries if left unaddressed. Sports massage also enhances proprioception, or body awareness, which can improve coordination and balance. Regular sports massage sessions ensure that your muscles remain flexible and responsive, reducing the risk of strains, sprains, and other common sports injuries.

5. Improved Mental Focus and Relaxation

Physical performance is closely linked to mental well-being. The relaxing and stress-relieving effects of sports massage can help to calm your mind, improve your focus, and boost your overall mood. This mental clarity and relaxation can help you concentrate, translating into better performance and a more enjoyable training experience. Improved mental focus means you can strategize and perform with greater efficiency, making sports massage a valuable tool for both physical and mental improvement.

Incorporating sports massage into your routine offers a wide range of benefits that can elevate your athletic performance, promote recovery from and prevention of injuries, and bolster your mental well-being. The techniques used in sports massage are designed to target the specific needs of athletes and active individuals, ensuring maximum benefit from each session.

Whether you’re a seasoned athlete or someone who enjoys regular physical activity, sports massage is a valuable addition to your wellness routine. Experience the transformative effects of sports massage by scheduling a session with our experienced massage therapist.

---

As Physical TherapPT’s in-house massage therapist, Jamison helps to expertly deliver comprehensive care to our patients and athletes. His area of expertise includes: range of motion assessment, postural analysis, trigger point treatment, and manual therapy for injury prevention.

Jamison is currently accepting new clients.

To learn more, check out these articles:

American Massage Therapy Association. (2011) Position Statement on Massage Therapy for Those Who Exercise. Retrieved from https://www.amtamassage.org/about/position-statements/massage-therapy-for-those-who-exercise/

Kargarfard, M., Lam, E. T. C., Shariat, A., Shaw, I., Shaw, B. S., & Tamrin, S. B. M. (2015). Efficacy of massage on muscle soreness, perceived recovery, physiological restoration and physical performance in male bodybuilders. Journal of Sports Sciences, 34(10), 959–965. https://doi.org/10.1080/02640414.2015.1081264

Lee, J., Crosman, B.S. Chateauvert, S.R., Hateauvert, J.W. (1984). The Effects of Massage to the Hamstring Muscle Group on Range of Motion. Journal of Orthopaedic & Sports Physical Therapy, 6(3) 163-208. https://www.jospt.org/doi/epdf/10.2519/jospt.1984.6.3.168

Aeini, Maryam. (2022). Effect of Massage on Fatigue and Mood in Female Rowers. Humanistic Approach to Sport and Exercise Studies (HASES). 2. 10.52547/hases.2.2.7.

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.

---

Upper Extremity Sport Durability

For the majority of our upper extremity athletes, the toughest opponent they face is their screen. Here in the Capital of Tech, the hour or two you spend on the field may be the only break from technology. With the challenges of the last year, we’re all spending more time online and on a screen than ever before. While intuitively we all recognize that increased screentime can lead to decreased performance, this post will help break down the impact on upper extremity athletes.

Daily Posture

Start by assessing your resting posture. Look at the position of the head, neck, shoulder and arms relative to the torso. All too often when working on a laptop or handheld device we find ourselves seated with shoulders slumped, looking down, arms and hands together at chest center. Sound familiar?

This will impact your resting breathing posture, as well as your anterior chest and neck muscle tone. The closed position of the throat and rib cage requires the body to work harder and recruit different muscles to inhale and exhale, potentially overusing some muscles in the neck. Adducting the arms, or bringing them together in front of the chest, shortens the muscles of the chest causing them to tighten. The muscles in the back are put in an over-lengthened position, causing them to atrophy due to lack of use. This combination of tight and weak muscles makes it more challenging to find and maintain your athletic posture when you need it.

Finding Balance + Repetitive Behaviors

Using the body described above as our example, the strength imbalance and shoulder position will impact throwing mechanics. To rebalance the system, more emphasis needs to be placed on pulling exercises. This allows the muscles in the upper back to contract while lengthening the muscles in the chest. To compliment this work, incorporate focused dynamic chest stretching and thoracic spine mobility to re-enforce these new postures.

Looking to the back of the body, scapular control is equally essential for throwing mechanics. The scapula has limited ligamentous attachments- it’s the reason the shoulder has such a large range of motion. The catch? The scapula relies more heavily on muscular control than other joints. If you plan on throwing longer and faster, you need to have the eccentric strength to slow all that extra power down. Building a stable foundation (and maintaining it) requires regular rotator cuff strengthening- try incorporating these exercises into your pre-practice warmup or post-strength cool down.

Daily + Weekly Load

Every single athlete, no matter the level, needs recovery days. These low intensity days are the body’s chance to “recharge and download” new movement patterns and muscle fibers. Consistent optimal load to rest ratios will ultimately result in increased durability. To start tracking your load, try this simple low tech strategy:

Upon completing a workout or competition, rate the session using the scale. Multiple that number by the duration of the session in minutes. Track these numbers daily. On a weekly or monthly cycle, aim to create a soft waves rather than dramatic spikes and gaps in activity. Use this chart to plan for important competitions and heavy training days.

M.Gibala Ph.D.

Recovery is not synonymous with rest. Several of our highly competitive athletes have balked at the idea of a rest day, envisioning being confined to the couch for the day. Instead, think about recovery in the following areas:

• Getting adequate sleep following training (7 hours or more!)

• Optimizing soft tissues between sessions (massage, foam roll, stretching, etc)

• Rebalancing consumed macro + micro nutrients (Protein AND electrolytes)

• Diversifying your skills by trying new sports or activities (VR for reaction time, or swimming for reciprocal rotation)

---