How athletic trainers and physical therapists work together
Treating them right
How athletic trainers and physical therapists work together
Athletic trainers are the first line of defense when sports injuries occur in high school, college or the pros. They’re highly visible on the field, court or rink – immediately assessing and treating injuries and jumpstarting what could be a lengthy process of recovery.
Their duties don’t end there, however. In many cases, athletic trainers oversee an athlete’s entire rehabilitation, from the moment of injury to a return to sport. They often are the bridge between
physicians and physical therapists as care plans are implemented.
That behind-the-scenes collaboration is crucial in assuring the process goes smoothly. Good athletic trainers stress communication with medical staff and with patients and their families. With everyone on the same page, there are no surprises and, consequently, success often follows.
In celebration of National Athletic Training Month, we’re focusing on the collaboration between athletic trainers and physical therapists when treating six of the most common sports injuries. In consultation with an athletic trainer and a physical therapist who work closely together, here’s a look at how the two professions converge to get athletes back to top performance levels.
Concussions
From an athletic trainer’s point of view: Because they are on-site for games, athletic trainers often witness collisions occurring and can establish early concussion protocol. The best practice is for athletes to immediately leave a game when a potential concussion occurs and relax for about five minutes before an athletic trainer’s evaluation. That creates a cooling-off period and a more accurate assessment, which includes searching for up to 30 concussion symptoms.
This is one of those “guilty-until-proven-innocent” situations. A headache alone likely won’t get a player grounded for the rest of a game – a head is sure to hurt if a collision occurs – but another one or two accompanying symptoms, such as light sensitivity, dizziness, nausea or difficulty tracking with the eyes, will end an athlete’s night of competition.
Athletic trainers typically require a visit to a concussion specialist shortly after an incident occurs – an appointment always can be canceled – while continually checking on the athlete’s progress. A key benchmark for young athletes is how the following day of school goes. Sitting in lighted classrooms and attempting to focus on verbal and written lessons within 24 hours of an incident can provide clarity as to whether an athlete needs more monitoring or a specialist’s evaluation.
From a physical therapist’s point of view: The majority of concussion patients normally stay under the supervision of a specialist and/or an athletic trainer, but if they are not progressing within a week, a physical therapist may get involved.
The number one concussion symptom that sends patients to physical therapy is lingering neck pain or stiffness, stiffness or pain , a common offshoot similar to the aftereffects of a car accident. Having a clinician loosen up neck muscles and tension can relieve alleviate headaches relatively quickly.
Another physical therapy treatment for concussion symptoms is light exercise, such as 20 minutes on a stationary bike to get blood flowing to the brain and potentially reducing a concussion’s duration. Normally, concussed athletes spend only a couple weeks in physical therapy before returning to an athletic trainer for the transition to practice and competition.
Lower-extremity muscle strains
Athletic trainer: Whether it’s a strain of the hip flexor, hamstring or calf, lower-body muscle tweaks are the most common injuries an athletic trainer sees during preseasons. Often caused by overuse or underuse as athletes begin formal practice, these strains are still commonly treated with the RICE method (rest, ice, compression and elevation) method .. Tolerable strength training of the affected muscle and core strengthening will be added gradually until a return is impending.
One note of warning: If you are dealing with a muscle strain, minimize stretching that area while it still aches. Athletes have a tendency to stretch a muscle that has already been pulled to a point of discomfort. Those muscles need time to heal; do some light exercise such as biking or limited strength training, but the more you stretch the affected area the longer it likely will take to heal.
An athletic trainer will spend a few days overseeing the progress of muscle strains, and if there is no improvement, a physical therapist may step in.
Physical therapist: If an athlete is dealing with a serious muscle strain – a Grade 2 or 3 – or if it keeps lingering, a physical therapist offers longer sessions and more direct care than an athletic trainer.
The physical therapist gradually will add exercise and strengthening, and work on improving creating mobility and agility without pain. Once athletes reach that point, they’ll return to the athletic trainer and begin non-contact practice.
Lower-back pain
Athletic trainer: Normally, back pain starts out as a tweak during running, lifting or in daily life. The key is to diagnose it early, pinpoint the issue and determine if any muscle imbalances or restrictions can be resolved quickly. Those are usually handled by athletic trainers and last a few days.
Back issues can become more serious, though. If an athlete enters the trainers’ room and can’t bend over and touch toes without experiencing significant pain, the next step is usually seeing a doctor and undergoing tests such as a MRI or CT scan. It could be a nerve impingement or even stress fractures within the spine, which can sideline an athlete for two months or more.
Physical therapist: If stress fractures aren’t detected, but back pain is lingering, a physical therapist likely will focus on mobility exercises.
Oftentimes, young athletes concentrate on specific muscle groups such as arms and chest, and have weaknesses in their core, hips and glutes. Those become a focus for physical therapy.
Labrum tears/shoulder injuries
Athletic trainer: Most athletes who suffer shoulder injuries usually can pinpoint when they first occurred, especially if hearing a pop. That makes it easier for athletic trainers to locate and diagnose the issue.
If a tear of the labrum – the sheath of cartilage that rings the shoulder socket – or an unstable or dislocated shoulder dislocation or an unstable shoulder is diagnosed, a referral to a doctor and subsequent surgery may follow. If the shoulder remains stable, bracing, taping and physical therapy for several weeks can help get an athlete through the season.
Physical therapist: This becomes tricky, because once protective tissue is torn, the chances for further injury increases, and a second, similar injury, like a full labrum tear, almost always means surgery. A physical therapist can help strengthen the rotator cuff – the muscles and tendons that protect the shoulder – and navigate it through various positions to assess and increase range of motion.
Some athletes can injure or “dislocate” their shoulders and be back playing relatively soon. But if the issues persist for six weeks or longer, surgery is the likely endgame.
ACL tears/knee injuries
Athletic trainer: Most clinicians can immediately recognize when athletes have torn their anterior cruciate (ACL) or medial collateral (MCL) ligaments. Their knees buckle and the athletes, if they remain upright, pull up and hop.
In those situations, athletic trainers stabilize the knee as quickly as possible; shortly thereafter, MRI and orthopedic appointments are scheduled to confirm what is feared. Knee ligament tears are usually surgically repaired, meaning the end of an athlete’s season and a recovery time of six-to-nine months, a period in which athletic trainers, physical therapists and orthopedists work in concert.
Physical therapist: Because there often is a time lapse between the injury occurring and knee surgery, prehabilitation physical therapy will begin in some instances. The physical therapist works with patients throughout recovery, slowly building strength and mobility and range of motion in the knee.
A few months into the process, the athletic trainer may supervise some on-field activities, such as light agility drills, so the athlete can be around his or her team and isn’t working in isolation.
UCL tears/elbow injuries
Athletic trainer: The elbow injury that strikes the most fear in athletes, especially pitchers, is tearing the ulnar collateral ligament. The UCL runs along the inside of the elbow, connecting the upper arm to the forearm, and acts as a primary stabilizer of the elbow joint. Along with ACL tears and concussions, it’s the injury that grabs the most attention in the sporting world.
For athletic trainers and athletes, it’s also one of the most recognizable. Immediate pain on the inside of the elbow, specifically after throwing a pitch, or in the forearm is often the harbinger of ligament-replacement surgery and a lengthy recovery process that can last between 10 and 18 months (although new procedures may push that timetable closer to the front end).
An athletic trainer’s initial role in a UCL tear is playing traffic cop. Contacting medical staff and other trainers – pitchers, for instance, often have their own personal coaches – and potentially setting up second and third opinions. The athletic trainers also often serve as counselors and encouragers, because a UCL injury means a slow and arduous recovery.
Physical therapist: The worst part of a year-long recovery is its pace. Although athletes differ, UCL rehabilitation is now fairly routine, assuming each calculated milestone is achieved.
That means a lot of core and lower leg work and light strengthening without picking up a ball or bench pressing weights for months. That can drive athletes crazy, so physical therapists need to combat the boredom while convincing their patients to trust the process.
Once throwing is allowed, perhaps as late as six months after surgery, a physical therapist will work again closely with athletic trainers and any personal coaches to start a progression back to the field or court.
Bottom line
These are microcosms of what occurs with most rehabilitations. The first is a concerted effort among patients, physical therapists, athletic trainers, doctors and other medical personnel to focus on one goal. The second is getting athletes back to competition healthy and ready to excel.
If you are an athlete dealing with pain or muscle fatigue or have recently suffered an injury, seek the help, advice and expertise of an athletic trainer, a physical therapist or both simultaneously.