Among the things which increase the anxiety level of parents of children playing contact or collision sports, or any sport for that matter, is the fact that many high school programs don't employ certified athletic trainers (ATs) who have received training in treating sports injuries, including heat illness, spine and neck injuries, sudden cardiac arrest, and in recognizing the often subtle signs or symptoms of a concussion.
The preliminary results of a study presented in October 2012 to the American Academy of Pediatrics (AAP) National Conference and Exhibition in New Orleans, LA show that having an AT on staff makes sports safer: overall injury rates were 1.73 times higher among high school soccer players and 1.22 times higher among basketball players in schools without athletic trainers, while recurrent injury rates were 5.7 times higher in soccer and 2.97 times higher in basketball in schools without athletic trainers. In contrast, concussion injury rates were 8.05 times higher in soccer and 4.5 times higher in basketball in schools with athletic trainers.
"Athletic trainers facilitate treatment of injuries and monitor recovery so that athletes are not returned to play prematurely. This likely explains the lower rates of recurrent injuries in schools with athletic trainers," said Cynthia LaBella, MD., FAAP, who presented the study to the AAP conference, in an interview with Science Daily.
Funding is a problem
According to a 2010 University of Michigan poll  two-thirds of middle and high school parents surveyed supported a requirement that high schools have an AT onsite for practices and games. The challenge, in an era of shrinking school budgets, is to come up with the money to fund the position:
- 43% thought the money should come from the general school budget;
- 28% believed funds should come from team fundraising or user fees;
- 20% said the state or federal government should fund the AT; and
- 9% felt that volunteer health professionals should be recruited.
The bottom line, as one AT recently remarked, is that if a high school can afford to have an interscholastic sports program, "it had better figure out a way to afford an athletic trainer."
ATs and concussions
Given the increased media attention in recent years on concussions in sports - from the youth level through the pros, the presence of an AT at games and practices in contact or collision sports is particularly critical because:
- In high schools with at least one AT on staff and concussion assessment involving only one medical professional, nearly nine of ten concussions were assessed by an AT and only 9.7% by a primary care physician;
- The AT often sees the athlete on a daily basis, and thus has the opportunity to establish a trusting relationship. This trust is a vital part of the process of evaluating and managing a concussion;
- Under-reporting of concussions by athletes is a chronic problem. Athletes may be more comfortable reporting symptoms to an AT, who they see on a regular basis, than to a physician they do not see regularly, or to their coach;
- An AT may also be better able to identify subtle signs that an athlete has suffered a concussion because he or she knows the athlete's usual behavior and demeanor.
- An AT is also in best position to perform daily follow-up examinations that allow the AT and team physician to determine when the athlete is symptom-free and determine when he or she may safely return to play.
- According to a 2011 study  physicians were on site at the time of reported concussions suffered by high school athletes during the 2009-2010 school year only 7.7% of the time, while ATs were on site for at least 70%, and, where they were present, assessed an athlete for concussion 94.4% of the time. Reassuringly, the same study found that ATs and physicians used similar return to play intervals when managing athletes who have sustained sports-related concussions, although, where the return to play decision was made by a physician, they were more likely than ATs to utilize computerized neuropsychological testing (52.5% versus 35.7%) in making that decision, and ATs returned athletes to play more quickly than physicians, although the
differences were not found to be statistically significant).
An AT is thus essential, and we should work towards the goal of having a certified athletic trainer on staff at every high school in this country.
High schools with ATs: on the rise
The National Athletic Trainers' Association recently released preliminary data showing that approximately two thirds of U.S. secondary schools with an ongoing athletic program have access to athletic trainers (ATs), whether full-time or part-time. That's an improvement from its 2005 estimate  that only about 40-45% had such access. In some states, the number is much lower (Over three-quarters of Nebraska high schools, for instance, are without ATs).
According to the NATA, it is in the process of completing its data gathering (NATA is conducting a similar study for private schools in the U.S.) and will release national and state-by-state data in 2014. Specifics will include extent of access to athletic training services, type of medical care provided when no AT is on-site, and reasons why schools do not provide an athletic trainer.
For the most comprehensive and up-to-date concussion information for sports parents, visit MomsTeam's pioneering Youth Sports Concussion Safety Center.
1. LaBella L. "A Comparative Analysis of Injury Rates and Patterns Among Girls' Soccer and Basketball Players." Paper presented October 22, 2012 at American Academy of Pediatrics (AAP) National Conference and Exhibition, New Orleans, LA; High Schools with Athletic Trainers Have More Diagnosed Concussions, Fewer Overall Injuries. Science Daily http://www.sciencedaily.com/releases/2012/10/121022080649.htm, accessed on February 21, 2013.
3. Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503, accessed on October 3, 2011.
4. Gary Mihoces, "Use of athletic trainers on the rise in high schools." USA Today, June 24, 2013. http://www.usatoday.com/story/sports/2013/06/24/national-athletic-traine..., accessed on January 2, 2014.
5. Waxenberg R, Satloff E. Athletic trainers fill a necessary niche in secondary schools. National Athletic Trainers' Association: 2009. Available at: http://www.nata.org/NR031209.