Road Less Traveled

January 29, 2015
Instead of taking the traditional route to a high school, college, or clinic, these athletic trainers decided to brave the unbeaten path and put their skills to use elsewhere in the athletic training world.

It's no secret the athletic training profession is expanding. It's growing in the sheer number of licensed athletic trainers entering the workforce, but also in the variety of job settings. While most athletic training jobs will continue to be in schools or clinics, there are other opportunities available, too.

In this article, three athletic trainers working in nontraditional settings share their journeys. See what it's like being an athletic trainer at a U.S. Army training center, hear about what it takes to work the racetrack at a motocross event, and go inside an industrial setting that requires working with correctional facility employees.


ON BASE
By Elizabeth Thometz

Elizabeth Thometz, MSAT, ATC, CSCS, is an Athletic Trainer at Fort Jackson U.S. Army Training Center in Fort Jackson, S.C. She can be reached at: elizabeth.thometz@gmail.com.

I took a less traditional route to becoming an athletic trainer. In fact, perhaps my unique journey started me off on the right foot for working in a nontraditional setting.

When I was in the college career center a few months before graduating with a psychology degree, I came across a couple of books about athletic training. I hadn't heard much about the field before then, but my interest was piqued and my post-graduate plans soon changed.

During my second year as an undergrad, I had spent a year as an officer candidate for the U.S. Marine Corps with the intent to enroll in the Marines after college. Instead, I opted to pursue my master's in athletic training. Right after graduation, I started attending a community college to get my prerequisites in order while simultaneously recording observation hours in the athletic training room at my alma mater.

I began applying to entry-level master's programs as soon as I was able, and a couple of years later had my degree and passed the Board of Certification exam. This entire time, I knew that I eventually wanted to return to working with the armed forces in some capacity. Soon after graduation, I got a call from a friend about a part-time athletic training internship at the Fort Jackson U.S. Army Training Center. The internship was a civilian opening, so I didn't need to be active duty to apply.

There was no guarantee that the internship would become a permanent or full-time position, but I was willing to take my chances because I knew if it did, it could be the perfect job for me. Eight months after I began working part-time, about 18 months since athletic trainers were first brought on base, the Army decided to see what the difference in care would be if the athletic trainers were working full-time.

Those of us on base as part-time interns went through the interview process and were officially offered full-time slots. Our job descriptions didn't change, but we started working about 15 more hours per week. I continued as the sole athletic trainer for the battalion that I had been working with since my arrival.

Because my position is contracted by the government, I don't work weekends. But I do begin my weekday workday at 5 a.m.

For the first hour, I do general wound care and taping for the Soldiers before they start their training. This requires a significant number of arch support or plantar fascia, Achilles, and general ankle taping jobs. I also see a wide spectrum of blisters, many of which have evolved into crater-like wounds on Soldiers' feet before they come see me.

For the next several hours while the Soldiers are in training, I run the musculoskeletal aspect of what the military refers to as sick call. All Soldiers who are sick or injured come see me or the medic in the facility. I perform anywhere from five to 12 evaluations per day, depending on what sort of training the Soldiers are participating in. Approximately 80 to 85 percent of the injuries are lower extremity chronic/overuse problems like patellar tendonitis, illiotibial band syndrome, and shin splints. I also see a lot of ankle sprains, large contusions, shoulder overuse issues, ligament sprains, and muscle strains.

If time allows after evaluations, I go out to the field training events to provide on-site coverage. Just like watching a game or practice, I'm there to make sure that if someone gets seriously hurt, the situation is handled correctly. During this time, the most common injuries I treat are acute ankle sprains, but I've also cared for a fair number of fractures.

Unfortunately, I don't get to regularly practice all that I learned in school--this is especially true with regard to rehabilitation and acute care. For example, I don't do as much rehabilitation work as athletic trainers who work with athletes. Because of the tight training schedule that the Soldiers must adhere to, it's rare that they have time to visit me for follow-up rehab sessions. If a Soldier has an injury that he or she can safely self-manage, I usually give them stretches or exercises to do on their own.

I generally finish my day around 2 p.m. However, my schedule is flexible to accommodate off-hour training events, and it's not unheard of for me to attend training events late at night.

Because of the nature of my government contract, its imperative that I keep up with all the paperwork that accompanies my daily duties within a 40-hour work week. This can make for a tight squeeze since paperwork includes everything from making sure that evaluation notes are entered into the computer before I leave for the day to filing numerous tracking sheets that give the Army command an understanding of what I do on a daily basis.

Though the hours are different, there are a lot of similarities between my setting and that of high school or college athletic trainers. For example, though I work with Soldiers anywhere between 18 and 40 years old, the majority of them are just out of high school or in their early 20s. You could also equate a high school athletic trainer telling a parent about their child's injury to how I report a Soldier's condition to his or her superior.

I had a leg up when I started here because I had already spent some time around military personnel, but one of the toughest parts about working in the military as a civilian is understanding how the military is structured. The intricacies in the chain of command can be hard to follow. The countless acronyms used by everyone on base and even military time can be confusing at first. Sometimes, things that seem simple, like a change to my schedule or a budgeting item, get bogged down by over-specified procedures and "red tape."

Every athletic training job has its downfalls, and my position is no different, but I love the sense of reward my job gives me. I've had a direct hand in helping Soldiers recover from injury in order to pursue a dream that many of them have had for years. Knowing that I've had an impact on someone's life and that I'm caring for our country's military is extremely gratifying.

Even with the military's hesitancy toward change, the feedback that I've received working at Fort Jackson in a position that didn't exist five years ago has been great. By doing our jobs well, the military athletic trainers working around the U.S. have educated the military about what we do and how we can be of great benefit to the armed forces in many facets.


AT THE RACES
By Eddie Casillas

Eddie Casillas, ATC, CSCS, is Head Athletic Trainer for the Asterisk Mobile Medical Center and owner and Clinical Director of iCHOR Sports Medicine in Murietta, Calif. He can be reached at: eddiecasillasat@gmail.com.

When I was a kid, one of my friends crashed his BMX bike and ended up with a split lip and a handful of teeth. While my other friends turned their heads away at the sight of the resulting blood, I was riveted with curiosity. I could feel my adrenaline pumping and was excited to help him. Though "helping" my friend consisted primarily of going to a neighbor's house to call 9-1-1, I have no doubt that this experience helped lay the foundation for my eventual career in sports medicine.

After high school, I enlisted in the Army as a combat medic. While I gained invaluable experience and certainly felt that adrenaline rush again, it was just one stop on my journey. My career goal was a job in sports medicine. So after finishing my enlistment, I enrolled in a community college while working full-time as a physical therapy aide at a local PT clinic.

At the time, I had no idea what an athletic trainer was. We didn't have any at my high school, and my guidance counselor had recommended I pursue a career in physical therapy, so that's what I did. One of my coworkers at the clinic who was a certified physical therapist and athletic trainer must have sensed that physical therapy wasn't quite the right fit for me, so when I began applying to four-year universities, she recommended I take a look at some athletic training programs.

"If you want to be the one running out on the field and in the trenches of sports medicine, then you need to be an athletic trainer," she told me. That was all I needed to hear. I attended the University of Nevada-Las Vegas and the first time I walked into the athletic training room, knew that I was where I belonged. I had found my calling.

After graduation, I returned to the physical therapy clinic where I had worked prior to attending UNLV. The town I lived in had a large population of motocross and BMX athletes, and it wasn't long before I started seeing them in the clinic. I had raced BMX professionally and am an avid skateboarder and snowboarder, so there was a lot of common ground between us. Working in the clinic allowed me a great opportunity to get to work with some of these athletes.

During this time, I met two motocross team managers and they invited me to work at a few races. They wanted to see how an athletic trainer might be able to help their teams. What started out as a few races turned into two full seasons.

During the second year, I met two physicians who were working together to develop a mobile medical unit that would offer services on the racing circuit. My dream of working in the action sports industry was within arm's reach. Using information I found on the NATA Web site, I put together a proposal describing the importance of including an athletic trainer on the mobile medical unit staff.

I was immediately shot down and told they were looking to hire someone from a different area of healthcare. But I felt strongly that athletic training embodies sports medicine in a way no other healthcare profession can. So I made numerous phone calls and sent many e-mails expressing my frustration with their decision. A couple of months later, I received a call informing me that the job was mine.

The best way to describe the Asterisk Mobile Medical Center (AMMC) is to picture an emergency room, urgent care facility, and athletic training room all rolled up into one large tractor trailer truck. Upstairs is the sponsored athlete support center. Asterisk is an industry leader in off-the-shelf knee braces for action sport athletes, and the company provides its riders knee brace refurbishment and on-site repairs.

Downstairs houses a clinic, which is staffed by at least one physician (either an emergency room physician or an orthopedist), one nurse, and one athletic trainer (me). Aside from some major trauma emergencies, the AMMC has the capability to manage any medical situation that may arise during a race weekend, including taking x-rays and performing minor surgery. All medical services provided by the AMMC are free of charge to the athletes.

I should note that this is a part-time gig for the medical workers on the team. For 30 weekends out of the year, we fly around the country to wherever that weekend's race is being held on Friday evening, then fly home in time to work our respective nine-to-five jobs on Monday morning.

During the week, I am the owner and Clinical Director of iCHOR Sports Medicine--an athletic training facility that offers the same services to the public that athletes get when they visit their school's athletic training room. On a daily basis, I do injury evaluation, rehabilitation, and prehab work. We also offer ImPACT testing, functional movement screening, and performance testing. My weekday job is a great one, but the weekends provide me with an opportunity to switch things up.

When I'm working on the AMMC, race day begins with a staff review of the previous week's injuries, paying special attention to any concussion cases. We are very conscious of the long-term effects of concussions and place extra effort on educating riders about the dangers of competing with a head injury. We currently use the ImPACT testing system on a limited basis, but I hope to make it mandatory in the near future.

In the hours leading up to the start of a race, I will likely dispense over-the-counter drugs, set up a sterile field, position a racer or two for x-rays, apply various splints and casts, size crutches for riders, evaluate aches and pains, and apply all forms of tape from Kinesio to Elastikon to traditional white. During practice runs and actual racing laps, myself and the physician on hand split up to monitor different parts of the track. Local emergency service personnel are always on hand as well.

One of the unique things about motocross racing is that if there's a crash, the race doesn't stop unless the medical staff deems it necessary. That means that depending on the course setup, I may have less than a minute or two to choose one of three options: stop the race, assist the racer off of the track, or organize track personnel to direct racers away from the crash site while I attend to the fallen rider.

Most crashes involve multiple racers. There are times when several are off their bikes lying right next to each other, but also plenty of instances when they are scattered around the track. Then I'm performing triage on the fly. Race organizers definitely want to keep the races going, but in the rare instance that there is loss of consciousness, stopped breathing, or spine pain, we stop the race without question.

I tell other athletic trainers interested in this field that over the course of one racing season, they will see every injury ever described in our textbooks. The most common are wrist and ankle sprains and strains, followed by wrist and ankle fractures and lacerations. I also see a handful of shoulder, knee, and hip dislocations, ACL tears, femur and clavicle fractures, chipped teeth, and heat illness over the course of a season. Once or twice a year, athletes suffer jaw fractures, liver or kidney lacerations, and even punctured lungs.

The main challenge in working with the riders is that they have a very high pain tolerance and often mask the severity of an injury. For example, a rider who was leading the women's championship race series a few years ago fell at the start of the last race of the season. She knew she needed to finish in fifth place or better to win the championship, so she remounted her motorcycle and proceeded to pick riders off one by one until she crossed the finish line in fifth. She rode straight to the AMMC staff and told us she thought she had broken her collar bone in the crash more than 20 minutes earlier. Upon inspection, we could easily see that her collar bone was indeed broken and actually on the verge of popping through her skin.

Athletic trainers who work in this setting have to remember that this type of medical care is still fairly new to action sport athletes. In the past, they had little to no options for proper on-site medical care, often times self-diagnosing their injuries in order to not have to go to the emergency room for fear of being chastised about what they do for a living.

It's been amazing to introduce athletic training to motocross and supercross athletes. Gone are the days of being chased by the police for skating ditches and being the only one on a snowboard at the local ski resort. Today we have city-funded skate parks, BMX in the Olympics, and often, more snowboarders than skiers on the mountains. Visionaries such as Jeremy McGrath, Tony Hawk, and Jake Burton have helped pave the way for what has become a huge industry and has allowed me to turn a passion into a career.


FACTORY WORKER
By Traci Jo Hubbard

Traci Jo Hubbard, ATC, CEAS, is Program Manager of the Work-Fit® Injury Care Program at the Michigan Department of Corrections in Jackson, Mich. She can be reached at: thubbard@work-fit.com.

It was an internship and my first job out of college that got me hooked on working as an athletic trainer in the industrial setting. While I was in school, I completed a three-month internship at a General Motors plant in Saginaw, Mich., and was hired to a full-time position there after graduation.

During the internship, my main role was to work with the athletic trainers on staff by assisting with treatments for common work-related injuries like low back, shoulder, knee, and ankle pain. I learned how to use modalities like diathermy, ultrasound, electric muscle and nerve stimulation, massage, paraffin, whirlpools, and hot and cold packs.

There was also an on-site fitness facility, and I helped start employees on individualized fitness programs to get them on track to meeting their goals. This included doing a fitness assessment where I took blood pressure and resting heart rate, and measured their flexibility and strength before creating a plan for improvement. I felt a strong bond with the working population right away.

After leaving the GM plant, I spent the next 20-plus years working in several industrial sports medicine facilities before landing at Work-Fit. I had opportunities to work in the scholastic setting and clinical arena, but my heart was always in the industrial setting. Other options just never quite appealed to me in the same way.

Work-Fit was founded by NATA Hall of Famer Ken Kopke, MEd, ATC, who has been recognized for opening up the industrial arena as a viable career path for athletic trainers. The company currently employs about 50 athletic trainers across seven states. Companies can hire us to implement wellness and fitness programs, on-site rehabilitation services, and/or work safety programs.

For example, one company might employ Work-Fit to manage a sports medicine clinic at a job site. Another might want to offer their employees a fitness program with the idea that having healthy employees would help save on overhead insurance costs. A third company may ask that a Work-Fit athletic trainer work closely with people like ergonomists, engineers, line workers, and managers on a biomechanical analysis of employees' jobs on a production line so they can make it safer for the workers.

The main difference in industrial athletic training is the setting we work in and the people we work with. Our clients aren't athletes per se, but their jobs are often physically demanding, and I've found this setting is a tremendous opportunity for athletic trainers to use our sports medicine knowledge. But we don't necessarily work with injured workers all the time. My job also entails things like making work station setup suggestions for a safer and more ergonomically-friendly area for the worker.

In my role as Program Manager of the Injury Care Program at the Michigan Department of Corrections, I work closely with the officers and employees at the Jackson County facilities. Work-Fit provides both on- and off-site injury rehabilitation services, and my staff and I custom design fitness programs that include a combination of cardio, weight training, and functional conditioning so employees can stay healthy and in shape. Jackson County also allows retirees to utilize our fitness space and programs, so I work with a lot of different age groups.

We also triage all occupational injuries. A typical day may include providing first aid treatment for acute injuries as well as emergency care for more critical cases. We assist injured employees in figuring out their medical care options and act as a liaison for their care until their case is completed.

Though I work with an older population than a high school or college athletic trainer, the injuries I see and treatments I employ are often the same. Our on-site rehabilitation provides treatment for a plethora of conditions from typical strains and sprains to post-surgical care for knees, shoulders, elbows, and backs. Due to the nature of the job for many of the correctional facility employees, we suggest that an aggressive strengthening program follow any rehabilitation protocol.

I stay active in the world of high school sports as well. I've filled in as an official, coach, and athletic trainer when local high schools need help. It's become a fun outlet for me and allows me to keep my emergency response skills up to snuff.

Standard hours and a regular schedule are two of the greatest draws for athletic trainers in the industrial setting. Burnout is a real concern in our profession, especially for those in the scholastic setting, but this environment allows me to continue contributing in my role as an athletic trainer while also affording me more time to enjoy my family.

I've found that the best part of working in the industrial environment is the opportunity to make an impact on someone's life. Each and every day, I meet people who need my help to keep their job, lead a productive life, and earn a living. When a company employee gives me a hug with tears in their eyes and thanks me for helping them, I wouldn't want to be anywhere else.
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