Riding the Wave

September 1, 2015

Nontraditional sports continue to gain in popularity. Now may be the perfect time to sell them on athletic training services.

The following article appears in the September 2015 issue of Training & Conditioning.

By Erik Nason

Erik Nason, MBA, MS, ATC, CSCS, is owner of Xtreme Action Sports Medicine, Inc., in Titusville, Fla. He is also Manager of Athletic Training and a physician extender at Health First Medical Group in Viera, Fla., and President of the Athletic Trainers’ Association of Florida. He can be reached at: [email protected]

Like most athletic trainers, I’ve always been a big sports fan. In high school, my goal was to be an athletic trainer at the professional level—specifically with a Major League Baseball team. In college, I learned just how big of a challenge I set for myself.

But what I also realized as I progressed through my undergraduate years is how much potential there is for athletic trainers to explore professional sports outside of the traditional realms. There seemed to be a whole other world of athletes that could benefit from our services.

Along with baseball, I have a passion for motor sports. In debates with other students in college, I constantly argued that an auto racing driver was as much of an athlete as a football or baseball player. I began to wonder if a better goal for me was to be an athletic trainer in sports not typically on our professional radar—for athletes who elevate danger and risk of death by competing against the laws of gravity and produce stunt-like performances that most people try to avoid.

After finishing graduate school, I accepted an athletic training position with NASA’s RehabWorks Program at the Kennedy Space Center. My job was to provide on-site musculoskeletal rehabilitation for injured employees and to care for our astronauts pre- and post-launch. I quickly learned that these industrial athletes were not much different than traditional athletes. They had the same types of injuries and required similar treatments. Differences were mechanisms of injury, activity-specific physical demands, and their goals. I officially began my goal of treating the nontraditional athlete, and I never looked back.

Through networking and volunteering, I progressed through a variety of other unique experiences. These included: covering professional rodeo athletes through the Justin Boots Sports Medicine program, developing an athletic training program for professional wakeboarders, and establishing athletic training services in auto racing, which eventually afforded me the privilege of working with Dale Earnhardt and Dale Earnhardt Jr., in 2001.

In 2005, I created my own company, Xtreme Action Sports Medicine, Inc., (XASM) with the mission of providing athletic training services to the nontraditional professional athlete who defies restrictions of physics and pushes the limits of physical competition daily. Over the years, XASM has catered to three major sports: professional rodeo, professional motor sports, and professional water sports (primarily wakeboarding and ski jumping).

Many people ask me: What does it take to work with nontraditional athletes? The most important factors, I’ve learned, are understanding the mentality of those competing in high-risk sports, the demands of the activity, and an athletic trainer’s role on-site.

IN THEIR HEADS

Any athletic trainer can provide first aid services at any event. But to truly add value to athlete care, an athletic trainer needs to do some homework on the sports they’ll be covering. To start, I’ve found it critical to comprehend the mentality of the competitors.

For example, a rodeo athlete’s adrenaline and focus occurs in an eight second hurricane. What happens in that brief amount of time makes or breaks their world. And they will not let an injury stand in the way.

That means an injury that would sideline a traditional athlete is viewed very differently by a rodeo athlete. Their question to me is, “How can you help me ride for another eight seconds?” Understanding this mentality and choosing not to resist or argue has been critical to the athletes’ success and to furthering my services.

The athletes I work with also tend to have no fear. For them, success is not about getting another out or hitting one more 3-pointer. It is about adding one more flip or making a risky move at a higher rate of speed. Fear is not an option, so they will push their bodies to the limits no matter how high the danger. Many of these sports are like a poker game—athletes out-perform opponents by adding risk.

That mentality obviously leads to a higher likelihood of significant injuries, so I make sure I am prepared to handle them. I work closely with EMS, discussing our roles and how to best complement each together. This must be choreographed before each event.

Another important component is that, for many of these athletes, the continued financial viability of their activity is directly related to their performance. They often pay entry fees to compete and can take home prize money if they do well. If they don’t participate because of an injury, they not only lose a chance to bring home earnings, they forfeit the dollars they paid to enter. There are no substitutes waiting on the sidelines for the action-sport athlete, and the pressure to compete even when injured is great.

In addition, in most cases, sports medicine professionals are not empowered by a league or team to hold an athlete out of competition. Therefore, I provide them with the best education, treatment options, and care possible, and then follow their lead. This has built trust and acceptance, which have taken years to develop. Because I recognize the athletes’ culture and needs, they now value my opinion and take time to weigh the options that I give them.

SPORT SAVVY

Along with understanding the mindset of the athlete, an athletic trainer needs to become knowledgeable about the sport. Being aware of the physical demands, biomechanics, and culture of the activity allows me to better treat the patient and produce more effective outcomes.

For example, a rodeo athlete wears cowboy boots, which precludes him from using an ankle brace. If his ankle needs protection, a low profile tape job is the only option.

A rough stock rodeo athlete also depends greatly on the strength of his inner thighs and knees. He grips the bull or horse with an adduction motion and must be able to acutely feel the movement of the animal to best perform. If this athlete suffers a knee injury, he is not going to want a bulky brace interfering with the inner knee. A specially designed low profile rodeo brace or injury-specific tape job is the only answer.

In wakeboarding, injuries to the biceps are very common. The yanking of the tow-rope constantly puts a repetitive strain on the upper arm. In addition, any slack in the rope can lead to a forceful pull on the biceps. So I make sure I am well-versed on these types of injuries.

Wakeboarders are also prone to low back pain. They must maintain a squatting, knee flexion posture to maneuver and control the board. This constant knee flexion results in chronic hamstring tightness that can cause low back pain. Very often, symptom relief is achieved through hamstring massage and stretching pre- and post-event.

My strategies for getting to know an untraditional sport are simple: exposure and experience. I volunteered with the Justin Boots Sports Medicine team for six years before I became program manager, and I learned something new at every event. I listened to the needs of the athlete, and I asked, “What can I do for you to make you more comfortable and successful?”

It can also be helpful to try the sport yourself. This is not always possible, but I at least attempt to experience some aspect of the activity. During my initial time in motor sports, I often took laps around the race track as a passenger, just to understand the G-forces, elevation changes, and other elements that affect a driver.

In addition, I make sure I am well-versed on the most recent research pertaining to the sport, such as the different external forces and impacts the athletes may experience. One particular study that I found helpful compared bull riding injury rates with other contact sports, concluding that bull riding is the most dangerous sport in the world. The injury rate in a two-year period was 19.81 per 100,000 and the fatality rate was 7.29 per 100,000. In another study, the gravitational forces of rodeo athletes were compared to those of athletes in other sports. Researchers found that bareback riders experience similar forces to that of a 200 mph IndyCar crash.

Knowing the sport also requires keeping up-to-date on its safety equipment and protective gear. Some action sports have definitive guidelines and rules while others are vague.

Motor sport governing bodies tend to mandate very detailed safety regulations. For example, in most races, drivers are required to wear a head and neck restraint system called a HANS device, which provides stabilization to the head during impacts.

In rodeo, the safety standards are rather low. Everyone wears a vest, which is made to dissipate the blow from being stepped on by a bronc or a bull (which can equal 20,980 pounds of force from the hind hooves). But helmets have been much slower to gain acceptance. They can provide protection when thrown to the ground, kicked, or hit by the metal chutes. And in bull riding, if the rhythm of the rider and the bull are not in sync, a helmet can reduce the damage from a facial impact with the back of the bull’s head. However, a strong tradition makes it hard to replace the cowboy hat with a helmet, and no manufacturer has agreed to place a seal of safety on any rodeo helmet.

In the sport of wakeboarding, athletes must wear a helmet and life vest. Due to the heights of most of their aerial tricks, the impact on the water can be like landing on hard ground, and helmets help prevent head injury. The vest is an obvious lifesaver if the athlete becomes unconscious in the water.

AT THE EVENT

When it comes to on-site coverage for action sports, there are two key differences from traditional athletic settings. One is that emergency medical professionals are often unaware of an athletic trainer’s expertise. Secondly, there is no easy way to “run on the field” to treat an athlete.

Since action sports elevate the risk of injury, it is pertinent that athletic trainers and EMS work together and have a clear understanding of each other’s roles. In wakeboarding, for example, I am obviously not able to reach the athlete myself as a first responder. Instead, paramedics trained to make water rescues are stationed on wave runners. Before the competition begins, I always communicate with the water paramedics to establish a detailed operating procedure for extracting an injured athlete from the water to our medical tent.

Pre-event communication with EMS prior to a rodeo is extremely important, too. We often work with EMS personnel who have never been to a rodeo before, so our response plan dictates that the athletic trainers enter the arena first to provide treatment. However, we always start by visually triaging the situation from behind the chutes. This is important for two reasons. First, the rodeo athlete may not be injured—riders often take a few moments to gather themselves before standing up. Second, there could be a loose bull, and we don’t want to put ourselves in harm’s way.

When we do enter the arena, the “pick-up men” on horseback either lasso the bull/bronc or drive the animal quickly out of the arena while several cowboys watch our backs as we provide medical care. Still, we are always aware that this could be a dangerous situation and never let our guards down.

Becoming well-versed in the sport-specific injuries is an important step in preparing and providing efficient care. (See “Common Injuries” and “Unique Injuries” below.) Armed with that information, we make sure to have proper supplies, gear, space, and treatment tables to accommodate the needs of each sport.

For example, endurance motor sports drivers often develop blisters on their hands from prolonged driving in sweaty gloves. To remedy this common problem, we have a specific bandaging method that keeps bandages in place despite continued friction and stress.

Another example is addressing rodeo athletes’ need for stretching and manual therapy. Because they spend long hours driving across the country to and from competitions, they tend to have significant flexibility issues and low back and hip tightness. Having on-site treatment tables, with lots of room, is very important for helping these athletes obtain proper flexibility.

Covering action sports also requires being prepared for catastrophic injuries. In rodeo and motor sports, we always establish hospital transportation protocols. Some questions to think about are: land vs. air, how far away is the medical facility, and is it a trauma one facility?

One more important aspect of covering action sport athletes is that we are only treating them at the event, and they tend to not have follow-up or continuity of care for acute or chronic injuries. For instance, a rodeo athlete who suffers from chronic shoulder dislocations could benefit from a very detailed rehabilitation program for multi-directional instability of the GH joint, but this likely won’t happen with his travel schedule. So we treat the instability that day for that competition with tape, wraps, or braces.

Once we settle on a plan of care for the competition at hand, and before they leave for home or their next event, we take time to educate them on home exercise programs, rehabilitation needs, self-treatments, medications, or surgical interventions. This provides athletes with treatment options and a complete understanding of the injury.

GETTING INTO THE FIELD

If all of the above sounds intriguing, you may be wondering how to get involved with action sports. Unfortunately, there are not a lot of opportunities for internships or full-time positions. But I do see sports medicine coverage of these sports growing.

For me, gaining a foothold took a lot of time and patience. My nontraditional sports odyssey started in 1998, volunteering with the Justin Boots Sports Medicine program, which provides athletic training services to professional rodeo athletes in Florida. After six years, I became Southeastern Program Manager, a position I continue to hold. I provide coverage and manage approximately seven rodeos a year within the Southeastern United States, in addition to our annual trek to Las Vegas for the national finals.

In 2001, via networking, I landed a job as an athletic trainer for the factory Corvette Racing Team, which is where I worked with the Earnhardts. In 2002, I joined forces with the Mobile Sports Medicine Group and provided athletic training and sports medicine care to drivers and teams of the American LeMans Racing Series for the next 10 years.

To get your foot in the door, I would suggest networking with medical coordinators of action sports events and volunteering. If others are skeptical of your services or you have no experience, ask to simply observe. Here at XASM, we host many students and veteran athletic trainers, but before they treat athletes, we request that they watch the events and allow us to educate them on the risks, safety, and competitive nature of the sport.

This is not to say that athletic trainers should volunteer to work for free. There is a cost to our value and worth. But sometimes others need to sample our professional health care services before they will support us.

When working with event managers or associations that are unfamiliar with what an athletic trainer does, it’s important to clearly explain what your expertise entails. The immediate response by the King of Wake Tour to my offer of providing sports medicine care for their professional wakeboarding series was, “We already have EMS on-site.” Expecting this, I created a document that outlines the medical services that we offer and compares them to the services of EMS. It is important to not downplay the value of EMS but instead emphasize the benefit of having EMS and athletic trainers form a complete medical team.

Educating the athletes is also critical. We often explain our services to them during pre-event contestant meetings. We also use signage in our treatment area that lists our services. Sometimes it will take an event or two to gain the athletes’ trust, but once that happens, they flock to our tent. Recently, a retired professional wakeboarder who is now an event organizer told me, “If I had the sports medicine services of Xtreme Action when I was competing, my career could have lasted 10 more years.”

As athletic training continues to expand, I foresee more opportunities in nontraditional sports. But for now, interested athletic trainers need to be as courageous as these athletes and jump into the ring. Call coordinators of your local action sports events and volunteer your services. You never know where it may lead.

 

Sidebar: READY FOR ANYTHING

I have seen some unique and unfortunately catastrophic injuries while covering action sports, especially in rodeo. One night in Ocala, Fla., I encountered the worst succession of injuries I had ever seen.

It started when a young bull rider, despite wearing a helmet, was knocked unconscious after smashing his face into the animal’s head. As he went limp, his hand stayed in the rigging, and his body was tossed around violently as the bull kept bucking. His hand finally broke free, and the unconscious rider fell face first into the thick arena dirt. While in a prone position, one leg of the bull landed on the back of his helmet, breaking the facemask clips and forcing his head even farther into the dirt. This all happened within six seconds.

When I got to the athlete, I rolled him over (with assistance) onto his back and found he was not breathing. His facemask and mouth were filled with dirt. I did a finger sweep to clean out his mouth, but he had started to turn blue. As he was gurgling and gasping for air, I performed a jaw thrust to open his airway, being cautious of a potential spinal injury. The move allowed him to begin breathing again, and I was able to detect a broken jaw.

His color started to return, but he was still unconscious. We placed him in a C-collar, boarded him, and transported him to the local trauma center. The athlete was diagnosed with bilateral jaw fractures, pneumothorax, four fractured ribs, and a severe concussion. He was placed in a medically induced coma for two weeks. The athlete survived, but he did not get in the ring again.

 

Sidebar 2: COMMON INJURIES

The following are typical injuries to be aware of in three action sports.

Rodeo:

Groin strains

Low back pain

Cervical tightness/myofacial trigger points

Sprained ankles

Shoulder dislocations

Open wounds and lacerations

 

Motor sports:

Cervical tightness/myofacial trigger points

Hand blisters

Cumulative trauma disorders, such as lateral epicondylitis, carpal tunnel (in crew members)

 

Wakeboarding:

Low back pain

Elbow tendinitis

Shoulder impingement

 

Sidebar 3: UNIQUE INJURIES

The following are atypical injuries to be aware of in three action sports.

Rodeo:

Peroneal nerve crush injury from inside the chute

Lacerated livers resulting from a crush injury after being stepped on

Ruptured biceps tendon

Facial fractures from impact with bull

Pneumothorax

Spinal trauma

Puncture from being gored

Concussions

 

Motor sports:

Carbon monoxide poisoning to drivers in closed cockpit cars

Forearm and hand burns as the crew is working on hot brakes

Impact trauma

Leg and ankle fractures to drivers from frontal impacts

 

Wakeboarding:

Tib/fib fractures

Shoulder dislocations

Spinal trauma

ACL ruptures

Concussions

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