Jan 29, 2015Breaking Down Walls
At Northeastern University, athletic training and strength and conditioning are no longer operating as separate entities, or even in separate rooms.
By Art Horne & Dr. Gian Corrado
Art Horne, MEd, ATC, CSCS, is the Director of Sports Performance at Northeastern University, where he is also the athletic trainer and strength and conditioning coach for the men’s basketball team. He can be reached at: [email protected]. Gian Corrado, MD, is the Head Team Physician at Northeastern and oversees the Sports Performance department. He can be reached at: [email protected].
Traditionally, collegiate sports medicine and strength and conditioning departments operate as separate units under the supervision of the athletic department. But recently, some schools have challenged this classic model by converting to alternate organizational schemes. Northeastern University is one of those schools.
Last year, we combined our athletic training and strength and conditioning services into one department: Sports Performance. This new department is directly supervised by sports medicine personnel and operates under the direction of the campus health center instead of the athletic department.
The head strength coach and head athletic trainer both report to the Director of Sports Performance, who is dually certified as an athletic trainer and strength and conditioning coach. That person reports to the Head Team Physician, who reports to the campus health center leaders.
The reorganization of these departments has been very positive as it benefits those who matter the most: our student-athletes. In this article, we share why we decided to make this change, how we implemented it, and how it’s been working.
Three years ago, an internal audit of the athletic department and a round of staff evaluations revealed that there were some things we could do better in terms of delivering sports medicine and strength and conditioning services to our student-athletes. We weren’t necessarily doing anything wrong, or anything different from other college athletic departments, but we realized that there may be a better way than the traditional model we were following.
One big shortcoming we pinpointed was a lack of standardization of services for our student-athletes, especially related to injury prevention. For example, there were no formal efforts being made to prevent ACL tears or stress fractures in our female athletes. Some teams had preventative strategies in place, but they were not well regulated or consistently implemented, which meant we didn’t know if they were working.
Athletes also sometimes received conflicting messages from staff members. Athletic trainers and strength coaches were not always in sync in terms of the way they explained causes of injuries. They would often call the same exercise by two or three different names, which created confusion for the athletes.
Overall, there was little communication between athletic trainers and strength coaches, which led to some inefficient practices. For example, an athlete might perform an exercise as part of their rehab with the athletic trainer, then also perform the very same exercise during a workout with the strength coach.
Another example is that the athletic training staff would often tell athletes with lower body injuries “no lower body work” out of fear they would re-injure or further injure themselves by overdoing it with an overzealous strength coach. But in reality, the strength coaches were perfectly able to choose appropriate lower body exercises that would not cause re-injury.
Finally, there were some very good reasons to take sports medicine and strength and conditioning out from under the oversight of the athletic department and move it to the oversight of the campus health center. To start, it would enable athletic trainers and strength coaches to have authority over their own policies that relate to athlete care. Our athletic trainers would also have administrative support for duties such as insurance claims processing and access to shared medical record keeping.
Being housed under the college health service umbrella would mean our athletic trainers are viewed as healthcare providers and our strength coaches are treated as professionals who are integrated into the care and health management of our athletes. Both staffs would be given performance reviews by professionals who are in and understand the fields, which means they cannot be threatened by sport coaches or administrators in the athletic department who may not understand the scope of our practices.
The Head Team Physician and dually trained athletic trainer and strength coach who now heads the Sports Performance department created a presentation that highlighted the problems we were facing and proposed reorganization as a solution. It also helped that nearby Boston University had successfully undergone a similar transition that put their athletic training services under the direction of college health instead of the athletic department. Our university listened to what we had to say, and with further support from key athletic administrators and campus leaders, agreed to reorganize and implement the Sports Performance department.
From the audit and staff feedback, it was apparent that communication was the biggest issue preventing our athletes from getting the best care possible. We’re pleased to say that the new model has helped communication in several ways.
For example, we have improved continuity of care with a smoother and more effective transition from rehab to strength training because athletic trainers and strength coaches now work together to come up with comprehensive rehab plans for injured athletes. The traditional model we subscribed to before fragmented an athlete’s return to play into two distinct phases: rehab and return to training. The goals during the rehab process were disconnected from the goals during the training period when in fact they should go hand in hand.
More often than not, our athletic trainers were rehabbing athletes until they were free of symptoms. Then the athlete would be discharged to the strength and conditioning staff, regardless of their ability to perform the expected training movements. That setup left plenty of athletes in an athletic purgatory–too healthy for sports medicine but not well enough for strength training.
In many cases, it was like the strength coach was left on his or her own to serve as an “advanced rehabilitation coordinator” by applying strength training solutions to a medical problem that still needed a medical solution. Now, our athletic trainers and strength coaches are all involved and update each other throughout an athlete’s return-to-play process.
Remember that problem where injured athletes were doing exercises during their rehab session and then again during their workout with the strength coach? Now that the athletic trainers and strength coaches are in better communication, this inefficiency no longer exists and has actually allowed athletes to progress more quickly through the return to play process.
Coordinating the care of our athletes under medical guidance has also helped improve the gaps in terminology that existed between the athletic trainers and strength coaches. When the Sports Performance department came together, we developed a common rehabilitation exercise list from which all rehab programs are built. This forces the athletic trainers to choose exercises from a predetermined list that everyone understands. All of the exercises we chose are also supported by research.
There is improved communication during the various preseasons as well. On the first day athletes report to campus, the athletic trainer and strength coach overseeing a particular sport sit down with the Director of Sports Medicine, Director of Strength and Conditioning, and Director of Sports Performance to conduct a thorough review of each athlete. Past medical history, current fitness level, injury status, and performance goals are discussed. This initial meeting removes questions as to what the athlete should and shouldn’t be doing.
Follow up meetings between athletic trainers and strength coaches take place on an ongoing basis and there is an “athlete watch list” discussed at each staff meeting. This is when we review difficult cases and provide a learning environment for our younger staff members.
Not only does the improved communication between everyone on staff help our athletes get the best care possible, it also shows them we are one unit that works together. Any conflict between staff members is no longer present because our athletic trainers and strength coaches are working as one cohesive unit that operates smoothly and without conflict.
While the newly formed Sports Performance department has helped us fix a lot of problems, it also provided some unexpected advantages. One byproduct is the improved effectiveness of our athletes’ pre-participation examinations (PPEs).
At most NCAA schools, a PPE includes taking a comprehensive medical history, immunization history, and performing a physical exam. While this fulfills NCAA requirements, it does not truly evaluate an athlete’s readiness to participate in elite level athletics.
Recent research has pointed to easily measurable musculoskeletal risk factors that can be identified during a PPE, including a study that found a 17-fold increase in injury risk among professional ice hockey players who exhibit adduction strength that is less than 80 percent of their abduction strength. Another study found that athletes who lack appropriate hip abduction and external rotation strength demonstrate increased rates of lower extremity injuries and knee pain from patellofemoral syndrome.
Our strength coaches have started to administer these tests during the PPE process so that we can screen for risk factors. When an athlete exhibits increased injury risk via these screenings, we implement targeted medical management and/or training interventions to help reduce that risk.
Another piece we have added to our athletes’ PPEs is a functional movement screen. Strength coaches usually conduct this screening separate from the PPE, but by integrating it into the medical care of our athletes, more unified management results. For example, if an athlete’s functional movement screen reveals poor squat mechanics, it could be a symptom of psoas restrictions or dorsiflexion limitations. Once identified, the strength coach can collaborate with the medical professional present to devise an appropriate plan to correct the problem.
“This data sharing alleviates the burden on one staff member or skill set, and instead creates a synergistic approach to best address an athlete’s dysfunction,” says Dan Boothby, CSCS, Director of Strength and Conditioning. “For example, if lack of dorsiflexion is noted in the PPE evaluation process, sports medicine may address the problem with manual soft tissue or mobilization work and the strength training staff may add additional massage stick or foam rolling to the affected area. Both groups are now working together toward the same goal. In the end, we make each other’s jobs much easier.”
Because an integrated and holistic approach that involves both sports medicine and strength and conditioning is not currently mainstream, a number of staff members from both units initially questioned the move. The athletic trainers worried we were going to try to turn them into strength coaches, and the strength coaches worried that we were going to try to turn them into athletic trainers.
We clearly stated that each staff member would continue to do what they know how to do and their overall role would not change. Instead, the expectation was that they develop a clear appreciation and understanding of each other’s roles and goals as they fit within the overall scheme of the Sports Performance department.
We wanted them to see that their own success depended on each other. We explained to our athletic trainers that stronger athletes typically sustain fewer injuries, and we explained to our strength coaches that athletes who are able to concentrate on their rehab and proceed through the rehab process quickly are able to return to play faster and achieve their performance goals more readily.
As we began our transition, staff members soon realized that many elements of athlete care and development overlap, and that by combining efforts, each staff was able to provide more efficient care and training for our athletes. Most importantly, the earlier miscommunications that existed between departments dissolved, allowing for the free exchange of ideas, suggestions, and methodology.
Another key part of the implementation has been the opening of a newly renovated sports medicine and performance area, which embodies our new, integrated approach. We literally knocked down the wall that separated the two departments and replaced it with a glass partition and doorway so that staff members, athletes, and information can pass unimpeded from one area to the other. Our athletic trainers and strength coaches are now invested in one another’s success.
“The Sports Performance department really forces both the strength and medical staffs to get past their egos and think beyond traditional roles and work together,” says Steve Clark, MS, ATC, DPT, CSCS, Assistant Athletic Trainer. “It’s not easy at first. The strength staff has to learn to appreciate diagnoses and look at athletes from a medical perspective, and it forces the medical team to learn and appreciate strength principles so that both truly become part of the injury prevention team.”
Since transitioning to our new model, student-athlete satisfaction surveys have improved dramatically. We also have quantifiable data that demonstrates the positive changes we’ve seen. We began tracking games missed due to injury three years ago. Since then, a large number of teams have seen steadily declining rates. For example, our field hockey athletes dropped from 65 games missed in 2009 to 17 in 2010 and zero last season.
This new approach toward the care of our athletes is undoubtedly the wave of the future. Such a model has provided our athletes with improved care, and we won’t be surprised when more schools follow suit.
Sidebar: THREE UNITS, ONE TEAM
Like Northeastern University, the University of Delaware has combined separate units of the athletic department into one. The move has resulted in only positive changes.
By Scott Selhiemer, Assistant Director of Athletics for Media Relations
It has been said that the whole is greater than the sum of its parts. That’s exactly what the University of Delaware was thinking when it reorganized its sports medicine, strength and conditioning, and equipment departments into a single operation we call our Student-Athlete Performance department.
With a longstanding tradition of successful athletic programs, including six NCAA Division I championships, why change? “By integrating those units we were able to achieve greater communication and collaboration,” says Bernard Muir, who was Athletic Director at Delaware until this past summer when he took on the same role at Stanford University. “We took an already outstanding group of operations and turned it into a much more effective and efficient model for helping our athletes achieve a quality experience.”
The change took place one year ago, when Muir promoted Head Strength and Conditioning Coach Augie Maurelli, CSCS, CSCCa, to Associate Director of Athletics for Student-Athlete Performance and hired a new head strength coach. Maurelli manages and oversees all three units of the Student-Athlete Performance department and reports directly to the athletic director.
The idea is that instead of the three units working independently, they work as a team by discussing problems, sharing ideas, and ultimately figuring out what is best for Delaware student-athletes through collaboration. They also have a direct line to the athletic director through Maurelli.
The collaboration is sometimes formal. Maurelli holds monthly meetings with the three unit leaders–the head athletic trainer, head equipment manager, and head strength coach–to discuss major issues or do strategic planning. But most of the collaboration is informal. All three of their offices are in the same hallway, they have lockers near each other in the staff locker room, and each is responsible for communicating with one another not only about the issues of a particular day, but their ideas for unit improvement over the long term.
However, the sharing of information and ideas doesn’t start and stop with the department’s leadership group. Maurelli strongly encourages discussion among all staff members in the three units and has even put activities in place to help. For example, during the summer training season, the athletic training and strength and conditioning staffs work out together on Tuesdays and Thursdays between team sessions. The workouts are designed by a different athletic trainer or strength coach each session and everyone participates, including graduate assistants and interns.
If there is a disagreement among staff members–whether to use the functional movement screen or a performance metric approach for athlete evaluation, for example–there is no hierarchy and everyone gets a say. The strength and conditioning staff is no higher or lower than the athletic training staff. Everyone, including the equipment staff, is on the same level and under the same umbrella.
The department organization is also allowing bigger changes to occur. For example, when the athletic training and strength and conditioning staffs wanted to improve the quality of hydration and recovery products available to our student-athletes, the three unit leaders approached administration about it and later played a role in the decision-making process for a new campus beverage contract.
Setup for football practices now includes strength and conditioning equipment as well as field equipment. And both the equipment and strength and conditioning staffs share the trucks that are used for practice setup, leveraging budget dollars and resources. Another example recently played out when the athletic training, equipment, and strength and conditioning staffs all met with the school’s apparel provider and switched off-season training shoes in an effort to reduce foot injuries.
When the new structure was put in place, there was some concern about potential resistance from athletic trainers due to the change in reporting structure. But Head Athletic Trainer John Smith, MS, ATC, made sure to consider the impact this structure would have on his staff members and presented it to them as a means to elevate their visibility and leadership roles in the department.
“The Director of Athletic Performance position hasn’t changed the fundamental athletic training job,” Smith says. “Our staff quickly realized that Augie is a resource and a facilitator in sharing the goal of improving each athlete’s performance. He interacts with athletes on a daily basis and understands the rigors of the athletic trainers’ day-to-day operations, so our staff has confidence in him.”
Maurelli appreciates the praise, but credits the three unit leaders with making the transition work. “John, Head Strength and Conditioning Coach Brian Hess [CSCS], and Head Equipment Manager Kevin Rose all are selfless individuals who truly want what is best for our athletes,” says Maurelli. “When competitive people share a common goal, this type of structure enables synergies well beyond normal operating standards.”