Jan 29, 2015
Have Tape, Will Travel

Working overseas as an athletic trainer offers challenges, rewards, and a chance to blaze a new trail. In this three-part article, those who have made the leap offer their insights.

By Joshua Euten

Joshua Euten, MAE, ATC, is Head Athletic Trainer at Shanghai American School in Shanghai, China after spending the 2013-14 school year in a similar role at the Western Academy of Beijing. From 2008 to 2013, he served as Head Athletic Trainer at Coker College in Hartsville, S.C. He can be reached at: [email protected].

The volleyball, cross country, and baseball teams all have practice today, so there are wrists and ankles to be taped, cuts to be bandaged, and injuries to be assessed.

Does this sound familiar? It is just one of my daily thoughts. Athletic training in a secondary school is similar no matter what country you are in. I just happen to have the Oriental Pearl Tower and the rest of the Shanghai, China, skyline as a backdrop.

That doesn’t mean it’s all been smooth sailing since I came to China in July 2013 to be the athletic trainer at the Western Academy of Beijing (WAB). As the first-ever athletic trainer to work in Beijing–and one of only eight in the country currently–it took some time to educate others on exactly what my profession entails. In my current position at the Shanghai American School (SAS), I’m still asked, “What exactly do you do?” but I’ve embraced all that China has to offer and adapted to the traditions and cultures of my new country. The experience of being here has changed my life.

So how did I get a job in a country where “athletic training” has no direct translation in the native language? The wheels were set in motion about two years ago when I was the Head Athletic Trainer at Coker College in my hometown of Hartsville, S.C. It was a great job, and I loved the student-athletes, my colleagues, and the impact I was making at the school and in the community. But when I turned 30, I had the opportunity to travel and realized it was a passion that I wanted to pursue further.

There were also two significant events that pushed me to expand my horizons. One fall Friday night in 2012, I was helping a colleague work a Hartsville High School football game. Four minutes before halftime, a young man from the home team collapsed. The sports medicine personnel on hand did everything possible to revive him, while I kneeled at the player’s head and talked to him. Tragically, he didn’t respond. He took his last breath on the football field.

Watching the life of a 17-year-old boy leave his body made me question why I was working all the time and not following my true passions. This incident, coupled with coming out to my family and friends earlier that year, inspired me to write a new story for my life and career.

While I browsed the NATA Career Center webpage, I was intrigued by a posting for an internship at WAB through the Institute for Western Surgery (IWS), a company that employs sports medicine professionals from the West to work in China. I decided to apply, and after an interview, I was offered the position. A few weeks later, I found out I would be heading to Beijing in late July 2013.

Although I was excited for the new beginning, I did have a few reservations about moving to China. I knew that medical care there was more old school than I was used to in the United States, and I was worried that there would be a huge language barrier. Being from South Carolina, some people think I barely speak English correctly, and the prospect of learning Mandarin–a very different language from English–was intimidating. However, I knew this was an opportunity I couldn’t pass up.

At WAB, I was greeted by the stifling Beijing summer air. WAB is an international school that is set up like most schools in the United States, except its student population is composed of children from around the world whose parents work in Beijing.

Financial limitations had prevented WAB from hiring an athletic trainer before. But since I was hired and paid by IWS, WAB was able to take me on for a yearlong internship.

The students and staff at the school were excited about finally having an athletic trainer, even though most thought my job was to show them how to work out. Through my daily work and interactions, however, I began to educate them on my actual job duties, with a big breakthrough occurring at a WAB rugby tournament. During the last match, one of the student-athletes was tackled hard. Her head hit the ground twice, and an opposing player then kneed her in the temple. She started seizing on the field, and I immediately ran into action. After seeing how I effectively handled this emergency, everyone at WAB understood that I did more than write workout prescriptions, tape ankles, and watch practices.

With the WAB students and staff aware of my skills, my next task was getting the nurses and coaches accustomed to referring injuries to me. Before I arrived, WAB student-athletes relied solely on school nurses for any type of injury, who would immediately refer them to a physician. But when the nurses realized I specialized in working with musculoskeletal injuries, they soon started sending athletes my way.

Making inroads with the coaches was assisted by the presence of a few American coaches who already knew what an athletic trainer was and were comfortable referring players to me. The other coaches caught on soon after.

When my yearlong contract at WAB came to a close, I took a job at SAS. Since starting at the beginning of the 2014-15 school year, I have faced many of the same issues that I did at WAB. But in addition to my athletic training duties, I am also teaching a sport, exercise, and health sciences course. In the classroom, I’m able to interject my professional experiences into the material, as well as introduce the athletic training profession to my students, which helps them see its value.

With more than a year in China under my belt, I can now reflect on my experience. One of my reservations about moving here was adjusting to the more traditional approach to medicine. Treatments rendered by physicians in China are sometimes starkly different than what I am used to seeing. For example, casting is very common–for anything!

How did this newcomer adjust to such deep-rooted history? I took a step back and evaluated if the treatments still helped the athletes recover. Many of the methods were once considered the standard of care 15 to 20 years ago, but advancements have made others available. The traditional treatments aren’t incorrect, just “old-school.” Can they still be effective? Absolutely.

Getting used to some “older” approaches has also meant learning not to rely on modalities. I haven’t used an e-stim machine or performed an ultrasound in more than a year because it’s difficult to get those machines in schools here. Now, my best tools are my hands and mind, and muscle and joint mobilizations are a part of daily life. In many ways, I’ve gone back to my roots.

Another adjustment has been the lack of a relationship between athletic trainers and physicians in China. In the U.S., I had great partnerships with many different specialist physicians and surgeons, with several on my speed dial. Here, physicians don’t know a lot about athletic trainers. However, I’ve teamed up with the other athletic trainers in Shanghai, and we have started reaching out to physicians. We’re moving in the right direction.

My friends and family back home always ask, “What about the language barrier?” I have learned enough Mandarin to survive–I can order food and get home from a night out, but I am not close to being fluent. One of my goals for this year is to be certified HSK1, which requires knowing about 300 Mandarin words and phrases.

In school, we use English. I only run into communication challenges when I work in the community or have to talk to a parent who does not speak English. For these situations, I have learned to explain injuries in a unique way.

For example, when a Chinese-speaking parent asked about her child’s avulsion fracture, I pulled a branch off a plant beside us, making sure that some of the bark was still attached. Using some words but mostly gestures, I showed her that–like the branch was affixed to the tree–tendons and ligaments are attached to bones. Sometimes, athletes tear just the tendon or ligament, which I demonstrated by breaking another branch in the middle. Then, I explained that some injuries apply enough force to the tendon or ligament for it to pull away a piece of the bone rather than tearing in the middle, causing an avulsion fracture. To illustrate this point, I showed her the bark still attached to the broken branch in my hand, just like the bone would be attached to the tendon/ligament.

As for my life outside of athletic training, Shanghai and Beijing are vibrant and exciting cities. There is always something to do. In my free time, if I am not traveling through greater Asia, I am out exploring Shanghai. I try to pick an area of the city I haven’t been and explore, and I enjoy going to local markets, bargain hunting, and tasting local foods.

When I first moved here, I had to get used to traffic, crowds, and being stared at or asked to pose for pictures as a Westerner or “lao wai.” But despite the different traditions, culture, and language, I’ve adjusted well to my new life in China. Above all, I am here for the benefit of the student-athletes. And ultimately, athletic training is the same no matter where you lay your scissors down.

Dream Fulfilled

By Ellie Thometz

Ellie Thometz, MSAT, ATC, CSCS, is the Rehabilitation Therapy Technician for Bravo Company in the Warrior Transition Battalion-Europe. Previously, she was Athletic Trainer at Fort Jackson (S.C.) U.S. Army Training Center. She can be reached at: [email protected].

Ever since I went on a three-week tour of Europe while in high school, I knew I wanted to live there someday. For the next several years, as I went through college, graduate school, and started my career as an athletic trainer at Fort Jackson (S.C.) U.S. Army Training Center, I kept my eyes and ears open for an opportunity.

That opportunity came knocking in summer 2011 when my graduate program director told me about a new position with the U.S. Army in Germany. The supervisor of this program was a physical therapist who wanted to start partnering with athletic trainers in rehabs, but it wasn’t 100 percent clear what the rest of the job would entail. Even without a full job description, I jumped at the opportunity to apply and immediately sent in my resume.

After an initial review, I had a brief interview with the battalion surgeon and was offered the position. A few months later–after getting a physical, passing a drug test, obtaining an official passport, booking a flight, and shipping my household goods overseas–I was on a plane to Vilseck, Germany, for a new adventure.

My title is Rehabilitation Therapy Technician for Bravo Company in the Warrior Transition Battalion-Europe. I am one of a handful of athletic trainers who work with the U.S. military abroad. My main objective is to help injured soldiers develop a strategy for conquering the challenges of transitioning to the next phase in their lives. I work with a team of occupational therapists, nurse case managers, social workers, and other medical professionals to make this happen.

One of the best things about my job is that the days are never the same. Sometimes my schedule is full of meetings with various health care providers and Army leadership, in which I discuss the healing process of each soldier. Other days, I could be working in and out of the gym with soldiers, teaching a yoga class, or traveling for an event.

Every soldier who I work with is different. Their physical injuries can range from limited use of their limbs to lower back pain, but these are often compounded by “invisible” issues such as post-traumatic stress disorder or mild traumatic brain injury. The soldiers have varying levels of motivation to heal, which means I need to employ a plethora of strategies to help them reach their physical goals, such as constructing strengthening plans for rehabs or utilizing adaptive sports.

Not all the soldiers in the unit want to be helped, but for those who buy in, my program can have amazing results. I remember one soldier who developed cardiomyopathy after catching pneumonia and being hospitalized for an extended period of time. While in the Warrior Transition Battalion, he signed up for every adaptive sport we had, from wheelchair basketball, to sitting volleyball, and even inner tube water polo. The adaptive sports were a physical struggle for him, but by the time he left the unit, his cardiovascular threshold had almost doubled. He said he felt like he could lead a little bit of a normal life and be physically active again.

Besides working with soldiers, I also volunteer at the American high school on base. I cover athletic team practices twice a week and most competitions. While many states are currently working on legislation to require athletic trainers in all high schools in the U.S., the Department of Defense Dependents Schools system has seemingly been forgotten in this regard. To my knowledge, I am the only athletic trainer in Europe volunteering in the secondary school setting on a base.

Most of my athletic training experience in Germany has been through the military, but I have developed a general sense for how sports medicine here is different from the United States. For starters, the closest thing to an athletic trainer in Germany is a sports physiotherapist, which is similar to a physical therapist but with a specialization in sports injuries.

In addition, outside of professional teams, most sports leagues are not covered by any type of health care provider. I was able to volunteer for one season with a German team that plays American football, and it took the players a while to realize what my skill sets were. Once they did, however, they were so grateful to have me on their sideline.

However, just because some German practices are different does not make them ineffective. I have seen positive results come from German treatment methods, especially with massage related to pain relief and lymphatic draining.

Aside from missing some of the conveniences of living stateside, I absolutely adore being overseas. Of course, it can be hard to be so far away from my family and friends, but athletic training abroad is an experience that cannot be outdone.

I travel whenever possible, and my list of places to go gets longer the more of Europe that I see. I travel frequently to Italy, and I’m considering taking classes in Italian since I am there so often. I have already taken some German classes, as well. Because I work with American soldiers, I only need to know English, but learning new languages is a good personal challenge for me to try.

An unexpected result of my time in Germany is that it has strengthened my passion for the athletic training profession. Seeing so many areas where athletic trainers’ skill sets have yet to be utilized can be both frustrating and inspiring, but it has opened my eyes to how unique our profession is and makes me proud of what I do. Every time I explain athletic training to people from other countries, I get a burst of energy knowing that I am helping the profession grow. Being the voice for athletic training is a one-of-a-kind experience, and I encourage others to give it a try.

For those interested, one great resource is the NATA International Committee. They have a LinkedIn page where athletic trainers can connect with peers who already live and work around the world, as well as like-minded professionals within the U.S. Do not be afraid to take a leap of faith.

On a Mission

By Justus Bejno

Justus Bejno, ATC, is Head Athletic Trainer for the Northside Bulls in Stockholm, Sweden. To learn more about athletic training in Sweden, visit www.attsweden.com or e-mail him at: [email protected].

My title is Head Athletic Trainer for the Northside Bulls, an American football team playing in the Swedish Football League (SFL). To some, a title is a line on a resume or a rung on the career ladder. But to me, my title is a mark of progress as I strive to create awareness about the athletic training profession in Sweden.

My quest started in 2008 when I moved to the U.S. from my native Sweden. I was pursuing an education that would allow me to work with sports while utilizing my passion for anatomy and physiology–something that was not available to me in Sweden. During my first semester in college, I took the course, “Introduction to Athletic Injuries,” and I immediately felt called to the athletic training profession.

Over the next several years, in addition to my work in the classroom, I was able to apply athletic training theory to practice through four internships. My first was at Santa Barbara City College, my second at Rancho Bernardo High School in San Diego, and my third was at the University of San Diego. At the latter position, I had the opportunity to pick the brains of some of the most renowned professionals in the sports medicine industry. I worked extensively with traumatic brain injuries. After rehabilitating multiple head traumas in athletes, concussion research became a passion of mine that I have brought to my work with the Bulls.

In September of 2013, I began my fourth internship with the San Diego Chargers. Being a part of the team’s sports medicine staff allowed me to develop in a fast-paced role, increasing my alertness and ability to treat athletes in stressful situations with limited time. But while I loved the experience, I still wanted to bring my skill set home.

By late 2013, I flew back, hoping to be a pioneer who could establish athletic training in Sweden. After all, there was a time when athletic trainers weren’t understood in America. Just as the gap of knowledge about athletic training had been filled in the U.S., I was confident it could happen in Sweden.

My first step was to find a job, but I encountered some roadblocks. There is no job database for athletic trainers in Sweden, and professional teams often prefer to have their health care needs met by physical therapists and naprapaths, who practice a manual therapy derived from chiropractic.

I met these challenges by networking often and holding face-to-face meetings with other professionals. In order to maximize my output, I handed out business cards and developed a website. Confident in my expertise as an athletic trainer, I told potential employers about my extensive experience treating sports-related injuries in a wide variety of athletes.

My breakthrough finally came when a friend introduced me to the Bulls’s staff and coaches. They were eager to learn from my experience, and I joined them during the team’s preseason at the end of January 2014. Knowing that American football was the sport that sparked the demand for more athletic trainers in the U.S., I felt that the SFL would be a good setting for me to introduce my skills in Sweden. In addition, the majority of SFL players and coaches follow NFL and NCAA football, so many were aware of athletic trainers’ impact on athlete performance and health.

However, despite the organization’s willingness to learn, I had to build the athletic training program from scratch. I started by developing methods to collect data on the athletes’ injury history. The team had no clear protocol for assessing and treating traumatic brain injuries, either. To remedy this, I introduced SCAT3 and educated the players on the possible signs, symptoms, and long-term consequences of concussions.

In addition, the only equipment available to me was my medical kit and a treatment table. I was used to having access to advanced modalities during my time at USD and with the Chargers. I have adapted by performing a lot of manual therapies and utilizing cost-efficient modalities.

I’ve been with the Bulls for almost a year now, and I think embracing my role fully has been a key component to my success with the team. There is a knowledge gap among physical therapists, naprapaths, and doctors in which athletic trainers fit perfectly. It’s just a matter of helping people see the need that athletic trainers meet.

I did this by finding a way to stand out with athletic training-specific expertise, such as alternative modalities, concussion treatment, and taping. I have utilized hydrotherapy, cryotherapy, thermotherapy, and proprioceptive neurological facilitation to appeal to athletes who are looking for treatments that are a little outside the box, since these modalities are not common in Sweden. When it came to working with concussions, I knew that the standards of practice taught by the NATA would come in handy. Lastly, taping techniques gave me a unique edge because no professionals have the same proficiency and precision in taping as athletic trainers.

With the Bulls, I’ve started making progress in bringing athletic training awareness to Sweden. However, the SFL is a part-time engagement for the players and staff, and the majority of the athletes have full-time jobs. As such, I only spend 15 to 20 hours a week in the athletic training room, so working solely with the Bulls wasn’t a sustainable option for me.

After brainstorming a few avenues to take, my thoughts eventually led me to the Swedish military. When I did my military service in 2007, I observed a high rate of chronic injuries in the soldiers, especially stress fractures and back pain. So I approached the military with a proposal aimed at developing programs to prevent these injuries.

My idea was well-received, and I was hired in a full-time capacity. I analyzed data from 300 soldiers to assess their health status and get an understanding for the root of their chronic injuries. I am currently in the process of creating instructional videos that demonstrate injury prevention exercises in addition to continuing my work with the Bulls.

To my knowledge, I am the only athletic trainer in Sweden, but based on my experience over the past year, the future of sports medicine worldwide is ready for growth. In September 2014, I attended the World Federation of Athletic Training and Therapy’s yearly conference in Dublin, Ireland. At the meeting, athletic training organizations from the U.S., Ireland, and Canada signed an international mutual recognition agreement, acknowledging each other’s education and certification standards. This will ease the process of obtaining credentials in several countries and was a huge step in the right direction.

In the meantime, I am committed to standing at the forefront to aid athletic trainers in all of Scandinavia. The demand for our services in Europe is there, so now it’s up to us to demonstrate our expertise and value.

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