May 29, 2019
Managing stress in the athletic trainer position
By Timothy Neal, contributing writer

The athletic training profession is full of stress, given the amount of responsibility for someone’s health, the time demands, the high expectations in outcomes, and the challenge in autonomy to make decisions. All athletic trainers have experienced stress and stressful moments inherent to the profession. The goal for the athletic trainer should be to manage their response to these stressors.

I was asked to provide some insights and considerations for athletic trainers to effectively manage their stress to become more efficient in their positions and to balance their work and life. In my nearly 40 years as a certified athletic trainer and now athletic training educator, I have had my share of stressful moments. Additionally, I have had experiences in life that were of high stress. So, I am very familiar with the impact of stress on the professional and person.

In this series of articles, I will provide some thoughts on stress and then some considerations on addressing stress so it does not negatively affect the athletic trainer. In this piece, I will focus on the perspective of stress and anticipating stress.

Perspective on stress

To paraphrase Dr. Scott Peck, a psychiatrist and author of The Road Less Traveled, life is difficult. Once one accepts that life is difficult, it is no longer difficult. Mishandling or misunderstanding stress from managing life’s difficulties is what makes a person stressed out.

Athletic training is what I refer to as a “problem” profession. All day long, day in and day out, athletic trainers are handling problems.

I have observed that some athletic trainers who find themselves chronically stressed by these professional demands came into athletic training for the wrong reasons. I always ask young athletic trainers or athletic training students why they want to be athletic trainers. Those who answer because they like athletics and want to be around athletes usually are those that experience high levels of stress.

I chose athletic training as my profession because I enjoy studying, anticipating, addressing, articulating, and teaching others about problems in athletic health care. Those going into athletic training had better understand that they are getting into a life beyond going to games.

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Study after study is showing that millennials in particular are highly stressed. Anxiety and depression are on the rise for all age groups, but particularly for millennials. Researchers believe the irrational desire to achieve, along with being overly critical of oneself and others, can be traced to perfectionism. For the clinical athletic trainer and the athletic training student, strive for excellence, not perfection. I have seen athletic trainers miss an assessment and totally lose their confidence, even after decades of outstanding clinical outcomes. Now, I work with athletic training students who, though they earned an “A” on a test, question the points they miss because they wanted a perfect score. I continuously remind both the clinician and student that they are working toward excellence, not perfection.

People have life histories that make them susceptible to internalizing stress. Some people who have had stressful events in their lives — particularly at an early age before their brain can properly process it — are at risk for mismanaging stress. Certainly an athletic trainer who is experiencing a mental health disorder or challenge is susceptible to any type of stress and may have a hard time working through stressful moments.

Anticipating stress

As I wrote in an earlier article for this newsletter, joining a profession is like having a baby — one must take the challenging with the rewarding. Also, the analogy of picking up a stick is appropriate. When you pick up the stick of anything, you pick up both ends — the good and the bad. This is true for anything in life: relationships, professions, jobs, children, friends, etc.

How does that relate to the athletic trainer? This concept of stress is something that one must prepare for. Constantly anticipating and developing strategies to manage stress is something that is not taught. I believe secondary school and college students should be required to take courses in adversity, resiliency, and coping strategies. Another area that I am now addressing in athletic training education is anticipating stress with content and skill requirements of the athletic training student.

Here are some considerations in anticipating stress for the athletic trainer:

• For the clinician, look ahead each day to the next day or week. Develop care plans and articulate them to the patient. This lessens confusion, which begets stress. Additionally, plan out daily activities ahead of time, so you are preparing for them instead of reacting to them.

Going into a coach’s meeting with an injury report can be stressful. I was able to work with outstanding coaches at Syracuse University who appreciated what I did in caring for athletes. However, several coaches were always challenging me, my decisions, and my care plans. I anticipated those meetings by being prepared for their reactions and questions and wove into my narrative the answers to potential questions. I also had written out on my report particular answers to questions I anticipated hearing. This reduced any stress. I now teach the advanced part of my classes on performing injury reports to the coach to ready the athletic training student to effectively manage this with reduced stress.

• For the athletic training student, being prepared is the most important element to their academic success. I recommend that they read the assignments ahead of time, preferably before the start of the semester, as I did as a student at Ohio University. They’re all given the syllabus ahead of time. I also recommend they print any slides used in class from Blackboard and bring them to class. That way, they can highlight key content I tell the class that will be on quizzes and tests. Further, I provide all of the skill competencies for the athletic training profession and list them in the syllabus, with corresponding textbook page numbers to review.

The students that struggle come unprepared despite my encouragement and providing them with the materials well ahead of the class sessions. This produces great stress on the unprepared. I find those who do not make athletic training the first and primary focus of their education also struggle. These students are sometimes athletes, in the choir, etc. Unless they are excellent time managers, the overly scheduled student will struggle with stress and have a higher attrition rate.

Learning under stress

A person under stress will degrade to their prior level of training. Having been in many medical emergencies, I can attest that one of the greatest gifts my mentors instilled in me was to learn skills under pressure. The stress that Skip Vosler, MS, ATC, Ken Wright, DA, ATC, and Don Lowe, MA, ATC, put me in while learning my skills made the difference in every medical emergency I was ever involved with. I cannot thank them enough — the athletes’ lives that I helped save also thank them for this educational dynamic.

Now as an educator, I am a strong believer in learning content and skills under pressure. In class, if I ask a question on material we covered (even weeks or months ago) to a student, and they do not know the answer, I quickly ask the next student, and then the next, and so on. In skills lab, I expect skills to be performed right the first time after appropriate demonstration and practice. I encourage the students to practice, practice, and practice their skills, and review content already tested for better retention. We have a beautiful clinic in our building here at Concordia University Ann Arbor, and the faculty members are available to work with the students during non-class hours.

I encourage all students to dedicate themselves to “first thing first.” Their education should be your primary focus, and you should always be studying and practicing your craft. Do not hesitate to look at injuries. While at Ohio University and later during my graduate work at Syracuse University, I confess to literally running in front of others to look at injuries. Repetition of skills and history taking makes all the difference. Repetition also helps address the stressors of performance. Ask any athlete or coach why practice is so important. It is to hone your skills and to learn to perform under pressure.

Responding to stress and the Law of Impermanence

I encourage athletic trainers to respond to — instead of react to — stressful moments. I have been guilty of reacting to stress, and looking back on those moments, I wish I had responded instead.

Now, I try to take a moment to reflect on the stressful moment, pause, and respond appropriately to the moment. This could be a difficult athlete or care case, a challenging coach or administrator, or a fellow athletic trainer on staff. Take the time to know the facts, check your own stress, and respond.

One of the best coaches I have ever worked with was former Syracuse Head Men’s Lacrosse Coach Roy Simmons, Jr. He had a saying that sums this up: “Grace under pressure.” He continuously spoke to the lacrosse team that no matter what was happening, comport yourself under control, and don’t make a stressful moment worse. That motto came in handy dozens of times. I witnessed many instances where events in a game that were going against the team were turned around by the players’ not getting too upset and focusing on the next face-off, ground ball, or goal.

The Law of Impermanence is important in managing stress. All things change — whether for the good or bad. No great moment lasts, and no terrible moment lasts permanently. Keep focused on the present and future. If an injury was missed, or you had a bad moment with a fellow athletic trainer, coach, administrator, athlete, or parent, learn from it and move on. That was a bad moment. Dwelling on it makes it more likely you will miss another injury or be less than effective with the next decision. Try not to take anything personally.

Another area for consideration when experiencing stress is to stay in the cognitive. As an approved instructor of critical incident stress management in my role as an interventionist in the NATA ATs Care Program, advising those in crisis following a critical incident to move toward the cognitive to help normalize their response to stress is very useful. In moments of stress, feel the emotion, but control it. Feel sadness, uncertainty, anger, or frustration. Do not deny your emotion. However, do not dwell on the emotion for very long. Start thinking about the situation and how it is best handled. This helps formulate a response instead of merely reacting emotionally to a disturbing circumstance.

Examples of managing stress and pushing oneself to manage stress

It can be helpful to examine people who have effectively managed stressful moments. This includes family members, friends, and those outside of athletic training as well as fellow athletic trainers. This also includes training yourself to handle stress outside of the profession. Here are some examples I have personally witnessed or experienced:

  • I admire to this day the way my wife, Anne, managed the stress of life-threatening breast cancer and numerous surgeries. She did it with “grace under pressure.” In addition, I witnessed her several times go up to a strange woman in public who was wearing a bandana to hide her baldness due to chemotherapy treatments and reassure her that everything would be okay. That woman was so relieved, and you could see the stress leave her, if only for a short while.
  • I saw first-hand how one of my mentors, Don Lowe, MA, ATC, built very successful sports medicine clinics in the Syracuse area while he was constantly working as the Coordinator of Sports Medicine at Syracuse University. He held clinic meetings at 6 a.m. and worked at night after his busy SU schedule to develop these successful clinics. He managed this hectic SU schedule and the stress of developing these clinics very well.
  • Colonel Charles Reynolds, a retired U.S. Army chaplain, is one of finest people I have ever met. He and I developed a close friendship starting in 2006. I also draw inspiration from him in managing stress. He was in harm’s way for years serving with the 10th Mountain Division in Afghanistan and Iraq. He was able to manage the high stress of caring for the emotional and spiritual needs of the soldiers, surviving attacks, speaking in Christian churches in a Muslim world, and praying over the fallen soldiers in a combat zone. The grace in which he conducted himself in the face of such stress is an inspiration to me.

I urge every athletic trainer to push themselves into stressful moments to strengthen their ability to manage stress. This includes non-professional moments.

A stressful experience that I benefited from while living in Syracuse was volunteering at the Syracuse VA hospital. For several years, I took my late dog, Buster, who was a registered therapy pet, and visited the VA hospital to provide a few moments of normalcy to veterans and staff. While those visits were some of the most cherished moments of my life, they were also full of stress. Visiting with combat wounded, veterans at the end of their lives in the oncology unit, or into the locked area of behavioral medicine could challenge one’s emotions. Trying to speak with and encourage someone in mental and physical pain, with the uncertainty of their life reflected in their eyes, can be stressful.

Thankfully, meeting Buster would break the ice, and oftentimes the service man or woman — who was in tears just a few minutes prior — would brighten up and talk about their dogs or families. I learned a great deal about stress, both in others and in my own way of viewing real stress, through those visits.

Self-care to reduce the effect of stress

Stress is something that never goes away for the athletic trainer. Learning how to manage the stress of being an athletic trainer is a critical component to a fulfilling career. Below are some suggestions on managing stress so stress does not manage you:

  • Self-care. Make sure you are on a good sleep schedule, staying hydrated, and eating regular healthy meals. Stress is hard to manage when you are sleep-deprived, hungry, or dehydrated.
  • Gratitude. Despite tough and bad days, be grateful for the many blessings you have, and realize untold numbers of other athletic trainers, and perhaps millions around the globe, would trade places with you in a second. Each day, I reflect upon and am grateful for my health, wife, children, and friends, being lucky to be born in America, veterans who risked it all to defend my freedom, and to work in and contribute to a profession I love.
  • Support units. Having a significant other, friends, and colleagues to talk with and share some of your feelings with is important.
  • Humor. No matter how difficult a situation is, try to find something humorous about it to lighten the moment. I have been in hundreds of stressful moments in my career, including being cussed out, yelled at, etc. Later, I would chuckle at some of the phrases used and how someone looked while yelling that their team only got powdered Gatorade in a cooler versus individualized Gatorade bottles.
  • Being the one others want to reach out to during moments of stress. Strive to be the person others want to vent to after a bad moment or day. Oftentimes, having someone listen empathetically is all a person wants. All athletic trainers have had bad days, been yelled at, or experienced sudden scheduling changes that are frustrating, let alone a difficult injury to navigate. We understand … I am an athletic trainer too.
  • Establish relaxation moments. The athletic trainer must have moments where they can relax and release from the pressures of the profession. I enjoy working out, spending time with my wife, talking or texting with my children, playing with the dogs, reading, or connecting to friends.

Managing stress is a critical element to a successful and fulfilling athletic training career. Having some information on stress and knowing it is all right to feel it is normal. Controlling it so it does not control the athletic trainer is the goal.

Timothy Neal, MS, AT, ATC, CCISM, is Assistant Professor and Program Director of Athletic Training Education at Concordia University Ann Arbor. Previously, he spent more than 30 years at Syracuse University, serving in a variety of sports medicine roles. Neal is also a member of the Ohio University Alumni Association Board of Directors.

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