May 16, 2015
The Next Frontier
Mark Letendre

Increasingly, athletic trainers are finding fulfilling careers in non-traditional environments. In this three-part article, authors share how they work with MLB umpires, police officers, and aerospace professionals.

The following article appears in the May/June 2015 issue of Training & Conditioning.

Back when I was an athletic training student at the University of Maine in the early 1970s–before the profession had been fully recognized–I never dreamt I would one day direct Major League Baseball’s Umpire Medical Services. Now in my 16th year providing care for what I consider to be the league’s 31st team, I’ve been able to put my athletic training skills to use in a position like no other.

My first taste of work in MLB came when I got a job as an athletic trainer for the New York Yankees in 1978. I learned much of what I know now from longtime Yankee Head Athletic Trainer Gene Monahan, ATC, who spent nearly 50 years with the club before retiring in 2011. And although George Steinbrenner wasn’t the easiest employer to work for, he stressed accountability, professionalism, and honesty–traits that I’ve carried with me throughout my career.

Eight years after starting with the Yankees, I became the Head Athletic Trainer for the San Francisco Giants and was eventually appointed the team’s Director of Medical Services in 1997. In this role, the sports medicine and strength and conditioning staffs reported to me, and I developed programs to educate players about personal wellness. Little did I know this position was a harbinger of my future career.

In 1999, MLB Commissioner Bud Selig started drawing up plans to create a sports medicine team for the league’s umpires. Because I had been a vocal presence and served in several leadership roles throughout my 20 years in the league, I was asked to be the director of this new program. I knew I was accepting a challenge, but that’s what made the job so appealing. It was a once-in-a-lifetime opportunity that I knew would make a huge impact on the well-being of an underserved population.

I am now responsible for the health of 76 major league and 22 minor league call-up umpires. Over the years, I have created an all-encompassing umpire wellness program. It incorporates both treatment of on-field injuries and addressing lifestyle management issues.

Although umpires are not necessarily athletes, they engage in athletic movements, and the nature of their job is physically demanding. For instance, home plate umpires are required to move in and out of a squat position for three hours or more. Officials also go from being static to dynamic over and over during a game. Every ball put in play requires all four umpires to move–sometimes up to a 45-foot run from a set position. And they frequently lunge in various directions to get a better look at a play.

Because of these movements, the primary injuries I see in umpires are soft-tissue contusions. In addition, there are a significant amount of muscle pulls and overuse injuries.

The difference between Umpire Medical Services and a more traditional sports medicine staff is we don’t have a central brick-and-mortar location. Instead, we use a virtual network of medical care, which stores a digital database of information for each official.

When an umpire injury occurs during a game, the home team’s sports medicine staff takes care of any emergency situations and triage. Once the injury is diagnosed, the umpire enters the virtual medical network. I receive video clips and images via text message from MLB Advanced Media when injuries happen. Our sports medicine physician and I review the images and have a phone conference with the home team’s athletic training staff to determine what level of care is necessary and the best course of immediate action. Together, we decide whether the official should receive treatment in his current city, obtain care in his next assigned city, or go home.

Beyond treatment, Umpire Medical Services puts a lot of effort into injury prevention. In 2000, we started examining the various planes of motion the umpires engage in and designed a flexibility, symmetry, and core regimen from that data. Then, our physician, physical therapist, functional movement expert, and I customize it to each major league umpire. We provide exercise equipment like stretch tubes, yoga balls, foam rollers, massage sticks, stretch straps, and mats, as well as a stretch station in the umpire rooms at each ballpark so they can complete their workouts.

Additionally, gear plays a large role in warding off injuries. To prevent heat illness in the umpires, we use a technology called X-temp, which is a phase-change pack that extracts heat when it touches the body. We also worked with the officials’ shoe provider to design footwear with a bit of lift in the sole to keep their lower legs from being pre-stretched when standing.

Besides injury treatment and prevention, Umpire Medical Services offers wellness advice to provide lifestyle management techniques. Umpires have extremely challenging daily lives. They typically work night games and then must travel to their next scheduled location at the crack of dawn the next morning. Airplane food, dehydration, and the physical requirements of their job all take a toll on their health. My department’s goal is to provide information and resources to mitigate as many of these issues as we can.

We started by addressing scheduling concerns. For the most part, MLB avoids asking crews to fly across three time zones and work in the same day. Time off is another essential element in maintaining a balanced life. Currently, our umpires are provided four weeks of vacation throughout the season.

We also offer dietary guidance. After compiling a list of the umpires’ favorite restaurants in each city, our nutritionist picked out the healthiest options on each menu so officials are able to maintain some semblance of nutritional health when they eat out night after night.

Despite it being my 16th year in this position, I still wake up excited for new challenges every day. I feel satisfaction in knowing that I’ve helped numerous umpires stay on the field. Providing officials with comprehensive care was a missing link in professional sports, and since MLB started, both the National Basketball Association and National Hockey League have followed suit.

Protect & Serve

By Nancy Burke

Nancy Burke, MS, ATC, VATL, is Athletic Trainer for the Fairfax County (Va.) Police Department. She is the founder of the Public Safety Athletic Training Society and owns Injury Management for Public Safety, a consulting company. Named a NATA Most Distinguished Athletic Trainer in 2004, she is a member of the Halls of Fame for the Virginia Athletic Trainers’ Association and the Mid-Atlantic Athletic Trainers’ Association. Burke can be reached at: [email protected].

For the first 30 years of my career, I was a fairly typical high school athletic trainer. I taught classes in sports medicine, health, and physical education while providing care for athletes at South Lakes High School in Reston, Va. Coupled with my experiences as a Site Medical Director for the 1996 Olympic Games and Chair of the U.S. Lacrosse Sports Science and Safety Committee, I was content.

However, over the years, I found that every encounter in life can lead to something else if we remain open. So when fate intervened in 2005 with a chance for me to provide athletic training care to the Fairfax County (Va.) Police Department, I seized the opportunity. I’ve been here ever since.

My foray into law enforcement injury care started as conversations with the officers assigned to cover South Lake’s athletic events. They frequently asked me questions regarding injury care and prevention, bracing, nutrition, and overall fitness. Over time, they started commenting, “We need an athletic trainer in the police department.”

The turning point occurred when the local station lieutenant asked me to expedite an injured officer’s orthopedic evaluation and entry into rehabilitation. The experience of getting this officer back to work led me to make an overture to the Fairfax County Police Department to hire an athletic trainer. I sent a letter of interest to a commander, and we met to discuss how an athletic trainer could assist in reducing the department’s medical costs and time lost due to injury.

The commander was convinced, so we collaborated to create an athletic training position for me. I was excited for the challenge of trying something unique, where my presence could make a huge difference in medical costs, quality of life, and work productivity.

We started a pilot athletic training program at the Fairfax County Police Academy in 2005. As is often the case when an athletic trainer enters a new setting, there was a significant learning curve for both sides. To educate staff and recruits about my services, I met with them individually.

However, my treatment of a traumatic injury is what made the biggest difference in helping officers to understand what I did. A recruit with a dislocated shoulder was able to continue training rather than face dismissal due to his injury thanks to a treatment and rehabilitation plan I put together.

On my end, I took to studying the law enforcement industry, as my knowledge and experiences from the world of athletics did not cover all the bases. First, I learned the terminology, rank structure, worker’s compensation procedures, risk management, and human resource requirements for injured workers.

Next, I took a look at the job’s physical requirements so I could better assess when an injured employee was ready to return to work. I reviewed the officers’ uniforms and equipment to acquire an understanding of the challenges and limitations of wearing them. I also did ride-alongs to learn the demands of the “moving office,” which included a trip to the driving track for a tutorial on law enforcement driving skills. Finally, all sworn law enforcement officers carry a gun, so I learned about shooting handguns, rifles, and shotguns to assess what was required to hold them and absorb the forces exerted when they are fired.

The pilot program was successful and expanded to the entire Fairfax County Police Department in 2006. Currently, I serve more than 1,700 employees, which includes fire marshals and animal control workers.

Part of my job entails education. I go to worksites around the county to teach employees about injury care, concussion management, and other wellness issues. But most of my day is spent in the athletic training room, located at the training academy and open to all recruits and officers via scheduled appointments or walk-in visits.

My weekly schedule is eight hours a day, five days a week. A typical day for me starts with checking injury reports and receiving patients for assessments and treatment. Then, I might meet with academy staff or the Department Injury Review Committee, observe training, and assist with safety matrices for recruit and incumbent training.

Many of the injuries sustained by law enforcement officers are musculoskeletal, but with employees that range in age from 21 to over 65, I frequently see meniscuses that have had too much trauma or tendons that have been stressed to the limit. Additionally, I encounter environmental illness, concussions, deer tick bites, contusions, and general illness.

Even though some of the injuries sustained are similar to those of athletes, the scenarios in which officers are hurt vary drastically. Common mechanisms include chasing suspects over uneven ground, going over or through barricades, and being physically accosted by a suspect.

If you’re looking for a career as an athletic trainer in the law enforcement industry, I recommend you start by talking to a mid-level commander, not the chief. The chief gives the ultimate “Yes” or “No” on a project, but it’s a lower-level administrator who can pick up your idea and make it happen. The key is to convince them that athletic trainers can reduce lost work time, cut medical costs, and improve employee outcomes.

Even if an agency is initially resistant to hire an athletic trainer due to a lack of funding, don’t take this response as a definite, “No.” Is your local department hiring 20 recruits? Convince them to hire 19–and one athletic trainer. It won’t be long before the medical savings and reduced lost work time more than make up for your salary.

I do have one word of caution for athletic trainers hoping to work in law enforcement: These are not entry-level positions. I recommend five years as a head athletic trainer before pursuing a job in this industry.

At the Fairfax County Police Department, the recruits, officers, and commanders have accepted me as a key component to their overall wellness. As of early 2015, only one-third of the department has known a time without an athletic trainer on staff, and that number is shrinking every year. There is a commitment in law enforcement to protect and serve, and I’ve found that athletic trainers can play a vital role in achieving this mission.

Ground Control

By Mary Kirkland

Mary Kirkland, MS, LAT, ATC, is Athletic Training Supervisor for the RehabWorks program located at Florida’s NASA Kennedy Space Center. A former chair of the NATA’s Council on Employment and two-time president of the National Coalition for Promoting Physical Activity, she was honored as a NATA Most Distinguished Athletic Trainer in 2009. She can be reached at: [email protected].

All my life, I’ve been a part of NASA. Growing up, my father was a Kennedy Space Center (KSC) engineer who worked on the Apollo, Space Shuttle, Atlas, and Delta programs. Following college and graduate school, it only seemed right for me to return to Florida’s Space Coast to start my professional athletic training career.

My dad had told me about a job opening in the KSC Fitness Center, so I applied and was hired, working for a summer in 1987. I returned in 1989 as an Exercise Specialist, and I provided health and wellness services to KSC.

Knowing I was an athletic trainer, employees from every department would ask for my help in dealing with injuries or recovering from surgery. Over time, I began to see the need for an established athletic training clinic at KSC to more formally address these issues.

In 1996, I proposed the creation of such a clinic to NASA management, offering my services. They agreed and gave me a 100-square-foot space in the Fitness Center that served as the first site of “KSC RehabWorks,” NASA’s first and only athletic training and musculoskeletal rehabilitation clinic.

After an initial year of success, RehabWorks moved to a 400-square-foot space and hired another staff

athletic trainer. Since then, RehabWorks has continued to expand. Now housed in a 1,500-square-foot facility, the clinic is staffed with two full-time athletic trainers, administrative support, and a well-established athletic training internship program.

RehabWorks is open Monday through Friday from 8 a.m. to 5 p.m. Mondays, Wednesdays, and Fridays are patient treatment days, when KSC employees can come in for evaluation of work, non-work, or sports injuries, as well as receive pre- and post-op rehabilitation when needed. These appointments typically last an hour, and most patients have two to three appointments per week. Tuesdays and Thursdays are dedicated to new patient evaluations and employee injury prevention outreach and training.

I see a diverse group of patients, from college student interns to septuagenarians whose NASA experience dates back to the Apollo missions. Their job titles include astronaut, engineer, administrative professional, janitor, IT specialist, road and grounds personnel, SWAT and security officer, researcher, and scientist, just to name a few.

Unlike my colleagues in the high school or college athletic settings, I don’t see many acute sprains, strains, fractures, or contusions, and the ones I do see often come as a result of recreational sport activities. Instead, the type of care I provide is more geared toward evaluation, diagnosis, and treatment of symptoms and functional loss due to subacute, chronic, or post-operative conditions. Specifically, I treat a lot of cumulative trauma disorders, such as carpal tunnel syndrome, epicondylitis, and “tech neck,” as well as low back pain and radiculopathies. And with an aging workforce at KSC, I’ve seen an increase in degenerative issues like total joint replacement, lumbar stenosis, and joint decompression/debridement.

One of my favorite experiences with RehabWorks was serving on NASA’s Aerospace Medical Team from 1998 until the Space Shuttle program ended in 2011. I provided athletic training services for American and international astronauts during the launch and landings of several space shuttles, including John Glenn in 1998 after his return to space on STS-95; Eileen Collins–NASA’s first female shuttle commander–who commanded the STS-114 “Return to Flight” after the loss of Space Shuttle Columbia; and Pam Melroy during her missions as a pilot on STS-92 and space shuttle commander on STS-112.

In the three days leading up to a launch, the astronauts would be quarantined in crew quarters, which is located in the same building as RehabWorks. My role was to help them stay “launch ready” for the mission, primarily through athletic training modalities, massage, or stretching.

When the astronauts would return from a mission, I had similar responsibilities. It takes some time for the body to adjust when going from a 0G to a 1G environment, and the astronauts would occasionally experience backaches due to the elongation of the spine in space. Often, heat and massage worked to get them back to feeling 100 percent.

In addition to treatment, one of my biggest passions is injury prevention. My most recent undertaking at KSC has been the development and implementation of a Balance Initiative to reduce a rise in injuries associated with slips, trips, and falls. The project uses a combination of old-school methods, like balance boards and agility drills, with the latest technology of Wii Fit games to build proprioception. The goal is to teach our employees how to respond to a sudden change in surface or body position without getting hurt.

In all my time at KSC, the only drawback to my position has been budgetary constraints. Working for the government, my budget is dependent on appropriated funds, which can make expanding staff and services difficult. Having said that, I have had full, continuous support from NASA management, and I’ve been able to advocate for funding during difficult financial times by demonstrating the value RehabWorks brings to KSC.

Each patient visit has saved an estimated four hours of workforce productivity. Instead of employees having to spend half a day offsite seeing an orthopedist or therapist for injuries, they can make an hour-long appointment with me. And with reduced time lost due to injury, decreased insurance costs from fewer doctor visits, and prevention programs that keep injuries from happening, the return-on-investment for RehabWorks is $2.82 for each $1.00 spent in the program. With more than 50,000 patient visits since the program’s inception in 1997, this equates to a savings of several million dollars over its 18-year lifespan.

Even after 26 years, I still feel like I have the best job in the best location, caring for some of the best professionals in the country. Where else can athletic trainers be part of America’s space program, watch shuttles and rockets launch, and contribute to the exploration of the universe? I truly feel blessed beyond belief, and I’m grateful each day for an incredible athletic training career.

Mark Letendre, ATC, has been Director of Umpire Medical Services for Major League Baseball since 1999. Previously, he spent 20 years as an athletic trainer in the New York Yankees and San Francisco Giants organizations. He can be reached at: [email protected].

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