While March may well be synonymous with basketball madness, there is another reason to celebrate. It’s perhaps less known but vital to athlete health.
March is National Athletic Training Month, recognized each year to spread awareness about the important work that athletic trainers do. This year’s slogan is “Essential to Healthcare.” The open secret is that athletic trainers are healthcare professionals who specialize in the prevention, diagnosis and treatment of injuries.
And the field is booming.
According to the United States Bureau of Labor Statistics, athletic trainer employment is projected to grow 23 percent from 2016 to 2026, steeper growth compared to other healthcare practitioners and technical occupations. More people are becoming more aware of sports-related injuries and an active youth and adult population may need additional support.
Athletic trainers are the first off the bench when an athlete goes down.
“We’re the first responders and we take great pride in making sure that we’re actively prepared in emergency medical situations, being able to provide any necessary emergency skill when it comes to a heat illness or a concussion management or a heart problem,” said Dr. Ky Kugler, a professor and associate dean at Chapman University in California.
Like many athletic trainers, Kugler always looks forward to the arrival of March.
“We’re always excited for March to come about,” he said. “Certainly coincides a little bit with March Madness. I guarantee you every athletic trainer that’s still involved in March Madness is dealing with bumps and bruises and sprained ankles or strained hamstrings or low back spasms.”
For some, if not most, athletic trainers, the desire to work in the field stems from two passions: helping others and being involved in sports.
At the University of Southern California, associate athletic director for athletic medicine and head athletic trainer Russ Romano has been a trainer since 1991 and on staff since 1993. Romano has been head athletic trainer since 1998.
His passion for this field began at a young age. “I’ve always been really interested in medicine and I grew up playing sports, and there’s nothing better than combining the two,” he said. “So being able to help our student-athletes medically while they’re participating athletically is the perfect blend of sports medicine for me.”
As head athletic trainer, Romano oversees 16 staff members who provide medical assistance and guidance to over 600 student-athletes across 21 sports.
Senior Sydney Tullai is a former USC cross country and track and field athlete. Tullai’s career came to an end when she took an internship with Fox Sports and decided to focus on her future long term.
During her time as an athlete, she said trainers indisputably prolonged her career.
“There are many times where my athletic career could have been cut short or just difficult to come back from things [because of] a physical or mental side of competition when you get injured,” said Tullai. “It’s really tough. To have that encouragement of, ‘We’re going to make it through this together, [and] here’s the step-by-step process of how we’re going to do it,’ it definitely allows for athletes [like myself] to have a more successful career long term.”
To become a certified athletic trainer takes time and education: they must complete a program that is accredited by the Commission on Accreditation of Athletic Training Education (CAATE) and passing the Board of Certification (BOC) exam.
According to the National Athletic Trainers’ Association, more than 70 percent of athletic trainers have earned a master’s degree. Since 2020, all accredited programs are offered at the master’s level only.
Forty-nine states and the District of Columbia license or regulate athletic trainers. California is the only state that does not.
When athletic trainers travel to other states with their teams or companies, they can risk their jobs because of the lack of licensure in California. The unlicensed status causes athletic trainers to practice outside of the law in those states, which can invalidate their malpractice insurance.
In California, trainers are certified, not licensed. According to the Board of Certification for Athletic Trainers, licensed athletic trainers have the legal right to practice. Certification is voluntary, and for certified athletic trainers this means that a professional body – for example, the BOC – has determined that their knowledge and skills have met a predetermined standard.
Romano, like Kugler, urged change. “Why would [California] be the only state in the country not to recognize and basically license athletic trainers so that the public would know that they’ve met certain requirements?” said Romano.
“That’s been a struggle and it’s something that I’m hoping that we can accomplish in the very near future,” said Romano.”
Kugler said having licensure allows different states to regulate what their athletic trainers can or cannot do when it comes to the services they provide and who they may be able to serve.
For example, dry needling is a technique that is used in some states but not all. According to the NATA, the treatment may increase blood flow and relax trigger points related to muscular tension, resulting in decreased pain and improved function. Before athletic trainers perform this technique, they must ensure their state practice act does not bar them from performing it.
For example, according to the Integrative Dry Needling Institute, this technique is allowed in Delaware but not in California.
Dr. Mimi Nakajima, director of the athletic training program at Long Beach State University, says because there is no regulation on this profession, anyone can claim he, she or they are an athletic trainer. This could put many clients and young athletes at risk because someone may not have the proper knowledge and training to be providing medical assistance.
“There has been increasing awareness among youth sports, high schools and [more], but there’s still so many people that call themselves [athletic] trainers and they work in the shoes of one,” said Nakajima. “Sure, they do something that’s similar to what athletic trainers do, but they never went through the proper training or education and that has caused injuries, that has caused death.”
According to the California Athletic Trainers’ Association, 48.5% of California high schools do not have an athletic trainer onsite at any athletic events. In theory, if not in practice, this puts 277,386 student-athletes at risk every day because there is a lack of medical care or unqualified medical care at athletic events.
The site also asserts that 13 percent, or one in six people, currently work and call themselves athletic trainers in California high schools. Since the state does not regulate the profession of athletic training, some “trainers” are either unqualified or they have not met the requirements.
When there is no medical staff on-site, there is a great risk. They can try to prevent injuries with proper preparation and aid, but regardless of if they are present or not, injuries are bound to happen -- with 64% of sports injuries occurring at practice.
One of the most common misconceptions is that athletic trainers are specifically meant for athletes. Nowadays, athletic trainers can be found anywhere in different industries, said Nakajima.
“Many athletic trainers are now hired in industrial settings,” Nakajima said. “So, Boeing, Amazon, Google, all of them hire athletic trainers because we could work with ergonomic things and prevention because posture and whatnot will influence productivity. There’s also [athletic trainers] working in performing arts. So, Disney, Cirque du Soleil, ballet, all of those kind of performing arts companies will hire athletic trainers as well, and [including the] military setting [such as the] FBI, firefighters.”
While National Athletic Training Month lasts the whole month long, Romano and many other athletic trainers said the job is a day-to-day thing -- providing care and help for others.
“It’s great to be able to execute that on a daily basis and go home knowing that you did the best you could,” said Romano. “That just gives us so much satisfaction as health care professionals to know that we can deliver. It’s really nice to be recognized, but that’s not why we do what we do. I think we have an incredibly important role because nothing’s more important than your health.”