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Do High School Athletes Really Need Athletic Trainers? Part II: Concussions and Time-Loss Injuries

Several leading medical organizations, including the American Academy of PediatricsAmerican Medical AssociationAmerican Academy of Neurology and others, recommend that high schools employ athletic trainers to care for athletes and prepare for sports-related emergencies. Many physicians, coaches and athletes attest to their value. But until recently little research has actually measured their impact on the health and safety of student athletes.

“The athletic trainers know the athletes,” says Stan Herring, M.D., cofounder of The Sports Institute at UW Medicine and a team physician for the Seattle Seahawks and Seattle Mariners. “They see the athletes frequently, if not every day. They know when something is wrong. They are medical professionals who evaluate, treat and rehabilitate athletes. It’s important that we document whether the evidence supports our perception of their contributions.”

Three recent studies suggest that athletic trainers are linked to significant improvements in the diagnosis of concussion in young athletes and significant reductions in “time-loss” injuries that require athletes to take time away from sports.

(Note: In Part I of this series, we reviewed the evidence assessing the impact of athletic trainers on survival after emergencies.)

Making concussions safer

concussion is an injury to the brain. Prompt recognition and immediate removal from play are critical for a full recovery. Doing both will speed an athlete’s recovery and prevent a potentially more-devastating repeat concussion. But many athletes don’t report their symptoms, and many coaches fail to recognize them. (See our article, Why it is critical to report concussions.)

Two recent studies illuminate the vital role athletic trainers play in recognizing concussions in young athletes. They compared concussion diagnosis rates at schools with or without athletic trainers.

In one, researchers from the University of Colorado analyzed concussion data from more than 200 girls’ high school soccer and basketball teams. Five to eight times more concussions were diagnosed in schools that had a full-time athletic trainer compared to schools with no athletic trainer.

The researchers say it’s unlikely that fewer concussions are occurring in schools without athletic trainers. More likely, they argue, athletic trainers are seeing injuries others miss. “[Athletic trainers] are better skilled than coaches and athletes in identifying signs and symptoms of concussions and more adamant that athletes suspected of concussion be removed from play until cleared for return by an appropriate health care provider,” they say.

In another study, researchers asked 144 high school football and soccer coaches across Washington State to report the number of athletes on their teams who sustained a concussion within the most recent season. Some schools employed athletic trainers and some did not.

  • Compared to high schools without athletic trainers, high schools that employed athletic trainers reported significantly more concussions in boys playing football and soccer. (Concussion diagnoses among girls playing soccer were no different.)
  • There was a two- to four-fold greater chance that multiple boys on a team would be diagnosed with a concussion if a school employed an athletic trainer.
  • Schools that did not have athletic trainers were more likely to be rural, have low student enrollments and have more youngsters eligible for school lunches.

“[S]tudents who sustain a concussion at schools with fewer resources are less likely to have their concussion diagnosed as [a] result of the lower odds of an [athletic trainer] being employed at their school,” observed Emily Kroshus, Sc.D., M.P.H., and colleagues from the University of Washington. Because failure to diagnose a concussion can lead to a range of concussion-related problems, they note, “identifying all concussions is an essential aspect of harm reduction.”

Reducing the burden of time-loss injuries

The vast majority of athletes treated by athletic trainers return to sports the next day. But less common problems often have a bigger impact and require athletes to take time off from sports. These include noncontact injuries such as anterior cruciate ligament (ACL) tears and ankle sprains that occur when cutting, stopping or landing from a jump. They also include overuse injuries such as tennis elbow or shin splints that sometimes develop when athletes repeat the same activity over and over.

The University of Colorado researchers compared rates of these injuries and repeat injuries among girls soccer and girls basketball players in more than 200 U.S. high schools. About half of the schools employed full-time athletic trainers and about half did not.

Youngsters at schools with full-time athletic trainers had significantly fewer ankle and knee injuries, noncontact or overuse injuries, and repeat injuries.Schools with athletic trainers reported:

  • About half as many ankle and knee injuries
  • About half as many noncontact or overuse injuries
  • Four to six times fewer repeat injures

By recognizing and treating injuries early, suggest Lauren Pierpoint, Ph.D., and colleagues, “[athletic trainers] likely prevent at least some from becoming time-loss injuries.” Athletic trainers may also help by putting into place programs designed to prevent ACL tears and ankle sprains. Another likely benefit: Saving money for injured athletes’ families “who might otherwise seek care in a medical clinic, urgent care center or emergency room.”

Inequities in services and outcomes

The barriers to hiring an athletic trainer can be considerable. Lack of funding, small student enrollment or a rural location can hamstring a school’s ability to attract or pay for one.

The current research across this field—whether it is assessing time-loss injuries or survival after sudden cardiac arrest—reveals that youngsters who are poorer or nonwhite have limited access to athletic trainers and health services that can alter the course of their athletic careers and lives.

“The evidence supporting the work of athletic trainers is growing, and strengthens the endorsements from professional societies,” says Herring. “Now we’ve got to do better at righting the inequalities of access, and help make these important health care providers available to more people.”