Athlete based treatments

Hello Everybody,

In today’s SOAP Note I will discuss routine treatments or as I often call them, “the feel good stuff”. I would classify these as treatments that are performed almost daily on an athlete, or treatments that the athlete asks for based on what they like. Typically with the intent of just making the athlete “feel good” prior to activity without relation to any particular injury. I work mostly with baseball athletes, so most of my discussion will use baseball specific examples but this topic fits with any sport.

In my undergrad studies, one thing that was consistently imposed on me was being able to answer the question “why?” this is also something I always reinforce to my students. Part of answering “why” for treatments is being able to justify what treatments you decide to use based on sound medical science. Godforbid you find yourself in court, they will judge you against decisions made by a prudent athletic trainer faced with the same information. This is the reason that I always try to make sure I can justify my treatments with medical logic.

That being said, because of my principle “I can never affect your body as much as you can” I have recently started allowing for more patient input in regards to their treatment. Let’s use the example of an athlete who is rehabbing for rotator cuff weakness and let’s assume today’s exercises are focused on the upper back (scap stabilizers). After completing their rehab protocol for the day, I typically ask the athlete if they want to ice their arm or not. In my medical opinion, the rehab exercises shouldn’t have caused any inflammation and ideally the athlete completed the protocol with no pain. I have no pressing reason to now ice his/her shoulder, but I find (especially with baseball) they like to ice after. Same thing with e-stim.

I used to get frustrated with athletes who would ask for a specific treatment because I’m the one who is held liable and therefore should be making the decisions. As I slowly started to form my principle, I realized that consciously or subconsciously the athlete will know what is best for their injury by what “feels good”. Therefore their opinion should hold more weight when it comes to treatments. For example if I’m faced with a scenario where I have no medical objection, I will allow the athlete to make a decision on what treatment they will get. Usually I provide options with similar treatment goals and let them tell me what they want. I’ll ask “Graston or a massage?” Or “ice cup? Ice bag? Or stim and ice?” Occasionally I will want a specific modality for whatever reason, but more and more I am including the athletes into the conversation.

There’s a difference between being hurt and being injured. Being injured requires tissue damage that will result in time lost from activity. Being hurt is usually more of the achy pains or dull pains that are just bothersome, like being extra sore from weights. Some sports result in athletes being hurt a lot. Baseball, I would argue is a sport that gets athletes hurt more often than injured with it’s notorious shoulder aches and pains as an example. Baseball is also notorious for superstitions. This combination leads to athletes coming into the athletic training room asking for this and that because that is what they feel they need to get ready since last time they had that particular modality they hit a homerun. As I mentioned before, this kind of behavior used to be very frustrating for me. But then my thought process changed. For athletes who are merely hurt and not injured I started to accept more of their own input. Of course I have boundaries, and I would never let an athlete just roll over me and start dictating their own treatment. I’ve been able to build a good rapport with the athletes I’ve worked with, and part of that is related to how I include the athlete in his/her own treatment.

One last thing I want to touch on before I wrap this up. The biggest hurdle I had to clear before accepting more input from the athletes was myself. I had to check my ego at the door a little bit to let go of complete control over treatments. Ego plays a funny role in the sports medicine/performance world. It’s important to be confident in what you’re doing (be able to answer “why”) but that is different than having a big ego. A collegiate student-athlete is constantly getting pulled in multiple directions from professors to coaches to parents to therapists. When one of those elements catches an ego and pulls more than they should, the student-athlete is the one who suffers. This looks like overtraining, stress related injuries, lack of sleep, poor grades, poor athletic performance, etc. As an athletic trainer, we are often responsible for the health and safety of 40+ student-athletes, sometimes across multiple teams too. It’s easy to lose sight of what we are here to do. I know I have personally been guilty of this from time to time (especially in grad school when I was balancing a full time job and classes of my own). However, we are support staff. We are here to support the student-athlete. I’m not arguing that athletic trainers should work more hours (is that even possible?) or aren’t doing their jobs correctly. Just a simple reminder so that maybe you will read this and check in with one of your athletes that has maybe been slipping lately.

I want to hear your thoughts. Is it okay to take an athlete’s opinion into consideration with treatments? Or should we maintain our decision making for our sake and theirs? Do you have any experience with somebody’s ego disrupting your job or interfering with the welfare of the athlete? Do you think ego is ever an issue for athletic trainers?

More next time,

Mark D.

@MarkDomATC