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Athletic training in dance medicine and science.

The field of athletic training has long been misunderstood. It is time to take another look at the robust competence possessed by certified athletic trainers and bring to an end the confusion that often misconstrues the legal and practical capabilities and tested skill set of this profession. A clear understanding of athletic trainers is particularly important now as the orthopaedic sub-specialty of dance medicine and science continues to grow and relies more and more on the international community of dancers, teachers, choreographers, scientists, healthcare providers, and others to develop and share vital knowledge toward the ultimate goal of supporting optimum health and wellness among dancers. This special issue of the Journal of Dance Medicine & Science provides readers a fresh perspective on the field of athletic training and insight into the role of the athletic trainer as a present member on the world stage of dance medicine and science.

Much like dance as a profession, modern day athletic training can be traced to ancient Greek civilizations; with the birth of organized sport came the need for sport-specific healthcare practitioners to prevent and care for injuries. (1,2 ) The establishment of university athletics in the United States during the late 1800s brought about the early stages of athletic training as we know it today. The field continued to evolve: the National Athletic Trainers' Association (NATA) was officially formed in 1950 with the purpose of establishing professional standards for athletic trainers, and its subsequent alliance with the National Collegiate Athletic Association provided a means to measure, in a valid and standardized way, the number and rate of athletic injuries in order to better protect athletes from sustaining injury (an initiative begun by the US Centers for Disease Control in the early 1900s). Today, athletic trainers play a major role in the health care of athletes and physically active people around the world, as further evidenced by the charter membership of the NATA in the World Federation on Athletic Training and Therapy (WFATT), a coalition of national organizations whose mission is to promote the highest quality of healthcare and functional activity for active populations worldwide. (3)

Despite the depth and integrity of this rich professional heritage, there continues to be a lack of understanding both in the United States and abroad of the athletic trainer's role as an allied healthcare professional. According to O*Net OnLine, a consortium funded by the U.S. Department of Labor, athletic training, chiropractic, physical therapy, dietetics, and nutrition are allied healthcare occupations that fall into the Job Zone 5--occupations involving extensive preparation. (4) The preparation to become a certified or licensed athletic trainer includes completion of a Bachelor's or Master's degree from an accredited athletic training educational program that meets the strict educational standards of the Commission on Accreditation of Athletic Training Education. These programs require a minimum two-year competency-based curriculum in classroom and clinical settings with a variety of populations along a continuum of care. Upon completing educational requirements, students take a national certification exam designed to assess their ability to resolve cases similar to those they might encounter in practice. To ensure professional growth, athletic trainers are required to obtain 75 hours of medically related continuing education credits every three years; additionally, they must maintain health professional emergency cardiac care certification annually.

Historically, the athletic training profession has been concerned with the athlete's health and safety. Today's athletic trainers have evolved into unique healthcare professionals who practice in a variety of settings specializing in the prevention, diagnosis, treatment, and rehabilitation of injuries and illnesses in physically active people. (5) Certified athletic trainers have positively impacted musculoskeletal disorders by significantly reducing re-injury rates and time loss from non-surgical injuries. They have produced outcomes that are equal to or better than those of other allied healthcare professionals. (6,7)

The title Certified Athletic Trainer is reserved for an individual who has properly qualified, and pledged to uphold the standards and ethics of the NATA. Often, the term athletic trainer is inappropriately used interchangeably with "trainer"--someone who trains or coaches animals or humans--or the more recent term "personal trainer"--someone who, on the basis of this title alone and without additional credentialing , is limited to assessing and designing exercise regimens to assist individuals in achieving fitness goals. Additionally, unlike the stringent education requirements and numerous hours of field work the certified athletic trainer must complete, the role of "personal trainer" has no uniform requirement for college education or hours of preparation. These are very different occupations and need to be recognized as such by use of the proper title "Certified Athletic Trainer" or "Athletic Trainer," not just "trainer."

Another area of confusion is between certified athletic trainers and physical therapists. Athletic trainers and physical therapists share a number of common clinical skills; often they jointly contribute to the development of treatment and rehabilitation programs. In some cases, athletic trainers hold a second credential as physical therapists. While physical therapists are prepared to treat diverse patient populations and injuries, the athletic trainer is primarily focused on preventing and treating illness and injury in physically active populations, including conventional and non-conventional sports, industrial settings, law enforcement, youth programs, the military, and the performing arts. The broad range of employment settings has resulted in advanced healthcare delivery and changes to the educational programs to ensure that athletic trainers' professional competencies and proficiencies are universal. (2)

Traditional athletic training settings include secondary schools, colleges and universities, and professional sport teams. However, with the NATA's current membership of 32,000, athletic trainers now also serve a much broader population, with more than 400 athletic trainers working in 25 countries outside the United States. (3) The majority are employed in nontraditional settings such as physician offices, hospitals, emergency and urgent care centers, military medical clinics and hospitals, physical therapy clinics, commercial settings, or with performing arts groups.

Athletic trainers bring a unique skill set to these "non-traditional" settings, including the cornerstone philosophies of injury prevention, acute care, and the ever-important transition from clinical rehabilitation back into a high level of participation. In each setting, they adapt the traditional sports medicine model, and thereby provide a major link between the organization, the patient, and the medical community. When functioning as a physician extender, the athletic trainer's tasks vary but, in general, he takes the medical history, assesses the patient, and reports findings to the physician. After the physician makes a medical diagnosis, the athletic trainer may arrange for further testing, fit the patient for crutches or braces, develop the rehabilitation program, prepare the patient for injection, retrieve test results, and so forth. In this role, the athletic trainer, having more time to spend than the physician, also serves as an educator. These billable services permit optimum patient care while freeing the physician's time for higher patient volume, increased efficiency, and revenue.

Certified athletic trainers have been involved in dance medicine and science since at least 1981. (8) Currently they work in numerous dance settings including professional companies, collegiate, university, and conservatory departments, and community programs, as well as in clinical, research, and educational institutions. In these settings athletic trainers act as a primary party responsible for injury prevention, body conditioning, first aid, injury evaluation and management, dance-specific rehabilitation, education, initial psychosocial intervention and referral. (2) They provide on-site athletic training services for dance class, rehearsal, and performance, as well as clinical time before and after these activities. Athletic trainers work with physicians in conducting pre-participation screenings to minimize injury and illness risk and to expedite care and referral to additional healthcare professionals when necessary. Shared philosophical opinions and clear communication with the physician and other allied healthcare professionals facilitates timely and appropriate return to dance activity. Athletic trainers may also communicate pertinent and legally appropriate information to the teacher and choreographer to assist with the injured dancer's safe transition back into class, rehearsal, and performance.

The articles presented in this issue exemplify the knowledge and skill that certified athletic trainers contribute to dance medicine and science. The authors, all of whom are certified athletic trainers, merge dance-specific research methodologies with fundamental philosophies based in the six major practice domains of athletic training: prevention; clinical evaluation and diagnosis; immediate care; treatment, rehabilitation and reconditioning; organization and administration; and professional responsibility. Each article explores aspects of dance training, performance, injury prevention, or management. Although the articles focus specifically on the lower limb, the athletic training principles put forth apply generally to all injuries, aspects of health, wellness, and peak performance in the dance population.

The authors have created a "Key Points" section at the end of each article, with pertinent information for the dancer, teacher, scientist and healthcare professional, as a quick reference to promote safe dance participation.

By illuminating the contributions of athletic trainers, it is hoped the myths and misunderstandings about the profession of athletic training can be put to rest, thereby laying the groundwork for future collaborations among the international professions in the multidisciplinary field of dance medicine and science, as well as between dance and sport. This is an exciting time for partnerships to evolve; as the athleticism of dance continues to increase, such collaborations may lead to greater exchange of ideas, resulting in the advancement of care in both dance and athletics.

I would like to thank the authors for their generous contributions and proficiency in preparing these articles. I would also like to thank Jim Costello of J. Michael Ryan Publishing and the editorial staff for their assistance throughout this process. Finally, I would like to offer a special thank you to IADMS Past-President Virginia Wilmerding for her interest in devoting a special issue of the Journal to the field of athletic training.

More information about certified athletic trainers can be found at:


(1.) Highwater J. Dance: Rituals of Experience (3rd ed). Oxford: Oxford University Press, 1992.

(2.) Prentice WE. Arnheim's Principles of Athletic Training: A Competency-Based Approach (13th ed). Boston, MA: McGraw-Hill Higher Education, 2009.

(3.) Ferrara M: Globalization of the athletic training profession. J Ath Train. 2006;41(2)135-6.

(4.) O*Net Online. Occupation Comparisons. National Athletic Trainers' Association. Available at:

(5.) National Athletic Trainers' Association Unique Health Care Providers. National Athletic Trainers' Association. Available at: docs/unique_healthcare_providers.pdf.

(6.) Albohm MJ, Wilkerson GB. An outcomes assessment of care provided by certified athletic trainers. J Rehabil Outcomes Meas. 1999;3(3):51-6.

(7.) Halls C. Executive Summary: Certified Athletic Trainers Deliver ROI in Occupational Work Settings. National Athletic Trainers' Association. Available at: CertifiedAthleticTrainersDeliverROI.htm.

(8.) The Jets, The Joffrey, and Marijeanne. National Athletic Trainers' Association. Professional Football Athletic Trainers' Society Newsletter, June 1986. Available at:

Katherine L. Ewalt, M.S., A.T.C., H.H.P., N.C.T.M., PAARTS Wellness Studio, San Diego, California.

Correspondence: Katherine L. Ewalt, M.S., A.T.C., H.H.P., N.C.T.M., PAARTS Wellness Studio, 2650 Truxtun Road, Suite 206, San Diego, California 92106;
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Title Annotation:Introduction
Author:Ewalt, Katherine L.
Publication:Journal of Dance Medicine & Science
Geographic Code:1USA
Date:Jul 1, 2010
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