Athletic Trainer... What IS in a name?
The disputes and debates over the name Athletic Trainer have been of passing interest to me since 2015. Given the origins of the profession this title was once quite accurate. While this seems to no longer the case, I would like to submit that, particularly at the secondary school level, this is entirely a failing of us as a profession. While we are now first and foremost medical professionals who specialize in the evaluation and assessment of orthopedic injuries in active populations and the acute care of sport related injury, perhaps it is the word TRAINER we should focus on as a positive rather than the negative.
Allow me to elaborate. At a recent fundraiser, I recently heard a program director remark to another ATC that "If you want to know how good you are, work at a high school." I work at what I have affectionately dubbed Stability and Motor Control Dysfunction High School. This must change as we approach basketball (ACL) season and I have the luxury of having nearly full control over the weight room that is directly adjacent to my clinical space. I also have the attention of my coaches and administrators to a remarkable degree. Without any strength and conditioning staff, a rare situation in most environments I am accustomed to whether functioning as a clinician or strength and conditioning coach, the responsibility to TRAIN these student athletes falls on me, the Athletic TRAINER. I also have the luxury of having an athletic training student who is a strength athlete and coach in his own right. Between the two of us we possess expertise in olympic lifting, power lifting, and kettlebell training. These factors, combined with both the boys and girls basketball coaches allowing us 40 minutes at the beginning of each teams practice to work with their teams in two 20 minute split blocks, has created a prime environment to produce a culture of training, and sport readiness, into SMCD High.
As a result my clinical student and I put our collective expertise together to create the following hierarchy of strength-skill mastery in six major areas of training.
HIP HINGE: Hip Hinge (HH) - Dead Lift (DL) - Romanian Dead Lift (RDL) - Kettlebell (KB) Swing - Single Leg RDL - Double (DBL) KB Swing - Single Arm (SA) KB Swing - Barbell (BB) Power Clean Pull - DBL KB Clean - SA KB Clean - BB Snatch (Sn) Pull - SA KB Sn - DBL KB Sn
SQUAT: (Sq) Goblet Sq - BB Front Squat (FSq) - DBL KB Rack Sq - SA KB Rack Sq - Loaded Step Up - Rear Foot Elevated Split Squat (RFESS) - BB Back Sq - Single Leg (SL) Squat (AKA Pistol)
PULL: Horizontal (Rack) Pull Ups - Strict Row - Pendlay Row - Chin Up - Pull Up
PUSH: Push Up - BB Strict Overhead (OH) Press - BB Push Press - BB Bench Press - KB SA OH Press - KB DBL OH Press - KB DBL Push Press - BB Push Jerk - KB SA Jerk - KB DBL Jerk
CARRY: Bilateral Load at Hip (Farmers) Carry - Unilateral Load at Hip (Suitcase) Carry - Bilateral Load at Chest (DBL Rack) Carry - Unilateral Load at Chest (SA Rack) Carry - Unilateral Load OH Carry - BB Bilateral Load OH Carry - Mixed Carries
PLYOMETRICS: (Low Amplitude)
SAGITTAL Plane DBL Take Off/DBL Landing - Single (SGL) Take off/DBL Landing - DBL Take Off/SGL Landing - SGL Take Off/DBL Landing
FRONTAL Plane DBL Take Off/DBL Landing - Single (SGL) Take off/DBL Landing - DBL Take Off/SGL Landing - SGL Take Off/DBL Landing
TRANSVERSE Plane DBL Take Off/DBL Landing - Single (SGL) Take off/DBL Landing - DBL Take Off/SGL Landing - SGL Take Off/DBL Landing.
As stated above, we are approaching this as skill mastery not training for training sake, as strength, after all, is a skill. Upon writing these lists on our whiteboard some interesting realities became quite apparent. My clinical student and I began to see a trend in 4 o f the 6 movement patterns. Much of the time, particularly at the high school level, significantly advanced movements are taught, or introduced, as baseline training principles. For example:
SQUAT - 7 of 8. The BB Back Squat is perhaps one of the most difficult movements in this pattern to technically master as it requires a lower BB position and promotes the incorporation of both the HH and the Sq with equal importance.
PULL - 5 of 5. The Pull-Up is perhaps the most difficult movement in this pattern to technically master as it requires an immense amount of core strength and control, excellent shoulder strength, scapulo-thoracic rhythm, and, without assistance, the ability to pull at least ones own body weight through space under control.
PUSH - 4 of 9 The Bench Press requires great specific strength and technical ability under conditions of artificial stability and limited scapular mobility.
PLYOMETRICS - This is an area where amplitude is the driver of ego and volume creates fatigue and diminishes control rapidly increasing injury risk. Many athletes have a 30 inch vertical leap. A large percentage of these also lack control of valgus knee collapse in a static environment making little mention of dynamic environments. (See Robert Griffin III.)
With this in mind I return to my original question, what IS in a name? Perhaps we as Athletic Trainers, professionals with real barriers to entry, an advancing academic environment, and a vested interest in the durability of our patient population, should usurp our colleagues in the personal training and strength and conditioning professions. Perhaps we should focus on training in our educational model accounting for our title and our unique clinical practices and patient populations.