High Anxiety

To best care for student-athletes, athletic trainers must be in sound mental and physical shape. Here are some ways to keep the inevitable occupational stress at bay.

By Guillermo Metz

Guillermo Metz is an Associate Editor at Training & Conditioning.

Training & Conditioning, 12.3, April 2002, http://www.momentummedia.com/articles/tc/tc1203/anxiety.htm

As an athletic trainer, you accept job-related stress as part of the territory. But, left unmanaged, this stress can affect your job performance, your health, and even your relationships with family and co-workers.

Head athletic trainers face a double whammy, as they have to keep an eye out for their staff and students while at the same time taking care not to become over-stressed themselves. The good news is that stress can be minimized and managed. In this article, we discuss stress management with athletic trainers at some of the nation’s most athletically demanding schools and learn some coping strategies from a psychologist who’s intimately aware of the stress athletic trainers face.

Personality Check
The best place to start your stress-management effort is with yourself. Begin with a personality check to ensure that you’re not setting up yourself and those around you for excess stress.

“If you’re the type of person who always has to have the answer for everything, who is always in a hurry, who is always striving to do things in a very perfect way, who feels like you have to be in charge of everything and monitor everyone--you are a prime candidate for burnout,” says Stephen Russo, PhD, Director of the Sports Psychology Program in the Center for Sports Medicine at the University of Pittsburgh.

Avoiding stress-related burnout begins with an understanding of what elements in your life can and cannot be controlled. “Part of the general problem in sports medicine is that people always want to be helpful and always want to be there for their athletes. And sometimes that’s just not possible. You need to recognize your own limitations in terms of what you can and can’t do,” Russo explains.

Similarly, you need to recognize that it’s not up to you to get everything done. As the head athletic trainer, you may manage a group of assistants and students, and work with physicians, strength and conditioning coaches, sport coaches, and administrators. It’s important to realize that those people are qualified to do their jobs, and, in most cases, you are not. Attempting to do a co-worker’s job will only put you in a stressful situation.

“Having clearly defined roles is critical,” says Russo. “That way, the athletic trainer doesn’t have to be athletic trainer, psychologist, and team doctor all at one time. In other words, he or she needs to identify who’s responsible for what. Whose training is more appropriate for a given situation? That way, athletic trainers aren’t put in a position where they have to step outside their comfort zone.”

“On the job, the thing that helps me reduce stress as much as anything is having a qualified, quality staff that works well together and a delegation of responsibilities with a confidence in each others’ skills, responsibilities, and roles,” says Scott Anderson, ATC, Head Athletic Trainer at the University of Oklahoma. “So, neither the success nor the failure is wholly dependent on me. That eliminates a lot of the stress.”

Relinquishing some control is also crucial to the well-being of those around you. “It’s amazing how much stress you can create in people by always looking over their shoulders and constantly questioning what they’re doing,” says Jim Berry, MEd, ATC, SCAT, NREMT, Director of Sports Medicine and Head Athletic Trainer at Myrtle Beach (S.C.) High School.

Another personality trait to check is your attitude. Being intense and very serious all the time is a breeding ground for stress. “One of the things I’ve learned is that I need to wash my hands of things sometimes and not allow those things to control my emotions and the way I react,” says Berry. “I make an effort to allow things to roll off a little bit more and to put things in perspective.”

In other words, sometimes you just have to loosen up a bit, and add some laughter to the mix. “One of the things that I think helps the most is having a well-developed sense of humor,” says Sandy Worth, ATC, Head Athletic Trainer at the University of Maryland. “We joke around a lot and have fun when we’re in here.”

Stress-Relief Strategies
It’s true that prevention is the best medicine. But stress, unfortunately, is not 100-percent preventable. That’s why it’s also important to implement strategies for reducing the inevitable daily stress. This can be as simple as taking periodic breaks during the day, creating a relaxing environment, and making sure you get some regular exercise.

In order to educate himself and his staff about stress-management strategies, Louisiana State University Head Athletic Trainer Jack Marucci, MS, ATC/L, decided to call in the experts. Last year, he arranged for members of LSU’s sports psychology department to conduct a series of stress-management seminars.

Four sessions were held for all athletic training staff and graduate assistants, twice a week for two weeks. That allowed enough time to discuss stress in a general sense, to delve into specific issues anyone was having (that he or she could share in the group), and to explore some realistic ways to deal with their stress.

“We talked about things like taking 10 minutes and going for a walk to get away from the environment,” says Marucci. “We think that’s very important, to get out of the training room, even if it’s just to go somewhere for lunch. That can give you a little bit of creative thinking time and it better prepares you for when you go back into that stressful situation.

“We also talked about taking just 15 minutes out of your day and going into your office, closing your eyes, and maybe trying to think of things that have gone well earlier in the week, to give yourself some confidence. Some other strategies included relaxation and meditation techniques--whatever they felt was most beneficial to them.”

The seminars also highlighted the need for rest. “Sleeping and getting enough rest is very important to keep your mood up, to keep you creative and better able to cope with stress,” says Marucci. “It’s important to not try to squeeze two days into one. If you can’t do it all today, then stop and start it again tomorrow.”

Although he has a much smaller program than the one at LSU, Berry has used similar techniques. “There are simple things you can do,” he says. “For example, I like to play some nice background music in my office. I don’t play it out in the training room because it’s like elevator music--not what teenagers want to listen to. But it helps create a relaxing mood for me when I’m working in here.

“You also need to have an office that has walls around it,” he continues. “They can be glass, so you can still observe what’s going on, but you need a place you can retreat to so you can get away, even if it’s for five minutes.”

Berry has also found that taking the time to make the athletic training room comfortable can work wonders. “I think it’s important to make your training room a little bit non-institutional,” he says. “Make it look homey. We have plants throughout the room to help make it a comfortable place to work and a comfortable place for the kids to come into.

“We’ve also got a little five-gallon fish tank,” he continues. “One of my physicians suggested that because I have high blood pressure. I don’t know how much it calms me or how much it stresses me out taking care of the thing, but it does add some ambiance to the office.”

Russo adds “getting exercise” to the list of essential stress reducers. “I know it’s hard to find time to exercise, but it is very important,” he says. “Some sort of an exercise regimen is going to help an athletic trainer deal with his or her stress better. Beyond that, it helps if he or she can develop a stress-management program of some kind, whether it’s doing relaxation exercises or meditational kinds of things.”

The problem for many athletic trainers is finding the time to fit these things in. The key to keeping stress-reducing techniques from becoming stressors, says Russo, is to set realistic goals. Assess your situation and set a standard you know you can reach--for example, how much exercise you’d like to get and how much time you’re going to be able to devote to it.

Personal vs. Professional
A common struggle for many athletic trainers is balancing work with family or an active personal life. There’s good reason for that. Long and unpredictable hours are the norm in athletic training and do little to help life outside the job. Add the fact that athletic trainers work with so many people in a given day--and feel pressure to please all of them--and things have the potential to get pretty messy.

“One of the big stresses that I have is the balance between doing my job the best I can and the pull that my family has,” says Scott Bruce, MS, ATC, Assistant Athletic Trainer at the University of Miami. “Am I taking away from my family too much? If I’m spending more time with my family, am I taking away from my job too much? There’s that constant tug of war.”

While there are no simple answers, Bruce cites two strategies for reducing stress related to family-work conflicts. “I try to involve my family as much as possible. My two young children often ask if they can come into work with me. Whenever I can, I bring them into the training room, as long as it’s safe and appropriate for them to be here.”

The other strategy involves including your family on a different level. Bruce remembers explaining to his wife the first year they were dating how busy he would be during football season. They got through their first football season together just fine, only to be blind-sided by the demands of the basketball and baseball seasons.

“She said she hated me working basketball and baseball,” he recalls, “because I’d work three or four nights a week and travel with the team. They’d play weekends. If they made the playoffs she never knew from one week to another if I was going to have to continue.

“It wasn’t the long hours she objected to, it was not knowing ahead of time when I’d be working. So, I made sure to give her the schedule as far in advance as possible.”

And it has to work the other way as well, says Bruce. “Co-workers have to understand that whether you have a family or not, there are things in life that may pull you away from your work. So, you have to be flexible,” he says. “If someone asks me to cover a game for them because they have a family emergency or need to get away, I have no problem with that. And I know that I can find someone to do that for me, too.”

This is one area where the head athletic trainer’s lead can be particularly important. “Everyone here knows how I feel,” says Marucci. “I tell them, ‘We’re going to work hard and we’re going to get the work done, but don’t live for your job. Don’t make this job everything that you know in life. You have to have other interests.’”

When one’s family or other interests are getting ignored because of work demands, or the balance sways too far the other way, something has to give. “If it gets to that point,” says Anderson, “ultimately, you have to sit down as a family and look at the whole picture. If it’s getting to a point where the demands of the job are getting to be too much, you have to reassess and make a family decision about your priorities.”

That’s what happened to Berry a few years ago. Berry’s son, now five, was born with a form of muscular dystrophy, and that made balancing family and work seem insurmountable. “He’s in a wheelchair,” says Berry, “and it’s a life-threatening situation. For me, that creates an enormous amount of stress.”

Berry, who identifies himself as a Type A personality, found himself in a situation that demanded he look at work differently. “In talking with other athletic trainers who have been around a lot longer than I have, I discovered that you reach a point in your life where you say, ‘There’s more to life than the training room,’” he says. “One of the things I’ve found throughout my career is that athletic trainers have a tendency to put everything else before themselves. You want to please the coaches, you want to please the athletes, you want to please the parents to some extent. You’ve got all these people who want a piece of you, and at some point there are no more pieces to give and you have to say ‘No.’”

When It Gets Too Much
For Berry, saying “No” didn’t come easy. Things got pretty bad before he made changes that allowed them to get better. “I’ve tried to be as healthy as I can be and take care of myself, but one of the things I wasn’t doing was dealing with my stress,” he says. “It was getting to a point where it was making me physically ill. Through my family physician, we realized that if we didn’t do something about that stress, I was going to get to a point where I couldn’t work any more or I was going to have a heart attack or something. So, we decided there needed to be some intervention.”

The good news is that, “Burnout and stress in general are very receptive to treatment,” says Russo. “The first step is getting help. Having support--whether it’s people you work with or people who are just in your life--is going to be your first line of defense.”

A second line of defense is outside counseling. “There’s no stigma to recognizing that you’re like every other human being and you’re experiencing pressure or stress in your life,” says Russo. “Not everyone has to seek treatment, but if you see that these things are affecting your relationships, your ability to function in your job, your ability to communicate with athletes and co-workers, or your success as an athletic trainer, these are all warning signs that maybe you do need to speak with somebody.

“It has to start with that athletic trainer,” he says. “You have to realize that you can’t help other people if you’re not functioning 100 percent on your end.”

SIDEBAR: Emergency Stress Management

There’s one type of stress athletic trainers may face at almost any time. And no matter how well you defend against it, this stress can be devastating. That’s the stress of dealing with a medical emergency. Your expertise and professionalism are called on at the time, but afterwards the emotional toll is often ignored. Even if everything went flawlessly and the athlete turned out okay, don’t downplay the fact that managing an emergency is an extremely stressful situation.

“It is a part of sport that you have to accept and be prepared for--that something bad could happen today,” says Sandy Worth, ATC, Head Athletic Trainer at the University of Maryland. “Our training and experience allow us to deal with it. You deal with what you’re presented with, and then you deal with the emotional part. But sometimes that takes time to work through.

“I’ll give you an example,” she continues. “One of our football players ran head first into an opponent and fell straight to the ground. When we got to him, he had no feeling in his arms or legs and he had some pain in his neck. So, we went ahead and did all the things we’re expected to do in a situation where there may be a cervical spine injury.

“But, it’s one thing to do all those things and quite another to see a helicopter land not 50 feet from you, put someone on a backboard who 20 minutes ago was perfectly healthy, and fly him away, and you don’t have any idea if he’s going to be okay. Finally we got the phone call, ‘Everything’s clean, he’s feeling better.’”

But for the athletic trainers, the ordeal wasn’t over. “When we came in, we all talked about it,” says Worth. “I just let them know that it’s okay to be scared. And it’s okay to feel bad, and it’s okay to feel sad about this. Those things are all perfectly normal. Our team doctor was still here, so he had an opportunity to say a few words as well. We sat and talked about it for about half an hour and I think that was helpful.”

Some athletic departments include debriefing in their emergency care plans--as much to inform everyone who needs to know what happened as to deal with the stress that can remain following such a traumatic event. “We go over what happened,” says Jack Marucci, MS, ATC/L, Head Athletic Trainer at Louisiana State University. “We talk about things that were positive that happened in the steps that we took to ensure the safety of the athlete and any problems that came up. If there are any problems with someone’s own experience in handling that catastrophic injury, we talk about that, too.”