Head of the Class

Teaching your coaches some basics about sports medicine can ensure they are in sync with your procedures. Here are some tips on what to teach them and how.

By R.J. Anderson

R.J. Anderson is an Assistant Editor at Training & Conditioning.

Training & Conditioning, 14.3, April 2004, http://www.momentummedia.com/articles/tc/tc1403/headofclass.htm

Running from school to school and field to field is nothing new for Christopher Hobler, ATC, who for 16 years has provided athletic training services for high schools in Upstate New York. Based out of the Orthopedic Surgery and Sports Medicine Group in Ithaca, Hobler facilitates sports medicine coverage for three school districts in the area.

Because of the large number of athletes he deals with and the distance between each school, Hobler can obviously provide only minimal services to his student-athletes. So to help make the athletes as safe as possible when he’s away, Hobler has taken to educating the coaches.

While teaching the basics of sports medicine may not be a major part of an athletic trainer’s job description, delivering some of your knowledge may be the key to providing the best possible service—especially in a situation where an athletic trainer can’t be on every court or field, all the time. The challenge lies in deciding what coaches should learn and how you will teach them.

What To Teach
Deciding what your coaches need to know takes some thought. You don’t want to give them the idea that they can perform your job. In fact, you should do the opposite. You want to show coaches that athletic training is complicated, but if they are in sync with you on the basics, they can help you perform your job more efficiently and effectively.

"Coaches may have the most pivotal role in the sports medicine chain," says Melinda Flegel, MS, LAT, ATC, CSCS, Head Athletic Trainer at the University of Illinois Sportwell Center, an extension of the school’s student health center. Flegel, author of Sports First Aid for coaches adds, "It’s a difficult position because they have to communicate with athletes, parents, and sports medicine personnel, and in most cases, they are the primary responder. To handle all these responsibilities, they have to know the basics. At the same time, to be safe, coaches also have to know their limits."

Most athletic trainers agree that the base-level requirement is CPR and first aid. Though coaches can attain certifications from a variety of outlets, Hobler feels that the most effective teaching scenario is when he instructs his coaches.

"I prefer it that way because I can get all the coaches together, and I can handle administrative questions or policy issues," he says. "I also make sure to hold the training at their respective schools—a setting in which the coaches are relaxed, comfortable, and more likely to ask questions."

Dealing with a medical emergency is another must-teach subject. Your school probably has written guidelines for its emergency plan, but you may want to supplement that information with education on specific life-threatening scenarios. "I would make sure to teach coaches how to handle wound care basics," says Flegel. "What they should do if somebody is bleeding heavily, or if they can’t get the bleeding to stop. I would talk about when athletes should be taken for stitches and when to call for an ambulance. I would also go over splinting and assessing when an injured athlete needs to be immobilized."

Hobler worked with athletic directors to revise the emergency guidelines at two of his schools to include regulations for dealing with specific injuries and situations. The changes included how to treat concussions and other head injuries, and when to call an ambulance. His input also led to making pre-practice warmups standard procedure and a mandate for readily available practice-field ice and water. Hobler says this input has made his services more effective.

Hobler also finds coaches need some instruction on assessing an athlete’s pain. "They need to be aware that the ‘no pain-no gain’ philosophy of years ago is obsolete," he says. "Coaches need to know that athletes should not push through pain, and that they should encourage an athlete to be in tune with their body and its limits."

"Lots of coaches want to think, ‘He’s just not real tough and that’s why he continues to complain about this or that,’" says Larry Gurchiek, DA, ATC, Professor of Health and Physical Education at the University of South Alabama. "But most of the time, kids are tougher than we give them credit for—coaches need to understand that an athlete may not be performing well because he or she is in pain and has an injury."

Jerry Whetstone, MEd, ATC, Coordinator of Athletic Training Services at Ohio’s Kettering Sports Medicine Center, tells his coaches that a good time to address individual aches and pains is during post-activity stretching sessions. "We encourage them to watch their athletes closely and listen to what they are saying during this time, and maybe have a question and answer period about each team member’s injuries," he says. "It’s also an opportunity to encourage those athletes who are hurting to get attention from the athletic trainer."

Strength and conditioning is another area not to neglect. An athletic trainer should not be expected to develop a strength program for every team, but teaching some basic concepts can go a long way in preventing injuries.

The most obvious may be the importance of flexibility training. Though embraced more and more, stretching remains an area where coaches can benefit from more information and prodding—especially in using stretching during cool-down periods.

Whetstone—whose clinic provides athletic training services for 21 high schools, two community colleges, and two professional teams—says athletic trainers should also stress the importance of each player keeping a personal fitness log to record their training. "We tell our coaches to be wary of the repetitions they have each individual athlete do," he says. "With plyometric training, for instance, you can’t say, ‘Day one everybody is to do 10 jumps. Day two everybody should do 20.’ In reality, on day two there are going to be athletes still struggling to do 10. You have to advance your athletes on an individual basis, while at the same time advancing the group."

Hobler finds strength training education especially important for multi-sport coaches. "Most high school coaches tend to generalize too much," he says. "I’ll see a baseball coach who is also a football coach have his athletes go in the weight room and do a ton of bench pressing. That might be okay for football players, but it’s not okay for baseball players."

To prevent these kinds of errors, Hobler meets with the coaches who utilize weight training and presents them with a basic, sport-specific program for their athletes. "I’ll sit down with the baseball coaches and give them lists of exercises to do in preseason to prevent shoulder problems, and I do the same thing for soccer coaches to reduce knee injuries," he says.

How To Teach
Just as important as figuring out what to teach your coaches is determining how to best educate them. Sometimes it’s a balancing act between not stepping on the toes of the veteran coach who already knows some of what you’re teaching, and reaching the new coach who may be reluctant to ask any questions. Usually a mix of formal and informal methods works best.

Hobler likes to start each sport season with a mandatory refresher course for all his coaches. Whether it’s to satisfy a first aid certification for the state or fulfill a staff requirement made by the athletic director, the course allows Hobler to impart knowledge to coaches he will be working with throughout the year.

By getting all the coaches together, Hobler is able to keep the entire staff’s base of knowledge on a somewhat even level. It gives him a chance to find out what each coach knows about dealing with injuries. And it allows him to go over the specifics of the school’s injury treatment protocol.

The courses, which generally last two hours, start with a 15-minute section on administrative issues like physicals and emergency contact information. Hobler then moves on to a section he calls sprains and strains. Starting with the shoulder and working his way down, Hobler describes every joint and the common injuries associated with each.

"Instead of showing slides of each body part, I like to perform demonstrations on somebody from the audience," he says. "I’ll show the group how I look at an ankle and what I’m looking for. I also go over what I’m asking the athlete while I examine the ankle in terms of trying to assess the injury."

Hobler says he finds demonstrations are more effective than slides when discussing anatomy and physiology, because they keep his audience involved. He also tries to show his coaches what type of injuries can be treated with ice and elevation, and which require a visit to the emergency room.

Going over sprains and strains is also a good time for Hobler to talk about common injuries he’s seen at his clinic and read about in trade periodicals. "For instance, when I talk about the knee, I’m going to cover ACL tears," says Hobler. "And then I bring up a more current trend: how ACL tears among female basketball and volleyball players are increasing at an alarming rate. Then I tell the coaches my opinions on why that is happening."

By introducing current events into a spiel that some coaches have heard for the last 10 or 15 years, Hobler is able to hold the group’s attention, whether it’s the first or the 10th time a coach has heard him talk about ACL tears. And that’s something he finds key to fostering discussion and provoking questions.

"This year I’ll probably talk about steroids and supplements, as well as asthma—which seems to be affecting more and more high school athletes," Hobler says. "I’ll give them some information about asthma they might not know, and ask them questions like, ‘If half your team has asthma, how many inhalers should you have in your medical kit?’

"With supplements, I’ll talk about the stuff that’s banned and encourage the coaches to post that information in the locker room," he continues. "Then, I’ll encourage them to take a glance into the kids’ lockers as they walk around the locker room, and if they see something that shouldn’t be there, to talk to the kid and his or her parents."

Hobler estimates that he spends nearly half of a two-hour session discussing emergency preparedness. "I want them to be aware of how to handle difficult situations before they arise," he says. "After they leave my course, I want them to think, if somebody gets hurt, ‘Where’s the nearest phone or the nearest AED.’ Or if a kid loses consciousness without having received a head injury, I want them to be able to recognize immediately that it’s probably a cardiac problem. That way they won’t waste time wondering what to do. I want them to think about it beforehand because that’s going to save lives."

Kathleen English, MS, LAT, ATC, a Primary Instructor and Clinical Supervisor at the University of Nebraska-Kearney, says role play is an effective vehicle for delivering information. "Role play opens some eyes by allowing coaches to anticipate how something is going to happen, and how they will respond," says English, who uses role play in a class for prospective coaches. "Where role play becomes important is learning how to deal with variances. The more times you are exposed to those types of things, the better prepared you are to make a prudent decision in regards to the athlete’s needs."

To incorporate role playing, English, the former Head Athletic Trainer at Nebraska-Kearney, recommends setting aside time during the preseason to target athletic injury management and care—possibly a half a day.

Another formal way to teach is through handout materials. Gurchiek suggests using guidelines put together by an accredited organization—especially if you have coaches resistant to your advice. Flegel backs up his information with handouts heavy on illustrations and diagrams. Though often informative and full of great advice, handouts are effective only when the coaches actually take the time to read them.

"Let’s say there’s an article in Training & Conditioning that we may be able to use," says Whetstone. "I’ll make a copy for the coach and hand it to him and say, ‘Hey coach, I just came across this article and I thought it might be of interest to you.’ Then, maybe the next day I’ll see the coach and say, ‘Did you get a chance to read that article on plyometrics?’ If he hasn’t, I’ll follow up with something like, ‘Why don’t you go ahead and read it, I think it would be helpful, especially as we move forward with our conditioning program.’"

Whetstone says he continues to follow up until the coach shows that he has read the article. And, he adds, you can usually tell that they’ve read the article because they’ll have questions. "The whole point is to stimulate them so that they open the door and ask you questions," he explains.

Don’t forget that all the education does not have to come directly from you. Gurchiek suggests setting up workshops run by strength and conditioning experts from clinics or local college and university athletic programs. By encouraging a coach to tap into that type of expertise, an athletic trainer is able to provide continuing education in a setting that will grab a coach’s attention in a manner that resonates without offending.

As effective as hand outs and mini-clinics can be for educating coaches, don’t forget the importance of old-fashioned interpersonal communication. That often means visiting each coach individually on a regular basis.

"In order to approach every coach at a school, the athletic trainer has to be pretty organized," says Gurchiek. "You can’t go in and try to wing it—you must have a program and plan out what you are going to say to each coach. I would say something like, ‘Coach, here are some things you’re going to see with soccer, here are some things to be aware of in preventing knee injuries. Here’s what we’re doing with these injuries, and here are some things you can do to give your athletes better care and help you make better decisions until we can get out here and help you.’"

The key, says Gurchiek, is to present yourself as a partner to the coach, not just an authority figure on sports medicine. "The athletic trainer needs to develop a relationship that encourages a coach to invite them in and say, ‘Here’s what we are doing. Do you see anything we are doing wrong?’" he says.

Hobler has found this approach effective with his coaches. He points to a situation a couple years ago in which many of the school’s football players developed shoulder problems. "The coach and I sat down together and said, ‘Why are we having all these bad shoulders,’" says Hobler. "We went over their workout routine and found out that they were overemphasizing the bench press—they were doing just one push, like it was a competition to see who could do the most weight." Hobler says that once they modified the players’ weight lifting habits, the shoulder problems went away.

Whether full-time or part-time, an athletic trainer’s main concern is providing care for student-athletes. By setting aside a little bit of time to spend with your coaching staff to share some of the basics of sports medicine, athletic trainers might find their jobs become easier and their care more comprehensive.

SIDEBAR: Preseason Screening
At the University of Illinois, Melinda Flegel, MS, LAT, ATC, CSCS, primarily treats athletes who are hurt in club sports or intramural-related activities. To both help prevent injuries and educate the club coaches on some sports medicine basics, she runs a preseason fitness assessment program for the school’s 50 club teams.

"The point of the preseason screening is to explain what the overuse injuries are for each sport, then apply a specific test to look for any muscle imbalances that can lead to those overuse injuries," says Flegel. "The screening sessions can be very time-consuming. But if you get the coaches involved, it will go much quicker, and at the same time, teach them basic assessment techniques."

To replicate her process, Flegel recommends teaching coaches simplified techniques. For example, to check any deficiencies in hamstring flexibility, she has athletes lie on the ground with one leg perpendicular to the floor and the other straight ahead.

"You can show the coaches what to look for and give them specific exercises to work on based on what they see," she says. "And then you help the coaches figure out a sport-specific conditioning program to help the athletes individually or as a group."