College and University

Arizona Athletic Trainers Focus on Prevention


Article reposted from Cronkite News
Author: Jonathan Saxon 

Joshua Johnson’s title at Northern Arizona University reads athletic trainer. But he calls himself a “performance enhancer.”

He’s among a new breed of college athletic trainers across the country who have adopted a different philosophy in treating injuries. Their goal is preventing injuries in the first place – and using drugs, long a staple, as a last option.

“The first thing we really believe in is preventative medicine,” said Randy Cohen, the associate athletic director of medical services at the University of Arizona and athletic trainer of the football team. “I think that’s the most important thing. If you can prevent problems from occurring, then you don’t have to deal with them when they occur.”

Johnson is on the same page.

“If you’re able to stay on the field, you’re able to maximize your potential as a student-athlete,” he said. “So that’s our No.1 goal.”

It wasn’t always that way.

In the early days of athletic training, trainers were more likely to treat players by injecting them with substances like numbing agents for dental surgery to mask the pain and get them back on the field. It was not unusual for players to take the injections without knowledge or education about what was going into their bodies.

“Back in the day, we didn’t do a lot of informed consent with the athlete,” Cohen said. “It used to be, do whatever you can to keep the athlete on the field.”

Johnson added that “when athletic training was kind of born, it was about having someone there who could handle acute injuries and provide medical coverage right then and there.’’

Not any more.

Playing sports can be tough business for the body. Depending on the sport, the near- constant running, jumping, throwing and frequent collisions with other competitors can take a toll on an athlete’s body during a season. Nagging aches and bruises become a new reality for players, and sometimes injuries sustained during the year require rehabilitation during the offseason.

Athletic trainers are responsible for evaluating and treating the injury to the best of their abilities, so the player can get back on the field. In the case of more serious injuries, trainers are also responsible for working with the athlete in recovery and rehab until they are healthy enough to return to action.

Trainers normally work behind the scenes to support their teams and coaches, but they are the first to respond and run to the side of a player who is slow to get off the field after a big hit or to come up lame after landing awkwardly after a jump.

But their work begins long before that.

Before players take the field, today’s athletic trainers put them through a range of assessments such as movement screenings. They assess previous injuries and look for risk factors that can contribute to future injuries. But even with all the information, injuries still happen.

Johnson said a lot of injuries are the result of muscle imbalances that come from repeated actions, like jumping for rebounds on the court or running and cutting on the field. Because of this, trainers look at how a player moves, determine the source of particular muscle imbalances and develop a regimen of exercises to address the injury. Cohen ran through a scenario with the precision of a mechanic analyzing a vehicle.

University of Arizona athletic trainer Randy Cohen pulls up a player’s rehab program in the trainer’s room. (Photo by Alex Caprariello/Cronkite News)

“If someone has back pain,” Cohen said, “is it because they don’t have enough hip flexibility to get in position without putting stress on their spine versus having good mobility of the spine? So it’s figuring out what is causing it and then fixing that problem.”

When dealing with new, non-catastrophic injuries, the first option athletic trainers turn to for treatment and pain management is not painkillers but corrective and rehabilitative exercise, such as range-of-motion drills and gradual resistance training.

The purpose for the exercises is twofold: exercises that work to directly strengthen the injured area and exercises that also strengthen the muscles that support the injured area to prevent further injury.

“Is corrective exercise a new idea? No,” said Johnson. “But as far as the athletic training realm, I think it’s kind of emerging among athletic trainers in, number one, trying to prevent injury in the first place.”

However, while corrective exercise is almost always the No. 1 option, it may not be the most effective solution for every case of injury and pain management.

“We refer to physical therapy when necessary,” said Johnson. “We have our orthopedics we consult who may be able to offer some insight. Maybe (the team doctor) can provide them with an anti-inflammatory that’s going to help reduce their pain.”

Even though medicine may be used to treat and manage pain, Johnson said the team physician generally tries to avoid using opiates.

“The effects of opiates on the nervous system could have negative effects on reaction time and sports-related skills,” Johnson said. “And the addictive nature of the drug, it’s really not safe for a student-athlete to be taking them on a consistent basis.”

Cohen also favors a more conservative approach than prescribing drugs to treat pain. For nagging pain, he prefers the tried-and-true methods of icing, deep tissue massage and electrical stimulation. He believes long-term dependency on drugs to perform is a sign of a greater problem that has not been addressed.

“We actually use a lot less prescription medication than we have in the past,” said Cohen. “I’m a believer where if you need prescription medications to really be able to participate on the field, we’re doing something wrong in our prevention early on.”

Cohen and Johnson see the landscape shifting toward preventive medicine in the treatment of athletes. While they may not be able to predict and prevent all injuries, they believe a proactive approach is more beneficial to long-term athlete health than sitting back and waiting until a player gets hurt.

“More and more of the preventative,” said Cohen. “Really figuring out how to prevent problems from occurring. And I think the emphasis needs to be on chronic overuse issues, the chronic back pain, the stress fractures.”

And Johnson sees athletic training continuing to change in the future.

“I think it’s just becoming broader. It’s less about acute injury care and it’s more about what can we do to upfront to prevent injuries from occurring to begin with. I think that is where athletic training is moving and going, because I think it increases the level of care that we can provide the student-athletes.”


College and University

University of Arizona Athletic Trainers Keep the Wildcats healthy


Arizona’s traveling squad to Stanford will include six trainers and two doctors, or roughly one medical attendant for every seven players.

After the unusually high number of injuries incurred by UA football players this season, you wonder: Is that enough? Only six trainers?

These questions do not make Randy Cohen smile or even change expressions.

“Everybody’s beat up in college football,” he said after arriving at 4:30 a.m. Wednesday for the UA’s rare morning practice. “The question is: Are you missing (game) time?”

Cohen is the UA’s associate athletic director for medical services, a Purdue grad who is chair of the NCAA athletic trainers’ committee. He looks at college football much differently than the guy in Row 23, Seat 14.

“Probably the No. 1 factor of teams that win championships, across the board, is that their starters play all season,” he said. “It used to be that we’d patch them up and they’d hobble out there and push through it. You had guys gimping around all the time. Most of that has changed.

“I also think the kids are a little more conservative with their bodies. They see the long-term consequences; they’re worried about what happens down the line. They don’t rush it.”

In 1993, the height of the Desert Swarm years, Arizona’s defensive regulars started 130 of 132 possible games. In Arizona’s historic 12-1 season, 1998, the UA’s regulars started 145 of a possible 156 games.

Already this season, the Wildcats have used 18 different defensive starters. Incredibly, only 15 defensive players started for Arizona during the 2014 Pac-12 South championship season.

Now the team’s two most essential players, quarterback Anu Solomon and linebacker Scooby Wright, are injured. I strongly suspect Wright won’t play again in 2015. He has a foot injury. Solomon suffered a concussion against UCLA and is officially “day-to-day.” The UA’s injury report will be released around noon Thursday.

“We’ll play with 11,” Rich Rodriguez said Wednesday morning. “The injury thing is what it is.”

Here’s how important “the injury thing” can be:

In 2013, Arizona was 5-2 as it traveled to Cal for a game against the then-woeful Bears, who finished the season 1-11. In the days leading up to the game, Cohen treated 35 players for various injuries and placed 23 on limited or no practice availability.

Thus diminished, Arizona hung on to beat Cal 33-28 in a game not decided until an onside kick with 2:14 remaining, It was Cal’s only competitive Pac-12 game of the season.

“I don’t necessarily think there are more injuries now than previously; perhaps this is just cyclical for us,” said Cohen. “But I do know there is more news about injuries than ever. Every time you look at the ticker on the bottom of the TV screen, it’s filled with news of those who are injured. If a guy’s walking around with a boot on his foot, boom, it’s on Twitter.”

If the UA is fortunate, it will never match its 1991 season for injuries. In what was Dick Tomey’s only losing season between 1987-2000, the Wildcats started four right tackles, four tight ends, four nose guards, six outside linebackers and three quarterbacks, including, ironically enough, walk-on QB Billy Prickett, now Dr. William Prickett, one of the team physicians in Cohen’s network of medical services.

The Wildcats went 4-7. Because of injuries, Mu Tagoai started games at right tackle, right guard, left guard and tight end.

“There is some data from a 2-year-old NFL study that shows there are more foot sprains and more bad ankle sprains since the advent of field turf,” said Cohen. “It’s not a huge number, but there has been a spike of more foot-related injuries because there’s not as much give on field turf as there is on grass.”

 UCLA lost three defensive starters in September, all potential NFL players. But the Bruins are deep enough to keep winning. Arizona? Probably not.

College football has changed significantly from 1991 when Tagoai gamely played unfamiliar positions from week to week. Today, an out-of-position — or gimpy — player is considered a significant liability.

“If a player chooses to play through the pain and limps out there, opposing coaches expose it immediately,” said Cohen. “The game’s so fast, so technical, that you can’t have a guy out there who’s 80 percent. Opposing coaches find your weak link. The dynamics have changed.”

Every Pac-12 school has world-class training facilities for football. Since Cohen arrived in 2001, Arizona’s football training staff has gone from 1½  full-time employees to six. The spacious training room at Lowell-Stevens Football Facility has 12 treatment tables, hot tubs, cold tubs, every imaginable treatment and injury-prevention device. On most days in football season, Cohen and his staff are on duty from 7 a.m. to 9 p.m.

Game time is 1 p.m. each Sunday when Cohen supplies RichRod with an update and treatment schedule of the team’s injured players. Many weeks the list exceeds 30 players.

This week it includes Scooby and Solomon.