Understanding the Interprofessional Relationship between Physical Therapists and Athletic Trainers by Riley Shore
A team is most successful when all members work together to achieve a shared goal. Conflicts occur when team members don’t know how to work together despite their differences. The ability to recognize those differences and acknowledge all of the member’s contributions to the team is crucial for success.
Physical Therapists (PTs) and Athletic Trainers (ATCs) work as a team of healthcare professionals who have a shared goal of providing athletes with the most optimal care. One should not work without the other.
PTs work alongside ATCs in a variety of clinical settings including professional, collegiate and high school athletics as well as outpatient orthopedic clinics. In my experience as an ATC and now as a student PT I’ve developed a passion for improving the interprofessional relationship between PTs and ATCs. By using my personal experiences and the experiences of other PTs and ATCs, I’ve identified characteristics that positively impact the relationship between the two healthcare professions as well as barriers that impact this relationship.
Effective communication is an essential part of having a positive interprofessional relationship. There are times where PTs and ATCs co-treat an injured athlete. A small miscommunication can drastically impact an athlete’s care. In both the high school and professional athletic settings, communication between the PT and ATC is through emails, phone calls, text messages or face to face meetings.
Dr. Diana Marquez-FitzPatrick is a PT/ATC and Board Certified Orthopedic Clinical Specialist who works in external relationships with local high school athletics. When asked to describe the communication between her and the ATCs she works with, she states, “We try to keep it very team oriented, using our own experiences and education to best help the athletes. Oftentimes we will tag team an evaluation, or ask the other to also take a look to make sure we are coming up with the best diagnosis and game plan for the specific individual. In my setting we also have to communicate often with team physicians or other providers, and we just try our best to make sure all parties have all necessary information to avoid miscommunications within our team.”
In the professional athletics setting, face to face meetings are held before practices and games to discuss the health status of every athlete on the roster. Those included in these meetings are the PTs, ATCs, coaches and strength & conditioning staff. Josh Fallin is the Assistant Athletic Trainer for the White Sox Organization and claims that all of those who interact with the athlete on a daily basis need to be on the same page regarding what the athlete can and cannot do based on their injury status.
Board Certified Physical Therapists are qualified to treat patients with musculoskeletal injuries, cardiopulmonary conditions, neurological impairments, burns & wounds, etc. It is not until after graduating from an accredited physical therapy education program and passing the National Physical Therapy Exam, that PTs can specialize in specific areas. PTs can ensure adequate preparation for practicing in Sports Physical Therapy by obtaining additional training to become a Sports Certified Specialist (SCS) through the American Board of Physical Therapy Specialties (ABPTS).1 Obtaining this qualification then allows the PT to care for any athlete on the sidelines and throughout their rehabilitation and return to play process.
Board Certified Athletic Trainers are qualified to care for any athlete on the sidelines and throughout their rehabilitation and return to play process without needing additional training or education.2 ATCs obtain this qualification by graduating from an accredited athletic training education program and passing the Board of Certification Exam.
ATCs have specialized training in developing and executing emergency action plans during on-field emergency situations. Studies have shown that ATCs perceive themselves fully prepared to manage acute injuries and medical conditions more than PTs do.3
PTs have a lot of experience and knowledge in performing thorough evaluations. Mr. Fallin works alongside Dr. Brett Walker, a Board Certified Physical Therapist and Certified Athletic Trainer for the Chicago White Sox. Mr. Fallin is the first to respond when an athlete is injured on the field. Once Mr. Fallin has made the decision to remove the athlete from play, Dr. Walker provides the athlete with a further injury evaluation. The PT then assists the ATC throughout the rehabilitation process.
During an interview with Mark Dominick, former Assistant Athletic Trainer at the University of North Carolina Wilmington, he states, “There is a lot of overlap in the rehab realm between ATCs and DPTs. In my experience, DPTs who have experience with an athletic population have a more in-depth appreciation for specifics of anatomy and some of the functional/biomechanical considerations”.
Injury rehabilitation in the sports setting must include both the PT and the ATC. Mr. Dominick also states, “If I have more expertise in late-stage sport specific rehab, but a PT has more experience with manual therapy then together we can provide an elite level service.”
PTs also have a lot of knowledge in concussion management. Concussions are a common traumatic brain injury seen in athletics.4 The vast knowledge that PTs have regarding the vestibular system and how to manage vestibular impairments make them a valuable member of the healthcare team when treating an athlete post-concussion.5 PTs understand that not every rehabilitation process post-concussion looks the same. Concussion management is based on the patient’s impairments. Not every patient presents with the exact same impairments after obtaining a concussion and PTs know how to respond accordingly.
ATCs are experts in the return to play management for all athletes post-concussion. Protocols and Laws, such as the Gfeller-Waller Concussion Awareness Act have been put in place to ensure a safe return to play for an athlete post-concussion.6 In my experience as a PT student, I’ve never come across a PT who is familiar with on-field concussion management and the return to play protocols, unless they have gone through additional training. On the other hand, in my experience as an ATC, I’ve never come across a high school or collegiate athlete, parent or athletic staff member who is not somewhat familiar with the North Carolina Concussion Management Protocols. I have never been placed in a situation where I was co-treating a patient post-concussion but if I was, I would foresee conflict occurring if I was co-treating with a PT who is not familiar with these protocols. I truly believe this is an issue that needs to be addressed. Lacking the understanding of each other's knowledge and skills for concussion management can negatively impact the athlete.
ATCs need to recognize the knowledge that PTs have in the rehabilitation process for patients post-concussion. In contrast, PTs need to be educated on the fact that an ATC must follow specific protocols before returning an athlete to the field.
When asking Dr. Marquez-FitzPatrick about the roles and responsibility of the PT and the ATC in concussion management in the high school setting, she states, “In terms of the high school I do concussion evals and return to play progressions, but as my ATC is hired/managed by the school, I give ultimate decision making to her. Particularly as we want them to return-to-learn first and then return to sport. I do additionally treat concussions at the PT clinic, so I bring the athletes into the clinic if they have more long-term symptoms or vestibular needs”. Because of Dr. Marquez-FitzPatrick’s background in athletic training, she has knowledge of the return to play progressions, but she still respects the ATC’s role of having the ultimate decision making.
A common trend here is that trust and humility make up a good interprofessional relationship. No matter if an athlete obtained a concussion, sprained their ankle, fractured their wrist, etc. the patient will receive the most optimal care when the PT and the ATC work together and build off each other.
In conclusion, Physical Therapists and Athletic Trainers are healthcare professionals who both have the knowledge and skill set to evaluate and treat an injured athlete. When these two professionals work together as a team, an injured athlete receives the most optimal care.
References:
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Athletic trainers. Occupational Outlook Handbook (Online). 2019. https://proxy.campbell.edu/login?url=https://www.proquest.com/reports/athletic-trainers/docview/2299153337/se-2.
Wallace A, Briggs MS, Onate J, DeWitt J, Rinehart-Thompson L. Perceived Management of Acute Sports Injuries and Medical Conditions by Athletic Trainers and Physical Therapists. Int J Sports Phys Ther. 2021;16(6):1548-1565. Published 2021 Dec 2. doi:10.26603/001c.29850
Milan A. Concussions under the Microscope This Year in High School Sports. Tribune Content Agency LLC; 2011.
Postconcussion | Gfeller-Waller Law. gfellerwallerlaw.unc.edu. Accessed November 20, 2023. https://gfellerwallerlaw.unc.edu/postconcussion/
Burkhart S, Price A, Caze TJ II, Knell G, Ellis C, Abt J. POST-CONCUSSION PHYSICAL THERAPY REFERALS. Orthop J Sports Med. 2021;9(7 suppl3):2325967121S00069. Published 2021 Jul 14. doi:10.1177/2325967121S00069
Huggins RA, Olivadoti JM, Adams WM, et al. Presence of athletic trainers, emergency action plans, and emergency training at the time of sudden death in secondary school athletics. Journal of Athletic Training, suppl.Supplement. 2017;52(6):1. https://proxy.campbell.edu/login?url=https://www.proquest.com/scholarly-journals/presence-athletic-trainers-emergency-action-plans/docview/1914566510/se-2.
Sport Concussion Assessment Tool 6 (SCAT6)British Journal of Sports Medicine 2023;57:622-631.
