Athletic Training Started in D-1 Athletics. It Can Be So Much More.

Ally Smith [00:00 – 00:11] – We’re part-time healthcare provider, we’re part-time mental health specialists, we’re part-time nutritionists. We’re the master of a lot of things and we really are relationship driven. 

Jasper Nighthawk [00:16 – 01:35] – This is the Seed Field Podcast, the show where Antiochians share their knowledge, tell their stories and come together to win victories for humanity. I’m your host, Jasper Nighthawk, and today we’re joined by Ally Smith for a conversation about athletic training, health inequities, and the special opportunities that athletic trainers have to affect the public health of their communities. Athletic trainers are highly visible frontline healthcare workers. You see them on the sidelines in sports broadcasts or running onto the field when someone gets hurt. But this medical profession extends far beyond D1 college sports, and athletic trainers have the chance to affect populations far beyond star athletes. Preparing for this episode, I’ve learned that athletic trainers are in high schools where they often provide care to students who may be uninsured. And they’re increasingly addressing populations we don’t traditionally consider to be athletes, like warehouse workers and first responders. So I’m excited to learn more about the preventative care philosophy behind athletic training and to learn about the unique role they fill in the American healthcare system. Our guest today is the perfect person to have this conversation with. Ally Smith is a longtime athletic trainer, and she’s the founding chair of the new athletic training program in Antioch’s Graduate School of Nursing and Health Professions. So Ally, welcome to the Seedfield Podcast. 

Ally [01:36 – 01:37] – Thank you so much for having me. 

Jasper [01:38 – 02:26] – So to start off, we always ask as our first question to share some of your positionality, where you’re coming to the conversation from. And I can go first. I’m white. I’m a cisgendered man. I’m queer. I’m not living with a disability, but I do experience anxiety and depression and have treated those over the years in many different ways. I have a college degree and a master’s. I have steady housing and a steady income, which I don’t take for granted at all. I’ve experienced insecurity on both of those accounts before. I also have a three-year-old child who I parent. And I also wanted to share that I have some experience with high school sports. I was captain of my high school cross-country team, but I never encountered an athletic trainer in all of that time. All right, Ally, I’ll pass it over to you. 

Ally [02:26 – 03:01] – Yeah, so I am a straight female living in Westerville, Ohio. I am Caucasian, but also identify as an American Indian. I too do not suffer from any disabilities, but have managed low level anxiety over the past handful of years. I was an athlete growing up. I was a gymnast and a cheerleader and I got hurt a lot, which is, I’m sure we’ll talk about how I got into this field and found a love for athletic training. I do suffer from arthritis from those years of being an athlete. I also don’t have any insecurities in housing or income, so I’m pretty lucky to be here today. 

Jasper [03:01 – 03:12] – Yeah, we are lucky. And thank you for sharing that with us. How did you get into athletic training? And can you walk us through what you learned about the profession and what drew you to make that your career? 

Ally [03:13 – 05:17] – Yeah, for sure. So I was a gymnast from the age of four to the time I was in fourth grade. I got started getting more competitive. And when I became part of that team, one of my teammates, her dad was a dual credentialed athletic trainer, physical therapist at the time. And so he would always be around to kind of if we had any major things like injuries or strains or sprains. And so I knew of him and of his career. But it wasn’t until two years later when I was in sixth grade, I had a freak accident where I fell and I ended up tearing my ACL pretty young at 12 years old. And so he was my first kind of medical provider for that. So he evaluated me and ended up needing surgery. And then he was my physical therapist, which I had a few complications from that surgery. One stemming from I was so young to I wasn’t a great patient being a young 12 year old doing exercises at home after surgery did not sound fun to me. And so I wasn’t very studious in doing those. And so it’s typically a six to nine month recovery took me over 12 months. And so I got to know him very well. I was seeing him three days a week for a couple hours a day. He had made such an impact on me personally of just like the empathetic care that he gave. You know, I was a difficult 12 year old girl, you know, teenager that was super frustrated of having to go do these exercises that I didn’t feel like were working. I is. And he just really was like a person first to me versus just a healthcare provider. And I knew that the impact he had on me, and I just wanted to be able to do that. And so I started looking at the trajectory of the careers. And, and back when I was going to college, athletic training was a, an entry level bachelor’s degree, meaning you could get a four year college degree and go in and practice. And where I really found my passion or love for the healthcare setting was being on the sideline and being like the, we call it the acute care, the first responder on the field, in the elements. And that’s where I really found my joy and passion. So I really transitioned into wanting to stick with athletic training. And so I ended up graduating and went into practice and got to see firsthand what an athletic trainer does. 

Jasper [05:17 – 05:34] – I so appreciate you talking about the like individual impact that this provider, your friend’s dad had on you. But I want to back up just slightly and ask, what do athletic trainers do on a day-to-day basis? 

Ally [05:35 – 06:32] – You know, we are the acute care, the first responders to most physically active, typically sports, but athletic training really focuses on prevention, which is like the pre-injury parts. Obviously, what you mentioned about is like the actual evaluation of an injury, but then also the recovery and the return to play. We’re typically seen on, you know, football fields, basketball fields, college athletics, high school sports, But the field of athletic training, especially in this country, is emerging into things like ballet and performing arts, the military, like you mentioned, first responders, where anybody that is doing a physically demanding job that could get injured, we have started to see a really cost benefit to having an athletic trainer in those positions because of the skill set we have of not only being able to evaluate and treat those injuries, but really that preventative piece where if our whole goal is to make it so people don’t get injured, don’t ever get hurt in the first place. 

Jasper [06:32 – 07:02] – Yeah, that makes a lot of sense. So can you talk a little bit more about the preventative care aspect of this? Because I think we hear a lot in the medical system about how an ounce of prevention can be worth a pound of care afterwards. But it’s not always obvious how preventative care can actually enter people’s lives. And I think athletic training offers a way to really help prevent injuries before they happen, which like injuries, once they happen, have a tendency to recur and have all these downstream effects. So how do you go about preventing? 

Ally 07:03 – 08:53] – I’ll talk from like two perspectives. One from my experiences is like a college athletic trainer, which has been the majority of my experiences working clinically. So in the college setting with our typical, you know, NCAA sports, every year we have to do, they do a physical and we review those. And a lot of those, we look for these like muscle imbalances or things that would predispose people to injury. and then we just try to fix it. You know, I try to simplify it for our students and say, you know, if somebody has a deficit in strength or flexibility, we try to make them stronger or more flexible so that their body moves in the right way. And so it’s as simple as a stretching routine or sometimes fitting people for the right size shoes. But our biggest thing is just trying to educate the patient as well of how important that is. I love the saying that you said of, you know, an ounce is worth a pound in the outcome. because a lot of times it’s more time consuming to treat an injury than it is to prevent an injury. But another thing would be I worked at a small STEM academy in Louisiana for a year where I was the only health care provider. We didn’t have a school nurse. We didn’t have any other like I was it. And so I was I was teaching at part of the day and then at last period of the day and then onward, I was the acting athletic trainer. And so we would do a lot of those like in gym class, we would talk to the gym teachers and say, what are some things that we can do to make sure that everybody that takes gym class, what they can do and how can we make it fun to where they don’t feel like they’re doing exercises or that they’re having to go sit on a table and do this, that, or the other. But really trying to make people understand that preventative care is really just taking care of yourself. If something hurts, trying to do a little bit deeper dive of why does that hurt before it gets torn or broken? Yeah, that makes a ton of sense. 

Jasper [08:53 – 09:05] – But I’m interested, you brought up working at a STEM academy with high schoolers. And I’m interested in how athletic trainers end up working with students who might not be accessing healthcare in other ways. 

Ally [09:06 – 10:46] – I was really lucky in that experience that it was a pretty affluent area. And so insurance coverage wasn’t a problem, but I’ve had colleagues that have worked in low income rural areas that being the athletic trainer at the high school is the only form of healthcare some of these individuals are getting. And so you will find a common theme with almost every athletic trainer that you talk to is that a lot of us got into this field, one, because we were athletes and got hurt ourselves, or two, we just want to help people. And that’s really the basis of our profession. It’s empathetic care. And so when we’re in those settings of high school, low income, you know, low socioeconomic status, you want to do everything that you can. And so that not only expands to athletic care and getting them better back to go to the basketball game, but it’s also like teaching them about healthy diet, teaching them about healthy hygiene, making sure that they understand a Starbucks Frappuccino isn’t the thing you should be drinking before a game or just things like that. And so it really kind of digs deeper into our, you know, pulls at our heartstrings more of our empathetic nature than really what our, you know, our skill set in college, what the tasks that we’re learning. And honestly, I’ve gotten really a lot of feedback from our students now at Antioch, past students at Otterbein, my colleagues that are, I’m still really close with that. We see more value in our jobs as athletic trainers of getting to see that athlete go back into play or to see that athlete say, I’m telling my parents to make healthier decisions at dinner and we’re all losing weight and becoming healthier. That means more to me than any paycheck. 

Jasper [10:46 – 10:52] – Yeah. And I was also thinking, do you end up doing some screening for mental health? 

Ally [10:52 – 12:01] – Yeah. So that’s been a huge increase over the obviously just with the state of our our country, our world mental health is at the forefront of a lot of conversations. There’s less stigma. So people are OK to say, you know, I’m having these challenges or I’m experiencing these things. I might need some help with this. And so, again, in the college setting, it’s a requirement now to screen for those. It’s an NCAA mandate to screen for mental health. The caveat to that and a caveat to a lot of these injuries as well as it’s self-report. And so we really are, we have to stay within our scope is the other part is that athletic trainers, part of our accreditation, me as a program chair and as a faculty member, there are certain things our KD accreditation dictates to us that we have to teach. Mental health is one standard out of our 92 or 94 standards. In that one standard, it’s got like eight bullet points. And so we have decided to make a whole class about it because there are a lot of things that athletic trainers encounter, right? Not only the, you know, shock from an injury, actual mental health disorders like eating disorders, anxiety, depression, suicide, that we’re the front lines. Athletic trainers are typically the safe place for people to come and talk to. 

Jasper [12:01 – 12:03] – Yeah, that’s kind of what I was thinking. 

Ally [12:03 – 13:16] – Yeah, I’ve been fortunate in my career that I’ve never had to deal with an athlete in crisis, but it’s obviously becoming a huge epidemic. Our national organization, the National Athletic Trainers Association, has really tried to empower us and to really equip us as we do our continuing ed. So when I came back to Otterbein to work as a clinical athletic trainer after I finished my PhD, the first thing I told our head athletic trainers, we need to find a nutritionist in the area that specializes in college athletes because it’s such a niche thing that most high schools aren’t going to have that and have that resource. So having being the only health care provider in that person’s life, you might have to do a little bit more of the, you know, the background work, doing the Googling and saying what’s even available in our area. We’re lucky now that we have things like this, where you’re in LA, I’m in Westerville, Ohio, but we can telehealth medicine a lot now where we can partner individuals or patients with specific providers across the country. And usually the athletic trainers that like bridge to those connections, which is another part of my job that I really like to advocate for is that we’re not just taping ankles. We’re not just carrying around water bottles. We really are dealing with some of these really heavy potential things in people’s lives. 

Jasper [13:16 – 13:57] – No, I love that vision as a bridge. And just I think you bringing up eating disorders, which obviously athletes are as susceptible as other people are maybe even more to those. But also so many people having regular exercise is a key part of how they’re maintaining their mental health. So I can imagine also, when people are injured, they might be more at risk of having a depressive episode. And I mean, through all of these, it just sounds like it would be so useful to have a relationship with a trained athletic trainer who is kind of your friend, somebody who’s helping you, and also somebody who’s looking out and trained to look out for these things. 

Ally [13:58 – 14:20] – That’s the one thing I think right now as I’m recruiting new students and trying to explain to them what athletic trainers, what the whole kind of job entails. It really is what you just said. We’re part-time healthcare provider. We’re part-time mental health specialists. We’re part-time nutritionists. We’re the master of a lot of things. And we really are relationship driven. 

Jasper [14:21 – 15:12] – Yeah. And having a relationship before the hard time is such a gift towards treatment. I mean, that’s why we have like primary care physicians so that somebody sees us for years. And then when we do face a crisis, we’re like, I know I can trust this person because I’ve already built that relationship. I mean, it makes a lot of sense. And I wanted to circle back to something you said earlier, which is that athletic trainers are finding that they’re useful working with first responders, working with folks in the military, and also working with like warehouse workers. Yeah, I think these are places where that it would make sense to have that sort of person looking out to see that you don’t get injured slash pre-existing relationship for when you do get injured. So talk a little bit about that and what you’re finding with your colleagues who are working in those settings. 

Ally [15:13 – 16:34] – Yeah, so I will preface it by saying I have never worked personally as an industrial, we call it industrial athletic training, but I do have a few colleagues that are. And so the thought behind it is these warehouse workers think of like an Amazon plant worker on a line or UPS drivers that are doing this really repetitive movement day in and day out where, you know, they have a lot of what we call overuse injuries. And so what we’ve seen is that the skill set of an athletic trainer to do that preventative piece, but also to treat it once it’s happened, those types of businesses really see the benefit of if I can keep my worker healthy, I don’t lose productivity. I don’t have to pay overtime for somebody else. I don’t have to pay workers comp. And the rapport of the staff is maintained because people aren’t coming and going because they’re hurt all the time. And now we’re starting to see this return on investment of people are really starting to see the value of what an athletic trainer can bring to that. And like I said, the rapport before the factory workers, the first responders are starting to see like, I have somebody, a resource or an outlet that can keep me safe, but also make me better at my job. So we’re seeing it with the first responders of, you know, they have physical fitness requirements that they have these tests that sometimes pay bonuses or incentives are tied to. And so if they can work with their athletic trainer to be bigger, faster, stronger and keep themselves safe, it’s a win win for everybody. 

Jasper [16:35 – 17:31] – And you bring up the idea of rapport and sort of the cohesion of a team. You know, we think about this a lot when we think about sports of like, oh, we’re all in this together. If one person gets injured, they’ll stay close to the team and we’ll kind of bring them back. But we’re also trying to build strength together. And we definitely talk in our careers about like, oh, yeah, what team are you on? I’m on this team, whatever, within a business. But I think it’s interesting to think of the athletic trainer kind of makes literal the idea of the team. I mean, I think under capitalism, like we do end up thinking about things through the lens of money, but showing the way that like the health of the people who are coming together to make up an organization or a team is the same as like the financial success of that team. Like you can’t separate those things. And that’s good as much as we’re seeing people not as disposable, but as an asset to be taken care of and nurtured. 

Ally [17:31 – 17:32] – For sure. 

Jasper [17:32 – 17:44] – I know that all of the programs in the Graduate School of Nursing and Health Professions have, as a lodestar, the concept of training students to be competency-based clinicians. And I wanted to ask how that plays out in athletic training. 

Ally [17:44 – 19:18] – Yeah. So for our competencies, we are training our students to do a skill. And so our competencies really are skill-based. And so over our two-year program, our students do a handful of different clinical rotations in a variety of different settings. So we’re required to give them things across the lifespan. So that’s like a high school, a college, a physician practice, this industrial setting that we just spoke about, trying to give them all variety to teach them how the same skills we know as athletic training and what they look like in all these different settings. And so we have these competencies that each semester we have a set of skills that the student has to demonstrate that they’ve mastered. And those build on each other over the course of the two years into culminating their final semester. They basically check all of them off again. They do an immersion experience. So our final semester is completely asynchronous from classwork. Our students are really in the field full time with somebody of their choosing in a site that they see themselves working in clinically. And so they have to demonstrate that they could be an athletic trainer. They’re supervised by their preceptor during the program, but they have to really demonstrate that they know how to do these things. And so that’s what I would say competency-based means to me and my program is really trying still these skills in our students, but also taking it a step further to where we build this confidence and kind of the muscle memory to where they don’t feel like they’re faking it until they make it, but that they actually feel like really confident in these skills and that we scaffold it through our program to where they do it so many times throughout the curriculum that it’s kind of second nature to them by the time that they’re done. 

Jasper [19:18 – 19:40] – Yeah, that makes a lot of sense. And also seems like maybe the only way that you would ever finally become confident and competent in a profession like that is to actually drill it and go out and use it. How do you go about preparing students to think about the social determinants of health?  

Ally [19:40 – 21:43] – Social determinants of health have been part of healthcare, obviously, for a long time. And in my shift from my previous institution to now this program at Antioch, and it being such a social justice initiative and being at the forefront of everything we do. I’ve had to shift my viewpoint of we were always doing it, but now we just need to name it and be very cognizant of what this is. And so we’ve tried to be very specific with our students of saying, you know, we do things that we call them disablement case models or case studies where they might say like, oh, I had an athlete with an ACL tear. Okay, well, let’s dig a little deeper into these things that revolve around the social determinants of health. We put him on crutches, but he lives on the third floor of his dorm that doesn’t have an elevator. How do we treat this patient or how do we educate this patient? Make sure that they don’t break their leg falling down the stairs from trying to manage that. And so the social determinants of health have really, we’ve created a much bigger emphasis in calling them that versus just kind of implying them through our curriculum. And our students are becoming well-versed in that. One of the awesome things about being in the School of Nursing and Health professions is we have our colleagues and the other programs in allied health and nursing and all the fields that nursing has. And then we’re bringing on the nutrition and dietetics. And so my goal is in a year or two, when we have all these programs up and running with students all over the country, we can start to do what we call interprofessional education that focuses on these social determinants of health. So we can say we have this patient that has this ailment or this illness. This is what I can do as an athletic trainer to impact these different social determinants of health, what would nursing add to this? Or what would nutrition add to this? And really broaden our students scale of their knowledge, but also their skill set in the colleagues and in the different people in their network to when they leave Antioch, and they get away from Westerville as a clinician, they have that empowered, and they really are focused on treating the patient holistically, and all the determinants of health that they bring to the table and not just treating them as a knee sprain or an ankle sprain. 

Jasper [21:43 – 22:30] – That makes a lot of sense. And it also points up like one of the strengths of having a graduate school of nursing and health professions in that, you know, you’re talking to your colleagues, but also your students can potentially down the line, be in community with students in these other programs. Athletic trainers exist within like a web of care within the medical system. So if someone tears their ACL, they might have it surgically repaired by a specialist doctor, be taken care of after that by nurses, then maybe work with a physical therapist, and then working with you to get back on the field. That sort of seems like you all need to be working in concert and be conversant in what each other is able to offer.

Ally [22:30 – 23:27] – I think the in concert analogy really makes sense because I feel like a lot of times the athletic trainers, like the conductor, were the middleman to all of these conversations. typically because we’re the ones that see the athlete every day. Like you mentioned earlier, I see my primary care once a year for my physical. But when I was an athlete, I see my athletic trainer every single day of practice game off day to get recovery treatment. And so usually the athletic trainer is the one that’s on top of all of those moving parts of somebody’s care of you need to go see a nutritionist or you need to go see your specialist or you need to go back follow up with your surgeon and kind of have the do’s and don’ts of these time periods when they’re out of play. We have to be pretty well organized to make sure we’re talking about the right patient to the right person. Obviously, we’re talking about medical information and we want everything to be protected. But we really are kind of the facilitator of all of this moving forward at a rapid rate and with the patient at the center and our patient care being our highest priority. 

Jasper [23:28 – 23:36] – That’s beautiful. I’m glad you took that word in concert. And you were like, no, this is a perfect metaphor. And I love the athletic trainer is the conductor. That makes a ton of sense. 

Ally [23:37 – 23:37] – Yeah, good. 

Jasper [23:37 – 23:56] – So as a last question, I wanted to ask, as you are seeing your students go out into the world and be athletic trainers in all sorts of different contexts, how do you hope to see them kind of affecting the health overall of their communities and maybe transforming the profession? 

Ally [23:57 – 25:21] – I am so excited about that. So I have been a program director now for a little over a year, but I’ve had students for about the last decade in some capacity. And so being in this seat now where I get to effectively make the changes and impart on them what I really want them to go out and be with the backing of Antioch’s mission of social justice being one of our main focuses, I would love to see our students in five years not be working in college athletics as the primary population. right, that we’re in some of these lower income high schools, that we are the health care provider for the entire school, that being able to expand athletic training into another avenue where Antioch graduates are the first to do, you know, skydiving rehab, you know, something crazy like that, where it’s where we, if you ask most college students, when they go into athletic training, and you say, where do you want to work, the majority of them will say division one football or professional sports. And then the reality is that there are not that many jobs that come available every year for those things. Once people are in it, they don’t leave. And it’s a very demanding job, work-life balance in those positions. And the people that do it love it, but there’s a need for all these other populations. And my hope is that in five years that we could do another podcast like this and I can rattle off 20 different graduates that are in different types of populations that aren’t college or high school athletics. 

Jasper [25:22 – 25:30] – That’s such a beautiful place to leave this conversation. I think you’re on a good path. And thanks so much for coming on the show and teaching us so much about this today. 

Ally [25:31 – 25:39] – Thank you so much for having me. Hopefully you learned something about athletic training and your listeners will be keeping their eye out now for the next athletic trainer they can spot out in the wild. 

Jasper [25:39 – 26:46] – I know, I’ll be keeping my eyes peeled. You can learn more about the Master of Science in Athletic Training that Allie chairs on Antioch’s website. We’ll include a link in our show notes to that webpage. And we’ll also link to the website for the Coalition for the Common Good, in case you want to learn more about that. We post these show notes on our website, theseedfield.org, where you’ll also find full episode transcripts, prior episodes, and more. The Seedfield Podcast is produced by Antioch University. I’m your host, Jasper Nighthawk. Our editor is Nastasia Green. Our producer is Karen Hamilton. Dani LaPointe and Liza Wisner are our work-study assistants. We received additional production help from Amelia Bryan, Jonathan Hawkins, Jefferson Blackburn-Smith, Gina Calcamuggio, Jenny Hill, Kati Skon, and Laurien Alexandre. Thank you for spending your time with us today. That’s it for this episode. We hope to see you next time. And don’t forget to plant a seed, sow a cause, and win a victory for humanity. From Antioch University, this has been the Seed Field Podcast.