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How does the role of the athletic trainer working in the clinic differ from the responsibilities of the athletic trainer working in a university setting?
How does the role of the athletic trainer working in the clinic differ from the responsibilities of the athletic trainer working in a university setting?


The role of an athletic trainer is dictated by that state’s regulation of the practice of athletic training
The athletic trainer should treat only those who have sustained injury due to physical activity & not patients w/ neurologic or orthopedic conditions


What actions can the athletic trainer take to reduce the number of injuries and to minimize the risk of injury in the competitive athletes at that high school?

  1. physical exams & preparticipation screenings
  2. ensure appropriate training & conditioning of the athletes
  3. monitor environmental conditions
  4. select & maintain properly fitting protective equipment
  5. educate parents, coaches & athletes about the risks of sports

A second-semester college sophomore has decided that she is interested in becoming an AT. Her college has a masters degree in AT yet does not offer an entry level CAATE approved curriculum.

How can she most effectively achieve her goal of becoming an AT?


Everyone must graduate from a CAATE-accredited program to take the BOC exam.
Therefore she must transfer schools


What considerations are important for inclusion in a risk management plan for an athletic program?


Security Issues
Fire safety
Electrical and equipment safety
Emergency injury management


How can the athletic trainer most efficiently set up the preparticipation exams to clear 200 athletes for competition in the fall sports?


The preparticipation exam should consist of:
Medical hx
A physical examination
Brief orthopedic examination
May be effectively administered using a station examination system w/ a team of examiners


A collegiate athletic trainer is approached by the school administration to determine the potential risk of injury to their football team.

What approach is best suited to gather this information?


The NCAA Injury Surveillance System


If a patient brings a lawsuit against the athletic trainer, what must the patient prove if he is to win a judgement?


If an AT fails to provide an acceptable standard of care, there is a breach of duty on part of the AT
The athlete must then prove that this breach caused the injury or made the injury worse.


What is the statue of limitations for an adult patient to file suit?


In personal injury cases, the individual would typically have btwn 1 & 5 years to file a suit for negligence


What type of insurance policy should the meet organizers carry to cover medical costs?


Low cost accident insurance

Often covers accidents on school grounds while athletes are competing


A marathon runner comes into the sports medicine clinic, complaining of feeling tightness in her lower extremity during workouts.

What should the AT recommend as a specific warm up routine that this patient should consistently perform before her workout?


5-7 min slow jog, breaking into a light sweat
Stretch: either static or PNF technique
Each stretch performed 4 times, held 15 to 20 secs
Cool down period: stretch


Following the competitive season, a football player took the months of Dec & Jan off from intense training. It is now time for him to begin the preparatory phase of training.

What activities should he begin with & how should these activities progress over the next several months?


Early part of preparatory phase: training should be low intensity with a high volume of repetitions. This phase should last several weeks to 2 months.

Just before preseason: the athlete should train at a high intensity, and volume should decrease to allow full recovery btwn sessions


An ice skater falls and hits the back of her head on the ice, incurring a possible cerebral concussion.

Initially what observational signs may indicate a cerebral injury?

Signs of a cerebral injury:
Pale face color
Moist skin
Rapid pulse
Shallow breathing
Pupils may become dilated

A football player sustains a cerebral concussion while making a tackle during a game.

How should the AT determine the athlete’s level of orientation and memory

Assessing orientation and memory:
Current date
Name of last week’s opponent
Who won that game
Who scored this games last goal

An ice hockey player is checked hard into the boards head first and sustains a concussion. It is his second concussion this season.

What guidelines should be followed regarding his return to play?


The patient should be held out of all activity until he is completely asymptomatic and can perform at baseline levels on neuropsychological tests and balance tests

The physician may consider keeping the player out the rest of the season


A 40 year old former professional football player with a history of numerous concussions begin to complain of memory difficulty, difficulty in concentrating and on occasion some irritability and problems in visual focusing.

What problem foes this patient have? How should his condition be managed?


Post concussion syndrome

Cannot return to play until cleared by a thorough neurological examination


A high-school lacrosse player experienced a concussion with a brief loss of consciousness.

One week later, the patient is symptom free except for a headache.

Should the athletic trainer allow the patient to resume normal contact activity at this point?


Due to the patient’s young age & possibility of second impact syndrome

In order to return to play need to have:
Absence of post concussive symptoms
Clearance by a physician


A professional firefighter falls from a ladder, striking his head on the pavement, and develops a subdural hematoma.

How can an AT distinguish the symptoms of a subdural hematoma from the symptoms of an epidural hematoma?


A subdural hematoma is due to venous bleeding
Symptoms appear gradually over hours or even days

A epidural hematoma results from arterial bleeding
Symptoms appear rapidly


A field hockey player sustains a severe blow to her cheek by a stick. The blow fractures her maxilla but does not knock her unconscious.

How should the patient be transported to the hospital and why?


The conscious patient with a fractured maxilla is transported to the hospital in a forward-leaning position. This position allows external drainage of salvia and blood


A basketball player is elbowed in the mouth while fighting for a rebound. He goes to the sidelines w/ blood in his mouth, saying he thinks he chipped a tooth. On examination, the AT determines the blood is coming from a cut in the lip and that a small portion of one of his upper front teeth is broken, but there is no bleeding from the fracture and it does not appear that the pulp chamber has been exposed.

What type of tooth fracture does this patient have and how should this incident be managed?


Uncomplicated crown fracture

If the fractured piece of tooth is found it can be placed in a plastic bag

The patient can finish the game

Should be seen by a dentist within 24 to 48 hours


A wrestler is hit in the nose, which injures the lateral nasal wall and causes epistaxis

How should this nosebleed be managed?


Patient should sit up with a cold compress placed over the nose and ipsilateral carotid artery.

Digital pressure should also be applied to the affected nostril for 5 minutes


A 30 year old male is accidently poked in the eye while playing basketball with a few friends in his driveway.

What symptoms indicate that this may be a serious eye injury?


Blurred vision
Loss in the visual field
Major Pain
Double Vision


A racquetball player who is not wearing protective goggles is hit in his eye with a ball and develops a collection of blood in the anterior chamber.

What type of eye injury is this and what complications may follow?



Could lead to major lens, choroid or retinal problems
Immediate referral to physician


A patient develops an eyelash follicle infection.

What is the cause of this condition, and how should it be treated?


Caused by a staphylococcal organism

Hot, moist compresses
1 % yellow oxide or mercury ointment


While carrying the ball, a football back is clotheslined and seriously injures his throat.

What should the AT be concerned with in such an injury?


Could produce a blood clot in the carotid artery

Fracture to the larynx - rare

Could cause a breathing crisis


A soccer player is kicked in the abdomen above the umbilicus. Initially, she had the wind knocked out of her. Now she is complaining of pain and her abdomen is tight on palpation.

What should the athletic trainer be most concerned about, and what organs may be involved?


Injury to an organ that can lead to internal blood loss
Can lead to shock
Could injure: spleen, liver, stomach, small intestine, pancreas & gallbladder

Could also be a contusion to the muscles of the abdominal wall causing guarding


An aerobics instructor complains that when she takes a deep breath, she feels some funny cracking sensations in her lungs. The patient’s athletic trainer wants to listen to her chest with a stethoscope.

What sound should the athletic trainer listen for?


Be able to identify abnormal breathe sounds
Adventitious breath sounds are not normally heard

Wheezes or Rhonchi (musiclike sounds w/ a high pitch)

Rales (crackling or bubbling sounds)


An ice hockey player is checked into the boards by an opponent. He has the wind knocked out of him and, on recovery, says that he feels pain when he tries to take a deep breath. The AT suspects an injury to the thoracic cage.

How can the athletic trainer differentiate between a rib fracture and a costochondral injury?


AT should palpate at along the rib, the intercostal space btwn the ribs, and at the costochondral junction to locate a specific point of tenderness

Apply AP compression to the thoracic cage

Costochondral injury:
More pain w/ transverse compression applied laterally to the rib cage


A lacrosse player is hit in the thorax with an opponent’s stick. He has immediate, localized pain over his ribs and within minutes begins to develop some respiratory difficulty. The athletic trainer suspects that the player has likely fractured a rib and is extremely concerned that the fracture has damaged the lungs.

What lung injuries are possible, and how should this injury be managed?

Injuries severe enough to fracture a rib may cause:
Tension Pneumothorax
Traumatic asphyxia

All conditions should be considered LIFE THREATHING
Access rescue squad
Be prepared to initiate CPR


A Football player is running 60 yard sprints during a conditioning workout with the rest of the team. Even before beginning the first practice, the athlete knew that he was not very fit and was worried about how he would do. On the 5th sprint, he called for the AT and said he felt as if he could no breathe. He appeared to be gasping for air.

What might the athletic trainer suspect is wrong with this patient, and what is the immediate treatment?


Likely caused due to anxiety that existed over having to do these sprints

Increase level of carbon dioxide in the lung

Breathe slowly through one nostril or Breathe into a paper bag


A bball player collapses during a practice sessions when running sprints. The player is conscious and complains of chest pain, heart palpations or flutters, syncope, nausea, profuse sweating, shortness of breath and general malaise.

The AT suspects a cardiac related problem, yet the player has no history of such a condition.

What can cause these symptoms, and how can the AT provide the most appropriate and immediate care for this patient?

Potential causes:
Hypertrophic cardiomyopathy
Marfan’s syndrome
Right Ventricular dysplagia

All of these have contributed to sudden cardiac death syndrome
Life threatening situation


A football player receiver jumps to catch a high pass thrown over the middle. A defensive back hits the receiver in the low back. The athlete does not seem to have a specific injury. After the game, the patient notices blood in the urine and gets really worried.

Is blood in the urine a cause for concern? What should the AT do to manage this condition?



Kidney contusion
The blood should disappear in the next couple of days

Referral to physician for dx


Immediately after finishing a meal, a patient begins to complain of mild to severe pain in the lower abdomen. She has nausea, vomiting, and a low grade fever. The AT suspects she has indigestion; in a hour however the cramps begin to localize into pain in the R side, and palpation reveals abdominal rigidity and tenderness at McBurney’s point.

What should the AT suspect is wrong?

How should this be managed?



Most often needs surgical intervention


A baseball player is hit w/ a pitch in the left upper quadrant. Initially, he appears to be all right but, towards the end of the game, he becomes nauseated and starts to vomit. He complains of pain in the left upper quadrant and pain in his L shoulder extending down his arm. The AT palpates the abdomen and detect rigidity. Within minutes, the player develops shock like sx.

What should the AT suspect happened to this patient?

How should the injury be treated?


Ruptured spleen

AT should treat this injury as life threatening


A wrestler is engaged in a strenuous off-season weight-lifting program. Recently, he has begun to experience pain in his groin. It seems that whenever he strains hard to lift a weight and especially if he holds his breath, the pain appears. He is concerned he developed a hernia.

What symptoms and signs should the athletic trainer look for that would indicate that the patient does in fact have a hernia?


History of a blow or strain to the groin area that produced pain and prolonged discomfort.

Superficial protrusion in the groin area, that increases with coughing.

May experience weakness and pulling in the groin area.

An inguinal hernia results from an abnormal enlargement of the opening of the inguinal canal through which the abdominal contents may be pushed.


A cross-country runner complains of a recurring stitch in the side. She has cramp like pain that develops on the left costal angle during a hard run. She indicates that when she stops running, the pain disappears, but it comes back when she starts to run again.

What can the AT recommend?

  1. Modify eating habits which might produce gas or constipation
  2. Improper breathing
  3. Poor conditioning or weak abdominals

An inexperienced runner wearing new shoes during a 3K charity race sustains a completely denuded blister on the back of the heel.

How should this condition be managed after the race?


Completely remove skin flap
Clean area with soap and water
Apply antiseptic liquid benzalkonium w/ an occlusive dressing like second skin


An overweight construction worker complains of a skin irritation in his groin region. The area appears red and macerated. Some of the tissue is cracked, and there are oozing sores.

How could this chafing have been prevented?


Chafing = Intertrigo

To prevent intertrigo the skin should be kept clean and dry and friction free.

Wear loose cotton underwear.

Males should wear a supporter over underwear


A cyclist slides on some road gravel and sustains a serious abrasion on the left side.

What are the major concerns with this type of injury? And how should it be managed?



Clean with mild soap and debrided with a brush

Cover injury w/ antibiotic ointment and a nonocculsive dressing


A patient has sustained a laceration just above the eyebrow and there is a good deal of bleeding. On close inspection, the AT realizes that, despite a large amount of bleeding, the laceration is not very long, but it is fairly deep.

Should this laceration be closed with steri-strips or a butterfly bandaid or should it be sutured by a physician?


Because it is on the face, best to have it sutured by a physician as soon as possible


A wrestler first experiences a mild itching and soreness in his left axillary region. Later, small pustules form that develop into yellow crusts.

How should the athletic trainer handle this problem?



Highly contagious disease

No physical contact w/ other athletes

Managed daily w/ cleaning of crusted material, followed by application of an antibiotic salve or oral medication


A patient goes into a hospital sports medicine clinic concerned about multiple, small, white circular macules on the abdomen, neck and chest.

What infection could cause these symptoms?


Tinea versicolor

Selenium sulfide


A patient experiences a tingling and sometimes painful sensation in the upper lip region. 24 hours later, swelling occurs, followed by the formation of vesicles. The patient also experiences a mild headache, sore throat, and lymph gland swelling.

What condition is this? And how could the later symptoms have been prevented?


Herpes simplex viral infection

Referral immediately to physician for prescription of valacyclovir which can minimize symptoms


A tennis player complains to the AT that she has a sharp pain in the ball of her right foot. She says that it feels as though she has stepped on a piece of glass. On inspection, the AT observes excessive callus formation on the ball of the foot that is dotted with w/ a cluster of black specks.

What is this condition and how should it be treated?


Verruca plantaris (Plantar warts)

Accumulated callus should be pared down
40% salicyclic acid plaster should be applied
Doughnut pad should be used to protect the area


A cross country runner complains to the AT of extreme nocturnal itching. Observation of the athlete’s skin reveals dark lines in the area of the fingers and toes.

What insect infestation is this?


Mite Sarcoptes scabieei AKA Scabies

Causes extreme itching at night


After mountain biking on a trial in the woods, a patient finds a tick on his leg.

What signs and symptoms should the patient look for as a warning sign of a disease?


Headache, fever, malaise, myalgia and a rash

Any small dark spots or enlarging red ring

Sx of Rocky mountain spotted fever and Lyme disease


A patient who has had previous allergic reactions is stung by a bee.

What physical reactions might the patient be expected to have?

Anaphylactic reaction
Increased heart rate
Fast breathing
Chest tightening
Possible LOC



A rowing athlete complains of feeling tired lately and more exhausted than usual after workouts. She also states that she has noticed many bruises on her legs and arms. The bruises randomly appear in different places all over her body. When asked about her diet, she mentions she eats 2 meals a day and it’s food she grabs on the run. She cannot remember the last time she had a meal w/ vegetables and quality meat.

What do you suspect is wrong with her and what is your plan of action?


Refer to team physician or nutritionist

From her history the AT can assume she is not consuming enough iron & Vitamin K

Iron is essential for hemoglobin formation and energy formation
Vitamin K is important in blood coagulation


A high school football player has become interested in bodybuilding. He is most interested in seeing an increase in muscle mass. He is religious about his weight training but has heard that increasing his protein intake causes the muscles to hypertrophy more quickly.

What advice can the AT give him about taking commercially produced protein supplements?


A small amount of protein (slightly above to double the protein DRI) is needed for developing muscles.
RDA = 0.8 g/kg of BW
Athletes = 1 – 1.5 g/kg of BW

An athlete can easily get higher amounts of protein by eating a variety of foods.

Athletes do not need to take a protein supplement


A recreational runner has been training to run his first marathon. He feels good about his level of conditioning but wants to make certain that he does everything that he can do to maximize his performance. He is concerned about eating the right types of foods before and during the marathon to help ensure he does not get excessively fatigued.

What recommendations should the AT make in regards to glycogen supercompensation, the pre-event meal, and food consumption during the event?


Glycogen supercompensation:
Increases amount of glycogen that can be stored in the muscle & liver
Reducing training volume a few days before competition and increase carbohydrate intake during the week before the event
Pre event meal:
Eat 3 hours before competition
Glucose-rich drinks should be taken at regular intervals for high intensity and prolonged events


A female softball player has a problem controlling her weight. Her body fat percentage has been measured at 25% and she asks the AT what she needs to do to be able to lose some weight quickly and then to maintain her body weight thereafter.

How should the AT respond?


Recommend that this athlete should set a goal of 18 to 20% body fat

She should not lose weight quickly, should consume fewer calories than she is burning off

Needs to achieve calorie balance in order to maintain weight loss


A tennis coach observes that one of her players has lost a significant amount of weight. Along with this loss of weight, the athlete’s level of play has begun to decrease. The coach becomes seriously concerned when another player tells the coach that she thinks her room-mate was purposely throwing up after a meal. The coach ask the AT to become involved.

How should the AT respond?


AT should approach the athlete w/ support

Help her secure counseling
Athlete must be willing to admit she has an eating disorder before treatment and counseling will be effective


An ice hockey attackman has an excellent level of fitness and has superb skating ability and stick work. He is convinced that the only thing keeping him from moving to the next level is his low body weight. In recent years, he has engaged in more weight training activities to improve his muscular endurance and to increase his strength.

What recommendations should the AT make for him to be successful in his weight-gaining efforts?


Must aim to have a positive caloric balance of about 500 calories/day.

Additional calories should primarily be carbs

Protein supplementation is not necessary

Needs to incorporate a weight training program using heavy weights that will overload the muscle, forcing it to hypertrophy over time


A wrestler collapses during a match and exhibits signs of profuse sweating, pale skin, mildly elevated temperature (102), dizziness, hyperventilation, and rapid pulse. When questioned by the AT, the wrestler indicates that he took a diuretic medication earlier.

What type of heat illness is the athlete experiencing?
What does the AT need to do?


Heat exhaustion

Occurs due to dehydration


Can move to a cooler environment


A high-school football team is doing conditioning outside. The temp is 80 degrees w/ 85% humidity. The players have their helmets on and are running 100 yard sprints. One player looks like he is becoming fatigued and slightly disoriented. 30 yards into a sprint he collapses.

What is the immediate course of action to treat this athlete? What’s wrong?


Heat stroke

Check vitals (airway, breathing and circulation)
Activate emergency action plan
Remove helmet & as much clothing as appropriate
Immerse in cold water tub
Continuously monitor vital signs
Temp should be 100 F before removing from cold tub


A track athlete from Florida is traveling to Colorado to compete in a week long track meet. She is concerned because she will be competing at a much higher altitude than she has been training at in Florida.

What should the AT recommend to maximize her ability to compete at the higher altitude?


Arrive 2 to 3 weeks before the event.

If unable to, at least 3 days before her first event


A lacrosse team is practicing on a remote field w/ no indoor facility in close proximity. The weather is rapidly worsening. 20 mins are left in practice, and the coach is hoping to finish before it begins to rain. Suddenly there is a bolt of lightening and an immediate burst of thunder.

How should the AT manage this situation?


As soon as lightening is observed, the AT should immediately end practice.

Get the athletes under cover, if no indoor facility than cars.

Last resort, assume a crouched position


An athlete falls and sustains a dislocated right shoulder.

How should the athlete be transported safely to the hospital?


Apply a sling and swathe technique


A cross country runner steps in a hole and suffers a lateral ankle sprain to the right ankle.

What taping technique should be selected initially to provide ankle joint support while still allowing for swelling?


Open basket weave ankle taping.


A wrestler complains of pain, swelling, and warmth around the knee that seems worse after practice.

What should an athletic trainer suspect is wrong with the knee, and how should it be treated?



Rest, Ice, NSAIDs, protective padding


An 11 year old soccer player fell on an outstretched hand during practice. There is obvious deformity in her right wrist.

What is a possible complication with a fracture in this wrist?


An epiphyseal condition
Growth plate fracture

Can impair growth & further skeletal development


A patient sustained a grade 2 lateral ankle sprain 3 weeks ago. It was given proper immediate and follow care.

What repair has taken place during this time?


Grade II: implies joint capsule and ligaments are partially torn.

At 3 weeks, the injury has been cleared of debris & is undergoing the process of secondary healing.

Granulation tissue fills the torn areas, and fibroblasts are beginning to form scar tissue


A patient complains of a swollen ankle that never become completely resolved since he sustained a sprain 9 months ago.

What is the reason for this chronic swelling?


In its acute phase the injury was never allow to heal properly.

As a result the injury became chronic, with proliferation of the scar tissue, lymphocytes, plasma cells, and macrophages


A field hockey player falls and sustains an acute fracture of the left humerus.

What are the healing events typical of this acute bone fracture?

Uncomplicated acute bone healing goes through 5 stages:
Hematoma formation
Cellular proliferation
Callus formation

A gymnast is receiving e-stim for chronic low back pain.

What is the purpose of E-stim for chronic pain?


Stimulate large, rapidly conducting nerve fibers to inhibit the smaller and slower nerves that carry pain impulses


Patients who are injured must deal with both the psychological aspects of injury.

What stages of psychological reaction does the patient typically go through following injury?

5 stages of psychological reaction:

A receiver in football has his feet taken out from under him by a tackler and lands flat on his low back w/ his legs above him. An on-field evaluation reveals unilateral decreased muscle strength, dec sensation, and a dec patella reflex in the right LE.

Based on the findings, how should the AT manage this injury?


In general an injury to the spinal cord would result in bilateral symptoms.

Unilateral symptoms are more indicative of peripheral nerve injury.

AT should move the patient from the playing field via stretcher or preferably a spine board


A participant in a corporate wellness program has been diagnosed with Hep B.

What are the signs and symptoms of HBV?


Flu-like symptoms:
Headache, Fever, Fatigue, Weakness, Nausea, some abdominal pain.

A blood test will reveal the presence of the HBV antigen


During a bball game, one of the players sustains a nose bleed. Blood is visible on the court and on the player’s jersey and skin.

What actions need to take place before the game can resume?


Athlete must be removed from game until bleeding has ceased.
Remove/change jersey if saturated with blood.
Any blood on skin must be cleaned off.

BBall court needs to be cleaned and disinfected.

Solution to clean the court: 1 part bleach to 10 parts water.


A track and field athlete complains of pain in his left knee. The athletic trainer assesses the injury as patellar tendinitis.

What type of massage would be indicated for this condition in the acute stage?

What type of massage may be indicated in a few days?


Effleurage is ideal during the initial stages of injury to encourage venous and lymphatic drainage.

Friction massage is beneficial for patellar tendinitis to increase circulation


An aerobics instructor has a recurrent breathing problem, especially during high intensity fitness training. Since the weather has gotten warmer, her symptoms have gotten worse.

What is wrong? And how should she be managed?


Exercise induced Brochospasm (AKA exercised induced asthma)

Asthma therapy


A 12 yo physical immature patient complains of pain in his right heel where the Achilles tendon attaches.

What is this condition?

Why and how does this disease occur?


Sever’s disease.

Traction injury to the apophysis of the calcaneal tubercle where the Achilles attaches.


A collegiate field hockey player has a history of repeated ankle sprains. She complains of constant pain and aching and says the ankle feels like it catches when she runs. There also appears to be some mild edema.

What would the AT suspect is wrong?


Osteochondral fracture or osteochondritis dissecans


A rodeo cowboy gets kicked in the anterior thigh after being thrown off a bull.

What is the most important thing that an AT can do to allow this cowboy to continue to compete?


Construct a protective thigh pad.

Repeated contusions may result in development of myositis ossificans