Summer Sixteen: How to Survive Your Summer Athletic Training Experience

Posted May 2, 2016

Kurt Andrews

By Kurt Andrews MS, ATC, PES, CES

It’s the last few weeks of your spring semester in the first year of your entry-level master’s program. Fatigue set in a long time ago. You have 3 different projects to finish up, and you’re over the grad-school diet of $5.00 Hot-N-Ready and the unlimited supply of Gatorade in your fridge. Your head is buried in between the pages of your Prentice book while there isn’t enough coffee left in your cup to keep you going through the night. Your hands rapidly flip through your upper eval class PowerPoint slides as you try to remember the difference between D1 and D2 PNF patterns for shoulder rehab exercises. We have all been there. Those days pass, and the grass gets greener. It is just a necessary part of the process.

As the summer approaches, some students prepare to enter the working world. Their days are filled with résumés, applications, interviews, rejections, second interviews, rejections, emails and phone calls with their Program Directors and clinical coordinators. Eventually, a job offer comes, and sooner or later it will come. For everyone else who has a year left in your program, summer time means the opportunity to go out and gain experience in the setting of your preference. As our profession continues to grow, more and more opportunities are out there to gain quality experience alongside Certified Athletic Trainers (ATs).

The Value of a Summer Experience

Gaining summer athletic training experience alongside ATs is very important and gives students the opportunity to work in the setting they see suitable for their prospective careers. It gives students the opportunity to decide whether or not the work environment meets their career wishes and interests. The experience emphasizes what students have learned in the classroom, but also teaches them important lessons about the athletic training profession outside the classroom.

One of the most important opportunities offered to a student is the chance to acquire new skills by observing the practitioners who work in that setting. However, students and practitioners must be aware of state regulations governing summer athletic training experience. Remember, students are responsible for knowing the state practice acts and what patient care they can engage in if this experience is not part of their clinical education.

Of equal importance, this experience allows many opportunities for students to network with people in their setting of interest who they otherwise would not have had access to. The first-hand experience also represents the crossover between the classroom and clinical setting, making it easier for students to kick start their careers post-graduation. At the culmination, the student should feel that it provided both career development and meaningful work experience. They should also feel they were able to explore their interests, develop their professional skills and continue to improve their competency.

It is especially important for those of us practitioners who work with athletic training students to realize that we have an opportunity to mold the up-and-coming ATs. We can be an integral part of the growing process for the students we work with, in addition to the future of our profession.

Tips for Athletic Training Students

As a current AT and former athletic training student, I can speak with confidence about how important these experiences are for students in the athletic training field. Therefore, the following are tips on how to get the most out of your experience:

- Be open minded and adaptable. The professional setting doesn’t always operate in black and white, and not every answer can be found in a book. In this role, you have to be able to problem solve and critically think under pressure.

- Show initiative. A good piece of advice I learned long ago, when I was 14 working at McDonald’s, was something my manager always said, “If you’ve got time to lean, you’ve got time to clean.” You should never be bored nor should you be caught just standing around. Always have the mindset that something needs to be done or could get done.

- No one is too good or above doing a certain task. In this role, you are a very important part of the sports medicine team, so don’t think that your work goes unnoticed. Filling the fridges, doing the laundry, cleaning the coolers and warm/cold tubs, stocking the cabinets and cleaning the athletic training facility are part of your  daily tasks. If these tasks don’t get done, the team as a whole can’t function.

- Stand out for the right reasons. The goal of this experience is to further your clinical work experience. However, the importance of getting positive recommendations from the supervising practitioners cannot be understated. They are the ones who will be able to recommend you for future job openings.

- Plan for the financial burden. These positions are paid positions, which can help offset some of the incurred costs. Remember, you are there for the experience and opportunity to grow, both personally and professionally. This is an investment in your future, so plan out a budget for the summer and stick to it.

- Work hard. Keep your head down and stay focused. You want your peers, players, coaches, administrative and sports medicine personnel to remember you as the hard-working member of the team. You are a significant person on the sports medicine staff, and the tasks given to you are very important.

- Ask questions. This is the time to ask them. You are there to learn from experts currently in the field. If you feel uncomfortable asking a question, go home to do some research on your own and come in the next day to talk it over with your supervisor. Just remember to find the right time to ask questions. Each AT may have a different philosophy on when questions should be asked.

- Observe, listen, learn and repeat. Be a sponge. Listen to how the ATs interact with players, coaches and administrative personnel. Learn as much as you can from all the staff members you come in contact with. These observations will help you identify what is most important to put into your “athletic training tool box” and allow you to grow as a professional at your future clinical sites.

- Be punctual. This should be pretty straight forward: don’t be late. As a good rule of thumb get to work earlier than your boss. It will never be held against you.

- Don’t panic and have fun. Remember that you chose this because it will help you reach your professional goals. You got the position over other qualified candidates, so the staff has high expectations for you. Be confident. Laugh at yourself and with others. Learn from your mistakes and keep your head held high. You want to look back at the end of the summer with fondness at the memories you created.

About the Author

Kurt Andrews, originally from the metro Detroit area, graduated with his bachelor’s degree in Exercise Science in 2008 from Oakland University. He has been a BOC Certified Athletic Trainer since 2011 where he earned his master’s in Athletic Training from the entry level master’s program at the University of Arkansas. He currently is in his fifth year as an assistant Athletic Trainer for the Major League Soccer (MLS) club LA Galaxy. He currently holds memberships with NATA, CATA and PSATS where he serves on the sponsorship, continuing education and research committees and was presently serving as the Western Conference senator.


The 2016 Boston Marathon: It Is More Than a Race

Posted April 27, 2016

Beth Wolfe

By Beth Wolfe, CAGS, ATC

April 18, 2016 was the 120th Boston Marathon. From Hopkinton, Mass. to Boston, Mass. thousands of spectators crowded the sidewalks to cheer on over 30,000 runners as they ran right on Hereford Street and left on Boylston Street. Over 1,000 medical volunteers from across the United States came together to provide care for the ill and injured. Despite the warm temperatures early in the day and the cooler temperatures into the afternoon, the runners and volunteers embraced the day and were thankful to not have to battle rain and cold as they did in 2015.

One of the most memorable moments from this year’s marathon came from the perspective of athletic training students from Louisiana State University. These students stated that of all the events and festivities on marathon weekend their favorite part was the people. The events of 2013 forever changed the hearts and lives of many, and as we continue to heal the marathon has now become a symbol of unity, peace and family. Patriot’s Day in Boston is more than just a marathon and a road race: it is about people.

On Friday, April 15, the third anniversary of the bombings, Mayor Marty Walsh led the second annual One Boston Day1. One Boston Day serves as an opportunity to celebrate the resiliency, generosity and strength demonstrated by the people of Boston and those around the world in response to the tragedy of April 15, 2013. On April 15 each year, Bostonians and citizens from around the world are encouraged to perform random acts of kindness to celebrate the spirit of Boston and of the marathon. Next year, we hope that Athletic Trainers from across the country will engage in One Boston Day as we look forward to carrying on a tradition of love, hope and peace into our communities.

Overall, the essence of the Boston Marathon is best expressed by Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”

Ari Ofsevit, an ill runner who had to be carried across the finish line at this year’s race, said “There’s 30,000 people in the Boston Marathon, and I think 29,900 would have done the same thing…It’s about paying it forward.” 2 I’m proud to be a part of a profession and family that truly cares about their students, colleagues, patients and over 30,000 runners on Boylston Street.

2017 will be another great year and race. Until then, cheers!


1. One Boston Day. Accessed April 20, 2016. Boston Globe. Marathon runner carried across finish line said kindness ‘captures the spirit of the race’.

2. Published April 20, 2016. Accessed April 21, 2016.


About the Author

Elizabeth “Beth” Wolfe is the Injury Prevention Coordinator and Research Assistant for the Tufts Medical Center Division of Trauma and Acute Care Surgery in Boston, Massachusetts. Wolfe received her undergraduate degree from the University of South Carolina (2010) and master’s in Health Education (2012) and CAGS in Sport Psychology (2013) at Boston University. Wolfe is currently pursuing a Doctorate of Health Science in Healthcare Administration and Leadership at the Massachusetts College of Pharmacy and Health Sciences. A few of her research interests include bike and pedestrian safety; fall prevention; concussion/head injury documentation and coding; and performance/quality improvement programming for the profession of athletic training. Wolfe is an active medical volunteer for the Boston Athletic Association and numerous other races/events throughout the greater New England area. In her free time, Beth loves to ride her bike around Boston and participates in local rugby and softball leagues.



Daily Leadership Yields Lifelong Mentorship

Posted April 25, 2016

Desi Rotenberg

By Desi Rotenberg, MS, LAT, ATC

Cultivating a leadership mindset within any group or organization is paramount. Not only for the global success of the program or the team, but also for the success of every individual involved. Being the leader of an organization or for a group of individuals brings with it both a great power and a great responsibility. Regrettably, many supervisors and employers in the 21st Century do not understand that leading is much like parenting. Character influences character 100% of the time, and when leading a group, an individual is indirectly setting the precedent for how the employees will someday lead when given the opportunity.

The great sages of the Talmudic Era stated, “When a father teaches his son, he is also teaching his son’s son.” Leadership in the workplace functions in a similar fashion: A leader’s staff members will mimic how they were led, both taking in the positive and sometimes even the negative qualities. When entering any work place, the keys to success and ultimately, the keys to both professional and personal happiness, begin with what I like to call the leadership mindset.

Before taking a leadership position, or in some cases, being thrust into a leadership position without warning, we need to create a personal philosophy that will govern how we lead. It begins with creating a personal slogan. For example, in my classroom, I have a sign that reads “Champions Adapt” hanging over the doorway. It has been my personal slogan for about 5 years now, and it will be the basis for the direction of an individual’s leadership.

Every person, whether in a supervisory or employee role, needs to have a vision for how they want to see themselves and how they want to lead others. At its core, an individual who is responsible for the success of others and the success of the organization can be centered on the following paradigm: Daily leadership yields lifelong mentorship.

So, what exactly does daily leadership look like?

A leader is an Individual who meets all events, favorable or unfavorable, with calmness and composure, conducts him/herself using correct morals, behaviors and logic and always has the best interests of their employees as priority number one. An effective leader can focus on the goal at hand, is an active delegator and strives to create personal relationships with each of their employees.

The key to becoming a successful leader lies not in their abilities or their strengths; the key to becoming a successful leader is in cultivating strong relationships with everyone associated with their program, and in maintaining a loyalty that is unwavering.

At the end of the day, cultivating a daily leadership mindset can offer the following to anyone within the organization:

1. The GIFT of believing in someone

a. Most people want to know that they matter in the overall grand scheme; as the leader, believing in the abilities of the people who work for you and the people who you work for can propel the team to another level of productivity

2. The POWER of positivity

a. Positive encouragement and positive affirmation, combined with constructive feedback and a plan for improvement, will help individuals grow on a daily basis

b. Patience and constant action yield long term results

c. People naturally are going to have rough days; as a leader, if we maintain a positive attitude at all times, it shows those working for us that it is okay to have a rough day and tomorrow is another opportunity to start fresh

3. The IMPORTANCE of hope and dreaming

a. It will revolutionize how people perceive you

b. If the leader believes that success will happen, everyone working with them will also believe that it will happen

c. Celebrating the success of others will help everyone gravitate towards you and will show that you genuinely care about the lives of other people


Here are some things to try to bring out the leader in each of you:

1) Write down your personal mission statement:

- What is your purpose in life? What is your passion? You should update this often to continually direct you toward your ultimate goals

2) Next, ask yourself the following questions and write the answers down in a safe place:

- WHY do you do what you do?

- WHERE do you draw your inspiration and motivation?

- WHAT defines you?

- WHO do you belong to?

- WHAT do you believe in?

Every person has the potential to be a leader. The Talmudic sages also said that “In a place where there are no leaders, strive to be a leader.” Whether we want to or not, leadership often finds us when we least expect it. Having a leadership mindset even in a non-leadership role will prepare an individual to reach their full leadership potential when opportunity inevitably presents itself. If we are willing to believe in the people around us and actively help them become better at what they do while maintaining a positive attitude, it will substantially improve the morale and productivity of the group while helping all parties involved feel valued within the system.

About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 

A Day in the Life of a DME Athletic Trainer

Posted April 20, 2016

Brian Bradley

Brian Bradley, MS, LAT, ATC, CSCS

Durable Medical Equipment (DME) is a fancy term for braces, splints and crutches. I work in an orthopaedic clinic that employs 7 Athletic Trainers (ATs) to work in the DME Department. Here is what an average day looks like.

Clinic typically runs from 8:00am to 5:00pm with an hour lunch. During clinic, I use the electronic medical records (EMR) system to track the DME ordered by the physicians. When an order comes up, there are several things I have to do before the fitting. First, I check to see what was ordered, the diagnosis, what insurance the patient has and the size of the patient. There are also different rules for each insurance carrier I need to know.

I select the proper brace ordered from inventory and bring it to the patient’s room. There, I instruct the patient on what the brace does, how to use it and the general care of the brace. Once they understand everything, I go over the insurance information with them including how it will be billed and how much they should expect to pay. I then escort the patient to check-out and follow through with inputting the appropriate HCPCS codes into the charge ticket. Afterwards, I log the brace into our inventory tracking system.

Brian Bradley on the job as a DME Athletic Trainer.

Sometimes physicians order a home exercise program for a patient. In that case, I create a progressive home exercise program geared specifically for the patient based on their diagnosis. I also take into account their age, height and weight. Once I create the program, I go into the patient’s room to explain and demonstrate how to perform the exercises. I then answer any questions they may have and teach them the importance of translating the exercises over to everyday life. It is important for them to be aware of their body posture and daily functioning to assist in preventing further injury.

Although some physicians order more DME/HEPs than others, there is still a lot of work that needs to be done when I do not have many DME orders. I contact both commercial and worker’s compensation insurance carriers to obtain benefits and authorization for high-end items like functional knee braces, TENS units and range of motion devices. Updating and managing the inventory for the clinic is another important part of my job to make sure we have enough items in all the sizes. I also contact patients who may need to pick up items for surgery and schedule them to come into 1 of our 6 locations. I take calls from patients who have questions on how to use a brace or how to adjust the brace so it fits better.

I enjoy being an AT in the clinical setting because I get to see a wide range of patients, from pediatrics to patients on Medicare, from athletes to patients with worker’s compensation claims. At the orthopaedic clinic, I am exposed to a wide variety of injuries. We have 21 physicians with 7 physician assistants. They treat everything from anterior cervical disc fusions to hammer toes, total joint replacements to patellar femoral pain. There is even an orthopaedic surgeon with a specialty in orthopaedic oncology treating musculoskeletal tumors.

One thing that attracted me most to working in the DME department was the regular schedule. I do not have to work any Saturdays or late night games. I am home every night with my wife and daughter eating dinner as a family. While I did love being an AT in the secondary school setting, I love that I get to see my family more. I also have the opportunity to pick up additional work as needed that fits into my schedule. I enjoy being an AT and am happy I found a setting where I get to use my education and experience but still spend a lot of time with my family.

How does an athletic training student reduce stress?

Posted April 18, 2016

By Mackenzie Simmons, ATC

April is Stress Awareness Month; stress is an issue that affects the athletic training population as a whole. This month, we are focusing on being more cognizant of stress levels in athletic training students. The typical athletic training student has a chaotic schedule, involving class, clinicals, homework, extracurricular activities and jobs, amongst other obligations. The number of responsibilities an athletic training student has can quickly become overwhelming and stressful.

It may be possible to identify stress in the athletic training students. Watch out for the following:

- Lack of motivation or focus

- Irritability or anger

- Sadness or depression

- Angry outbursts

- Social withdrawal

- Drug or alcohol abuse

There are several preventive measures to reduce stress in athletic training students. Creating a mentorship program with older students and Athletic Trainers (ATs) can help the athletic training student feel more supported throughout their education. Also, scheduling bi-weekly check-ins with faculty members can keep the athletic training students on task with class and clinical responsibilities. Encouraging the athletic training students to continue to participate in hobbies can help them maintain a better work-life balance, thus reducing burnout.

By reducing stress levels, athletic training students will ideally be able to excel on the academic and clinical side. Handling stress as it occurs is important, but prevention is key to reducing stress. Make an effort to talk to your students or coworkers about their stress levels this month.



COLLABORATION: Athletic Trainers and Registered Dietitians Joining Together in Athlete Care

Posted April 15, 2016

Kurt Andrews

Kurt Andrews MS, ATC, PES, CES

As Athletic Trainers (ATs), we are constantly looking for ways to improve the health and performance of our athletes. One of biggest developing areas of athlete care is sports nutrition. Following changes in 2014 to National Collegiate Athletic Association (NCAA) bylaws governing the provision of meals and snacks to student athletes, there is a race to fuel student-athletes across the country like never before. The professionals behind well fueled student-athletes are registered dietitians, and they work in collaboration with ATs to maximize health, training, performance and recovery.

Providing nutritional guidance is not only a job important for NCAA student-athletes, professional athletes across the spectrum of sport are in need of assistance too. At the LA Galaxy, we work with a registered dietitian to oversee sports nutrition for our first team, United Soccer Leagues (USL) team, and youth academy teams. This includes providing healthy breakfast options; designing daily lunch menus; planning meals for the team while on the road; providing individualized recovery protein shakes after training sessions and games; one-on-one nutrition consultations; providing individualized supplement recommendations; regular body fat testing; blood testing and analysis; and hydration testing.

While there are still few registered dietitians working in collegiate and professional sports, it is important that ATs understand the importance of incorporating nutrition professionals into the care of our athletes. Is it efficient for us to spend time using manual therapy to help players recover after practice if they don’t consume the appropriate post training fuel to repair and replenish their muscles? Could we ameliorate an athlete’s constant struggle with colds after team travel with maximized nutrition to strengthen their immune system rather than scramble to make them feel better with medicine after the fact?

The future of sports medicine is one in which registered dietitians are present in larger and larger numbers in both university athletic departments and professional sports teams’ athletic training facilities.  This makes it vital that ATs be ready to take full advantage of the skill-set they offer to further advance the health of the athletes. As of 2016, only 58 Division I universities employ full-time registered dietitians, which means the vast majority of student-athletes continue to go without access to nutrition professionals. As the practitioners with the highest level of contact with the athletes, it is our responsibility as ATs to advocate for the use of local sports dietitians. To find qualified sports dietitians in your area capable of having a positive impact on the health and performance of your athletes, visit the Sports, Cardiovascular, and Wellness Nutrition practice group website at

About the Author

Kurt Andrews, originally from the metro Detroit area, graduated with his bachelor’s degree in Exercise Science in 2008 from Oakland University. He has been a BOC Certified Athletic Trainer since 2011 where he earned his master’s in Athletic Training from the entry level master’s program at the University of Arkansas. He currently is in his fifth year as an assistant Athletic Trainer for the Major League Soccer (MLS) club LA Galaxy. He currently holds memberships with NATA, CATA and PSATS where he serves on the sponsorship, continuing education and research committees and was presently serving as the Western Conference senator.




Treating SLAP Injuries in Baseball

Published April 11, 2016

Tim Koba, MS, ATC
Twitter: @timkoba

Tim Koba, MS, ATC

Overhead athletes place a lot of stress on their shoulders that can lead to tissue injury over time. One of the injuries that occurs is a SLAP lesion, or a tear of the labrum, which is the ring of cartilage that surrounds the socket in the shoulder joint. This injury can be painful and debilitating. For athletes who require their shoulder to perform their sport, it is important to know how to treat these injuries.

Treatment for a SLAP lesion is either conservative physical therapy to reduce inflammation and improve shoulder movement and stability or surgery to clean the labrum up and potentially involve more in-depth anchoring. Either method can lead to a return to play, but questions remain. Which is more effective and which leads athletes to return to their prior performance? Athletes don’t just want to return, they need to return at or above their pre-injured state. Using performance markers to gauge success sheds light on the best treatment options.

As with most things in medicine and injuries, the answer is not straight forward. Professional baseball pitchers who sustain SLAP tears do not return to the prior performance as well as position players do. With the extra strain on the shoulder, every pitch may be too much to handle regardless of the treatment. Athletes who have a rotator cuff tear in addition to a SLAP lesion have even worse outcomes; they tend not to return at all. Debriding the labrum is less invasive so athletes tolerate this procedure better than more in depth surgical intervention when returning to their sport. The good news is athletes who underwent more physical therapy had similar return to play and return to prior performance as their surgical counterparts.

When treating overhead athletes, efforts can be made for rehab as long as possible in hopes of prolonging their playing days. Surgery is not a guarantee of continued play, so rushing into surgery hoping to improve your sport may not occur. Like other conservative therapy of the shoulder, the goal is to reduce pain and improve movement and stability. Focusing efforts in correcting glenohumeral internal rotation deficit (GIRD), addressing posterior capsule tightness and improving scapular stability when treating baseball players with SLAP lesions can help keep them playing.

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.




ETHICS IN ACTION: Cognitive Enhancement Drugs in Sports: A Slippery Slope with Ethical Considerations

Posted April 6, 2016

Kimberly S. Peer, EdD, ATC, FNATA

Smart drugs or nootropics are on the rise in academic settings to enhance cognitive performance. Often called cosmetic neurology or academic doping, this evolving issue is becoming rampant in schools and universities across the country. Although demonstrated through the literature to only provide a modest increase in cognitive ability1, these drugs are now infiltrating the sports world as potential performance enhancing agents. Taken primarily to enhance concentration, the appeal of these substances in sport could become a major factor in future years. Despite the ethical issues associated with performance enhancing as a whole, we have seen an increase in their use as well as efforts to control their use in the past decades.

Although full coverage of the ethical issues associated with performance enhancing drugs collectively is beyond the scope of this blog, ethical arguments typically stem around the concepts of fairness and autonomy. If an athlete chooses to use these substances, despite the risks to health and reputation, it should be the autonomous right of the athlete to choose. However, on the justice perspective, performance enhancing substances create an unfair playing field as not everyone will choose to use these substances to enhance their performance.  Although superficial in deliberation, performance enhancing drugs have been banned to various degrees at all levels of sport. The constant challenge remains defining exactly what should be included in the list of banned substances and, of course, regulation.

As Athletic Trainers (ATs), we are intimately involved in the athlete’s health history. It is a growing trend to see more athletes and students overall reporting cognitive enhancing drugs. Provided they are prescribed and of the appropriate chemical compound, these drugs can be a therapeutic intervention. However, the dilemma occurs when athletes who are not prescribed these medications find non-therapeutic means of accessing them to use at their discretion. Discerning who truly needs them and who does not is a true challenge and disadvantages those individuals who do genuinely need them medically.2

Cekic1 presents several interesting questions to consider as we begin to face the outcomes of these ever-evolving drugs. Why are we so offended by taking a pill to increase cognitive awareness yet we will gladly consume coffee to increase alertness? Should these drugs be banned in academia as well as athletics? If so, is it even possible to regulate the misuse of these drugs when so many are being prescribed them? Do these drugs differ from other performance enhancing substances? There are many tough challenges ahead as we begin to face these issues in our profession.

As ATs, we need to be aware of this ever-increasing dilemma of illicit use of cognitive enhancing drugs as a potential performance enhancer in sport. We are bound by our Code of Ethics and the BOC Standards of Professional Practice to report any illegal use of any performance enhancing drug, including the consideration of this new generation of performance enhancers. It will be very complicated to address the increasing availability and access of these drugs to our athletes of all ages. Our responsibility as professionals remains to educate and inform our athletes of the risks and to report any suspected illegal use of these substances.


1. Cakic, V. Smart drugs for cognitive enhancement: ethical and pragmatic considerations in an era of cosmetic neurology. J Med Ethics; 2009. 35:611-615.

2. Greely, H. et al.  Towards the responsible use of cognitive-enhancing drugs by the healthy.  Nature; 2008: 702-705.


Sodium’s Role in the Hydration Practices of an Active and Healthy Population

Posted March 31, 2016

Mike McKenney

By Mike McKenney, MS, ATC

In a previous blog post, I briefly mentioned sodium ingestion plays a significant role in the application of hydration strategies. This is a topic often met with some confusion as there are many different recommendations available to healthcare providers. These recommendations can have a direct effect on the fluid balance of an athlete, such as those from the CDC1 and the FDA.2 With that said, this post is not intended to refute the CDC and FDA recommendations, or downplay potential health risks of excessive sodium ingestion, but rather provide a more refined context on the role sodium plays in the hydration practices of an active and healthy population.

Sodium should not be actively avoided by athletes. It is the primary electrolyte that helps drive thirst and maintain appropriate fluid balance in the extracellular fluid space.3 Repetitive bouts of exercise with insufficient sodium replacement can lead to decreases in plasma volume due to an athlete's inability to retain water. This further reduces an athlete's performance as well as the ability to tolerate exercise in hot environments.4 Exercise-associated muscle cramping (EAMC) is a condition commonly assumed to be the result of decreased sodium levels. However, recent investigations indicate there is no reliable, scientific link between EAMC and sodium loss.5 But if athletes should be ingesting sodium, how much is appropriate to ingest?

According to the CDC1,consuming excessive amounts of sodium will have negative effects on the human body to include increased risk of heart disease and high blood pressure. However, similar to general hydration recommendations, sodium recommendations are made to be broadly applied to the general population. The FDA2 agrees with the aforementioned statement, but adds a caveat to their recommendation (added emphasis is mine): "Sodium is an essential nutrient and is needed by the body in relatively small amounts (provided that substantial sweating does not occur)." As Athletic Trainers (ATs), we often find ourselves in settings where substantial sweating is not only a normal occurrence for our patients, but a daily one, which places them in a population who have different needs.

It should not be assumed that a typical diet will be sufficient to replace sodium in athletes. Sweat sodium concentrations and sweat rates can vary widely6, resulting in the need for individual replacement plans. In situations where fluid loss is great, sodium losses can far exceed standard nutritional recommendations. Currently, it is recommended adults 14 and older should consume about 2.3g of sodium per day.7 However, it has been demonstrated athletes can easily exceed this recommendation in a single training session or game:

- Ice-hockey players can lose 5.7g in a single game8

- Soccer players can lose 2.4g in a single training session9

- Football players can lose up to 17.5g following a two-a-day practice6

Likewise, due to large variations in sweat rate and sweat sodium concentrations, some athletes are perfectly fine with their diet alone. Knowing how much an athlete needs is necessary in order to make an appropriate recommendation, and this can be accomplished with minimally invasive sweat testing services offered by a number of companies. Additionally, replacement can be achieved with the sodium consumed as part of a meal, such as chicken noodle soup,10 or with a number of commercially available products. However, care needs to be taken to understand an athlete’s medical history prior to making any sodium supplementation recommendations in order to account for medical conditions where this practice is potentially contraindicated.



2. (Know Your Numbers)

3. Shirreffs S, Maughan R. Volume repletion after exercise-induced volume depletion in humans: replacement of water and sodium losses. Am J Physiol. 1998;274(5 pt2):F868-875.

4. Shirreffs SM, Sawka MN. Fluid and electrolyte needs for training, competition, and recovery. J Sports Sci. 2011;29(S1):S39-S46.

5. Murray D, Miller KC, Edwards JE. Does a reduction in serum sodium concentration or serum potassium concentration increase the prevalence of exercise-associated muscle cramps? J Sport Rehabil. 2015 [Epub ahead of print]. 

6. Fowkes-Godek S, Peduzzi C, Burkholder R, Condon S, Dorshimer G, Bartolozzi AR. Sweat rates, sweat sodium concentrations, and sodium losses in 3 groups of professional football players. J Athl Train. 2010;45(4):364-371.


8. Godek, S.F., Godek, J.J., McCrossin, J., and Bartolozzi, A.R. 2006. Sweat and sodium losses in professional ice hockey players during a pre-season practice and a game. Med Sci Sports Exerc. 38: S218–S219.

9. Maughan R, Merson S, Broad N, Shirreffs S. Fluid and electrolyte intake and loss in elite soccer players during training. Int J Sport Nutr Exerc Metab. 2004;14(3):333-346

10. Ray ML, Bryan MW, Ruden TM, Baier SM, Sharp RL, King DS. Effect of sodium in a rehydration beverage when consumed as a fluid or meal. J Appl Physiol. 1998;85(4):1329–1336.

About the Author

Mike McKenney is an Athletic Trainer (AT) at Northeastern University in Boston, Massachusetts, where he is the Medical Coordinator for their Division I men’s ice hockey program.  Prior to Northeastern University, he served as an AT in multiple settings including secondary schools, Division I athletics and professional cycling; additionally, he worked as an AT who extends the services of a physician for a large orthopedic group.  He has also provided services for many organizations to include the Boston Marathon, USA Cycling and USA Volleyball.

McKenney is a hydration and electrolyte replacement consultant for the Atlanta Hawks of the NBA.  His professional interests include hydration, electrolyte replacement, thermoregulation in sport and postural restoration.  McKenney completed his athletic training education at Gustavus Adolphus College in Saint Peter, Minnesota and master’s degree at North Dakota State University in Fargo, North Dakota.  His graduate research was published in the February 2015 edition of the Journal of Athletic Training.

Why Should Athletic Trainers Get an NPI?

Published March 29, 2016

Kathy I. Dieringer EdD, ATC, LAT

District VI Director

You’ve heard it before, but now it is even more important. As Athletic Trainers (ATs), we are at a crucial time in the history of our profession, positioned to be a leader in healthcare since our team-based approach is the model on which the future is based. ATs are the experts in injury prevention, and healthcare is moving in the direction of emphasizing prevention. We have worked for years to improve our status in healthcare and have made incredible strides, but our work is not done!

So why don’t some ATs take the 5 to 10 minutes to get their NPI? We’ve all heard the reasons: I’m in the (fill–in-the-blank) setting so it doesn’t apply to me; I will never bill for my services; I don’t like how we’re categorized; or it doesn’t help me.

Let’s take the I and me out of it, and think we, as in we, the athletic training profession. It doesn’t matter where you work, it doesn’t matter if you are seeking reimbursement and categories can be changed. What matters is representing yourself as a healthcare provider with an NPI. We were recognized by the American Medical Association over a decade ago, and while that recognition was important, we must continue to progress.

When any entity is trying to assess market penetration of healthcare providers, they use one common tool: the NPI database. This is true of legislators, regulatory agencies and insurance companies.  This occurs on the state level as well as the federal level. Imagine the powerful representation we would have if all ATs were represented during this search. There is definitely strength in numbers. Using NPI statistics gives ATs more power in legislative, regulatory and healthcare initiatives, increasing our value as allied healthcare providers.

The most commonly understood reason to have an NPI is its necessity when billing third party payers for services performed by a healthcare provider. Any claim submitted to an insurance company must identify the AT by an NPI or the claim will be rejected. Is third party reimbursement important to our profession? Absolutely! Is it THE most important reason to get an NPI? In my opinion, no.

The most important reason for all ATs to get their NPIs is to increase the representation of our profession in the healthcare market. We are stronger together, and this most definitely pertains to market penetration of our profession.

I implore every AT to take the time and get your NPI. The process takes all of 5 to 10 minutes, and your NPI follows you for the rest of your career as a healthcare provider.

Follow this link to learn more about how easy it is to obtain an NPI, as well as step by step instructions: