My dad was the coach; I was the Athletic Trainer.

Posted June 17, 2016

By Mike Hopper, MS, ATC

Many people love spending time with their families, and my family was no different. But what made my family unique was that life always revolved around sports. Growing up with 3 older sisters and a younger brother, with mom being a teacher and dad being a teacher/coach, to say that I grew up around athletics would be an understatement. In fact, that childhood experience clearly drew me into my career as an Athletic Trainer (AT).

All of my siblings were active in one sport or another, and I played 3 myself. In fact, I played for my dad in all 3 sports. So working together in the sports atmosphere was nothing new. When I graduated from college, I spent a little over a year at one school before I was transferred to my alma mater. At the time, my dad was an assistant boys’ basketball coach at Waterloo.

At Waterloo, I worked alongside my dad for 2 years.  My dad was the coach; I was the Athletic Trainer. During those 2 years, we spent a lot of time together. Some would see it as a negative thing to say that work often went home with us. However, we also had many great conversations because we shared so much in common.

My dad and I did have slightly different perspectives resulting from our different roles, but I did learn something from the experience. I know that I have been able to adapt and work alongside different coaches due to my relationship with my dad. He taught me how to work with coaches who have different personalities and to be loyal.

As a veteran of 40+ years in high school coaching, my dad is that “old school coach” who may not always understand our role as ATs. But I know he is terrified thinking about how quickly we can be put into life-threatening situations, and as the AT it’s my job to manage the situation. After all, I am still his son, and it’s scary to him that I have to take on that responsibility.

When it was time for me to move on, and into bigger and better things, I too became Coach Hopper. In Texas, many ATs go by “Coach” or by “Doc.” It was such a weird feeling for a long time because Coach Hopper was always my dad, and now it’s me. For many, my dad will always be Coach Hopper, but to me he’ll always be Dad.

So on this Father’s Day weekend, I want to wish Coach Hopper a Happy Father’s Day! I have learned so much and being the son of a coach has helped make me into the AT I am today.



Guidelines on Listing and Abbreviating Degrees, Licenses and Credentials

Posted June 14, 2016

By Melissa Breazile, Content Coordinator

Proper treatment of degrees, licenses and credentials has been a source of confusion and misuse for years. Many Athletic Trainers are unsure how to list or abbreviate the qualifications that follow their names.

Consistency in how Athletic Trainers identify themselves alleviates confusion and lends credibility to the profession. The following is intended to provide clarity as you identify yourself in signatures, business cards, letterhead or any other written format.

A 2003 article by Ken Knight, Chad Starkey and Chris Ingersoll established guidelines for displaying degrees, licenses and credentials, and this information is still valid today.

The article says it is proper to list academic degrees first, licenses second and credentials last. Here, credentials include BOC certification. For instance, a BOC Certified Athletic Trainer holding a master’s degree and working in a state where licensure is not required should write, “Sally Snow, MS, ATC” – not “ATC, MS.”  The same BOC Certified Athletic Trainer working in a state with licensure would correctly write, “Sally Snow, MS, LAT, ATC.” See the illustration for an example.

What do these qualifications mean? Licensure provides a legal right to practice, while certification, which is voluntary, states that a professional body – in this case, the BOC – has determined that your knowledge and skills have met a pre-determined standard. If you use more than one credential, list them in order of difficulty of obtaining them. With credentials of similar difficulty, such as ATC and PT, list them in chronological order.

Common Errors and Exceptions
Because confusion has persisted over the years, we know of several common errors. One such error involves listing licensure and certification as a single abbreviation; such incorrect examples include ATC/L, LATC and ATC/R. The first example implies that certification is more important than licensure, which is not the case. The second and third examples improperly append the ATC® credential, which is a registered trademark and cannot be modified.

- Two exceptions exist. Wisconsin, by state law, does not allow you to use ATC®; the law specifies the use of LAT.

- And in Texas, everyone is an LAT because not all Texas ATs have to be certified. Texas has its own set of requirements to earn a license, BOC certification and/or the Texas licensing exam.

So as far as BOC and our protection of the credential, we do not regulate against the improper treatment of licensure and regulation. However, we do regulate against those who use the ATC® credential and are not currently certified.

Finally, we offer one more note on usage. Despite the common misconception, ATC is not a noun. An AT is the person who holds the credential, while ATC is the credential. For this reason, it would be inappropriate to say, “Bob Jones is the ATC for the Cardinals.” Instead, it is correct to say, “Bob Jones is the AT for the Cardinals.”

Access the article by Knight, Starkey and Ingersoll at, and click on the “Public Relations” tab.


Practicing Responsibly: Understanding Athletic Training Regulation and State Practice Acts

Posted June 7, 2016

Nicole T. Wasylyk

Nicole T. Wasylyk, MSEd, LAT, ATC

Athletic training regulation varies across the United States from no regulation to registration, certification and licensure. Understanding the laws that regulate athletic training services within your area is key to responsible practice.

So what’s the difference between certification, registration and licensure?

The least restrictive form of government regulation is registration; these states require individuals to submit information prior to practicing as an Athletic Trainer (AT). Registration usually requires name and qualifications, but this can vary based on the state. Next is certification; certification protects the titled use of the term Athletic Trainer and is granted to those who meet predetermined standards. In a state where certification is the only requirement, an uncertified individual may perform the duties of an AT but they may not use the title Athletic Trainer. Finally there is licensure, which is the most restrictive form of government regulation. In a state that requires licensure it is illegal to practice athletic training without first obtaining a license.

With ATs employed in clinics, hospitals, collegiate and interscholastic roles, it’s important to understand the language of laws and practice acts. Some states contain restrictive wording that may, unfortunately, limit an AT’s ability to perform services for certain populations. Alaska, for example, states ATs may provide services to athletes; their definition of an athlete “means an individual who participates in an athletic or sport-related exercise or activity, including interscholastic, intercollegiate, intramural, semiprofessional, and professional sports activities.”1 Although not completely restrictive, the act does reveal concerns about use of language and how it can limit an AT’s ability to practice in certain settings.

An example of non-restrictive language includes that from the state of Wisconsin. ATs in this state may evaluate and treat individuals who participate in physical activity with the definition of physical activity being “vigorous participation in exercise, sports, games, and recreation, wellness, fitness, or employment activities.”2  This definition is inclusive of a myriad of patient populations, allowing ATs to practice in any number of settings.

ATs are growing into more dynamic and diverse roles; we provide services to individuals indiscriminate of athletic ability. Rethinking the way our practice acts are written may be critical in the coming years as we progress as a profession so as not to restrict our services to athletes and athletic populations. Some practice acts may not yet be reflective of our new roles or may contain legislation that is over a decade old with minimal amendments since inception.

If you’ve ever seen the Schoolhouse Rock “How a Bill Becomes a Law,” you’ll understand how it takes time and significant effort and support to pass legislation. Similar effort is needed when amending these laws. The National Athletic Trainers’ Association (NATA) and Board of Certification (BOC) have made strong efforts to improve the practice of athletic training, both through support of state licensure and bills related to athletic training practice. Current legislative efforts include the Sports Medicine Licensure Clarity Act (H.R.921 / S. 689), which seeks to provide legal protection for ATs or sports medicine professionals who travel to another state with an athletic team solely to provide care for their team. Currently, medical liability insurance does not cover an AT when they travel with their respective team to states where they are not licensed to practice.3

Be sure to access your state practice act and read through it in its entirety. Even though licensure is required for the vast majority of states, not all practice acts are created equal. Scope of practice is not entirely determined by a practice act, but it is crucial to know exclusions to practicing that may be described within the document. Access your state practice act through the NATA or BOC websites.

References and Resources:




State Regulation

NATA Scope of Practice Webinar

Sports Medicine Licensure Clarity Act

About the Author

Nicole Wasylyk works as an Athletic Trainer in a physician practice at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire. Prior to DHMC she resided in Madison, Wisconsin and was an Athletic Trainer in a physician practice at Meriter-Unity Point Health. Wasylyk obtained her Bachelor of Science in Athletic Training from Boston University and Masters of Science in Education from Old Dominion University. She has completed a residency program for healthcare providers who extend the services of a physician at UW Health. Wasylyk also obtained her orthopedic technician certification. Her professional interests include injury surveillance and prevention, standardization of best practices and patient reported outcomes collection. 


Best Practices for Young Athletes

Desi Rotenberg,

By Desi Rotenberg, MS, LAT, ATC

Athletics and sport play a significant role both in the lives of the child and in the lives of the parent. A positive experience can yield retention and adherence to a sport, whereas a negative experience can lead to non-compliance and an unwillingness to grow within the sport. The goal for youth sports is two-fold: to create a fun, engaging environment that is learning and team-centered, and to teach young athletes how to begin priming their body and improving their performance through fitness training.

The first aspect is ensuring the children are with teams, coaches and programs that are truly vested in the development of their self-esteem and their true potentials. Development of talent and skill is important; however, as we often see, when the focal point is solely on winning, the development can be hindered.

Dr. JoAnn Dahlkoetter, a leading sport performance psychologist, came up with the “Top 5 Mistakes Parents and Coaches Make in Motivating Young Athletes”1:

1. Parent or coach overreacts when the athlete does not perform up to expectations

2. Demanding too much time or commitment from the athlete, resulting in chronic injuries or being burnt out

3. Giving an inordinate amount of attention to the star player and ignoring the value of other team members

4. Increasing the pressure and expectations as the season goes beyond the appropriate expectation for that age group

5. Not encouraging the young athlete to have a balance within their life (i.e. school, family, social circle, rest)

Over time, these negative stigmas and reactions can have a deep, long-lasting impact, especially on athletes who are emotionally fragile and sensitive. We must ensure that before an athlete can begin a productive and successful fitness training regiment, their mindset must be pointed in a positive direction and healthy priorities must be established. It will be the responsibility of the parent and the coaching staff to create an environment that brings out the greatest potential of each child in a safe, controlled manner.

Furthermore, sport specialization can also be harmful to a young athlete’s growth and development. Myer et al. validate that focusing young athletes on one specific sport and quitting all other sports can lead to increased likelihood of chronic injury and burnout.2

Avoiding burnout can be a product of diversifying sport and exercise at a young age and encouraging young athletes to engage in healthy training habits. In order to ensure the optimal growth and development of young athletes, allowing unstructured play should be encouraged. In addition, sports should allow young athletes to continue to develop motor skills and to participate in an alternative, fun atmosphere. This can alleviate some of the pressures placed on young athletes by the demands of the sport.

A follow-up study by Myer et al. indicated that a “periodized strength training model” should be utilized to prepare young athletes for the demands that will be placed on them later in their athletic lives.3 Every athlete should have opportunities for mental and physical rest and recovery, and parents and coaches must be sensitive to the needs of each individual.



2. Myer, Gregory D., et al. "Sport Specialization, Part I Does Early Sports Specialization Increase Negative Outcomes and Reduce the Opportunity for Success in Young Athletes?" Sports Health: A Multidisciplinary Approach (2015): 1941738115598747.

3. Myer, Gregory D., et al. "Sports Specialization, Part II Alternative Solutions to Early Sport Specialization in Youth Athletes." Sports Health: A Multidisciplinary Approach 8.1 (2016): 65-73.

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. 

Decreasing Injury Risk

Tim Koba, MS, ATC
Twitter: @timkoba

By Tim Koba, MS, ATC

If you are involved with youth sports and have seen injuries suffered by the participants, you should

know it doesn't have to be that way. There have been several studies examining the effectiveness of implementing an alternative warm up specifically geared to decrease injuries. So far, the findings have been successful. Now, a study out of Canada also points out decreasing injury risk in sport saves money for the healthcare system, too.

Depending on the injury an athlete suffers, the financial, physical and mental cost can add up quickly. In the event an injury requires a surgical repair, the costs can skyrocket and the athlete may not return to participation. This lack of participation can have profound health effects if they suffer early joint pain, arthritis and inactivity leading to chronic illness or obesity. Obviously, this is a worst case scenario and the majority of injuries are relatively minor and easily treatable. Still, the possibility does exist for long term impairment. This is especially true for ACL injuries, medial elbow injuries in baseball players and shoulder labral tears.

So, if there is a chance some of these injuries can be decreased, we should take it. The good news is that while preventing all injuries is not possible, there are steps that can be taken to decrease certain ones. We know some of the global and more specific risk factors for suffering an injury. When athletes increase the intensity of their activity too quickly, they are more likely to get injured. Having already sustained an injury makes you more likely to suffer a recurrent injury.

Prior to puberty, boys and girls demonstrate similar movement patterns that change after puberty. Part of this divergence may be contributing to the increase in injuries suffered by female athletes after this time. We also know females are more likely to suffer ACL injuries and following a specific exercise program can decrease that risk.

Many studies have been conducted with soccer teams to determine the effectiveness of these programs. But, there is nothing specific about the exercises that make it special for soccer. The exercises are more global neuromuscular movements that if performed properly can improve movement quality, strength and performance metrics while decreasing the risk of injury.

Many programs are readily available for implementation, or there are community resources that are able to help. Finding and working with a qualified Athletic Trainer, physical therapist, strength coach, personal trainer or coach who understands the sport, common injuries and conditioning is a great place to start. They are able to find the research studies and programs available, demonstrate and instruct teams in how to perform the drills and be available to assess ongoing progress.

Taking the time to learn a few specific movement based exercises and drills can improve movement quality and strength. It can also lead to better, more conditioned athletes who are able to stay healthy throughout the year. With the ever increasing cost of healthcare and percentage of people with obesity, we need to do everything we can to keep people healthy and active from an early age. Incorporating injury prevention programs into a practice is a simple way to have a large impact.


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.

You can connect with him on twitter @timkoba or check out his blog,


In-Depth Look: Meet an Athletic Trainer who Specializes in Dance Injuries

Posted May 24, 2016

Alison Deleget, MS, ATC, is the Program Manager at Harkness Center for Dance Injuries in New York City.  She works with research, education and clinical care of dance patients. 

Describe your setting:

I work at the Harkness Center for Dance Injuries, a non-profit organization which is part of the NYU Langone Medical Center in New York City. We have several service areas including research, education and clinical care of dancer patients. The Athletic Trainers (ATs) in my department, me included, are skilled within all of these areas. We work with our dance companies to provide on-site care at the company studios, much like a traditional athletic training setting. We also provide educational workshops to dancers, dance teachers and healthcare providers. Our ATs are also an integral part of our research initiatives, authoring or co-authoring publications in dance medicine and serving as investigators on center-wide research studies.

In my current role as Program Manager, I am doing more administrative work now than clinical work. I oversee all service areas of the Harkness Center to ensure our patients are receiving the best possible care. I also ensure our employees are working in a safe and enjoyable workplace, and that the department is in compliance with all of the various state and federal guidelines governing medical practices.

How long have you worked in this setting?

I just celebrated my 10th anniversary at the Harkness Center for Dance Injuries. I have been in my new position of Program Manager for the last 8 months. Prior to that, I held the title Clinical Specialist.

Describe your typical day:

That’s a tough one! Every day is different, which is one of the things I love about this job. In one week, I can be in several different places, doing very different things.

A typical week may involve: treating one of our companies at their studio, giving an educational workshop to dance students and working with physicians at our dance clinic. I also meet with my department’s management team and/or the hospital’s leadership and spend time completing the various administrative tasks that consistently need attention.

What do you like about your position?

I like the variety of job tasks. I like that I’m constantly challenged to learn and grow, both as a clinician and as a leader within my workplace. And, of course, I LOVE working with the dancers. I am in the unique position to say I do what I love – I get to combine my passions for dance and athletic training every day!

What do you dislike about your position?

I definitely have days when the administrative parts of this job are less than exciting. On those days, I do remember progress comes through good leadership, and I have the opportunity to help this organization grow every day.

Globally, I’m frustrated with the practice limitations ATs have in New York State due to limited third party reimbursement and a practice act that is in dire need of revision. Both of these issues are being actively worked on by dedicated people in New York State Athletic Trainers’ Association (NYSATA) and Eastern Athletic Trainer Association (EATA), so I know things are on the brink of changing for the better.

What advice do you have about your practice setting for a young AT looking at this setting?

My advice to any AT who is interested in working with dancers or in the performing arts field is to be creative! This is a very new setting for athletic training, which means job opportunities are not plentiful just yet. But, there are thousands of dancers in the United States alone who need good care and would be very appreciative, dedicated patients!

If you can be creative and proactive, there are opportunities out there. Many employers would love to expand their practices into the dance world – a new population means a new revenue stream. They just need the right AT to open that door for them.


Is your secondary school eligible for the prestigious distinction of the NATA Safe Sports School Award?

Posted May 19, 2016

By Jennifer Striggle-Young, MEd, LAT, ATC

Are you a secondary school Athletic Trainer whose athletic program provides or coordinates pre-participation physical examinations? Is your athletic equipment properly maintained and fitted to the individual wearing it? Does your school have an athletic training healthcare team in place with knowledge of automated external defibrillator (AED) and cardiopulmonary resuscitation (CPR) care? These are just a few of the questions used to distinguish a school as a Safe Sport School. If you haven’t already done so, take this quiz, provided by the National Athletic Trainers’ Association (NATA), to see if your school is a candidate for the award.

The NATA introduced the Safe Sport School Award in 2013 with the first group, consisting of 3 schools, recognized on April 12, 2013. The program was developed following the 4th Annual Youth Sports Safety Summit with the desire to reinforce the importance of providing the best level of care, injury prevention and treatment for student athletes around the country at the secondary school level.

To date, the NATA has awarded 766 schools, 728 first team and 38 second team. First team is awarded to those schools that act on all of the recommended and required elements. Second team is granted to schools that have completed only required elements. The awards are good for 3 years, and then the schools must reapply. The NATA has already started to receive renewal applications.

Tom Yabor, MS, ATC and head Athletic Trainer of William Penn Charter School in Philadelphia, Penn., first became aware of the NATA Safe Sports School award via a District II email blast. More encouraging emails followed, and he finally downloaded the application packet in spring 2015 to see what it entailed. He was surprised to see the school was already doing most of the recommendations. “Penn Charter has continually made health and safety of student-athletes a top priority. They have had an Athletic Trainer and supervising physician since the late 1960s!”

Tom is grateful to have a very good support structure at Penn Charter and an administration who gives them the tools needed to administer great healthcare to their students. After addressing every detail and submitting the application, William Penn Charter School officially became a first team Safe Sport School in summer 2015. They were the first school in the 5-county Philadelphia area to make first team.

In March 2013, past NATA president, Jim Thornton, MA, ATC, CES, stated, “Not only does this award highlight those schools that have put safety first, but it may generate some competition among schools to be the first in their community to receive it. The ultimate hope, however, is that 10 years from now the award will no longer be needed because Safety First will have become the norm.”

If you are a young or new and emerging athletic training program, the Safe Sport School application and checklist is a good place to start when developing your program. For existing programs Tom also believes, “The requirements of the Safe Sport School Award give good expectations of how to conduct a sports medicine program. It may aid in identifying inadequacies, which may sound like a negative, but that’s the only way you’ll become a better program.”

The Safe Sport School award information and application are available on the NATA website.  Any secondary school can apply. Applications require a $150.00 fee and must be signed by the school principal or athletic director and an Athletic Trainer or team physician. Schools qualifying for the award will receive a banner and artwork to promote their achievement.  Recognition as a Safe Sport School provides the opportunity to heighten the awareness of the AT’s role as a healthcare professional as well as reinforcing the importance of providing the highest safety standards for its student athletes.

About the Author

Jennifer Striggle-Young earned a Bachelor of Science from West Chester University in Pennsylvania. She also earned a Masters of Education from Temple University, Pennsylvania.  She has served as an Athletic Trainer in the secondary school setting as well as the orthopedic clinic setting.




How I Studied for the BOC Exam

Posted May 17, 2016

Elishia Jackson

By Elishia Jackson, LAT, ATC

You were admitted to an athletic training program, spent hours with your head in text books and reviewing notes, and spent more hours observing and working with BOC Certified Athletic Trainers (ATs) to get your athletic training clinical hours. Now it is senior year and time to start studying for, quite possibly, the most important exam you’ll ever take, the BOC exam. If you’re nervous, don’t worry, that’s normal!

The first thing I had to remind myself was that, in actuality, the past 3 years in my AT program I have been studying for the exam. Everything I learned in classes and in the clinic have prepared me for the BOC exam and the professional world. Therefore, I collected past notes, exams and lab papers. Luckily, most of my documents were already organized into a very large binder – my athletic training “hero,” as I like to call it. I began there by reading and reviewing all that I had collected.

Another tool I used was Principles of Athletic Training – A Competency Based Approach by William E. Prentice. This was the first athletic training book I purchased when I started my athletic training program. I used it for reference throughout my time as an undergraduate, and I still continue to use it as an AT. With this book, I decided to start from the very beginning and read or scan through it from cover to cover and make note of concepts and topics I wasn’t comfortable with. Afterwards, I went back through and spent time reviewing and studying those topics more in depth until I felt confident with them.

I did also find it very helpful to utilize the sample exam questions and exam development and scoring from the BOC website. They offer 25 sample exam questions formatted in the exact way you will see them on the real exam. This was especially helpful because I felt more prepared knowing what to expect, including all the question formats, buttons to click for going to the next question, and answering the question or flagging the question to come back to at a later time. Find these and other BOC study tools here:

I dedicated about a week of study time to reading and reviewing the NATA Position Statements and Code of Ethics. These are important to know not only for the exam but for your future career as an AT.

NATA Position Statements:

NATA Code of Ethics:

When it comes down to it, everyone learns and studies differently. This is what worked for me, and I hope it gives you an idea of how you want to study for your own exam. Good luck!

About the Author

Elishia Jackson is originally from the small town of Orting in Washington State. She earned her Bachelor of Science in Athletic Training with a minor in Coaching from Eastern Washington University in 2015. Jackson has experience with athletic training at the collegiate level (NCAA and NAIA), and high school level. Her passion for athletic training stemmed from her time as a junior level Olympic gymnast. Jackson suffered multiple injuries including a career ending neck injury. She believes working in the athletic training profession is a way to help others achieve their goals and dreams. In the future, she hopes to be able to enter back into the world of gymnastics as an Athletic Trainer.


What are the Health Risks of E-Cigarettes? Are E-Cigarettes a Safer Alternatives to Tobacco Cigarettes?

Posted May 12, 2016

Nicole T. Wasylyk, MSEd, LAT, ATC

By Nicole T. Wasylyk, MSEd, LAT, ATC

Electronic cigarettes (e-cigarettes) are a type of electronic nicotine delivery system (ENDS), which are battery powered products delivering nicotine in the form of an aerosol or vapor.  ENDS, which include e-cigarettes, e-hookahs, hookah pens and vape pens, contain a liquid solution commonly composed of propylene glycol, glycerin, nicotine and flavoring agents. These agents are then heated to create an inhalable aerosol.

E-cigarettes were first invented in Beijing, China by Pharmacist Hon Lik in 2003. Hon created the e-cigarette as a means to reduce tobacco smoking dependency; however, its efficacy in reducing dependency is now highly debated. Many of the ENDS products are marketed as healthier alternatives to tobacco or as a means of tobacco cessation, yet there is no current evidence to suggest ENDS are efficacious smoking cessation aids.1

E-cigarette use is rapidly increasing. The CDC reported in 2014 that approximately 12.6% of adults have tried an e-cigarette at one time in their lifetime with 3.7% being current everyday users.3  In teenage populations ENDS use more than doubled from 4.7% in 2011 to 10% in 2012.4  Sales have also risen over the past years with an estimated $3 billion spent globally in 2013.5  Although there is little evidence on the healthcare associated cost resulting from ENDS use, we do know the US healthcare costs for smoking-related illnesses are more than $300 billion annually.6

ENDS products are currently unregulated whereas tobacco cigarettes are regulated by the FDA. ENDS and e-cigarettes may contain any number of chemicals, and companies are not currently obligated to disclose this information. Lab tests conducted by the FDA in 2009 found cancer-causing chemicals in some e-cigarettes to include diethylene glycol, a chemical commonly found in antifreeze that is toxic to humans. They also found nicotine levels vary greatly even in products of the same label.7

So why do some think e-cigarettes are a safer alternative to tobacco smoking?

Smoking has known cancer causing effects and profound effects on tissue microenvironment. It affects both the inflammatory response and reparative cell function, which can lead to delayed healing. Tobacco has been shown to delaying the inflammatory response and impairing bactericidal activity. This delay reduces the body’s ability to control wound contamination, thus leading to a higher risk of infection.8 Tobacco also causes a vasoconstrictive response, believed to be an effect of nicotine. ENDS are thought to be safer since they lack tobacco. They do however contain nicotine along with a number of unknown chemical compounds. Further research is needed on ENDS regarding y their safety and their effects for both users and second-hand exposure.

As ENDS and e-cigarettes become more prevalent in our society, it is important to understand the associated risks with these unregulated items. It’s also important to consider counselling patients and student-athletes on risks of tobacco and nicotine use, especially in regard to their detrimental effects on healing and recovery from injury or surgery. Most importantly, ENDS should not be considered a safer alternative to tobacco or used as a means of tobacco cessation. Effective ways to quit smoking and ENDS use can include avoidance, individual or group counseling; behavioral therapy; over-the-counter or prescription medication or a combination of treatments. The US Public Health service has found combination therapy (medication and counselling) to be most effective in smoking cessation.9

For more information and resources on smoking cessation please visit or call 1-800-QUIT-NOW (1-800-784-8669)






6. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual Healthcare Spending Attributable to Cigarette Smoking: An Update[PDF–157 KB]. American Journal of Preventive Medicine 2014;48(3):326–33 [accessed 2015 Aug 17].


8. Sorensen LT Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012 Jun; 255(6): 1069-79


About the Author

Nicole Wasylyk works as an Athletic Trainer in a physician practice at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire. Prior to DHMC she resided in Madison, Wisconsin and was an Athletic Trainer in a physician practice at Meriter-Unity Point Health. Wasylyk obtained her Bachelor of Science in Athletic Training from Boston University and Masters of Science in Education from Old Dominion University. She has completed a residency program for healthcare providers who extend the services of a physician at UW Health. Wasylyk also obtained her orthopedic technician certification. Her professional interests include injury surveillance and prevention, standardization of best practices and patient reported outcomes collection. 




What can PA7 do for you?

Posted May 9, 2016

By Cherie Trimberger

Communications Coordinator

Imagine a Hollywood movie premiere event with red carpet, camera lights flashing and celebrities and press everywhere. It’s easy to picture the excitement and eagerness everyone shows before being allowed to experience and enjoy the final product.

I’ll admit, the Board of Certification (BOC) releasing the new Practice Analysis, 7th Edition (PA7) may not seem as glamorous as a movie premier. However, the important role PA7 plays in identifying essential knowledge and skills for the athletic training profession more than makes up for any lack of glitz and glamour.

PA7 depicts the current knowledge and skills entry-level Athletic Trainers (ATs) should possess within domains and tasks. This document is also one of the methods used to identify and prioritize the critical tasks of the profession and the essential competence an individual should possess to perform the required functions satisfactorily.

For certification purposes, PA7 is used to establish a defined set of domains, tasks and associated knowledge and skills necessary to carry out the responsibilities of the job to the standards required for certification. This document serves as a blueprint for exam development and continuing competence programming. PA7 will become effective for BOC exams beginning April 2017 and for continuing education beginning January 1, 2018.

In addition to the previous mentioned benefits, PA7 has many other uses for many difference audiences.

Candidates - Use PA7 as a study tool for exam preparation by looking at weak domain areas from a diagnostic report of self-assessment to get an idea of the content associated with them.1

Program Directors, educators and approved clinical instructors - Use PA7 in conjunction with competencies to develop athletic training education curriculum by seeing where the practice analysis corresponds with the NATA Executive Committee for Education’s competencies document.1

Employers - Use PA7 in conjunction with a state’s practice act to support the AT scope of practice. The practice analysis outlines the knowledge and skills entry-level ATs have been evaluated with.1

State regulators, state associations and legislators - Use PA7 as a resource to determine in what knowledge and skills entry-level ATs have been educated for the purpose of writing state and federal legislation.1

ATs – Use PA7 as a guide to identify areas in need of continuing education. If an AT knows they are weak in the domain of Injury/Illness Prevention and Wellness Protection, they can use the PA7 to identify the types of continuing education they should target. It can also be used to promote the profession by highlighting all the knowledge and skills ATs have.1

A full electronic version of PA7 is available for purchase from the BOC Store for $14.95.

The following supporting documents are available at no cost:

Content Outline for PA7

Comparison of PA7 to RD/PA6

How to Use PA7

The Role Delineation Study/Practice Analysis, 6th Edition (RD/PA6) remains in effect for the BOC exam until January/February 2017 and for continuing education until December 31, 2017. You can also learn more on the BOC website.


1. How to Use PA7: