Athletic Trainers Expand their International Reach

Pictured are, from left, BOC President Susan McGowen, CATA President Richard DeMont and ARTI President Paul Berry.

Pictured are, from left, BOC President Susan McGowen,
CATA President Richard DeMont and ARTI President Paul Berry.

Athletic Trainers and Athletic Therapists from the US, Canada and Ireland will now be able to obtain credentials in each other’s countries more easily, thanks to an agreement signed last week by the BOC and its Canadian and Irish peer organizations.

Representatives from the BOC, Canadian Athletic Therapy Association (CATA), Athletic Rehabilitation Therapists of Ireland (ARTI) convened at a Dublin conference to sign the international mutual recognition agreement (MRA) September 4, 2014. Under the agreement, the national certification bodies for athletic training and athletic therapy in all three countries will recognize each other’s education and certification standards.

“We have very strict standards by which we certify our Athletic Trainers,” said Susan McGowen, President of the BOC. “ATs’ skills are in demand worldwide and this just makes it easier for them to work where they want to go. We are working collaboratively by removing barriers for qualified professionals to reach the top of their profession.”

The MRA, signed at the Joint Ireland Faculty of Sports Exercise Medicine and World Federation of Athletic Training and Therapy (WFATT) Conference, allows for a certified professional in one country to practice in another signatory nation following the successful completion of the respective nation’s examination.

Expanding upon a mutual recognition agreement signed in 2005 by the BOC and the CATA, this new agreement ensures common recognition among those organizations and ARTI, their peer organization in Ireland.

“As standards continue to align globally, the Board of Certification, in cooperation with our current partners and the World Federation of Athletic Training and Therapy, look forward to future agreements with other organizations of like-minded professionals around the world dedicated to the prevention and care of injuries to the physically active individual,” McGowen said.

Election for the Next BOC AT Director is Now Open!

BOC Certified Athletic Trainers (ATs) are encouraged to vote in the Board of Directors election. The election is being conducted by electronic ballot beginning September 4, 2014, through 11:59pm CT on October 16, 2014.

The field includes three candidates for the next BOC Athletic Trainer Director. They are Thomas M. Dodge, PhD, ATC, CSCS; Marsha Grant-Ford, PhD, ATC; and Patrick J. Sexton, EdD, ATR, ATC, CSCS. Biographies, videos and CVs for the candidates are available on the BOC website.

On September 4-5, ATs will receive an email with voting instructions from the BOC’s external partner for the election, Survey and Ballot Systems. To make sure the email arrives on time, ATs are encouraged to add the following email address as an approved sender: ATs who do not have a valid email address on file with the BOC will receive a letter via US mail.

BOC Certified ATs have the responsibility of electing Athletic Trainer Directors to serve on the BOC Board of Directors. To see the job description for board members, visit the BOC website. Please note that the BOC Athletic Trainer Director election is separate from the NATA presidential election, which is occurring at the same time.

To stay up-to-date on BOC Board of Directors election news, follow the BOC on the social media outlets listed below, and be sure your contact information is current in BOC Central™.

In-Depth Look: An AT for Omaha’s Pro Baseball Team


Dave Iannicca

Dave Iannicca, MSEd, ATC, CSCS, PES, CES

Name and title:
David Iannicca, MSEd, ATC, CSCS, PES, CES, Certified Athletic Trainer

Describe your setting:
I work in professional baseball with a Kansas City Royals Triple-A affiliate in Omaha, Nebraska.

How long have you worked in this setting?
Eleven years total. I worked two years with the New York Yankees, one year with the Atlanta Braves and eight years with the Kansas City Royals.

Describe your typical day:
My typical day for an evening game (7pm game time) begins around 12:00pm – 1:00pm with preparing the athletic training facility for the day, planning players’ rehab and injury prevention programs, and catching up on other duties such as organizing and preparing for our upcoming road trip, etc.

Players generally start reporting to the stadium around 1:00pm – 2:00pm. Treatments and rehab programs are conducted, in addition to assisting with our strength and conditioning coach for player workouts. Batting practice starts at 4:00pm. During this time I will conduct any on-field functional rehab progressions players may have; otherwise, I am out on the field in case an injury occurs during pre-game. After batting practice I will continue with player treatments/rehab as needed and get players ready for the game. Typically games last from 2 ½ hours to 3 ½ hours on the field.

After the game I’ll continue with post-game injury prevention routines and finish up any last minute treatments before players leave the stadium. Once my work in the athletic training facility is complete, I will enter all my daily notes into the MLB electronic medical records system and send out an end-of-day report to the Kansas City Royals front office, team physicians and other various staff. I generally am finished for the night around midnight.

What do you like about your position?
This is a fast-paced and demanding work environment that challenges you to have a strong work ethic and stay current on the latest research and medical information out there to utilize on our athletes. It provides the opportunity to work with elite players who are looking to improve their athleticism and skills in the game of baseball.

This position has also given me an opportunity to travel all over the United States and visit many cities and states I probably would have never seen or visited. The team and Royals organization are like a family, with the ultimate goal of the players and staff to advance their career to the major league level.

What do you dislike about your position?
The hardest part about this work setting is the time away from home. My family and I reside in Virginia Beach, Virginia, and although they make several trips to visit throughout the season, my job has me traveling away from home for 6-7 months a year for Spring Training in Arizona and to Nebraska for the current season.

What advice do you have about your practice setting for a young AT looking at this setting?
My biggest advice would be to apply for an internship with a professional baseball team through the Professional Baseball Athletic Trainers Society (PBATS) internship program to get a true experience and understanding what this job setting is like and if it’s something you would really like to pursue. There are a lot of hard working and knowledgeable Athletic Trainers in this work setting who have a real passion for the sports medicine field. A young Athletic Trainer just starting out can learn a great amount from them.


In-Depth Look: An AT for Major League Umpires



Mark A. Letendre

Mark A. Letendre, ATC

Name and title: Mark A. Letendre, ATC, Director of Umpire Medical Services, Office of the Commissioner, Major League Baseball (MLB)

Describe your setting:
I work from Scottsdale, AZ, and am responsible for the health and welfare of 74 Major League and 22 Minor League Call-Up Umpires. This is a year-round job with primary duties as a Medical Navigator charged with responsibilities that include pre-employment physicals; umpire specific functional activity assessments; lifestyle management and nutrition; handling stress, sleep, travel, injury and illness; and head blow awareness.

In addition, I have an acute sense of workers’ compensation and personal insurance rules and regulations, as well as familiarity with labor relation laws and working with a collective bargaining unit.

I work alongside a primary care/sports medicine physician, Dr. Steven Erickson, and Minor League Coordinator of Umpire Medical Services, Mark Stubblefield, ATC, to oversee the virtual medical network in place – from Seattle, WA, to Miami, FL, and Boston, MA, to San Diego, CA, and Major League cities in between, including Toronto, Canada.

How long have you worked in this setting?
I am presently in my 15th year in this position and 37th overall in professional baseball.

Describe your typical day:
I am on call 24/7, from the first day of Spring Training games in early March until the conclusion of the World Series in late October. I have set up a phone texting program with Major League Baseball Advance Media Group for immediate alert of an umpire illness or injury on the field as well as video clips of any ball, bat or bodily contact with an umpire. The video clips are emailed for review the next day.

Daily responsibilities include the following:

·         Work hand and glove with home team medical staff that is charged with triaging any acute injury or illness. Once an umpire is diagnosed, he either continues with home team medical staff for care or enters the MLB Virtual Medical Care Network
·         Set up appointment(s) for care and provide any support that is needed within the Medical Network for an umpire unable to work
·         Work daily with Director of MLB Umpiring Randy Marsh to make sure if a replacement umpire is needed, he will arrive in time for the game and estimate how long the MLB umpire will be out. MLB always wants to start a game with four umpires
·         Text, email or phone an umpire who may have sustained an illness or injury and communicate with the attending health professionals as well as with Dr. Erickson
·         Assemble all medical records and enter into Umpire Electronic Record Program
·         Process bills for treatments, supplies and services not covered by workers’ compensation
·         Work with medical provider billing departments so bills for services are earmarked correctly for processing
·         Prepare Mid Week Umpire Health Status Report for weekly Umpire Department conference call
·         Submit End of Week Umpire Health Status Report to Umpire Department supervisors and administration staff and the umpire union, World Umpire Association
·         Attempt to stay current with ever-changing sports medicine care information, particularly in concussion care, heat illness, sleep deprivation, stress and protective equipment

What do you like about your position?
I enjoy every day because it has new challenges that require multi-level problem solving. I am blessed knowing that I am contributing to the health of individuals who are charged with the integrity of our national pastime. Sharing all the health information that we Athletic Trainers have acquired empowers the umpires to be knowledgeable about themselves and make the correct calls more often than not!

I am also proud of the fact that the Office of the Commissioner chose an Athletic Trainer over a physical therapist, chiropractor, physician assistant or medical doctor to set up and be in charge of the first ever professional sports Umpire Medical Services Department!

What do you dislike about your position?
Not many dislikes.  Not part of my DNA!  I do miss the hands-on work and connection that evolves between an AT and his or her patients, and I miss seeing all the wonderful people who have come through my life because of professional baseball.

What advice do you have about your practice setting for a young AT looking at this setting?
VOLUNTEER your time to attain more experience in whatever setting you set your goal for. Heck, had it not been for my volunteering for an American Legion baseball team in my college summer months, perhaps I would not have been as attractive to my first employer, the New York Yankees.

VOLUNTEER for a task, a work group or committee. Sure you will make mistakes, I do every day! However, ask yourself: “What’s the worst that can happen to me? Get fired from volunteer work?” You can’t pay enough for experience.

Go out of your way to “meet and greet” yourself.  There many amateur officiating associations that would love the wealth of information you possess!

Never lose your curiosity. Every person is an industrial athlete, much like the MLB and MLB (Minor League Baseball) umpires, so how do you find them to work with?




The BOC Seeks Physician Director

The Board of Certification (BOC) for the Athletic Trainer is accepting applications from individuals who may qualify for, and be interested in, serving as the Physician Director for the BOC.  Athletic Trainers (ATs) are healthcare professionals who collaborate with physicians. The services provided by ATs comprise prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.  For more information, please visit  The job description can be found on the BOC website. It concisely outlines the responsibilities of a Director.

Applications will be reviewed by the BOC Nominating Committee; the Committee will forward qualified nominees to the BOC Board of Directors (Board) for appointment.  The nominees are to be reviewed and an appointment made by the BOC Board in November 2014. The new Director will be expected to attend the February 2015 and July 2015 meetings and will officially assume their duties January 1, 2016.  The term is three years with the possibility of one reappointment.

If you or someone you know are interested in the Physician Director position, please submit a letter of interest and a resume to the BOC office no later than September 15, 2014:

Fax:  (402) 561-0598
Mail:  BOC
Attn: Physician Director Position
1415 Harney St, Ste 200
Omaha, NE  68102

If you have questions regarding the position, please contact Shannon Leftwich at  Thank you for your consideration.

Additional Information

Job Description

BOC Bylaws: Article III, Section 6 Qualifications:

All Directors

(a)  A person shall be eligible for election or appointment as a Director who:

(1)  Does not hold elected or appointed office on a state, provincial or national regulatory board, and;
(2)  Does not serve on the CAATE Commission, NATA, Inc. or NATA Foundation, Inc. Board of Directors, and;
(3)  Demonstrates experience with oversight boards (e.g., NATA, CAATE, state athletic training organization).

Any person shall be eligible for appointment as a Physician Director who:

(a)  Is licensed as a Medical Doctor or Doctor of Osteopathy, and;
(b)  Is currently recognized in good standing by the governmental authority responsible for licensure of his/her profession, and;
(c)  Demonstrates interest in health and safety through a willingness to be a physician medical advocate for consumers of athletic training services.

How Do You Stay Current Despite Limited Time, Access and Funds?

By Stacy Walker

Staying current in the fast-paced healthcare profession is vital to providing the best patient care. All Athletic Trainers want to provide the best possible care. However, staying current can be difficult and little information is available about access to resources such as apps and medical journals. I started pondering this while I was collaborating on an article about the beliefs and use of evidence in the practice of athletic training. One of the findings is that Athletic Trainers want more resources. Then I wondered, what exact resources were being alluded to? Of course all of the athletic training based ones were mentioned (i.e., continuing education courses, “Clinical Bottom Line” in the NATA News, Evidence-based Practice in Athletic Training web-based course, Journal of Athletic Training, NATA Foundation’s Building Blocks for Clinical Practice). What about other resources? One of my specific questions was about those Athletic Trainers in the high school setting.

ATs in the high school setting may have no or limited access to medical journals other than the Journal of Athletic Training. It must be difficult for Athletic Trainers to stay current with such little access. Where does the responsibility of the employer come into play in terms of offering resources such as apps, subscriptions or access to medical journals? I do not have an answer but wanted to pose the question.

To describe the many types of apps for healthcare providers to stay current is beyond the purpose of this blog post, but I did want to show one very cool one, UpToDate®.

UptoDate® is a service that provides evidence based clinical decision support information. Group pricing is offered. ATs could go to their employers and describe the benefits of staying current with the evidence to provide the best patient care and ask the employer to pay for this. It’s a stretch, I know, but we really need to start exploring more options other than the free ones.

So what do you think? What resources do you find helpful to help you stay current and provide the best care for your patients?


*The BOC does not endorse or recommend UpToDate® and has no business connection with the company. The product is mentioned only as an example. 

How to Ask for a Raise as an AT

By Amanda Webster, ATC

As healthcare professionals we tend to put the needs of others ahead of our own. This can lead to poor performance, dissatisfaction and eventually lead to burnout or changing careers.  In order to set up for a long happy career we must mind our needs, and a big part of that is compensation.  Before gearing up for your next preseason, take time to consider your contract.  If you’ve referenced the 2011 salary survey, you already know the national average at the time of this survey was $51,483.  If your pay stubs put you nowhere near that, it may be time to ask for a raise.

How much should I ask for?
Check out the NATA Salary Survey. Compare your setting, education, number of years certified and region to the trend from 2005, 2008 and 2011. How do you stack up?

AT Salary by District

Prove your worth
Athletic directors and administrators don’t know the hours you put in after they go home.  Weekend tournaments, weeknight basketball games, annual physicals: they all add up. Make a spreadsheet to track your hours that you can share with your supervisor (along with the salary survey) when you decide the time is right to ask for a raise.  They would probably be shocked to see how much time you commit to your work and they will want to compensate you appropriately.

Plan B
Decide how much you’re willing to negotiate.  If your employer isn’t willing or able to give you a raise, you can still increase your worth and keep your job by limiting your hours.  Look at the numbers.  If you’re only making $45,000 after taxes, your take home is about $707 a week; if you work 70 hours a week that equates to only $10/hour. Yikes!  At the same salary, you could enjoy your evenings away from work and still put in a standard 40 hours with an hourly wage closer to $18/hour.  To do this, look at your schedule at the beginning of every week and decide which events take precedence based on catastrophic risk.  Also decide which games or practices will go without coverage or will require per diem coverage. Put it in writing to your supervisor.  If they want more coverage, they will have to pay more, either to you or for per diem coverage. It’s not easy, but it is the only way to ensure we’re not shortchanging ourselves or devaluing our profession.

As always, practice professionalism. Show up early, mind your appearance and speak in a professional manner.  If your employer is happy to have you, they will do what they can to keep you happy.

9 Ways to Protect Student Athletes When It’s Hot

High temperatureBy Mike Hopper, MS, ATC

At the beginning of June, we posted an article about how one high school athletic conference is taking on the heat issue. Read the article by Aaron Kremmel here.  But what other steps must be taken? As we begin to start thinking about fall sports, let’s take a look at what we should be doing to protect our student athletes.

The Korey Stringer Institute is a leader in heat illness prevention. They have many recommendations on their website and they have worked with many different states and leagues to pass on those recommendations and guidelines. I was fortunate during my graduate coursework at the University of South Florida to learn under Dr. Lopez, who was a graduate of UConn. This is one topic we discussed, and our conversations honestly really changed my outlook on the topic!

Here are some key points that I think we must all consider when it comes to practicing and playing in the heat and humidity!

1)     Have a limit on when it’s time to quit. When is too hot?

2)     Be prepared to modify and possibly even cancel practices.

3)     Provide unlimited amounts of water and consider electrolyte drinks such as Gatorade or PowerAde®.

4)     Encourage frequent water breaks and rest periods. Allow the athletes to get into the shade and possibly remove equipment if needed.

5)     Know the signs and symptoms of heat exhaustion and heat stroke!

6)     Have an Emergency Action Plan in place.

7)     Use only valid methods of determining core body temperatures.

8)     Have a tub prepared with cool water and ice.

9)     Cool FIRST, transport second!

Take the steps necessary to protect your student athletes. Heat illnesses are preventable, and we must be diligent in doing just that.

The NATA will soon have out a new position statement on heat illness. You can read the executive summary from the NATA here.

New NCAA Guidelines Aim to Improve Student-Athlete Safety

Note: This blog has been cross-posted from the NCAA Sport Science Institute’s website with permission. The original alert appears here.

For the past six months, the NCAA and College Athletic Trainers’ Society have been working with prominent medical organizations, college football coaches, administrators and conference commissioners to develop new guidelines to improve safety for college student-athletes.

Today, those groups released three inter-association guidelines that address independent medical care for college student-athletes, diagnosis and management of sport-related concussion, and year-round football practice contact.

Highlights from the Inter-Association Guidelines

Year-round football practice contact

• Preseason: For days when schools schedule a two-a-day practice, live contact practices are only allowed in one practice. A maximum four live contact practices may occur in a given week, and a maximum of 12 total may occur in the preseason. Only three practices (scrimmages) would allow for live contact in greater than 50 percent of the practice schedule.
• Inseason (including postseason and bowl season): There may be no more than two live contact practices per week.
• Spring practice: Of the 15 allowable sessions that may occur during the spring practice season, eight practices may involve live contact; three of these live contact practices may include greater than 50 percent live contact (scrimmages). Live contact practices are limited to two in a given week and may not occur on consecutive days.

Independent medical care for college student-athletes

• Institutional medical line of authority should be established independently of a coach, and in the sole interest of student-athlete health and welfare.
• Institutions should, at a minimum, designate a licensed physician (M.D. or D.O.) to serve as medical director, and that medical director should oversee the medical tasks of all primary athletics healthcare providers.
• The medical director and primary athletics healthcare providers should be empowered with unchallengeable, autonomous authority to determine medical management and return-to-play decisions of student-athletes.

Diagnosis and management of sport-related concussion

• Institutions should make their concussion management plan publicly available, either through printed material, their website or both.
• A student-athlete diagnosed with sport-related concussion should not be allowed to return to play in the current game or practice and should be withheld from athletic activity for the remainder of the day.
• The return-to-play decision is based on a protocol of a gradual increase in physical activity that includes both an incremental increase in physical demands and contact risk supervised by a physician or physician-designee.
• The return to academics should be managed in a gradual program that fits the needs of the individual, within the context of a multi-disciplinary team that includes physicians, Athletic Trainers, coaches, psychologists/counselors, neuropsychologists and administrators, as well as academic (e.g. professors, deans, academic advisers) and office of disability services representatives.

To learn more about the inter-association guidelines and view additional resources, click here.

Kids Get Arthritis Too

Young athlete

Juvenile arthritis affects kids ages 16 and younger

By Kelly Berardini, MHA, ATC

When Ann Huffman looks at old photos of her daughter Leslie and sees her little girl’s swollen wrists and fingers, she thinks, “How could I have missed that?” Leslie began exhibiting signs and symptoms of juvenile arthritis at age 5 but was not diagnosed until after her 11th birthday. A mother’s guilt hurts, but even Leslie’s pediatrician didn’t put the diagnostic puzzle together. This can be attributed to a lack of awareness – among parents and some healthcare professionals – that kids can get arthritis too.

It’s a common misconception that arthritis afflicts only the elderly, but nearly 300,000 American children age 16 or younger have been diagnosed with the disease. July is Juvenile Arthritis Awareness Month- a great time to promote early detection and to connect families with essential resources.

Defining Juvenile Arthritis
Juvenile arthritis (JA)
is an umbrella term for several rheumatic disease manifestations affecting the joints and musculoskeletal system with onset before age 16. Different forms of JA share common signs and symptoms, but complications and treatment approaches vary per type. Only about 10 percent of children have a disease that closely resembles adult rheumatoid arthritis.

Juvenile idiopathic arthritis (JIA) is the most common form and is characterized by swelling of one or more joints for six weeks or longer. Other types of JA include dermatomyositis, lupus, scleroderma, Kawasaki disease, mixed connective tissue disease and spondyloarthritis (SpA).

Early Signs and Symptoms
Kids frequently can be sidelined by an injury or illness, whether a monkey bump from a bike wipe out or the latest green-snot-producing bug shared among classmates. When should an Athletic Trainer be suspicious that pain, stiffness or fevers could be JA? The following S&S warrant speedy referral:
• Joint pain: typically bilateral and worse in the morning. Most common sites are knees, wrists, ankles and jaw.
• Stiffness: limping, holding joints in fixed positions, struggling with normal movements (e.g., holding a spoon). Worse in the morning.
• Joint swelling: unrelated to acute injury. Joint might feel hot.
• Fevers (unrelated to acute infection): frequent temp spikes with malaise and fatigue. Might occur at the same time each day and then disappear.
• Rashes: persistent, faint pink rashes on the knuckles, across the cheeks nose, and/or on the trunk, arms and legs.
• Eye problems: persistent redness, pain or blurred vision. Some forms of JA cause serious ocular complications such uveitis.
• Weight loss with poor appetite and fatigue.

The prognosis for today’s young arthritis patients is much improved. Thanks to newer drugs and smarter use of older medications, kids with JA are leading healthier, more active lives with decreased incidence of joint damage.  Treatment options include NSAIDs, intra-articular corticosteroid injections, disease-modifying antirheumatic drugs (DMARDs, e.g., methotrexate) and biologic drugs (e.g., Enbrel). Exercise therapy and regular physical activity can also decrease disease parameters and improve quality of life. The ultimate goal is remission – inactive disease.

Juvenile Arthritis and Sports
Children with JIA can safely participate in athletics when parents, physicians and Athletic Trainers monitor them carefully and follow evidence-based recommendations. In fact, inactivity can worsen disease symptoms and accelerate muscle atrophy and bone loss, so patients should be encouraged to participate within their tolerance and capacity.

Kids whose disease is well controlled and who are screened for C1-C2 instability can participate in contact sports. Activity should be limited during active disease flares with gradual return to play following.

1) DMARDs can cause significant side effects, including increased risk for infections. What procedures would you employ to help protect a JA patient from infections?
2) Spondyloarthritis accounts for up to 20% of JA cases. Review the clinical features of SpA, along with beneficial and contraindicated exercises for these patients.
3) Children with JA can benefit greatly from individualized exercise training within a group setting. How might you incorporate this model into your practice?

Arthritis Foundation
Kids Get Arthritis Too
American College of Rheumatology
Evaluation of the presentation of systemic onset juvenile rheumatoid arthritis: data from the Pennsylvania Systemic Onset Juvenile Arthritis Registry (PASOJAR).
Biologics for the treatment of juvenile idiopathic arthritis: a systematic review and critical analysis of the evidence.
Systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis.
The role of exercise therapy in the management of juvenile idiopathic arthritis.
Economic impact of juvenile idiopathic arthritis.
The clinical effectiveness of intra-articular corticosteroids for arthritis of the lower limb in juvenile idiopathic arthritis: a systematic review
The future of treatment for juvenile idiopathic arthritis
Does sport negatively influence joint scores in patients with juvenile rheumatoid arthritis. An 8-year prospective study.
Physical conditioning in children with arthritis: Assessment and guidelines for exercise prescription.
Pilot study of fitness training and exercise testing in polyarticular childhood arthritis.