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Athletic Trainers: Every High School Should Have One

New survey finds that 70% of high schools covering 86% of athletes have some AT access


Among the things which increase the anxiety level of parents of children playing contact or collision sports, or any sport for that matter, is the fact that a significant number of high school programs still did not employ certified athletic trainers (ATs) who have received training in treating sports injuries, including heat illness, spine and neck injuries, sudden cardiac arrest, and in recognizing the often subtle signs or symptoms of a concussion.

The preliminary results of a study[1] presented in October 2012 to the American Academy of Pediatrics (AAP) National Conference and Exhibition in New Orleans, LA showed that having an AT on staff makes sports safer: overall injury rates were 1.73 times higher among high school soccer players and 1.22 times higher among basketball players in schools without athletic trainers, while recurrent injury rates were 5.7 times higher in soccer and 2.97 times higher in basketball in schools without athletic trainers.  In contrast, concussion injury rates were 8.05 times higher in soccer and 4.5 times higher in basketball in schools with athletic trainers.  

"Athletic trainers facilitate treatment of injuries and monitor recovery so that athletes are not returned to play prematurely.  This likely explains the lower rates of recurrent injuries in schools with athletic trainers," said Cynthia LaBella, MD., FAAP, who presented the study to the AAP conference, in an interview with Science Daily. 

Funding problem? 

According to a 2010 University of Michigan poll [2] two-thirds of middle and high school parents surveyed supported a requirement that high schools have an AT onsite for practices and games. The challenge, in an era of shrinking school budgets, is to come up with the money to fund the position: 

  • 43% thought the money should come from the general school budget;
  • 28% believed funds should come from team fundraising or user fees;
  • 20% said the state or federal government should fund the AT; and
  • 9% felt that volunteer health professionals should be recruited. 

The bottom line, as one AT recently remarked, is that if a high school can afford to have an interscholastic sports program, "it had better figure out a way to afford an athletic trainer." 

An October 2015 study in the Journal of Athletic Training [6] identifies three major obstacles to the hiring of ATs by more U.S. high schools: lack of AD hiring authority, budgetary constraints and non-budget factors, including rural location, misconceptions about an AT's role, and community interference.

Recent anectdotal evidence gathered by the Korey Stringer Institute, however, suggest that those U.S. high schools who choose not to hire a certified athletic trainer, or who lay off an AT, because of budgetary constraints, may be acting in a way that may be penny-wise but pound foolish. According to KSI's Executive Director, Douglas Casa, Ph,D, ATC, conversations with liability insurance carriers and medical providers suggests that insurance premiums are far higher for schools without ATs, and that, in one instance, the added insurance cost was more than the salary of the AT laid off.


ATs and concussions 

Given the increased media attention in recent years on concussions in sports - from the youth level through the pros, the presence of an AT at games and practices in contact or collision sports is particularly critical because:

  • In high schools with at least one AT on staff and concussion assessment involving only one medical professional, nearly nine of ten concussions were assessed by an AT and only 9.7% by a primary care physician; 
  • The AT often sees the athlete on a daily basis, and thus has the opportunity to establish a trusting relationship. This trust is a vital part of the process of evaluating and managing a concussion;
  • Under-reporting of concussions by athletes is a chronic problem. Athletes may be more comfortable reporting symptoms to an AT, who they see on a regular basis, than to a physician they do not see regularly, or to their coach;
  • An AT may also be better able to identify subtle signs that an athlete has suffered a concussion because he or she knows the athlete's usual behavior and demeanor.
  • An AT is also in best position to perform daily follow-up examinations that allow the AT and team physician to determine when the athlete is symptom-free and determine when he or she may safely return to play.
  • According to a 2011 study[3] physicians were on site at the time of reported concussions suffered by high school athletes during the 2009-2010 school year only 7.7% of the time, while ATs were on site for at least 70%, and, where they were present, assessed an athlete for concussion 94.4% of the time.  Reassuringly, the same study found that ATs and physicians used similar return to play intervals when managing athletes who have sustained sports-related concussions, although, where the return to play decision was made by a physician, they were more  likely than ATs to utilize computerized neuropsychological testing (52.5% versus 35.7%) in making that decision, and ATs returned athletes to play more quickly than physicians, although the differences were not found to be statistically significant).

An AT is thus essential, and we should work towards the goal of having a certified athletic trainer on staff at every high school in this country.

High schools with ATs: on the rise

The National Athletic Trainers' Association recently released data showing that approximately seven out of ten U.S. secondary schools with an ongoing athletic program have access to athletic trainers (ATs), whether full-time or part-time. That's double from its 1994 estimate that only about 35% had such access.  In some states, the number is much lower (Over three-quarters of Nebraska high schools, for instance, are without ATs).

At MomsTEAM Institute's September 15, 2014 SmartTeams Play Summit, KSI's Casa reported that a comprehensive survey of every U.S. high schools, both public and private, found, like the NATA, that between 60 and 65% of U.S. high schools had an AT at games and practices every day, which Casa viewed as "extremely promising."   [Editor's Note: when the KSI study was eventually released, the number was pegged at 70%].

Even more promising, reported Casa, was the fact that between 85% and 90% of all high school athletes now have an AT working with them on a daily basis. [Editor's note: the actual number reported in the subsequent study was 86%] Why the higher number? Because, said Casa, the vast majority of large U.S. high schools have ATs (in some cases, as in high schools in Fairfax County, Virginia, more than one).  



de Lench is the Founding Executive Director of MomsTeam Institute and the
publisher of MomsTeam.com. Producer of: The Smartest Team: Making High School
Football Safer (PBS) and author of: Home Team Advantage: The Critical Role of
Mothers in Youth Sports (Harper Collins) is well known as the “Mother of Youth
Sports Safety” for her tireless advocacy and solutions based work in
safeguarding young athletes.


For the most comprehensive and up-to-date concussion information for sports parents, visit MomsTeam's pioneering Youth Sports Concussion Safety Center.

1. LaBella L. "A Comparative Analysis of Injury Rates and Patterns Among Girls' Soccer and Basketball Players." Paper presented October 22, 2012 at American Academy of Pediatrics (AAP) National Conference and Exhibition, New Orleans, LA; High Schools with Athletic Trainers Have More Diagnosed Concussions, Fewer Overall Injuries. Science Daily http://www.sciencedaily.com/releases/2012/10/121022080649.htm, accessed on February 21, 2013. 

2. C.S. Mott Children's Hospital National Poll on Children's Health, Vol. 10, Issue 1 (June 14, 2010)

3. Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools.  Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503, accessed on October 3, 2011.

4.  Gary Mihoces, "Use of athletic trainers on the rise in high schools." USA Today, June 24, 2013. http://www.usatoday.com/story/sports/2013/06/24/national-athletic-traine..., accessed on January 2, 2014.

5. Waxenberg R, Satloff E. Athletic trainers fill a necessary niche in secondary schools.  National Athletic Trainers' Association: 2009.  Available at: http://www.nata.org/NR031209. 

6. Mazerolle SM, Raso SR, Pagnotta KD, Stearns RL, Casas DJ. Athletic Directors' Barriers to Hiring Athletic Trainers in HIgh Schools, J Athl Tr. 2015;50(10):1059-1068. (accessed December 9, 2010 at http://natajournals.org/doi/pdf/10.4085/1062-6050-50.10.1.)

Most recently updated and revised December 9, 2015