Getting Along

Over the years, I cannot count the number of times I have received phone calls or emails from universities regarding the tenuous, and at many times, adversarial relationship between their athletic trainers (ATCs) and strength & conditioning coaches (S&C). It astounds me that this is still a problem, and it’s even more astounding that this is even an issue in the first place. Perhaps I feel this way because my career began in the private sector where this type of sour relationship doesn’t even exist. Regardless of the cause, there seems to be this “turf war” at many schools that tends to resonate between the two departments.

This conflict likely stems from the “old school” S&C coaches who were a bunch of “meat heads” who loved to lift weights but didn’t really understand much about training. This lack of understanding usually lead to maladaptation, injuries, and excessive and undue wear and tear on the athlete.

On the other side, ATCs were always the “go to” people for anything related to the human body. So when a question about nutrition or recovery would arise, the ATCs were to ones who provided the answers. But, with today’s S&C coaches growing smarter and smarter, and the addition of other support staff (e.g. sports nutritionists, sports psychologists, etc.), the role of the “go to” or “global” ATC has been reduced. Many of the those extra duties the ATCs picked up in the past but most likely weren’t qualified to handle (they at least had taken one nutrition course) have now been delegated to those support positions I previously mentioned. This reduction in ATC responsibility has allowed more in-depth support services and techniques delivered to the athletic population.

However, the aforementioned reasons are only a few of a myriad of explanations as to why both groups continue to point fingers, shift blame and not get along. Let’s examine the two different scenarios and comments I typically hear from both sides.

Scenario #1:

Are you an ATC? “Our strength coach is terrible…people are always getting hurt in the weight room.”

If people are always getting hurt in the weight room (this is something which does happen, but should never happen), the number one predictor of a new injury is a previous injury, so perhaps we need to examine possibilities on both sides. Maybe the rehab from the previous injury wasn’t sufficient, and the lingering altered motor control issue that wasn’t remedied during the previous rehab process, was the cause of the new weight room injury. While the ATC should have caught this, so should the S&C coach…the result is that both groups are at fault. Maybe the implementation of a strategy such as the FMS or SFMA should be used to tease out some of these motor control issues. This would help to identify whether or not the athlete has a deficiency with one or many movement patterns or if the athlete should be loaded or not.

Scenario #2:

Are you an S&C? “Our ATC is terrible…our athletes are always rehabbing and never seem to be getting better.”

If you are not happy with the progress your athletes are making in the training room and feel the rehabilitation process is taking far too long, maybe there is something which can be done/implemented in the weight room that can make the job of the ATC easier. In turn, this will better utilize the athlete’s time. Perhaps there is something that you can learn to help prevent these types of injuries from occurring. The result is the same as scenario #1…both sides are at fault. This is a multi-disciplinary approach and both sides work symbiotically.

The Gray Area

One of the factors contributing to these issues between the two departments is territorial in nature. In other words there is a perceived “gray area” where both professions reside, and this territory is where most of the grievances spur. I’ve illustrated this in the Venn diagram below.

Since the number one goal of training and preparation should be injury prevention, I’ve labeled the S&C side of the diagram as the proactive side. Since ATCs spring into action after an injury occurs, and rehabilitate the athlete, I have labeled the ATC side as reactive. The way I like to look at this, is listing the primary responsibilities of each group like the list of ingredients on a nutritional panel of a particular food.

Ingredients are listed from the most abundant ingredient (which is listed first) all the way down to the least abundant ingredient (which is listed last). If we examine the roles of both the ATC and S&C professionals in this same fashion, we can better illustrate not only the “gray area” that these two professions share, but also the priorities of each profession. For instance, the number one ingredient for the ATC is rehabilitation. Later down that same list of ingredients is injury prevention. For the S&C coach, their number one ingredient should be injury prevention, and then later on down the list rehabilitation.

While this gray area exists, I have come up with some very black & white solutions to these less than ideal relationships that exist at many schools to this day.

Potential Solutions:

Eliminating the Gray:

When dealing with a gray area, the most important thing is to eliminate it. I have successfully accomplished this by categorizing athletes into one of two categories: healthy or hurt.

How do you determine in which category an athlete resides?...the injury report. When an athlete is on the injury report, then they are classified as “hurt.” When an athlete is not on the injury report, then they are classified as “healthy.” From there, it’s a very simple process.

If an athlete is on the injury report (hurt), then the ATC makes the final call to what the athlete can or cannot do. The S&C coach can (and should) make recommendations to the ATC and provide his/her opinion. However, the ATC may or may not take those recommendations. It is important for the S&C coach to not be offended if his/her recommendations are not taken. We are all professionals, and at the end of the day, the ATCs are the experts in injuries and rehabilitation. Additionally, there is typically a team physician involved with this process, and the sports medicine side holds an enormous amount of liability when treating athletes.

If an athlete is not on the injury report (healthy), then the S&C coach makes the final call when it comes to what the athlete can or cannot do (assuming the workout isn’t placing the athlete in harm’s way, and is not concerning a prior injury). In this instance, the ATC can (and should) make recommendations to the S&C coach and provide him/her with his/her opinions. However the S&C coach may or may not take those recommendations, and most importantly, the ATC cannot become offended if he/she does not. Again, we are all professionals, and at the end of the day, the S&Cs are the experts in injury prevention and training.

My response to the S&C coaches who complain about this…”if you don’t like what the ATCs are doing in the training room, then do your job better, and don’t let your athletes get hurt!”

Over-communicate:

This is one method that I have stood by for years. Seek to over-communicate with your colleagues. As a S&C coach, if an athlete had any complaint in the weight room (e.g. soreness, tightness, stuffed up, or felt like they were catching a cold), I would always shoot a text to the ATC for that sport just to give him/her a heads up. If he/she is aware of a potential problem before the athlete has seen them, then the ATC might be able to get around or in front of an injury/illness before it becomes worse. Not only that, but this also sends a message to the athlete that their support system is supporting one another and in turn them. Lastly, do not leave it up to the athlete to communicate your message to your colleague. Not only can this can lead to a really poor game of telephone, but it also sends a message to the athlete that there is little or less than ideal communication between groups. Additionally, athletes historically don’t communicate well, and will tend to push themselves too hard when they shouldn’t regardless of the advice of the ATC and the S&C coach.

Weekly meet up (yes, weekly):

When I was at the university level, our ATC, PT and I would meet for coffee on Fridays at 10:00 AM. We would then spend the next hour talking but not necessarily discussing athletes or specific cases. We would talk about anything. We might chat about our families, the weather, or the farmer’s market. Perhaps we would chat about conferences we were attending or some article. The point was to just talk. And where did this lead…to a better respect and a friendship among the three of us. We not only respected one another as peers but also as people. I have heard a number of people say that they are just too busy and don’t have time to meet. I believe that you don’t have time not to meet!

Mr. Athletic Director, tear down this wall:

Having a separate weight room and athletic training room never made much sense to me. If the two groups need to work together, then it would stand to reason that they should be intertwined, and if possible, share much of the same space. I’ve already illustrated the overlap between the two professions, shouldn’t this same overlap be seen in the working spaces as well? I’ve already seen a movement toward this type of allocation of space-- moving the areas adjacent to one another, but I still see physical walls and doors separating the areas. Shared workspaces, areas, meeting rooms, etc., should be implemented. Back in the early 2000’s at Athletes’ Performance (now EXOS), our PT/ATC Sue Falsone and I shared an office. What this did for our professional relationship cannot be described by words, but could be seen with the type of product we delivered to our athletes.

Dual Certification Dilemma:

At the end of the day, S&C coaches are not hired to be ATCs. Sure, I have met a number of S&C coaches who have their ATC, and I know a number of ATCs who have an S&C certification. But, if you are an S&C coach that has your ATC, or an ATC with a CSCS, it doesn’t mean that’s your job. If you weren’t hired to do it, then stay out of it…whether you’re capable or not, it’s not your job! Learn to collaborate and listen!

Seek to understand not just know:

This notion, based upon another blog of mine, speaks to making a concerted effort to truly understand the aspects of the S&C coaches and ATCs respective jobs and “a day in the life”. I cannot tell you the number of times that I received an injury report indicating an athlete shouldn’t perform Olympic lifts. The frustrating part of this communication is that each time I have received this response, my athletes didn’t have these in their programs, not to mention that very rarely do I use them. It was at this time I realized that the ATCs didn’t have a complete understanding of what I was doing. Spend time with one another (this would be easy if spaces were intertwined) and give the ATCs your programs and review them together. Perhaps they will shave some insight. Spend time with your ATCs during treatments. It will give you great insight to how they think, problem-solve, and the amount of work they are truly putting in to get the athletes healthy. Reach out and be the first to invite them over to your “home”.

However:

The caveat to all of these potential remedies is that sometimes it comes down to the type of people in the organization. If you don’t have people who can let go of their ego’s for the betterment of the team, acknowledge that they don’t know everything, who respect different or divergent methods other than their own, and who want to make an effort to collaborate, innovate, learn and grow, then I am afraid that very little success and progress will be achieved.

If someone doesn’t know something, criticizing him or her isn’t good business. Seek to help them understand and grow. Invest in them. If I have a staff member who isn’t performing at the level I would like them to perform, then I should help them improve, not criticize them, or complain about them. If you don't want to see your coworkers improve and grow, maybe you are the barrier to growth.

At the end of the day, both groups are needed for the betterment of the athlete, and one group is not more superior to the other. Each possesses a unique and specialized skill set to help athletes achieve all of their athletic endeavors. These skill sets can be very powerful when used together, but it should be noted that you and your athletes will be significantly limited if you are a S&C coach without an ATC, or an ATC without a S&C coach. This is a symbiotic relationship and one that has an endless amount of upside if the egos are checked, we listen, and treat one another with respect.

More to come…

Jesse Free is a certified and licensed athletic trainer with over five years of experience in multiple practice settings. Jesse has provided cutting edge medical services for Olympic and collegiate athletes while at Stanford, as well as current NFL players during their collegiate careers. Jesse and Brandon worked side by side during their time at Stanford, setting the standard and precedent for collaboration and communication across the multidisciplinary healthcare approach. Currently, Jesse is captivating the emerging practice of the Industrial Athletic Training setting by bringing the same treatment and rehabilitation techniques utilized for elite athletes to the workforce of Boeing employees.

Jesse Free, MA, ATC, L/AT can be reached at jfree@work-fit.com.