National Collegiate Athletic Association Division I Football Players' Perceptions of Women in the Athletic Training Room Using a Role Congruity Framework

Context:

Previous researchers have demonstrated that male and female athletes feel more comfortable with treatment by a same-sex athletic trainer for sex-specific injuries and conditions.

Objective:

To address football players'' comfort with care provided by same-sex and opposite-sex athletic trainers for sex-specific and non–sex-specific injuries and conditions through the lens of role congruity theory.

Design:

Cross-sectional study for the quantitative data and qualitative study for the qualitative data.

Setting:

Two National Collegiate Athletic Association Division I Football Bowl Series university football programs.

Patients or Other Participants:

Male football players within the 2 university programs.

Data Collection and Analysis:

We replicated existing methods and an existing survey to address male football players'' comfort levels. Additionally, an open-ended question was used to determine male football players'' perceptions of female athletic trainers. Paired-samples t tests were conducted to identify differences between the responses for the care given by a male athletic trainer and for the care given by a female athletic trainer. Three categories were analyzed: general medical conditions, psychological conditions, and sex-specific injuries. The qualitative data were coded and analyzed using content analysis.

Results:

Male football players were more comfortable with treatment by a male athletic trainer (mean  =  3.61 ± 1.16) for sex-specific injuries and conditions than they were with treatment by a female athletic trainer (mean  =  2.82 ± 1.27; P < .001). No significant results were found for comfort with overall psychological conditions, although a female athletic trainer was preferred over a male athletic trainer for the treatment of depression (mean  =  3.71 ± 1.07 versus mean  =  3.39 ± 1.16, respectively; P < .001). Qualitative data provided support for role congruity theory.

Conclusions:

Both quantitative and qualitative evidence were provided for the support of role congruity theory.     

Discrepancies in perceptions held by injured athletes and athletic trainers during the initial injury evaluation

Fifty injured athletes and six athletic trainers participated in this study, the purpose of which was to determine whether perceptions held by the athlete were similar to the perceptions of the athletic trainer during the initial evaluation. We developed a questionnaire to examine six areas: the athlete's understanding of the injury and the rehabilitation program, objective elements, the athlete's frame of reference, type of communication, short-term objectives and long-term goals, and the development of a rehabilitation strategy. A Cohen's kappa was used to determine interrater agreement/disagreement. Fifty-two percent of the athletes reported that they did not understand the rehabilitation process associated with their injury. There were significant discrepancies between the perceptions held by the athlete and the athletic trainer for items in all but one of the six areas examined—the objective elements of the evaluation. It appears that a significant level of miscommunication occurred between the athlete and the athletic trainer during the initial injury evaluation. Athletic trainers need to develop better communication skills so that athletes can gain a better understanding of their injuries and requirements for rehabilitation.     

The level of medical services and secondary school-aged athletes

Context:

Medical organizations have recommended that administrators, parents, and community leaders explore every opportunity to make interscholastic athletic programs safe for participation, including employing athletic trainers at practices and competitive events.

Objective:

To determine the overall level of medical services provided for secondary school-aged athletes at high school athletic events in a rural southern state, to evaluate the employment of athletic trainers in the provision of medical services in secondary schools, and to compare athletic training medical services provided at athletic events among schools of various sizes.

Design:

Cross-sectional study.

Setting:

Questionnaires were sent to administrators at 199 secondary schools.

Patients or Other Participants:

A total of 144 administrators, including interscholastic athletic directors and school principals, from 199 secondary schools participated (72% response rate).

Main Outcome Measure(s):

Participants completed the Self-Appraisal Checklist for Health Supervision in Scholastic Athletic Programs from the American Academy of Pediatrics, which has been demonstrated to be valid and reliable. The Kruskal-Wallis and Mann-Whitney tests were used to measure differences in groups.

Results:

We found differences in cumulative scores when measuring between institutional classifications (P≤.05). Cumulative scores for the Event Coverage section of the instrument ranged from 80.5 to 109.6 out of a total possible score of 126. We also found differences in several factors identified in the Event Coverage section (P≤.05).

Conclusions:

The number of coaching staff certified in cardiopulmonary resuscitation or first aid was minimal. Most schools did not have a plan for providing minimal emergency equipment, ice, or water for visiting teams. We found that 88% (n = 7) of the 8 essential Event Coverage components that the American Academy of Pediatrics deems important were not addressed by schools represented in our study.     

Collegiate Athletic Trainers' Confidence in Helping Female Athletes With Eating Disorders

OBJECTIVE: To examine college athletic trainers' confidence in helping female athletes who have eating disorders. DESIGN AND SETTING: We mailed a 4-page, 53-item survey to head certified athletic trainers at all National Collegiate Athletic Association Division IA and IAA institutions (N = 236). A 2- wave mailing design was used to increase response rate. SUBJECTS: A total of 171 athletic trainers returned completed surveys for a response rate of 77%. Eleven institutions either did not identify their head athletic trainer or did not have an identifiable mailing address. Two surveys were undeliverable because of incorrect mailing addresses. MEASUREMENTS: The survey consisted of 4 subscales: (1) efficacy expectation, (2) outcome expectation, (3) outcome value, and (4) experience in dealing with eating disorders. Content validity was established by review from a national panel of experts. Reliability ranged from.66 to.73 for the subscales. RESULTS: Although virtually all athletic trainers (91%) had dealt with a female athlete with an eating disorder, only 1 in 4 (27%) felt confident identifying a female athlete with an eating disorder, and only 1 in 3 (38%) felt confident asking an athlete if she had an eating disorder. One in 4 athletic trainers (25%) worked at an institution that did not have a policy on handling eating disorders. Almost all athletic trainers (93%) felt that increased attention needs to be paid to preventing eating disorders among collegiate female athletes. CONCLUSIONS: Collegiate athletic programs are encouraged to develop and implement eating-disorder policies. Continuing education on the prevention of eating disorders among athletes is also strongly recommended.     

Principles of Liability for Athletic Trainers: Managing Sport-Related Concussion

OBJECTIVE: To provide an overview of the general legal principles of negligence for sports medicine professionals and apply these principles to situations involving athletes with head injury. DATA SOURCES: Case law dating back to 1976 and recent studies of sport-related concussion. SUMMARY: One of the most difficult problems facing athletic trainers and team physicians is the recognition and treatment of sport-related concussion. Providing medical clearance for sports participation and treatment of athletic injuries involves legal as well as medical issues. The threat of lawsuits exists for the sports medicine professional, whether the athlete is allowed to play or not. In general, established medical malpractice principles govern claims by athletes for injury or death caused by improper treatment by health care providers. The elements of negligence are examined, as well as the primary defenses an athletic trainer would use in court and risk management techniques to avoid litigation. CONCLUSIONS/RECOMMENDATIONS: Athletic trainers may protect themselves from liability by including standardized cognitive or postural stability testing in preparticipation examinations, using objective tests rather than subjective judgement to evaluate athletes who have sport-related concussion, working closely with physicians, and keeping excellent records.     

Social Support Patterns of Collegiate Athletes Before and After Injury

Context:

Social support has been identified as an important factor in facilitating recovery from injury. However, no previous authors have prospectively assessed the change in social support patterns before and after injury.

Objective:

To examine the preinjury and postinjury social support patterns among male and female collegiate athletes.

Design:

Prospective observational study.

Setting:

A Big Ten Conference university.

Patients or Other Participants:

A total of 256 National Collegiate Athletic Association Division I male and female collegiate athletes aged 18 or older from 13 sports teams.

Main Outcome Measure(s):

Injury incidence was identified using the Sports Injury Monitoring System. Social support was measured using the 6-item Social Support Questionnaire. Data on preinjury and postinjury social support patterns were compared.

Results:

Male athletes reported more sources of social support than female athletes, whereas female athletes had greater satisfaction with the support they received. Athletes'' social support patterns changed after they became injured. Injured athletes reported relying more on coaches (P  =  .003), athletic trainers (P < .0001), and physicians (P  =  .003) for social support after they became injured. Athletes also reported greater postinjury satisfaction with social support received from friends (P  =  .019), coaches (P  =  .001), athletic trainers (P < .0001), and physicians (P  =  .003).

Conclusions:

Our findings identify an urgent need to better define the psychosocial needs of injured athletes and also strongly suggest that athletic trainers have a critical role in meeting these needs.     

The Development of Expert Male National Collegiate Athletic Association Division I Certified Athletic Trainers

OBJECTIVE: To identify the major influences in the development of expert male National Collegiate Athletic Association (NCAA) Division I certified athletic trainers. DESIGN AND SETTING: The participants were individually interviewed, and the data were transcribed and coded. SUBJECTS: Seven male NCAA Division I certified athletic trainers, who averaged 29 years of experience in the profession and 20 years at the Division I level. RESULTS: We found 3 higher-order categories that explained the development of the certified athletic trainers and labeled these meaningful experiences, personal attributes, and mentoring. The growth and development of the athletic trainers were influenced by a variety of meaningful experiences that began during their time as students and continued throughout their careers. These experiences involved dealing with challenging job conditions, educational conditions, and attempts to promote and improve the profession. The personal attributes category encompassed the importance of a caring and service-oriented attitude, building relationships with athletes, and maintaining strong bonds within their own families. Mentoring of these individuals occurred both inside and outside the athletic training profession. CONCLUSION: We provide a unique view of the development of athletic trainers that should be of interest to those in the field, regardless of years of experience.     

A survey of athletic trainers as health care advocates for testicular and breast self-examination in athletic populations

There have been no previous studies of athletic trainers' educational practices regarding breast or testicular cancer, so we surveyed athletic trainers regarding: 1) the incidence of cancer among athletes, 2) educational practices concerning breast/testicular cancer, 3) educational practices regarding breast/testicular self-examination, 4) breast/testicular concerns of athletes, 5) breast self-examination and testicular self-examination among athletic trainers. A researcher-developed questionnaire was randomly distributed to athletic trainers at the 1994 NATA convention, and SPSS-X was used to analyze results, using Chi-square. One alarming finding was that 28% of athletic trainers surveyed had worked with an athlete who had cancer. Twenty-two percent of the athletic trainers surveyed reported that a female athlete had brought a breast concern to them, and 51% reported that a male athlete had brought a testicular concern to them. Most of the athletic trainers surveyed do not educate athletes about breast or testicular cancer and do not teach athletes about self-examination procedures, but do perform breast self-examination or testicular self-examination on themselves. Acting as a role model is an important step toward the education of athletes in our care, but more must be done. As health care professionals, athletic trainers must become more proactive, rather than reactive, when dealing with cancer prevention.     

Assessment of Certified Athletic Trainers' Levels of Cultural Competence in the Delivery of Health Care

Context:

The concept of culture and its relationship to athletic training beliefs and practices is virtually unexplored. The changing demographics of the United States and the injuries and illnesses of people from diverse backgrounds have challenged health care professionals to provide culturally competent care.

Objective:

To assess the cultural competence levels of certified athletic trainers (ATs) in their delivery of health care services and to examine the relationship between cultural competence and sex, race/ethnicity, years of athletic training experience, and National Athletic Trainers'' Association (NATA) district.

Design:

Cross-sectional survey.

Setting:

Certified member database of the NATA.

Patients or Other Participants:

Of the 13 568 ATs contacted, 3102 (age  =  35.3 ± 9.41 years, experience  =  11.2 ± 9.87 years) responded.

Data Collection and Analysis:

Participants completed the Cultural Competence Assessment (CCA) and its 2 subscales, Cultural Awareness and Sensitivity (CAS) and Cultural Competence Behavior (CCB), which have Cronbach alphas ranging from 0.89 to 0.92. A separate univariate analysis of variance was conducted on each of the independent variables (sex, race/ethnicity, years of experience, district) to determine cultural competence.

Results:

The ATs'' self-reported scores were higher than their CCA scores. Results revealed that sex (F_1,2929  =  18.63, P  =  .001) and race/ethnicity (F_1,2925  =  6.76, P  =  .01) were indicators of cultural competence levels. However, we found no differences for years of experience (F_1,2932  =  2.34, P  =  .11) or NATA district (F_1,2895  =  1.09, P  =  .36) and cultural competence levels.

Conclusions:

Our findings provide a baseline for level of cultural competence among ATs. Educators and employers can use these results to help develop diversity training education for ATs and athletic training students. The ATs can use their knowledge to provide culturally competent care to athletes and patients and promote a more holistic approach to sports medicine.     

Sex Differences and the Incidence of Concussions Among Collegiate Athletes

OBJECTIVE: To compare sex differences regarding the incidence of concussions among collegiate athletes during the 1997-1998, 1998-1999, and 1999-2000 seasons. DESIGN AND SETTING: A cohort study of collegiate athletes using the National Collegiate Athletic Association (NCAA) Injury Surveillance System; certified athletic trainers recorded data during the 1997-2000 academic years. SUBJECTS: Collegiate athletes participating in men's and women's soccer, lacrosse, basketball, softball, baseball, and gymnastics. MEASUREMENTS: Certified athletic trainers from participating NCAA institutions recorded weekly injury and athlete-exposure data from the first day of preseason practice to the final postseason game. Injury rates and incidence density ratios were computed. Incidence density ratio is an estimate of the relative risk based on injury rates per 1000 athlete-exposures. RESULTS: Of 14 591 reported injuries, 5.9% were classified as concussions. During the 3-year study, female athletes sustained 167 (3.6%) concussions during practices and 304 (9.5%) concussions during games, compared with male athletes, who sustained 148 (5.2%) concussions during practices and 254 (6.4%) concussions during games. Chi-square analysis revealed significant differences between male and female soccer players (chi(2)(1) = 12.99, P =.05) and basketball players (chi(2)(1) = 5.14, P =.05). CONCLUSIONS: Female athletes sustained a higher percentage of concussions during games than male athletes. Of all the sports, women's soccer and men's lacrosse were found to have the highest injury rate of concussions. Incidence density ratio was greatest for male and female soccer players.     

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

OBJECTIVE: To present recommendations for the prevention, recognition, and treatment of exertional heat illnesses and to describe the relevant physiology of thermoregulation. BACKGROUND: Certified athletic trainers evaluate and treat heat-related injuries during athletic activity in "safe" and high-risk environments. While the recognition of heat illness has improved, the subtle signs and symptoms associated with heat illness are often overlooked, resulting in more serious problems for affected athletes. The recommendations presented here provide athletic trainers and allied health providers with an integrated scientific and practical approach to the prevention, recognition, and treatment of heat illnesses. These recommendations can be modified based on the environmental conditions of the site, the specific sport, and individual considerations to maximize safety and performance. RECOMMENDATIONS: Certified athletic trainers and other allied health providers should use these recommendations to establish on-site emergency plans for their venues and athletes. The primary goal of athlete safety is addressed through the prevention and recognition of heat-related illnesses and a well-developed plan to evaluate and treat affected athletes. Even with a heat-illness prevention plan that includes medical screening, acclimatization, conditioning, environmental monitoring, and suitable practice adjustments, heat illness can and does occur. Athletic trainers and other allied health providers must be prepared to respond in an expedient manner to alleviate symptoms and minimize morbidity and mortality.     

Laryngeal fracture in a high school football player

Laryngeal injuries are rare in the athletic setting, but such sports as football, basketball, and hockey often place the athlete in a position to receive blunt trauma to the throat area. Such an injury has the potential of developing into a life-threatening situation. A high school athlete sustained a fractured larynx during a football game. The injury required surgical repair. Unfortunately, because this type of injury is uncommon in sports, many athletic training books do not extensively address soft tissue and cartilaginous injuries to the structures of the anterior neck. Athletic trainers must be able to recognize the signs and symptoms of a laryngeal injury and refer the athlete for immediate medical attention.     

Collegiate Student-Athletes' Satisfaction With Athletic Trainers

Context: In today's sport settings, the athletic trainer is often the first member or the health care team with whom the athlete interacts. Delivery of patient care can be improved by increasing patient/athlete satisfaction.Objective: To evaluate the satisfaction collegiate student-athletes had with their athletic trainer(s) and the athletic training services provided at their institutions.Design: A survey format was solicited to 40 randomly selected National Collegiate Athletic Association Division I and II athletic training programs in 4 regions across the United States.Setting: Collegiate athletic training environment.Patients or Other Participants: A total of 325 student-athletes from 20 of the programs solicited agreed to participate.Main Outcome Measure(s): The questionnaire was a variation on a previously used instrument developed for assessing athletes' perceptions of care. Validity and reliability analyses supported use of the instrument. A linear regression model was calculated to determine predictors of satisfaction score.Results: Significant differences in satisfaction scores were observed between athletes in high- and low-profile sports and between male and female athletes. When sex and sport profile were combined, differences in scores were noted between female athletes in high-profile sports and males in low-profile sports. Both sex and sport profile were predictors of satisfaction among the student-athletes who participated in the study.Conclusions: Female athletes and athletes in high-profile sports demonstrated greater satisfaction with their athletic trainer(s). Competitive level did not have a significant influence on satisfaction.     

Auscultation of the Chest and Abdomen by Athletic Trainers

OBJECTIVE: To present a practical overview of the methods and techniques of auscultation of the chest and abdomen for use during the physical examination of athletes. Our intent is to provide information on this clinical technique to assist athletic trainers in recognizing and referring athletes presenting with potentially serious internal organ conditions. BACKGROUND: Use of the stethoscope is a clinical skill increasingly necessary for athletic trainers. Given the expanding breadth of both the assessment techniques used by athletic trainers and the populations they care for and the fact that clinical instruction guidelines have changed in the newly adopted National Athletic Trainers' Association Educational Competencies, our goal is to provide a framework upon which future instruction can be based. DESCRIPTION: This review covers the use of a stethoscope for auscultation of the chest and abdomen. Auscultation of the heart is covered first, followed by techniques for auscultating the breath sounds. Lastly, auscultation of the abdomen describes techniques for listening for bowel sounds and arterial bruits. CLINICAL ADVANTAGES: During the assessment of injuries to and illnesses of athletes, knowledge of auscultatory techniques is valuable and of increasing importance to athletic trainers. Athletic trainers who do not know how to perform auscultation may fail to recognize, and therefore fail to refer for further evaluation, athletes with potentially serious pathologic conditions.     

Current Sport-Related Concussion Teaching and Clinical Practices of Sports Medicine Professionals

Context:

Various consensus and position statements recommend a multifaceted approach when diagnosing a possible concussion. The effectiveness of these materials depends largely on their content being disseminated to educators and to those in the clinical setting.

Objective:

To identify the concussion management methods and guidelines currently taught in the athletic training classroom and clinical settings and to track the dissemination of the Vienna guidelines throughout the educational curriculum.

Design:

A 17-question Internet survey.

Setting:

A Web link was e-mailed to the program directors and certified athletic trainers holding educational positions in athletic training at 300 accredited programs in the United States.

Patients or Other Participants:

513 program directors and athletic trainers.

Main Outcome Measure(s):

Survey questions addressed education level, years of certification, employment setting, concussion assessment and return-to-play guidelines used in the clinical setting and the classroom, and clinical and teaching preferences for existing position statements and concussion grading systems. The Vienna guidelines'' “simple” and “complex” definitions of concussions were provided with the return-to-play stepwise approach.

Results:

The National Athletic Trainers'' Association position statement was the most widely used method of assessing, managing (61%), and making return-to-play decisions (47%) among participants. More than half of participants (66%) had never heard of the Vienna guidelines. After reading the Vienna guidelines'' definitions and return-to-play criteria, nearly three-fourths of participants agreed with them. In addition, 68% said that they would use them, and 84% reported that they would teach them to students.

Conclusions:

The majority of program directors and certified athletic trainers used a multidimensional approach to assess and manage a concussion. The National Athletic Trainers'' Association position statement and Vienna guidelines were underused in both the classroom and clinical settings.     

Development and Preliminary Validation of the Injury-Psychological Readiness to Return to Sport (I-PRRS) Scale

Context:

Only a few scales measure confidence within sport; however, these scales are insufficient to measure confidence after athletic injuries. Therefore, better measures are needed to determine the psychological readiness of injured athletes to return to sport participation.

Objective:

To develop a scale that measures the psychological readiness of injured athletes to return to sport participation and to provide preliminary evidence of reliability and validity for the scale.

Design:

The Delphi method was used to develop the Injury-Psychological Readiness to Return to Sport scale (I-PRRS). Two 1-way analyses of variance with repeated measures and 6 Pearson product moment correlations were computed to help validate the scale.

Setting:

Athletic training clinics at 3 National Collegiate Athletic Association (NCAA) schools.

Patients or Other Participants:

Four certified athletic trainers (ATs) and professors of Commission on Accreditation of Athletic Training Education-accredited athletic training programs and 3 NCAA Division III coaches made up a panel of experts that participated in the Delphi portion of the study to develop the I-PRRS. In the second part of the study, 22 injured athletes, who missed a minimum of 1 week of practice, from 3 NCAA schools in Divisions II and III were surveyed along with their respective ATs. The injured athletes and ATs participated in the validation of the I-PRRS.

Main Outcome Measure(s):

The injured athlete completed the Profile of Mood States (POMS) short form and the I-PRRS shortly after injury, before returning to the first practice, before returning to competition, and immediately after competition. The respective AT completed the I-PRRS before and after competition. The I-PRRS is a 6-item scale that measures the psychological readiness of injured athletes to return to sport, and the POMS short form is a 30-item scale that measures mood states. I added the negative moods of the POMS and subtracted the positive moods of the POMS to calculate a Total Mood Disturbance (TMD) score.

Results:

The I-PRRS scores were negatively correlated with the TMD scores of the POMS short form at all 4 time intervals, showing concurrent validity. The I-PRRS scores were lowest after injury, increased before practice, increased again before competition, and had no change after competition. The I-PRRS as completed by the athlete and respective AT was positively correlated both before and after practice, demonstrating external validity.

Conclusions:

Preliminary evidence for reliability and validity of the I-PRRS was demonstrated. The I-PRRS can be a beneficial tool for ATs to assess an athlete''s psychological readiness to return to sport participation after injury.     

Fracture through the distal femoral epiphysis

Injuries to the distal femoral epiphysis are not common, but when they do occur, at least half of them occur in sports. Many athletic trainers work with skeletally immature athletes, thereby increasing the likelihood that they will face this type of injury. The case of a 14-year-old football player who sustained a Salter-Harris III fracture of his medial femoral condyle is presented to illustrate the classic natural history and prognosis of this injury. To properly evaluate this injury, the athletic trainer must understand the anatomy of the immature skeleton and be able to recognize signs that epiphyseal injury has occurred. These injuries frequently result in long-term complications such as leg-length discrepancy, although this and other complications can be minimized or eliminated through proper immediate treatment. Athletic trainers must be aware of these injuries and include them in their differential evaluation, since immediate treatment can mean the difference between permanent leg-length discrepancy or deformity and an uncomplicated recovery with the athlete returning to full athletic activity.     

Perceptions of clinical athletic trainers on the spiritual care of injured athletes

Context:

Treating both the body and the mind of an injured or ill patient is accepted as necessary for full healing to occur. However, treating the spiritual needs of the patient has less consensus.

Objective:

To determine the perceptions and practices of certified athletic trainers (ATs) working in the college/university setting pertaining to spiritual care of the injured athlete.

Design:

Cross-sectional study.

Setting:

A survey instrument was e-mailed to a stratified random sample of 2000 ATs at 4-year colleges and universities.

Patients or Other Participants:

Five hundred sixty-four participants (296 men, 234 women; 34 did not specify sex).

Main Outcome Measure(s):

We measured the ATs'' perceptions and practices related to spiritual care for athletes.

Results:

We found that 82.4% of respondents agreed that addressing spiritual concerns could result in more positive therapeutic outcomes for athletes; however, 64.3% disagreed that ATs are responsible for providing the spiritual care. Positive correlations were found between personal spirituality and items favoring implementing spiritual care.

Conclusions:

Athletic trainers have a conceptual appreciation of the importance of spiritual care for athletes, but the practicalities of how to define, acquire skills in, and practice spiritual care are unresolved.     

National Athletic Trainers' Association position statement: safe weight loss and maintenance practices in sport and exercise

Objective:

To present athletic trainers with recommendations for safe weight loss and weight maintenance practices for athletes and active clients and to provide athletes, clients, coaches, and parents with safe guidelines that will allow athletes and clients to achieve and maintain weight and body composition goals.

Background:

Unsafe weight management practices can compromise athletic performance and negatively affect health. Athletes and clients often attempt to lose weight by not eating, limiting caloric or specific nutrients from the diet, engaging in pathogenic weight control behaviors, and restricting fluids. These people often respond to pressures of the sport or activity, coaches, peers, or parents by adopting negative body images and unsafe practices to maintain an ideal body composition for the activity. We provide athletic trainers with recommendations for safe weight loss and weight maintenance in sport and exercise. Although safe weight gain is also a concern for athletic trainers and their athletes and clients, that topic is outside the scope of this position statement.

Recommendations:

Athletic trainers are often the source of nutrition information for athletes and clients; therefore, they must have knowledge of proper nutrition, weight management practices, and methods to change body composition. Body composition assessments should be done in the most scientifically appropriate manner possible. Reasonable and individualized weight and body composition goals should be identified by appropriately trained health care personnel (eg, athletic trainers, registered dietitians, physicians). In keeping with the American Dietetics Association (ADA) preferred nomenclature, this document uses the terms registered dietitian or dietician when referring to a food and nutrition expert who has met the academic and professional requirements specified by the ADA''s Commission on Accreditation for Dietetics Education. In some cases, a registered nutritionist may have equivalent credentials and be the commonly used term. All weight management and exercise protocols used to achieve these goals should be safe and based on the most current evidence. Athletes, clients, parents, and coaches should be educated on how to determine safe weight and body composition so that athletes and clients more safely achieve competitive weights that will meet sport and activity requirements while also allowing them to meet their energy and nutritional needs for optimal health and performance.