The history of athletic training and sports medicine are intertwined because both professions grew primarily out of the professional service of providing care to injured athletes. This section begins with a brief history of athletic training and then concludes with an overview of the historic development of sports medicine.
Injury Rate (per 1000 Athlete-Exposures) 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 88-
89 89-
90 90- 91
91- 92
92- 93
93- 94
94- 95
95- 96
96- 97
97- 98
98- 99
99- 00
00- 01
01- 02
02- 03
03- 04 14.8
4.1 13.1
3.9 14.6
4.2 13.2
4.0 12.9
3.8 14.0
4.2 14.0
4.1 13.1
4.0 14.3
3.0 14.4
4.3 13.7
4.2 15.0
4.2 14.2
4.0 14.5
4.0 12.9
3.8 11.4
3.7 Game injury rate
Practice injury rate
Academic Year
FIGURE 5.3 ▼ Overall injury rate during game competition and practice activities for 15 National Collegiate Athletic Association–sponsored sports during the period from 1988–89 through 2003–04 (31).
Rate
100 90 80 70 60 50 40 30 20 10 0
Age (in years)
Men Women
<1 5 10 15 20 25 30 35 40 45 55 55+
* Per 1,000 population.
FIGURE 5.4 ▼ Overall rate for all nonfatal sport and recreation injuries treated at emergency rooms during the period of July 2000 to June 2001 (12).
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Early History of Athletic Training
The formal development of athletic training as a profession occurred in the early 1900s, and its growth coincided with the emergence of the sport of American tackle football (46). In reality however, athletic training probably had its origin with primitive man. To survive, early man had to continuously develop physical skills and maintain fi tness to meet the demands and dangers of the environment.
These early hunters believed in a medicine man, called a “Shaman,” who was a specialist in healing. The shaman used herbs and heat to keep the hunter healthy so that he could continue his search for food and survival (46).
The Greek and Roman civilizations played an important role in the devel- opment of athletic training. The Greeks had trainers called Paidotribes, Aleittes, and Gymnastes. The meaning of Paidotribes and Aleittes were boy-rubber and anointer, respectively. The use of these terms in Greek writings suggests that mas- sage was an important part of the duties of the trainer (21). Herodicus of Megura, considered the greatest of all the Greek trainers, was also considered a physi- cian as well. He was the advocate of modern gymnastics and was the teacher of Hippocrates, the father of modern medicine. The medical gymnastae were not responsible for training individuals in a particular skill or sport activity but to pos- sess some idea of the effect of diet, rest, and exercise on the development of the body (46).
Claudius Galen (130–200 AD) is considered one of the fi rst “athletic trainers”
and team physicians. Galen wrote broadly about medicine and athletics and his writings frequently criticized other athletic trainers and coaches for their practices and training of athletes. He recommended that patients exercise in the gymnasia as a means to recover from sickness and fatigue. Unfortunately, from the time of Galen until early in the twentieth century there is little written record of the work of athletic trainers (46).
Recent History of Athletic Training
In the early twentieth century, athletic trainers began to understand the need for the development and advancement of athletic training as profession. A group of athletic trainers began to envision the development of a professional organiza- tion, which ultimately became the National Athletic Trainers Association (NATA).
The NATA has had a profound impact on the professional development of athletic training. The fi rst national association for athletic trainers was organized in 1938;
however, the challenges of travel, communication, fi nancial limitations, and the infl uence of World War II led to the dissolution of the fi rst NATA in 1944 (46).
The reemergence of the NATA was the result of the development of regional associations of athletic trainers within various collegiate athletic conferences.
These associations eventually came together to form the distinct regional orga- nizational structure of the NATA and included the following conference associa- tions: Southern, Eastern, Pacifi c Coast, Southwest, and Southeastern. This original regional structure remained in place when the conference associations were des- ignated as districts in the NATA (46).
In 1950, the NATA was offi cially formed by representatives from the regional collegiate conference associations. A total of nine districts comprised the new
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organizational structure of the NATA. The organizational leaders at the time wanted the association to build and strengthen the profession of athletic train- ing through the exchange of ideas, knowledge, and methods of athletic training.
Central to the development of the NATA was the Cramer Chemical Company, a producer of athletic training and sports medicine equipment that covered all the expenses of the association for the fi rst 5 years of its existence (46). In 1956, in an effort to disseminate information about the profession of athletic training, the NATA began publication of a journal titled The Journal of the National Athletic Trainer’s Association. The NATA later changed the name to Athletic Training: The Journal of the National Athletic Trainers Association before fi nally settling on the name Journal of Athletic Training (46).
From 1950 to 1975, the NATA steadily expanded its professional infl u- ence and standing in the athletic communities through two major accomplish- ments. In 1969, the NATA Committee on Professional Advancement developed and implemented rules and regulations for the certifi cation of athletic trainers.
A national certifi cation examination was developed and in 1970, the NATA began testing and certifying professional athletic trainers. Also during this time period, a curricular program was approved by the NATA Professional Education Committee for a program of study in athletic training. This educational program was adopted as part of the college and university curricula for the professional preparation of athletic trainers. The NATA Board of Certifi cation, Inc. oversees the certifi cation of all athletic trainers. Only graduates of an athletic training program accredited by the Commission on Accreditation for Athletic Training Education (CAATE) may become a certifi ed athletic trainer. The NATA remains a key advocate for the development of athletic training as a profession. A sum- mary of some of the key historic events in the development of athletic training is presented in Table 5.1.
Early History of Sports Medicine
Sports medicine, like many other disciplines related to health and medicine, had its origin in Greek and Roman times. For example, early writings have Claudius Galen serving as a physician to Greek gladiators (5). Much of the early written work, however, is centered more on the role of physicians in their dealings with
Table 5.1 Key Historic Events in Athletic Training
DATE DEVELOPMENT
1938 First attempt at formation of the NATA 1950 Formation of the NATA
1956 First publication of the Journal of Athletic Training 1969 Development of certification program for athletic trainers
1970 Development of accreditation guidelines for college and university athletic training education programs
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health, physical activity, and exercise. During the period of enlightenment in the eighteenth century, there was a surge in the interest of orthopedic medicine.
For example, in 1741, Nicolas Andry, a professor of medicine at the University of Paris published the fi rst edition of Orthpaedia. Andry developed the concept of the splinted tree for practicing orthopedic medicine in children and thereby helping to correct and prevent deformaties. The concept for the splinted tree arises from the Greek meaning of the word orthopedic; ortho meaning straight and pais mean- ing child. From this origin, orthopedic sports medicine grew into the professional discipline that we know today (1).
Recent History of Sports Medicine
In the fi rst half of the twentieth century, orthopedic medicine was a specialty area with a primary focus on children and only a limited role in the treatment of traumatic injuries. Following World War II, orthopedic surgeons expanded their medical treatment of fractures and severe trauma through the use of advanced surgery. For example, the development of the total joint replacement proce- dure allowed reconstructive surgery to grow as a specialty area throughout the 1950s and 1960s. In the early 1970s, the birth of modern day sports medicine occurred. Initially, sports medicine was described as “locker room medicine”
(61). Much of the science behind sports medicine was anecdotal, and the papers were mostly testimonials and observations of physicians and surgeons who were working with athletes. The practice of sports medicine initially focused on competitive athletes but gradually expanded its scope to include recreational athletes. The acceptance of primary care sports medicine for athletes signaled a major change in the fi eld. A team approach for sports medicine developed in the 1980s and 1990s and incorporated orthopedists, primary care physicians, athletic trainers, physical therapists, exercise physiologists, cardiologists, nutri- tionists, and others (1).
Another key historic development in sports medicine occurred in 1989 with the recognition of sports medicine as a subspecialty by the American Board of Medical Specialties. The development of several professional organizations such as the American Orthopaedic Society for Sports Medicine (AOSSM) and the ACSM have further facilitated the growth and maturation of sports medicine.
The AOSSM was founded in 1972 and began publishing the American Journal of Sports Medicine in 1974. The ACSM serves sports medicine physicians as part of an overall organizational structure. The publication of the Sports Medicine Bulletin and the Team Physician Consensus Statements (22–29) has allowed the ACSM to distribute current information to physicians and help shape the care given to those individuals participating in competitive sports and athletics. The American Medical Society for Sports Medicine (AMSSM) was founded in 1991 and is a multidisciplinary organization that serves primary care physicians with fellow- ship training in sports medicine, nonsurgical sports medicine, and full time team physician programs (2).
Several advancements in the treatment of injured athletes and other pre- ventative measures have helped further shape sports medicine. One of the key technologic advancements was the development of the arthroscopic surgery pro- cedure. First used in the early 1930s, arthroscopy grew dramatically so that by
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the late 1990s approximately 700,000 knee and shoulder arthroscopic procedures were being performed each year (1). A diagnostic and treatment intervention called soft-tissue endoscopy decreases the time it takes for athletes who have had tendon injuries to return to play. Once considered revolutionary, anterior cruci- ate ligament (ACL) surgery and ulnar collateral ligament reconstruction are now considered common in the sports medicine fi eld. Future advances in sports medi- cine care will likely include treatments such as chondrocyte implantation, bone morphogenic protein, and gene therapy (58).
Several prominent orthopedic surgeons were instrumental in promoting the development of sports medicine. Frank Jobe performed the fi rst ulnar collateral ligament reconstruction procedure on a baseball pitcher named Tommy John in 1974. James Andrews is known for his pioneering work on the surgical correc- tion of knee, elbow, and shoulder injuries. In 1984, Jack Hughston opened the Hughston Sports Medicine Hospital, the fi rst facility of its kind in the country.
Hughston is well known for his work in treating knee injuries and for being the fi rst to establish postdoctoral fellowships in sports medicine. Hughston was also one of the founders of the AOSSM, and in 1972 he founded the American Journal of Sports Medicine (1).
Recently, sports medicine physicians and other exercise science profession- als have continued to improve the care given to athletes by further refi ning the preparticipation physical examination (43) and providing guidelines for exercise during pregnancy (16). Sports medicine professionals have also advanced the understanding of the female athlete triad (22), the higher prevalence of ACL injuries in female athletes (3), and improved head
concussion management and treatment (28). The generation of knowledge within the discipline has been enhanced by having sports medicine profes- sionals embrace the scientifi c inquiry and evidence- based approach to the treatment and care of injured athletes (57). Table 5.2 provides some of the signifi - cant historic events in the development of sports medicine.
➤
Thinking CriticallyHow has the historic development of athletic training and sports medicine contributed to providing better medi- cal care for individuals injured during participation in exercise or sport activities?
Table 5.2 Key Historic Events in Sports Medicine
DATE DEVELOPMENT
1741 Andry published the first edition of Orthpaedia 1934 Development of the arthroscopic surgery procedure
1972 Formation of the American Orthopaedic Society for Sports Medicine
1974 Jobe performed the first ulnar collateral ligament reconstruction procedure also called John surgery
1989 Recognition of sports medicine as a subspecialty by the American Board of Medical Specialties
1991 Formation of the American Medical Society for Sports Medicine
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