Relationship between trainers, coaches back under spotlight

Ron Courson, who oversees athletic trainers at the University of Georgia, has a short version of what he sees as the best relationship between those who tend to injured athletes and those who coach them.

"I work with the coaches … but not for the coaches," says Courson, Georgia's senior associate athletic director for sports medicine.

That concept – not always followed – is addressed in a recent article co-authored by Courson in the Journal of Athletic Training. Aimed at high schools and colleges, it describes a chain of command designed to assure medical decisions such as when an injured athlete can return to play are made by medical personnel – without pressure from coaches or fear of losing jobs.

Courson is the lead author of the consensus statement by multiple groups, including the NCAA, the National Federation of State High School Associations, the National Athletic Trainers' Association and the College Athletic Trainers' Society.

The issue is not new, but it has been spotlighted in recent years by highly publicized issues involving concussions. There is a renewed push to assure medical decisions are made for health and safety.

"We just want to be certain that there's not an influence in which a coach or someone else says, 'Look, we want that kid back right away.' … but the student-athlete might not be ready from a medical point of view," said Brian Hainline, chief medical officer for the NCAA.

"So it's really just trying to put up safeguards so that the team physician and the athletic trainer … know that when they make a decision they can make it in the best interests of the student-athlete and there won't be any repercussions in terms of their job security."

Last fall, the Chronicle of Higher Education published a survey that was responded to by 101 athletic trainers and training-staff members from NCAA football programs. Among the results:

- 53 said they had felt pressure from football coaches to return a student to play faster than they thought was in his best interest.

- 42 said they had felt pressures from football coaches to return an athlete to the field even after he suffered a concussion.

"I think concussion has brought this all to a forefront. All the news and the information that we're getting regarding concussions has basically allowed us now to bring out a model that we think is totally appropriate for this time,'' says Bill Moore Smith, head team physician, University of Tennessee at Chattanooga.

At Tennessee-Chattanooga, which hosted a "Sports Injury Epidemic" conference last week, Smith says that under that new model he supervises the athletic trainers, evaluates them annually and leads the hiring process.

He says the typical old model was that athletic trainers reported to either the coach or athletic director. "Guys who may or may not be in a position to render some unbiased decisions regarding a kid's welfare," says Smith.

In the Chronicle survey, 32 respondents said a member of the football coaching staff had influence over hiring and firing for their position.

"If I realize that taking a player out of the game may impact the game itself and that it may impact my job future, it's going to cloud my judgment," says Courson.

At Georgia, Courson says the athletic director evaluates him with regards to such matters as whether he stays within budget and other administrative matters. He says the team physician evaluates his medical performance.

On May 5-7, Georgia will host a three-day conference on "Best Practices for Intercollegiate Sports Medicine Management."

Hainline, who assumed his post at the NCAA's first chief medical officer in 2013, will participate in the Georgia conference just as he did the Tennessee-Chattanooga conference.

"It's not the coach is the bad guy and the athletic trainers are the good guys. … It's just that you have to make sure that the medical decisions are made for medical reasons," says Hainline.

In January, Hainline attended a player safety summit in Atlanta co-sponsored by the NCAA and the College Athletic Trainers' Society. Groups involved include the American Football Coaches Association.

Hainline says one outgrowth of that summit will be a report this summer addressing independent medical care. He says that it will come out as a "best practice recommendation" – rather than an NCAA mandate that would require legislative action by the various NCAA divisions.

"Sometimes by the time you pass legislation if it takes a year to pass you're ready to update it," says Hainline. " … Best practices are much more nimble and they can be updated."

But if it's not a mandate, will schools follow it?

"If the culture really changes – and we know that Alabama and Stanford and the University of Washington and Notre Dame are doing it – well, if you aren't doing it that almost puts you at a disadvantage in terms of recruiting and so forth," says Hainline. "It's a potential culture shift that I'm working very hard to move to."

Hainline was formerly chief medical officer of the United States Tennis Association.

"I'm a neurologist, so I certainly know concussions and I've done sports medicine,'' he says. "But I'm by no means a football insider, nor am I an NCAA insider. It does help that I come in with a fresh perspective."

Pending further court review of a tentative settlement, the NFL is still caught up in concussion-related suits by thousands of former players. Similar suits have been lodged against the NCAA, with former players alleging it concealed long-term risks of concussions.

Hainline says he's not at liberty to discuss litigation.

"The way I work is I do what I believe is best," he says.