Complementary Care: Athletic and Fitness Training in O&P

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Working with athletic or fitness trainers-or attaining these credentials yourself- as a part of your approach to comprehensive patient care can help improve patient outcomes.

Dan Minert, MS, CO, ATC, owner of Kensington Valley Orthotic and Sports Services Inc., Brighton, Michigan, was a certified athletic trainer for 18 years before he entered the orthotics profession. As an athletic trainer, he had become interested in the hands-on fabrication of special pads and protective devices. Minert felt that orthotics was a good fit with the skills he had. He started working for a local orthotist and completed the orthotics certificate course at Northwestern University, Chicago. Later, he opened his own practice.

A Natural Fit

Minert has found his two disciplines to be complementary. He is still practicing as an athletic trainer, working with local high school teams. Several area physicians with sports-related practices refer patients to him. He fabricates special protective devices for area high school and college players, such as facemasks for athletes with nasal fractures and other injuries. He works with college athletic trainers to assist with care of players with foot and ankle issues. Thanks to his relationships with local athletic trainers, Minert has been invited to assist in evaluating athletes on a preventative basis, which has expanded his orthotic practice. "For instance, I evaluate their gait and, if there's a potential problem, I may provide a foot orthosis or knee brace."

Becoming a certified athletic trainer requires a minimum of a bachelor's degree, and Minert notes that many athletic trainers have master's degrees. "There also are an extensive number of athletic trainers with PhDs who are working in colleges and universities," he says.

Certified athletic trainers (ATC) have completed educational and certification requirements similar to those of an O&P practitioner certified by the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC). Sometimes the ATC credential is confused with certified fitness trainer (CFT) although the two are much different in terms of education and scope.

The National Athletic Trainers Association (NATA) website ( www.nata.org ) defines an athletic trainer as "a highly educated and skilled professional specializing in athletic healthcare. In cooperation with physicians and other allied health personnel, the athletic trainer functions as an integral member of the athletic healthcare team in secondary schools, colleges and universities, sports medicine clinics, professional sports programs, and other athletic healthcare settings. Certified athletic trainers have, at minimum, a bachelor's degree, usually in athletic training, health, physical education, or exercise science.

"In addition, athletic trainers study human anatomy, human physiology, biomechanics, exercise physiology, athletic training, nutrition, and psychology/counseling. Certified athletic trainers also participate in extensive clinical affiliations with athletic teams under appropriate supervision."

Minert's experience as an athletic trainer also helps patients who aren't athletes but want to increase their activity level in some area. He can make sure they have the right footwear for safe performance, based on their foot type and configuration of feet, ankles, and knees, and can spot potential problems that may require physical therapy or training for a specific activity. However, not all of Minert's practice is sports-related. Many of his referrals from orthopedic practices include geriatric patients along with cerebral palsy patients and others.

Minert stresses the importance of maintaining open, positive lines of communication with other health professionals, including physical therapists, in order to work together for optimal orthotic solutions to maximize the patient's return to activity.

CFT Helps Prosthetic Practice

Randy Alley, CP, FAAOP, CFT, owner of biodesigns inc., Thousand Oaks, California, considered a career in athletic training while obtaining his bachelor's degree in kinesiology at the University of California, Los Angeles (UCLA), but opted for the prosthetic profession instead. "Although prosthetics allowed me to use the biomechanical and physiological knowledge I gleaned in college to some extent, I have always felt that since choosing a career in prosthetics, I wanted to pursue the higher performance aspects of our profession, rather than just from a rehab perspective," says Alley.

"I became a member of NATA because I desired to keep in touch with this highly evolving field," he adds. "I chose to become a certified fitness trainer because I wanted to have the credentials to back up my lifelong dedication to the study of human performance and provide my patients with an added level of service that is difficult to find elsewhere. My passion is to focus on high-performance prosthetic applications, while certainly applying this knowledge to create more advanced systems for those interested in rehabilitation alone."

A trainer helps to improve spine problems.
A trainer helps to improve spine problems.

Alley has found that his fitness trainer knowledge helps him provide optimal care for his patients. "I understand what muscles to watch for in various activities and what actions will help strengthen those muscles," he says. "Since many of my patients are complex in terms of trauma, knowing how to exercise these muscles safely for high-performance prosthetic use benefits them; this crosses the border between the athlete and the person who just wants to gain more functional control."

There are several organizations that provide fitness training and certification. Advanced education is not a requirement although many certified fitness trainers do hold degrees in various areas.

According to Wikipedia, "A personal trainer is a professional who educates people about physical fitness.... Personal trainers typically design exercise routines and teach physical exercises to their clients." Depending on their qualifications and certification, some fitness trainers can assist clients to improve sports performance and help persons with physical dysfunction improve balance, range of motion, and knee and shoulder problems.

Concepts in Patient Care

Minert's and Alley's athletic and fitness interests are expressed in their beliefs about patient care.

"I think there's a continuum in terms of activity from sedentary up to Olympic and Paralympic and professional-level athletes," says Minert. "We all lie somewhere along that line. I look at where people are in that continuum and ask what can we do to increase their function and move them farther along that continuum of activity."

Says Alley, "The important concept is looking at persons with an amputation as no different from the rest of us in terms of what they want to do in life. We need to help them look at the prosthesis as simply an extension of themselves to help accomplish these goals. We need to get them motivated to look beyond their own self-imposed limits. We need to give them not just hope, but the skills and the belief systems to reach their goals."

Miki Fairley is contributing editor for The O&P EDGE and a freelance writer based in southwest Colorado. She can be contacted via e-mail at miki.fairley@gmail.com .