Medical decisions have a lot of variables. As we treat our patients, we consider everything from the impact of a treatment on the patient's job, to the opinions of colleagues and family members, to the patient's own goals and values. It's never as simple as "we're going to do this because this is the indicated course of treatment."

Most medical providers see patients in a hospital, clinic, or practice. But as university sports programs become community cornerstones, the "patient" is also the "student" and the "athlete." So athletic trainers (and the healthcare providers that collaborate with them) have many roles to juggle. Because of my observation of athletic trainers' artful juggling of these roles, I wasn't surprised to see a recent article on the limitations that university sports teams and their medical trainers face in treating their student-patients. University sports programs, especially the most successful, often have legitimate 7-figure deals with companies like Nike, Adidas, and Under Armour. These deals exchange logo exposure for fees paid to the sports program.

With so much money, careers, health and university survival on the line, sports programs face hard decisions in choosing treatments.

Problems arise when a medical treatment -- such as spatting -- interferes with the visibility of a logo on a player's shoe or uniform. "With the NCAA battling multiple lawsuits regarding players' inability to profit off their likenesses and the long-term health effects from football, the ankle joint becomes where commercial and medical interests can be at odds."

Something like spatting, in which the ankle is wrapped outside of the shoe to increase stability and prevent or care for an ankle injury, may not seem like a very big medical issue. But when an individual's livelihood depends on the performance of their ankles to support them, as is the case with many student-athletes, even simple medical issues have complex ramifications. In fact, although many sponsorship contracts prohibit or limit spatting because it covers up sneaker logos, it is an effective treatment for many ankle issues. "A 2009 study published in the "International Journal of Exercise Science" studied 17 subjects during warm-ups and 60 minutes of touch football and found spatting to be more effective than taping at limiting range of motion. A 2011 study from researchers at Drake University published in the same journal found spatting and taping together to be as stable as bracing." Plus, strategic issues come into play: "Although many of the contracts prohibit it, a player with one injured ankle might get both spatted to prevent opposing teams from targeting the injured ankle." (Both references here.) 

Further complications arise because, for college athletes, the contract is not between the athlete and the sports company -- it is between the team and the sports company. So decisions around a course of treatment can be somewhat distanced from the individual player's interests and decisions -- medically, personally, and financially.

Team trainers, athletic directors, and a team's sports medicine providers face all the complexities of any medical provider -- plus a set of business, educational, and sports considerations. 

We believe that conversation and collaboration can help manage these colliding interests, and thus reduce the athletic trainer's headaches. What about those of you who are athletic trainers? How have sponsorship contracts affected your ability to treat patients? We'd love to hear more about your experience in the comments below...

And if you're curious how telemedicine can support your sports medicine program, click below for your free guide on telemedicine pros and cons...

Image courtesy of 41992695@N04 on Flickr, used under Creative Commons rights.