As medical providers, we want all of our patients to stay healthy, have as few medical interventions as possible, and return to health quickly after sickness or injury.

For our patients who are athletes, the consequences of injury or illness are particularly great. When players -- whether amateurs or professionals -- get injured, they may be putting their careers on the line. Additionally, a single player's injury can endanger the viability of the entire team. Despite the consequences, injury remains a huge part of the experience of athletes who are performing at a high level. And athletic trainers are the primary line of defense against these injuries.

The Athletic Trainers that I know are concerned by trends like the ones acknowledged in a recent New York Times article about the epidemic of baseball players who are having the "Tommy John" ligament surgery:

• The volume of injured pitchers in MLB is huge and growing: "The year with the most documented Tommy John surgical procedures was 2012; there were 69 between the majors and the minors."
• Many pitchers are playing year-round to satisfy the level of performance required of them, which can increase injury rates.
• 1 in 5 professional players who have surgeries like this one never make it back to full strength.

Some Athletic Trainers, however, manage to flip the statistics and keep their players injury-free at greater-than-average rates and help their players recover faster than other athletes.

We've found that successful trainers focus on 3 specific things:

• Prevention. This is the real forté of Athletic Trainers. Through careful, consistent attention and thoughtful pre-injury measures, the best Athletic Trainers prevent dramatic injuries and interventions. The best way to solve the problem is to keep it from happening.
• Collaboration. The best Athletic Trainers know that they are not the only member of an athlete's medical team. They find ways to collaborate with other medical providers to shorten the length of time between diagnosis and treatment, drop transport and wait time, improve medical decisions, and make the best possible plan for that particular patient. We've seen Hybrid Store-and-Forward Telemedicine to have dramatic results in improving athletes' medical outcomes. 
• Rehabilitation. As all medical providers know, rehabilitation is a fundamental part of wellness. It's a piece of the puzzle that can get lost in the shuffle, especially when many providers are on the medical team. But with good medical collaboration and consistent engagement by the Athletic Trainer, rehablitation can happen with surprising speed. 

To learn how Hybrid Store-and-Forward Telemedicine can help you keep players and patients injury free:

Image courtesy of ucniss on Flickr, used under Creative Commons rights.

Student athletes face a challenging set of pressures. Like any young people, they must navigate their own aspirations, work with their family's needs, and juggle academics. But students that are also athletes face the additional pressures to maintain scholarships, perform on the field, adhere to team requirements, and keep up demanding practices and training schedules. In fact, a 2011 NCAA survey showed that football and men’s basketball players identify themselves more strongly as athletes than as students. For that reason -- we discuss the ways in which an athlete's pressures almost match that of a job -- the National Labor Relations Board ruled that Northwestern University’s football team was eligible to unionize.

The pressures that student athletes face, however, don't necessarily imply that the team is in any way exploitative -- or under any less pressure than the athlete herself. Teams face a myriad of pressures as well, and often with insufficient resources to meet them. Despite widespread beliefs that sports teams are money-making machines, only 10% of Division I college sports programs turn a profit. Teams -- and the coaches, athletic trainers, and other staff that make them up -- are under pressure from the university, their own budgets, professors, parents, and the athletes themselves. It's a delicate balance with high stakes. An injured player can present a set of difficult decisions and each stakeholder may have a different opinion on the right course forward.

One example of the recognition of these pressures is Natasha's Law, which requires high school coaches and trainers to make sure that a player with a concussion doesn't experience any further symptoms for a full 30 minutes before putting back her into play. Some coaches, trainers, or players may object to this kind of regulation, arguing that they can make better decisions than the law can. But sometimes this kind of regulation actually makes athletic trainers' lives easier by mitigating demands.

As the New York Times recently wrote: 

"Strong athletic departments do two things well. They afford young athletes the chance to reach their full potential, and they prepare them for life when the cheering stops."

Athletic trainers walk this line every day. First of all, there can sometimes be a contradiction between supporting a young athlete in reaching his full potential today and preparing him for life after sports. Second, the athletic trainer and department must consider the needs of not just "this" athlete -- but of all the athletes on the team, present and future.

What pressures do you face as medical providers treating athletes? Have you noticed them increasing over time? We look forward to hearing, in the comments below. 

And get our guide on how telemedicine can help deal with the pressures you face as an athletic trainer:

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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...

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Several days ago, a 26-year-old man was hit in the face with a baseball going close to 100 miles per hour. A traumatic and dangerous injury for anyone, this injury was compounded in its complexity and potential impact by the fact that the patient was Aroldis Chapman, famed Cincinnati Reds pitcher.

After the horrific line drive hitting him in the face, his team sprung into action. He was transferred from the stadium to the hospital and stayed overnight. Chapman and his medical team had a number of difficult decisions to make and a large team of providers and "stakeholders" to coordinate.

If he had an orbital fracture, he could be expected to lightly throw, 2 to 3 weeks after surgery, and play in 4 to 6 weeks. He's swollen and difficult to evaluate. Should his plastic surgeons save time on the schedule for him next week? Or see him next week and then schedule him? If they do that, then who will they bump from their already too full schedule? Does he need neurosurgery or ophthalmology or a dental consult? How might the OR, admitting nurse, and anesthesiologist be prepared? Then, what about followup? Can he travel with the team? What about the patient? How should his providers share the ramifications of what happened and what would be happening with Chapman and his family in Cuba?

Happily, Chapman was scheduled for surgery less than 24 hours after the injury, repairing fractures above his left eye and nose. He's expected to pitch again this season. It is clear that whatever medical collaboration tools were used, an incredible amount of medical collaboration did occur.

When medical collaboration occurs (whether with a tool like iClickCare or through other means), that's when good outcomes occur.

In fact, the rapidity and efficacy with which Chapman appears to be put on the road to recovery creates a bittersweet contrast with a similar injury from several decades ago. As baseball fans will remember, Herb Score, a pitcher for the Cleveland Indians was hit in the face by a batted ball in 1957. The injury and its ensuing treatment seem to have been career-ending: Score didn't play again until 1958 and retired completely just before turning 29.

Often, we don't think of sports teams or medical trainers as needing to do urgent medical collaboration at this level of complexity. The truth is, however, that for athletes, medical trainers are part of a large team of providers that are doing some of the most complex and high-pressure medical collaboration there is. These providers need to care for the patient-athlete (as for any other patient) but also weigh the impact of treatment, injury, and rehabilitation on careers that hang on a thread of health, timing, and performance. We applaud Chapman's team (both his sports team and his medical team) for their collaboration and success… and we wish Chapman a speedy recovery.

How are you using medical collaboration in sports medicine or team trainer situations? We'd love for you to share your stories from the front lines in the comments below...

For more medical collaboration stories and strategies, get our free quick guide:

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Walk into any pharmacy these days and you can measure your blood pressure. At some kiosks you can even measure things like BMI, vision, and your likelihood of being a bone marrow donor.

It's exciting to sit down for a few minutes, at low or no cost, and feel like you're tapping into data that -- until a few years ago -- was available only through a long-awaited doctor's appointment.

But once I sit down and measure my blood pressure, what value does that reading have? If my blood pressure is obviously so high or so low that it registers as "sick", then I would need a very specific kind of intervention. That intervention would be effectively cued by the blood pressure reading itself -- with no other conversation, context, or background needed. However, when I sit down at the kiosk to measure my blood pressure as a reasonably healthy person, and my reading is "within the range of normal," then what? Then the data itself -- the reading -- is not worth much without a lot of context about my age, other symptoms, and habits. So it appears that the blood pressure reading is very helpful for indicating the presence of acute disease, but may not be so helpful for cultivating a greater state of overall health.

Is health data only useful in cases of true illness? Or can health data be used in the service of greater health?

The overall movement towards e-monitoring, health data, and telehealth has created unreasonable expectations for health data. The data can be crucial for many conditions of illness. There is huge promise in the technologies and innovation in this area. But in some contexts, in which optimal health is the goal -- like sports medicine, for instance -- the data itself becomes almost useless. Most people, on most indicators, are within the range of normal. Without a conversation among multiple healthcare providers around what that data means, it literally is meaningless, and may even be damaging.

So what is important in situations where e-monitoring or health data can't help us to the degree we'd wish? Collaboration and context. For the pro athlete that has just had an injury, we don't need data, we need a sophisticated, time-sensitive collaboration among the healthcare providers that can best manage that injury within the context of the pro athlete's priorities and demands. A strained ankle seen in the training room needs to be addressed specifically as a part of the body, of a unique individual. Similarly, for a 38-year-old woman who is having trouble conceiving, a BMI reading is not going to do much for her. But a collaboration among her fertility specialist, nutritionist, midwife, and endocrinologist may do much more for her.

What do you think? Has health data ever seemed like more of a hoax than a help in your practice as a healthcare provider? Or does the e-health data and monitoring movement seem like it's making strides across the board? Join the conversation in the comments below.

And for collaboration strategies and stories from healthcare and beyond, check out our free quick guide to collaboration: