A typical day for athletic trainer Ruth Young begins by leading firefighters at the Riverview Fire Protection District through a vigorous workout that mimics things they do on the job.
"We'll drag heavy weights on towels, move giant hoses and hit used tires with sledgehammers," she says. She also counsels them on nutrition.
Then, at 2 p.m., she heads to Francis Howell High School, where she works with student-athletes to prevent, treat and rehabilitate injuries and illnesses on the sideline and in the training room.
Young and her colleagues at Excel Sports and Physical Therapy in O'Fallon, Mo., illustrate the growing demand for athletic trainers as well as their versatility.
Last week, more than 8,000 athletic trainers from around the country converged on America's Center in St. Louis for the National Athletic Trainers Association's annual meeting. That was a fraction of the 35,000 who make up their membership nationwide. The U.S. Bureau of Labor Statistics estimates that job opportunities for athletic trainers will grow by 30 percent by 2020, much faster than the average for all occupations.
"High school has been the most solid growth, but other areas of growth are industrial places like Boeing and working with orthopedic surgeons, who hire them to work side-by-side with them. They get hired every couple of months," says Anthony Breitbach, director of the athletic training program at St. Louis University.
Most of what athletic trainers do concerns musculoskeletal injuries such as ankle sprains and muscle pulls. But they also treat concussions, heat stroke and cardiac events.
Professional and college teams were the first to hire them. Then high schools started using them during games, and now many use them full time for practices as well.
"Athletic trainers are an important part of sports medicine team and they serve a vital role," said Dr. Mark Halstead, an orthopedic surgeon at Washington University Orthopedics in Chesterfield and an expert on concussions. "They're our eyes and ears and the initial evaluator and the first to treat them."
Young estimates that she and her colleagues at Excel test and train more than 300 firefighters at four local fire districts.
Since joining the Riverview district a year ago, Kendell Jones, 23, has lost seven pounds and increased his flexibility and energy level.
"The nutrition part is the hardest. We could all do better in that," he said. "It would help if Ruth was there so when we picked up something bad, she'd slap it out of our hands and say: Here, eat this."
Jones was at the Excel fitness center recently trying out VO2Max testing equipment, which measures how efficiently the body processes oxygen, and computer software that tailors workout and nutrition plans to each athlete.
The goal is to help the firefighters perform better and prevent injuries when they're wearing 50 pounds of gear. If they are injured, the athletic trainers develop other plans to rehabilitate them.
Dr. William Feldner, a sports medicine specialist at St. Anthony's Hospital, has noticed an uptick in the number of companies hiring athletic trainers for employees who have physical jobs.
"They're starting to look at them as worker-athletes," he said.
But most health experts agree that athletic trainers are most vital when something goes terribly wrong with athletes during practices and games.
Nearly all local school districts, including Ladue, Francis Howell, Ritenour, Rockwood, Clayton, Parkway, Webster Groves and Lindbergh, have athletic trainers on hand for practices and games.
In 2005, the Fox School District in Arnold hired two full-time athletic trainers after Mizzou football player Aaron O'Neal collapsed during a volunteer strength and conditioning workout and later died.
Three years ago, a California woman created Advocates for Injured Athletes to bring a certified athletic trainer to every high school in the U.S. Her son sustained a cervical spine fracture during a lacrosse game, and the team athletic trainer refused to let him stand up on the field. It saved him from becoming a paraplegic and possibly even dying.
Yet fewer than half of all high school athletic programs nationwide have access to them. Some simply can't afford them, while others choose to spend money elsewhere, says Jim Thornton, president of the National Athletic Trainer Association.
"So we have all these kids competing in football, lacrosse, soccer and other high-impact sports with a significant chance of injury and no one there to take care of them except a coach," he says. "Coaches often don't have a lot of medical training and are busy coaching, so they can't monitor how each athlete feels."
Breitbach knows of schools that don't have athletic trainers but have built new, modern football fields. They could set up an endowment with that money and pay for an athletic trainer into perpetuity, he says.
"Someone is eventually going to start asking, when a school board decides not to hire an athletic trainer, are they making the best use of funds?" Breitbach says. "Or are they trying to participate in an athletic arms race where everyone has to have nicer, cooler stuff."
Feldner points to the rise in cases of rhabdomyelosis in recent years. It's a syndrome marked by muscle degeneration and muscle enzyme leakage after a workout that's too intense. In severe cases it can result in renal failure and sudden death.
Two years ago, 12 Oregon high school football players were treated for it after a preseason workout. Athletes with sickle cell trait are more susceptible to it, and has been linked to the death of O'Neal.
"If an athlete has more than normal muscle soreness, the athletic trainer is the first person he'll see, and the athletic trainer will determine whether it's normal for a strenuous workout or it's a significant problem and they need to get it checked out," Feldner says. "They're the first line of defense."
Halstead points out that athletic trainers also usually recognize the signs of concussion better than most physicians and know how to treat them better. He also says they become like counselors or psychologists to the athletes."
"Sometimes they'll realize that it's more than just an injury going on," he said. "Some kids may not want to truly get back out there and play, and they don't want to tell the coach or the parents. And the athletic trainer has the inside information."