Southwest Washington is nursing an injury. It’s not alone.
Roughly half of the 15 million American high schoolers played a sport in 2017-18, but less than 40 percent of schools employed a full-time athletic trainer. Of the 15 area schools within The Daily News’ coverage area, only two have full-time athletic trainers. It’s mostly due to a lack of financial flexibility within school districts, despite research which shows lower injury rates for schools with a trainer.
The two full-time trainers are R.A. Long’s Mike Hooper, who is also listed as a health teacher, and Mark Morris’ trainer, Dan Ruiz, a dedicated trainer who spends the bulk of his time issuing individual treatments. That’s one of the reasons he isn’t surprised by a finding that schools with trainers have a lower injury rate.
“My opinion is that I agree with that, and the reason is because student athletes have access to health care sooner, and those things that are minor, they’re taken care of,” Ruiz said. “By just doing that, it decreases the rate because it doesn’t allow that minor thing to become major.”
There’s several different ways that can be solved, and it’s what consumes much of Ruiz’s day-to-day. He kicks into high gear around 3 p.m., when practices typically begin, and makes rounds issuing treatments to relatively minor injuries. It’s an everyday grind.
“A lot of electrical stimulation treatments for muscles, a lot of icing, ice baths,” Mark Morris senior Noah Mejia said. “He will tape before games, stretch you out, hot packs. In games, he’s right there for every injury, dealing with it. He’s there almost every day for baseball season as well dealing with guys’ arms.”
Mejia is a three-sport athlete and tore his meniscus during the most recent football season.
“Mark Morris was blessed to have Dan Ruiz as our athletic trainer,” Mejia said. “That guy should be in the pros somewhere and already was. I know for me personally he has been there for every injury and kept me playing.”
Ruiz worked as a trainer for the Carolina Panthers before relocating to Longview with his wife several years ago.
It might be a twisted ankle, or a sore shoulder, though there are times when the ailment is more significant. Diagnosing injuries, at least initially, is up to coaches and volunteers for most schools. It’s not uncommon for football players to walk the sidelines, trying to keep loose, before receiving an opinion from a trained professional.
It’s something that those professionals might note when discussing the lack of trainers in school sports.
“I think there’s more to it, because how do you know it’s not a fracture?” said Jennifer Carrol, President of the Washington State Athletic Trainers’ Association. “What someone might say is a ankle sprain, how do they know it’s not a fracture at the fifth metatarsal? … I think that’s why you have an athletic trainer, because that’s what we’re trained to do.”
Once there is a more definitive diagnosis, the trainer can issue regular treatment and advise coaches on what needs to happen next.
“It’s every day,” Ruiz said. “We have those conversations everyday.”
There are two general types of athletic injuries, according to the American Academy of Orthopedic Surgeons: acute injuries and overuse injuries.
The differences are subtle.
Tendinitis, for instance, is an overuse injury and might occur when a pitcher has thrown more than their body can handle. Acute injuries might include a sprained elbow, or torn ulnar collateral ligament caused by one specific action. There might be similar pain indicators, though a trainer can usually distinguish them. And a trainer has the education and experience to help kids on their path to recovery.
Woodland girls basketball coach Glen Flanagan, who also assists on the football and track teams, said he and other coaches are confident in the medical training they receive. Flanagan played football at Woodland and Boise State. That experience may have helped diagnose certain injuries, and he’s especially careful with knee injuries.
Even then, Flanagan believes there could be a conversation about hiring an athletic trainer if the district could find a way to pay for it.
“I think you’d have a pretty good argument on your hands with the programs, because you could hire one extra coach for each program,” Flanagan said. “But if we had the money for a trainer, I’d go for that.”
Most of what a trainer does happens before, during, and after practices rather than on game day. As Mejia experienced, the benefit is discovered in limiting more serious injuries, and treating ailments so that an athlete can get back to doing what they love.
“People think of trainers as the guys on the sidelines taping ankles and putting ice on, but there’s a lot more,” Ruiz said. “People only see (what trainers do) during the game that day. Like people only see the work athletes do on game day. … We do a lot of rehab in consultation with our physicians. We do a lot of that. I know I do a lot of that at Mark Morris.”
Concussion evaluations are one of many specialized services provided by trainers. Many schools require football coaches, as well as coaches of other sports, to undergo concussion detection training.
But diagnosing a concussion without advanced training is like someone knowing the difference between a bone fracture and a severe sprain while lacking an x-ray: next to impossible.
“(Coaches) can recognize signs of concussions but they can’t make a diagnosis or a return to play decision,” Carrol said. “That’s what makes athletic trainers unique and highly useful to schools. … We can recognize them, we can evaluate them, and we can return athletes to play.”
Carrol also understands the restrictions that come with hiring fulltime trainers.
“I get it. I’ve worked in the secondary schools so I understand the decisions,” Carrol said. “But I don’t necessarily think it’s a rational decision. From the side of cost savings, to the expenditures, the athletic trainer is trained to evaluate a spine injury, recognize a concussion.”
Carrol added that the cost savings to families, specifically saving on a co-pay, is another element and that there’s a potential cost savings to a school district if an injury-related lawsuit were filed.
A 2015 study published in the Journal of Athletic Training, which surveyed 20 athletic directors from around the country, identified three themes: lack of power, budget concerns, and geographic roadblocks to hire or contract qualified professionals in rural areas.
It all comes down to money, Ruiz said. School districts in Washington are caught up in a significant dilemma regarding teacher salaries, and that discussion requires a considerable effort to conclude.
“I think if you talk to any high school athletic director, they’d love to have a trainer on staff,” Ruiz said. “Trainers also have a relationship with the medical community, to get them referred and that’s a really big benefit.”