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INFORMATION AND INJURY:
THE EXPERIENCE OF STUDENT ATHLETIC TRAINERS

presented by

Stephan R . Walk

has been accepted towards fulfillment
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INFORMATION AND INJURY: THE EXPERIENCES OF STUDENT ATHLETIC
TRAINERS

By

Stephan R. Walk

A DISSERTATION

Sumbitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Physical Education and Exercise Science
Department of Sociology

1994

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ABSTRACT

INFORMATION AND INJURY: THE EXPERIENCES OF STUDENT ATHLETIC
TRAINERS

By
Stephan R. Walk

Sociologists of sport have begun to focus on the way in which pain and injury are seen as
accepted parts of athletic participation. Nixon (1992) proposed a social network analysis of
sports organizations or "sportsnets," suggesting that members of sportsnets and related
subcultures conspire to foster the acceptance of injury by athletes and to compromise
medical services athletes receive. While the concept of a sportsnet is a useful starting point,
a conspiratorial conception does not consider the fact that institutions are negotiated orders
which are more or less able to achieve a totalizing (Goffman, 1961) effect over the lives of
their members. The purpose of this study was to begin to understand the medical services
athletes receive and the degree of totalizing a sportsnet is able to accomplish. Group and
individual interviews with 22 undergraduate and graduate student athletic trainers involved
in an intemship program at a large Division I institution were conducted. These student
trainers worked from 40 to 70 hours per week in their internships, spent more time with
college athletes than other members of the sportsnet, and undertook comprehensive health
care and other responsibilities for athletes for little or no pay. Women student trainers were
excluded from key sports assignments and were subject to sexual harassment by athletes.
Student athletic trainers socialized with and became friends of athletes, placing them in the
"middle" of a number of decisions regarding the health and team status of athletes. Such
information also provided a broad context for student trainers to assess injuries and other
problems of athletes. In some cases, student trainers counseled athletes on these problems.
Serious injuries were witnessed by all of the student trainers in the study and were viewed
as risks that college athletes understand as implied aspects of sports participation . Many of

the student trainers were aware of athletes who continued sports participation despite

knowledge of permanent disability risks and limited benefits of participation. 'lhe study
concluded that, as a result of multiple and competing beliefs and the dual identities of
student athletic trainers as both students and apprentices, it is implausible to conclude that

sportsnets are either conspiratorial or totalizing.

Cepyn'ght by
Stephan Robert Walk
1994

These words will be read by few and understood by even fewer. A couple of things, I
think, are true. The first is that the submission of this document closes the most incredible
year of my life. The second is that this time period began on August 7, 1993 when I met
Amber Louise Story. Not only are both of these things true, they are true together, the
second making the first possible. 'Ihis dissertation is dedicated to Amber and our
continuing to make incredible years possible for each other. We are true together.

I also dedicate this dissertation to my friends Jeffrey and Kimberly Klocke and Richard and
Marilyn Peterson, whose adoption of me as a surrogate son went silently unacknowledged.
The silence is now broken. May the bombers pour. To my mother Sandra Johnson, my
stepfather Stanley Johnson, my father William Walk and my brothers David, Michael,
Brian and Matthew, I wonder if you know how much of all of us is in the words to follow.
I will let you decide.

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ACKNOWLEDGMENTS

It is typical to thank the participants in one's research but that task is made difficult
by the requirements of confidentiality. To those student trainers who interrupted their
incredibly busy lives to tell me what they do and how they feel about it, I can only repeat
my tremendous appreciation. I must also thank the head trainers at Great State University
(whose names will not appear for confidentiality purposes) for their tremendous help,
insights, information and toleration of my many fits and starts at this research.

I have been extremely fortunate in the fact that those who bravely chose to
participate on my committee were genuinely interested in my research and in helping me
produce a reasonably coherent manuscript. Dr. Deborah Feltz has been tremendously
supportive of me not only in the completion of this dissertation, but as a student and
graduate assistant. 1 thank Deb for her patience and understanding of me during my career
and for looking out for my interests when I myself was not. I also drank her for her
confidence--a word I use carefully--in my ability to take on responsibilities not often given
to graduate students.

Dr. Bo Anderson has also been a great mentor and friend whose extraordinary
knowledge of sociological scholarship and willingness to discuss at length its usefulness in
my endeavors has been invaluable. The ideas that my work will explore for years to come
will be unavoidably rooted in my coursework and conversations with him. I will never
forget the lengths to which he went to ensure that I produced a defensible dissertation
during extremely trying circumstances. I will also never forget his implicit reminders that,
while being productive, the job of a scholar is also to think and thinking requires both time
and patience.

Dr. Folke Lindahl has similarly been a sounding board and friend whose subtle
manipulation of my intellectual development has formed the basis of my own political,
theoretical and personal orientations to scholarship. Most of the books that rest on my

shelves and those to which I turn when attempting to broadly conceive a theoretical

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question are those he suggested I read. I have kept up with the most recent developments
in both political theory and extra-scholarly activities as a result of my association with
Folke. I will continue to count on him to manipulate me in these ways.

I must also thank Dr. Doug Campbell for sharing his expertise on the complex
methodological issues of qualitative research and for sharing his invaluable insights on the
substantive aspects of this dissertation. Moreover, it is all too often forgotten that those
who volunteer as subjects in a study not only donate their time to the researcher's work,
but also often risk their own status by simply being honest. Doug's concern and
suggestions for protecting the participants in the study led me to substantively rethink not
only the way I asked questions, but also the way I presented results.

Though not an official member of my committee, I must also thank Dr. Jayne
Schuiteman for her enthusiastic and insightful observations on work I have done at
Michigan State, including this dissertation. Given the somewhat unique circumstances of
my graduate education, it has been vitally important to me to have someone who acted not
only as a mentor but as a friend. I always felt that I could count on Jayne to be both an
advocate and a critical thinker who could help me steer clear of my ever-present tendency to
play with theoretical abstractions. I thank Jayne for reminding me that the most important
thing that emerges from scholarship is what happens on the ground.

Finally, though not a member of my dissertation committee, I must finally thank
Dr. Vern Seefeldt for his unwavering support of me during my seven years at Michigan
State University. Through his support of me as a graduate assistant with the Youth Sports
Institute, his mentorship of me both directly and by example, and his relating to me as both
a colleague and student, I have benefited in innumerable ways. Knowing that Dr. Seefeldt
was my advocate eased countless anxieties and permitted me opportunities few graduate
students enjoy. I will always consider it my goal to emulate his dedication to scholarship,

professional activities and public service.

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TABLE OF CONTENTS

CHAPTER I Introduction and Review of the Literature ..................................... 1
CHAPTER II Methodology...........................' ......................................... 27
CHAPTER III Results .......................................................................... 42
CHAPTER IV Discussion and Conclusions ................................................ 138
APPENDIX A Background Questionnaire .................................................. 166
APPENDIX B Human Subjects Approval Letter ........................................... 167
APPENDIX C Human Subjects Approval Letter ........................................... 168
APPENDIX D Consent Form. ................................................................. 169
LIST OF REFERENCES ...................................................................... 170

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CHAPTER I
Introduction and Review of the Literature

The growth of institutionally sponsored and publicly viewed sport in the twentieth
century has brought with it the emergence of large organizations devoted solely to the
fielding of skilled athletic teams. On the intercollegiate level, these organizations, their
athletes and their interested publics have come to compose virtual societies in miniature. As
in other segments of society, the emergence of increasingly specialized occupations has
occurred within and around sport. Among the many individuals and occupations
associated with sport, athletic training in the United States grew out of a recognition of the
regularity of injury in sport and the need for the delivery of on-site skilled medical services
to participating athletes. As with other emerging occupations, athletic uaining moved in the
middle part of this century to establish itself as a professional field founded upon the
application of medical knowledge to the treatment of sports injury. It therefore established
a unique set of skilled practices and a specific sequence of preparatory experiences for its
students.

The development of athletic training as a relatively recent addition to a burgeoning
number of other health-related professions came during a period of increasing scholarly
interest in the way individuals, groups and institutions conceptualize and treat the body in
modern society. By the early 1980's, a number of scholars in mainstream sociology began
to call for a renewed and reconceptualized theoretical understanding of the body,
particularly in light of "postmodern" developments in the social sciences and elsewhere
(Turner, 1984). The sociology of sport, although perhaps predating this turn in
mainstream sociology (Maguire, 1993), also displayed an increasing number of scholars
interested in the body and its obviously central place in sports participation. Among these
developments in the sociology of sport were several largely independent works focusing on
various bodily dimensions of sport. Despite their independence, all shared the theme of a

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critical look at the corporeal aspects and consequences of sports participation in the form of
violence in and around sport (e.g. Dunning, 1990), drug use and scientific experimentation
on athletes (Hoberman, 1990), and risk, pain and injury among athletes (Curry, 1991,
Frey, 1991, Nixon, 1992a, 1992b, 1993, Young, 1993).

While sociology has an extensive history of scholarship on the development of the
medical profession and its allied professions (e.g. Merton, Reader & Kendall, 1957,
Hughes, 1958, Freidson, 1970, Starr, 1982), the apparently peculiar place of athletic
training as a dimension of "sports medicine," most frequently housed in intercollegiate
athletics departments, has meant that it has escaped all but brief mention in critiques by
sport sociologists. This is true of those authors cited above who have recently undertaken
the study of risk, pain and injury among athletes. Hence, while athletic training has not
been studied, it is a profession which emerged as a result of, and was made possible by,
the recurring fact of regular and severe injury in sport. Athletic trainers, and the students
professionally preparing to become trainers, are regularly in a position to “duress,
diagnose, treat, rehabilitate, return, or refuse to return, athletes to the activities which injure
them. The fact that they are in this position, and perhaps uniquely so, also suggests that
they have a unique perspective not only on the injuries and pain of athletes, but on the
whole corpus, as it were, of intercollegiate athletic participation.

Hence, while there is a theoretical intersection conceivable among the sociological
trends toward the reconceptualized study of the body in society, the study of emerging
allied health professions, and the critique of pain and injtu'y in sport, the empirical fact of
athletic training within the organizational structure of collegiate athletics has apparently not
yet inspired its sociological investigation. What is significant about this intersection is that
much of the study of corporeality in modern life, both by sociologists and, more recently,
sport sociologists, has principally followed and been inspired by work which is highly
critical of modern institutions. For example, Foucault's (1986) work on prisons and
Goffman's (1961) study of a mental hospital essentially argued that, while these

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institutions were premised upon measures to arreliorate human problems, their principal
accomplishments have been largely self-servin g and only marginally ameliorative. Indeed,
Foucault (1977) argued that, at most, modern institutions have served as new, scientific
manifestations of older forms of power and domination in society. In the case of medicine
and its descendants, Foucault (1973) argued that the power to treat certain human
conditions has simply been centralized and monopolized by small elite groups of self-
proclaimed professionals. Hence, following on the intersections described above, and of
relevance to the critique of pain and injury in sport, is the emergence of an allied health
profession, athletic training, whose principal purpose is the claimed amelioration of sports
injury and pain, under the umbrella of medicine.

Clearly, the inference which is possible here is that the profession of athletic
training is simply another development in the continuing and presumably power-driven
encroachment of medicine over yet another aspect of modern life. While work in the
sociology of sport is consistent with this conclusion, it is only superficially so, and in ways
which do not utilize the fruits of related work in sociology. My purposes in this study are
both to begin to investigate such intersections and take advantage of my experiences with,
and herein study of, students involved in professional preparation as athletic trainers.
Specifically, I believe the critiques by sport sociologists of the bodily dimensions of
modern sport need to be transformed into investigable hypotheses about actual people
working with actual bodies of athletes in competitive sports settings. I am not concerned
about the strict scientific form of these hypotheses and am indeed encouraged by the recent
forays into these areas. I am troubled, however, by what have become all too common
leaps from theoretically-based critiques in sport sociology, devoid of empirical support--in
this case, the critique of pain and injury in sport--to recommendations for institutional and
structural changes in sport practices. More specifically, I believe that the empirical work in
this area is grossly underdeveloped, such that practical recommendations are at the very

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I have in mind, in particular, the work of Nixon (1992a), who outlined a "social
network analysis" for the study of sports organizations and their apparent fostering and
naturalizing of the pain and injury of athletes. While I find this framework to be
fundamentally useful for the study of student athletic trainers, I believe it can be
strengthened by building on related though unexplored concepts by figures in sociology
and the sociology of sport. My purposes in this Introduction and Review of Literature,
then, are to review and critique Nixon's framework and to build on its apparent
intersections with work in sociology, and in particular the study of institutionalized
medicine, and other work within the sociology of sport. Hence, I begin with a summary of
Nixon's (1992a) work which criticized practices in sport that he argued lead athletes to
accept pain and injury as a natural part of sports participation. I will then move on to
highlight what I take to be four useful ideas of Nixon's framework, suggesting ways other
work in sociology and sports sociology can enhance these ideas. Along the way, I will
also suggest ways that the study of student athletic trainers may represent a fruitful avenue
for more fully understanding the contexts in which pain and injury, and a number of other
processes, occur in what Nixon called the "sportsnet." Finally, I will show how this
review leads to the basic questions in the present study of student athletic trainers.

. .. . 1 . ..

As stated earlier, the most developed work attempting a sociological understanding
of the intersections of the body, professional medicine and sports are those interested in the
acceptance by athletes of pain and injury. Sports sociologists working in this area have
attemped to explain the acceptance of what is often extreme pain and debilitating injury in
sport by identifying the social conditions which make this acceptance possible. Perhaps
the most formal framework for the study of pain and injury in sports was offered by Nixon
(1992a). He outlined a "social network analysis" for the study of what he termed a
"conspiratorial" alliance of coaches, athletic adminismators and sports medicine personnel,

and others whose activities perpetuate the acceptance by athletes of risk, pain and injury in

 

 

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sport. He termed these agglomerations of individuals in sports organizations "sportsnets"
(i.e. sports networks), the characteristics of which "make athletes vulnerable to cultural and
interpersonal messages exhorting and encouraging them to play with pain or injuries" (p.
127).

Nixon's (1992a) social network analysis is intended to map out "relations among
persons, positions, roles or social units" (p. 128) and show how their interactions produce
a standardized ideology which encourages athletes to play with pain and take unreasonable
health risks. A sportsnet, then, may also be seen as the functional map of "athletic
subcultures," groups sharing a common cultural identity, a set of reinforcive practices and a
common language for describing their activities. Nixon strongly suggests the compatibility
and complimentarity of a social network analysis with studies of these subcultures. A
study of subcultures would focus on "special meanings, symbols, clothing, values, beliefs,
norms, attitudes, identities, language, rituals and ways of acting" (p. 128). A social
network analysis, on the other hand, would focus on such things as interactions among
individuals and organizational subunits. For the purposes of the study of risk, pain and
injury in sport, then, a study of the athletic subculture would "[emphasize] the significance
of sharing the culture of risk in sportsnets" (p. 129).

Hence, using social network analysis, Nixon suspects that what occurs in
sportsnets is "rationalization"--a feature of organizations meant to minimize uncertainty of
outcomes in the pursuits of organizational elites-resulting in the heaping of risks onto
athletes. As he states, "What happens is risk transfer" (p.129). By this, he means that
sportsnets tend to avoid unnecessary uncertainties about outcomes that might stem from the
otherwise routinely cautious application of sound medical judgment to the cases of injury
found in sport. In other words, a standard reaction to injury is too destabalizing to the
sportsnet's goals of winning and other forms of success and requires a functional and
cultural isolation from that judgment. The assumption is that medicine is practiced

differently in non-sports contexts, and that exposure to the latter would lead athletes to at

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least question their acceptance of risk, pain and injury, if not reject these as premises for
their continued participation. Instead, the sportsnet’s rationalization tendencies foster the
development of a culture which transfers these concerns about pain and injury from elites to
athletes themselves. Moreover, this comes in the form of ideologies meant to suppress
competent medical judgment and its possibly uncertain consequences for the organization.
This rationalizing culture fosters the belief among all sportsnet membersuinclutfing medical
staffs—that injury and pain are natural, expected and even essential parts of continued
membership in the group. The repetition of phrases related to injury and pain, such as "it's
part of the game," and "it's all in your head," among others, Nixon sees as the discursive
component of these sub-cultural practices.

What assists this subculture in developing and resisting presumably normalizing
and healthy influences from outside is the insulation of the organization and its members
from the rest of society. These insular characteristics of the sportsnet translate into
"communication networks in which information and meanings are interpreted, filtered, and
modified to rationalize risks for athletes and reinforce the culture of risk in sport" (p. 129).
That is, the discourses produced within sportsnets effectively distort the athlete's own
views of his or her physical condition or potential risk in ways that will insure his or her
continued commitment to participation. Indeed, the will to live by these principles becomes
the distinguishing feature of elite membership within, as opposed to outside, the sportsnet.
Moreover, Nixon argues, these ideologies about risk, pain and injury are essentially
softened in impact (i.e. they are made to seem less threatening than they really are) by
virtue of their attachment to a "support" system for the athlete. Such a support system
clearly includes the medical staff, which functions to help retain the athlete's identity as an
athlete while they are injured. Moreover, when risk-takin g messages also come from those
in the sportsnet who are in a position to make decisions about the athlete's status on the
team (i.e. coaches), they are especially effective. This is particularly true, Nixon argues,

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Again, the result of this "collusive, closed system" (p. 12), for Nixon, is to
generate beliefs which will foster acceptance of risk, pain and injury by athletes. As a
result of their realization of the impact of injury within this subculture, and the attendant
costs within economies of playing time, team status, and athletic identity, athletes are
encouraged to hide injuries from influential and connected members of the sportsnet, who
might transfer this information to decision-makers. In this context, Nixon noted Kotarba's
(1983) discussion of the role of athletic trainers as "bridges" among athletes, coaches,
physicians, administrators and others within the sportsnet. Kotarba noted that athletic
trainers in his study seemed committed to resisting the interests of coaches by not allowing
athletes to play with what they believed were medically prohibitive injmies. For this very
reason, however, he also found that athletes, where possible, tended to hide what they took
to be such injuries from athletic trainers. In addition, athletic trainers tended to like to work
with athletes who did not frequently complain about pain and injury, thereby
"unnecessarily" complicating their already busy schedule. Instead, Kotarba found these
trainers to prefer athletes who were tolerant of injury and who seldom complained about
pain, who rarely paid them a visit and who evidenced a strong commitment to their
achievement within the sport. While Nixon cites his own study (Nixon, 1992b), which
suggests that athletic trainers, coaches and others in the sportsnet rarely exploit athletes and
condone risks and sacrifices in a conscious manner, he states that the effect of their
activities are nevertheless exploitative. What may or may not be a conscious process,
wherein coaches "exhort, cajole, encourage, or push," is nevertheless an "insidious" one,
and "easily seen by coaches as the natural or appropriate way to relate to athletes" (p. 131).

Nixon theorizes that injury acceptance processes are especially effective in
sportsnets which feature seven characteristics. Specifically, these are networks that include
large numbers of (replaceable) athletes; are "dense" in terms of stronger intra- versus inter-
network contacts; are centralized in terms of infomnation and resource control; include

coaches and other authorities who can easily have contact with athletes; close off athletes

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from non-network individuals and groups; have "homogeneous transactional content" (p.
132) among members; and are "stable in their social relational patterns" (p. 132).
According to Nixon's framework, athletes within a sportsnet possessing these seven
characteristics will essentially have no choice but to accept the limited range of possible
meanings for pain and injury they engender, as each subunit within the namow and
homogeneous network will essentially mimor the other. That is, "the people with whom
the athletes have close ties, such as teammates, trainers, and coaches, have close ties to
each other and share the same beliefs" (p. 132). Moreover, the sportsnet is, in Nixon's
words, "structured to limit, block, deflect, or discredit contacts with people who might
challenge the nature of risk in sport" (p. 133).

Nixon concluded his piece on sportsnets with several suggestions for mitigating the
force of sportsnets in the perpetuation of athletic risk—taking and injury. Based on the
assumption that athletes do not venture outside the sportsnet for medical information, and
that they are unlikely to be encouraged to do so by sportsnet members themselves, he
states:

Even if athletes do not voluntarily take responsibility for their own health

and safety in sport, those who manage sportsnets have a responsibility to

assure that health and safety measures will be employed for the benefit of

athletes. Such assurances cannot depend on the goodwill of coaches,

doctors, trainers, or sports administrators. Sportsnets are structured to

rationalize risk and minimize consideration of pain and injuries. High-level

network members may disregard or exploit athletes in pursuit of their self-
interest and for the good of the sport,’ even though it is not their intention

to do so (p. 133).

Hence, Nixon calls for the establishment of independent networks of medical
personnel in place of existing medical staffs that are intimately related to sportsnets. He
also suggests that athletes be required to seek second opinions outside these networks in
cases of persistent disabling or nondisaan g injury. Finally, he supports the abolition of

athletic dormitories and recommends other ways of breaking the insulated nature of

sportsnets for athletes. He closes by reiterating the call for the conduct of more specific

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analyses of sportsnet structures, their properties and relations among their members which
are more or less fertile for the acceptance of risk, pain and injury by athletes.
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I believe with the notion of a "sportsnet" that Nixon has provided a useful
beginning framework for examining tle actual practices of student athletic trainers and the
contributions these students may or may not make to what he calls a "conspiratorial"
alliance to provide legitimacy to pain and dangerous and disabling injuries in sport.
Specifically, these useful ideas come from three intemelaed and investigable components of
the framework. First, Nixon suggests that the institutionalized delivery of medical services
to athletes is part of a network of individuals whose daily practices will determine the type
of medical advice and services athletes receive. Second. Nixon observes that sportsnets are
unusually isolated from the rest of the world, and non- sportsnet medical services in
particular, and that this condition is conducive to the acceptance and normalizing of
behaviors within them. Third, Nixon suggests that members of the sportsnet may also be
part of various athletic and other subcultures, and that the activities of these subcultures will
to some degree shape the activities of this network.

However, as I will argue below, some of the assumptions behind the sportsnet
framework need to be clarified. These relate to the relationship between knowledge and the
institutional practices of medicine within the sportsnet. In this regard, I will review work
arguing that medicine depends as much on local practices and "recipe knowledge" as it does
on a claim to the standardized application of medical science-which Nixon argues is
lacking in the sportsnet. Moreover, the notion that institutional orders are products of
varying degrees of negotiation and compromise is lacking in Nixon's notion of a
conspiracy. Therefore, I will briefly argue that institutions, the profession of medicine and
athletic maining as a medical paraprofession must be seen as negotiated orders. That is,
while Nixon proposes that members of the Sportsnet collude to isolate athletes from sound

medical judgment, he does not consider that the activities of some members may run

10

counter to the wishes of sportsnet elites. This, I argue, may be particularly true in the case
of student trainers, given their potentially conflicting allegiances to both the sportsnet and
peer student athletes. Indeed, there is little mention by Nixon of actual discourses, daily
practices, or institutional characteristics which would help explain his conclusion that
athletes are immersed in an insidious set of practices which manipulate them in ways that
distort their perceptions of self-interest. In other words, Nixon's model is lacking
consideration of both theoretical and intuitive considerations about medical services for
athletes and, obviously, empirical investigation of those providing these services. What I
will present next, then, are the ways in which I believe these three areas may be both
theoretically enhanced and made more prone to investigation in a study of student athletic
trainers. This will be done by attempting to relate these ideas to relevant and more
theoretically developed work in sociology and the sociology of sport and by considering
the circumstances of the unique circumstances of the work of student athletic trainers. I

will undertake these issues in the sections that follow.

I . . I 1° . l l S l E S
I . . E . l K I l
Berger and Luckmann in W (1966) provided a set

of concepts for understanding how the practices of a segment of society come to be
acceped by its members. They observed that social institutions are built upon
habitualization in human conduct. Habitualization is simply the repeated performance of
acts in patterned ways, recognition of the relative efficiency of those ways, and the fact that
those ways can be called upon when needed to bring about the same result. Habitualization
that becomes regularized and mutually predictable among actors in a stable division of labor
can be said to be institutionalized. Once such stability is established, moreover, actors can
develop innovations on these established patterns, thereby creating new habitualizations.
Institutions are constructed upon a history of these mutually predictable patterns of

conduct. Once they have been in place long enough for a new generation of actors to enter,

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11

the activities of institutions will take on what Berger and Luckrnann called "objectivity" (p.
58). Objectivity refers to the point at which institutions are "experienced as possessing a
reality of their own, a reality that confronts the individual as an external and coercive fact."
(p. 58). That is, the practices of institutions become "crystallized" and "thickened," as
"ways things are done" to the point where the individuals within them do not recognize
their origins as human constructions. The practices of institutions are thereby increasingly
resistant to change through time, even though they are in origin and in fact "humanly
produced, constructed objectivity" (p. 60). If it can be assumed that this broad definition
of institutions might then apply to sportsnets, it follows that to account for the settled
practices of a sportsnet is to account for the ways in which its activities take on this air of
objectivity. Nixon (1992a) did not acknowledge the apparent fact that all institutions take
on coercive characteristics which are not immediately perceptible to those immersed within
them.

What may further add to the settling of institutional practices are especially salient
experiences of its members. In Berger and Luckmann's words, these experiences become
"sedimented," that is, "they congeal in recollection as recognizable and memorable entities"
(p. 67). When such experiences are common to the biographies of others and are then
shared and articulated into language, they accomplish "intersubjective sedimentation" (p.
67). In institutions, such intersubjective sedimentation might be thought of as an
institution's "memory." These memories, as they are constructed in language, make
sedimented experiences accessible to those who did not originally share in them. Language
thus becomes the most important means of organizing and articulating a number of these
sedimentations.

Because institutions are inhabited by succeeding generations through time, they
develop the need for "legitimations." The reason for this is that, while the originators of an
institution will have within their biography both sedimented experiences and the rationales

for the practices the institution has established, new generations will not share such

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12

memories and therefore must become convinced of these reasons through other means.
Often this is achieved by presenting new members with an integrated description of the
institution's crystallized practices and the institution's history of sedimented experiences.
These legitimations need to both convincingly and comprehensively explain the practices of
an institution. If they are not both convincing and comprehensive, institutional activities
will be less amenable to understanding by new members as generations pass and some
degree of control may be lost. Note that there was no mention by Nixon (1992) of the
potential loss of administrative conuol and instability a sportsnet must constantly confront.
That is, a sportsnet, like any institutional order, will be more or less prone to change, given
its ability to successfully negotiate with new members and maintain stability. Hence, an
account of crystallization and sedimentation in a sportsnet requires attention to the
legitimations deployed to achieve predictability and control.

How predictable and controllable conduct is made to persist over time, in light of
new members increasingly removed from an institution's original intent, becomes a central
question in the analysis of institutions. Berger and Luckmann argue that it is language,
articulaed into a set of working knowledges, that is able to provide a coherency and
integration to institutions in ways that accomplish this predictability and control. Hence,
they conclude that "if the integration of an institutional order can be understood only in
terms of the 'knowledge' that its members have of it, it follows that the analysis of such
'knowledge' will be essential for an analysis of the institutional order in question" (p. 65).
Moreover, in describing this knowledge, they add:

It is the sum total of ’what everybody knows' about a social world, an

assemblage of maxims, morals, proverbial nuggets of wisdom, values and

beliefs, myths and so forth . . [Ejvery institution has a body of transmitted

recipe knowledge, that is, knowledge that supplies the institutionally

appropriate rules of conduct (p. 65).

The meaning of one's conduct and the roles played within institutions are thereby generated

out of this knowledge. That is, these working knowledges will provide a logical coherency

and integration which will further cement the hold of the institution on its members, even

thong

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13

though portions of this knowledge will in fact have been created in order to provide
legitimacy to the institution's existing practices. Acquainting new members with this
knowledge becomes the principal means of socialization into the institution. In these
socializing experiences, this core knowledge lends meaning and value to the practices of the
institution and becomes the framework for interpreting new experiences. It also presses
upon members the need to be able to articulate the meaning and necessity of the institution
to society.

As Nixon (1992a) suggested, the language of sportsnet members will tend to reveal
the inherent beliefs that underly the practices it establishes. It must be realized, however,
that such language and working knowledge will be referenced to daily practices and other
behaviors in the organization. These behaviors and practices may fit more or less
adequaer the forrmalized language and logically coherent frameworks constructed to make
sense of them. This suggests that members of a sportsnet may learn the practices and the
rationales for them, but may see contradictions or inconsistencies between the two. For
example, a pre-participation medical examination of athletes may be argued as necessary to
detect underlying physiological conditions but may be seen by a sportsnet member as
actually serving the management concerns of coaches. The point is that sportsnet members
are conscious of these inconsistencies between stated objectives and manifest functions of
the organization and may work to resolve them. Institutional orders, this example
indicates, are maintained by negotiations between what it does and how successfully it
explains to its members what it does.

This may particularly be true in the case of modern institutions which have emerged
with the development and application of certain forms of rationality (e. g. science) to human
problems. Medicine is among the most powerful examples of such rationality, in that it is
both highly institutionalized and exists as the paradigmatic example of a profession.
Freidson's (1970) We studied the development of medicine utilizing a
sociology of knowledge perspective that holds much in common with that of Berger &

by m
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335,

14

Luckmann (1966). Following the latter's evolution of institutions, Freidson observed how
the term "medicine" has been used to describe a whole gamut of practices, from individual
self-healing techniques to the most scientifically sophisticated fomis of medical services.
Hence, Freidson looked at medicine first as an occupation-«hat is, as a set of practices of
diagnosing and treating illnesses--and only secondarily as a scientific body of knowledge.
Indeed, he questioned the notion of a body of knowledge as orienting a profession,
remarking that "[m]edicine...in this sociological usage, is an organized consulting
occupation which may serve as the discoverer, carrier, and practitioner of certain kinds of
knowledge, but which is not a body of knowledge as such." (p. 5).

Starr (1982) noted that the growth of the authority of medicine was made possible
by mechanisms of both legitimation and dependency. The legitimations were the
establishment by medicine of standardized education and legal licensing. The dependency
was created by instituting controls over the dispensation of drugs, the formation of health
insurance, and the founding of medical institutions-the hospital. The growth in the
physician's knowledge that permitted these legitimations and dependencies, as Freidson
nowd, should not be mistaken for the growth in scientific knowledge. Rather, the
physician gained public prestige as a result of service to the public. Hence, it is a mistake
to place scientific medical knowledge as being on par with academic knowledge. Instead,
as Freidson observes, "[t]he request is, 'Doctor, do something,‘ not, 'Doctor, tell me if
this is true or not'" (p. 22). Hence, Freidson sees as radically different the activities
associated with solving practical problems and those associated with the production of
knowledge.

K11 12"!ll'I'i

Hence, the distinction between the scientific knowledge created for the purposes of
public lioensure and autonomy of a profession and the "recipe knowledge" and sedimented
traditions of the institutionalized practice of an occupation must be kept in mind. This

suggests that any medical or paramedical occupation should be analyzed as much for its

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actual practice of medicine as it is for its identification with a centralized professional
organization and body of scientific knowledge. Indeed, in the case of athletic training its
practices and techniques date back to ancient history (Fahey, 1986), and only in the 1950's
were attempts made to form the occupation into an allied health profession. Only recently
have scientific journals and other professional activities in athletic training emerged.
Moreover, it was not until 1991 that the profession of athletic training received recognition
by the American Medical Association as an allied health profession (Weithaus & Fauser,
1991). In other words, the practices of athletic training predate its establishment as a
profession founded on an application of medical knowledge.

These points are also relevant to N ixon's observations about the isolation of the
sportsnet. If it is the case that all medical and paramedical practices are matters of working
knowledges and particular contexts, Nixon's suggestion that sportsnet medical services
may be worse than those outside the sportsnet is an empirical matter to be investigated not
assumed. Indeed, Nixon seems to presuppose that the ideologies created by the sportsnet
are unique to it, and that other non-ideological or "objective" medical assessments, immune
to sportsnet agendas, are available outside. While this is certainly the case, Nixon (1993)
himself, along with Young (1993), provided evidence from popular literature and legal
documents that these injury-legitimizing ideas are not unique to sportsnets and are indeed
what function to keep sports violence and injuries acceptable within society. It is not clear
what the effect of isolation is if outsiders share, or might come to share, the same
ideologies. This is precisely what makes his suggestion that athletes pursue second
opinions on their injuries and pain rather suspect. What is to insure, were athletes to flock
to other health care personnel, that these persons in other organizations would not also
succumb to the same injury-legitimizing ideologies of the sportsnet?

Moreover, to suggest athletes pursue "outside" opinions on their injuries implies
that there actually is a grand, uninterrupted and unchallenged consensus within the

sportsnet on the appropriate treatment of athletic injuries. Again, one of Nixon's own

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studies concluded that there is seldom intent on the part of coaches, trainers and others to
deliberately harm and otherwise exploit athletes (Nixon, 1992b). He also cites Kotarba's
(1983) study indicating that athletic trainers actually resisted some of the impulses of the
sportsnet and provided sound medical advice to athletes, only to have the athletes
themselves avoid revealing their injuries. Does this mean that athletic trainers are not part
of the sportsnet, or that the sportsnet itself is in a continual process of negotiation and
dispute about medical judgments and related participation decisions? Hence, an explanation
for how sound, scientific, medical counsel (presumably available elsewhere) becomes
distorted, compromised or avoided within the sportsnet is needed in order to make clear
how one might distinguish collusive influences from benevolent ones.

5 . I 1 In . . 9

A useful component of the sportsnet framework is Nixon's observation that
sportsnets are relatively closed off from the rest of the world. While some of the
characteristics of the sportsnet Nixon describes are quite vague, particularly the notions of
"homogeneous transactional content," and "[stability] in social relational patterns,” it seems
clear that "big-time" intercollegiate athletic departments which include large staffs of athletic
trainers, physicians and others are a good, if not paradigmatic example of a sportsnet.
Perhaps a useful adaptation of Nixon's "sportsnet" model for this study emerges from
consideration of the fact that the practices of sportsnets may be ways of managing athletes
that are simply convenient to the competing and sometimes contradictory needs of those
running them. That is, sportsnets may become, consciously or not, means of the social
control of athletes rather than a tool for addressing the needs of athletes. This opens up a
wider set of questions related to the broader sociocultural contexts of institutionalized
professions, and their internal practices. Indeed, Bourdieu (1987) and Gruneau (1991)
have speculated on the similarity of modem athletic complexes and their internal operations
to Gofi'man's (1961) description of "total institutions," the label he used to describe mental
hospitals in Asylums. Gruneau (1991) suspected that athletes may be subject to similar

17

kinds of controls as patients in mental hospitals, given what he saw as similar institutional
and physical characteristics between an asylum and the typical football practice facility.
Goffman called asylums “total institutions,” which he describes as “a place of
residence and work where large numbers of like-situated individuals, cut off from the
wider society for an appreciable period of time, together lead an enclosed, formally
administered round of life” (p. xiii). Moreover, he states that institutions like asylums have
the tendency to encompass its residents and be self-contained in operation, most obviously
evident in the physical layout of the institution itself. Such institutions are often
characterized by formidable barriers to the outside world, which include high walls, locked
doors and other barriers to interaction of external and internal worlds. An oft-quoted
segment of the preface of Asylums is Goffman’s observation that "any group of persons--
prisoners, primitives, pilots or patients -- develop a life of their own that becomes
meaningful, reasonable, and normal once you get close to it, and that a good way to learn
about any of these worlds is to submit oneself in the company of the members to the daily
round of petty contingencies to which they are subject” (p. ix-x). Hence, as Nixon
suggests in the case of the injuries of athletes in sport, the situations to which mental
patients have been subject in asylums may become normalized for those within them.
Following Gruneau's (1991) suggestion, if sportsnets are to be investigated in
terms of their insulation and total immersion of athletes, it seems plausible to use a
paradigmatic example of an institution that has accomplished this totalization. I believe it
useful to draw on several of Goffman's observations about total institutions as potential
ways of looking at the practices of student athletic trainers. In particular, I see intuitive
connections between the activities of student trainers and four of the practices Goffman
points out as part of total institutions. First is what Goffrnan called "mortification,"
wherein one's identity is essentially stripped and replaced with one convenient to the
administrative procedures of the institution. The process of mortification involves several

steps, according to Goffman. These include role dispossession, wherein the staff attempt

18

to break the patient's attachment to past roles. Related to such activities are practices which
essentially attack patient behaviors that in the outside world indicate that the individual has
control over his or her own life, in particular, those that suggest a patient "knows" the
status of their health and well-being. Significantly, a central portion of this process
includes a control of the language of patients, wherein their words cease to carry the same
weight as those of a staff member or otherwise "normal" human beings. In addition, one's
full immersion in the purposes of the institution are measured by a kind of asceticism,
where one accepts the indignities of the institution's practices in exchange for what
Goffman called a "sociological comfort," in that an identity about which there are
predictable social conditions is created (p. 48).

The process of mortification in the case of the provision of sports medicine services
would obviously be applied to athletes, who are the "patients" in such situations. One
might argue that such a process would seem to serve as a useful tool for those in the
sportsnet who are interested in "encouraging" athletes to return to participation in the sport,
ala Nixon's "conspiratorial alliance." Although it is unlikely that one would find student
athletic trainers, in positions analogous to staff, engaging in the types of humiliation
described by Goffman. such degradations mright be engaged in by coaches and other
athletes on the team. While one cannot help but note the use of numbers, last names,
positions, and other means of identity traditionally associated with sports participation,
these are conditions that an athlete will have undergone for some years prior to their
participation at the collegiate level. Indeed, athletes may have undergone an entire history
of degradations and other public humiliations, especially those that occur within
traditionally male sports such as football. While student athletic trainers may only witness
such processes, of interest here are any contributions they may make to the effect of such
transformations in the identity of athletes through the perhaps complimentary practices they

learn as allied health personnel or by their simple association with athletes.

19

Second, and as a result of mortification, Goffman argues that the patient begins a
"moral career" in the eyes of those operating the total institution as a result of their knowing
the life stories and comprehensive activities of the patient. Such knowledge is acquired by
means of several of the processes Goffman associated with mortification. Among these are
two which seem particularly relevant to the practices of student trainers. First, there is a
kind of ongoing surveillance of patients conducted not only by the simple exposrne of staff
to the day-to-day life of the patient, but also by their knowledge of quite personal
information about the circumstances which brought them to, and keeps them within, the
institution. These personal biographies about patients serve as the moral backdrop for the
medical evaluations of their conditions and the treatment they receive in response. Second,
Goffman considered confessions of various sorts, many of them forced by virtue of the
level of surveillance that such institutions also conduct, as useful tools in the monitoring of
the patient's moral career. In other words, by virtue of being constantly watched by
medical personnel, one will tend to submit oneself to admitting to the problems they
suspect.

Several considerations, then, about the unique place of student athletic trainers
within the sportsnet render them particularly interesting with respect to surveillance and
confession. First, student athletic trainers may be expected to be placed in the position of
regularly “lending an ear” to or actually counseling peer athletes on a range of medical,
quasi-mdical, team and personal matters. Indeed, skill in “education and counseling” is a
required competency of the National Athletic Trainer's Association for which students are
evaluated (N ATA Board of Certification, Inc., 1991). The provision of counsel is
particularly interesting in light of the fact that student trainers are fiequently and uniquely
exposed to the comprehensive activities of the team, including practices, games and travel.
Hence, they may be expected to be engaged in a number conversations with athletes on
topics which extend beyond athletic training matters and include such things as particular

athletic performances and their evaluation; personal orientations to health and well-being;

Sll

20

relationships among and between team members and/or coaches or other personnel;
instances of success and praise or apparent injustice and mistreatment; and various “off-the
field” matters, including relationships with roommates, professors, or others. Student
trainers must therefore decide what degree of personal familiarity with athletes is acceptable
within the boundaries of their developing roles, how they are to handle both medical and
possibly quite personal information and when the conveyed information necessitates a
referral to another party.

Moreover, modern athletic training may be seen as an ongoing health status
surveillance system for athletes. Collegiate athletes, at least in the realm of immediate
medical care, essentially have no choice but to accept the on-site facilities and health care
personnel offered as part of their participation. Unlike such apparently analogous para-
professions (Freidson, 1970) such as nursing, however, these student trainers often
witness the activities which lead to the necessity for their services. They may not only see
the mechanisms of the injuries they confront, they may also participate in lengthy
rehabilitative processes and witness the daily behaviors of those in their care immediately
subsequent to that care. Moreover, the recent attention paid to the issue of prohibited
substance use by athletes (Anderson, Albrecht & McKeag, 1993) has resulted in the
addition of other surveillance functions taken on by athletic trairers, including in some
cases the obligation of student trainers to report instances of such use. This surveillance
introduces issues of paternalism (Brown, 1985, Ravizza & Daruty, 1985) not only on the
part of the institution, but on the part of peers. Hence, the practice of having student
trainers in the position to monitor extensive periods of the lives of athletes, lend them
counsel, and conduct health and potentially drug use surveillance may inform the "moral
career" of athletes as recipients of athletic training services.

A third consideration which emerges out of the analogy of a total institution to the
milieu of sportsnets are the generalizations of staff about human beings as a result of

having chronicled a number of moral careers. Out of these, Goffman noted, come

21

"theories of human nature" that emerge as a result of staff evaluations of the degree to
which a patient submits him or herself to the wishes of the institution. These theories will
serve as rationales for all manner of actions and "provides a subtle means of maintaining
social distance from inmates and a stereotyped view of them, and justifies the treatment
accorded them" (p. 87). The demonstration of an institution's efficacy, moreover, is its
ability to somehow break the resistance of clients to its demands, evidenced in those who
show immediate deference to staff. The result of such a process, in Goffman's view, is a
reinforcement or apparent validation of the staff’s theory of human nature and views of
character where the "compliant" patients are distinguished from the "problem" ones. With
respect to theories of human nature, Goffman concludes that “since mental hospitals have a
legitimate claim to deal with the ‘whole’ person, they need officially recognize no limits to
what they consider relevant, a socially interesting license” (p. 156, footnote). Hence, a
machinery of organization and administration are constructed and “validated” on these
operating theories of human nature.

Theories of human nature that student trainers might form as a result of their work
with athletes, then, might be expected to become established as a result of their knowledge
of the athlete's status on the team, the details of the athlete's personal life, and the apparent
compliance of athletes with advice and other orders given them regarding their health and
well being. Moreover, such theories might also be constructed out of the ideologies
operative in the "athletic subculnire" to which they may have some relationship. In
particular, student trainers may well adopt these ideologies as convenient ways of
explaining athlete behaviors which seem unusually resistant to their wishes. One might
also, therefore, expect that these theories would become operative lenses through which
newly entering athletes would be seen. Finally, one might expect that a standard set of
procedures might be developed which are adapted to "cases" of athletes fitting the
stereotypes these theories construct. Again, these are empirical matters to be investigated in

a study of student trainers.

22

The fourth component of the sportsnet/total institutions analogy relates to the
consequences of what Goffman calls a "servicing relation to the body," wherein the patient
is treated not as a person, but as a body in the forrrr of a serviceable item or
"physiochemical machine." He notes several of the special considerations of fitting the
body into what he calls “the tinkering service framework.” Noting that the body is highly
cathected, in that “persons place great value on its appearance and tend to identify
themselves with it” (p. 340), Goffman observes that the body can’t be dropped off to be
serviced and then picked up later, except in the cases of anesthesia and “non-person
treatment”--for example, when a group of physicians discuss a patient’s case in the latter’s
presence, using technical jargon. Among the most damaging criticisms of this service
orientation is the view of it as a “workshop complex” (p. 346). This is basically the
disturbing public perceptions of medicine practiced using only the particular schemes,
approaches and techniques in which the institution specializes. Moreover, as Freidson
(1970) noted, there are often a number of different and competing "schools" within
medicine, which vary along the lines of treatments and their degree of radicalism or
conservatism to the existing physical state of the subject. While a patient may have a choice
among these schools, there are few choices patients are deemed competent to make once in
tle care of a particular school. That is, once enclosed within a particular school, one enters
what Friedman (quoted by Freidson, 1970) called "'the dogma of immaculate perception,
the belief that the data collector is a non-person, the general avoidance of the social
psychology of . . . research . . .all part and parcel of that govemring ideology, that
unattainable image of cleanliness'" (p. 265).

Goffman (1961) concludes that part of the "moral career" of the patient is the fact
that a diversity of individuals within a school are suddenly seen as remarkably similar. In
this regard, Goffman also keenly observes that a hospital is a poor place to witness a
"classic repair cycle," in that, rather than ongoing evaluations of patients, only aberrations

in their fit with existing medical models are recorded. He notes that the same applies to the

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23

administering of treatments. The latter, he notes, are often “given across the board to a
whole entering class of patients, with the medical work-up being used more to learn if there
are counter indications for the standard treatments than to find indications for them”

(p. 360-361). Finally, Goffman observes, the patient is often sent back to the very source
of the problems leading to hospitalization. He notes, that

since the interpersonal situation cannot be brought in and serviced . . .the

figure and ground of usual service merge into one, the patient’ s

interpersonal environment being inseparable from the trouble he is

experiencing. Theoretically, it might of course be possible for a slight

therapeutic change in the patient to have a benign circular effect on his

environment when he gets sent back to it, and it might be possible to

arrange to return him to a new environment, but in practice the patient is

usually returned, when he is discharged, back into the system of which his

psychotic response is a natural part’ ' (p. 363).

It must be reiterated that athletic training is a profession primarily focused upon
providing care to the bodies of athletes under the assumption that bodily injury is an
implied aspect of participation in sport. Indeed, the very existence of the occupation
depends upon the acceptance and nomnalization of behavior in accordance with this fact.
Hence, it follows that the day-to-day preparation, ongoing care, emergency treatment and
rehabilitation of athletes will tend to foster certain ideas about. and orientations to, the
requirements of elite level athletic competition and the athletic body as it participates in
sport. Through this process student trainers may be expected to similarly acquire practices
associaed with a particular "school" of athletic training and to standardize these practices.
Moreover, the principal concern of Nixon is identical to that of Goffman quoted above: the
return of the athlete, perhaps counter to sound medical judgment, to the activity which
injures them.

Indeed, current research literature within athletic training reveals particular concern
for the clinical aspect of professional preparation not principally related to the medical
competencies of the individuals prepared, but rather with the social context and extra-
medical demands of the occupation (Mangus & Ingersoll, 1990, Kuzrrets, 1991, Buxton,

Lankford & Glieck, 1992, Buxton, Lankford & Noda, 1992). Ironically, while these

24

demands include the provision of counseling services about which at least some trainers
feel under prepared (W eidner & Vincent, 1992), the National Athletic Trainer's
Association's Role Delineation Study (1991) indicated that professional trainers rank
“education and counseling” low relative to medical services on a prioritized list of athletic
training competencies. This suggests that professional athletic trainers see themselves as
primarily health care personnel who Work on the bodies of athletes as extensions of the
medical profession, and secondarily as educators and counselors of athletes. That is, they
may see themselves as rendering strictly technical services which may or may not be
impeded by the social environment of the training room, the demands of the occupation, or
the personal difficulties of individual athletes. Of importance to the study of student
trainers, it also suggests that becoming an athletic trainer is composed of processes by
which students also come to accept all of these facts as the conditions of their work.

WW

Again, the intention of this review was to point up insights into institutions which
may be relevant to the study of student athletic trainers immersed in what Nixon sees as a
closed off and ideologically homogenous world. Goffman's idea of a "total institution"
provides an example of a way such totalization is achieved. It is clearly possible, then, to
explore athletic training as a variant of a total institution. This study, then, will begin to
explore how fruiaful such an approach may be by examining the degree of totalizing of one
segment of the sportsnet. Again, of particular interest here are four processes taken up by
Goffman which included "mortification," which may take place through a combination of
various physical controls, discursive practices, and the regimentation of medical services
for athletes. A "moral career" made possible through srn'veillance and counseling practices
may then begin, wherein the behavior of the individual athlete is placed within a
comprehensive view of their life and values. Such activities are both premised upon and
help reinforce implied "theories of human nature," which may be the ultimate rationales for

the treatment of athletes. Third, one might investigate the establishment of a "servicing"

relation

 

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25

relationship between medical staff and the body of the athlete through the standardization of
practices. Finally, the application of the medical model to the servicing of selves, and the
ultimately self-serving conception of the self that emerges from it, might be pursued in a
study of student uainers.

However, as noted in the review of institutions, it should also be anticipated that
there will be certain sedimented practices in institutions that have more or less continuing
support among its members. This will be particularly true in cases where members do not
have experiences of the need for certain of these practices. Institutions may have
inadequate legitimations for these practices, or other failures in their systems of control,
and hence a number of sources of resistance to totalizing practices may be found. This may
especially be the case in the work of student athletic trainers. As Goffman (1961) noted,
even in encompassing institutions, "the system or pattern borrows only a part of the
individual [and] the role others for whom [the individual] performs similarly represent only
slices of these others" (p. 86-87). Hence, there may be compromises in institutional aims
brought about by the encroachment of the other "slices" of individuals into the institution.
There may well be mortification processes through which athletic trainers themselves must
pass and in which athletes may participate, due to their status as peers and the fact that
student trainers "serve" athlete needs. Additionally, while "moral careers" of athletes may
be construced through the familiarity of student trainers with athletes, this very familiarity
may also eliminate the consequences of such knowledge. That is, student trainers may
become the allies of athletes over against the purposes of the sportsnet. T‘lese relationships
may work to undermine a number of totalizing tendencies the sportsnet may have.

Moreover, as noted earlier, the subcultural practices of athletes mentioned by Nixon
may also be expected to determine the degree of totality the sportsnet is able to exercise
over its members. Nixon suggested that these subcultures, composed of common beliefs,
norms, values and symbols, may also encompass and legitimize playing with pain and

avoiding sound medical advice. A subculture is, by definition, a group composed of

26

discordant values, common interests, problems and pursuits which mark it off from a more
encompassing culture (Phillips & Schafer, 1976, Donnely, 1981). While some subcultures
are formed on the basis of deviance (e.g. Coakley & Hughes, 1992), other work has
identified sport subcultures which feature the degradation of others (e. g. Donnely &
Young, 1985). For example, literature in the sociology of sport has examined male
subcultures and their treatment of girls and women (e. g. Theberge, 1989, Curry, 1991). It
is also possible, however, that various subcultures related to the sportsnet might also form
around resistance to pain and injury, or otherwise resist the aims of the sportsnet. Overall,
a study of student athletic trainers must also be conscious of the possibility that existing
subcultures, of which student trainers themselves may be members, may either work for or
against the wishes of a sportsnet.

While the above discussion was intended to point up investi gable aspects of the
work of the student trainer, it is obvious that not all of them can be examined in a single
study. A study of a social institution like a sportsnet must identify the settled practices and
attendant working knowledges that are inherent to it. It must also examine forms of
resistance to these practices found among its members. What actually goes on among the
people working in the medical units of the sportsnet, and in the present case, student
trainers, will be expected to be a product of continual interaction, compromises and perhaps
relative autonomy of its members from those who control it. Hence several questions for
the present study arise. First, what are the characteristics of the general work context of the
sportsnet on the practices of student athletic trainers? What is the result of the fact that
student trainers are both students and apprentice athletic trainers? \Vrth whom do student
trainers interact and what is the nanne of their relationships? What impact does the
knowledge they acquire as a result of these relationships have on those with whom they
work? How much control does the sportsnet have over the practices of student athletic

trainers? These were the principal questions addressed in this study.

 

 

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CHAPTER II
Methodology

As mentioned in the Introduction and Review of the Literature, the purpose of this
study was to examine the experiences of student athletic trainers as part of a larger sportsnet
within which college athletes sustain injury and receive medical treatrrent and advice. This
study was intended to investigate a portion of this sportsnet by attempting to understand
student athletic trainer's conceptions of what they do, what their relationships with athletes
are, and how they think about the injuries athletes sustain. Moreover, it sought to
understand the degree to which the sportsnet is a totalizing institution. In an effort to gain
this understanding, I interviewed 22 undergraduate and graduate men and women students
enrolled in an athletic training internship program at a large, Midwest, NCAA Division I
institution (hereafter described as GSU--Great State University). There were two types of
interviews involved, one a group session, the other an individual interview.

E . l E l I . 1 1 l 1

As indicated in the review of literature, the principle concern of sport sociologists in
the few studies which have included athletic trainers has been to attempt to understand how
groups and their ideologies may or may not contribute to the acceptance of pain and injury
by athletes. The conclusion by Nixon (1992a) in this regard was that there is a need to
understand the operations of "sportsnets" and related "athletic subcultures" within which
athletes are immersed and encouraged to accept pain and injury. One examines the
sportsnet, Nixon suggested, by studying the structure of relationships within it, that is,
who interacts with whom, the nature of those interactions, the flow of information and
resomoes, and the impact of these activities on sub-units and individuals. The "athletic
subculture," on the other hand, is studied by focusing on the shared meanings and common
practices distinguishing it from outside groups. In the latter case, then, one studies such
things as beliefs, norms, attitudes, and language. As I concluded in the Inu'oduction and

27

28
Review of Literature, Nixon's conception of a sportsnet and related "athletic subculture" is,
when refined by related sociological work, a useful way of conceiving of the context in
which athletes are immersed. There is still, however, a dearth of empirical work on, and
hence understanding of, both these networks and subcultures, and, in particular, the
practices and beliefs held within them.

Quantitative techniques appear to be most appropriately applied to a number of the
problems and issues Nixon outlined in his description of a sportsnet. One might begin to
get an understanding of these sportsnets by surveying college and university departments
of intercollegiate athletics and the network of internal relationships within them. For
example, one might study the associations among variables such as sportsnet size, access
of other sportsnet members to athletes, athlete living arrangements, and patterns of
communication. One might also attempt to determine the relationship between frequencies
of contact between various sub-units within and outside sportsnets and attitudes of athletes
concerning risk, pain and injury. As suggested earlier, these associative and correlative
hypotheses are as yet untested in empirical work.

However, in the study of athletic subcultures, one is attempting to expose beliefs
and uncover meanings inherent in practices and language. Traditional quantitative
techniques, and their transformation of ideas into variables through operational definitions,
may miss these important meanings and beliefs. Quantitative techniques may also lead one
to ignore or otherwise "control for" the impact of personal biography, and group and
institutional history, in favor of drawing generalizable conclusions. While generalizability
is desirable in attempting to understand an unstudied phenomenon, the fact that people most
often place the meanings of events and their own actions within personal narratives, rather
than within categories of variables, suggests that such meanings may be lost when using
quantitative methods. At minimum, sole reliance on a quantitative methodology would
supply an incomplete picture of the experiences of student athletic trainers. While it is true

that beliefs may be implicit in the practices of a group, it is more likely that they will be

29
apparent in the actual language used by its members. More specifically, the meanings
student trainers attach to the issues of pain and injury in sport, and their own roles and
relationships within the sportsnet or athletic subculture, will most likely be evident in their
own descriptions and accounts.

Hence, qualitative methodologies seemed more appropriate than traditional
quantitative techniques for the task of examining the student's conceptions of their work,
their beliefs about injury, and the general context in which they interact with athletes.
Additionally, because one may develop rapport with interviewees in ways similar to
naturally occurring conversations, one may also illicit self-disclosures unattainable through
other methods (Bodgan & Biklen, 1982). Moreover, the use of such techniques to study
the perceptions of college athletes (Adler & Adler, 1985, 1991, Meyer, 1990, 1991) have
shown that subjects explain decisions, recount experiences, and react to popular
perceptions of their activities in ways not elicited with traditional survey methods. In this
way, subjects have a voice in the presentation of "results" of research by having what they
actually say presented, therefore making their feelings and perceptions immediately
available to observers. It may also, as a result, require researchers to construct
explanations that are "closer" to their data than they might be in cases where data are
summarized in the form of statistical analysis. Finally, because the purpose of the study
was to understand these meanings and beliefs, I decided to use a qualitative methodology,
in the form of semi-structured group interviews followed up by individual interviews.

It must be noted, however, that the assumption behind the recommendation that
sportsnets be quantitatively measured and athletic subcultures be qualitatively studied
indicates questionable dichotomies in both the phenomena and the methodologies. It
suggests first that sportsnets and athletic subcultures are distinctly different empirical
realities, rather than the theoretical constructions of scholars interested in sport. Indeed, it
may well be that the differences between the two are precisely those between scholars who

prefer using statistical analysis and those who prefer interview methods, respectively. Of

30

course, either methodology may have uses in the study of either of these concepts.
Moreover, to pr0pose that by interviewing student athletic trainers, rather than, for
example, having them complete a questionnaire, one is studying the "cultural aspects" of
their lives rather than the organizational relations in which they are immersed, is equally
suspect. The information obtained through an interview may well be as revealing of a
sportsnet as it is of an athletic subculture. Hence, while my intention was to examine
thoughts, meanings, and beliefs, it was inevitable that I would also obtain descriptions of
relationships, patterns of interaction, organizational characteristics and information flows.

I decided to conduct group interviews, followed by individual interviews, for two
reasons. First, I believed that, because research on student trainers of this type had never
been conducted, I needed to efficiently familiarize myself with the work and the major
issues concerning these student trainers. In other words, I wanted to be able to ask
informed questions within the subsequent individual interviews, which I believed would go
into more depth. Hence, the group interviews were conducted first and concerned the more
general issues of the student trainer's actual duties, disruptions occurring in the workplace,
gender issues, and things they might change about their internship. The second rationale
for both group and individual interviews stemmed fiom my belief that the group interview
might have a "priming" effect for the individual interviews. That is, having covered the
basic landscape of the actual job, we could then move on to central issues of the study with
each student trainer. Hence, individual interviews dealt with the student trainer's
expectations upon entering the program, their perceptions of gender differences in their
experiences, their feelings about injury, and their knowledge about and relationships with
athletes.

While any research methodology has weaknesses, what is considered a weakness
also depends on the intentions one has for the inquiry in which it is used. As Bogdan and

Biklen (1982) have suggested, there are several matters to which one should attend when

31
both planning and conducting an interview. These measures should be taken in order to
assure comfort on the part of interviewees which will permit self-disclosure, the sharing of
honest, versus socially desirable, information, and the establishment of some degree of
control over the topics discussed.

It is important, first, to present oneself to the interviewee in ways that are neither
threatening nor evaluative (Bogdan & Biklen, 1982). One must take measures to establish
general environmental conditions for the interview which are comfortable and non-
distracting, such that interruptions are minimized or eliminated. Steps must be also taken to
establish a rapport by indicating a genuire interest in what the interviewee is saying. In this
regard, one must pay attention to dress, the preparation of the interview site, and the
placement and use of recording or note-taking materials. One may also establish this initial
comfort by doing such things as posing very general and easily answerable questions near
the beginning of the interview (Bogdan & Biklen, 1982).

The interviewer must also be conscious of cues which may tip off the interviewee to
any personal biases they may hold with respect to the responses or the more general
research topic being discussed. Similarly, the interviewer must avoid "steering," or
otherwise controlling the interview to such a degree that the natural responses of the
participant are replaced with those consistent with the interviewer’s implied agenda. This
giving of socially desirable responses may, indeed, happen regardless of any steps the
interviewer might take (Bogdan & Biklen, 1982). One may check for such phenomena,
however, by altering the fomn in which questions are asked, thereby permitting some
degree of "triangulation." However, among measures for checking validity, including
using multiple observers, or multiple data sources (Hammersley & Atkinson, 1983), this
must be considered a particularly weak triangulation method . One must also be concerned
about over-correcting for the tendency toward social desirability, as it may lead to the loss
of control over the topics being discussed, such that the interview is not consistent with the

purposes of the study. Moreover, one should be conscious of the fact that consistency

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32
across answers is not necessarily an indication of validity. One must be wary of the
tendency for interviewees, particularly those from the same organization, to propagate a
particular managed impression, or professional ideology.

Another limitation of the interview method is that it relies on the interviewee to
freely recall information which may not be especially salient or particularly memorable at
the time of the interview. Of course, this can be expected to be the case when one is asking
for information about events that may have occurred months and years earlier. Such
temporal distance, however, can also allow time for the interviewee to reflect upon and
place the events into a more cogent perspective. Nevertheless, the degree of temporal
distance one has fiom the event or circumstance in question is something for which the
interviewer should be prepared. It is possible that questions may need to be dropped or
alternative question posed in order to account for these circumstances.

These considerations of setting, social desirability, interviewer bias and control,
and the problems associated with memory were reviewed as I prepared for and conducted
each interview. It was nearly impossible, however, to anticipate the range of possible turns
each interview could take. Hence, while I felt these were adequate ways of preparing,
there seemed to be no substitute for simply beginning to conduct these interviews and
modifying them where appropriate.

E . .

The student athletic trainers who participated in this study were 22 undergraduate
and graduate students, 9 women, 13 men, participating in an athletic training internship
program at Great State University. While other descriptive data on the group were
collected in a background questionnaire (see Appendix A), the condition established for
collection of this information was that it would be used only to inform questions asked in
the individual interviews and would not be presented in summary form The reason for
this was protection of the identity of the participants (see Confidentiality Procedures
below).

 

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33

Student athletic trainers at Great State University were chosen for the study because
they are involved in providing medical services to athletes at a large university sponsoring
more than 20 athletic teams, some with widespread regional and occasionally national
visibility. Because they are involved in an internship program, the majority of their
activities as student trainers involve actually working with athletes, versus classroom
experiences. This fact suggested that the students were in a position to witness the
comprehensive scope of activities in which athletes are involved, including their receipt of
medical services, but perhaps also including relations with coaches, teammates, physicians,
and others within the intercollegiate athletic setting. Given the fact that many of the student
trainers participating in the study had more than 2 years of experience as student trainers, I
assumed that they would have a diversity of experiences and established perspectives on a
range of issues relating to practices within intercollegiate athletics.

The internship program in which the students were enrolled is intended to meet the
standards for certification set by the National Athletic Trainer's Association (N ATA) , the
profession's national association. The NATA requires seven areas in which students must
demonstrate competence in order to receive professional certification. These include
prevention of athletic injuries and illnesses; evaluation and recognition of athletic injuries
and illnesses and medical refemal; first aid and emergency care; rehabilitation and
conditioning; organization and administration; counseling and guidance; and education
(Draper, 1987). The NATA accepts two types of preparation programs for students
leading to certification: a curriculum-based program constituted primame of formal
academic course work along with 800 hours of clinical practice; and an internship program
relying less on course work and requiring 1,500 hours of clinical practice (Buxton,
Lankford & Noda, 1992). Again, the program at GSU was of the latter type.

Internship programs, although varying across institutions, involve assignments of
students to athletic teams at their institutions, with which they work as trainers under the

guidance of a professional trainer. At GSU, students progressed through three primary

levels:
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34
levels: learner, assistant and head of sport. Learners at GSU were reported to be most
often initially assigned to the football team, working under the guidance and supervision of
the head and assistant head trainers on the GSU staff. Once they satisfactorily progressed
through the learner portion, usually a full season assignment to the football team, these
students became assistant trainers, working under the guidance of a head trainer, or a head
of sport. Assistants, again, given positive evaluation, then became heads of sport, who
were reported as being more senior-level undergraduates or graduate students. Graduate
students who had already received N ATA certification were, although under an initial
probation period, generally assigned as heads of sport. These heads of sport were
responsible for the comprehensive, daily performance of athletic training duties for a team
to which they were assigned by the staff coordinator of athletic training and/or staff
assistant athletic trainer. Depending on the size of the team, these heads of sport may or
may not have had undergraduate assistants working with them.

During their internship, these students are exposed to a number of experiences,
including rotations in various area medical clinics. During the course of their internship
experience, they are to practice and become competent in the comprehensive scope of
athletic trainer skills. These skills include such things as pre-season and ongoing
physiological assessments; emergency and other immediate care of injuries; pro-practice
stretching, treatments or other preparation of athletes, including bandaging and taping;
ongoing rehabilitative processes; administering of drugs and other remedies; use of
rehabilitative and other equipment; and other duties. The skills developed during these
periods are then evaluated in a practical portion of the NATA examination required for
certification.

Wale

After obtaining pemrission to conduct the study from the University Commitee on

Research Involving Human Subjects (Appendices B & C), I attended an in-service

workshop held for student trainers in April, 1994. There, I made an announcement

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35
describing the study and circulated a sign-up sheet to the students which requested that they
provide their names and telephone numbers if they were interested in participating. I
informed them that the sign-up sheet did not obligate them to participate, but asked them to
circle their names if they were certain that they would like to be involved. Thirteen student
trainers from this initial list were contacted and ultimately participated in the study. These
students were subsequently telephoned and group interviews involving them were
arranged. Nine others who agreed to participate heard of the study through other student
trainers already involved in the study. These students either telephoned me or had provided
their telephone numbers to other student trainers in the study, who then passed them along
to me. Again, these students were contacted and a group interview was arranged. There
were two participants whose participation in the study was only in the group interview (one
woman, one man), and two others whose participation was only in the individual interview
(one woman, one man). In all four cases, schedule conflicts were responsible. In
summary, the student trainers in the study were a convenience sample made up strictly of
volunteers.
C E 1 . 1'

Prior to starting each group and interview, the participants were given a description
of the study, which also functioned as the Consent Form (Appendix D), and were asked to
sign it at the bottom and return it to me as indication of their willingness to participate under
the conditions described therein. As they read the Consent Form. I asked them to direct
any questions about the procedures to me before signing. Prior to having them complete a
background questionnaire I again asked them if they had any questions. In the two cases
wherein an individual interview participant had not participated in the group interview, I
went through this exact process. For those participants who participated in subsequent
individual interviews, I provided them with the Consent Fomn they had signed and again
asked if they had any questions about the procedures. As I indicated in the consent form,

their participation was voluntary, could be ended at any time during tle interview, and their

36

names would be known only to me and not connected to their responses in the study. I
also informed them that the interviews would be tape recorded, and that indications of their
identities that might be revealed in the study would be removed.

I asked the participants to complete a questionnaire with the intention of using it
only to enable me to ask specific questions of them in the individual interviews. This did
not ultimately take place because I realized that, due to the small nature of the program,
even a single descriptor, such as a sport assignment, could identify them as participants in
the study. Because many were to be involved in the program in subsequent semesters, I
decided that I would neither summarize nor use any of the information provided in the
questionnaire and that I would attempt to use as few descriptors of the students as possible
in the writing of this dissertation. Further, where I felt it necessary, I have deleted portions
of, or not used at all, quotes which might also have revealed the identity of a participant.
The participants were made aware that the interviews would be tape recorded and that I
would be the sole person to hear and transcribe these tapes. I have since also concluded
that the transcriptions themselves will also not be seen by anyone but myself, except,
obviously, in areas where I feel it appropriate and safe for the participants to quote them.

W

Site

After arranging the group interview by telephone, the participants in the group
interview met in a conference room located in a building on the GSU campus. The site was
convenient and known to most of them, many of whom had taken courses in the building.
The first group interview included five women participants, the second included three men,
the third two men and two women, and the fourth included one woman and seven men
student athletic trainers.
Batman

I attempted to establish rapport with the participants by explaining the purposes of
the study and thanking them for taking time out of their busy schedules to come in and

37
speak with me. Moreover, it appeared to me that a benefit of a group interview was that the
participants knew each other, in some cases quite well, and were, with the exception of one
case, therefore not hesitant to speak in the presence of each other. In one group interview,
a first-year student trainer was in a group in which the rest of the participants were heads of
sport. He did not speak as much as the rest of the group. Another group interview, on the
other hand, went on what one might call "auto pilot," in that the students kept talking nearly
uninterrupted for 90 mrinutes, covering every issue I had intended for them to discuss
(nearly in order!). In summary, all of the group interviews were characterized by good
rapport, owing, again, to what I believe was the participant's personal association with one
another.

In one case, the participants in a group interview expressed concern with
confidentiality, asking several questions about the use of the information, the fate of the
tapes, and how the information would be published. I spent several minutes with them
discussing the procedures I would use to keep their identities from being revealed in the
study, although I also told them that determined investigation might result in their identity
being discovered. This experience, along with my judgment of the potential volatility of
some of the information contained in their statements, led me to discontinue my plans for
use of the background questionnaire information. While much of this information has been
omitted from the analysis and will not be presented in the study, responses I felt to be
relevant to the intent of the study remained, again as devoid as possible of identifiers.
Wm

As mentioned above, one group interview lasted nearly 90 minutes. However, the
other three group interviews were approximately 75 minutes in length. Because the intent
of the group interviews was to obtain general information about the duties and general
conditions under which these student trainers worked, my personal orientation to their
progression was simply that every topic was generally covered. Hence, these interviews

were considerably less structured than the individual interviews and were therefore slightly

long:

 

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38
longer. This meant that some questions were asked out of order, and on a two occasions,
the final question on changes the students would make within the profession were not
asked at all.
12 . 1 I .

The questions discussed in the group interview focused on five principal areas
intended to reveal the work student athletic trainers do, things which hinder their work, the
role of gender on their work, what they talk about when they have informal conversations,
and any changes they would make within the profession given the opportunity. Below are

the five areas and the approximate form of the central question asked in each.

p—n

. If you were talking to someone who was thinking about being a student trainer, how
would you describe what it is like?

2. How would you describe to that same person what you do on a daily basis? In
particular, what do you spend most of your time doing? Is it the same most of the
time?

3. What kinds of things happen to disrupt your day during your internship or otherwise
make your job as a student trainer difficult? Can you describe an incident?

4. How would you describe the athletes who are easiest to work with? What makes them
easy to work with?

5. How would you describe those who are the toughest to work with? What makes it
tough to work with them?

6. Do your interactions with athletes differ when they are men versus when they are
women athletes? If so, how?

7. When you talk with your fellow student trainers about work, what kinds of things do
you talk about ?

8. Say you had the power to make changes to things that happen within the training
room or in your clinical experiences. What would those changes be?

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39
Site .

The individual interviews took place an average of eight days after the initial group
interview, with the exception of two individual interview participants who could not attend
a group interview. The interviews were all held in the same building as the group
interviews, in most cases in the same room, although a small office was used on three
occasions due to prior scheduling of the latter room for other events. In most cases, the
interviews were held without interruption, although a telephone rang during one, and an
officemate mistakenly walked in during another.

Batman

Having held the prior group interview, I believe that good rapport was the case with
all but one of the individual interviews. Again, it seemed as if the group interview
"primed" these individuals, that is, got them to think about the issues surrounding their
work. The single exception was one of the cases involving a participant who had not been
involved in a group interview. Rapport seemed never to have been established in that
interview, although I did not feel the responses were dishonest or evasive. It simply
seemed as if the participant was uncomfortable with the questions. Little eye contact was
made and the answers were cautious and quite non-descript. In all cases, participants were
asked whether they had questions or would like to review the Consent Form they had
signed prior to the group interview. None asked to review these procedures or had
questions about the nature of their consent.

Length

I had informed each participant that I would attempt to keep the interview at or
around one hour. The range was from 75 minutes to approximately 50 minutes. This
estimate served to be quite accm'ate for the interview itself, although several participants

stayed after the interview was over to talk about the study, various aspects of their work, or

2. As

3. Iti

4. HC

5» B:

6. m

7. 0V

40
their future plans. I instructed the participants that we could take as much time as needed
and that in no case would I stop an interview due to my own concern with its length.
I} . I I .

Questions in the individual interviews were intended to examine the following
areas: expectations versus realities of their work as a student trainer; the role of gender in
the experiences of student trainers; feelings about serious injuries and the numbers of
injuries in sports; relationships with athletes and their role in doing the work of an athletic
trainer; and finally, overall views of the experience. Below are the five areas and the
approximate form of the central question asked in each.

1. When you decided to become a student trainer, how did you imagine what you would
do on a daily basis? Did it turn out that way?

2. As a (man/woman) trainer, do you think your experiences might be different than those
of a (man/woman)? If so, how? How do you feel about this?

3. It is possible that you have been confronted with situations in which the injury
sustained by an athlete is serious in your view. Have you had such cases? How do
you feel about the fact that such injuries occur in sport?

4. How do feel about the numbers of injuries in general? Do you think that the number of
injuries athletes have are reasonable, too many or surprisingly few?

5.. Because you are the same age as some of the athletes you work with, you tend to know
a lot about them, yet there are policies against becoming close to athletes. How
have you handled that?

6. What if any advice do you give to players? Do you think you are involved in
conversations with athletes that others aren't because you are a student?

7. Overall, how do you feel about your experiences as a student trainer?
5 l . I E . . E C S E
All interviews were transcribed from mini-cassette tapes directly into a computer
software program called HyperQual (Padilla, 1991), a program based on the Apple
Computer software HyperCard. HyperQual is designed to speed up the "mechanical"
aspects of qualitative analysis by recording the data as a "stack" in the HyperCard software.
HyperQual stacks are analogous to stacks of note cards, with the exception that they can

contain up to 40,000 characters (i.e. the transcribed data) in a scrollable field upon which

41
various operations can be performed. The response to each question was entered verbatim
into a single HyperQual card, hence there were a total of 32 (eight questions, four groups)
group "cards," and 140 (seven questions, 20 participants) individual interview "cards."

As in all qualitative analysis, each HyperQual data card was scrolled through and
read, searching for common themes and assertions. Having read through the data and
established these themes, I then scrolled back through the data looking for "chunks" of data
(i.e. quotations) which either supported or ran counter to this theme. HyperQual allows
one to highlight such "chunks" of data, select a "Tag and Sort" function, by which the
chunk is copied from the original card and stored on a new card within a new stack of cards
possessing common themes. This new card receives a "Tag," which is used to provide
more descriptive information about the chunk which has been pulled out and added to this
new, more specifically named stack. For each question in the study, I continually pared
through the data performing these tagging and sorting operations. Once a tagging and
sorting operation was completed for a particular question, I then performed what is called a
"filtering" operation on the newly tagged and sorted stacks. What filtering does is simply
refine once more the tagged chunks placed into the new stacks by pulling together the
chunks given the same tags, creating yet another stack. One may continue this operation
down to finer and finer levels of analysis, although in no case did my filtering process
continue past a second operation. Once filtered, the final stacks were then placed in an
"Exemplars File," which simply pulls all of the chunks out of these stacks and places them
into a word processing file, in this case, MicroSoft Word 5.1. I then could either "write
around" these exemplars (i.e. add my summative and analytical comments to the
exemplars) or copy and paste the exemplars into existing text in another MicroSoft Word

file. In most cases, I did the latter.

CHAPTERIII

Results

The principle criticism of the Introduction and Review of Literature was that, while
athletic trainers would seem to be at the nexus of a number of current interests within the
sociology of the body and the sociology of sport, scholars interested in the area of pain and
injury in sport participation have been somewhat remiss in documenting their activities.
Again, it would seem incumbent on a preliminary study of student athletic trainers to "map
out" the territory of this apparently hidden world. Unfortunately, however, what may be
the most appropriate method for doing this mapping-namely, thorough observations of the
work of student trainers--was not undertaken in this study. I felt it important, for this
reason, to get the students in both the individual and group interviews to provide a
description of what they do. In the group interviews, I posed two questions which asked
them how they would describe the activities they perform to someone interested in entering
the student trainer internship program. Then, in the individual interviews, the opening
question asked them to describe the duties they expected to face prior to entering the
program, and to compare those with the duties they actually encountered once they began.

What I was to discover in the first group interview seemed to set the tone for all of
the group interviews and a number of individual ones: These students were under a great
deal of stress for reasons similar to those among professionals as reported in the literature
in professional athletic training joru'nals. Indeed, athletic trainer burnout is among the most
discussed issues within the field (Campbell, Miller & Robinson, 1985). When asked about
their duties and activities, the student trainer's responses, therefore, had two elements.
One might be described as informational, the "just the facts" portion; the other reflective of
the stress inherent in the work. These student trainers appeared to want to alert the world
to the tremendous and often hidden obligations involved in their jobs. In some cases, this

was to such a degree that I felt the interviews were as much therapeutic as they were a

42

43
simple sharing of information. In the case of the description of duties, then, were the
attached warnings to potential enrollees about the heavy weight of the occupation's
commitments, the stressful environment of the work, and the implications of these stresses
for one's activities as a college student.

The issue, then, became how to present these factual and evaluative answers in a
way which gave due weight to both without clouding one with the other (i.e. obscuring the
duties by discussing the complaints about them, or vice versa). Given the fact that this may
be the first view of student athletic trainers seen through a sociological lens, I felt it was
important to first present an overview of what these trainers stated that they do. Hence, I
will attempt to present duties separately from evaluations of them. Of course, one must
keep in mind that both the "facts" and the "evaluations" of those facts came from the
students themselves. It seemed unlikely, however, that a student trainer would claim to be
performing a task they did not perform, particularly in the group interview setting, which
involved others with whom they worked. Nevertheless, one must keep in mind the
singular source of the data presented, and that this attempt at splitting facts and evaluations
will be a recurring pattern in the analyses that follow.

My intent in this first section, therefore, is to acquaint the reader with the actual
work itself ("facts"), and follow it with an exploration of the varying perspectives of the
students ("evaluations") on the work. The subsequent three sections of the Results and
Discussion follow what appeared to be three distinct breaks in the data. All three are
foreshadowed in the "Duties, Disruptions and Anxicties" section to follow and
corresponded generally to three areas of questions. These areas concern the role of gender
in the experiences of student trainers; the nature of relationships between student trainers
and athletes and information the former acquire as a result; and finally, the student trainer's

feelings and beliefs about the injuries they confront as part of their work and education.

44

The SATs (student athletic trainers) described their duties in two primary ways.
First, these activities were listed according to, or otherwise qualified by, one's status in the
program (i.e. learner, assistant, head trainer, graduate trainer). Second, the activities were
described by student trainers in terrrrs of the particular sport and their associated facilities,
equipment resources and other social environmental conditions. I believe that, for the sake
of presentation, and in order for one to fully understand the tone of the warnings SATs
have for potential peers, it is necessary to provide a brief summary of these duties and
activities as they were described by the students themselves. Hence, in this case, I will use
the categories (i.e. year in the program and sport assignment) supplied by the student
trainers. I believe only then can the full nature of the warnings follow for the reader.
Hence, by way and in lieu of a description based on observations, to follow are
descriptions of the various duties of these trainers meant to lend color to the previous,
rather sterile, description of the subjects and the internship program in the Methods chapter.
To follow, then, is a summary of these descriptions and the student's feelings about them.
Duties

W

Perhaps the most visible, and publicly suspect, activity of student athletic trainers is
their rushing out onto fields during college football games with plastic bottles of water,
squirting them through the face masks into the mouths of anonymous players. Reflecting
on his first experiences as a student trainer, one graduate student stated, "I never really
realized that I'd have to feed water to football players out of a bottle. I never fatth that.
I thought they could always walk to the water fountain or pipe, like we all do." This basic
duty apparently leads observers to labeling these student trainers as "water boys” and
"water girls." Indeed, it was much to the chagrin of these aspiring professional trainers
that providing water to athletes is an enduring part of the job. As they stated, it is a part of

every sport and performed by those at all but the highest levels of the profession, and for

45
this reason, these labels appeared to be given to SATs on a regular basis. A description of
this basic activity and the other duties of beginners also provides a hint of the struggles of
young student trainers, and women trainers in particular, to achieve respect among those
with whom they work.

This seems to be especially the case with football, a team which includes over 120
athletes and the sport to which every student trainer is initially assigned in the student
athletic training program at GSU. Hence, among the first large scale logistical tasks and,
apparently, tolerance-testing activities of student athletic trainers is the preparation of large
plastic coolers of water, their transport onto football fields in modified golf carts, and the
delivery of their contents to players, in some cases directly into their waiting mouths. As
suggested above, student trainers were all too aware and in some cases resentful of being
labeled "water boys" and "water girls." Some SATs seemed to laugh the label off with the
euphemisms "hydration technician," or "hydro tech." Others were not so tolerant:

I was wondering about doing water, but I didn't think I was considered a

water boy. A lot of the coaches really had no respect for us. . . Once in a

while the coach was like, 'Hey water boy, come here, ‘and everyone just

gets pissed ofir at that. I mean, I'd go up to my head trainer and say, 'Hey,

I am not a water boy. Please let that coach know that.’

As I was to quickly learn in the interviews with women SATs, having to perform
water duties with the football teams came both with the humiliation at the actual task
indicated in the above quote, and operated in a larger context (which will be explored later)
of general devaluing and, in sonre cases, overt harassment. Asked if she'd ever heard a
male trainer being addressed as a "water boy," one woman stated that, "If they have, I‘ve
never heard it." Indeed, the women seemed to indicate that they were much more prone to
the "water gir " label and that this served as a launch point for their general devaluation.
Yet, while the following quotes reflect this devaluing, they also show how the women's
views of the task are accompanied by a description of the ways in which they cope or

otherwise rationalize the demeaning behavior of athletes:

I think the women, when you start out, if you're an assistant you're treated
a little bit diflerently, but you can't really do anything, you don't know how

46

to do a lot of stuff. But in my case, the guy who called me water girl, it
was just a case where we became friends and he always used to like to tease
me. He didn’t say it snotty or as a crude remark or anything. It was just
joking around. With football it’s a little bit different because the guys think,
’Oh it’s a girl. Get out of here.’ . . .

Well, it can be frustrating. When you work football, you’re all gung ho to
work football. Half the time you’re standing there holding water. And
players yell at you, ’Water !’ I mean, it’s not nice, some of them can be
very mean. And they’ll be like, ’Water ." and I’ll be like, ’Say please.’
(laughs). If they don’t say please, they don’t get water. It can be
derogatory. It can be humiliating a little bit. But yet at the same time,
everyone has to do it. It’s just one more stepping stone. It’s not like you’re
being persecuted. No. The highest level trainer held water and got yelled at
one point in their life. It can take you a while to realize that.

Not surprisingly, however, both men and women trainers described how the duties

associated with water delivery were increasingly more frustrating and difficult to reconcile

with their expanding responsibilities and skills. Indeed, as one woman described it, they

seemed to involve two different identities:

Half the day, you’re sitting there telling everyone what to do, taking care of
everybody. Then the next minute you’re holding water (laughs) and you’re
like, I ’m like part water girl and part this.’ But that’s part of the job.

You’re not lowering yourself by holding water. Again, you’re just
providing one more aspect of the athletic competition. They need water,
someone’s got to give it to them.

Hence, in her case, she was able to make sense of the situation by thinking in terms of the

larger purposes of the athletic trainer. To one graduate student, however, the duties

associated with water, regardless of their importance in athletics, are wastes of time and

talent:

One of the things, as an athletic trainer . . . Being in athletic competition,
one of the most important things is rehydration. A lot of times people
perceive the athletic trainer as a water boy. Well no, you can get a fancy
word, hydro-tech, or whatever. But the thing is, you get put on the spot
where you get a level in your time, like right now, you know--we talked
about this before--that at a level you start gaining more responsibilities, and
then at a grad level--the level I ’m at right now-J don ’t feel that it’s my duty
to stand out at a practice for five to six hours just handing out water, when I
think the players can come over to a water table and have breaks and do
that. I could be used somewhere else. I think my skills could be used for
rehab, even administration, doing paper work or something, I am wasting
my time doing this, I feel.

47

"Watering athletes" is somewhat unique in that it appears to be something student
trainers must do, regardless of level. Next, however, is a description of duties more
characteristic of the beginning level student trainers, or "learners," as they were called.
Indeed, it appears that the delivery of water is only one of the ways that student trainers,
and beginning ones in particular, are subject to what they described as humiliating and
degrading tasks.

leammandflmntflork

The student trainers in the study included only two who might be considered
"learners." However, nearly all the trainers spoke of their early expectations of entering
the program and being directly involved with "actual" athletic training duties, only to be
disappointed by the "grunt" work to which they were initially assigned. Indeed. the
diminutive label of "water boy" or "water girl" simply translated into "errand boy" or
"cleaning lady" by the students themselves in their descriptions of these tasks. As one
student put it, "If you're a first year, you're going to be running errands. You'll feel like a
taxi cab driver, you'll feel like an errand person." Specifically, new student trainers are
required to do cleaning, run various errands for more senior level trainers, and transport,
setup, "tear" down and return multiple items of athletic training equipment to storage areas.
As with water duties, this most often was described as taking place in the context of an
assignment to the football team, to which 12 or more student trainers may be assigned.
Since this work was under the direct supervision of the head and assistant head trainers,
who oversaw all students in the student training program, there was also an apparent need
to demonstrate enthusiasm for the work, while suppressing one's actual sentiments about
it.

The cleaning of training rooms during these stages of their internships seemed
particularly tedious to these beginning students. Training rooms themselves generally
include anywhere from a few to a dozen or more "training tables"--large wooden tables

with rectangular tops upon which athletes may sit or lie while being taped, undergoing

48
treatments, or being examined. These tables have storage slots for athletic tape below and
in many cases have pads, supports, blankets and other adjustable features for placing the
athlete in various positions for treatment, examination or preparations. Often alongside
these training tables are various pieces of rehabilitation and other equipment, such as ultra—
sound machines and electrical muscle stimulators ("stims"). Also typically found in athletic
training facilities are extensive wall-mounted and "island" cupboards with large counter
surfaces, sinks, and containers of supplies; attached rooms with Whirlpools and other tubs
for the therapeutic use of water, and, in some cases, exercise bicycles, isokinetic muscle
testing machines (e. g. Cybex) and other types of weight lifting and exercise machines.
Adjacent rooms may also house the water coolers described above, along with medical kits
and other emergency equipment (e.g. spineboards) which must be transported to and from
fields for practices and games.

While the above listing was not intended to be exhaustive and may not be fully
illustrative of a typical training room, the point here is that all of these things were
described as requiring regular cleaning, stocking and organizing by all of the student
trainers, and in particular, the learners in the study. Many spoke of disillusionment and
frustration at spending several horns of their internship scrubbing countertops, whirlpool
machines and training room walls. Moreover, as one student put it, the job can be
thankless:

I mean my first year I was fi'ustrated because . . . you do all the odds and

ends things but you never, no one ever, it’s always like you’re not doing

enough. You know, The cupboards still look like shit,’ after you scrub

them for 20 minutes and it’s just like, ’My god, why am I doing this?’

In the midst of all this seemingly meaningless and degrading activity, these learners
were to be equipping themselves with basic athletic training skills, including perhaps most
importantly, taping. One must learn to tape ankles, for example, with certain preventative
outcomes in mind (e. g. taping for "inversion," or the turning in of the foot, at the ankle),

and without wrinkles in the tape--wrinkles being unsightly, uncomfortable, and possibly

leading to losses in circulation. These beginning students must also learn basic first aid

49
procedures and spoke of being allowed to treat minor injuries, such as blisters, cuts and
scrapes. They also described learning how to manufacture molded supports and other
pads, how to use rehabilitative and other equipment, as well as the sequence of various
emergency procedures. These requirements were described as coming from limited comse
work, in-service workshops, and the inevitable observations and formal and informal
mentorships that take place in the internship setting.

Again, while this does not cover the comprehensive scope of the skills and
requirements of new student trainers, it adds some measure of perspective to the multiple
and diverse activities and associated skills that must be acquired in the context of being
asked to "feed water," fetch an ice bag or scour a sink basin. These are, one must be
reminded, also in the context of being a full-time student at a large university. Some
students spoke about how their initial disillusionment was also accompanied by a need to
be aggressive in obtaining these learning experiences and instruction from more senior level
trainers. Additionally, as in the case of water duties, the "grunt wo " was seen by the
following "learner" as somewhat peripheral to the actual work of an athletic trainer, which
was to be overcome by an aggressive pursuit of knowledge and experience:

I first started out doing a lot of what would seem like a lot of little oddjobs

that are pretty meaningless; just doing grunt work and kind of being there.

Yeah, cleaning stay? up, running errands, whatever needed to be done. At

first, I was sitting there thinking, ’What the hell am I doing here?’ I wasn’t

learning anything. And yeah, I wasn’t doing much but you have to apply

yourself. You know, you can be real passive about it and not learn

anything. You have to nag a little bit, you know, ’teach me this, teach me

that,’ then you can learn stufi’. And you have to get into it yourself too.

But at first I didn’t do a whole lot, you know, cleaning, running errands,

that kind of stuff. As time went on, I started doing more of the training part

of the job. It got better.

The apparent creation of a scarcity of opportunity (i.e. the opportunity to perform
"real" athletic training duties in real contexts) seemed to provide impetus for this aggressive
pursuit. Accordingly, the very increase in responsibilities seems to have been the primary

reward for the student's persistence and toleration of these undesirable experiences. As

will be described next, the move to assistant trainer and head of sport did indeed seem to

50

both change and increase the duties of student trainers, as well as change the structure of
their activities. It is to these that I now turn.

Wis

As was described in the methods section, the student trainers in the program
eventually received assignments to specific athletic teams with which they worked for an
entire season under the guidance of a more senior level trainer (heads of sport), who were
either senior undergraduates or graduate students. While learners were described as almost
always being assigned to football, and therefore had a single, large and well-equipped
training facility Specifically for football, rrrost of the students who described their
experiences as assistant trainers worked with sports other than football. These other sports
involved work at other athletic facilities, and hence cther training rooms, on the GSU
campus (although it must be kept in mind that football includes student trainers at all
levels). In some cases, large training rooms at these other sites were shared by several
sports teams (i.e. athletes and their trainers). Heads of sport and assistants spoke of being
confronted with the confusion of several other uainers and their athletes pursuing common
objectives in these crowded training rooms. What also seemed to be different for assistants
and heads of sport, as compared to learners, was the expansion of their days and the
increases in their duties and responsibilities. The following description of a typical day of
practice for a head of sport is indicative of the structure and sequence of activities described
by assistants and heads of sport, and is therefore useful in shedding light on these
expanded duties and responsibilities:

For me, my day usually begins at about two o’clock with the training, two

or three o'clock, depending on what time I get out of class. I usually work

until about seven. You get to the training room right away, everybody is

waiting. People you are supposed to be rehabbing are in there rehabbing.

If they’re not, you’ve got to find them. You have to prepare, get ready for

practice, get the ice bags ready, coolers, water, spine boards if you ’re in a

game or something. All the emergency equipment, set it out. Basically,

practicing begins and you sit and watch and keep an eye out and look for

injuries. 0r, depending on what the coach allows you to do, some coaches

will make you sit there and watch them. I have heard of some that let you

do homework; not many of those. You watch practice, if you have an
assistant, you work with them, help them out. You ’re trying to get them to

51

learn as much as they can in the time that you have. Goof around every
once in a while, that’s part of it too. Talk to, you know, associate with the
players and stufi. After practice, you have got rehab again. Get them in,
ice them down, clean up everything. Then from there you look at what you
did that day, write it down, document all the, like your [assessment] notes
for all the injuries. If you have new injuries, you have to document them. .
. So now you’re doing all this paper work and stuff and then doctors come
along where you have to accompany your athletes, injured athletes, get them
checked or re-checked by the doctors. It’s getting up to six, seven o’clock
now. Sometimes you end up scribing for the doctors. Pretty much after
that you go eat and go study some more. It’s a cycle that keeps going.

This description is similar to others provided by students in the study, although
they varied according to the specific sport assignment. The above description was of a
sport for which there is a single practice each day. However, a number of sports schedule
two practices per day, sometimes called "two-a-days," for which student trainers have to
similariy prepare and around which they must schedule their coursework and other
activities. Thus, some SATs essentially double their duties during certain sports
assignments.

As referred to in the description above, what also became a regular activity at the
assistant and head of sport level was the requirement to keep detailed records, both in paper
files and computer form, for each athlete on the team to which they are assigned. Several
student trainers said that they had not anticipated how extensive and time-consuming this
record-keeping was. As they were described, these records sounded similar to those a
family physician might keep, and contained detailed information about each athlete. The
following illustrates the detail of this information:

Well in the beginning of the year all the new athletes you have to put in the

computer. You have to put all their insurance; their school address; their

home address; who to call in case of emergency; if they are allergic to

anything; any previous injuries or any serious injuries that they might have

to get cleared for; you have to put them on a roster with their height, weight,

blood pressure; getting them in for a physical. Then when you get to

injuries, you have to put each injury in, go through and, there’s like a whole

number scale and you have to go through and do all that. And each week

you're supposed to go in and revise it, what kind of treatment you’re doing,

are they getting better, are they getting worse, did they re-injure it, are they

staying the same. And every week you’re supposed to. go through and do

that. You have to record every time they see a doctor, you have to put it in
the computer; who they saw, what for, when, what medication they were

52

put on. Just everything to do with injuries has to be in that computer.
Anything we ’re doing treatment on for a period of time has to be in there.

The monitoring of players through the daily, weekly, and seasonal schedule of
preparation, practices and competitions, and post-activity therapies, then, seems to
constitute the basic formal structure for the student trainer's activities and interactions. In
terms of hours, some SATs reported that, by the time one becorrres a head of sport, one is
spending anywhere from 40 to 70 hours per week in the internship. However, and as will
be discussed later, these formal interactions are not necessarily a complete description of
student trainer interactions with athletes. Nor is the keeping of medical records only but the
beginning of the information these trainers possess about the athletes with whom they
work. What can be said for now is that the schedules of assistants and head trainers
appeared to be fairly consistent across the SATs in the study. To summarize, they
normally involved preparing athletes for activity or competition; setting up facilities for
practices or games; monitoring the practices and games and assisting head trainers as
assigned; "tearing down" after practice; treating athletes after practice; and recording
information in the athlete's files.

Within this basic sequence were a number of activities of the assistants and heads of
sport. To summarize statements from assistant trainers, they spoke of doing some taping,
limited first aid, pre- and post-practice treatments and rehabilitation activities, scribing for
doctors (i.e. taking notes during a doctor's examination of a player on the assigned team);
stretching of athletes; and packing, loading and traveling with the team to off-campus
competitions. It must be kept in mind that these latter activities were also described as
being performed by undergraduate and graduate heads of sport, who may or may not have
trainers assisting them in these duties. Hence, in some cases, the duties described as being
unique to heads of sport are in addition to all those described above, including water duties,
cleaning, and all of the activities of assistants. A student trainer assigned as head of sport
to a team functioned as the full-time athletic trainer for that particular team. While they did
have a staff level trainer to whom they reported, the SATs who were heads of sport spoke

53
of taking immediate responsibility for any injuries, however serious, which occurred
during practices or competitions.

This immediate care, as heads of sport stated, included "evals," or immediate
evaluations of the injuries they either witnessed or had reported to them by athletes,
followed by various forms of immediate care. Although no one head of sport spoke of all
of these, if one were to combine all of the processes the heads of sports described as part of
an "eval" and immediate care, including the case of a serious inj my, it would include the
following: rendering first aid or emergency care, including arranging for an ambulance;
determining whether the player can continue play; taping a particular body part for return to
play; the cleaning of blood for return to play; palpation of the affected areas; the
performance of specific diagnostic procedures; splirrting or immobilizing of the affected
area; transporting the player fiom the field or court; the making of a preliminary diagnosis
and communicating it to a supervising staff trainer and/or physician; and accompanying
athletes to a hospital. Some also recounted sitting through an athlete's surgery and visiting
them afterwards. An illustration of an SATs first "eval" and immediate care as a head of
sport was provided by one graduate student:

At [former school], working women’s soccer, the athlete just planted and
turned. She said she heard a pop, and she just went down. I was on the
sidelines. From the sidelines, I saw her plant her foot, she fell down, and
she was just on the ground, holding her knee. That happens all the time, so
you really don’t know. You don't know what’s going on, you just try to
get out to the field. I don’t know. When you see somebody go down on
the field, you get in a mode; you’re just like ready. You go out there and
see what’s wrong. Try to calm them down, try to get them relaxed. Say,
’What happened?’, you know, ’I planted my knee and I heard a pop.’ Your
heart’s beating kind of fast, and you just want to make sure they’re okay,
nothing is dislocated, they’re breathing and the pulse rate is okay, so it’s
okay to get them off the field. Then once you get them of the field, you
can assess what happened. So, I’m going through all my joint stability
tests, and I had practiced enough. This was the first time having my own
sport, and I did the Lachman’s Test, which is a test for the ACL (anterior
cruciate) ligament, to test the integrity of it, if it’s still intact or not. So, I
did a test on that and the tibia came forward a lot, and I looked kind of . . .
She saw my eyes kind of . . . That was the first time. I wasn’t good, you
know, so she's like, ’What?’ She felt it move, and was like, ’What’s
wrong?’ You’re not really supposed to tell them, ’Well, I think you have an
ACL,’ because you’re just a student. You don’t know, so you’re supposed
to tell the doctor what you think and he will tell the athlete that it's torn or

54

whatever. Trainers are not allowed to diagnose injuries. So, anyway, I

went through the other tests, I tried to do it again, and it went again, and she

felt it go in and out. That was my first time I really got nervous. Then we

went in and told the doctor, and I told him what I thought, she was real lax

on her right ACL. He came in and, yeah, it was torn. Then she just broke

down and started crying. I guess that was the first instance where I had to

deal with somebody with a major injury.

Heads of sport also described their activities following an "oval," initial care and
referral to a physician. These included accompanying athletes to examinations by
physicians, at which prognoses and rehabilitation instructions are given. Heads of sport
then described their comprehensive participation in the rehabilitation process. As will be
seen in the next section, a number of trainers spoke of frequently having to "track down"
an athlete who had not arrived at their scheduled time for rehabilitation. Once begun,
however, rehabilitation involved daily sessions with athletes using various means,
including the application of various modalities, such as icing and ultra-sound and manual
manipulation of injured limbs. These rehabilitation processes ranged from a week to
several months in duration, obviously depending on the nature of the injury. Near the end
of the process, heads of sport described the performance of evaluative tests, such as
isokinetic testing, for assessing the ability of the athlete to return to play. At this point.
trainers also spoke of fitting special pads, orthotics and bracing equipment for players.
They also stated that they provided advice to athletes on certain stretching, weight training
and other ways the athletes could care for their injuries while not in the training room.

Among other duties described by heads of sport were those attendant to the daily
activities surrounding practices and competitions and the treatment of athletes. Hence,
while they described rehabilitations, they also spoke of keeping an inventory of and
dispensing over-the—counter medications for various athlete ailments, including muscle
soreness, headaches, menstrual problems, colds and other illnesses, and in a couple of
cases, the after-effects of excessive alcohol consumption. Regarding the latter, a few

student trainers explained how they had been assigned to drive vans with members of their

team for off—campus competitions or "road trips." Part of this duty was the obligation to

55
act as "stall" and monitor athlete behavior, including the content of conversations, for
indications that the athletes had violated a team policy for drug or alcohol use. While this
obligation will be described in rrrore detail later, heads of sport said they were expected to
report instances of rules violations to their supervising head trainers or the coaches of
teams. Finally, heads of sport also gave their home telephone numbers to the athletes on
their assigned team, so that they could be telephoned in case of an emergency or, as will be
described later, consulted on a range of questions.

To summarize, then, the student trainers explained that, by the time they became
heads of sport, they assumed far-reaching responsibilities for the comprehensive care of
athletes. Additionally, based on their statements, I believe it reasonable to conclude that
these trainers spent more time with athletes than any other single person within the athletic
department. Although no information about others within the department was collected,
student athletic trainers at GSU claimed to spend more time with athletes than coaches,
supervising staff trainers, head trainers, physicians, administrators, or others. Moreover,
the scope and number of their duties and related responsibilities and the sheer number
hours in the work meant that, even though they were students, they had to come to share
similar stresses with their professional level counterparts. I therefore felt it important to
identify not only their complaints about these facts, but to get them to identify specifically
the problems, accidents or other types of incidents in their duties which seemed to be the
most disruptive.

D' .

Garfinkel (1967) suggested that a social structure can be revealed by examining
cases where things go wrong or a natural flow of events is disrupted. This approach
assumes that, while it is possible to specify the structure of an organization in charts and
job descriptions, very often these are idealizations that do not to capture actual practices and
their meanings. Indeed, this may be, to some degree, true of the description of the duties

just presented above. To study disruptions, on the other hand, is to attempt to get beyond

56

these idealizations to the realm of social expectations. In other words, it may be possible to
know exactly what a group takes to be its purposes only in those cases where its members
feel those purposes have been subverted, diverted, interfered with, or distorted. Such
considerations were behind my asking the following question within the group interviews:
What kinds of things go wrong during your work or otherwise make your job as a student
trainer difficult? Additionally, student trainers essentially addressed this issue of
disruptions in responses to other questions and these responses are also included in this
discussion. The responses to these questions concerning disruptions generally clustered
around three rather broad, and certainly not unanticipated, themes of their work context, the
natrue of the injuries presented to them and the behavior of the athletes with whom they
work. I begin with the ways in which the students spoke of difficulties in the general work
environment.

Given the fact that nearly three-foruths of the SATs in the study were heads of sport
(either as undergraduates or graduate students), most of them had grown accustomed to,
yet not necessarily tolerant of, the difficult schedules and demands described above. One
woman who said she was head of sport, noted that, "When you're head of sport, there's
no one you can push stuff off to. You can't be like, 'Can you help me out or stay later?‘
because you're the only one." Another trainer was able to laugh about "fighting for the
cart," referring to the fact that one training facility had only one cart used for transporting
water to several teams practicing simultaneously. Yet, these responsibilities and conditions
secured to be accepted as part of the job, obviously so by trainers who had conre this far in
the program. Indeed, the consequences of not being able to fulfill one's responsibilities,
for one reason or another, seemed to be particularly anxiety provoking:

If you miss a day, you’re screwed. You’ve lost time, you feel like you’ve

lost control of . . . If you’re not in that doctor’s ofiice to know exactly

what’s gone on and to ask questions, you don’t know what’s going on.

Indeed, ironically, some student trainers spoke of sacrificing their own health in

order to attend to that of their athletes.

57

I think though too that you feel very obligated to your team. And you don’t
want it to be pinned on you. And a [conference tournament] came up and
we were going [ out of town] I had tonsillitis, a sinus infection, and a 102
fever, and I was on that plane to go with them. And they were like, 'Why
are you here?’ And I said, ’Well, you know you guys would not come
without a trainer. You would have had no trainer.’ And they went, ’Oh
well, we’re glad you’re here. We wouldn’t have wanted to go without
you.’ And I was like, because everybody told me, ’Don’t go.’ My fiance
was going, 'You’re not going. This is not right for you to be going, you’re
on your death bed and you can’t go.’ And I ’m like, ’I gotta go.’

While being personally absent is obviously the paragon example of a disruption to
one's work, apparently more salient to the SATs was the lack of clarity in what tasks or
projects were to be completed, the competing interests in what was to be given priority, and
their "place" in making a decision from among these interests:

Just lack of communication. 1 think most of the problems . . . The boss

expects you to do most things, or you understood that he expects a certain

amount from you, and you don’t want to go over your boundaries and if

you don’t do something he expects . . . You know, there’s that lack of

communication

Especially, I mean, that goes between the coaches, and the staflr trainers,

and the athletes, you’ve got to cover your ass with everybody. I mean you

have to watch what everybody’s . . . You 've got to try to guess what

everybody’s thinking.

This particular week we have a knee rehab, but then the staflr may think it’s

more important. But the coach might think getting this guy is more. . . Plus

we deal with so many difi’erent people, and everybody wants their thing

done first. That causes problems. We try to define our own priorities,

what we think is important, but then our stafi' sets priorities; the coach does;

the athletes, you know, think they should comefirst. So, we’re the

middleman; we catch a lot from everyone.

Surrounding the students, then, seemed to be multiple, and often conflicting, agendas of
coaches, athletes and supervising trainers. Indeed, as the following series of examples
suggest, there seemed to be as many requests as there were people with stakes in or
perhaps a dependency on, the outcomes of the students' activity. Clearly among these
interested individuals were coaches, about whom several students cited a "lack of
communication." One spoke of "a lot of miscommunication back and forth," adding that,
"It seems like there's a lot of waste; wasted time, money, man hours, that type of thing."

An instance of lack of communication also was apparent in examples where a coach would

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58
not alert an SAT about a change in plans. One student recounted walking into a practice
that had, unbeknownst to her, begun early, and in which athletes were participating in what
she described as "a pretty dangerous play or throw." As she stated, "I'd walk in there and
[athletes] would be bleeding. I wouldn't even be ready for it." She also described how
this same coach would "punish them and make them stay late," adding, "I never felt
comfortable leaving when there were kids still on the field, especially during contact-type
drill. So I had to stay longer." One trainer concluded,

The biggest problem is a lot of coaches, I think, are just too demanding,
especially on the trainer and the athlete. When someone does get hurt, or
something, they want them back out there as soon as they can. And they’re
hounding you. They don’t think you’re doing your job if you don’t get
them back out there in a couple hours or something. Sometimes they just
put ungodly demands on you.

While the "couple heurs" is obviously an exaggeration, it is also the stereotypical image of
a coach to want to return a player to participation prior to the time indicated by a sound
medical evaluation. One trainer described his first experiences with such a demand:

That’s one of the hardest things. I had a player who continually had stress
fractures, shin splints, and the coach is like, ‘I want him playing. I want
him playing.’ And it's hard to say, ’He can’t.’ I mean, that’s your job,
and the body can only do so much, and you can only do so much, and

I mean it’s not . . . It’s a demanding sport and the coaches, even in any
sport, you’re in that situation where the coaches, I mean, they’re on the
line. They need to win. And if they’re not winning, why not? And if their
star athlete is hurt, they need to get them to play. You're in that conflict and
it’s . . . I mean this year was the first year I have been in that and it’s not a
good situation. A lot of stress.

In some cases, the result of these varying expectations, it seemed, was that the
students were ill at ease about decisions they had made. As one trainer put it

There’s, yeah, there ’s a lot of things, I mean you’re really responsible for
these athletes as far as the rehabilitation, as far as sending athletes back to
competition when you feel that they are ready, because you are the judge to
decide whether this person ’s going back or not. I mean other than, like
testing them and that kind of stuff. But you have to make sure that when
they go back that they're at 90 percent or 80 percent strength to go back and
compete and I guess if you see an athlete go back out there and compete and
pulls his hamstring again, I mean, you kind of feel as an athletic trainer that
you didn’t do your job right.

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Beyond varying expectations in duties was also an anxiety about athletic training
techniques and protocols themselves. A number of student trainers pointed out that there
were varying "philosophies," strategies, and specializations within athletic training. These
can include a particular method of taping a certain body part, or differences in rehabilitation
modalities and sequences. Such differences were most evident and disruptive to trainers
who had come to GSU from other schools, as in the following instance:

Because I came from a difi'erent school, we had like protocols; this is how
you do a combination with this injury. Here we have dtfi'erent protocols for
different things. Just different combinations, I was like, 'Oh, I never had
thought about it because I never came from that train of thought. ’. . . Like
we do PNF on every injury here at GSU. I mean every injury has PNF, so
that was new to me. It’s called proprioceptive neuromuscular facilitation.
It’s a type of stretch and [the stafl] is very big on it . . , trying to teach all of
the people that come through. I had done PNF on ankles and shoulders
because those are the two most common joints to do that on. Here, they do
it on everything: knees, toes, everything.

While this student seemed to accept these changes in protocols and technique, another
trainer found the differences disturbing and frustrating.

One thing that I don ’t like about it is everybody kind of has their own
philosophy as far as what techniques to use. So, I guess you kind of have
to go in and either accept the viewpoint you're being taught at that university
or college, or you got to kind of go out and get your own experience in
other places, figure out for yourself which way you want to . . . I don’t
really like that that there is so many . . . Like, for one simple prevention
ankle tape job there might be 20, 30 different ways of doing it. Like here,
if you don’t do it the GSU way, you don’t do it any way at all, that type
attitude. I don’t like that too much at all. When you’re at one place you
shouldn’t have to do it one way. Like for incoming grads, the first thing
they get taught is the GSU wrap, the prevention tape job. It’s like forced
upon them, that’s the way they have to do it if they’re going to be at [Great
State I . I don’t know if it’s like that at all universities.

Another set of disruptions in the work of the SATs revolved around handling what,
for athletes, is always a disruption-~injuries. Student uainers described as disruptive what
they saw as unusual, unanticipated or what they viewed as non-existent injuries. One
trainer spoke of having to deal with athletes who had chronic back problems and who were
constantly in the training room. Similarly, another trainer spoke about how injuries tended
to accumulate over the course of the season, meaning more taping and other treatments

added to his daily schedule-injuries for which he had no assistant trainer. As he stated, "I

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60
had like six or seven ankle injuries, and it took like 45 minutes to do everything for each
person. . . There just wasn't enough time to get everyone through."

Another type of injtu'y about which the student trainers expressed frustration were
those they had never before seen and which seemed to stubbornly resist standard
approaches to treatment. They also included those not apparently covered in the students’
formal education:

We get weird things in there where it’s just like no idea....We had a girl this
season who would lose feeling in the quadrant of her foreamts about
halfway through practice. Then it would go away three or four hours
afterwards. Eventually it became a permanent sensation loss in her arm. . .I
talked to her a couple of weeks after the season ended and the feeling was
coming back, sent her to neurologists, ran MRI’s, EMG’s, CAT scans,
unbelievable. Nobody knew what it was. So, those kind of weird,
frustrating things, which I didn’t ever imagine; I figured I 'd know what
everything was.

Another class of disruptive injuries were those the trainers saw as unnecessary and
preventable. As in the case described earlier, in which the trainer believed the coach to be
punishing the athletes, one trainer expressed frustration at cases

where the coaches have somewhat like punished the athletes for doing . . ,
well, you know, really performance issues; and made them run ungodly
amounts of time in really bad weather, or stufir like that, when they could
have gone indoors. That gets frustrating, because then you know you’re
going to have cases of the cold the next week. They’re going to start getting
stress fractures. But, that can get frustrating.

Indeed, such stress fractures, in which muscles pull on bones to the extent that the bones
splinter, are injuries that are termed "overuse," in that they develop over time and are often
the result of repeatedly demanding workout sessions. Recollecting his experiences with a
particular coach, one trainer saw stress fractures not only as unnecessary injuries but also
the result of a lack of knowledge on the part of the coach about the physiological demands
of their sport:

But, then again, with [my sport], I had a lot of injuries, and you wouldn’t

expect it. I had a lot of problems with shins and stress fractures, and I think

they did a lot of long—distance running and training-which is kind of not

what they need to do. They were working aerobic and the sport is totally

anaerobic. Maybe someone, maybe I should step in and say, 'Listen,

you’re training them wrong,’ or, 'What are you doing? You’re running
them 3 to 5 miles, when they shouldn't be doing that.’ Half the team came

61

down with stress fractures, and these [athletes] have played all their lives
and never had a problem until they came here.

Also suggested by the trainers as being unnecessary were those injuries that were a
result of the athlete voluntarily taking unreasonable risks. One SAT described instances
where "an athlete does something really stupid, like tries for something they really can't do
or goes in the street and starts playing their sport and gets hurt really bad." While I did not
pursue how this trainer distinguished between a "stupid" activity and a "smart" one, her
characterization seemed to suggest that there are unreasonable risks both in the sport and
outside of it. Note, too, that in the case of these latter "unnecessary" injuries, they are put
in the context of the moral behavior of the athlete-that is, what they did in the course of
sustaining the injury determined its worth. This classification of injuries in terms of the
evaluation of the action with which it is associated will be seen in more detail in the section
on injuries.

A final class of disruptive injuries, or what these student trainers might have called
"injuries," were those which were either quite minor in severity in their view, or those they
believed were concocted or exaggerated for various reasons. In the case of minor injuries,
several trainers spoke of athletes in infantile terms and suggested that athletes needed to
take responsibility for handling them:

A lot of it is baby-sitting sometimes, baby-sitting the athletes, because some

of them will come in, and I ’m not kidding, with a hang nail. And they’re all

upset because they have this paper cut or this hang nail on their finger and

you need to fix it. And [we] discussed this a little bit this year, when we

have colds and the snifi'les or a paper cut, who do we go to?

[Another trainer answers] : We come to work.

There seems to be an implied obligation on the part of the athlete to recognize cases in
which their injury or ailment is not the appropriate concern of these trainers. In another
case, not only was lack of responsibility for oneself the issue, but also the inability to
handle pain:

I have had people that are big babies that, ’Ouch, I scratched . . .’, you

know, he scratched himself and it's a major catastrophe. I deal with them.
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62

want to say that I don’t think that they are real athletes, but if they can’t take
just a little bit of the pain, they shouldn’t be in athletics. I don’t know, I
have been dealing with someone now who, even other people, when he left,

other athletes were in the room going, 'You got to be kidding me. He came
in for that?’

Once again, these evaluations of an athlete's complaints are, in the student trainer's
counter-complaint, seen in terms of the athlete's ability to fit into the standard range of pain
tolerance levels of the surrounding athlete witnesses. "Coming in" to see a trainer seems to
be not only an event, but a gesture of sorts, which seems to signify to the trainers the
importance of their work and the value of their skills-~a gesture which is apparently
devaluing to the trainers if the injury does not contain some sense of urgency, require a
skilled reaction or at least is done to draw attention to matters seemingly outside their range
of responsibility. As shown in the following, one head trainer viewed the appropriate use
of athletic training services to be a matter of an athlete’s acquired wisdom:

A lot of times athletes, especially being freshman I’ve seen the most, a lot of

these athletes come into universities in particular, and have never had an

athletic trainer. And so they kind of abuse them in that context, thinking

that they have to come in here everyday even if . . ., For instance, I had a

kid come in because he cut his fingernails too short and thought he was

going to die. I mean, some of these instances these kids come in and

there’s just a little hang nail or they feel like they have to come in and grab

you when you have ten athletes yelling at you wanting this and that. So I

think what happens, I think, is you, it’s kind of maturity, as you come

through the program as you get older you kind of learn from the other

fellow athletes who’ve been experienced, who ’ve been around, that ’I-Iey,
don’t go in there, you don’t need to go in there to see the trainer, you know,

it can wait,’ whatever.

As mentioned above, the final type of disruptive injury--and, similar to minor ones,
those which seemed to be the most upsetting to the student trainers--were those the trainers
suspected were feigned by the athletes. While attention will be devoted to these later, what
is important for now is their role in disrupting what the trainers took to be a normal flow of
events. Moreover, as in the following quote, feigned injuries, like mysterious ones, leave
the student trainer in the position of being unsure about their knowledge and skills:

But a lot of times the athletes are really, and this really is with any sport,

any little ache or pain, they’re going to try to use that to get out of practice

or to get out of . . . they don’t want to go to a certain competition. They try
to use that to get out. And it puts us in a really hard spot, because then we

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63

have to make the call, and you never know if the athlete is telling you the

truth. I mean you have certain athletes that you know you always believe,

and you have other athletes that, well, you never want to believe them. But

the time you don't believe them it’s going to be something serious.
It may be that what scrubbing Whirlpools is to a "learner," a malingerer is to a head of
sport, in that the duties associated with serving such athletes place the knowledge and skills
of the trainer in doubt--indeed, how can one learn the "true" nature of injuries given a
sequence which may include those which are potentially false? While it might be tempting
to conclude that the observations of these trainers are simply reproduced ideologies about
"tough" athletes "playing through pain," their frustration may also be what they take to be a
disruption in their education as uainers, in addition to a "waste" of their acquired skills.

What appeared to be the basis of both an athlete's moral career, and an economy of
injuries-the moral evaluation of the injtu'y in terms of the apparent importance to the
interest of the student trainersuwill be discussed later. For now, it must be noted that these
complaints about the behavior of athletes were the most commonly identified source of
disruption and difficulty for the trainers in the study. Because I was specifically interested
in interactions with athletes, I decided to ask the trainers in the group interviews what they
felt were the characteristics that distinguished the athletes who were the easiest to work
with from those who were the most difficult to work with. The issue, as they were to
describe it, is called "compliance," made most salient by those athletes who fail in various
ways to follow the advice and appropriately utilize the services of the student trainers.
Inked, references to the non-compliance of athletes came up in the context of asking
number of different questions. Hence, the final section on disruptions is a fuller discussion
of what a number of trainers felt was the most frustrating aspect of their work: non-
compliant athletes.

Compliance

As has started to become evident, the SATs in the study viewed disfavorably the
athletes who failed to recognize and knowledgeably use their available skills. The

distinctions they made between compliant and non-compliant athletes seemed to cluster

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64
around four sets of overlapping characteristics, although not all of the trainers agreed about
them. These characteristics of athletes included dedication versus a lack of dedication to the
sport; relatively high skill levels versus a lack thereof; experience versus inexperience; and
education versus ignorance about injuries and the use of trainers. I felt that these were best
presented and most revealing as contrasting pairs.

While one student trainer joked that the most compliant athletes are "the ones that
aren't hurt," many of the trainers felt that the easiest athletes with whom they worked were
those who had what they saw as a serious commitment to their sport. As one trainer put it,

I think sometimes the most dedicated ones, not always, but I think

sometimes the most dedicated ones are the ones that really care about their

sport, really care about getting back out there. They want to do this as

quick as possible, so they’re the most compliant with you.

Another SAT described the dedicated ones as "there because they love their sport, not
because they have to be there." Dedicated athletes were also described as being in the
pursuit of a position on the team:

The ones that really wanted to play had to prove something. They were

probably the best at coming in and getting treatment. They were on the edge

of playing and they wanted to be a starter. So when they got hurt, they

wanted to get healed as quick as possible so that they could go out there and

prove to the coach that they should be starting.

It would seem that these dedicated athletes, while making the jobs of the trainers
less difficult, would also be valued members of their team, also as a result of their
dedication. Some trainers were aware of the problems the absence of these athletes might
pose in this regard. One trainer--the same one who joked about the uninjured athletes being
the most compliant--expressed ambivalence about these two necessary facts:

It’s hard though because ifybu do have a good athlete to work with that

means they’re hurt, and that’s hard. So, you know, you see one who has a

good attitude, that shows up, that works really hard. But if you’re still

working with them, that’s not good. It’s tough, because even the best

patient can wind up being hurt. . . The best ones are perfectly healthy and
doesn’t need to come in, or just needs to get taped or something.

65
Athletes who were seen as talented, yet also undedicated, were viewed in far
different terms. One trainer expressed the frustration at having a star athlete missing fiom
the team, and the resultant pressure put on them by a coach:

And it’s frustrating when you sit there and you see it happen and you try to
work yourself through this rehab program with this person and they don’t
comply with you and then they don’t get better, but then they complain to
you. So the stress level goes up because you worry more about getting the
athlete better. Then the coach starts ragging on you because the athlete is
the star athlete and they’re not out there . . . ’How, come? How come you
can’t make them better?’ ’Well, because they’re not coming in and doing
treatment.’ ’Well, then I ’ll talk to them.’ So then the coach talks to them.
They come in the next day and then you never see them again for a month.
It’s hard. It is really hard.

Some SATs seemed to uncover motives behind, or at least related to, the athlete's
lack of compliance. In this regard, some seemed to disagree that dedicated and talented
athletes were the most compliant. For example, one student thought this stemmed from
what they viewed as an air of invincibility, stating, "I think certain athletes think they're--I
don't know how to say it--that they're beyond, they're above getting hurt." It is as if the
athlete had confused his or her skill in their sport with their ability to heal. According to
other student trainers, athletes were simply so worried about their competitiveness that they
made poor, and ultimately unhealthy decisions about healing. One SAT spoke of athletes
who refused to stop participating in order to reduce inflammation, saying, "'I'll lose all the

endurance I built up . . I can't take a week off, Oh my god, I'll be the worst [athlete] in the

[conference]. Yet another example came from a case where the athlete, although

dedicated, was also fearful of losing her spot on her team:

Then you ’ll get the other extreme, the kids that won’t tell you, because
they’re on the borderline between starting and not starting. . . I had one girl
that had just huge contusions on her thigh; got nailed like three times in the
same place by a ball. And she was getting calcification. And she never told
me. Her roommate told me. And the only reason why her roommate saw it
was because her skirt lifted up or something. She was putting like Band-
Aids over this. Finally she got hit again and it got cut open. That's when I
knew she was hurt because it was bleeding. It was like, she just didn’t
want to . . . She was too afraid of the coach, didn’t want anyone to know.
She comes to me and she's like, ’You can’t tell the coach.’ I mean, the
situations you get put in.

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66
Other suspected motives included an indictment of an athlete for participating under
what one trainer saw as false pretenses:

One of the guys now, he doesn’t really want to be out there but he’s one of
our best runners. But he doesn't want to, and he didn’t. The only reason
he even came (was) because he got a free education. And that’s what he
wanted. So he is milking his injuries. He is the best, but he’s not the most
dedicated. Even the worst are the ones who are the most dedicated.

Success also seemed to breed compliant athletes in the views of some student
uainers. This phenomenon seemed to involve several issues, including dedication, but
primarily included the suspicion by the trainers that athletes were using an injury to explain
various failures.

What I’ve seen, and with the sports I ’ve been with, it seems like the athletes
that are the easiest people to work with are always either the captains or
easily the best people on the team. And every now and again you’ll get an
underclassman, like a freshman or a sophomore, that really sticks out on the
team because he’s good, but it seems to me like the athletes that are winning
don’t always fall back on injuries as problems. Like to use that as an
excuse. A lot of times you’ll have these phantom injuries that show up if
someone’s not performing and you ’re trying to figure out what is wrong
with them and you don’t sense that there’s an injury and stuff but they insist
that something ’s wrong. But it seems like people who are in the best shape,
and they condition themselves before the actual season starts, and before
they’re supposed to meet with the team, those will be the people we have
the least problems with. Especially, that’s what I saw . . .this year. People
who are the best and getting the credit for it are rarely in the training room.
They weren’t hurt.

Perhaps similar to these dedicated/non-compliant athletes were those, as one trainer put it,
who presented a "macho" attitude. One student trainer described athletes who would not
report their injuries and/or refuse treatment when it was offered:

I have run into a dtfi’erent type of problem. . . You always had the athletes,
some are tough and macho, think they 're it. You ’II have other ones that tell
you about every type of injury and stuff. Well, [these] guys are all . . .kind
of tough macho types and they would get hurt and like they felt they didn’t
need treatment. You know, ’Well, I '11 just shake it ofi'.’ I '11 actually have
to beg them to, ’Just let me take a look at it. Come on.’ I thought it was
fitnrty because it was the first time I actually had to do that. So a lot of
members on the team, because they’re so confident, just are used to shaking
it of themselves.

Similarly anxiety provoking to SATs were athletes they termed "lazy," one student

stating that, with his athletes, "It wasn't as much as they're tough as they just were lazy

67
and didn't want to come in." Indeed, several SATs spoke about what they believed to be
the laziness of athletes. In one case, I pressed the student to reveal what evidence he had
that an athlete was lazy. He stated that he knew the athlete didn't attend class, was always
late for practice and had never shown up for rehabilitation appointments. Such personal
knowledge of the lives of athletes, I was to discover, was quite common among the SATs.
While this will be explored later, for now, it is sufficient to observe that knowing such
details about an athlete's life seemed to create a broad context from which SATs could
render judgments about athlete behavior.

Other seemingly broad vantage points by which the compliant and the non-
compliant were distinguished came in the cases of the individual or team successes or in the
face of particularly difficult practice sessions. Regarding the latter, one trainer stated,
"They want so bad to be sick some days when they know it's going to be a hard practice
that day." Several trainers spoke of how the pattern of injuries "mysteriously” varied
according to individual or team competitive performances. In one case, a losing season
appeared to have far-reaching consequences for the team with whom a trainer was
working, and wherein non-compliance was attached to a number of season-long
difficulties:

I didn’t have any freshmqn on my team, and they were the worst nightmare

I have ever seen on any sport. Zero rehab, none of them ever came and did

their rehab. They all lied about having done it at home, that it wasn’t

working. I would say 85 percent of them would go to their home doctors

and come back and claim that we were all quacks and they hated the

university. And they’d send letters with them stating that. . . I was dealing

with parents that had trainers previously that just didn’t give a damn. And

so they expected that out of me. . .. So you get the people that are looking

to make trouble. I concluded that the team sucks . . . Really weak team.

And the injuries got worse, the worse the season got. They were all basket

cases.

This SAT also spoke about how injuries seemed to multiply after team losses, and others in
the group interview seemed to agree. Another student trainer in this group added, "I

remember sitting on the sidelines . . . going, 'Oh god, please make that touchdown,‘

because

It's

been ver

nears: |

(\fiofib.v~a

 

 

68
because if they win, you get truly hurt people. If you lose, you get them all. You get them
al ."

Similarly upsetting to another SAT was the case in which an athlete, who had not
been very compliant, suddenly begins attending treatment sessions as an important event
nears:

You’ll also get the athletes that will come up to you and tell you they’ve got

a problem. You tell them, ’Okay, we can do this, this. Come in and take

care of it.’ And they won’t, and you’re like, ’Okay, they’re not coming in.’

And the only time they care, the only time they come back and start

complaining and bitching is because it’s not getting better or anything. . .

[Another SAT answers ] : Just before the games

Yeah, just before. When they want to play. I had this guy that was coming

back from a PCL injury, torn in his knee, should have been back two

months before he actually was. And he had to miss one of the games. He

thought he was going to be able to play but he failed his Cybex test. And

we told him, ’Well, you didn’t do what you were supposed to, and it’s your

own fault.’ I mean they get all bent out of shape and everything.

To reiterate, the timing of reported injuries, along with knowledge about other contextual
factors, enabled these trainers to place the reports of injures into various categories of
difficulty. However, not all of these difficulties were matters of malingering or other
manipulations of the services of the student trainers.

While it is not uncommon for college level athletes to have participated at elite levels
for over ten years in their sport, a number of them, according to the SATs, had little
knowledge about the functioning of their bodies. One trainer considered it to be a general
"ignorance" about their bodies. She stated, "If they're not very smart or wise about what
they do about their bodies or what they've done to their bodies, and what they could do to
their bodies if they keep going on this injury, then, they'll be the ones who'll give you the
worst problems." Not only were athletes said to not understand the implications of an
injm'y, they also were considered unaware of the benefits the services of a trainer could
bring them:

I think that’s the worst thing. You can ’t get across to athletes, ’If you come

in and do treatment, even if it takes a week, you’re going to be better and at

a better level before this injury began. And if you keep putting it ofi'you’re
just stay at that mediocre level.’ So, it comes down to that knowledge level.

l

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69

One might expect that this form of non—compliance, the apparent misunderstanding
of one's own body and the assistance it may receive from athletic trainers, would diminish
as the athletes progressed through their careers. As suggested in the matter of disruptive
minor injuries, athletes are expected to acquire a competence in the use of the medical
services they are offered. To some trainers, this educational process was quite
understandable. They themselves reflected on the fact that they did not have athletic
trainers during their own athletic participation, and hence they reasoned that they should not
expect incoming freshman athletes to have such knowledge. However, as a number of
trainers pointed out, another form of difficulty are athletes who somehow never "get" what
a trainer's role is. The result, one of several trainers noted, are athletes who "overwhelm
you with problems they have," and develop a kind of dependency:

One big problem is ones that essentially treat you like a freshman or

sophomore, since you’re young. Treat you like another student or

something like that, and someone that’s on their support staff that’s there to

help them. I just think that’s always one of the biggest ones, I mean it

doesn’t happen a lot. But the ones that it does happen to I think that’s one

of the situations that irks me more than anything is that’s they figure that

you’re there just kind of to wait on them. I think it was quoted like from an

old football player, who, we were talking about something like this and he

said, ’Well, what do you expect when you guys go fetch us things?’ That

was his quote. It kind of sums up his attitude about trainers. How they are

there to fetch them water and ice bags.

One trainer considered such "veterans" to be more difficult than the freshman, in
that they apparently understood and were therefore able to circumvent various procedures
that were under the supervision of the SATs. For example, some of these veterans were
said to have seen other athletes undergo the processes used to handle the injuries they
themselves acquired and either rejected the procedures or attempted to perform them on
their own. As one SAT described them, veterans included, in particular, "Egos: Guys that
are just, 'I'm here and I'm just the shit.’ They'll let you know." Of course, these tended
to be those athletes who had received large amounts of publicity, some having earned "All

American" honors. Presumably, such athletes expected extra attention and services--and

apparently often got it--taxing the patience of the trainers.

 

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70

Similar to these veterans were those senior level or otherwise high status athletes
who were simply, in a number of different ways, intimidating (and hence, disruptive) to
both younger athletes and younger trainers. One trainer, working in a training room used
by multiple sports, noted that freshman athletes were hesitant to, for example, share a
hydrotherapy pool with a senior athlete. As she noted, "if they feel comfortable with you,
they'll just come up and tug on your shirt . . , and then you kind of take them by the hand
After a while, you teach them to shove and push (laughs)." Similar experiences were
recounted by student trainers themselves, who noted that football players were particularly
intimidating, due to both to their physical size and demeanor:

I was assigned to the football team, and I just remember that sometimes

those guys are tough to work with. You know, especially when they don't

know you very well. A lot of the guys on the football team have huge egos.

Now, whether they're good or not, and the thing is they can always take it

out on a trainer, because they can go out on the football field and get their

ass kicked but when they come in the training room they can, you know,

they can tear you apart. They can give you mouth and it doesn't, I mean

that's . . . So they can kind of exercise their power over you. I remember a

couple of cases where my first day and one of the big lineman coming in

and looking at me and he's like 'What are you looking at?’ You know, and I

just, well, my first few days in there, I 'm just, I look at him, he gets an

attitude with me and . . . Big guys are the toughest to work with in

general.

Such behaviors also included throwing water bottles back at trainers and otherwise
belittling their presence. Many reported that the solution to such problems was simply to
return the behavior, including throwing water bottles back at football players and returning
derogatory comments.

As is abundantly clear by now, it is nearly impossible to present a discussion of the
duties of student trainers, and disruptions thereto, without revealing a considerable degree
of information about their principle job-related anxieties. Nevertheless, I close this
description of the duties and disruptions with a summary of the things which appeared to

give them the most stress, and ways they dealt with that stress.

 

 

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Recall that the first questions asked of these trainers was intended to yield a
description of what they do in terms of how they would describe the job to a prospective
enrollee in the program and in terms of their initial expectations (in the group and individual
interviews, respectively). Again, the immediate and consistent feature of these interviews
was the fact that the students seemed to be "venting" a considerable amount of frustration
about their work. To follow, briefly, then is an attempt to summarize what they said in this
regard. Again, these comments should now be somewhat more understandable in the
context of the above discussions on duties and their disruption. I concluded that the main
sources of stress revolved around issues of the general time demands, the behavior of
athletes and others, and other work context factors. I also attempted to pull together any
indications of how these student trainers cope with these anxieties.

If there was any universal answer to a question in the entire study, it was the
unanimous insistence that the job of student trainer demands large amounts of time. Again,
it must be reiterated that these students, once they are in head of sport positions, may spend
40 to 70 hours per week in their athletic training duties alone. However, many were quick
to point out that they are essentially "on call" 24 hours a day. As mentioned earlier, heads
of sport, who comprised the majority of the students in the study, gave their home
telephone numbers to their athletes and it was not unusual for the athletes to phone during
late hours. This time, it must be repeated, is in addition to that these full-time students
must spend preparing for and attending class. The need to "be a good time manager," was
therefore frequently stated, one woman warning, "If you're not, you're going to get so far
behind that you can't see daylight. You don't even know where to start." Another trainer
added, "You‘re not here for academics, you're here as an athletic trainer. I mean they say
you're here for academics but that's not what you're here to do. But if you don't maintain

your GPA, then that's your problem and you're out." Of course, this sounds identical to

Staten

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or we
year,
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72
statements made about college athletes as well. Hence, in response to the question of what
they might tell a prospective intern, one SAT stated:

Yeah, they have to understand that it's going to take up a lot more time than,

I don 't know if I ever expected, but especially as the years go on, and your

second year. Really your third and fourth year you're really putting well

over 40 hours a week into working with your sport. I mean you have to be

able to balance that with your academics in order to succeed in this and with

school. That's why we see so many people that come into, that want to

become athletic trainers, will drop out after a couple weeks or maybe even a

semester or something. But I think they 'd really need to know that it's time

consuming.

Time demands were not only stressful in the fact that the job consumed entire days
or weeks, but, in some cases, holidays and other events. One woman recounted the past
year, stating that she "got only one holiday--New Year’s." The fact that intercollegiate
sports serve as some of the principal means of holiday entertainment were clearly behind
some of these missed holidays. Other trainers spoke of missed time to spend in personal
relationships and having to explain to loved ones the demands of their occupation. In the
words of one graduate SAT, "There's very, very little time for yourself, whether it be from
the standpoint of socializing or going home for vacations. You are 110% into athletic
training, and your sport, and your kids." Much to the dismay of some student trainers,
many do not seem to understand their commitment to the job:

A lot of people spend a lot of time looking at you going, ’Why do you do

this? ' You spend 50 hours a week or 60 and they're like, 'Why do you do

this, it's so stupid.’ And they don't understand when you have to miss

something and you have to work, and you have this responsibility. It's just

your responsibility.

Athletes, as was discussed above, were also said to not fully understand the role of
the trainer. Some SATs commented that they were often mistaken for being much older
than they were, given the position of authority in which they are placed. One student
trainer said she liked the effect of this misperception, saying that "if they know you're a
student just like them it sort of bonks you down a notch." As a result, athletes, many said,
do not take into consideration the schedules of the student trainers. Moreover, the parents

of athletes, with whom some student trainers said they interacted, also seemed to be unclear

73
on the trainer’s role, one apparently mistaking a student trainer for a physician-again, a
misperception the student trainer let stand.

Among other misunderstandings the student trainers observed were those related to
their actual duties. This, of course, hearkens back to the "water boy"/"water gir " issue, in
that the most visible of their activities are the least central to their work. One student
remarked, "A big misconception about the job is that it's just injuries. A lot of people think
you just tape and ice and that's just not true." As he added,

Also I 'd tell them that basically, it's the total health care of the athlete. They

get sick, you take care of them. If they have emotional problems, you try to

talk to them or find help for them. That besides all the basic injuries that

you see during competition or practice. Then you have to deal with

coaches. You have to deal with other support personnel in the diflerent

teams. Like with football, you have managers and everybody else and you

have to deal with all the crap that comes from that.

Within this network, to use Nixon's term, this student added, "As student trainers, we're at
the bottom of the totem pole, so everything runs down hill and we always get it at the end.
Even if it has nothing to do with us, we get it." Many of the SATs shared this view of their
status. To add to this, one other student said that athletic training as a profession is
similarly at the "bottom of the totem pole," as compared to other allied health professions,
including nursing and physical therapy. Ironically, as was discussed in one group
interview, there are few professional jobs within the field and many applicants, and
consequently a "cut-throat atmosphere" pervades the profession generally--something the
members of the group felt was palpable in their own program.

Much of the reason for the perceived low status related to what the students
described as low pay that is apparently standard for even professional trainers. This
circumstance, not surprisingly, is also that of the student uainers, who often receive little or
no pay for their work, and, apparently, little praise as well. "Long hours, low pay, very

little recognition," was the way one student put it. Moreover, nearly all of the student

trainers told of the fact that they are often surrounded by the various pieces of clothing,

 

 

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74
equipment, jewelry and other such items provided to athletes, coaches, physicians and
others, very little or none of which was offered to them.

Adding insult to injury, so to speak, these trainers also described being "yelled at"
by various individuals, including staff trainers, physicians, coaches, athletes and the
athletes' parents. Some spoke of being held responsible or scapegoated for things they did
not do. Others spoke of athletes and their parents questioning their medical expertise.
Moreover, these students are often, as they described it, "in the middle" of a number of
different ways, most often it seems, in the form of possessing information, sometimes
volatile, told them in full confidence by an athlete--an issue that will be discussed later. In
some cases however, the information given them by athletes must be shared, and as a
result, they are called "the rat" for having "busted" an athlete. Finally, some expressed
frustration at being "yelled at," in one student's words, as the result of one rare error:

How many times you have done everything to a T,’ but that one time you

forgot the ice bag, or you forgot the Ace wrap, and all hell breaks loose?

You’re not recognized for the other 99 percent of the time everything went

smooth. Just one time is all it takes and then it's over.

The final "work context" factor among the principal areas of anxiety for the SATs
revolved around a policy, which was said to be profession-wide, that essentially forbade
student trainers to "socialize," become friends with, live with, or otherwise have close
relationships with athletes. This policy apparently took various forms and was, in the view
of many, not consistently enforced within the program. The stress, as might be imagined,
stems from the fact that these student trainers, again who may spend more time with
athletes than any other single individual within the organization, have very little time in
which to develop relationships beyond those formed at work.

One might, and apparently many do, ask how or what it is that keeps these students
in a program which is so time consuming, emotionally draining, low paying, competitive,
cut-throat, and restrictive in terms of personal relationships. The trainers described

themselves, in many cases, similar to those athletes they considered to be "dedicated."

Specifically, many told of how they "love what they do." One trainer said "the only reason

we're

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75
we're here is because we love what we're doing and that is the reward of healing
somebody or making a friend" Another stated that

You've really got to enjoy athletics and the people you're around. And it's

got to be something that you really want to do. It can't be a fleeting

thought. It's got to be something that's going to carry you through your

life. Otherwise you're not going to be able to hack it.

Love and dedication, however, does not mean that these trainers had not developed
various ways of coping with the demands of the job. These coping strategies are those
which might be expected among any similarly stressed group. Nearly all spoke about the
need for a sense of humor and the unpleasantness of those who lacked it. In addition,
"bitching" sessions were said to follow days at work, and occasionally were continued at a
local bar. Indeed. I asked all four of the interviewed groups about the kinds of things they
spoke about outside of work. All of them agreed that these complaining sessions, both in
tone and content, were much like the interview itself. In other cases, the way to cope was
described as simply to leave the training room behind, both physically and psychologically.
In some cases, moreover, a "no shop talk" rule was put in place, as the trainers realized that
their evenings were often ruined by hours of complaining. Indeed, a few of the trainers
remarked that many of the groups of trainers functioned in ways similar to a family, or as
others put it, "a fraternity or sorority." This did not necessarily indicate, however, that all
of the trainers in the program were friends, or for that matter, even knew each other. One
student spoke of having met some trainers at the year-end social event. Others spoke of
cliques that had formed within the SATs.

El “E. [SIEII'I'

Recall that one of the issues which came out of the review and critique of Nixon's
(1992a) "sportsnet" framework was that it did not include a focus on gender in the relations
among its members. That is, the influence of powerful members of the sportsnet is
important, but may not be a complete description of the ideologies at work, including those

that are connected to pain and injury. Again, past scholars have noted at least a connection

between violence in sport and the degradation of girls and women (e. g. Theberge, 1989,

to]

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76
Curry, 1992). While this issue could not be fully addressed in this study, I felt it important
to begin to look into these potential connections by asking the student trainers about their
experiences of gender relations in their work.

As was evident in the discussions of the duties of these student trainers, many of
the formative experiences of the internship consisted of activities the students described as
degrading and humiliating, though ultimately necessary. These included handling water,
being harassed by athletes, having one's competence questioned, and having to control the
nature of one's relationships with athletes, including the perceptions of those relationships.
On the basis of these interviews, it is my perhaps overdrawn, yet nevertheless firm
conclusion that all of these problems were considerably more complicated for the women in
the study than for the men. Indeed, I concluded that this is the case despite some
statements to the contrary by both women and men. To follow, then, is a summary of
what I believe are three areas-~exclusion, roles and stereotypes, and sexualization and
vulgarity--wherein the experiences of women were described as being quite different than
those of the men in the study.

Exclusion

Similar to the previous section on the duties of student trainers, I will begin this
section with an attempt to lay out the "factual" matters pertaining to issues of gender,
followed by the perceptions and feelings of student trainers about those facts. In order to
understand the historical era in which the student trainers apparently saw themselves, I
think it is useful to begin with what I took to be a telling quote from a male trainer upon
being asked if he felt that his experiences were different from those a woman student trainer
might have in the internship:

The climate of that question has changed dramatically just in the six years

that I have been associated with it. When I first started, I would say a

resounding yes, I was having difi'erent experiences simply because the

gender difference was there and people didn't realize . . . There was a very

big difi’erence in the number of males that were coming out of the programs

and were ready to take jobs as opposed to females. Now, as we get to the

middle ‘90's and on the 2,000's, with the gender equity question that the
NCAA and the equality-they’re trying to get equal number of males as

the we
in this
are, un
as an i
and all

trainer

77
opposed to female athletes. They're trying to make the same ejfort with the

trainers. Even in the newest issue of the WW they
discussed women trainers with professional hockey, the pros and cons.

People are really becoming aware of it, and their thinking is changing,

saying, 'Hey, we can put a woman with a men's sport. We 've been putting

men, males in female sports all along. Why can 't we do it vice versa?’ So,

that question, the climate of that, has changed a lot.

The changing "climate" of the question of gender and the resulting changes within
the work setting of the student athletic trainers in the study is the first area to be examined
in this section. Of course, "change" toward "gender equity" suggests that there were, or
are, unequal conditions within the work environment of student trainers. Anticipating this
as an issue, I asked each student trainer the question to which this last quote is a response,
and also asked them to cite any specific examples of how they felt their experiences as
trainers have been different as it relates to gender.

1 should preface these responses by pointing out some basic facts indicated to me
about the assignments of student trainers to one of the university's teams. These
assignments, again made by the head staff trainers in the program, were neither random nor
without political implications within the program. That is, the student trainers almost
universally considered these assignments as indications of their status. Interestingly, the
hierarchy seemed to correspond both to the public visibility of the team and to the level of
potential acute injury within the sport. While I did not ask all of the trainers specific
questions about this apparent hierarchy, I was able to surmise from many of their
statements that the top sports to "get" were ice hockey (men's), football, men's basketball,
and gymnastics (men's and women's). Those mentioned as at the bottom of the hierarchy
were fencing, swimming and diving, and tennis. Again, while a definitive hierarchy
cannot be confirmed, what can be safely said is that football, ice hockey, and men's
basketball are among the most desired sports to work at GSU.

The most important facts to be considered at this point is that women student

trainers at GSU were never assigned to work ice hockey, were secluded to the training

room (i.e. not allowed by the head coach to watch practice) during their assignments to the

men's
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78
men's basketball team, and occasionally felt a considerable degree of hostility from players
and coaches on the football team. That is, one’s gender directly affected one’s placement
within the hierarchy of sports and one’s experiences within the sport. With football,
women stated that they were, more often than men, assigned to stay in the indoor training
room, while men student trainers were allowed to watch practice. In addition, some
reported being excluded from a post-practice huddle due, they were to understand, to the
obscene language used, including the naming of football plays after terms of female sexual
anatomy.

Other exclusions of women revolved around the issue of locker rooms and the
obvious nudity associated with them. Women were not allowed into the locker room and,
should the need arise to enter it, a male needed to be available. Clearly, the reverse held
true for male trainers and women's locker rooms. It must be mentioned, however, that
some locker rooms in which the student trainers worked were designed so that women
could be allowed to enter. In other cases, male athletes were simply instructed to be
minimally dressed when entering a training room in which women were working.

From what could be concluded from the interviews, while there were similar
prohibitions on student trainers about locker rooms and the performance of certain
therapies, there simply was not an equivalent set of exclusions for males working with
women's sports in the program. There were implications of the exclusion of women for
the men in the study. For example, exclusion from locker rooms meant that only males
could enter them in order to locate a particular athlete or perform cleaning duties.
However, similarly, women complained that while male trainers were attending the post-
practice huddle in football, as one woman described it, "getting all gung ho," the women
were beginning the lengthy process of "tearing down" equipment and supplies. Overall, a
basic division in duties also revolved around the practices of the exclusion of student
trainers, male and female, from certain areas and behaviors, which both men and women

seemed to resent.

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79

Although it did not seem to be nearly as salient to the SATs in the interview, there
were also suggestions that men were not assigned to women's teams. The reason, one
trainer stated, was the unique health problems of women and the fact that women athletes
might be less likely to confide such things as menstrual problems or a yeast infection to a
male trainer. An equivalent number, however, remarked that the opposite scenario is also
possible--women may not be as likely to be assigned to men's teams given the possibility
of hesitancy in reporting certain health problems, such as a groin injury. It was the
perception of the students, therefore, that there were assignments to teams made on the
basis of the assumed willingness of the athlete to confide health matters to the student
trainers. However, not all agreed with this, some saying that there seemed to be a
deliberate effort on the part of the staff to place women trainers with men's teams, and vice
versa, many stating that this was a strong point of the program.

The "reasons" for these widely known, variously accepted, and overt exclusions
will be elaborated upon in anecdotes and quotes to follow. What is important to consider at
this point is the effect certain of these exclusions had on women in the program The most
important of these facts seemed to be that women entering this student training program
immediately became aware, both subtly and obviously, of barriers to their advancement
into higher ranks of their profession. As one student put it:

' Well you know you'll never have hockey. And you know you can never

get an internship with a pro team. You know that you'll never get like,

men 's basketball or whatever, because there 's always a head there. I mean

they did have a woman, and she was like a freshman woman who didn’t

know very much, she was new to the program. She wasn't allowed out on

the court because [the coach] didn't like it. And you had to put up with

those type of things. And you have to know over at football I the head

coach] isn't going to like you very much. And you just have to put up with

it. The hardest part though was when, as far as we knew, the head trainers

weren't backing us up at this point. Why don't they fix it so that a woman

can have hockey? I mean that’s a great sport for someone to get and work

under. You learn a lot in those sports. But they don't do that around here.

As this student trainer indicated, one of the primary objectives in working these
sports is to acquire experience in the injuries unique to it. One apparently does this as part

of the process of building a resume composed of a variety of sports assignments, and

80
therefore experiences with injuries specific to certain sports. Moreover, not being allowed
to see the actual activity which leads to an injury (i.e. the "mechanism of injury") was also
said to put one at a considerable disadvantage in terms of understanding the how injuries
occur, and how they might be prevented. Other missed experiences cited as a result of
such exclusions included the fact that one might miss important activities during half-time
periods of football games. These circumstances were said to potentially include such
activities as injections of medications, special or emergency taping or preparations of
special pads. In general, many men and women SATs in the study cited such omissions in
experience as the most damaging result of such exclusions. Discussing the advantages one
has as a job candidate as a result of working hockey, for example, one SAT stated:

As far as I know, there has not been a female to ever work hockey. So,
right away, there 's obviously a discrimination right there. Supposedly,
hockey is the top undergraduate assignment for trainers over there. You do
very well with the students. All the students that come out of there, they are
possible top of the line athletic trainers. I think the key, for example, with
hockey is you're one on one with a head athletic trainer, and you get to
interact with them every single day and they get to teach you things and you
get to sit and observe what they do every single day. Now, at football, for
example, there are 120 athletes there, maybe 12 student trainers, and two
head trainers. You really don 't get that person-to-person relationship and
especially not every day. Maybe once a week you might get a little input in,
but there’s other responsibilities that they can take care of. And say if, by
chance, that what you’re doing is learning from grad students or maybe
seniors or juniors, they may not know or they may not have the experience
as a head trainer would, and you learn from their experience. I feel that
women don't get that advantage. There's not just one trainer that can sit
with them and be with them the whole year and sit there and learn from
them and ask them questions every single day. In that sense, yeah, I feel
that males get better understanding. At least they have a better advantage, I
guess.

One student trainer reported that, through conversations with women student
trainers at other schools, she believed herself to be relatively fortunate to be able to work
with the football team, as women were excluded much more severely at other schools. On
the other hand, one graduate trainer reported that he was aware of an institution at which
men SATs were excluded from women's sports. While this is an interesting point to
consider, the relevant facts are those about GSU. Indeed, another SAT also pointed to an

additional key fact about GSU--women compose the majority of students in the internship

8 1
program. Nevertheless, this SAT also indicated the consequences of these exclusions and
the further barriers for women in the field:

Now, they let women out on the football field and actually there's, in our

program now, it's a majority of women. But at this level, you're not going

to go much further than this. You can go be a high school trainer. Very

rare for a woman to become a professional trainer . . . There is [sic] only a

few women that are head football anywhere. T here 's a few women who are

head basketball, but it’s rare. There 's no professional women working for

NFL teams. And I would love to go work for an NFL program. There are

coaches who were at [Great State] who are at the pro level now and they ask

me why I don’t come out there and intern. Well, because they don't let

women in because they're on the good old boy system, is what they call it.

There are too many older men still in positions of authority and they do not

think that's a place for women to be. '-A woman cannot handle herself in

that type of a setting.’

Several of the male trainers in the study had indeed worked with National Football
League teams. Although these men spoke of a very competitive job market, their presence
in the program at GSU were reminders to women that the advantages of these professional
sports experiences were possibilities for their male colleagues but not for them. Indeed,
one trainer stated that, although he ultimately had offers from NFL teams to work as a
trainer from which to choose, the best candidates for the jobs were women, who, he said,
"have 4.0 grade point averages. . , way prepared." No women, he reported, were
accepted into these camps.

Again, I cannot confirm the status of NFL acceptance of women trainers from this
study. My purpose in reporting these statements, however, is to show the general context
of the work for women in the study. That is, women in pursuit of credentials in athletic
training in the study seemed to be in a double bind: They could gain experiences in football
by accepting an assignment to the football team, for example, and hope for changes in
professional football; or they could accept assignments to other, less prestigious (and less
injurious) teams, gain excellent credentials in those sports, yet limit their employment

possibilities because fewer employers (i.e. universities) offer those sports.

82

Reasons
When I began to probe the reasons understood by these student trainers for the

exclusion or otherwise hostile reaction to the presence of women within these sports teams,
there were many, varied responses. Among the most common was hostility by coaches.
Several women believed that coaches were looking for incidents in which women "screwed
up" or "got in the way," presumably as indications of the gender-based incompetence. A
couple of notorious incidents are illustrative of this hostility and seemed well known to all
of the trainers in the study. One revolved around a comment made by a coach to a staff
uainer, and apparently overheard by a woman student trainer; the other around an apparent
accident. Both are summarized in the following discussion during a group interview:

[Coach] calls us pussies. And he's 'Why the f_ do we have all of these
pussies out here? Look, pussy, pussy, dick, pussy, pussy.’ . . .

That is what he said. When I worked [coach's sport]. . , one of the bikes
was bleeding, and it leaked on his [facility floor]. One of the girl trainers
moved the bike. And she moved it from here to the door (about eight feet),
and it lefi an oil trail, but she moved it of the [floor], just like she was told
by a guy trainer. And [coach] blew up and called her a f ing girl trainer
and , ’Why the hell did we have those girl trainers up he? T hey're just
stupid, they're weak, they can't do this, they can't do that.’ But she didn't
do anything wrong. She didn't do shit wrong. It was just because she was
a girl and she was doing what she was told to do. It's hard. But then, now
some of the coaches aren’t like that here. Some of the coaches really
understand what the girls do.

The difference between the coach responsible for the above comments, and those
who "really understand what the girls do," was most often explained by referring to the
former as being from "the old school." That is, in the words of one SAT, "some coaches
believe that women should be home, barefoot and pregnant." Moreover, the practices of
the former school of one student trainer--who was alone in the study in his views on this
issuenabout the "place" of women are illustrative of what he called the "old school" (the
quote includes my follow up questions in brackets):

If I was a football player, I don 't want them in the locker room either.

[Because of the nudity thing ?]

Yeah. Plus, I mean I played sports, and I don't think, mentally they're not

at the same level. You know, they're not as intense as guys and even for

taping at the hotel, they'd be screwing around, making jokes with the
players, you know, being normal girls. You know, just being loose. All

83

us guys knew it's game day, their game face is on, and for those few hours
of the day, they don't care about girls. They don't want to, you know, see
their little cheery attitudes and sagf like that. So, even game days, I think
the girls were kind of shunned out a little bit. Don't want to let them tape
them or anything like that.

[Who shunned them out? ]

The players did, and even the head trainer and the graduate assistant trainer
did.

[Did they ever, instead, try to say, 'Please try to change your attitude while
you're working with them because it is game day and the players are trying
to be intense?’]

I really can 't remember an incidence where they did that. I remember where
one game, the graduate assistant . . . How it worked was the head trainer
and the graduate assistant worked football . There was no other assistant. I
remember he was trying to get all the girls out of there. He didn't want
them taping at all. He’d never mention to them, 'Hey, it's game day. You
got to be serious.’

[Did you know what the rationale was for that decision was? Did it have
anything to do with the quality of the work? ]

I don 't think so. It's just pretty much the attitude probably. Anyone can
tape an ankle. I don't think it was the quality. . . I come from the train of
thought that I think women should work women ’s sports and men should
work men 's sports. I mean, people, some of the girls at [former school]
thought I was, you know, sexist because I thought that. But from a privacy
standpoint, I think it’s better that way. Males know how male athletes
prepare for an event because most of us have played sports in the past.
Females just don 't have that state of mind, I guess you can say.

Again, this view was not shared by any other student trainer in the study, nor is it a
description of a practice found at GSU. It does, however, illustrate some of the ideologies
which may lie behind the exclusion of women and the practice of placing them into
traditional roles.

Other reported comments of coaches about women student trainers inclu®d the
perception that they were less competent than males. For instance, several women trainers
reported being overlooked by a coach for assistance with an injlned athlete in favor of men
with less experience. Additionally, some explained that these "old school" coaches
believed women uainers are "out there trying to look pretty, trying to get dates with their
players." A final "explanation" for the exclusion of women from these sports was that they
were a "distraction" to the male athletes-that is, a sexual distraction-and that such things

were not permissible by revenue sport coaches under pressure to win.

84

To understand this business of distraction, one must recall the policy mentioned
earlier that student trainers were not to socialize or become romantically involved with, or
otherwise become close to, the athletes with whom they worked. As might be imagined,
women felt differentially affected by this policy. Some reported that they had received
unfair evaluations of their performance due to rumors or a reputation that they were overly
friendly with, or even dating, an athlete with whom they worked as a trainer. For example,
one student trainer, not in the study, was reported to have been "blackballed," receiving an
assignment to a "less prestigious" sport, due to allegations that she had been dating an
athlete. While this issue will be discussed in more detail later, it is the point for now that
the hostility and differential treatment of women trainers was in the atmosphere in which
these trainers worked

I l 5' I 1'

As women in the study explained how their experiences differed from those of
men, it appeared to me that one of the ways members of the "old schco " were able to come
to grips with the presence of women student trainers was to fit them into traditionally
feminine roles. That is, it was evident in other portions of their responses to the questions
on gender that very often the presence of women seemed incongruous with the practices
that take place in traditionally male sports. Some of the women explained how many of the
athletes with whom they worked seemed to develop traditional role stereotypes, and to
some degree the women accepted these labels. As the title of this section indicates, these
labels and their associated roles included those of "mother," "sister" and "lady."

The most frequently mentioned roles that women seemed to adopt in their
perceptions of the work as student trainers were described, both in the words of athletes
and in their own words, as "motherly." One woman explained, "You become motherly,
you start taking care of them. And that's when they get to thinking you're a mom to them."
As another noted, "You get that knock on the door at 5 o'clock in the morning, 'I don't feel

good Can you give me something to make me go to sleep?” (laughter). Indeed, some

85

seemed to indicate that not only did athletes seem to treat them this way, they themselves
began to become "protective," particularly as a result of spending entire seasons with
athletes, one even going so far as to call it a “mOtherly instinct.” "You get closer to these
people and they get closer to you," as one woman described it. Indeed, as another SAT put
it, this got to the point of empathizing with the difficulties of intercollegiate athletic
participation:

I feel it's kind of a compliment that they feel comfortable enough with me. I

mean, being an athletic trainer is dtfi‘icult enough. But being an athlete you

can't overlook either. I mean these people work umpteen hours a day.

Their school, they get yelled at if their grades aren't good enough. At

practice, they get yelled at because they . . . You know, they were studying

late because they hadn't made the grades and now they're tired during

practice and they can get worn out just as fast as you can. Every now and

then they do need a shoulder to cry on or someone to just give them a little

back rub and be like, ’It's okay. Next game what if you try this?’ or This

will work better.’ I ’ve even helped athletes with their classes. So, you do,

you become a mom figure. And I 've had that with both men's sports and

women's sports. But I think that's nice that athletes feel that they have that

kind of crutch when they 're away from home, especially the freshman. I

was up one night for three hours with someone that was home sick. A lot

of people would feel that that's not my job description. No, it's not, but if

that girl 's up all night, she’s not going to perform well either and she runs

the risk of getting hurt. It’s kind of really piecing it together to wind up

with the athletic participation part.

As women spoke about the motherly role, I became interested in a couple of issues.
The first was whether they felt that male athletes were more likely to see women trainers as
mom figures, or whether this occurred with both men and women athletes. One SAT,
stated, "Sometimes the men are more accepting of you because you're female and they feel
you are more nurturing and can take care of them, which is what I found The men like to
come to me because I think they feel like the more maternal thing, taking care of them."
Another stated that she thought she was more motherly in the presence of male athletes,
stating that "they just came to me with everything, everything." One woman, however,
disagreed with the notion that she was more motherly to men than to women, saying, "It
doesn't matter whether they're male or female, it works on both sides." Another doubted

that men SATs would act in this way:

86

When you have a guy laying in bed with a 1 04 fever for three days, you're
the one checking on him every ten or fifteen minutes, just what a mom
would do. And so that's how you get that type of thing. And I think
sometimes that a man might not be quite as sensitive to those type of things,
but that's just my personal feeling. I don 't know for sure because I have
never seen a man handle it before.

Indeed, the other question I asked about the adoption of the motherly role was
whether men seemed to take on this role as well. The responses were generally "no,"
however, in some cases these were qualified Comparing men and women student
trainers, one male SAT stated that

But then they get things that we don't. Because they're like. . . Women are

more motherlyfigures kind of thing. You can get closer to them than. . . A

guy’s relationship with a guy is like, you know . . , you know . . , (long

pause) sex, sports, etc. There's a fine line that you only talk about certain

things with guys. And then a girl can talk to a guy, and they’ll discuss

relationships and stuff Guys don’t talk about that kind of thing. They get

a different perspective than I 'd say a male trainer does.

Hence, this trainer suggests that certain barriers exists for male trainers in pursuing
personal matters with male athletes that are perhaps not there for women. Another male
trainer stated, reluctantly, that he believes with women athletes he "might be a little more
sympathetic or take time to explain myself." Asked this question about male trainers and
mothering, one woman stated

You can't make guys feminine just to be a mom kind of role. I mean in

their own subtle guy way, yeah I think they do help each other out. I 've

seen it. I have seen men trainers really help out their male athletes

emotionally. I mean it's the same thing. You see it. Do you not intervene

or just help them out a little bit, just because you don't want to cross that

professional barrier? But at the same time, if that kid's not going to be

happy, and he's going to be miserable, there are going to be detrimcntal

effects that come out of it. So, it’s kind of like a catch 22.

Indeed, crossing a professional barrier is the principle issue these trainers spoke of
as complicating the m0thering role. While they emphasized the importance of having an
athlete trust a student trainer, they also noted that the problem with this is that staff trainers
believe they are becoming too close to athletes. One group recounted how they believed an
SAT was removed from a sport assignment for this reason. What might tip the staff off to

the status of these relationships was not mentioned, although a few student trainers told of

87
how their athletes lobbied staff trainers at the conclusion of their season to have them as
their student trainer for the following season.

One of the apparent results of this closeness, and interestingly associated with the
replacement of the word mother with "sister," was the fact that, not only did trainers
”protect" athletes, the athletes were also said to protect them. This notion came up
exclusively in the case of women SATs in the context of working with male athletes. In
some cases, this was described as being simply the nature of the relationship between
women trainers and their male athletes. In others, the sister label was used to describe
how, in some kind of crisis, a male athlete would come to the defense of a woman trainer.
In one case, the crisis was a rumor circulating about the sexual proclivities of a woman
trainer. The protective athletes, described as "leaders on the team," identified the sauce of
the rumor, and, as she stated, "shut them down. " She explained this had occurred in
several instances, wherein athletes would come to her with gossip about her personal life or
her skills as a trainer. She concluded by saying, "You've got to make friends or you're
dead meat."

A final kind of stereotypical label that seemed to attach to women trainers revolved
around the term "lady," and also was accompanied by a sense of being protected by
athletes. Some noted how football coaches would apologize for swearing in their presence
by speaking of "offending the ladies." Again, this kind of protection was the basis of some
of the exclusionary practices described above. One group of women laughed about how
some male athletes would criticize others for discussing "crude topics" in their presence,
saying, "Hey, there's a lady in the room!" One SAT said that such behavior was "nice to
hear," given the apparently common pattern wherein athletes, and football players in
particular, would not seem to mind who could hear such talk.

It should also be mentioned that stereotypes into which women trainers were often
cast were also directed toward women athletes by women trainers. Several women in a

group interview agreed that women athletes were more "whiny" or complaining about such

88
things as rehabilitation and undergoing ice treatments. They also agreed that women
athletes were more "moody," one SAT stating that while men could "block out" their
emotions, women athletes seemed to carry their emotions into their performances. This
latter assessment of women athletes was associated with menstruation. A male athletic
trainer also noted an incident where coaches had essentially stated that women athletes were
generally inferior to men, and that ideas about the inferiority of women were "rubbing off
from the male coaches onto the male athletes."

Among the roles apparently prepared for women in the program to assume, then
were those of mother, sister and lady, the latter of which seemed to have meant that these
women were, to some degree, Seen as potential romantic interests or sexual partners.
Again, the policy prohibiting the development of close relationships between student
trainers was particularly felt by women. As became evident, combined with these
perceptions was the apparent burden of responsibility on the student trainer to manage both
the substance and perception of such relationships. I explore next the context of men and
women student trainers as they described how their experiences have been sexualized—-that
is, where sexual innuendo and imagery pervade the work atmosphere. Again, I believe that
the burden of having to work in this context and the related responsibilities were borne
more by women than by men.

5 l' . l H

Recall that one of the reasons SATs cited for the exclusion of women from certain
practices were allegations by coaches that they were "distracting" to male athletes, the latter
of whom were presumably unable to concennate on their activities in the presence of
women trainers. The assumption behind the decisions of coaches to "kick" women trainers
out of practice--i.e. that they are there to pick up men--seemed almost universally to color
the experiences of women trainers working with male athletes. Additionally, this
assumption attended to nearly all conceivable interactions among women trainers and male

athletes. While there were similar prohibitions evident in the descriptions of male trainers,

89
in their case these seemed to revolve principally around the actual performance of athletic
training duties. One other distinction between men and women was that only women
reported being sexually harassed by athletes. To follow, then, is a summary of the SATs
comments about the sexual assumptions and associated precautions which revolved around
their activities, the experience of sexual harassment by women, and the ways women dealt
with these matters.

A good portion of two group interviews was spent discussing the implications of
the policy prohibiting socializing and other types of non-professional interaction between
student miners and athletes. Several women spoke about their meding to chm between
what was characterized as "bitch" orientations to male athletes-which were essentially
synonymous with both "professional" and "rude,"--and "friendly" ones, which were
described in terms such as "nice" and "sociable." The underlying assumption about these
interactions with male athletes, they said, was that it was seen as a "pick up" situation.
Interestingly, one of the apparent complaints lodged against some women trainers was that
their appearance seemed to be distracting to athletes. One male trainer spoke of "trouble
with them wearing their shorts too short or putting on lipstick on the field," which he said
had led to hostility from a coach. Indeed, one group spoke of how the issue of makeup
was included in comments one woman SAT received on an annual evaluation of her skills.
Moreover, another woman was apparently told that she was to ignore compliments on her
appearance from players and coaches. Male SATs were not immune from scrutiny on their
appearance, however. One description included an incident in which a coach told a male
SAT to remove an earring. The coach in the incident was quoted as saying, "Guys don't
wear earrings out here."

I asked these women what they were expected to do in response to the initiation of a
social conversation with a male athlete. One woman responded that she assumed she was
expected to be courteous but standoffish: "If they say, 'Hi,’ you say, 'Hi,' but you go and

scurry off and start reading or something." She added that she refused to engage in such

90
behavior, and instead liked to "be involved with what people were doing." Her
understanding of these prohibitions and warnings were

Because I guess they think it's unprofessional. That’s what they say.

Because then we’re being women, as far as were being nice and giggily.

Even if we were not being giggily. 'You're being too nice. You're acting

weak. You're acting pretty. You're acting like a girl.’ And we're not

supposed to do that.

When I asked whether there were an equivalent set of restrictions on men in the program,
one woman responded. "No the guys can talk; they can joke; they can party; they can do
whatever they really want. " Indeed, what struck many of these women about the
socializing policy was that, not only did it seem only to apply to them, it was part of a
larger system of double standards about social relationships. Several were aware of male
SATs who lived with athletes, which was presumably against the policy. However, I
discovered that it was also the case that women trainers had lived with women athletes and
that some women SATs had plans to live with women athletes in the future. Nevertheless,
while the living situations comparison might have been roughly equivalent, there seemed to
be little evidence that male trainers had sexualized assumptions attached to their everyday
interactions with athletes. As one SAT concluded, to which several men and women
trainers concurred, "It's your standard thing, you know. Guys who are social and
flirtatious are studs and women who are like that are sluts."

Among the activities of both men and women SATs which also involved
sexualization was the general talk the trainers described as pervading many of their work
contexts. A number of student trainers spoke of needing to "set the tone" in their training
rooms, given the proclivity of athletes of college age to discuss sexual t0pics. One SAT
described such talk as "getting way out of hand," and in some cases involving coaches. As
mentioned earlier, such vulgarity was part of the explanation for their exclusion from
hockey and the reason for their exclusion from certain portions of football practice. In the

case of football, moreover, one SAT said she understood the football coach's rationale to

be, "Our daddies never talked to us that way, so he doesn't want us to hear those words

9 1
from him." She added, however, that such protection from vulgarity does little good when
so many others in the work context are engaged in it. Indeed, other examples of such talk
included male and female athletes talking about sex on a bus dming "road trips," and
football players discussing the past weekend's "sexual conquests" in the training room.
Moreover, these latter discussions among athletes about sexual activity were intentionally
started, some women noted, when they were in the room. As one trainer noted

Just foul comments. Like if they know, if certain athletes know you're in

the room, and you may be cleaning something or minding your own

business, they will start up conversations that degrade women just to get a

rise out of you. And in those situations . . . When it's directed to me, I

don’t know. . .I don't know, maybe it's the stereotype that women are

softer emotionally that the guys constantly try to break you or try to get to

you.

Such general "atmospheric" conversations were also accompanied by direct sexual
harassment from players. While one woman reported that she had been approached by a
player who said, "Hey, I got a condom. Let's get busy," anOther told of being harassed on
a daily basis:

There are certain guys on the team that won 't leave you alone. Well, say

like there was this one guy who is known as one of the really rude guys on

the team. He was always, ’Yeah I know about you . . . I know what

you're like.’ And there was nothing to know. So he was harassing me in

that way. Then he'd always say, basically to everybody, ’50 baby, when

we going out? I know you want me,’ all this crap. So you just learned

how to deal with it. There were just a couple other incidences of that. In

that respect, you know I can see why they don't want you date the athletes

because then that would probably be even worse.

A few women also reported incidents of actual physical contact made by an athlete.
One reported being "kissed on the check," in a "friendly" manner. Another woman,
however, reported being alone in a room with an athlete who had continually harassed her,
and eventually being "nearly backed into a corner." Again, returning to the exclusion of
women from hockey, one SAT noted that the "mentality of hockey" was such that, he
believed, harassment would be such a problem that "it could turn into a bad situation." One
example he noted included ice hockey players joking about how a woman reporter and a

woman trainer had seen them naked While all of these incidents were reporwd to have

92
been handled to the satisfaction of the women involved, they are indicative of the types of
potential experiences exclusive to women trainers in the study.

Note however, that, thus far, such contact, along with the rest of the above
described incidences of the sexualization of women trainers, have been essentially outside
of the context of them actually performing the tasks described as duties in the previous
section. In light of the above, when it is recalled that actual physical contact is required of
- trainers with athletes, the potential for sexualized construals would seem to be great.
Physical contact between trainers and athletes timed out to be an issue about which both
men and women were equally concerned

In this regard, the issue of the legal liability of trainers was a point of discussion in
all of the group interviews, in most cases relating to the fear of being sued for sexual
harassment associated with their duties as trainers. As one student put it:

Even if you just put your hand on someone ’s back, that could be sexual.

Whether I was to do it with a female or male, depending on how they view

it, 99 percent of the people wouldn’t mind, if there ’s that one percentage

that would say, That’s harassment.’ Because if you can’t, and that’s with

any profession, you just have to cover yourself anymore.

While the issue of contact between trainers and athletes might be thought of as being similar
to that between, for example, nurses and patients, the context of the work of these students
apparently made certain kinds of contact impermissible. In particular, contact in or around
the genital area was described as basically prohibited, though it seemed to depend on the
particular context and individual comfort levels of the particular trainers and the athletes
with whom they worked Some trainers spoke of finding same-sex replacement trainers to
perform tasks, such as groin wraps, with which they or the athletes were uncomfortable.
Similarly, some brought in same-sex witnesses to be present during certain potentially
sensitive treatments. Others spoke of simply keeping the athlete informed of what they
were doing while performing a procedure and that athletes were to alert them should they

become uneasy about the process. Accompanying this latter approach with a "professional

demeanor," as one trainer put it, seemed to work well. However, one SAT noted an

93
example of an athlete who turned a stretching incident into a sexual encounter by "pressing
into" her. Again, this incident was reported and resolved to her satisfaction.

These ways of handling potentially litigious situations were perhaps the most
formally worked out in terms of actually managing problems associated with the work of
student trainers. As was mentioned earlier, in many other cases, it seemed as if the student
trainers were essentially on their own to manage problems associated with sexualized
assumptions about interactions, sexual talk among athletes and other problems. In some
cases, however, serious problems were reported as being referred to staff and were, again,
adequately addressed in their view. However, I was concerned with how they felt about
these differences in experience which were related to gender and any more general actions
they might see as helping provide a more equitable context for their work. It is to these that
I now turn.

Eercentiomandfionina

I conclude this section by discussing the student trainers' responses to how they felt
about the apparent differences in experiences between men and women in the program As
just mentioned, it seemed as if the majority of the responsibility for handling gender related
problems was placed on the student trainers themselves. Generally, the answers to
questions about coping with these problems revolved around powerlessness, doing one's
job and rationalizing sexist behavior. I conclude with the views of some of the trainers
about their perceptions of the differences in experiences for men and women, both in
general and in terms of professional preparation.

To reiterate, many of the trainers felt it was their personal responsibility to manage
for themselves, occasionally with the help of others, any of the experiences they had of
harassment and other sexualized or stereotypical views of them. Some women who, for
example, were the subject of sexualized comments "atmospherically," said they simply
ignored the behavior. Those who felt that such talk had "gone too far," stated that they had

adopted strategies for dealing with such situations, all of which were in the form of retorts

94
to the athletes who engaged in the behavior. Most of the athletes they worked with, many
of the women wanted to point out, did not engage in this behavior, felt it offensive, and
became allies of the women. In a couple of cases, however, the athletes were reported to
more senior level trainers who were then said to "handle" such problems in various, though
unspecified ways. As one woman concluded, "I had a problem once with an athlete and it
was taken care of. I waited until he was repeatedly obnoxious or made some gestures to
the point where it interfered with my jo ."

Regarding the more general "facts" about such things as sport assignments and
various exclusions in duties associated with men's athletic teams, there seemed more of a
sense of powerlessness. One woman noted that such exclusions, given the fact that a
majority of the program was composed of women, would inevitably mean that less
qualified males would be working more prestigious sports. Yet, many felt that they were
in a highly respected athletic training program, and for that reason, the benefits of silence
about these issues outweighed any risk they might assume in objecting to these exclusions
and other work conditions. As one woman put it,

Well they have a lot of excuses why they can’t put us somewhere. And

you know that’s, I mean you’re under their program and then it’s up to

them to give you the recommendation. You don’t want to leave because

you know you’re in a good program. And so there’s only a few things like

that really upset you sometimes. You know that it’s not only their call

either. That coach might be saying, ’You can ’t have a woman over here,’

or whatever. That’s when the university should step in and say, 'Well

that’s not the coach’s call if she ’s over there or not.’

As another woman put it, regarding the "old school" notions of a coach, "I don't
know. You never want to make waves. To me, it's not worth it. If that's what he
believes, then who knows? You deal with it." This strategy of simply explaining such
practices as stemming from irrational or outdated beliefs about women seemd to be
common. Many seemed to combine this writing off of the behavior with simply immersing
themselves in the work itself: "Just stay quiet, ignore it, do the extra work. Or, you
know, do as little as you can to get by. And I do some of that, too. Otherwise it's just

unbearable." In the case of the "dicks and pussies" incident, one woman concluded, "I

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think you can look at it as being offensive or you can look at it as him just being a jerk and
that's his attitude and you can't change it." More than this, one woman trainer said that
such exposure to these attitudes might help her ill the future:

Well, in a way it’s good because it’s reality. When I get out there, it’s what

I’m going to find because a lot of the coaches are old school. So I need to

know how to deal with it. It makes me angry to no end. I honestly was

waiting for [coach] to get into my face about something stupid, because I

was very determined that I was going to tell him to stick it up butt and turn

and walk away from him. I decided that at that point that I didn't care if I

had gotten kicked out of the program. It was worth it to me that I wasn't

going to turn into a little ball of Jello like everybody else did when he

screamed at them, because he’s [the coach]. So it made me mad. . . And I

don ’t think it was that bad, it wasn’t completely discriminatory in any way.

This last comment, that the program was not "completely discriminatory in any
way, " was more common than I had expected in light of the kinds of exclusions and cther
incidents that were described As I indicated at the beginning of this section on gender,
perhaps my conclusion that women in the program had considerably different experiences
than men was a bit overdrawn. Clearly, it may be that my own reaction to the content of
some of the few incidents these student trainers reported was not adequately put in the
context of the day-to—day experiences of these trainers. Moreover, being asked whether
their experiences had been different due to gender may have brought forth these responses
more than they might have had the issue been broached in another way. Attention to daily
experiences, again not undertaken in the form of observations, may have ”washed out"
these incidents considerably into the context of other more mundane and perhaps
compensatory activities that were simply not described by these students in the interviews.
I think this is a plausible way to look at the conclusions some of the student trainers drew
about gender-based differences in their experiences. On the other hand, the fear of long-
term consequences may also be reflected in the willingness of these women to stay in the
internship, not complain about it, and even cast in a favorable light a program that clearly
featured gender-based discrimination and harassment.

One woman, indeed, concluded that differences in experience were not entirely

based on gender:

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I don’t really see it along gender lines, the dijferences of the experiences. I
see it along like attitude and personality, really more than anything else, as a
combination with gender. We have one girl that's extremely grufir and like

. . . Her way of being standofi‘ish with the guys and being short with them,
to stop the harassment and wisecracking and stuff, was to be nasty about it.
And that backfired on her. They thought she was a bitch. But guys can do

that and it’s not that big of a deal. Mostly, a personality thing.

Others again noted the advantages of assignments of women and men student trainers to
women's and men's athletic teams:

Well, I don ’t think there’d be a dijference between males and females. All
pretty much get a share of the same. Like, it’s really just a matter of what
sports you get assigned to as far as what experiences you get. I don’t see
any differences in the way they, either male or female, they assigned to
what sport. It's usually everyone gets stuck with football for a while.
Eventually, you’re going to end up going back to the same sex sport. . . I
think they’ve got a pretty good system where everyone gets a similar
experience from the sports aspect, from what sports you get in. I think it’s
pretty fair that way as far as experiences, injuries and that type of thing. If
there’s any kind of bias there, I don 't think so. It seems pretty fair that, like
women they'll stick with men’s basketball or football, that type of thing,
and guys they’ll get stuck with women’s gymnastics or that type of thing.
So, I think it's pretty fair.

Finally, as noted at the beginning of this section on gender and experiences, one
SAT noted the changes being attempted in the profession in order to open employment
opportunities to women. He suggested that there are basically equivalencies in experience
and, as other student trainers also asserted, one needs to be aggressive and "make
something out of" the internship experience:

No. I think here the preparation is identical. It comes down to what you
make out of it. They could still learn more about the football, and I could
still learn more about female sports, so I don 't think you’re ever treated
different in that respect where the guys are put on one path and the females
are put on another path. I think, if anything now, there’s a push for the
females to be a little bit more aggressive to get more experiences because
there is a big hiring push for females trainers. There are a lot more jobs for
females, so I think they might even be pushed more than the males right
now to get the difi‘erent experiences and to gain as much experience as
possible. I don’t think one is sectioned of more than the other, or anything
like that.

I E . l E l .
The preceding discussion of the experiences of student athletic trainers in terms of

gender may have suggested that these students work in an air of extreme caution about their

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interactions with athletes. Again, this might seem particularly so for women, who said
they had difficulties in maintaining "professional" impressions of themselves without
undermining their rapport with athletes by being perceived as cold and indifferent.
However, as I learned from questions regarding the student's individual handling of the
policy against socialization, the "facts" of the circumstances in which student trainers work
are simply not conducive to such relationships. The most significant of these facts, at least
insofar as they are accurate, is that the majority of the interactions of members of the GSU
sportsnet with athletes were those involving student trainers. As was shown in the
previous discussion, these interactions take place in a number of varying circumstances,
and include conversational topics which extend well beyond sports participation.
Moreover, as just discussed, the status of relationships between student n'ainers and
athletes vary from those which seem "strictly professional," to "motherly," "sisterly," to
being close friends and perhaps romantic partners.

Also indicated by the previous section, some student trainers felt that the
establishment of trust in any of the relationships they have with athletes assists them in
doing their work as athletic trainers. I therefore asked these trainers how they personally
managed their relationships with athletes, what they learned and what happened to athletes
as a result. Again, my reading of Nixon's (1992a) concerns about sportsnets was that he
was primarily concerned with how medical information about athletes is produced,
processed, interpreted and shared with athletes, and that this process cannot be fully
understood without some knowledge of the social context of this process. Moreover, I
wanted to pursue the ways in which student trainers might assemble the materials for an
athlete's "moral career" as a recipient of athletic training services.

While I feel it necessary to explain my thoughts about this information process as it
regards student trainers, I think it useful to present a bit of further data first. I believe it
essential to begin with the reasons student trainers understood were behind the policy

against socializing with athletes. What I found was that, while most SATs could see the

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reasons the policy was put in place, many were insulted by it and found adherence to it
nearly impossible. Most stated that they possessed the self control and matrnity to be able
to successfully have a close relationship with an athlete and keep it separate from their
work. Additionally, some added that it is unreasonable to think that an athletic trainer
would not have common interests with athletes. One trainer explained, "I think that people
who go into the athletic training field have a background of athletics. They feel comfortable
around those pe0ple. That's why we're doing this." Indeed, in the words of another
trainer, it is also unreasonable to think romantic interests would not develop, in that not
only comfort but physical attraction is present:

I mean you just happen to be attracted to athletic bodies anyway. You

appreciate the hummt body as a trainer. I mean, I can’t believe a trainer that

wouldn’t appreciate someone who was fine-tuned, you know, and if you

get a chance to go out with them, why not? If they’re a nice person, I don't

think they should say that you can't.

Again, many added to such comments that they spend 40 to 70 hours per week with
athletes and that it is neither reasonable to expect them to develop "outside" social lives, nor
is it realistic to expect them not to come to admire some of those with whom they spend so
much time.

Others noted the potential for turmoil in the training room should a relationship
between trainer and athlete becorrre problematic. Some student trainers believed that the
policy was simply meant to insure that they adopted a professional demeanor, to insure that
they were taken seriously by athletes, and so that their authority in rendering professional
judgments was not undermined. A frequent example to illustrate this was the case of
student trainers, seen as representing sound health care practices, who presumably
contradicted their professional roles by going to bars with athletes. One SAT objected to
such practices and believed these trainer/athlete relationships ought to be similar to a
"doctor/patient relationship," saying that it was a matter of maintaining "ethical

boundaries."

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Yet a number of student trainers recounted examples of how they were successful
in the management of these dual roles of trainer and friend Again, they explained, it was
simply a matter of changing roles from one setting to the other. One SAT explained,

For me, I guess I was mature enough, if you can use ’mature,’ to make that

difference and put on that professional persona within the training room

environment, and then drop it when I was out and be able to socialize. As

long as a person can do that, I don’t see a problem with it.

Moreover, a couple of student trainers laughed about how their early experiences as student
trainers were spent learning precisely why such dual identities were necessary. As one
trainer recounted his experiences:

I did everything with them. We went out. We’d go to bars, whatever.

Because I didn’t know or understand the professionalism involved in

athletic training, I went out with them. And then I got into the profession a

little bit more and I kind of backed away from them. Because I was already

such good friends with them, they respected what I was doing. A lot of

times, I may see them out, or whatever-J told them, ’I’m a trainer. I don’t

want to talk about anything.’ And they were really good. They never

brought anything up. If I saw them in a bar, or if I was at a party and they

showed up, or I showed up at one of their parties, or something, they never

discussed it. They respected my privacy and I respected theirs. Actually, it
worked out real well.

This nainer's not wanting to "talk about anything" reveals another class of reasons
the student trainers stated was behind the no socialization policy, and the central interest of
this section of the data. Obviously, this warning related to what the student trainer might
see as a result of engaging in social activities with athletes. Again, both student trainers
and their athletes are college students, and as one SAT put, "do what college students do."
As briefly mentioned in the section on duties, heads of sport, as well as other trainers,
described being put in the position of having to monitor the behavior of athletes. Such
behavior may include that which is illegal, against team policy or, in the view of the trainer,
counter to their health and well-being. One trainer even developed a "rule" in this regard:

One rule that somebody passed on to me was, ’00 out and have all the fun

you want, but when trouble happens, leave, so that you’re not there to s ~-

when the football player beats the crap out of some guy, and you get called

into court--to say, 'Yeah, he did it,’ or lie for him and say, 'No, he didn’t.’

So, you're not in that position. I think I kind of followed that. If things
kind of got out of hand, I said, ’Guys, I can ’t be around this. If it’s going

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to continue, then I ’11 just take 017, no big deal. If you guys want to wait
until I leave to do it, that’s better.’

It seems, then, that student trainers are under a dual obligation: They are not to be
associated with rule-breaking behavior, yet they are to report it should they witness it.
Moreover, it also seemed that the concern of these students was not with having their
authority as student trainers undermined, but rather with having their identities as athletic
n'ainers associated with their identities as students and friends of athletes outside of the
work environment. It was, indeed, the knowledge produced as a result of these outside
interactions with athletes that student trainers felt was essential to doing their work inside
the training room. -

A number of issues emerge and build upon one another as a result of these
considerations. First, it appears that, to some degree, these student trainers may be in
positions of conducting "surveillance" on athletes. While none of the trainers actually used
this term to describe their monitoring activities, it seems to be the case that at least some of
these trainers witnessed the entire day-to-day existence of athletes, came into possession of
information about them as a result, and hence had a wide vantage point from which to
"contextualize" their injuries, illnesses and other problems. That is, they may see a
particular problem within a very large context of how these athletes live, and actually find
that information useful in doing their jobs. Importantly, with respect to Nixon's concerns
about injury, it may therefore becorrre part of the entire interpretive and practical framework
whereby an athlete's injury is evaluated, treated, rehabilitated and otherwise processed
within the system of medical services of which student trainers are a part.

Second, recalling the discussions of the assignments of trainers to teams, and the
"mothering" role adopted by some trainers, the building of trust was mentioned as being an
important way of encouraging athletes to share even highly personal health information
with trainers. This suggests that not only did n'ainers passively receive information
voluntarily brought to them by athletes, they believed it effective to actually foster these

tendencies in athletes. Hence, how these processes of revealing take place, whether they

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are encouraged or discouraged within the sportsnet, and what confidence-building
techniques these trainers use will be relevant to understanding the subsequent use of the
information they facilitate. That is, the "terms" under which an athlete may confide, or
"confess" their anomalies to trainers with whom they may be close may have very much to
do with how the knowledge of those anomalies is actually used

Third, as a result of the combination of being close to athletes, having possibly
taken steps to foster that closeness, and possessing personal information about them, these
student trainers may find themselves in particularly difficult positions as it relates to both
their obligations as peers and friends of athletes and as developing professional trainers.
Recall that in the case of professional athletic trainers, Kotarba ( 1983) found them to be
"bridges" between athletes, coaches, physicians and others within the sportsnet. We have
already seen glimpses of this in the examples of student trainers taking on "staff" roles and
having to "bust" athletes who break team policies. Hence, it is possible that student
trainers will be in the "middle" of such issues on a regular basis. Again, the fate of the
athletes in light of decisions these students make, and the subsequent path such information
takes, seems important to "mapping out" the world of student trainers.

Finally, it is likely that, given the scope of their knowledge about athletes, the
information student trainers come into contact with will go beyond their expertise and
include psychological and Other problems outside their range of their skills or resources.
Hence, they may then need to seek a referral in the "best interests" of athletes, even though
it may harm the relationship which made the revelation of the problem possible in the first
instance. Moreover, some SATs will undoubtedly decide to attempt to address the problem
themselves. How they decide, and when they do so will be revealing of their perceptions
of their own roles and also lead into the area of counseling or advising athletes. The name
of the problems they confront and how they themselves manage them will throw further
light on the workings of the medical sub-units of the sportsnet with which Nixon was

concerned.

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In any event, these were my "hunches" and the rationale for asking student trainers
how they personally have handled the socializing policy, and the issues that came up for
them as they acquired and used information about athletes. The following will describe
what student trainers said they learned about the athletes with whom they worked, where
the information they collected went, and what it meant both for trainer and athlete.
Moreover, among the things student n'ainers learned about athletes as a result were a
multitude of problems, to which some of them responded by engaging in counseling and
advising roles. Hence, I explore the problems and questions for which they were
consulted and, to some degree, the advice and counsel they gave.

Information

If you’re cold, you’re not going to get anywhere with it, you need to be

easy to talk to. The way we learn stufi is through information, by

communicating. If you can’t communicate, ifyou’re cold to the person,

you’re not going to get any communication. I mean communication is a

major key in athletic training. Communication like, ’Does this hurt?’ You

need them to say yes or no to you. That’s going to help decide. There are

some things that we can feel. But lots of times it is based on what they tell

you. So you need to be personable as trainer.

It should be fairly clear by now that the relationships among students and athletes,
combined with the responsibilities of heads of sport, rendered the health care system for
athletes quite unique. These student trainers were in a position to discover a myriad of
things about the athletes with whom they worked I begin here by summarizing the ways
that these trainers come into contact with such information. These seemed to fall into
categories of the basic circumstances in which these student trainers find themselves: the
actual fostering of relationships with athletes such that they would reveal information; and
finally a couple of examples where trainers were actually asked by others to acquire
information about athletes.

I begin with the simple circumstantial factors. As might be anticipated, the
proclivity of athletes and students to share information is partly a matter of commiseration.

Indeed, along with the fact that student uainers and athletes are peers at similar periods in

their lives, they are also, as the Duties section revealed, in very similar situations in terms

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of time demands, schedules, and simple interests in common issues. Hence, many spoke
of how common age and empathy play a role in these relationships. Some disagreed
however, that age was a crucial matter. One student trainer said that it was simply a matter
of convenience and "access" that explained the disclosures she obtained from athletes.
Another said that he believed, in some cases, similar age was a prohibitive factor:

Sometimes with the age thing, also, it’s, ’1 don’t know if I should go talk to

him because he is my same age.’ He or she will go talk to someone who is

older and maybe they think has the experience or some wisdom that

someone my age, or their age, doesn’t have.

While long periods of co-presence may not necessarily a confidant make, most of
the circumstances the student trainers described were just such periods. It was the
observation of one trainer that time on a road trip, and the resultant hours of company with
athletes, tends to "evaporate" the roles of both trainer and athlete such that, “it’s not trainer
advice; it's just sitting there shooting the breeze." One trainer pointed out, moreover, that
as a result of this state of affairs, they are in some cases the first to see problems with
athletes:

You’re going to know a lot of things before a head trainer does, because

while you’re on those road trips and stufi, you see these people for a long

period of time. You’re going to see if they have a drinking problem, or if

they have an eating disorder, or if they have an alcohol or drug problem, or

just a psychological problem, like depressed all the time, or don’t talk, don ’t

interact with their teammates. You ’re going to see those type of things and

those are the things that you’re going to have to confront.

Indeed, consistent with most medical epistemologies, the perception of a change in the
athlete's behavior seemed to be key to tipping off their recognition of problems. Hence, it
becomes important, SATs insisted, that they know each athlete individually and therefore
establish a set of baseline behaviors from which one may then pick up on aberrant ones:

Yeah, I think you need to know each member of the team you’re working

with on an individual basis because you need to know some of these things

that are going on. Actually last year one of the [athletes] had an eating

disorder. You have to be aware of those things and be aware of their

personality. Their roommate may have spotted it and brought it to your

attention, but you have to be aware of it and watch that person when you’re
around them, even if it’s outside the training room or whatever.

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One must be reminded, as well, that student athletic trainers attend the practices and games
of these athletes and therefore have an established picture of their performances, and the
nuances therein. Such things as changes in gate during running, facial gestures, or simple
declines in performance may be expected also to suggest problems.

Beyond these simple circumstances of long hours of monitoring, similar age,
immediate access, and the establishment of these baseline behaviors, SATs may actually
take steps to encourage athletes to inform them of problems they were experiencing. As
might be anticipated, some of these techniques were fairly obvious. Being what was
described as "open" and "accommodatin g" was among these. As noted earlier, providing
one's home telephone number was the most common example of this, and several student
trainers reported receiving telephone calls in early morning hours. Indeed, in terms of such
openness, one trainer severely criticized student trainers who were like "robots," or
"computers," who "tells you exactly what you punched in and gives you feedback and
that’s it.” Asked if she felt that being a confidant is within the job description of an athletic
trainer, one SAT replied

Yeah, I would. I would. Only because, if they don’t talk to you, who are

they going to talk to? And so, you know, but do not act on it. Most of the

time you do know. Because you’re this symbol of health care to this

athletic team. You’re the one who knows where the Band-aids are,

therefore you’re the one who would know what to do if . And so

that’s the way the athletes see it. And for me, I don ’t mind—that. But there

some situations where it can get really difi‘icult.

Indeed, several student trainers recounted incidents in which something an athlete
told them in confidence was not revealed to a coachuthough it well might have been under
the circumstances. It was after such events that SATs seemed to gain credibility and at
which point athletes were willing to confide in them. These incidents seemed not only to
be matters of holding secrets but also displays of defiance of authority. Athletes and
student trainers alike, it appeared, were aware of the implications of the information they
shared should it have been conveyed to a coach or other superior. In this way, student

trainers' holding of such information reflected their general willingness to be "social" with

105
athletes in opposition to policy, and hence build common alliances against the staff trainers
and coaches who controlled their fate.

Yet another way of winning the trust of athletes was explained as stemming from
simply being competent in one's work and skills. In other words, some trainers noted the
benefits of simply demonstrating their services as a trainer and being very skilled and
conscientious. Adopting what seemed to be a sales pitch, one trainer explained:

You should just say, ’Hey look. If you listen to me. Just give me an

opportunity to work for you for a week, and I ’11 give you an opportunity to

get from point A to point B.’ And all of a sudden you get them from point

A to point B, they trust you. From there, it’s just like a domino effect. The

next one goes to the next. Before you know it, then they have that

confidence to sit there and say. . , ‘Hey, I think I got a girl pregnant. What

do I do?’ And it all started because I helped him rehab his ankle and I got

him back in competition in two weeks. So that's how it leads. So it all

begins from day one. ‘

Among the most important athletic training skills, indeed, appeared to be making
accurate predictions for the rehabilitation period and return date of an injured athlete.
Related to accuracy in prediction, as one trainer noted, is simply telling athletes the truth
about their prospects, so that they are not disappointed by false hopes they might generate
as a result of being told "white lies" meant to boost their spirits in the wake of a serious
injury. Also, as noted earlier, if the substance of competence could not be demonstrated,
some student trainers said their simple position in a place of authority over athletes created
some misperceptions about their age, maturity, or even education level. Some spoke of
being mistaken for being "much older," or as graduate students, one as a physician.
Again, this, they believed, created conditions in which an athlete would share certain facts
with them.

Finally, a few SATs cited incidents wherein they were asked by a coach to attempt
to find out information about an athlete or take part in an investigative process. Examples
of these ranged from such simple things as a coach asking a student trainer to repeat what

an athlete had said under their breath in a heated moment, to having a drug test ordered for

106
an athlete suspected of using drugs. Among these is the following case, in which the SAT
was instructed to request a drug test, but then was not informed of the results:

Once I had a coach approach me and say, ’I think kid is smoking marijuana,
I mean he’s late for practice everyday, he missed five practices this
semester. I want him drug tested.’ Then, I don’t know what exactly the
policy is, but I called [the staff] and said he suspected. Anyhow he got
drug tested. Once I told them that they were like ’Fine, that’s all we need to
know.’ The only time I was contacted on that was when they said, ’Get a
hold of that athlete. Tell him that he’s got to be over to the doctor by 4
o’clock.’ And I never heard the results. Just because they’re afraid of the
fact that maybe if they test positive and say one thing to one of my friends,
it’ll spread like wildfire; They had a positive, better watch it.’ So I think
the things that are important or relevant like that are kept to the stem”.

This quote reveals several things. First, while these student trainers acquired much
information about athletes, there were some things they simply did not know, or are about
which they were not apprised Second, the fact that this information was purposely
withheld from the SAT suggests that staff trainers are aware of the alliances of student
nainers with athletes on such issues. Finally, this situation reveals the difficult situations in
which student trainers became involved. Being a part of such an invasive procedure as a
drug test of someone who may also be a close friend was but one among these.

Indeed, several SATs indeed spoke of the difficulties of being what was most often
called the "middleman," wherein they were torn as to what to do with knowledge they had
acquired about athletes or were simply placed in difficult positions between coaches and
athletes. Indeed, one of the steps SATs described as a part of entering the program was an
entry interview in which a series of hypothetical situations such as these were posed:

I remember when I was getting interviewed for the position and I had a
bunch of tough questions. I mean you have questions relating to what
would you do if you knew players were taking steroids. ’What would you
do if you were at a party and someone went to buy you a beer? What would
you do? If you saw a football player drinking, if you knew they were doing
drugs, this and that, and I remember thinking, 'What if you were at a party
and you see a football player drinking?’ You know, who am I to go up to a
football player and say, ’Put your beer down and go home’? ’ They have to
understand too that they still have a life; you still have a life. You don’t
walk into a party, see a football player, and turn around and go home
because you don’t want to or can 't see what they’re going to do or
whatever. I mean I don’t see it as. . . .I think if someone has a serious
problem then maybe you go talk to the right people about what’s going on,
if you know that something ’s going on. But, interaction, you know, you’re

107

with these guys three or four hours a day, five, six days a week. How
could you not talk to them about what goes on? You know, kind of
become their friends. You know, call them up, ’Hey what’s going on this
weekend?’ And next thing you know, you’re having a beer with them so
you're not going to go. . . . You have to be careful. but I don’t think, they
can’t be so naive to think . . .[stops]"

There was, to be sure, a good deal of exasperation at such circumstances by nearly
all of the SATs in the study. Again, many of the incidents they recounted involved their
possessing information athletes did not wish to be passed along to coaches. In some cases,
SATs were aware that athletes simply disliked their coach and were even aware of athletes
who had quit their teams for this reason. In others, student trainers were attempting to
provide satisfactory responses to coaches they felt were overly inquisitive. As noted in the
section on difficulties, a common occurrence was that athletes did not want their coach to
know about an injury they had sustained, and pleaded with their student uainer not to
inform them of it. In many circumstances, the SATs described withholding information in
accord with the athlete's wishes. The reasons for these decisions varied, but in a number
of cases, the student trainers seemed simply to decide that the problems were not
sufficiently serious to merit breaking their trust with athletes, as in the following
description.

I think those are the biggest things, like the drugs and the excessive
drinking just because it’s, I mean that’s team policy, school policy, NCAA,
all that. So there are definitely situations where you are told you have to
report them. I don’t think I really did ever report any of them, really. I
don’t think I ran into anything that was excessively out of hand. Some
things did break all the policies. I think if I would have seen somebody
doing cocaine, yeah, I would have, because that’s out of hand. If I knew
somebody that was drunk 24 hours a day, I probably would at least say
something to them, which would be kind of be breaking our policy--
because they don’t want us to be handling it since we are kind of just
learning what we’re doing-~but I don’t know if I would have ever just went
right away and said, ’Hey, you know . . .’ Actually, I did once. The
[athlete] broke [ a bone] because he was drunk and kind of pissed off. I had
heard stories that he gets a little out of hand. So I did mention it to staff.

So I guess there is one instance where I did that. [The athlete] was having
some other problems with home and school and everything else, so in that
one case I did report it. But, yeah, there are definitely specifics that you are
supposed to report.

108

There also seemed to be resistance and an unwillingness among the SATs to report
incidents that stemmed from their having been put into what they took to be unfair and
perhaps absurd situations by coaches. Interestingly, as mentioned earlier, two different
group interviews featured discussions of student trainers who were assigned to drive vans
to out-of-town competitions. In both cases, they reported having to follow other vans
being driven by coaches at high speeds and in unfamiliar places, and also being told that
they were to consider themselves "staff." In this apparently deputized role, they were to
monitor conversations and "bust" violating athletes if they were to reveal that they had
broken a team policy. In both descriptions, the SATs instructed athletes not to talk about
such violations in their presence rather than listening for and reporting them. As one
student trainer concluded, ”What you have to realize is that these people are adults. You're
not working with high school athletes here. If they decide to go out and get trashed that's
their decision."

It should not be concluded from these examples that student trainers were in the
habit of completely withholding information from coaches and staff trainers. Indeed, one
trainer, when asked if she had ever withheld information from staff, stated, "No, I don't
think that I have ever kept anything from them. I really don't. They need to know, I
mean, for liability reasons,-they need to know." In fact, in the description of the operations
of one training facility, the SATs reported constantly informing a staff trainer of
information they had acquired Perhaps the perspective of this trainer is illustrative of the
ways SATs approach the use of information:

As a student athletic trainer, I think you can take a little bit more relaxed

view on these things, unless you encounter a suicidal person, or person

with an eating disorder, that kind of thing. Then, I think that needs to be

directly assessed and evaluated.

However, there were cases presented of what might be termed "edited" information
being passed on--apparently adjusted in content in order to either lighten the impact it had
or to protect an athlete or the SAT him or herself. One example included telling a coach that

athletes had been sent home with the flu, rather than the fact that they were ill as a result of

109
excessive alcohol consumption the night before. Another was simply supplying a coach
and athlete with an extremely conservative estimate for the injury recovery timeline of an
athlete. Summarizing this issue, one trainer said, "emotions definitely do get involved,"
and seemed to want to protect the athlete:

It can get hard though because you do have athletes that get hurt. And

you ’re very upset too (laughs). You see these poor kids in pain and there’s

only so much you can do. And a lot of times you know what's going to

happen, but they don’t. And you know, should you tell them right away?
Indeed, information did get passed on or referred to other parties, according to a number of
student uainers. As might be expected, these were most often in situations the SATs
assessed as being outside their abilities.

We’re not supposed to be trained in all those areas, we’re just supposed to

be medically trained, but we end up having to deal with psychological,

sociological, physiological, every single level you can think of, you deal

with these athletes on.

Again, the apparent product of these "levels" is in some cases a comprehensive
picture of the life situations of athletes, and this brings up the issue of how the collected
information is used and what is concluded about athletes as a result. It should be pointed
out that when asked whether they thought knowing athletes personally helped them do their
jobs, nearly all of the student trainers said that it did Moreover, there seemed to be tluee
principal ways student trainers used the information they received about athletes. These
related to pain and injury assessments, gaining compliance and rendering advice.

Sharing much in common with the means by which student trainers detect problems
with athletes, the process of assessing the "pain tolerance" levels and presence of injury
was perhaps the most commonly mentioned use of comprehensive information about
athletes. As one SAT put it,

I think it’s important to know your athletes at a personal level because it also

tells you a lot about them and how they are going to deal with their injuries,

such as pain tolerance and attitudes toward their sport and how they feel

about other things. There may be a lot, like their coach or their parents and

their friends, or how they feel about their sport, is going to influence their

injury and their time of . . . And if you can find out a lot about a person,
you can find out a lot about how they are going to deal with it. Are they

110

milking it because they don’t want to go back? . Are they really hurt? Along
those lines.

As seen in the section on disruptions, the way SATs seemed to distinguish "real"
injuries from what they took to be manipulations of their services was by either having
constructed an informal history of athletes or by correlating the timing of the injury report
with certain stressful events. Emerging from these, again, were certain typologies of
athletes in terms of the student trainer's assessment of the honest reporting of injuries,
compliance with instructions and the competent "use" of athletic training services. Among
these, as several trainers noted, were "whiners," those who excessively and needlessly--in
the view of the SAT-complained about their ailments. Among the outcomes of these
typologies were certain preferences for athletes considered friends:

You have people coming in who are always whining, they’re just
complaining about something all the time. And you don’t really want to
work with them because you know there’s nothing . . . But then they could
be crying wolf, they hurt, hurt, hurt, and all of a sudden they really do get
hurt. I mean you have to pay attention to those people, but the people who
they are your friends who get hurt, you know when they ’re hurt because
you’re used to them. You’re used to seeing what bothers them and what
doesn’t. You learn each person ’s pain tolerance. Some people have very
low pain tolerance and you have to learn that. But with a friend, I give them
preference. I’m sure they would me. I don’t know if that’s the right or
wrong thing to do . . .

Yeah, you get to know them, and you figure out their pain threshold. Some
people, they might come over to you and, "oh, my hamstring, ah, ah! ”,
they’re in pain, they’re about to die, everything is wrong. But if you know
this person has a low pain threshold, granted you’re always cautious about
everything, you treat everybody the same, but you might not be quite as
suspicious if you know that this is such and such. His hamstring is always
. . . So, you know, you’re like, ’Well, let’s go ice it.’ Somebody comes
over that’s never hurt or they have a high pain threshold, you know they’ll
play through anything, just about. And if they go down, your eyes get kind
of big and you go out there and you’re thinking something, because, in
most instances, that’s the case. But, you have to treat both individuals the
same, initially, just to make sure nothing ’s wrong.

It seemed as if, ideally, these student trainers would like to think of themselves as
being genuinely concerned with every injury without prejudice, but it appeared that in some
cases, their own management problems and what they knew about the athlete colored their

approaches. Indeed, another way in which information about athletes was used, consistent

11 1
with these management problems, was in gaining compliance of athletes in both general

and specific situations. For some, it was simply a matter of maintaining order in the
training room:

I would go out with them and I would have fun with them but then also, if I
said something had to be done, they still had to listen to me. I mean, I was
the trainer, I was looking for their best benefit, you know. So, I got lucky.
I don’t think I ran into any circumstances where it was like, ’How can you
tell me this when you were out drinking with us last night,’ or, 'You were
out screwing around.’ I think most of the guys, especially the younger
guys now, like the athletes, understand that that line has to be. You have to
know about the line. If any problems came about, I probably would have
said, ’I can’t be doing this anymore.’

Other cases were more specific than a simple maintaining of order. Particular tasks
with definite objectives, such as attending and following rehabilitation regimes were among
these. A creative process, in the words of one trainer, was involved in assembling these
regimes:

I think every trainer, they know their athlete and they do the rehab according
to the athlete--you know, within the ankle sprain guidelines--but they still
modify things to fit that person. Because I don’t think a rehab is something
that is a, b, c . . . A rehab is something that, you have to make it more
personalized. First of all, they’re going to want to have to do it. If you

can ’t get them to do it, you’re not doing your rehab anyway; you’re not
following your a, b, c, d order of the professional way. I think all trainers
need to know about the person to get them to do the rehab and do the rehab
so that they'll do it.

Another student trainer noted that in creating a set of rehabilitation exercises for
athletes to perform at home, not only is personal information useful, such knowledge may
include some assessment of the resources of an athlete:

Most of the time it’s relevant. When you ’re creating a rehab for somebody

you have to know what they enjoy, what they have access to, what they can

afford. Be creative with the rehabs, you know. Nobody has a Cybex

machine at home, you can use the T herabands. If you don’t have a

Theraband, you get soup cans for a dumbbell weight; socks with pennies.

Use a broom handle. So I think it’s important to know what they have
access to.

A final use of the information by student trainers was in cases where they elected to
advise athletes or consult superiors in situations deemed serious enough to require

intervention by others. These issues are discussed in the following section on advice and

1 12
counseling. Here, a number of student trainers described how their use of information led
them to simply rendering advice and counsel to the athletes with whom they worked or in
serious cases, advising the athletes to seek other help.

Adsdooandfiounsol

One of the principal points that should be made before summarizing the cases with
which student trainers are confronted is that all manner of injuries, illnesses, discomforts,
anxieties, and difficulties, major and minor, seemed likely to be presented to these student
trainers. In most cases, the problems for which they were consulted were described as
being within the range of their skills. Much to their dismay, however, a few of the cases
were not neat and isolable problems leading to the straightforward application of their
talents. Rather, their descriptions seemed more like packages of interconnected problems
which may or may not have included an athletic injury, yet which perhaps they saw as
potentially leading to one. Hence, it should be remembered that the salience of the major
problems recounted by these students might overshadow the mundane nature of the minor
ones, and the latter are likely among those that the student trainers simply did not or could
not report, given the brevity of the interview.

The problems for which trainers were consulted revolved around career decisions,
personal matters, substance abuse, eating disorders, and other psychological problems,
including suicide. I asked the SATs to provide examples of the kinds of problems for
which they were consulted, and in a number of cases, they provided detailed accounts that
included names, assessments of personalities, and outcomes. While I felt it necessary to
provide a summary of the types of cases these students find themselves involved in, the
nature of the descriptions were such that, were they quoted verbatim, might have easily
identified the athlete, and certainly the student trainer involved. Hence, in some cases such
descriptions were omitted as quoted material, or were summarize in a form that I felt would
sufficiently disguise these cases not to reveal identities. These factors should be kept in

mind as the following is presented.

l 13

Given all of the cther issues that have been discussed thus far, it may be forgotten
that these student trainers, and those with whom they worked were located on a university
campus at which they were full-time students. Again, both athletes and trainers shared
similar schedules, although athletic training work schedules of the student trainers, and
heads of sport in particular, had necessarily to envelope those of the athletes to some
degree. Given this, it should not be surprising that there were a number of incidents
recounted by student trainers of rendering advice analogous to academic counseling. One
trainer spoke about how long road trips are "notorious" for providing career counseling to
athletes who have not thought about what they would like to do beyond their "careers" as
athletes. Another spoke about how the athletic trainers themselves appeared to athletes as
models of students who have chosen a career and are on their way to pursuing it:

They don’t know what they want to do in the long run. So a lot of people, it

seems, look to us, because we’re doing training right now, 60 hours a week

or whatever. We know we’re going to be trainers or in the health care

profession, and all these guys are here, 'Well, I know I want to play . . .

for four years, but I don’t know what I want to do after that.’ I had quite a

few discussions with a couple different people about how they don’t know

what to do with their life. And they’re like, 'You guys seem like you’re so

right on the line and you’re already set with what you’re going to do.’ So

they ask about that.

Another SAT told of how younger athletes came to them for advice on how to "handle" a
professor in a case of a missed assignment or poor grades. The SAT'said that he suggested
that they pursue extra credit options and request incomplete grades.

Another category of counseling the SATs reported revolved around problems
athletes were having with their personal relationships and families. These ranged from
talking to athletes about their romantic relationships to family problems and parental
pressure. Two trainers said that they attempt to stay out of rendering advice on dating.
While one said that the athletes can rely on their teammates for such advice, another stated
that "you don’t know them well enough to know the whole situation, and you might tell
them something and have it totally turn around on them." Another trainer, however, said

he not only attempted to help with such relationships, but with "lifestyle choices:"

114

Yeah, I feel like I make some lifestyle choices for some of my [athletes], in
terms of dieting, weight problems. I ’ve talked to people about that and
counseled them. We've sat down together and we ’ve gone over some diets,
done some little things. In temts of relationship problems, parental
problems, I ’ve counseled people on that. So, your answer is definitely yes.
I think that is definitely part of the job. Whether it stops at our level or
continues on to a higher therapy level, I think is not only up to us but up to
the athlete. I think we usually, generally, hear of things first. So as a
student athletic trainer, yeah, we do. We do a lot of therapy. At least]
have, personally.

Among the problems about which the student trainers said there were consulted
were those relating to the parents of the athletes. Some trainers reported that they had not
only come to know their athletes, but their athletes' parents as well, one even saying that
"you really become part of the family and they tell you everything." Another spoke of
how parents had constantly telephoned her to ask about the injuries sustained by their son,
who apparently did not keep them informed. She added that "they know they can get better
information out of me than they can get out of their son." As noted above, however, the
problems these student trainers confronted were sometimes combinations of intertwined
difficulties. The following two examples are illustrative in this regard:

. . .There were so many people that I saw that came in with all kinds of
problems that were just snowballing on them. They started out thinking that
they weren’t [performing well] enough and then they had a problem with
their relationship, then they had a big family fight. I am not used to dealing
with all that stuff. In a way it was interesting to see it, but some of these
people have some big time problems. A lot of it is caused by their sport, the
stress that they have. Some of the athletes I've seen, especially in [my
sport], they just put so much pressure on being so good that it can just mess
them up big time.

Yeah, [ an athlete]. Her parents were making her [compete]. She didn’t
want to [compete]. She was having trouble in school. She didn’t have a
boyfriend and she really wanted a boyfriend. She just broke down one day
and she came to myself and the other trainer and just broke down and cried
and it all kind of came out. All the pressures that were kind building inside
kind of came out. She couldn’t go to her mom. Her roommate was [a
teammate], she couldn’t go to her. She couldn’t go to the coach, because
the coach was another factor in it. And so I think that she saw us because
we understood what she was going through.

Another category of such problems related to diet and eating disorders either
suspected or reported to SATs. A number reported simply providing advice to athletes on
how they could eat healthier diets. Others either were consulted about, or actually

1 15
recommended, weight loss techniques to athletes by suggesting dietary changes. For
example, a student trainer suggested weight loss to an athlete, suspecting it might alleviate
stress fractures and other injuries associated with repeated impacts. Such situations, the
SAT added, are "touchy:"

It’s touchy though, I mean every situation is different. Usually, when there

is a weight problem, it’s usually some mental angst that goes along with it.

So you can’t just say, ’Well, lose weight.’ 'Well, how do you eat? Could

you write down what you eat for like four days and bring it in to me and

we’ll look it over and then we'll try to advise?’ And usually they’re really

up to it, as long as they don’t feel like that there’s just this iron fist coming

down that’s telling them to lose weight or else. ‘

In two cases, however, SATs described how their monitoring of the eating habits
of athletes during team meals on road trips clued them into what they suspected were eating
disorders. The principal concern in such matters seemed to be at what point the trainers
were to intervene and refer the athlete to more qualified help. One stated,

It’s real hard to know the point where you can just talk to the athletes and

give them advice on what they need to be eating, and where you need to

turn it over to the stajf because you think there’ s a eating problem going on.

It’ s really hard, especially with eating problems. They never want to admit

that they have them.

Asked if she saw a lot of anorexia and bulimia problems with athletes, another trainer said,
"Not too much, but I have always made myself step in." She added,

Because once they go over that edge as far as their eating habits, it's very

hard to get them to realize that they are not that big. And that's just what

I ’ve noticed. Well, you travel with the teams, so you know everything

about everyone (laughs). And you know what they eat because we all eat

together. So if I see a problem there, I will let it go until I feel it’s hurting

the person’s overall health. And then I will step in.

Another SAT described a case in which it was suspected that an athlete on their
team was alcoholic. Again, noticing the athlete's behavior during social activities during a
road trip, the SAT followed the athlete’s subsequent behavior upon renn'ning home, which
included missed practices and further signs of alcoholism during practices. After
confirming these suSpicions, the SAT reported consulting with staff, who then confronted

the athlete. The athlete was then said to have quit the team and left school. The SAT

1 16
reported being quite upset about the incident, wondering how its handling might have kept
the athlete in school. The SAT concluded, however, that

I had to have one of the players tell me, ’Forget it. It’s not your fault.

There’s nothing you could have done.’ And then finally I realized it. It

took me a week and I was really down for about a week. But then I was

like, 'You’re right. There’s nothing I could have done. [The athlete] is

gone. There ’s nothing we can do.’ So we just have to learn to deal with

those type of things.

Two other student trainers were contacted by athletes who indicated that they
intended to commit suicide. In one case, the trainer described receiving a 3 am. telephone
call from an athlete who said they had broken up a relationship and were going to take their
own life. The trainer described going to the athlete's home and talking with them. The
problem was resolved by the next day. The other case described seemed more serious and
the trainer simply referred the matter on to a staff trainer.

Again, what should be kept in mind in light of these examples is that student
trainers dealt with a number of different issues which concerned athletes. As was noted in
the section on duties and disruptions, these student trainers were consulted on a number of
problems that they felt were outside their responsibilities and expertise. Recall that these
included reports of injuries too minor for their attention or busy schedule, injuries they
suspected were feigned, and mysterious injuries to which the skills they possessed did not
respond. The serious problems summarized above similarly seemed at the margins of the
student trainer's skills, particularly given the caution they used in approaching them and
their proclivity to refer them to more senior level staff. However, the next set of problems,
and the student trainer’s reactions to them, are at the core of the problems for which these
students are in the internship program, athletic injuries. The issue, nevertheless, is the
degree to which presumably "contextual" knowledge-what they know about the athlete's

life, relationships, personal and other problems-- become parts of their assessments and

treatments of the cases of injury presented to them.

1 17
Injury

The preceding summaries of the themes of duties and disruptions, gender relations,
and information and advice have provided a picture of the work of student trainers and have
also been setting up a context for the discussion of the injuries student athletic trainers
confront. Of course, one of the central interests of this study was the way the sportsnet, or
the larger organizational and cultrn'al context of the work, may frame the medical practices
of student trainers. That is, we have seen that the work of these student athletic trainers is
time-consuming and stressful, often more so for women--who are seen through the two-
sided coin of distraction and stereotype--and done with the athletes whose life and
problems they may know quite intimately. My purpose in this last section is to summarize
the responses of these students to questions related to their experiences and feelings about
athletic injuries and their views about the injured athletes with whom they work. I found
that, as the interviews progressed, two general themes emerged from the responses. The
themes revolved around the student trainer's personal excitement at work and the personal
responsibilities of athletes for their injtnies. In all cases, I asked that the students provide
as many specific cases as possible from their experiences. Again, out of concern for
revealing identities, it will be necessary to disguise or rather blandly summarize some of
these descriptions.

S . I .

I began the questions about serious injuries by asking the student trainers to think
about any serious injuries to which they have been witness and/or for which they provided
care. I let the SATs themselves define what they took to be "serious," which essentially
meant three different things in their responses. In some cases, serious meant the injury
itself and its implications for the immediate health status of the athletes. The following
example was described by a student trainer, who said this incident was the most serious
trauma that he had witnessed:

We had a kid that-~it didn’t really look serious--it was one of those that
didn’t really look that serious. The kid looked like he had the wind knocked

118

out of him, and we go running out there and he was already kind of turning
blue. The end result, he ended up fracturing like five ribs, and ruptured
spleen, Iacerated liver, Iacerated stomach. . . He just got sandwiched. That
was the one that I felt helpless. We were trying to . . . We had opened the
airway, we maintained the airway. Trying to talk to him, the guy was in so
much pain that he couldn’t really talk. He couldn’t tell us anything. And
we’re just sitting there and we kind of felt helpless. We knew it was
serious. We knew something was wrong, but we were really helpless, just
sitting there waiting for the ambulance to get there, knowing we really
couldn't do anything. We didn't want to move him, because we didn’t
know. We could have had a spinal injury. We just wanted to make sure.
That was probably the hardest one; just sitting there and feeling helpless.

In a second class of "serious," the term secured to refer either to the implications the
injtu'y had for the athlete's immediate status as an athlete, including the consequences of
time loss from play in terms of position on the team, or the immediate consequences of the
loss of the athlete for the competitive chances of the team itself. The following is
illustrative of such an injury:

I had an athlete, you know, who had a serious hamstring injury and he
actually tore his hamstring and he wanted to compete. Well, he continued
competing but you know we had to sit down and think about, you know,
what's more important. 'Is it more important for you to finish the season
out running on pain or would you rather heal up nice and slow, come back
next year and be more competitive?’ He was an All-American . . .So I
think when it came down to our season, he had the high expectations of
going back out and getting All-American honors.

Finally, a third meaning of serious pertained to long-term consequences of the
injury for the individual, both in terms of overall health and status as athlete. The
following case illustrates both the athletic and other implications of the injury:

Actually, one [athlete] we had was told by a doctor that she probably
shouldn't [compete] anymore, and she’s still [competing]. And you can’t
change that. You can only give them the precautions and do so much, tell
them that, ’Look, what you’re going to do, you’re going to risk your life,
or the ability to move your [limbs] ’ She had . . .problems and she had to
have surgery on both [limbs]. And the doctor said that if it happens again
she can lose the ability to use your [limbs]. But she’s still [competing]. It’s
hard to make them look at it.

It should be noted that such serious injuries included both acute and chronic injuries. All
three of these meanings of serious were used as the student trainers described their feelings

toward such injuries in the summary to follow.

1 19

Several SATs in the study said they had never provided care for an injury that they
would characterize as serious. All, however, said that they had at least witnessed a serious
injury and its handling by other trainers. Those student trainers who said they had cared
for a serious injury described both their immediate reactions and overall views of such
injuries. Regarding immediate responses, a number simply described the set of procedures
they go through in providing immediate care, similar to the actions of the trainers in the
case of the "sandwiched" athlete described above. While I was not necessarily interested in
these descriptions, which seemed rather standardized and similar to first-aid procedures,
there were certain aspects of these descriptions which were similar. For example, some
SATs recounted going on what they called "automatic pilot," wherein they simply applied
their skills to the situation at hand, taking no time to reflect on the significance of the event.
Indeed, these students told of how they had been instructed by staff trainers to review their
responses to these situations and identify things they might have done differently to more
effectively serve the injured athlete. One trainer described such thoughts as follows:

And it’s just like automatic in your head, though. I mean you always say,

'Well, what would I do if this happened?’ But then when something like

that happens, you just go through it automatically, each step. It’s

something, you’re done and you’re like, 'How did I get through that? I

never even thought of that happening before.’ But you go on automatic

pilot and you just know to go through each and every step.

These student trainers also described some of the things they told seriously injured
athletes, in the immediate wake of the event. A number said that, despite any personal
feelings one might have about the athlete, one needs to withhold emotions while dealing
with trauma. As one put it, "If you personally can't handle blood or can't handle a bone
sticking out or out of place or something like this, you better not be in this situation." This
is, of course, not surprising and is certainly ideally the case in all medical and para-medical
responses to trauma in both acute and chronic scenarios. Describing an injury sustained by
a close friend, one student trainer stated

T he first season he was here, he blew out his one knee. Next season, first

practice he came back, he blew out his other knee and had to have surgery
again. It is something that you have to learn to deal with. And on a

120

professional level you can’t get into this emotionally. If it’s a really good

friend of yours or something that’s happened, you can’t get emotional about

it because you have to do what you have to do. You have to get him the

proper care.
However, not all of the SATs believed that they were capable of adopting such a
disposition to athletes with whom they were close. One trainer compared such a situation
to treating a family member, stating, "now it‘s totally different because your body
chemisu'y is changing, your heart's racing because it's your own [family member]."

Another set of responses on reactions to injtu'y revolved around communicating an
air of seriousness and rendering a preliminary diagnosis of the injury to athletes. Again,
consistent with any number of medical professionals, these students emphasized the need
to prepare for the worst trauma imaginable, and to rehearse what they would do. For
example, one trainer said that he adopted the practice of watching competitions in a way
that outwardly looks like any spectator, but actually involves a mental rehearsal of the steps
he would take should a trauma occur. Interestingly, it also involved using his experiences
as an athlete:

It’s similar to the type of preparation I used to do for playing sports, where

I used to visualize before I ’d go out and [compete] or go out and play. I ’d

visualize the plays and how I was going to attack my opponent and strfir

like that. I think it kind of carried me over into this realm now, whereas

during games-J am very much caught up in the game. I get the rush of

adrenaline just like I used to when I would step on the field and get ready to

play. I get the same rush. I think that’s why I enjoy it so much because,
when I step out on the field, I get that same rush.

 

Another trainer spoke of the need to approach an injured athlete as if they thought the injury
would end their career. Recall under the section on information that some student trainers
said that emotional involvement led them to withhold information about an athlete's
prospects should they be grim. Other student trainers had the opposite point of view. As
one put it, "Don't tell them that they are going to be 'okay' in that sense, because they're
not. I am not going to tell them, 'Hey, you'll be back next week.‘ You've got to be

realistic with them." Indeed, one trainer told of how athletes on one team, who were being

121
told that their injuries were less severe than they actually were, responded by visiting
another physician outside of the sportsnet to get a second opinion.

SATs also felt it important to support seriously injured athletes in various ways. As
mentioned earlier, some student trainers said that after a serious injury they accompanied
athletes into the hospital and through surgery. One SAT described such an experience:

We had a football player who had a tibe (tibia and fibula of leg) fracture.

He went in for surgery that night. After the game, we went there and when

he woke up he saw that we were there. Things like that, they’re your

friends for life after that. They know you care. There were like four of us

there, waiting for him to wake up, make sure he’s okay. That's just how I

am. Let them know that I care and I am therefor them.

Another trainer described being asked by an athlete to accompany her through surgery,
saying, somewhat humorously, that as a result of the experience, they were "soul sisters."
Describing the need to support athletes who sustain career-ending injuries, yet another
student trainer said that it was necessary "not to give up hope, but help them realize that
they need to move on, because moving on is very hard."

Ininntflannens

Of course, another primary interest in the area of serious injury was in how these
student trainers felt about such injuries in general. All of the trainers were unanimous in
the view that serious injury was something that just "happens" in sport. This was
expressed in multiple ways, which included "it's just something that happens; "you're
always going to have some type of injury;" "that's just life and that's all a part of sports;"
and "it's a risk that, when you're playing a sport, you're going to take." Others put such
traumas in terms of their being part of the profession they chose, saying such things as "I
think that's part of being a trainer; " "that's part of the profession we chose to work in;" and
"That's why we're here." The words of one trainer seemed to address up both points:

I’ve witnessed it when an athlete was told by doctors that he can ’t play ever

again in football. In your heart, you’re like, ’My God, the guy played

football ever since he was in Pee Wee football. Now they’re telling him

when he gets up to his prime his junior or senior year that he’s done

because he’s got a problem with a nerve in his neck.’ I mean that's sad, but
that’s just part of the profession we picked to work in. We’ve got to deal

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with stujf like that. There’s nothing you can do to prevent those kind of
things. ‘

Again, these should not be surprising answers from people who, after a few years in an
internship, have seen and understood the phenomena for which they are receiving
professional credentials.

Indeed, it seemed that a product of their experiences was the development of a
sports-specific assessment of the occurrence of injuries. I asked the student trainers what
they thought about the numbers of injuries they saw, whether they thought there were too
many, about what they would expect, or fewer than they expected. Several trainers said
that the answer to the question depended upon the sport about which one is speaking.
Recall that these trainers, by the time they were heads of sport, had received assignments to
several different sports teams. In many cases, these assignments were described as being
purposely mixed in terms of the gender of the participants and the injuries sustained in the
sport. Hence, it followed that they would reflect back to the tenure of their own
assignments and the numbers of injuries they encountered.

Recall also that football was a sport to which all student trainers in the program
were assigned at some point. Overall, these trainers were similarly surprised at how few
injuries they saw in football and felt that this was the case with a number of sports that
featured contact among players and challenging physical demands overall. Describing
football, one SAT remarked, "I don't think I ever thought there were too many injuries."
He noted how the number of knee injmies in football had been reduced from the previous
year, adding that "there are so many things that come into play on whether you get injured
or not." Another added, "Considering that these people are running at full speed, as fast as
they can, and colliding into one another . . . I mean the equipment is wonderful. It just
amazes me there aren't more injuries." Another related injuries to the level and intensity of
competition at GSU, concluding

They’re pretty close to being what they should be at this level. You’re at the

collegiate level, you 're looking at the top athletes in the [conference], so
they’re the top athletes in the country. They play hard; they’re going to get

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hurt and stress their body. And then they’ve got some of the best coaches

here who are going to work the athletes as hard as they can. So, they’re

about right.
Another SAT was amazed at football players who "get drilled on the football field . , and
get right up and move." Overall, many trainers thought that there were "a lot" of injuries in
football but concluded that they should be expected, given that it is a contact sport.

Other sports were viewed as having too many injuries. One SAT described having
a number of stress fractures that "should not be happening." Indeed, such chronic injuries
were mentioned by several trainers as more abundant than they should be. The problem,
according to one trainer, was that athletes were not rested:

I think chronic injuries, the ones that are long-running and seem to always

be with some particular athlete, I was surprised by the numbers of those.

There seems to be a lot of those. The same chronic things, little things like

bursitises, things like that, that are like just chronic type injuries from

overuse, I think some of them could be avoided. I think there is . . I don’t

know, it seems to be that there are a lot of those kinds of injuries. They

could probably be avoided, I think. I think the more chronic ones that you

see the same people in the training room all the time. Really, for a lot of the

things that they have wrong with them, it takes just a lot of rest--some rehab

with that rest.
It may be that the numbers of chronic injuries are surprising to student trainers due to their
enduring nature. While an acute injury can be seen, assessed, treated, rehabilitated, and
healed, chronic injuries, by definition, will persist over the length of a season and perhaps
always be a part of an individual athlete's participation.

Many of the SATs placed sports injuries within more general contexts of risk.
Such risks, most said, were well-known to athletes and others associated with sport and
were therefore, they seemed to imply, something to which the athletes consent. Inked,
these rationales of risk were presented in a number of ways. One way included attempting
to persuade athletes that protective equipment should be worn. One SAT stated that, "as
long as enough precautions are taken and pe0p1e aren't doing stupid things, then there's

nothing else that can be done. Another reflected on prevention as follows:

I think we have to make them realize that they’re not beyond getting injured;
that it does happen. It can happen to you. You can tell them the
preventions, but it’s up to them if they want to do it. We can’t make them

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wear the knee brace during a game. We can’t make them wear an ankle
brace during every practice or every game. We can say, ’Well I think you
should be wearing this,’ and, ’I really want you to wear this,’ but if they
don’t, we really can ’t do anything about it besides stress to them that it’s
really important; that it’s prevention for either re-injury or injury the first
time or whatever.

This explanation, of course, suggested that any athlete who is encouraged to put on a knee
brace must know what that brace is meant to prevent, and therefore should know the
potential consequences of not wearing one. Indeed, another student trainer quoted an
athlete precisely to this effect:

You know they sit there in the training room while we are treating their
injuries and they’re like, ’God, I ’m just going to hate myself when I’m 65.
I’m not going to be able to walk. I ’m not going to be able to do this. And
all for what? To play football.’ So they know it’s a dangerous sport. They
know what’s at risk. And football has more injuries than any other sport
just because it is a major contact sport like that. Another sport would
probably be hockey. It has a lot of facial injuries with the puck flying
around and guys don't wear masks. And I don’t understand that. It’s just
like, ’Why don’t you just wear a mask and save your face?’ They know the
risks but they are willing to deal with it I guess.

Indeed, other SATs viewed the risk of sports injury in the context of their own
participation in sport and the consequences of becoming an athlete at an institution such as
GSU. One stated,

The athletes, you don’t think about, getting hurt, you’re just out there
playing. In high school, I was never hurt-~that’s what everybody says,
high school, you’re never hurt. Then you move to college and you move to
another level. Everybody’s bigger, quicker, and more strain on your joints,
ligaments and everything. Big injuries are just going to happen. That’s just
a part of sports. I don’t know.

A few uainers seemed to read into my asking the question, "How do you feel about
the fact that serious injuries can happen in sports?" that I was suggesting that sports might
need to be eliminated because of injuries. As one trainer put it,

As far as athletics go, I am sure that you are on the proponent side as far as
athletics go. I think they're super and they do so many things for an
individual. There’s no reason why I should say anything negative about
athletics just because I ’m around for the injury part of it. It’s just part of the
game. I mean, you could have a 50 year old jogger who would need me. I
shouldn’t say that you should quit jogging just because you get hurt. The
same thing goes for a 21 year old football player.

Similarly, another stated,

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You can ’t kind of say that you can’t have anymore sports or anything like

that because you get injuries or whatever. I mean there’s injuries in

everyday life. You know, you can cut your finger dicing up an onion or

something. It's just something that you need to be prepared for.

Indeed, other student trainers went beyond just the fact of risk in sport and spoke of
the risk of injury in any kind of physical activity, "whether it be competitive collegiate
athletics or just recreational walking around the block." Others went a step further, as in
the above quote, and placed sports risk in terms of risk in everyday life. One trainer stated,
"It's a reality. You could die walking down the street. Doesn't matter how good you are at
something, you can get hurt." Another added, "If you take a look at it . . , serious things
that happen in sports are pretty much nothing compared to serious injtnies that happen in a
car accident or something." One SAT said, in this regard, "I think injuries happen in the
outside world, you know, outside of athletics, because people aren't aware of their bodies
like athletes are." Another concluded,

So, I think everything ’s got to be taken in perspective. Fine, maybe a guy

doesn’t play again, but he’s also going to live. They’re going to happen

regardless. You’ve got to do what you can to prevent them or to minimize

the risk, but it’s going to happen, especially the way things are going now.

With 300 hundred pound linemen hitting each other, you ’re probably going

to have these types of things.

Not all student trainers were comfortable with all of the risks that they saw being
taken by athletes. Indeed, sonre felt very strongly that certain sacrifices were not worth the
benefits athletes were receiving as a result of their participation. A number of SATs made
statements similar to the following quote: "No sport is worth never walking again on
Earth, never being able to be what you were before the sport, as far as I'm concerned."
Others suggested that athletes need to think about what they may not be able to do later in
life in continuing to playing with an injury.

E l . 1 E .

As indicated in the opening paragraph to this section, certain themes emerged in the

student trainers' answers to these questions on serious injury that merited follow-up

questions. Indeed, in the very first group interview, the following exchange occurred:

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That’s, you know, what a trainer likes to do. It’s kind of a sick thing. We

sit on the sidelines and wait for someone to get hurt. It’s like . . .

[another trainer]: Oh, that’s a cool injury.

’Please sprain your ankle,’ you know what I mean? [laughter] It’s a sick

thing, but it's what we want to do.

Of course, two competing interests were at play here. First, because the
interviewees are students interested in gaining professional credentials as athletic trainers,
they were interested in seeing a number and variety of injuries (i.e. the "cooler" the better).
Indeed, they must have experiences with injuries in order to gain skills in learning how to
handle them (i.e. the definition of an internship). On the other hand, however, the student
trainers feel "sick" at having such an interest because they certainly realize that someone,
perhaps a friend, must suffer for that to take place. Indeed, this is how one student trainer
answered when asked whether he had ever been upset about serious injuries:

That’s why we’re here. That’s the only reason we have jobs is because

that’s going to happen. I look at it . . . I mean we can sit and watch and

watch and watch and we ’d be eager to learn. We’d want to see injuries, but

for the sake that we don’t want to see people get hurt. It’s a tough job.

You want people to be able to learn and become a better trainer, you have to

be experienced. But the only way to be experienced is through people

getting hurt. So, it’s kind of a . . . It's not an easy job. You see the pain,

you see everyone getting down.

As might be anticipated, the desire to see injuries crept into the language of student
trainers as they described incidents in which they were involved, or, as the case was, not
involved. One trainer, after having described a season-ending injury that he had missed,
stated, "I didn't actually get to do any of the emergency, or the evaluation, that type of
thing. I kind of missed out there." Another similarly described witnessing, but not being
able to treat, some serious injuries:

I ’ve gotten to see a couple broken noses, a broken clavicle. I didn’t get to

see the fractured tibia. Then there was a very bad sprained finger we had.

We thought it was broken, but it turned out not to be. Yeah, the only real

experiences I’ve had with any kind of fractures, that type of thing, would be

the broken noses and the clavicle.

As is evident in the ironic enthusiasm for pain and injury, some student athletic

trainers are apparently excited about the prospect of confronting a serious injury. Indeed,

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sensing this, I simply asked some of the SATs in the study how they would define an
"exciting day." Many of them replied that an exciting day would involve "a big injury,"

"good injuries," "a significant injury," or as mentioned earlier, a "cool injury." Some

spoke of how such injuries are welcome relief from the mundane activities of taping and
icing. As one SAT put it:

There’s always that part of you that really sympathizes with the athlete
because you know what they’re going through. But then there's still that
part of you that is the trainer. You just want to see it. Usually, you just see
the same old things. You see sprained ankles, quad contusions, torn
muscles or pulled muscles. You don’t usually see real serious injuries,
which is good. But every so often it’s just nice to have something to really
think about and do. Probably keeps you from getting in a rut of just, ’Oh,
you’ve got a sprained ankle. Okay, well we’ll just do this.’ Ice it, and do
all this rehab with it. You have to just come up with new ways for
rehabbing and stuff like that.

Other student trainers had similar, but qualified, responses. Several indicated that
they also like to be part of the drama of a competition in which their work might make a
competitive difference:

You had a significant injury-«something wasn’t (long pause) . . . wasn't
real serious, that you can come back and evaluate them and you think they
can still go, and you make something for them; you do a special tape job or
fabricate something at half-time; and they go out and have a great half.
Then, when you get back, to me, that’s very exciting. That’s when I’m
using most of my capabilities during a game. I draw from everything I ever
learned, and try to focus in. T hat’s when I come home after a game and I ’ll
sit down and I won’t be able to sleep; I ’ll replay that whole scenario over
and over and over again. That’s what is probably the most exciting is being
able to do something on the spot.

Similar to the question on their feelings about serious injuries, some trainers sensed
an agenda in the question on exciting days, as well. Indeed, in some probes I asked
whether the SATs ever wondered about their enthusiasm for injury. The responses varied.
One student had no qualms about such excitement:

No. No, I think that’s the best thing about athletic training. I think it’s kind
of dull if you’re not, if you don’t have a lot of injuries. You’re just kind of
sitting there and, you know, taping them everyday and stuff like that. And
that’s just part of athletic training. The most exciting part, I feel, of athletic
training is being able to recognize an injury, and to treat, and to evaluate the
injury. and to treat the injury. I mean that’s the most gratifying experience,
is seeing an athlete become injured. It could be a life-threatening injury, but
then yet seeing them go back out and one, two, three, four months to get

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back to competition. So I think that’s the most gratifying experiences is
seeing the athlete go back and compete, you know, like they used to
compete.

On the other hand, another student wondered whether I was trying to "make [them] out to
be brutal." In such cases, the trainers clarified themselves. As one trainer put it, "I am not
around for them to happen. I am around if they happen." Indeed, the excitement of the
competition was salient to many of the trainers and secured to override their desire to
expand their professional experiences. As reflected in the explanation of one SAT, it
appeared that such excitement faded with age, as the graduate student trainers appeared to
be less excited by injuries than the undergraduates in the study:

In a way, you can say, yeah it’s exciting, but in a way the person's injured,
and that’s something you ’re going to see, but that’s something I don’t ever
want to see. I’d rather celebrate than have to have the whole team celebrate
and you’re over in the corner with this guy who is beat up and won’t be
playing for six months. I mean that’s not very exciting to me. I mean, the
actual fact that, okay, someone is injured, you get to evaluate it, that’s all
part of the career you’ve chosen; you get to evaluate and you know that
you’re going to have to go and rehabilitate this person. Y ou’re going to
have to get together and say, ’What am I going to do?’ and ’How long do I
have?’, and then I get pressure from here and there. And in a way that’s
exciting.

Many descriptions involved being part of victories over an arch-rival team or
winning a championship game. The following quote both indicates not only the
defensiveness some felt about the question, but also this drama of such competitions, and
how emergency responses to acute injury lose their appeal:

This is sort of a sick question, because a lot of trainers would say, ’Oh
Jesus, when poor people blow their knees out.’ I don’t . . . the most
exciting day? (long pause) Well, three or four years ago, I would have told
you if I would have liked constantly to be evaluating serious injuries.
Although, I think that's changed. I think an injury-free day, and a game
day with a victory is more satisfying than anything else in the training room.
Maybe that’s my competitive, athletic background. I’d much rather go and
watch my team play well and get a victory than evaluate an injury anymore.
Now, like I said, three or four years ago it would have been evaluating
injuries. Although, there’s that and one other thing would rival that in terms
of my excitement level and that would be taking someone through a four to
six month rehabilitation, say on an ACL, and having them play their first
game and be successful. Just seeing the look, not only on their face as they
are introduced or as they run out on the field, but touch the ball for the first
time. To watch that camaraderie on the team and the friendship on the team
really rally behind that person, yeah. Especially if it's one of their better

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starters or better players, to have he or she back in and watch the team
respond to that. Especially if it happens mid-season, it’s really special to

watch a team play and have this person return to them to see how they
unconsciously elevate their game. It’s really satisjying, even though God

healed them, you didn’t really heal them. And that athlete being there

everyday for you helps heal them. And you really just follow the protocol,

or you followed your own instincts or whatever, so you just told them what

to do. They still had to do it. Even though it is that, it is still a really, really

satisfying feeling to see somebody go back out on the field and be

themselves again. It’s extremely satisjying.

The overall feeling of having helped someone, others said, was their most
satisfying and exciting experience as an SAT. While, as noted in the section on duties,
many of these student trainers reported receiving little recognition for their efforts, some
provided several examples of athletes who had expressed appreciation for their role in their
trauma or rehabilitation. Indeed, one student trainer spoke of how an athlete thanked his
entire family for their patience, as the athlete apparently telephoned his home frequently.

It is indeed injured athletes, and student trainers' views of them, that will be
summarized to conclude the presentation of the results of the interviews. I asked the SATs
to attempt to understand and empathize with the athletes with whom they worked by asking
them about athletes in three basic circumstances: athletes who feign injuries, athletes who
are constantly injured and continue to participate, and any athletes they viewed as
"reckless." My intent with these questions was to identify what the student trainers took to
be their responsibilities, and therefore also what were not their responsibilities, in cases
where athletes were playing with injuries for which further participation involved taking
questionable risks. Again, I asked the SATs to identify actual cases of which they were
aware and render judgments in light of those.

I asked follow-up questions of student trainers who described incidents or
otherwise indicated that athletes with whom they worked were faking their injuries. Some
referred to these athletes as "head cases," though others were clearly disturbed at the use of

this term--it seems to suggest that these athletes may not have been taken seriously when

presenting an injury. Indeed, one trainer emphasized the need to "believe every injury,"

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even though the athlete "has a history of crying wolf." A number of SATs, as was
mentioned in the section on disruptions, identified such athletes by noting the context of the
reporting of the injury--i.e., prior to difficult practices or games or just after losses. Other
student trainers noted that such athletes were simply in the training room on a daily basis.
One noted how one athlete would move from one injury to the next. As she stated, "I mean
all of a sudden he had another one but you wouldn‘t hear about the other one anymore."
Her explanation of this behavior was the athlete was just "looking for attention," and
"seeing the benefits of being hurt." Regarding these benefits, she noted that the athlete was
simply given the decision as to when he would practice.

Another student trainer reported a case of an athlete who repeawdly complained of
pain. The athlete had surgery on the area and had been rehabilitated, in the SATs words,
"back to the point where it should have been better." However, the student trainer noted,
the athlete was young, homesick and neither liked the coaches of the team nor practices
they conducted. The athlete continued to complain of the injury to the point where a
decision was made, including consulting the athlete, to perform another exploratory
surgery to examine the problem. The athlete had also been approached about quitting the
sport through medical disqualification, but refused. The procedure did not result in
identifying any problems. Indeed, the SAT reported that this procedure was performed
even though those consulted on the problem could not identify the source of the pain and
did not believe the surgery would reveal it. Moreover, the student trainer suggested that
this athlete was willing to undergo surgery even knowing that there was no actual problem
that the surgery might identify.

Two other trainers reported experiences with "head cases," one stating that with
their entire team , "there was an abundance of injuries and it was way out of control." The
trainer added, "there was nothing I could do because it was to the point where they all
needed a psychologist. That's hard to deal with as a trainer too because you can’t ignore it

and tell them to take a hike." This trainer also noted that such athletes are "over-dependent

13 1
on modalities," such as ultra-sound. Indeed, one way this trainer noted that such
dependency was identified by using a modality as a placebo:

One of the trainers . . . a couple years ago had just . . . and they're all head
cases--and we’re probably out of line labeling them that but after you work
with them long enough, you can pick them. They really are over-dependent
on modalities as far as they think they need ultra sound or the stim, because
that's going to cure it, and screw the rehab or the weightlifting and the good
old fashioned stufi’. [The stafi’ trainer] was dealing with a patellar tendinitis
supposedly--[ the athlete] couldn't run on the knee, it hurt so bad--needed
ultra-sound, had to have ultra-sound, it worked before, got to do it again.

A relatively detached individual, really didn’t have a good grip. So [the
trainer] just unplugged the ultra-sound machine, gelled [the athlete] up,
ultra-sounded . . . for five minutes, sent [the athlete] on [their] way. Did
that for a week, and it was like, ’Look that’s all I could do.’ [The athlete]
was like, ’Oh, perfect, healed, better!’

Another trainer described a similar process used to assess pain tolerance level in an athlete
who constantly complained of pain:

I have had this athlete before in other situations, too. So, when [the athlete]
says how bad it hurts, like one time we asked, ’How bad does it hurt on a
scale of 1 to 10, 10 is like you’re dying, like it’s child birth,’ whatever, you
know. [The athlete] said it was a nine. . . We had a little trick, we could
distract [the athlete] and then you touch [them]. [The athlete] didn’t even
wince because it was an ankle. And so we’re like, ’Okay, you don’t
understand the pain scale.’ So I was basing my knowledge on what I have
worked with [the athlete] in the past to help evaluate this. I was poking [the
athlete], and [they] didn’t even wince, nothing. I mean [the athlete] was
able to do every other functional task, all without saying, ’0w, that hurts.’
And I was saying, ’When that hurts, you have to let me know.’ Nothing
bothered [the athlete] until one time I dug really deep. If you dig really deep
in anybody, you’re going to get a tender spot. If you poke the knee hard
enough, yeah, you still are. So, it was kind of funny.

Another trainer, however, reported that an athlete had been complaining of chronic
pain during the entire season. This athlete was apparently unusual in such complaining, the
SAT noted, as others with similar pain were able to keep participating without such
complaints. As the trainer stated,

But most of them can get through chronic back pain that they have. Most of
them will get through it, but then I had one that every chronic pain just
would, you’d touch it and it was, ’Ooh, ooh, aah, aah,’ you know. [The
athlete] couldn’t stand anything. And it was really hard because we know
we treated [the athlete] the whole season for one thing, and then [the athlete]
got to the point where [the athlete] just couldn't do it anymore and couldn’t
do it anymore. And the physician had been treating [the athlete] and he
finally ordered a bone scan and [the athlete] had like six stress fractures.
And so it’s hard because here [the athlete] had this going on, but the

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coaches didn’t, we didn’t, the physicians, nobody believed what was going
on with [the athlete] because [the athlete] had been pulling this all season
long. And so it’s hard because then it makes you look bad, but yet it was a
case where we ’d already turned it over to the physician ’s hands, and once
it's turned over to them, you're in it, you know it’s going on, but you can’t
say, ’Oh you need to this. You need to order this.’ It’s all their call. But
yet the coaches don’t see that, they see it as just the trainer, you know, we
still let [the athlete] go all season on six stress fractures. Well no, [ the
athlete] probably didn’t have those all season. [The athlete] probably only
had them for two or three weeks.

With regard to such constant pain, I indeed asked trainers to describe any examples
in their experience of athletes who were constantly injured and nevertheless continued to
participate in their sport. Some of the cases the SATs described seemed to be those where
the athlete had simply treated injury, as the noted above, as something that "happens."
These injury-normalizing athletes were described as knowing the procedures for treating
their injuries and simply followed the beaten path to recovery. One student trainer stated
that one such athlete, after having initially been upset at sustaining the injury, simply said,
'Well, it happened again. It's over and done with. What can I do about it now?'.

Other examples involved more serious injuries which were both the result of
chronic injury, re-injury of the same part of the body or repeated acute injuries in various
parts of the body. One trainer attempted to understand how the chronic injuries of athletes
on a team would not cause them to discontinue participation:

Unfortunately, that’s what I see a lot of the athletes doing with a lot of these

things. As far as, even, this past season, there were a couple of them from

[ my team], constantly beat up on their joints, or more or less destroyed or

whatever. When they get older they ’11 have real serious arthritis and that

type of thing. They are in just so much pain after practices and competitions

that, as a trainer you have got to wonder why they do it, but, you know

that’s more up to the athlete why they do it. Whether it’s the love of

competition, it’s hard to say.

An example of re-injury to the same area was described by another SAT:

Yeah, there was an athlete like that at [university]. He came in his freshman
year. The first day of practice, he blew out his ACL, I '11 never forget this.
So he rehabbed that. He was out for the season. Then he was ready for
spring ball. We were trying to get him ready. It was about eight months.
He wasn’t in full-contact drills or anything. But he was out there, planted
and cut, and I think he partially tore the same ACL again. You were just
sitting there looking like, ’Wow.’ Then, I think just this past year, when I

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left, he blew out his other ACL. He was a good guy, you know, but he
was just, all these major injuries. He still had a lot of respect because still
kept coming back, just trying and trying, just because he loved the game so
much. But, after a while, it seemed like, 'Wow, was this meant for me to
play?’ That’s what a lot of people think. A lot of people get hamstring
pulls or quad pulls, or, I don ’t know, they might break a bone and then
they’re down their whole career. You know, nothing really major, you can
just sit in a cast for six weeks, but here’s an ACL and you 're out for the
whole season. Then this guy just keeps coming back and back and back.

Another trainer provided an example of another athlete who was constantly injured
in several areas of his body. In the view of this student trainer, the approach to the way the
athlete played was a factor in the injury, as the example suggests:

He was a highly recruited out of high school. All the [conference] teams
wanted him. He ended up going to actually our state rival. Walked up and
three days after they started camp, left and came to [university] and walked
on. So, he had to sit out a year because he couldn’t participate. Everybody
was excited because this was a local kid. Spring ball, before he could play,
he got injured. The people saw his talent and everybody was really excited
about this kid's talent. He got injured doing what seemed like a stupid
thing. He was diving-~it was unimportant--dove for a ball, dislocated his
shoulder. Rehabbed all summer and first play of fall, basically it was agility
drills, it wasn't even . . , they didn't have pads on, dove for a ball,
dislocated shoulder--his other one. Seemed like he went from one thing to
another, butI think, his case, he worked at such a high intensity all the

time. He couldn’t shut it on and off. He couldn’t go out and play at 50%; it
was all or none. So, when he went out and played, he was going all out.

It didn’t matter to him if the quarterback threw a bad ball, he was diving for
it. I think that was his problem is we couldn't get him to shut it down; he
was always trying to work at 100 percent.

These were types of cases the SATs had described when asked to give an example
of athletes who were constantly injured. I subsequently asked them what they would do
were they in the same circumstances as these athletes. Some student trainers agonized at
this question, given the fact that they understood the nature of the injury but could not feel
the pain the athlete was experiencing. Additionally, the SATs said they understood the
desire of the athlete to keep participating, but weren't sme what the benefits were to the
athlete and whether they might be worth the pain the risks of permanent disability. Overall,
however, most said that they would keep playing:

Yeah, I would. Yeah. I wouldn’t feel satisfied until I had used up . . . If I

came to school to use four years of eligibility, I wouldn 't feel satisfied

unless I was able to do that. Now, if it was [ an athlete's] last year and--
that's a hard question to answer because I haven ’t experienced what it feels

134

like to have a knee that won’t stand up underneath you. There’s a certain

amount of fear, I am sure, that would go with that. But, even after it was

fixed and after everybody told me it was stabilized, you would still have a

little bit of doubt in your mind and I just . . . It’s hard to answer because I

just never have experienced that. I don’t think I would. I would be

disappointed in myself if I did, I think, just because I guess I expect my

athletes to get up of the ground and to keep going and to listen to me and

trust me to get them better . . , and that they will be better. So, I guess that

carries over to myself. I guess I wouldn’t let myself not do anything about

it. No, I don’t think I would, but like I said, it’s kind of hard to answer.

Notice how the SAT in the above quote seemed to reverse the phrasing of the question in
his answer. The question was asked, "Do you think you would still participate?", yet by
the end of the question, he seemed be answering the question, "Would you quit
participating?" One student trainer recollected a conversation with an athlete over such
matters:

’Is it worth ruining your career for? Is it worth getting arthritis when you’re

30?’ A lot of things he doesn’t know. He doesn’t realize what he is risking

and that’s why we're here to tell them and help them see the other side. So

you look at him in a compassionate way. You didn’t demand it, but what I

did, I said, ’I would do the same think that you’re doing right now if I were

in your shoes, but you have to look at the other side. You have to look at

the side of your future and not maybe the big competition next week, but ten

years, twenty years from now.’

A number of reasons were suggested by student trainers to explain why the
constantly injured athletes they knew were still participating. Some mentioned the desire to
maintain a scholarship and receive an education. Others cited parental pressure to stay in
the sport, which some suggested may also be related to wanting to maintain a scholarship.
Most of the SATs, however, said they believed that athletes continued to play through pain
and risk permanent injury because they had a "love for the sport." Such “intrinsic
motivation,” or “play” elements in these athletes, the SATs speculated, might be driving
them in ways not easily understandable. Indeed, some observed that, for many athletes,
participating in intercollegiate athletics signals the end of a career, given that few go on to
play professionally. Moreover, for many sports, there are no other opportunities beyond

intercollegiate competition.

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However, some SATs were puzzled at the continued participation of some athletes
who had constant pain and injury. There seemed to be two principal reasons for this
perplexity. One related to the fact that some athletes constantly complained about their
injuries, yet nevertheless continued to play. As one put it

I just . . . Having to listen to it, I guess I don’t mind it so much the ones
that are quiet about it and just kind of do their thing. But the ones that tell
you about it everyday, those are the ones that kind of wear at you. I ’m kind
of like, ’I don ’t want to hear about it anymore. I know you’re in pain.
There's nothing more I can do about it. The best thing for it is just to rest. ”
It’s those cases you wonder why do they do it or whatever. Those are the
ones that kind of wear at you after a while.

Of cornse, this goes beyond just a management problem. The trainer is perplexed at how
someone could continue in an activity about which one complained so vocally. Other SATs
also spoke about athletes they believed were not "getting enough out of the sport" to justify
their continued participation with pain and injury. In some instances the student trainers
described, there were clear risks to the long-term health of the athlete:

He never really complained that much, and if he did, he would come in and
know what to do, and he would do it on his own. They’d put him on
medication and he would kind of disappear and not come in and say
anything. But the fact that he’s going through all of this, and in a way he
probably knew he wasn’t going to see any playing time, and probably the
fact the he was advised that playing . . . could do some further damage to
his [joints]. He continued to play, and I don’ t know what the drive was
there. I don’ t know what drove him. Maybe it's a matter of being on the.

.team, who knows, being associated with that group of guys. But he’ s still
f ghttng, and tn that sense, there’ s no way in the world I would play
knowing that you would not play, and knowing that you were just
continually doing damage to your [joints]. . . He would have obviously
more laxity, and there would possibly be arthritic changes as he grew older-
-and he still may have those anyway. I mean, just the fact that, okay, I ’m
going to have arthritis when I’m thirty years old. . , but I’m still going to
play. I don’t think many athletes look at the long-term effect of what they
are doing to their body.

Indeed, a number of SATs replied that they definitely would not continue
participating in their sports given their knowledge of the risks and their assessment of the
benefits of participation. In this regard several SATs pointed to cases where the athletes
continued their involvement knowing that they were risking permanent damage and for

goals which were unclear. In other words, given the athlete's presumed responsibility to

l 36
make informed choices about their own health, some nevertheless made poor decisions.
Indeed, one speculated that players should be disqualified should they lack the physical
skills necessary to successfully play without injuries:

The thing that drives me crazy is you see athletes that are walk-ans. . . And

they wouldn't ever play a minute in a . . . game, and they keep getting hurt.

And you realize, I don’t know if [ the stafi‘] or somebody will say something

to them that maybe they are not fit for this kind of competition. It's hard for

me to recall if they have ever kicked someone off the team for that; I don 't

think so. But it’s frustrating from the standpoint of all the injuries that some

of these people get, knowing that they’re not going to play anyhow.

Given such examples, I asked the SATs if they had ever encountered an athlete
they would consider to be "reckless." I chose this term because it secured to connote a lack
of responsibility or an adequate sense of one's own well-being, although I again let the
student trainers define the term for themselves. A few said that they had never encountered
such an athlete, taking the definition to mean, as one SAT put it, "'I'm going to use my
body to win the game, regardless.” Those who said they had encountered a reckless
athlete, however, included cases that went beyond just playing in pain and risking long-
term health. They also included those who evidenced a comprehensive lack of regard for
themselves. One spoke of an athlete who was alcoholic and took many times the dosage of
an over-the-counter pain medication. Another example was of athletes who "work out
three times a day because they want to fight for a spot on the team."

Others included among "reckless" athletes those who refused to report their
injuries, or would otherwise not evidence a level of pain normally associated with their
injury. Several trainers, for example, cited examples of players not reporting and
continuing to play with broken bones. Again, these were examples of acute injuries.
Others cited athletes with chronic injtuies, some that involved the risk of a loss of use of a
limb, others that brought about temporary paralysis. Of course, both types of injuries
posed long-term disability risks for the athlete. Regarding the latter, one SAT noted an
example of an athlete who was told that she risked loss of the use of limbs, disagreed with

the GSU medical staff about the risks, and signed waivers releasing the school of

137
responsibility for such implications to permit further participation in the sport. While some
mentioned athletes having not been permitted by physicians to continue, it was not clear
what the policy was in this regard.

Fundamentally, it seemed, these trainers believed that the decision to participate in
the face of injury and pain was the athlete's to make, and that they were advisors in helping
them make it. As was noted above in the discussion of risks, nearly all the student trainers
in the study essentially agreed that, by the time an athlete reaches the level of competition
found at GSU, they knew full well what the. possibilities of injury were in their sport.
Moreover, they also said that a number of athletes often did not adhere to the medical
advice they were given both in attempting to recover from injury and in deciding whether to
continue their participation. On the other hand, when athletes evidenced "love for the
sport," the student trainers understood this as a legitimate reason not amenable to their

knowledge of the athlete’s personal life.

CHAPTERIV

Discussion and Conclusions

The purpose of this study was to investigate the experiences of student athletic
trainers in order to more fully understand the practices of the sportsnet and the degree of
control it exercises over those within it. Nixon's (1992a) argument was that a sportsnet is
a structural network of individuals and organizational sub-units within which athletes are
persuaded to accept unreasonable health risks. He suggested ftn'ther that athletic
subcultures related to the sportsnet would provide various legitimations for the acceptance
of pain an injury by athletes. I reviewed literature that explored the foundations of
institutional practices (Berger & Luckmann, 1966) in general, and medical practices in
particular (Freidson, 1970, Starr, 1982). They concluded that any social structure can be
seen as a more or less negotiated order, and that "room" for negotiation will depend upon
how crystallized its practices and sedimented its knowledge has become. The more
crystallized and sedimented these practices and knowledge, the more controlling the
structure. Moreover, because certain forms of institutionalimd medical practice have
become "totalizing" in nature, I decided to explore suggestions by sociologists (Bourdieu,
1987, Gruneau, 1991) that certain sportsnets bear totalizing (Goffman, 1961)
characteristics. The degree of totalization in a sportsnet, then, will be a matter of the degree
to which social actors within it are able to negotiate and resist its control over their actions.

Given these points, I noted that the principal roles of athletic trainers within the
sportsnet may either subvert the norms of standard medical practice, consistent with
Nixon's thesis, or resist them. I suggested that subversion or resistance to these totalizing
tendencies may form as a result of student trainer roles as students, in alliances with
athletes in defiance of coaches and staff trainers, or as apprentice athletic trainers, in

alliances with their peers and superiors, over against the influences of coaches. Moreover,

138

 

139
as members of a male-dominated athletic subculture which may value dedication, sacrifice
and playing through pain, in subversion of more conservative forms of medical practice,
these students may be prone to conflicting and contradictory influences. The data presented
in Chapter Three suggest that both of these roles were performed in the context of variously
sedimented practices. As I will argue below, in some cases the level of sedimentation left
very little room for negotiation. On the other hand, several aspects of the experiences of
student trainers indicated a great deal of autonomy and negotiation.

To follow, then, is a discussion of these roles which emerged from the four areas
of Duties and Disruptions, Gender, Information and Advice, and Injury presented in
Chapter Three. Again, my intent here is to summarize the descriptions of these students in
terms of their significance and bearing upon Nixon's thesis about conspiratorial alliances,
the degree to which they provide evidence of the sportsnet as a totalizing social structure,
and the way they reveal the context of the practice of medical care for athletes. I will
conclude with suggestions for further work in this area and address the subject of practical
recommendations.

5 l i l l . I . l S l 1

As I summarized in Chapter One, a subculture is an analytical device used to
describe a group within a larger collectivity that has formed as a result of some sense of
common activities, mutual problems or shared perspectives (Philips & Schafer, 1976,
Donnely, 1981). As a result of these commonalities, subcultures may be recognized by
such identifiers as common beliefs, norms, practices and symbols. Based upon the data in
Chapter 3, I believe it can safely be said that there is no single "athletic subculture"
underlying a sportsnet at GSU which functions to, among other things, legitimize the
acceptance of pain and injury by athletes. Indeed, there seemed to be a number of varying
and often contradictory beliefs and practices among members of the teams with which

student trainers worked. However, because I did not conduct observations of the student

140
trainer's interactions within their work settings, attempts to identify definitive subcultures,
based on interview data alone, are matters of some degree of speculation.

For example, there did seem to be indications of distinctive athletic subcultures
within various sports to which the SATs were assigned. Perhaps most palpable among
these was the practices and implicit beliefs of the football team and its coaches, which
subjected some student trainers to a number of various humiliations and other degradations.
Perhaps because all of the student trainers in the study had worked with football at some
point in their internships, usually as learners, their experiences with that sport were more
salient and memorable for them. As also noted, however, the football team was a
particularly hostile place for women student trainers, who were subject to both direct and
indirect forms of sexual harassment and otherwise sexist behavior. Men SATs also
experienced difficulties with football, although in their cases it seemed that successfully
tolerating these practices worked as a rite of passage. Again, however, these are only
glimpses of a subculture based on verbal accounts of one group and are entirely
speculative. As may be the case with other experiences of these students, the most
memorable may not be what is typical of daily practices.

To further speculate, however, there also seemed to be sport-specific subcultures
which were distinct precisely on the basis of their differences fiom football. Obviously,
men's basketball and hockey were distinct in their not allowing women to be assigned to
the team or to even watch practice. As some trainers noted, these policies were based on
more general assumptions about the attentional problems and harassment tendencies of the
athletes on these teams. Team assignments of student trainers, in general, may have
operated indirectly on similar sport subcultural considerations. Indeed, since all of the
other teams at GSU are smaller than football in size and sc0pe, some seeming to function
more as families, the dynamics of interaction among players and student trainers were
reported as quite different. This was especially the case where student trainers, and women

in particular, took on much broader roles that in some instances involved 24 hour

141
dependency by athletes. Clearly, women SATs in the "mothering" role were the best
examples of this. Moreover, although confidentiality considerations prohibit exploration of
these points, there were unmistakable differences in the apparent toleration and acceptance
of injury on several of the teams to which the student trainers were assigned. This was
particularly noteworthy in the differences between sports that involved chronic injuries that
were likely products of nearly lifelong participation in the sport, and those which more
commonly evidenced acute injuries. Considerably more frustration was expressed by
SATs about chronic injuries, due most likely to the fact that many of them were quite
resistant to treatments.

Also noreworthy in these intertcam distinctions were the apparent success or
failures of the teams and the association between these and the reports of injury to trainers.
While this may be a pattern that holds across teams, the particular ways in which injuries
are reported as a function of the dynamics of particular teams and personalities was also
evident in the statements of student trainers. While some athletes were apparently prone to
report all manner of minor injtuies, others withheld this information or pleaded that SATs
not release it to their coaches for fear of loss of team position or playing time. There has
also been research which has reported associations between life stress of athletes and the
incidence of injury (e. g. Bramwell, Minoru, Wagner & Holmes, 1975, Taerk, 1977,
Cryan & Alles, 1983). Indeed, student trainers, again more often women, reported that
they witnessed the effects of particular social stresses on athletes in the form of injuries.
The varying socio-economic and cultural backgrounds of the athletes, and their association
with these stressors, might have been apparent to the student trainers, although I did not
explore these associations. As I will summarize in the Summary and Recommendations
below, these are matters that should be explored through in-depth observations.

My perhaps simplistic contention is that the beliefs and values of student trainers
were various and conflicted primarily as a result of their dual roles and interests as students

and as apprentice athletic trainers, both of which operated in the context of these apparently

 

142
diverse athletic subcultures. My intention is to discuss both of the roles of student and
apprentice athletic trainer, noting where relevant the influences that were evident in cases
where they were also members of a distinctive athletic subculture. The difficulty in
collapsing the experiences of these student trainers into two roles lies in the complex
relationships between them, and the fact that any single one of their experiences (or in this
case, descriptions thereof), held varying degrees of significance within both of them.

For example, one of the most common complaints of the student trainers was that
they were not fairly compensated for their many hours of work, yet they witnessed a
sometimes obscene flow of desirable material goods to those within the sportsnet who
contributed little to its daily operation. As student trainers who are, for instance, not
student athletes in revenue sports-~and therefore not among the recipients of these trinkets--
they might have felt some resentment towards those who did receive them. This may also
have led them to question their career choice as professional athletic trainers, who similarly
will receive few of these goods. Recipients may have also included close friends who were
athletes, respected staff athletic trainers, team physicians (and apparently their spouses and
childrcnl), and admired coaches.

Obviously the student trainers did not sever their roles as student trainers or as
proponents of GSU athletics as a result of these inequities, however glaring and unfair.
Indeed, presumably, these gift-receiving members of the sportsnet are also individuals who
are members of a larger sportsnet with which student trainers share at least a core number
of common beliefs and values. Such conflicts or tensions would seem to send waves over
the primary roles of these student trainers, likely solidifying their identification with some
while loosening others. Student trainers may rally around what they see as a common
injustice and strengthen their ties with other SATs as a result, or they may become
irrrmerscd in the social or athletic subcultural aspects of their team assignments and
compromise their "professional" responsibilities. In general, while some experiences will

make them feel more like students, or student trainers, or key members of GSU athletics,

 

143
others will loosen the hold of these identities. Moreover, along with some of these
commonalities and tensions of SATs with others in the sportsnet may be associated certain
forms of resistance to the aims of the organization.

One may also imagine multiple others within the sportsnet whose membership is
strained by some perceived inequity, difference in belief, or exclusion, such as alumni who
are not allowed to watch practice; coaches from whom medical information about athletes is
kept; or athletes from non—revenue sports who are treated differently from those in revenue
sports. The strains created by these obvious discrepancies and resentrrrents would at least
intuitively serve to both cement some alliances and strain others. In any case, these
considerations cast doubt on the contention that members of sportsnets "share the same
beliefs" (Nixon, 1992a, p. 132). While it is possible that the cumulative ejfect of the
activities of the sportsnet are exploitative of athletes and their health, it does not seem
plausible that the organizational conditions which bring it about bear a resemblance to a
conspiracy.

In the case of student athletic uainers, what secured necessary was to identify the
principal roles which showed the most stability, intensity and mutual tension as relawd to
the larger more encompassing culture in which they were immersed. Consequently, I felt it
is useful to attempt to parcel out and discuss individually the two primary roles that
suggested signs of definitive breaks and attempt to discuss them individually. It was
inevitable, however, that portions of an overarching athletic subculture crept into each. In
what follows, I will discuss the roles of student and apprentice athletic trainer along three
lines. I will first review the sedimented practices that secured inherent in each role, what
their function in the organization secured to be and then explore the apparent ways that
student trainers seemed able to negotiate and resist the sedimented practices related to them.

5 1 E l l . I . S l

I might begin by pointing out that it has been necessary to repeat several times thus

far that the subjects in this study were university students on a large campus. Indeed, it

144
seemed on occasion that the student trainers had to remind themselves of this fact. Yet,
these student trainers seemed to share at least some common experiences with other
students. Perhaps most importantly among these commonalities was their being used to
operate large-scale functions of the university. The espousal by universities of the virtues
of individual dignity rings rather hollow given their near universal employment of students
as a cheap labor force. If the presumably unanimous opinion of sport sociologists that
college athletes are a modem-day proletariat has merit, the students in this study "interned"
to train athletes are perhaps the sportive lumpenproletariat. Student trainers in the study
were an underpaid or unpaid workforce enrolled in an internship requiring substantial
amounts of their time and imposing immense and diverse responsibilities on them.
Nevertheless, in many cases, these experiences, as the students stated, would not
ultimately lead to employment in the athletic training profession.

Student status translated into a number of largely "supportive" roles, restricted
behaviors, and demeaning activities for SATs, particularly for new students in the
program. The initial assignment to football was within a group of similarly subordinated
students, and subsequent assignments were continual indications of one's political status
within the program, including gender-based exclusions and harassment. Entering the
internship as unpaid student labor, as noted in the Duties section, meant entering at the
bottom of a hierarchy and the performance of labor essentially unrelated to the professional
responsibilities of an athletic trainer. The ever-present fact of water delivery, though
rationalized as a physiological necessity, likely functioned as a constant reminder to student
trainers that they are at the bottom of a "support" system, and not the center of attention.

Overall, much like other students around the campus, learners performed the kinds
of duties that often end up as euphemistic transformations on resumes (e. g. stocking tape
as "inventory management”). It might be asked whether there are allied health professions
analogous to athletic training, such as physical therapy, which feature requirements similar

to those made of the learners in the program to clean Whirlpools and countertops. A hazing

145
function indeed seemed evident in these requirements and other conditions for learners in
the study. While it is clear that others not interested in the athletic training profession could
have performed these duties, their function may have been "tests" of the character of
potential new members of a profession that often operates under the hegemony of
dictatorial coaches and which requires long hours of work. There was little indication,
however, that more advanced student trainers accompanied these activities with the
standard harassment seen in such hazing practices as those found in military institutions.
Indeed, these more senior SATs seemed to silently move away from this activity, indicating
both relief that it had passed and sympathy for those "goin g through" it.

However, another related consequence of student status was the "yelling" and other
types of public and private reprimand that the student trainers stated to have come from a
number of other members of the sportsnet, including supervising staff trainers. While it
may be true that such yelling was a common response to error and disagreement by all
within the GSU sportsnet, it seemed that student trainers were exposed to a special brand
of these attacks, including false accusations and scapegoating. Here again, an element of
the apparent football subculture of GSU seems to be a partial explanation, as these practices
bear an unmistakable resemblance to the dictatorial styles likely used by the "old schoo "
coaches holding sway over the revenue sports at GSU. Overall, it seemed that hostile
public reprimand was a solidified practice in this internship program.

While the above conclusions of exploitation, hazing and ridicule may be
overdrawn. what is significant is that the SATs in the study evidenced little overt
opposition and attenuated their resentment in their recounting of these practices.

Obviously, the students were largely powerless to change these practices and accounts of
resistance were few and none were described as collective. Indeed, a number of these
experiences were viewed with humor at how they eventually led to better rapport with
superiors. In any event, it appeared that those who did not care for these circumstances did

not remain in the program and certainly would not have been participants in this study had

 

146
that been the case. Nevertheless, the overt nature of these practices, and the fact that there
were likely few other areas on the campus that would tolerate them, indicate a good deal of
insulation of these portions of the sportsnet.

Similar points apply to the "educational" components of the internship, as the
students described them. First, they spoke of a need to be "aggressive" about learning
skills, given the fact that the more experienced uainers around them were often too busy to
take time to provide direct instruction. Many SATs shared the view that the quality of the
internship was a matter of what students were "willing to put into it. " Passivity seemed to
indicate a lack of interest in the internship and worked to the peril of the student trainer
needing to pass the "practical" examinations for certification. Additionally, student trainers
indicated that there were disputes about some rehabilitative modalities and their medical
indications. Variations in athletic training "schools" were seen when SATs pointed to
disagreements among superiors on sequences of modalities and preventative measures,
including the "GSU wrap." Finally, once acquired, the application of these skills to actual
cases of injury were complicated by the competing agendas of coaches, athletes and staff
trainers, lending a political significance to SAT decisions. Since the organization seemed to
be under the hegemony of a few powerful coaches--who apparently were granted
managerial carte blanche for making all manner of changes--it sceued that in cases
involving their teams these expressions of public loyalties tended to be consistent with their
wishes.

It must be reiterated that these experiences are those that appeared to stem primarily
from the status of these SATs as students. Any student enters an educational environment
with some degree of dependence on superiors to fill in gaps in knowledge and skill, present
coherent and consistent lessons, and show how the acquired skill ought to be used. While
professional trainers have presumably solidified their views and techniques, variation
among them in a single athletic training program left students in a number of quandaries.

While there was little evidence that core principles of athletic training were in question or

147

that student trainers were being neglected, uncertainties were noted in a number of
decisions the student trainers made. For this reason, again, political vacuums created by
such differences may have been settled by acting in ways consistent with the wishes of
athletes and coaches, although there was little evidence fiom the SATs that they succumbed
to pressrue from these coaches to permit injured athletes to play. This may be due to the
fact that these influential coaches had full-time staff trainers assigned to their teams.

However, one can also see in these circumstances the opportunity for students to
begin to craft a professional role, however perilously, by making choices from within the
apparent range of possibilities created by the indecision or disagreement of superordinatcs.
Of relevance to the treaunent and Other handling of athletic injuries, these conditions also
meant they had some degree of relative autonomy in their practices and decision making.
These may have related primarily to minor health problems of athletes, as many of the more
significant injuries secured to be referred to staff trainers. However, the day to day care
and treatment of these injuries were the responsibility of student trainers. There was
therefore some room for students to use their own judgment in the handling of the cases
they confronted. This included the "uriddleman" functions of keeping of potentially
damaging information about athletes from coaches and others, the adaptation of
rehabilitation regimes to suit the personalities of athletes, and the rendering of non-
professional advice to athletes in cases where a referral might have been preferred by staff.

These small "spaces" within which the student trainers were able to maintain some
degree of independence were complimented by even larger ones. An ironic result of their
commitment of substantial amounts of time to their internship was the establishment of
familiarity, fiicndship and perhaps even intimacy with the athletes with whom they
worked. As noted in Chapter Three, these associations with athletes were presumably
problematized by the policy against socializing, yet the problems were not equally felt
among all student trainers. There seemed to be few male SATs who transformed their

understanding of the policy into modifications of behavior. Women, of course, were made

148
to feign a disinterest in male athletes in order to insure the confidence of superiors that they
had only professional motives in their actions. Indeed, both men and women appeared to
maintain friendships with athletes.

The dependency of the students on this credential-granting program, therefore,
came with a counter-dependence of the program on student labor to deliver the majority of
its services. The "problems" the associations between student trainers and athletes might
have created appeared to be too unwieldy for the supervising staff and others to adequately
control. The transitory nature of any student workforce also runs against efforts to exercise
authority over interns. Control, rather, secured to be exercised in the most "obvious" or
perhaps symbolic cases--namely, those interactions involving women SATs and male
athletes-and the audience for these gestures again seemed to be influential coaches in the
athletic department. However, a more general sexualization of the actions of women within
traditionally masculine subcultures by all of the members of the sportsnet should not be
overlooked, including that by women trainers themselves. It also should be pointed out, in
this regard, that there may be a good deal of social capital for student trainers that could be
gained by becoming the social fiiends or intimates of athletes, particularly those with public
recognition. These opportunities may have been simply too tempting for SATs to forego.
The requirement, again particularly for women, seemed to be the need to skillfully manage
impressions of one's affective neutrality toward athletes in the presence of staff and other
influentials.

These were cases, then, in which student trainers affu'med their role as students, in
defiance of the conditions of their role as student trainers. This consisted in interacting
with athletes as students by engaging in normal social activities, cohabitation, and, as
suggested, by establishing intimate relationships. Perhaps this was the compensatory
space for the venting of a number of frustrations associated with student status, including
exploitation, hazing and public reprimand, the functions of which seemed to be to test the

mettle of learners to withstand the spate of pressures they might face as heads of sport and

149
as professional trainers. Yet, as Coakely (1991) suggested is the case with athletes
suffering from "burnout," a coping or "venting" strategy is evidence that one does not
intend to challenge the social structural arrangements which make the coping strategies
necessary.

Overall, as students, student athletic trainers were subject to a number of
degradations, humiliations and restrictions in behavior that translated into initially low
status, performance of duties of questionable relevance to their education, and subjection to
reprimands likely sharing much in common with their athlete counterparts. As suggested,
however, these very conditions created possibilities of autonomy, particularly in the ability
of SATs to have extensive interactions with athletes. The impossible task of monitoring
these relationships led to definite losses of institutional control, even though it was also
clear that the SATs felt some degree of anxiety about their relationships with athletes.
Again, as students, both of these groups secured able to pursue common interests which
may have provided a therapeutic function. This seemed particularly the case in instances
where superiors placed unreasonable demands on student trainers.

As I will summarize next, however, these alliances between students and athletes,
based on common roles as students, were not without problems. Indeed, in their roles as
apprentice athletic trainers there was another set of practices and forms of resistance that
reinforced solidarities with other trainers, including the very staff whose intentions were
circumvented in the violations of the no—socializin g policy. Moreover, some of the same
duties that led to implications in student trainer statuses as students also had implications
for their non-trainer relationships.

5 l I . E . E I l . I .

The participants in this study were primarily those who had attained some senior
status in the internship program, and were therefore strongly committed to accomplishment
as student trainers. As a result, they had begun to share with their superiors and with each

other a set of common perspectives on professional issues and dealings with athletes,

150
coaches, physicians, and others within the sportsnet. A good portion of Chapter Three
surrrrnarized the predicaments in which these student trainers found themselves, particularly
the section on disruptions. There it was noted that it was primarily athletes and coaches
who failed in various ways to understand and appropriately utilize the services of student
trainers, exposing SATs to some of what are likely the perennial (i.e. sedimented)
problems of the profession.

These problems seemed to begin with the visible activities of beginning student
trainers that, as mentioned above, may also function as hazing practices. The verbal
dimensions of the hazing practices missing from senior trainers towards learners may be
explained by the fact that the former shared the leveling task of providing water to athletes,
as noted in the very first portion of the Duties section. Moreover, athletes, and some
football players in particular, seemed all too willing to perform the tasks associated with
verbal harassment and intimidation, as seen in the "water boy/water gir " brand. As also
seen, some athletes were simply intimidating by virtue of their public recognition, skills
and team statuses, which also led to problems for SATs. In general, these duties, the
perception (and substance) of fetching items for athletes, and the play of personalities and
reputations appeared to create tensions between SATs and athletes and therefore solidarities
and counter-responses among both student and staff trainers.

What may be part of a larger pattern of resistances of athletes to their institutional
treatment was described by SATs as "noncompliance." Athletes confionted systems of
regimented practices that they likely considered with as much resentment as student trainers
attached to certain of their duties, yet student trainers were part of these regimented
practices for athletes. This was particularly true in the case of injury, where athletes
showed disparate forms of opposition to the medical system of which student trainers are
often the first on-site representative. As summarized in the section on Compliance, these
resistant acts of athletes occurred throughout the entire phase of injury, rehabilitation and

return to play or discontinuation of play. Athletes were said to have sustained injuries that

15 1

they did not report and reported injuries that they did not sustain; refused treatment for
injuries requiring it and requested treatment for injuries they were to handle themselves;
reported for treatments and not complied with instructions or failed to report and lied to
coaches with claims that they had; promised to do treatments at home and not done them or
done treatments at home and claimed they did not work; stayed in rehabilitation with false
claims about pain or exited rehabilitation with false claims about comfort. In addition,
athletes ventured to outside physicians to obtain second opinions based on beliefs that the
medical staff at GSU was incompetent, even though they did not fully avail themselves of
all the services GSU offered. While this may not represent a comprehensive summary of
these difficulties, they do suggest that SATs had a number of various athlete "conditions"
they had to evaluate, not all of which were strictly injuries in their view.

Additionally, the way in which an injury was sustained creawd pressures for the
SATs that may have stemmed precisely from the same familiarity the no-socializing policy
was likely intended to prevent. Injuries sustained outside of athletic participation and self-
induced illnesses (e. g. via alcohol consumption) were said to be more likely to be reported
to student trainers. The burden such knowledge carried placed them in the position of
potentially having to compromise their "policing" responsibility to report such ailments.
Otherwise, given the fact that some SATs did not report them, such disclosures at least put
them in the position of possessing knowledge they were to pass along to staff-~a failure
which would be discovered should staff acquire the information through other means.

With their athletic trainer "hats" on, these SATs had very few options for handling
the practices of athletes who were belittling, noncompliant or who took advantage of them.
What seemed most common, if and when they were used, were gestures of reciprocity.
Athletes who threw water bottles had them thrown back at them. Verbally abusive athletes
were ignored or received verbal abuse in return. Players who feigned injury were deemed
"head cases" and received feigned attention and, in a couple of cases, feigned treatment.

Athletes who did not show up for rehabilitation were met with blame for their own

152
conditions and were left to pay the price in terms of playing time and team status. Those
who confided conditions that were not the result of their athletic participation occasionally
had these conditions reported to coaches or staff trainers, or were at least dissuaded by
these possibilities. This was particularly the case in instances where the SAT possessed
knowledge about the more general aspects of the athlete's life and/or when the problem was
serious enough, in the SAT's view, to merit a referral.

In addition to these counters to athletes, the student trainers reported that some
athletes sought their advice for various matters, including, alas, their medical knowledge.
This included information on injury prevention, diet, and exercise regimes. As
summarized in section on Information and Advice, moreover, SATs also attempted to
create other conditions whereby athletes would reveal information to them, many stating
that they believed that such information helped put a particular injury or problem "in
context." Both of these practices, while perhaps ultimately aiding the athlete, are
nevertheless also ways of controlling the behavior of athletes and preventing compliance
problems. Recall that many SATs stated that their most compliant athletes were those who
they considered friends, and/or those who were knowledgeable and inquisitive about their
own bodies. These subtle ways of fostering deference, while occasionally effective, did
not ultimately seem adequate to the full task of gaining compliance. Some athletes were not
considered fiicnds, had little confidence in the medical knowledge of SATs, and were
simply not habitual users of athletic trainers.

Despite efforts to inform athletes about risks and ways of preventing injrnies, it was
the general feeling among SATs that "there is only so much you can do." Again, this was
the notion that "injuries happen," and that athletes and accidents were the primary
ingredients of injuries. However, SATs also attributed injuries to coaches who engaged in
behaviors that ran counter to their efforts. Indeed, in some cases it was clear that SATs as
well as the entire athletic training staff were not deferred to and were considered at the

"bottom of the totem pole" within the sportsnet. Coaches were among apparent superiors

153
and in some cases indicated little respect for student trainers and their expertise. These
behaviors of coaches included failing to notify student trainers about changes in practice
times and engaging athletes in injurious activities either through punishment or ignorance.
In cases where athletes sustained injuries, SATs noted that some coaches placed unrealistic
demands on recovery times or otherwise put pressure on them to "return" the athlete to
playing status.

As might be expected, these examples represent central professional dilemmas for
athletic trainers, both student and professional. Again, in the case of student trainers, there
was little that was done to directly confront coaches on these issues. A few SATs reported
having confrontations with coaches in the "heat of battle." Others simply nowd that, with
time, coaches would begin to defer to them on medical matters, particularly if the SAT had
demonstrated success with healing an athlete, and especially if the athlete returned to play
prior to the SAT's estimate. Other coaches, however, did seem to fully utilize the student
uainers, some in ways that went beyond the strict handling of injuries and other duties
described in the Duties section. In general, the practices of some coaches evidenced a
misperception of the roles of SATs such that, similar to athletes, coaches did not seem to be
knowledgeable users of trainer expertise.

It appeared, moreover, that the coping strategies of many of these student trainers in
handling their dealings with coaches, and perhaps in general, was by placing their services
within the dramas of the competitions, seasons, or the overall processes of healing and
return to play. That is, apart from the educational interest some had in evaluating injuries,
and apart from an interest in professional solidarity, student athletic trainers found
excitement and camaraderie in their roles that seemed similar‘to that of the athletes
themselves. Although a few trainers stated directly that they did not feel that they were part
of a causal chain of events which led to competitive victory, others secmd to believe that
they were necessary elements. Perhaps for some student trainers, their work was

conceptualized and performed in ways similar to those of the athletes with whom they

154
worked It was indeed these and other identities with the practices of athletes that may have
explained their willingness to undergo the kinds of sacrifices, embarrassments and other
hardships discussed above.
I 1' . 1 II S

In the Introduction it was suggested that the social structural arrangements that
surround contemporary athletes resemble what Goffman (1961) described as a "total
institution," the name Goffman used to describe a mental hospital. Drawing on the intuitive
connections I could make between the sportsnet and a "total institution," I proposed that
there were foru' similar processes which might be evident from interviews in this study.
These included mortification, or the intentional degradation of the "inmates" of an
institution; the notion of a "moral career" in which the inmate's entire life is subject to both
surveillance and convenient recording into the terms of the institution; the development of
"theories of human nature," based on these moral careers; and finally, the establishment of
a "servicing" relationship to the body in the form of standardized procedures. My
conclusions in this regard were that the intuitive connections were given very little help by
the data in the study.

Rather than an institutionalized system of mortification directed at the analogous
"inmates" of the sportsnet, the athletes, I found that the only mortification evident in the
interviews was that of the student trainers themselves. As mentioned above, these came in
the form of various quasi-hazing practices and belittling public reprimand. Again, the
duties associated with learner status, I speculated above, seemed to be both a product of
necessity--i.e. the training rooms had to be clean-- and perhaps an early signal to the SATs
of what they might expect should they decided to stay in the program. Those who elected
to exit the program were likely viewed as those who would not be able to withstand the
pressures that might confront them in cases where they had sole responsibility for a team.

Again, this is highly speculative and would require further investigation.

155

Verbal reprimands came from both staff trainers and coaches and emerged fiom
various accidents and seenringly misdirected anger. While some student trainers in the
study said they were under constant anxiety at the prospect of being subject to one of these,
the fact that the reprimands did not seem to be particularly systematic or methodical
suggests that they might have been simple reproductions of patterns of abuse, similar to
that often found in abusive families and, not. coincidentally, the coaching profession (Sage,
1973, Masscngalc, 1974). Coaches tend to coach in the way they themselves were
coached, which is most frequently the autocratic style. The apparent fact that the most
influential coaches in the program used this style with their players perhaps may have
reflected a larger pattern. Again, this is speculative, given that no systematic observations
of these coaches was conducted.

What might be concluded with respect to mortification of athletes is that, if there is
an analogous process, it is more likely a lifelong sequence of events that is part of the
formation of athletic identity. Mortifications may confront the athlete in the form of various
degradations from coaches, parents and others, both in the form of physical challenges and
psychological attacks. Presumably, these are to be seen as a series of challenges to be
overcome not unlike the challenges to physical skill inherent in their activity. It may be that
those athletes in the study who had a history of such treatment saw an insufficient challenge
in student trainers, and were considered to be variously noncompliant as a result. Indeed,
in some cases, athletes participated in the mortification of student trainers, in most cases
with impunity. There was simply no evidence from the study, however, to suggest that
student trainers were part of any such process directed at athletes.

A bit more could be said on the subject of the analogy of "moral careers," although
its presentation in the study itself bore little resemblance to that in Asylums. Again, a moral
career would result from members of the institution taking the athlete's life story and
essentially reducing it to an institutionally-serviceable one. The material for these stories

about athletes came in the form of knowledge held by student trainers as a result of being

156
friends, or in any event, constant companions of these athletes. In Asylums. "social
mobility between the strata (staff and inmates) is grossly restricted; social distance is
typically great and often formally proscribed" (Goffman, 1961, p. 8). While there were
formal proscriptions against student trainer socialization with athletes in the form of the no—
socialization policy, this policy was not and could not effectively be enforced by the staff
trainers. Again, this secured to be a matter of the sheer volume of SATs and athletes in the
program. Enforcement of the policy seemed to operate on rumor and mostly against
women.

The information assembled by student uainers about athletes, moreover, worked
both for and against the wishes Nixon (1992a) attributed to the sportsnet, although it
secured that in most cases the latter prevailed. That is, student trainers tended to withhold
information from staff and coaches that might do harm to the athlete's status on the team
and in the program. This was particularly true in cases where SATs were friends who
socialized with athletes. Other cases, however, were brought to the attention of the more
senior staff and coaches, and these were cases the student trainer saw as serious and likely
the type that would have become clear to all eventually, whether they relayed it or not.
These were generally substance abuse and severe psychological problems.

Overall, however, collusion and social interaction interrupted the functions these
reductions of life stories might accomplish. However, this did not have particular
consequences for the third analogy of "theories of human nanne," that stemured fiom the
systematic assembly of these typologies of athletes. There were, indeed, such notions as
"head cases," "babies," "egos," and "dedicated" athletes. As noted, head cases were
feigned injuries cropping up in the context of losses or other personal or collective failures,
leading to the conclusion that "when they lose, you see them all" in the training roour.
This may have constructed the theory that certain athletes cannot accept responsibility for

their own failures and therefore provide social cover for themselves under the pretense of

injury.

157

"Babies" were those who reported injuries too minor in nature to report to a trainer,
in the view of the SAT. In most cases the imputed motive to these cases had to do with a
"need for attention" arising from a larger social or emotional problem with the athlete.
Some student trainers felt ill-equipped to handle such problems, while others felt that they
were responsible for the entire person of the athlete. Other "babies" included those with
low pain tolerance levels as compared to other athletes. These athletes, along with "head
cases," received attention and treatment, although it was often accompanied by doubts
about the athlete’s honesty. These athletes also thereby earned a reputation they had to
overcome by being "legitimately" injured.

In the case of "egos" and "dedicated" athletes, there is simply no analogy in
Asylums. with the possible exception of the latter athletes being similar those who are
"broken" by the system's requirements and submit themselves to the wishes of the
institution. However, dedicated athletes are those who move into and out of the system of
medical therapies quickly precisely because they do not care for the consequences it holds
for them. Moreover, the fact that these medical services are voluntarily chosen by athletes--
or at least they are not forced to use them--submission to the requirements they impose is
less a matter of resignation to the sportsnet as it is a resignation to the fact of an injury.

However, if one were to construct a composite of the ideally injured athlete based
on a the statements of the student trainers in the study, it might be as follows. An ideal
injured athlete is one who is dedicated to their sport out of a love for it, and not due to
ulterior motives like a "free" education. Should the athlete sustain an injury, it will be the
result neither of ill-advised activities either inside or outside the sport. The injury will not
occur suspiciously before a difficult practice or competition or in the wake of a team or
individual loss. The injury will not be so minor that its treatment falls within the
capabilities of the athlete. Rather, the injury will be sufficiently serious and unique as to
both provide an educational experience for the trainer and not insult their skills and disrupt

their busy schedules. The athlete will immediately report the injury to the student trainer

158
and has neither a "macho" attitude nor a lack of trust in the student trainer’s competence.
The coach is aware of the nature of the injury and has reasonable expectations for the return
of the athlete stemming from an acceptance of the tiureline and other information provided
to them from the student trainer. The coach will not pressure the student trainer to return
the player to the team prior to the end of this specified time period, regardless of the
importance of the injured player to the team. The athlete will report as directed to
rehabilitation sessions and participate in those sessions without complaint and with the
same sense of dedication shown in their athletic activities. They, therefore, are not lazy
either as athletes, as students or as persons in general. They are informed about their
injury, and know what behaviors are consistent and inconsistent with healing, and choose
only the former. The attendance at treatment sessions is not a last-ditch effort to prepare for
a competition or spot on the team as a result of having previously failed to report for
treatment. The general status of the athlete, their on-field demeanor, and their physical size
are neither used to intimidate either fellow athletes receiving treatment or student trainers,
nor is their experience in the training room used to circumvent normal procedures. The
athlete heals ahead of the predicted time and the student trainer is thanked by the athlete, the
coach and the staff trainers for their hard work, dedication, and long, unpaid commitment
to the health of the athlete.

The final analogical concept from total institutions is the notion of a "servicing"
system for bodies seen in sets of standardized treatments that flow out of a particular
"school" of uredical practice. Obviously, again, the fact that no observations were
conducted prevents an informed discussion of such matters, although two points can be
made in this regard. First, because athletic training is itself a medical para-profession, the
treatments that it prepares its professionals to perform are not "radical" in any medical
sense. Clearly, no surgery is performed and other such treatments are passed along to
physicians. Secondly, there were, as noted earlier, differences in the approaches and

"philosophies" of staff trainers within the GSU program. These considerations render

159
questionable a notion of a "workshop complex," in all but routine matters, such as icing
and other simple treatments. The use of proprioceptive neuromuscular facilitation (PNF)
that the student trainers reported seemed to be the lone example of a fairly sophisticated
procedure that was used across multiple injuries. This procedure, however, is a
rehabilitative one and not particularly radical in the context of the other therapies used in
medicine.

Overall, with respect to the analogy of total institutions, I think it reasonable to
conclude that the sportsnet of GSU is far from totalizing in the way Goffman suggested
was the case in a mental hospital. Resistances to the practices of the services SATs
provided were numerous and effective testaments to the relative freedom of athletes to use
the services at their discretion. In no case was there a process of mortification evident for
athletes in any description of student trainers. Indeed, mortification appeared to be part of
the treatment of student trainers themselves, particularly for learners. The effect of the
"moral careers" constructed for athletes was diluted by the frequency and consequences of
friendship with student trainers. Stereotypes of athletes were also few in nature, although
not without consequence. Perhaps the most serious of these is the potential for missing or
dismissing serious cases of injury given an athlete with a reputation for "crying wolf" or
otherwise complaining about what are taken to be minor levels of pain. However, SATs
seemed thoroughly aware and appropriately anxious about such problems. Finally, there
seemed to be no corollary of a blind, systematic approach to treatments with the exception
of rather minor modalities involved in rehabilitation.

What was perhaps the most totalizing characteristic about the GSU sportsnet was
the commitment of time, the lengthy interactions, and the near total immersion of student
trainers themselves and student trainers and athletes, in relative isolation from other student
peers. It may be that there have developed in these groups a subculture oriented around the
many common problems of student athletes and student trainers. While it might be

tempting to conclude that this t0talization works in the conspiratorial interests of the

160

sportsnet and the quest for certainty Nixon (1992a) attributes to it, we might take our cue
from Goffman in casting some doubt on this conclusion:

Sociologists have always had a vested interest in pointing to the ways in

which the individual is formed by groups, identifies with groups, and wilts

unless he obtains emotional support from groups. But when we closely

observe what goes on in a social role, a spate of sociable interaction, a

social establishment-pr in any other unit of social organization--

embracement of the unit is not all that we see. We always find the
individual employing methods to keep some distance, some elbow room,
between himself and that with which others assume he should be identified.
. .Without something to belong to, we have no stable sense of self, and yet
total commitment implies a kind of selflessness. Our sense of being a
person can come from being drawn into a wider social unit; our sense of
selfhood can arise in the little ways we resist the pull. Our status is backed
by the solid buildings of the world, while our sense of personal identity
often resides in the cracks (p. 319-320).

Summdflmmmendations

This study was composed of interviews with approximately half of the members of
student athletic training internship program of a large university. These students were
engaged in a number of struggles that related to the establishment of professional
credentials in a highly competitive field and the desire to retain a social identity in spite of
the consuming requirements of their internship. The duties of student trainers were
hierarchically arranged and rewarded by progressively more responsibilities in the
program. The most desired sports assignments were primarily high profile revenue sports
and/or those with characteristically high numbers of acute injuries. Women were generally
excluded from the highest status sports in the program due to the considerations of privacy,
presumed sexual distractions to athletes, and protection from vulgarity. Men and women
trainers regularly engaged in social activities with athletes and acquired a great deal of
information about them as a result. This information was generally in the hands of student
trainers to use as they saw fit and was normally passed on to staff and others if it was
judged to indicate a problem viewed as serious and outside the scope of their skills. All
student trainers were aware of serious injuries in sport and concluded that they were a
natural part of participation understood by all athletes. While SATs held stereotyped views

about athletes who could not bear the level of pain of their peers, they also expressed

161
concern about and provided information to athletes they viewed as taking serious health
risks by continuing their participation.

Regarding the contention by Nixon (1992a) that athletes are embedded in a
conspiratorial sportsnet and associated athletic subculture that encourages them to play in
pain, there was little evidence of either of these in this study. Among the primary
revelations of this study was that student athletic trainers may spend more time with college
athletes than any other single representative of the sportsnet. Given this, there was not
singular set of common beliefs among student trainers about pain and injury that were
systematically deployed as counters to outside medical advice, nor did there seem to be a
consensus among athletes on these matters. Not only did student trainers give medical
advice that was then systematically ignored by athletes, there were examples of athletes
who sought advice "outside" the sportsnet only to return to play against the wishes of the
GSU medical staff. These examples suggest that legitimation for medically inadvisable
sports participation by athletes can be obtained both inside and outside a sportsnet.
Further, instances where student trainers were being pushed by coaches to permit injured
athletes to play were resisted and cited as among the stresses of the job.

This is not to suggest, however, that SATs were immune to ideologies and subtle
techniques that enforced a "mean" standard of pain enforced on the athletes with whom
they worked. Certainly such standards existed, particularly in the forur of "pain tolerance"
evaluations, but such standards may be expected to be parts of any system of medical
perception: one can only perceive an aberrant condition against the backdrop of a normal
one, both in individuals and groups. However, given the fact that the athletic training
services they provided were oriented to return athletes to participation, few of the practices
of student trainers included consideration of advising that the athlete discontinue play.
These decisions were, again, considered to be the ultimate responsibility of an informed,

sovereign, mostly adult group of athletes. While it may be that the series of practices

162
engaged in by student trainers, some sedimented, others spontaneous and accidental,
contributed to athletes taking unreasonable risks, this hardly resembled a conspiracy.

These points imply a need for further study, and the following are some
suggestions. First, a comparative study contrasting student athletic trainers with analogous
allied health professions, and which looks at the nouns, beliefs and practices of each,
might shed light on the function of the cleaning and other duties of learners in athletic
training. Second, a study of the relationship between the sets of norms SATs possess (e. g.
those related to personal relationships between SATs and athletes) and their ultimate
success in the profession might be undertaken to identify those which seem to be rewarded
within the profession. Third, a comparative study of student trainers across programs,
such as those that house football versus those that do not, might shed light on the issue of
whether football provides a hegemonic normative framework for the tolerance of injury in
other sports. Fourth, the degree of sharing of norms among members of the sportsnet,
including coaches, physicians, athletes, administrators, staff trainers, and others might be
undertaken to examine the multiple and competing views within sportsnets that were in
evidence among student trainers. Fifth, a study of the nationwide patterns of sports
assignments for women in men's sports and vice versa would indicate how widespread the
practice of exclusion is across programs. Sixth, a related study of the experiences of
sexual and other forms of harassment by women trainers should be undertaken. Finally,
photographic and other analyses of athletic training and related sports facilities, perhaps
examining the architectural accompaniments to the apparent barriers to public perception
and separation of the sportsnet might be done.

Regarding policy and practical recommendations, I believe my conclusions are only
applicable to the issue of altering medical practices for athletes and the policy on
socialization. In the Introduction and Review of Literature, I suggested that the
underdeveloped nature of the sociological work on the medical services provided to athletes

rendered questionable recommendations for changing the structure of existing services.

163
This study, I believe, lends even more weight to that argument. Recall that Nixon (1992a),
while offering a theoretical tool (i.e. network analysis) for the study of these issues,
presented no empirical evidence of a conspiracy among sportsnet members to convince
athletes to accept pain and injury--even presented evidence against such a notion-~yet,
nevertheless suggested that athletes seek "outside" medical opinions on their injuries. What
this study showed was evidence that athletes do seek such "outside" medical opinions. The
point Nixon did not confront is that the consequences of such actions may have little or no
influence on whether athletes continue to play with a medically prohibitive injury. Indeed,
one athlete described in this study sought "outside" advice in order to stay in the sport over
the objections of the medical staff at GSU.

If college athletes are vulnerable, they may be even more so if the consequences of
seeking "outside" medical services is the dissolution or dismantling of any "inside” medical
services they already receive, however compromised or dominated by the agendas of
coaches. That is, if medical services for athletes are already ineffective or otherwise
distorted by the context in which they are delivered, suggesting a regular practice of going
elsewhere may lead athletic administrators to seriously curtail or eliminate those that exist.
It is further fruitless to consider sportsnets as homogeneous across institutions, let alone
centrally organized conspiracies within individual ones. This is particularly the case in
sportsnets that employ a transitory workforce of peers to deliver a majority of their medical
services to athletes. The consequence of this fact at GSU was a loss of institutional control
over the way in which medical information was processed and used. This loss of control
stemmed both from the ineffable task of monitoring SAT/athlete interactions and from the
identification of student trainers with student athletes on a range of common interests and
values, most notably seen in socializing and the formation of friendships. The result was
student trainers making decisions about whether to act themselves or refer to others the
information they received. In some cases, this resulted in compromising the sportsnet's

ability to deliver medical services to athletes. In seemingly more rare cases, it resulted in

164
the athlete receiving medical services for injuries or other problems that might have gone
undetected. In general, a sportsnet appears to be considerably more complex than a
conspiracy. To undermine the set of independent medical systems that sportsnets contain,
particularly when so little is known about how they work, is currently an indefensible
recommendation.

If the cenual concern of work in this area is the exploitation of athletes and incidents
where the practices of sportsnets risk athlete health, this study might suggest that further
institutional controls be put in place to take student athletic trainers out of the "middle"
position regarding health information about peer athletes. This may be particularly
desirable in efforts to prevent student trainers from helping athletes hide injuries from staff
trainers and others. The result of such a policy, however, would likely be substantial
increases in the costs of health care services to athletes, as cheap student labor would
presumably be replaced by that of professional athletic trainers. Again, however, staff
trainers may be more prone to the wishes of coaches than student trainers, and hence
athletes might be treated more in line with the wishes of the sportsnet.

In the more likely event that student trainers continue to be placed in these important
positions, it is unreasonable for athletic training programs to expect uncompromised loyalty
to its wishes when it so overtaxes and itself exploits unpaid or underpaid student athletic
trainers. Further, the amount of social interaction among students who are essentially
adults is not the business of universities to dole out, particularly when it is duplicitously
claiming to be promoting student interests while benefiting from free student labor.
Moreover, it was not clear that the socializing and friendships between SATs and athletes
seriously undermined the health status of athletes. Indeed, some measure of protection
from the invasive practices of surveillin g athlete behavior were made possible by the
intervention of student trainers. Moreover, we should not underestimate or minimize the
roles and responsibilities of athletes themselves in exercising sovereignty over the treatment

of their own bodies. Presumably, the ideal situation is one in which educated student

165
athletes make informed decisions about their own futures. Policies regarding the assigned
responsibilities of student athletic trainers should be gaged by the degree to which they

make such a situation possible.

APPENDICES

166
APPENDIX A

W

Your responses to this questonnaire are being used only for the purposes of this study.

The results will not be shared with anyone Other than the investigator and have no bearing

on your status within the athletic training program. You may discontinue participation in

the study at any time and may refuse to answer any or all of the questions below. than];
. . . ,

Name W!) Most recent assignment

 

 

(list team)
Sex _M _F Year _Grad _Sr _Jr _SOph. _Fresh.

Race Asian American African American Hispanic Native American

_White _Other please specify

 

 

 

Date of Birth / / Academic
Major

mo day year
Minor

 

How long have you been in the athletic training certification program? (please
check one)

_less than 1 year _1-2 years _2-3 years _3 or more years

Please list the occupation you currently desire once you are finished with your
education?

 

Listed below are possible reasons for being in an athletic training certification
program. Please check all that apply to you

Experience as a former athlete
Sustained an injury as an athlete and became interested in treatment, rehabilitation,

etc.
Like being involved with sports teams

Interest in working in sports medicine setting upon graduation
Preparation for advanced degree in athletic training

Preparation for an advanced degree outside athletic training (e. g. Master’s, PhD.,
M.D., etc).

Other reason, please specify

 

 

OFFICE OF
RESEARCH
AND
GRADUATE
STUDIES

University Committee on
flanuuummhhe
umunamna:
(MENU)

Mucmgan State University
225 Admmustranon Buildung
East Lansmg, MICDIQBR
«muses
5177355-2180

FAX: 517/336-1171

   
 
  

167
APPENDIX B

MICHIGAN STATE

UNIVERSITY
June 27, 1994

TO: Stephan R. Walk
205 Im Sports Circle

RE: IRBI: 94-181
TITLE: A STUDY OF THE EXPERIENCES OF STUDENT ATHLETIC
TRAINERS
REVISION REQUESTED: 05/13/94
CATEGORY : l-C
APPROVAL DATE: 04/18/94

The University Committee on Research Involving Human Subjects'(UCRIHS)
review of this project is complete. I am pleased to adv se that the
rights and welfare of the human subjects appear to be adequately
protected and methods to obtain informed consent are appropriate.
lhegegorg, the UCRIHS approved this project including any revision

is e a ove.

RENEWAL: UCRIHS approval is valid for one calendar year, beginning with
the approval date shown above. Investigators planning to
continue a project be ond one year must use the green renewal
form (enclosed with t e original a proval letter or when a
pro’ect is renewed) to seek u ate certification. There is a
max um of four such expedite renewals ssible. Investigators
wishing to continue a project beyond tha time need to submit it
again or complete review.

REVISIONS: UCRIHS must review any changes in procedures involving human
subjects, rior to in tiation of t e change. If this is done at
the time o renewal, please use the reen renewal form. To
revise an approved protocol at any 0 her time during the year
send your written request to the CRIBS Chair, requesting revised
approval and referencing the project’s IRB i and title. Include
in our request a descr ption of the change and any revised
ins ruments, consent forms or advertisements that are applicable.

PROBLEMS

CRAN088:/ Should either of the followin arise during the course of the
work, investigators must noti y UCRIBS romptly: £1) roblems
(unexpected side effects comp aints, e c.) involv ng uman
subjects or 12) changes in the research environment or new
information ndicating greater risk to the human sub ects than
existed when the protocol was previously reviewed an approved.

If we can be of any future help, lease do not hesitate to contact us
at (517)355-2180 or FAX ($17)3 6- 171.

Sincerel

  

id E. Wrig
CRIHS Chair

DEW:pjm
cc: Deborah L. Feltz

168

 

APPENDIXC
UNIVERSITY
April 25, 1994
TO: Stephan R. Walk
205 Im Sports Circle
RE: IRB#: 94-181
TITLE: A STUDY OF THE EXPERIENCES OF STUDENT ATHLETIC
TRAINERS
REVISION REQUESTED: N/A
CATEGORY: -C
APPROVAL DATE: 04/18/94

The University Committee on Research Involving Human Sub ects‘(UCRIHS)

review of this project is complete. I am pleased to adv se that the

rights and welfare of the human subjects appear to be adequately

protected and methods to obtain informed consent are appropriate.
lheregorg, the UCRIHS approved this project including any revision
iste a ove.

RENEWAL: UCRIRS approval is valid for one calendar year, beginning with
the approval date shown above. Investigators planning to
continue a project be ond one year must use the green renewal
form (enclosed with t e original asproval letter or when a
project is renewed) to seek u ate certification. There is a
maximum of four such expedite renewals ssible. Investigators
wishing to continue a project beyond the time need to submit it
again or complete rev ew.

REVISIONS: UCRINS must review any changes in procedures involving.human
subjects, rior to in tiation of t e change. If this is done at
the time o renewal, please use the green renewal form. To
revise an approved protocol at any 0 her time during the year,
send your written request to the CRINS Chair, requesting revised
approval and referencin the project's IRB I and tltl... Include
in our request a descr ption of the change and any revised
ins ruments, consent forms or advertisements that are applicable.

PROBLEMS
CRANOES:/ Should either of the followin arise during the course of the
work, investigators must noti y UCRIHS promptly: {1) problems
(unexpected side effectsi comp aints, e c.) involv ng uman
n

 

   
   

subjects or (2) changes the research environment or new
OfimEm? information indicating greater risk to the human sub ects than
RESEARCH existed when the protocol was previously reviewed an approved.
AND .. , *
DURJE If we can be of any future help, lease do not heSitate to ccntac- us
BRA at (517)355-2180 or sax (517)3 6- 171.
STUDIES
University Commutee on S incere
RunuuummNMo . "
Human Sublecte
(UCIIIIIS) "

Michigan State Universny

avid E. Wright , pp
225 Admlntslrallon Bunldinq ”CRIBS Cha it

East Lansing. Michigan DEW: pjm
«ENJOW
gyxfi4wo cc: Deborah L. Felts

fiAX:5177336~117I

1 69
APPENDIX D

Consent Form:

I am engaged in a research project which attempts to understand what it is like to be a student
athletic trainer involved in the clinical aspect of the experience. Specifically, I am interested in
what a typical day is like, the kinds of information student trainers collect about athletes and how
they view their interactions with others in the clinical setting. I am also interested in how student
trainers handle injuries as a regular part of their duties and how these experiences may differ by
the gender of both the student trainers and the athletes with which they are working. The
information collected may help the profession of athletic training improve the experiences of
student trainers. It may also reveal how injuries in sport come to be accepted in society.

Your participation in this study is completely voluntary. You may decline to answer particular
questions or discontinue participation at any time without penalty. Should you choose to
discontinue you participation, the researcher retains the right to use the information you provided
up to that point in any presentation of the study. Your decisions regarding participation will not
affect your status as a student or as a student trainer. I assure you that the results of the interviews
and observations will be confidential. Your responses will not be make available to your
superiors nor will I indicate to them in any way whether or not you participated in the study.
Identifiers used by the researcher will be your first name (which will be known only to the
researcher and converted to pseudonym in all summaries of the study), gender, race, team
assignment, year of school, history of injury and intentions after graduation. This information
will be used to guide questions in the individual interviews. However, be aware that the group
interview portion of the study presents the possibility that those involved may share information
you describe with others, although participants will be asked to keep information confidential.
Also note that, although your name will not be used, it is possible that you may be able to be
indentified by those who are able to put together information you provide in your responses to
questions. Recorded tapes of the interviews will be heard only by the researcher.

Thank you for your cooperation!

Stephan R. Walk Signature

 

Doctoral Candidate Date

 

LIST OF REFERENCES

170

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