You are here

First Responders

Athletic trainers are a team's first line of defense

The crescendo of 51,236 voices yearning for six more points was snuffed out by a moment’s panic. The pass had flown a yard too far, but Austin Hill wouldn’t relent. His 40-yard sprint culminated in a headfirst dive, but the ball tumbled out of his grasp when his helmet and pads clattered into the base of the goalpost. When his body jolted to a stop, the roar on the spotless Tucson afternoon morphed into a concerned murmur that rolled over the field like a storm cloud.

The 21-year-old lay prone behind the end zone. Any concern on Arizona head athletic trainer Randy Cohen’s face was obscured by dark sunglasses as he strode onto the field alongside one of his assistants. Usually, they’re lost amid a sea of leviathans in navy jerseys on the sideline. But in this moment, 51,236 pairs of eyes shifted to them. For a few interminable seconds, they shed obscurity and became the most important people in Arizona Stadium.

The pair knelt beside the fallen player and began their work.

Arizona’s head athletic trainer Randy Cohen checks on receiver Austin Hill, whose full-speed collision with the goalpost cast a pall over the crowd.

 

 

 

 

 

 

Rare moments like those – the ones where a pall supersedes the typical bedlam of a college football game – may be the only time spectators notice athletic trainers or, perhaps, even remember that they exist. But their role is more comprehensive than rushing onto a field in a time of crisis or tending to a player on the sidelines when a hamstring tightens or a finger contorts. Athletic trainers often spend more time with student-athletes than coaches do. Their jobs aren’t essential only on Saturdays, but every single day from the beginning of summer workouts until the final out in the spring.

Athletic trainers are charged with ensuring that student-athletes recover as quickly as possible from the many injuries they’ll sustain through the course of the year, while simultaneously keeping the students’ well-being as the top priority. Some, especially at larger schools, are tasked with overseeing one team while those at smaller schools must work with student-athletes from a wide swath of sports. But no matter the level, trainers laugh at the notion of a 40-hour week. Many spend 70 hours in training rooms and on the field, while some, like Cohen, often exceed 90.

Football, they agree, is the most daunting challenge due to the brutality of the sport and rosters that often exceed 100. Athletic trainers must stay attuned to the needs of all of those athletes while serving as the conduit among team physicians, coaches, student-athletes and even concerned parents. They attend every practice, every game, every conditioning session, and must be prepared, at every second, to face the worst. Two student-athletes have died – one from an undetected heart abnormality, another from a pulmonary embolism – in Cohen’s 13-year tenure at Arizona.

“It’d be nice if people realized that we’re out there and we can deal with anything from a small blister to someone going into cardiac arrest,” says Roger Clark, head athletic trainer at Division II Colorado State-Pueblo. “That’s a lot of responsibility.”

+

On Friday, Nov. 9 – the day before Arizona hosts Colorado and he will rush to Hill’s aid – Cohen’s day starts at 6 a.m. when he strolls into the school’s expansive training room. It’s filled with nearly two dozen training tables, countless stacks of athletic tape and a bevy of treatment machines laden with wires and knobs. The main room is flanked by several offices, including his own, which might be mistaken for a coach’s if the footballs and helmets didn’t share shelf space with a knee brace, stethoscope and medical textbooks.

Hot and cold tubs – often teeming with student-athletes – rest in an adjacent room next to an underwater treadmill for players rehabbing serious injuries. This morning, Cohen and his staff will watch the roughly 50 football players who aren’t on the team’s active roster endure conditioning drills. As strength coaches put them through a series of competitive relays, it’s up to Cohen and assistant athletic trainer Leanna Olivar – one of 13 on Cohen’s staff, five of whom work primarily with football – to keep a watchful eye on each player’s breathing and mannerisms.

It’s imperative that athletic trainers familiarize themselves with each student-athlete’s physical tendencies, limitations, and exercise and medical history, Cohen says, so even the most subtle abnormality can be detected. For instance, vomiting during a workout might be the norm for one athlete while, for another, it could be a harbinger of something worse. Cohen, who landed at Arizona in 2001 after eight years as an assistant at Purdue, uses preseason physicals as a setting for lengthy conversations about health history and preventative tips. Plus, all new players – freshmen and transfers – are affixed with heart-rate monitors. Information can be the difference between life and death.

“The unknown is the scariest,” Cohen says.

And when it’s apparent that a player does need to be pulled from a game or practice, Cohen gets the final say. He’s an assistant athletics director, which affords him and his staff complete autonomy. Athletic trainers work those long hours to ensure that student-athletes can take the field on Saturdays, but they’ll never make a decision that puts the interests of the team above a player’s health. While his place in the athletics department hierarchy isn’t unique, it’s not a common arrangement, either. At many schools, he says, athletic trainers must still show deference to coaches.

“It’s vital having a person in sports medicine in upper administration in your athletics department,” Cohen says. “A coach’s job is to get the most they possibly can out of people, to push them beyond the limit they think they have. When you’re pushing somebody past their perceived limit, are you actually pushing them past their true limit? That’s a fine, fine line. If they go a little bit too far, you need somebody there to say we need to back off.”

Injuries, particularly concussions, are far too complex, he says, for coaches to expect a set recovery time and to judge the performance of athletic trainers based on that timetable. And if roughly 50 combinations of injuries can be sustained by a joint as relatively simple as the knee, then how can coaches or trainers expect to properly forecast how long it will take an organ as complex as the brain to heal?

“As an athletic trainer, you never want to lose your job for doing the right thing,” he says. “Every single concussion is different than the last one. So they have to be treated completely individually. It’s by far the hardest thing you have to deal with in sports medicine.”

+

Brian Binari, of Mount Ida, says the most satisfying part of his job comes when players thank him for his work after a grueling season.

After the conditioning session, Cohen retreats back to the innards of the McKale Center – Arizona’s basketball arena – to the athletic training room where players who will take the field against Colorado begin trickling in between classes. Though nearly every football player has some sort of ailment, 25 are on the official injury report for tomorrow’s game. Only one – Brian Chacon, the team’s long snapper – will be a game-time decision. Cohen does all he can through the week to ensure there are as few game-time calls as possible. When he gives coaches a definitive yes or no earlier in the week, backups have ample time to prepare for the game.

But freak injuries happen late in the week, too. Once, Cohen says, a player tore knee cartilage by ducking under a garage door, while another suffered a concussion when he was blindsided by a teammate opening a door. The 267-pound Chacon tripped during Thursday’s practice and landed hard on his right shoulder. Immediately, snapping or even raising his arm above his head became impossible. But he’ll get four treatments Friday, consisting of ice, electrical stimulation and stretching exercises. He’s one of several players who will lie on a training table, electrodes affixed to ailing body parts, and then go to a small exercise area to perform advanced stretches. There is ample room for all of this at Arizona, but that’s not always the case.

At Division III Mount Ida, head athletic trainer Brian Binari, 29, has only six tables at his disposal. And rather than a slew of offices, there’s just one, which he shares with both of the athletic training staffers who work for him. But at a school of only 1,400 students, Binari says he understands it comes with the territory.

“It’s kind of the nature of the beast,” he says. “When football comes in, it gets crowded.”

After overseeing more than a dozen treatments and observing Arizona’s practice alongside associate athletic trainer Dale Rudd on Friday afternoon, Cohen travels 30 minutes north of campus to the tranquil Westin La Paloma, nestled at the base of nearby Mount Lemmon, where the team will stay until venturing to the stadium the following morning.

After a team meal, a few players wander into meeting space where Cohen and other staffers have set up a makeshift training room. Chacon returns for more electric stimulation. His arm remains stubborn and sore; snapping a football and blocking a defensive tackle are physical impossibilities at this point.

Starting safety Jared Tevis arrives, and Cohen rubs and contorts his bloated left ankle for nearly 20 minutes in hopes of battling back inflammation and stiffness that could hinder his pursuit of Colorado receivers. More than a month earlier, Tevis landed at full speed with his ankle bent inward, but it didn’t break. With treatments and tape, Cohen has pieced him together and kept him on the field.

After Tevis’ grunts fade, Cohen moves to the floor, where cornerback Derrick Rainey is struggling to loosen a chronically sore hamstring. All the while, Cohen calls out orders to an intern, who has affixed electrical stimulation devices to three other players trying to keep pain at bay before the game. His work is finished by 9:30 p.m., though he’ll be on call through the night to tend to any issues. His eyes, much wider 15 hours before, are weary and red. His quick speech has slowed. But his alarm and the urgency of game day will jolt him awake before dawn.

+

Graduate assistant athletic trainer Darbi Scherer tapes one of many ankles she’ll tend to shortly before Arizona kicks off.

Cohen and his team – a pair of physicians, two graduate assistants, two other full-time athletic trainers and an intern – cram into the small training room in the belly of Arizona Stadium two hours before the 11:30 a.m. kickoff.

The tape flies. It’s applied liberally to ankles that need more, to aching shoulders and countless wrists. The team works quietly. Rainey gets a thorough tape job on his knee and hamstring. Cohen builds a custom thumb cast for an offensive lineman who put off surgery until after the season, as upperclassmen often do.

Amid the sound of tape stretching and the click-clack of cleats on concrete, Chacon talks with Cohen. Despite more treatment at the hotel that morning, the shoulder isn’t responding. He tries to warm it up on the field but can’t propel the ball backward. So he retreats to a private space in the back of the training room with team orthopedic surgeon Jon Nisbet and assistant team physician Bruce Helming. Nisbet explains that they can administer a painkilling shot that will allow Chacon to play. The consequences, he says, could be severe. Though it’s unlikely, he could fully tear the sprained ligament of the AC joint above his shoulder. At the very least, he will be in tremendous pain after the game.

“Everyone loves it after warm-ups, but they don’t after the game,” Helming says.

Aware of the risks, the decision is Chacon’s alone to make. He doesn’t hesitate. Nisbet works the needle deep into the AC joint above his shoulder. Chacon, lying prone on the table, averts his eyes, wary of watching the syringe do its work for 30 seconds. Immediately afterward, he’s able to lift his arm and push against Nisbet’s hand with his elbow, which he failed to do minutes earlier. Cohen, well aware of his patients’ phobias, pokes his head in and quips, “He didn’t pass out, did he?”

Two other players – wide receiver Dan Buckner and a running back – will receive the same painkilling shots in their shoulder and hip, respectively, while Cohen and his team work on a string of players who need last-minute equipment adjustments or treatments. Receiver Tyler Slavin felt an unsettling twinge in his back during warm-ups, and Rudd has to work out stiffness mere minutes before kickoff.

“Magic man,” Slavin says as he bumps Rudd’s fist before jogging into the locker room, where boisterous pregame chants are echoing through the cinderblock walls.

After a frantic hour tending to two dozen players, Cohen and his team are left alone for their final preparations. They stand in a small circle in the cramped room. Like the players, the trainers’ faces are sullen and heavy. Cohen rolls through everyone’s in-game assignments for the day, but it’s a mere formality.

“We’ve practiced this so much that it’s almost automatic,” says graduate assistant Samantha Young.

On the field, anything Cohen or his team could need is in a massive red trunk tucked next to the stands on the sideline. It’s full of braces, padding, splints, contact lenses, tape and more. There’s a training table beside it, only a few feet below the fast-filling stands. Helming has a portable EMS kit with everything from allergy medication to an emergency tracheotomy kit to an automatic external defibrillator.

The game starts well for Arizona – the Wildcats jump to a 21-10 lead. More importantly, Cohen and his team haven’t had much to do. Through little more than a quarter, they’ve monitored players only when they trot off the field and tended to a few scrapes and a bleeding thumbnail.

“Easy game for you so far,” someone on the sideline quips.

“Never say that; never, ever say that,” Cohen says – the muscles along his brow tightening, well aware that, in an instant, anyone could be severely injured. Soon after, offensive lineman Kyle Quinn limps off the field. Cohen performs a hasty evaluation and re-tapes his ankle on the training table.

“I felt it tweak; it popped a little,” the lineman, who suffered a high ankle sprain two weeks earlier, tells his athletic trainer. Cohen knows that his patient is safe; it’s simply up to Quinn to decide how much pain he can tolerate.

“He’s a senior,” Cohen says. “He’ll continue to play no matter what.”

Cohen then bounces to another player sitting on the sideline to check on a concussion he suffered last week. He’s not playing, but Cohen wants to make sure the crowd noise and intense sunlight aren’t exacerbating his symptoms. Cohen’s slight frame constantly darts through thickets of players. He pauses only to carefully observe the collisions at the line of scrimmage while the rest of the stadium watches the ball.

Soon after, safety Tra’Mayne Bondurant can’t will himself to his feet. Cohen and assistant Jenny Allen rush onto the field to tend to his ankle. Each helps bear Bondurant’s weight as he limps off the field, leg dangling. They hoist him up to the training table, pull off his shoe and cut the tape around his ankle. First, Cohen checks for fractures. Once that’s ruled out, he pulls the foot in different directions, probing for a diagnosis.

Fresh tape and the shoe go back on and he asks Bondurant to bounce from foot to foot, then on the hurt ankle alone. A mild sprain, Cohen knows; he’ll be fine to play when the defense takes the field again. All of this takes place mere inches from a sea of ardent fans amid the pressure of a tightening scoreboard – a disorienting place to make healthcare decisions. Yet the evaluation and re-taping take only a handful of minutes. Bondurant won’t miss a series.

Minutes later, Tevis comes off the field spewing expletives and struggling to walk. Cohen sprints to the trunk, gathers supplies and applies a mountain of tape to the safety’s knee, which has fallen victim to overcompensating for the ankle injury below. When Cohen’s work is finished, Tevis’ left leg looks like it’s swaddled in a cast, but his gait has improved.

At halftime, the air in the training room is thick with angst despite the best efforts of a rickety industrial-sized fan bellowing in corner. The sweat- and dirt-laden players grunt and groan amid the sound of scissors working fast and tape coming unglued off a roll.

“Any better?” Cohen asks Tevis, whose head hangs low as he sits on the training table, after even more bracing is applied in hopes of holding that leg together.

“Yep,” he glowers.

Randy Cohen and assistant Jenny Allen help Tra’Mayne Bondurant hobble off the field. Then they quickly go to work on his ankle on the sideline so that he can return to action.

Rainey contorts and leans back in a small folding chair, eyes shut firmly, as Cohen does what he can to soothe the hamstring. The efforts are in vain and he rushes to tell the special teams coach to adjust his roster – the junior cornerback simply can’t go. All the while, Rudd again works to massage the knots out of Slavin’s lower back.

In the first half, Chacon successfully snapped the ball and raised his arm to block on four extra points. About 15 warm-up snaps preceded each in the game, every one chiseling away at the injection’s masking effects. He winces as the trainers struggle to pull the shoulder pads up and over the damaged joint. Once they’re off, he’ll retreat back to the private room for another injection. Buckner, too, has returned for something to temper the pain.

“It hurts,” he says in an elevated voice. “That shot’s not working like I expected. It hurt the whole game.” Still, he caught a 21-yard touchdown in the corner of the end zone before halftime. He requests ibuprofen instead of the needle and darts back to the locker room.

“Most of these guys can keep going, so you have to do all that you can,” Rudd says.

The trainers’ efforts pay off. Despite his cries of pain only moments earlier, Buckner catches another touchdown two minutes into the second half and Chacon pulls off another successful snap on the extra point. Both will finish the game. Pristine weather and an 18-point lead evoke smiles in the stands and on the sidelines – even Cohen routinely beams. Nothing, it seems, can damper the exuberance.

Then Austin Hill loses his battle with the goalpost.

When Cohen and Allen arrive, they see that Hill is awake and alert, his mind crisp, his legs stomping the ground in frustration and pain.

“It’s just my shoulder,” Hill tells them. Cohen knows immediately that it’s an old injury he’s aggravated, a strain that runs from his shoulder through his trapezius to his neck. His vertebrae and brain were spared the brunt of the blow. After an anxious minute on the ground, Cohen and Allen tug Hill and the crowd to their feet. Hill sprints off the field with the trainers at his flank. The three recede into the sideline, and the stadium’s attention returns to the field.

Four plays later, as Arizona’s Ka’Deem Carey gallops in for his fourth touchdown of the day, Cohen is focused only on Hill, who sits on the training table with his head down. When he tries to turn, a nerve sends a shock down his left arm. Allen has to lean in close to ask him questions amid the euphoria evoked by Carey’s score. Cohen has ventured off to inform coaches that he’s pulling Hill from the game. He returns and places hands on both of Hill’s knees and tells him his day is over. The receiver sulks and slinks back to the bench with three catches for 29 yards, a throbbing shoulder and one averted catastrophe.

+

Tulane athletic trainer Danny Taylor (left) and team physician Greg Stewart help a Green Wave player off the field during a game last fall.

But disaster can’t always be dodged so easily. On Sept. 8, Tulane medical personnel galloped onto a football field in Tulsa. Safety Devon Walker couldn’t feel anything below his neck. Breath evaded him. Part of his spine had yielded to a headfirst collision with a teammate. But rather than being flustered by the moment’s horror, associate head athletic trainer Danny Taylor did his job. He knelt by Walker’s head and said all he could to assuage the 21-year-old’s fears while simultaneously trying to keep him alive. All the while, Taylor called out instructions to the others around Walker – team physician Greg Stewart, graduate assistant David Gambel and EMS workers – as the group carefully placed a spine board underneath him without rotating his neck. Plus, his diaphragm was unresponsive; they had to keep him breathing. With a life in his hands, Stewart says, Taylor’s composure never buckled.

“So often athletic trainers are really the unsung heroes,” Stewart says. “They’re first responders.”

It wasn’t until after an ambulance whisked Walker to the hospital that the enormity of the incident washed over them. Two weeks later, Tulane would take the field again. As always, Taylor and Stewart would have to gaze out at that field for three hours, ready to combat any injury. Only this time, the specter of Walker’s motionless body hung over every collision. Before the game, Stewart says, the pair locked eyes in a shared moment of quiet apprehension. But it was time to do their jobs again, they knew; time to stare down the image that had been seared into their minds. Walker has since regained some feeling in his extremities and has limited use of his arms. Taylor and Stewart haven’t forgotten Sept. 8. They never will.

“You’re never quite the same after that,” Stewart says. “It changes you.”

+

As the crowd and a slew of players celebrate the win under the bright Arizona sun, the training room bustles out of sight. Tevis, for one, needs immediate attention. He struggles to stand as Cohen cuts the layers of tape from his leg. He and Nisbet test the joint once the leg finally reveals itself; likely a sprained MCL, they agree. Chacon quietly thanks Nisbet for the injections and asks for some ice.

“You’re going to need some,” Cohen jokes.

Other players come in for ice wraps and, within an hour, the daylong storm is over. Ten more hours of work behind him, Cohen can go home for a rare Saturday evening with his wife and two daughters, though he’ll answer a few text messages from concerned players throughout the evening.

ADDING IT UP

From Aug. 1 through Nov. 9 – the day before the game against Colorado – Randy Cohen and his staff at Arizona performed the following treatments, amid myriad others:

894 injury evaluations
1,770 ice bags / wraps
1,073 cold whirlpool treatments
470 ultrasounds

 

At 10 a.m. on Sunday, Cohen begins compiling the injury report that he’ll deliver to coaches three hours later. Twenty-three players, he tells them, will be limited or held out of practice this week. Shortly after that meeting, players start flooding in for treatments. Within half an hour, all of the tables in the room are filled, some with more than one player per table. It’s a quiet symphony. Cohen and the several staffers working with him don’t need to communicate. They simply grab a player who needs help and jump in for each other when they get pulled away to a new task.

Cohen spends nearly half-an-hour trying to massage out the tension in Hill’s neck and shoulder; it tightened badly overnight. All the while, he’s instructing players in his vicinity on what treatments and exercises they should be doing. Some use ultrasound wands to provide deep, constant heat to sore muscles. The bulk of them, though, have electrodes covered in an anti-inflammatory gel affixed to their skin. Like magnets repelling, the ions from the electrodes force the gel deep into the tissue. It’s more effective than an anti-inflammatory pill, but not as invasive as an injection. Tevis’ knee is littered with electrodes and wires; he grimaces occasionally as the shocks work the medicine deeper into the joint.

“We’ve got a love-hate relationship,” Cohen says.

“Heavy on the hate,” Tevis retorts through a rare smile.

Buckner and Chacon both come seeking relief for their aching shoulders. In all, 35 football players will come in for treatments over an hour, though they’re not the only student-athletes in the room. Several members of the women’s basketball team are present, but Cohen trusts another of his staffers to handle them. Football requires far more time and energy than other sports and, despite having five staffers and graduate assistants devoted to the sport either full or part time, Cohen says it’s not enough.

The task is even tougher at smaller schools in other divisions. Clark, at Division II Colorado State-Pueblo, has a part-time and two full-time athletic trainers at his disposal. They’re tasked with handling football and the school’s 15 other varsity sports. Binari has two full-time trainers and an intern to help him work with Mount Ida’s 15 teams. “You work with what you can,” Binari says. “I can’t complain.”

Plus, Binari teaches two classes per semester, while Clark is tasked with overseeing Colorado State-Pueblo’s entire athletic training academic program. Like Cohen, both men work long hours in-season. At a glance, the day-to-day job is the same at every level; the differences lie in gaps in budget, staff and resources.

+

After players scatter, the once raucous training room is quiet again and Cohen and his team gather in his office to discuss the many ailments they’d just treated and to pore over who will be limited in practice or the weight room. Several players need to schedule postseason surgeries. Some are battling mononucleosis. Another needs to get insurance forms to the graduate assistants so that he can get an MRI. All of it will be painstakingly documented and entered into software that tracks every treatment, every injury, every single thing that the athletic trainers do.

Later that evening, Cohen will resume his familiar post on the sidelines for practice. He won’t leave campus until the sun has set and 36 hours of work over the weekend are behind him. He’ll return the next morning at 7 a.m. Through the first 10 games – 15 weeks, 105 days – of the season, he allowed himself only one day off. His wife is a “saint,” he says, for enduring his constant absence from late summer until the chill of December. Only then can he scale back to working 50 hours per week. But all of those hours are worth it, he says, for the satisfaction he derives from helping student-athletes stay healthy, from being the quiet hand that guides them onto the field on fall Saturdays.

“Game day is still exciting,” he says. “If it wasn’t, then you need to get out of this; you put way too much time in.”