Athletic Trainers Play Huge Behind-the-Scenes Role With Athletes

Hanley Ramirez stopped himself in mid-sentence.

The Dodgers shortstop didn’t want to discredit anybody, just praise the man responsible for pulling his career out of a confounding decline.

Had he never encountered Stan Conte, Ramirez’s surgically repaired shoulder likely would have landed him somewhere other than the verge of his first eight-figure contract.

Upon arrival via trade from the Miami Marlins in 2012, his status as a franchise player was seemingly slipping away. Ramirez credits the Dodgers head athletic trainer for his restoration.

“The difference was, shoot, he (Conte) knew what he was doing,” Ramirez said. “He knew what I needed to get back on that level that I was playing. Rehabbing is everything.”

Athletic trainers are at the center of a web stretched thin between athletes, coaches and front offices, to name a few. They don’t sign checks or fill out lineup cards, but make no mistake, trainers make daily judgment calls with championship ripple effects.

Injuries define the careers of some athletes. (Athletic) Trainers are largely to thank for those who don’t carry that label.

While surgeons like Dr. James Andrews, who operated on Ramirez, and Dr. Robert Watkins have risen to fame in the sports world by transforming career-ending injuries into routine repairs, even they point to the team (athletic) trainers’ realm as the crux of recovery.

Surgery lasts hours. Rehabilitation sometimes can’t be contained to months.

“It’s not just a matter of taking out some knee cartilage and call me in a year,” said Dr. Watkins, a spine specialist whose patients include Peyton Manning, Dwight Howard and Don Mattingly, to name a few. “I don’t have to be the first one to say overcoming an injury is sometimes the difference between who makes it and who doesn’t. I think the really important story is what these athletes do to make it back from these horrible injuries and it’s rehab, rehab, rehab.”

The first question is always the same: “When can I play again?”

Accordingly, rehabilitation in the sports world is synonymous with urgency. In other words, athletic trainers are never off the clock.

Conte’s day begins answering emails at 7 a.m., typically after treating players and writing reports into the early morning hours after the previous night’s game.

“It’s ridiculous and almost embarrassing to talk about what our hours are,” Conte said. “I spend about 30 minutes with my wife in the morning having coffee... and that’s about it. Every other (athletic) trainer in every other organization, whether it be football, basketball or baseball, is doing the same thing. So, it’s not for the faint of heart or someone who thinks they’re going to have a life.”

Lakers (athletic) trainer Gary Vitti has been working around the clock for the same organization the last 30 years.

He was never busier than this season.

The Lakers had more injured players than healthy ones by the end of a season that spotlighted Vitti more than he ever wanted. With up to eight players injured at a time, Vitti was not only responsible for juggling each of their rehabilitation programs, including daily evaluations and re-evaluations, but the Lakers counted on him to communicate the details of each case to all corners of the organization.

The myriad members of the coaching staff and front office need to know the prognosis — in this case so it could figure out how to field a team each night.

With all he has treated since, Kobe Bryant’s ruptured Achilles tendon is a distant memory for Vitti. This season was abnormal for the Lakers trainer in that the urgency to return to the court wasn’t comparable to most of his 30 years at the helm of one of the most successful franchises in sports.

Vitti will never forget his single most demanding assignment, or the resulting championship.

“Probably the most intense around-the-clock treatment regimen was when Kobe sprained his ankle in the 2000 finals,” Vitti said. “For two days we woke up every two to three hours to control the inflammatory process, but as a result he came back and won the championship. The NBA is a microcosm of society. Some players you have to protect from themselves and slow them down, others you have to push them through their fear.”

Clearing an athlete to play is just one decision in a long series of them for trainers. Rehab requires daily judgment calls, none of which are without risk.

When the same competitive nature and physical gifts that made them professional athletes are applied to rehab, overly aggressive efforts to speed up the process create delicate circumstances for a trainer to manage.

The slower route back is obviously not as pleasing to ownership, coaches or fans.

Managing conflicting interests can create sticky situations for (athletic) trainers, whose checks aren’t signed by the players they work on.

Dodgers outfielder Carl Crawford is elated to have escaped the pressure to play through injury he felt as a member of the Boston Red Sox.

After offseason wrist surgery following a disappointing 2011 season in Boston, Crawford tried to play through a spring training elbow sprain serious enough to eventually require Tommy John Surgery. He declined to specifically identify any sources of pressure, but insisted the urgings were very real after a string of injuries following a sub-par season in the first year of his $142 million deal with the Red Sox.

“You definitely have to play over there (in Boston), but here is different,” Crawford said. “You don’t feel that sense of anybody trying to force you on the field ... I’ve learned that when you make ‘X’ amount of dollars, nobody cares about what goes on behind the scenes.”

When they are furthest from the public eye may be when athletes work the hardest.

Rehab includes all the grit of being a professional athlete, with the glory only a flickering light at the end of a long tunnel. How they will recover from the injury is a constant source of worry in a sea of uncertainties.

There are plenty of athletes who don’t understand the vital importance of rehab, according to Dr. Watkins, who lamented the number of young athletes in particular who assumed surgery alone was the key to returning to their previous level of athleticism.

Forty years ago, Tommy John Surgery didn’t exist. When a player heard that sickening pop in his elbow, it signified the end of his career. Now, an estimated one-third of the pitchers in major league baseball have undergone the operation, including an overwhelming number of promising pitchers this season.

Technology in sports medicine has taken such leaps that what was once impossible is now largely taken for granted.

“The pendulum has swung so far in another direction ... everybody just assumes, ‘Oh, he’ll be back in three months,” Dr. Robert Watkins IV said. “Where, no, it’s still a very demanding occupation. In many ways, any time an athlete is operated on and returns to a sport, it’s still somewhat a miracle.”

The science of rehabilitation has advanced just as rapidly.

Virtually every move of an athlete is monitored during rehab by (athletic) trainers whose advantage over an independent physical therapist is the deep understanding of the players’ bodies gained during long work hours.

A rehab schedule is formulated the instant of an injury, but the plan can change at any moment based on the myriad responses from the player’s body.

“Anything you write down in rehab progression is going to be done in pencil,” Angels head athletic trainer Adam Nevala said. “You have to introduce one thing at a time to determine what causes what. Otherwise you don’t know if it was taking ground balls, swinging the bat or running the bases that caused inflammation.”

The (athletic) trainer doesn’t do it alone. An athletic training staff for a professional sports franchise typically includes team doctors, strength and conditioning coaches, chiropractors, dieticians, physical therapists and massage therapists.

Playing the part of psychologist is the head (athletic) trainer’s responsibility.

Coaxing a player through rehab with no guarantees as to the end result is a delicate part of the job.

Ramirez, for example, avoided the training room at all costs after he was first traded to the Dodgers. Conte had to massage the shortstop into trusting his experience would be different than it was in Florida.

“Hanley was very gun shy of medical when he came over,” Conte said. “He wouldn’t come in the training room. It took a little bit of, when he was in trouble, to show him you cared.”

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