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RE: NATA lawsuit filed against the APTA/Orthopedic section 2/1/08

 
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 12:29:49 AM   
Tom Reeves DPT ATC

 

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 I got a denial because I used the word "golf" in one of my goals.  Others were ADL-functional.  I clicked on the provider's website, and sure enough, there were kids rollerblading, people riding bicycles, and power walking.  How's that for mixed messages (Hypocrisy??!!?!?!)

(in reply to blast7)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 12:40:28 AM   
SJBird55

 

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There ya have it, blast... Tom said it better than me.  It is best to not include any sport goals in your functionally measurable goals.  Tom, they just don't want to pay.

(in reply to Tom Reeves DPT ATC)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 5:20:03 AM   
blast7

 

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I am glad you two cleared it up and yet I am also saddened by the payers' that do not reimburse with goals like these.  How much less would these payers likely pay if there subscribers were able to be more active by playing golf, or any other sport for that matter.  Yikes!(FRUSTRATED)

(in reply to SJBird55)
Post #: 23
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 5:43:29 AM   
Rwantz

 

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Okay, so things have gotten a little heated.  I didn't realize that I was going to start something this big.
HR 1846 would allow athletic trainers to practice as qualified under their scope of practice.  No athletic trainer is going to go beyond their scope of practice because this bill is passed.  It only allows access to patients under the scope of practice.
I do have an NPI number.  I got it about 3 years ago when it was first introduced.  I am not sure what was meant by that, but I assume it was supposed to be belittling or something.
Athletic trainers treat the physically active.  Are injuries that workers suffer (impingement, fractures, sprains, strains) not caused by activity?  I realize that a rotator cuff injury in a construction worker is completely different than in a football player (or is it really????).
I would still want a physician to have the opportunity to refer a patient to whomever they see fit.  If it is based on illegal practices then the physician should be called on it.  But if the physician orders athletic training then the patient should receive athletic training, from an athletic trainer.  If the physician orders physical therapy then the athletic trainer should never fill the script.  If it is for "therapy" I would say that that is general and that athletic trainers provide "therapy" in that it is understood that that is "rehabilitation."  It would not be defined as physical therapy in my mind.  Perhaps this is something that needs to be cleared up.  "Therapy" to me could be filled by a PT, an OT, or an AT.  Who owns the word "therapy?"
Is the only goal for a patient when they are seen by an athletic trainer to "return to golf?"  Certainly there is more benefit from rehabilitation than getting them back to their sport or activity.  Decrease pain.  Increase range of motion and strength.  Increase function.  That can lead to a return to activity, which physical therapists do everyday.  Athletic trainers are qualified.  I assume from your diatrobe that your impression is that athletic trainers are unqualified to practice.  I welcome a discussion on this, but let's please understand that nothing I said was an attack on physical therapy, the profession, or the future of the profession. 

< Message edited by Rwantz -- February 18, 2008 5:48:57 AM >

(in reply to blast7)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 1:39:37 PM   
SJBird55

 

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Has anyone seen a referral state "therapy" on it?  Most written referrals will specify "occupational," "speech," and/or "physical" prior to the word "therapy." 

Athletic trainers are not listed in the AMA CPT book.  The Physical Medicine and Rehabilitation codes are for physicians and therapists.  The third party world also dictates who may use the codes.

In a collegiate setting, the athletic trainer has freedom to do whatever under the supervision of a physician.  Athletic trainers are very well trained in treating the healthy, physically active.  (key word is healthy...)

(in reply to Rwantz)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 2:49:32 PM   
Tom Reeves DPT ATC

 

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Rwantz,

Remember SJ and I were athletic trainers first.  For me, it is the more fun part of my job.  I personally did not take your post as an attack but you have to realize that the APTA is defending turf.  I personally don't think that athletic trainers have the training to work with medicare patients or the un-well in general.  I also think that noone but a certified athletic trainer should be the primary health provider for an athletic team.  I get just as defensive when a high school team comes to my town and have a "certified sports chiropractic physician" as their medical team.  Just last week a kid from another school inverted his ankle during a basketball game.  Out rushed the DC (I am assuming) and he jerked and yanked caudally on the kid's leg.  Splain that one to me.

Anyway, I worked with some outstanding athletic trainers in KC where I used to live.  They are not trained to work with medical co-morbidities.  (I was not trained to work with medical co-morbidities in undergrad either) 

My stance on this is as follows:  ATCs are THE best trained at treating well but injured athletes using many of the same  skills as an orthopedic PT.  PTs are NOT trained to do sideline coverage.  I have always been against the NATA's recent push to get AT placement in clinics other than as an adjunct to PT.  Their mission should be to get a certified athletic trainer in every high school and college in the country.  I.E. fulfill their mandate, not change the mandate. 

Provide athletic training services, and do it well.  Don't try to be physical therapists.  I will defend their right by calling out/reporting whatever anyone who claims to be the team's "trainer" who is not one.  NATA can defend their skill set, so should the APTA. 

(in reply to SJBird55)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 3:03:12 PM   
Rwantz

 

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I appreciate your opinion and I respect your opinion.  I do disagree with some of it, but some of it I very much agree.  To me the setting in which an athletic trainer practices is not relevant to this lawsuit.  However, if I am qualified in the college, high school, or professional sports then I am equally qualified in a free standing rehabilitation clinic.
The basis behind the lawsuit is manual therapy.  I believe that the NATA is fighting for the right to practice, but also to be recognized as a qualified practitioner of manual therapy. 

(in reply to Tom Reeves DPT ATC)
Post #: 27
RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 3:35:26 PM   
Tom Reeves DPT ATC

 

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I was really trying to speak to a larger issue than just the lawsuit.  I think ATCs should be able to attend any CEU they want to.  I think PTs should be able to teach anything they want to, to whomever they want to.  So, I think that the Ortho section's point is silly.  I also think that the NATA doesn't have a good argument.  In other words, the tiime and effort and MY membership dollars to BOTH organizations could be spent in a MUCH MUCH MUCH better way than sniping at each other over these issues. 

I disagree with your assertion that if ATCs are OK in college HS and Pro athletics they are ok in a free standing clinic.  When you are a team trainer, you know all of your athletes.  you know their medical history, their motivation, their IQ etc . . .  When you are in a free standing clinic, you have to get all of that information in a 1 hour session.  You have to know the right questions to ask.  You have to be able to identify red flags for stroke, dementia, MI, cancer, sleep apnea, etc . . . 
Yes, I know that some ATCs know that stuff.  Fact of the matter is, you don't (at least I didn't) learn that stuff in school (athletic training school)  PTs do.  You might reply that you learn it on the job (for the record, I was all for discontinuing the internship route to certification for AT) but that does not prepare you to be in a clinic where the level of care that is expected is a bit different than in a training room.

The skills are different.  ATCs have skills that PTs don't have, PTs have skills that ATCs don't have.  I am not talking about manual therapy skills, I think that is an area of total overlap.  The lawsuit being about manual therapy is IMHO ridiculous.  The notion that ATCs are as qualified as PTs to work in a free standing clinic is not. 

(in reply to Rwantz)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - February 18, 2008 5:06:38 PM   
SJBird55

 

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I actually can see the ortho section's viewpoint.  I don't think it was silly.  The NATA making a big deal about it is what is ridiculous along with the NATA having some long letter of "the APTA said" crap and then a huge list that of required changes directed toward the APTA that has such strong wording there is no way the APTA will or would agree to any of it. 

When I look into my crystal ball, I foresee that knowledge is going to be highly relevant and valuable.  Manual therapy is a valuable skill (we've got the research to substantiate that manual therapy + exercise is effective) and I really think that based on the NATA website educational training and the experience I had with my training, physical therapists would be wise to keep that skill set to themselves.  We can't be providers of choice if we want to devalue and allow anyone to learn from us - because when they do learn from us, you better bet they will use that information to compete with us.  Over 50% of athletic trainers are not with athletes - what does that tell you?  ATCs want to be able to provide services to the elderly population - no way is that appropriate or right, in my opinion.

From the NATA website itself outlining the training:  http://www.nata.org/consumer/docs/educationfactsheet05.pdf
There isn't a whole lot of focus on manual intervention.

And look where athletic trainers are employed (again from the NATA website):  http://www.nata.org/consumer/docs/Factsaboutathletictrainers.pdf
Over 50% work outside of school athletic settings and provide services to people of all ages!  I also very much disagree with fact number 10.  The AMA does state "provider" for the Physical Medicine and Rehabilitation codes.  Taking the wording literally from CPT 2004... supervised modalities (CPT 97010-97028) do not require direct (one-on-one) patient contact by the provider.  (Provider is not defined for supervised modalities - so fair game for anyone, I suppose, which leaves the provider allowed up to the third party payor)  Constant attendance modalities (CPT 97032-97039) require direct (one-on-one) patient contact by the provider.  (Again, provider is not defined, therefore, fair game for anyone, I suppose, which leaves the provider allowed up to the third party payor.)  Therapeutic procedures (CPT 97110-97546) clearly states "physician or therapist required to have direct (one-on-one) patient contact.  (Manual therapy falls in this category of codes.)  In my opinion, the wording is very clear for therapeutic procedures that according the the AMA those codes are to only be utilized by a physician or therapist.  No interpretation is required, in my opinion.  Sad to say, an athletic trainer does not fall into that category. When the AMA incorporated the athletic training evaluation and athletic training re-evaluation the definition of provider was not concurrently updated.  If and when that happens, then athletic trainers will be literally allowed to provide therapeutic procedures - until then, according the the AMA athletic trainers are not the provider to be providing therapeutic procedures.  If a third party payor has some defining clause to allow athletic trainers, then so be it, but their defining clause did not come from the AMA or the universal CPT codes.

ATCs are the quickest, thinking on their feet provider and they need to be out on the field.  ATCs understand kinesiology and power, speed, strength and can rehab an athlete awesomely (and have some great knowledge in the overload principle and specificity of training).  In the clinic though, an ATC has the potential to be dangerous - just as Tom mentioned above, ATCs haven't had the training to perform differential diagnose.  ATCs don't have the training to understand the relationships and the impact co-morbidities can have on health or function.  The athletic trainers really don't have the manual skills that are often used in conjunction with physical therapy interventions.  The setting matters and it matters a lot.  The patient population is the factor.  An athletic trainer is not educated enough to be competent for all ages.

Now, I definitely do not believe that any PT, even those with sport certification, have any place on the field.  The best professional to be there is an ATC.  Day in and day out the ATC deals with injuries that occurred 3 minutes ago.  There is only a small window of time to do an evaluation before edema and spams set in and disallow for any objective information.  The ATC has a definite knowledge base of knowing the probabilities of certain injuries with a particular sport and observing the event that led to an injury.  The ATC can make snap decisions without second guessing and taking 45 minutes to an hour to determine the game plan.  ATCs have a huge value and provide a very needed service to athletes.  There should be a higher number of athletic trainers in the high school.  A single athletic trainer shouldn't be responsible for the whole darn array of sports and their athletes - there need to be a few athletic trainers per school to do the job justice.  A PT who has board certification in sports should be in a clinic and not on the field because an athletic trainer does more than just tape ankles.

I do definitely see value in an ATC; I'm one myself.  At the same time, I know the limitations of an ATC because I have had the luxury to know the training of both a PT and an ATC.  There may be overlap in some aspects of manual therapy, but reality is that I don't believe the necessary time has been taken in entry level education to practice and know indications/contraindications to adequately perform manual techniques.  As a side, when I was functioning at a high school, I didn't do manual therapy... the athletes were seen day 1 of injury and progressed just fine with modalities and exercise alone.  In some cases, my value was in injury prevention and yapping at coaches to change training routines because the routines were leading to increased injuries.

(in reply to Tom Reeves DPT ATC)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - September 13, 2008 4:01:48 PM   
jma

 

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Here is an update from the PTBulletin regarding the issue:

"Court Denies APTA's Motion to Dismiss NATA Complaint
On Tuesday, the US District Court in Dallas denied APTA's motion to dismiss the antitrust case that the National Athletic Trainers' Association (NATA) brought against APTA and the Orthopaedic Section in February.
In issuing its order, the Court said that NATA had standing to seek an injunction or declaratory relief against APTA but not to seek money damages. It also granted the Orthopaedic Section's motion to dismiss the complaint against the section, removing the section from the lawsuit. The Court also denied APTA's motion to transfer the case from Dallas to the federal court in Alexandria, Virginia.
The denial of the motion to dismiss means that APTA will have to file an answer to the NATA complaint. The parties are required to confer promptly regarding the expected plan for discovery.
For more information on the lawsuit, click here."

(in reply to blast7)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 12, 2009 3:36:44 AM   
JDMBBuilder

 

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Until AT's undergo 7yrs of undergraduate/graduate courses and take state board exams...they should NOT do what we do.  Period.

_____________________________

"Anyone can throw you on a "state of the art" machine and call it physical therapy. The only high-tech equipment I need are my brain and two hands..." -JSDPT

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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 12, 2009 5:25:48 AM   
bonez

 

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Wow I never saw this series when it first came out. By the flavor of the posts protecting one's turf is accepted.  If that were the case and my profession in the states were not so hokey, it would have been an interesting discussion 25 years ago regarding manipulation and it's use.

(in reply to JDMBBuilder)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 12, 2009 7:15:34 AM   
Dnorwood

 

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quote:

ORIGINAL: JDMBBuilder

Until AT's undergo 7yrs of undergraduate/graduate courses and take state board exams...they should NOT do what we do.  Period.


I hate to post on this dead post, but all ATs are required to pass a national board exam....

_____________________________

Denton Norwood, MS, ATC

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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 12, 2009 2:15:28 PM   
Sebastian Asselbergs

 

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Denton: how about that first part of JDBM's sentence?.....

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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 13, 2009 5:20:47 AM   
Dnorwood

 

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Bas,
So PTs do undergo 7 yrs or school, 4 of which are pre-reqs to get into PT school, I will not argue that.  But ATEPs are three year programs that are very intensive in both didactic and clinical education for all three years.  The programs have transitioned a great deal from the "internship" years when all was required to sit for the certification exam was proof of at least 1500 hours of internship underneath an AT.  Now the clinical education is incorporated into the programs.  When I graduated from my ATEP I had logged at least 2000 hours of clinical hours.  And that doesn't take into account the hours that instructors took in the early mornings to hold extra clinical sessions to allow students to come in and practice their proficiencies prior to being checked of on their module.

I feel that ATs can be just as skilled in manual therapy as a PT, and just like in PT schools, different AT programs put a focus on different skills, while still teaching all of the competencies required of the program.  Do ATs get in-depth instruction on some techniques, no, but many of these skills can be honed through continuing education courses, just like many PTs do.

If you have read some of my other posts regarding the whole PT/AT issue, you will know that I am on the fence on many of the issues.  However I fully stand behind my profession to be able to practice within the scope of our educational standards which includes the use of manual therapy techniques.  I feel that PTs and ATs have great skill sets, which at times do over lap, especially in the realm of orthopedic rehab.

_____________________________

Denton Norwood, MS, ATC

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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 13, 2009 12:14:20 PM   
Sebastian Asselbergs

 

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Thanks for that response Denton.
I have no trouble at all with the practice of ATs - worked with quite a few in medical teams in the past, and some have better skills than a few of the PTs.
That said, I will of course defend MY little PT world from others' infringements...... no matter what their designation. We all do that.
At present , it is very unlikely I will ever get competition from ATs, since my practice is very little "real" ortho.

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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 13, 2009 2:01:10 PM   
chrisatc

 

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Wow, then we may be able to call ourselves...???  Doctors maybe? 

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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 13, 2009 4:45:32 PM   
jlharris


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I'm confused about the point of ATC education. Not the competition can't be good (although when it's legislation that decides who gets to do what, and not the consumer, it's not real competition); I just don't understand NATA's big push into a rehabilitation field that is so firmly filled by another well established profession. Who is going to benefit besides MD's who can again make profit off of charging for "physical therapy"?

While PT's and ATC's have some overlap in what our roles in the health care field provide, why does it seem the NATA wants to abandon direct/acute care for sports participants (cough - ATHLETIC TRAINER) and back into being a physical therapist without having to graduate from a accredited PT program and pass national PT boards like all PT's did?

The whole manipulation issue between us and chiros is not the same, so not a way to argue what NATA is doing as the same as APTA is doing for us. While the lawsuit is over MT, the issue is what the NATA is trying to pass off ATC's as...and that is low cost PT's.

I know many PT/ATC's and none of them agree with the comments I've seen out there that their ATC education would have been enough to make them competent to practice in their current setting. And, I would have to say 90+% of those PT/ATC's work in OP orthopaedics. I'm sure the neuro/peds/IP hospital PT's would even have a stronger opinion on weather their ATC degree would have allowed them to be safe and confident to work with these specific pt populations.

@ChrisATC "Wow, then we may be able to call ourselves...??? Doctors maybe?"

What is your point? I'm sure you are hoping to continue a professional debate, but your post isn't clear on what response you want to elicit or make a clear point. Hope you can clarify.

_____________________________

Jason L. Harris, PT, DPT
My PT Blog

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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 14, 2009 3:15:25 AM   
chrisatc

 

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quote:

I'm confused about the point of ATC education. Not the competition can't be good (although when it's legislation that decides who gets to do what, and not the consumer, it's not real competition); I just don't understand NATA's big push into a rehabilitation field that is so firmly filled by another well established profession. Who is going to benefit besides MD's who can again make profit off of charging for "physical therapy"?


You know, I kinda agree with you, as to the NATA's motives.  Obviously, they want to advance the career path we have.  Possibly the issue is just plain out billing, and being able to bill for services, as we povide therapy/rehab services to athletes (at least I do).  the other issue could be, and regardless of whether PT's like it or not, some ATC's are being used in the outpatient clinic to provide services to non-medicare patients.  I am not saying I agree or disagree with this practice, but for a great deal of ATC's being employed in high school outreaches, that is where they go.  As for the education part, I really can't comment on current ATEP's as I went through the internship route.  But I would agree that, if this is what your point was to be, that requisites to enter ATEP programs should be much more stringent as opposed to trying to get as many ATC's out there as possible.

quote:

While PT's and ATC's have some overlap in what our roles in the health care field provide, why does it seem the NATA wants to abandon direct/acute care for sports participants (cough - ATHLETIC TRAINER) and back into being a physical therapist without having to graduate from a accredited PT program and pass national PT boards like all PT's did?


That is a very good question, again, while I commend the NATA for trying to progress our profession, maybe at this point and time we need to step back and return to our roots and rework our goals from there.

quote:

What is your point? I'm sure you are hoping to continue a professional debate, but your post isn't clear on what response you want to elicit or make a clear point. Hope you can clarify.


I apologize, I was trying to be funny, yet point out that I am not sure what 7 years education has to do with anything.  The OP's post seem sto suggest that if ATEPS made doctorate programs a requirement, then everything would be ok with everyone.  I do honestly have a good opnion on this "turf" war so to say, but hopefully will get back to it at a later time. 

(in reply to jlharris)
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RE: NATA lawsuit filed against the APTA/Orthopedic sect... - April 15, 2009 3:19:01 AM   
jlharris


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I cannot argue to strongly against ATC's working with and rehabing athletes. Even as an outsider, that's what it seems an ATC's education makes them fit for.

I think NATA wouldn't be doing their job if they weren't working to advance the ATC profession. IMO, if you aren't getting better, you are getting worse. This applies to us individually and as professional organizations. I'm concerned about NATA's (view the literature on the NATA website) push to portray ATC's as low rent PT's to physicians. Again, chiros may freak out about the whole manipulation thing, but PT's are not trying to become chiropractors. It's one treatment technique that another profession pretends they own. It'd be like PT's freaking out about chiros or ATC's giving out exercises. While that's our main modality, we don't own that.

I'm truly hoping this doesn't lead to a rift between our two professions. I've always worked closely with local ATC's (mainly high school and small college) to coordinate athletes rehab. I know I'm good at getting them better, and I know the ATC's are better at sport specific rehab for them.

_____________________________

Jason L. Harris, PT, DPT
My PT Blog

(in reply to chrisatc)
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