How Athletic Trainers Influence Design of Sports Medicine Spaces

Twenty years ago, when Kathy Dieringer was contracted to provide athletic training services to a small school in the second smallest of Texas’ six high school athletics divisions, she was working part time out of a space she reluctantly describes as a “glorified broom closet.” It featured one taping table, one treatment table and just enough room to conduct evaluation but little in the way of rehabilitation. When that particular employer built a new high school, Dieringer was asked to weigh in on its design. Square footage increased tenfold, and the quality of athlete care expanded right along with it. “As we got into the bigger space, and their budget got bigger as well, I was able to do so much more with those student-athletes,” says Dieringer, a former owner of D&D Sports Med and current president of the National Athletic Trainers’ Association. “And it shows the value of the space, as well as the athletic trainer.”

Rare is the athletic facility constructed today without space dedicated to athletic training, and rarely are athletic trainers not part of the design discussion from day one. “The athletic training facility is such a unique space compared to other athletic spaces within our facilities, and we have some unique needs,” Dieringer says. “In making sure that those needs are met, it just makes sense that we’re involved, and it should be from the very beginning.”

The approach to the profession may vary — often based on level of competition and resources — but some common themes emerge among athletic trainers who have had the opportunity to shape their work environments. Think more space, less ice.

Brewer High School, photos courtesy of Scott GallowaySpace

Mary Vander Heiden arrived at the University of Central Florida in 1999, designed the sports medicine space that opened there in 2003, and instantly realized her program had already outgrown it. Now, the associate athletic director for sports medicine and head football athletic trainer is in the process of shaping all-new facilities at UCF — including an outdoor “recovery cove” so posh it will serve as backdrop to game-day tailgating.

First and foremost, the indoor amenities within Vander Heiden’s operation, which counts 17 athletic trainers, needed an overhaul. “We’ve just gotten smarter with better use of the space,” she says. “Right now, the way that the athletic training room is set up, it’s kind of clunky. There’s a lot of table space that is just not needed. Twenty years ago, you’re lying on a table and doing straight leg raises and some really boring things. We work in multiple planes now. We’ve moved off the tables into a more functional rehab space, and so you just need more room for that.”

For example, UCF is employing more sensory-centric tools to rehabilitate athletes. “On a field or on a court, they’re having to react to different things, so I think we really evolved in the rehab space in challenging their brain at the same time as we’re challenging the physical aspect,” says Vander Heiden, explaining that one particular system she favors requires 8 square feet of room. “We can do reaction time at the same time as balance exercise, and now you have their brain trying to follow something and tracking it with their upper body, too.”

Photo courtesy of the Texas Rangers

Back in Texas, the first state to offer licensure to athletic trainers some 50 years ago, Scott Galloway has had the privilege of designing athletic training spaces at two high schools — one where the square footage increased from 600 to 3,700, and his current locale, which saw a similar expansion from 800 to 4,000.

“When I designed the facility at DeSoto — one of the largest high school facilities in the country at the time, and probably still is — the goal was how many tables can I get in that facility? How many pieces of rehab equipment can I get in there? And how many modalities can we buy to hook people up to, whether it’s electrical stimulation or some type of cryotherapy unit?” says Galloway, the current athletic director for the White Settlement Independent School District, home to Brewer High School. “When you’re one of two people, and you’re trying to take care of 20 people at once, those modalities are your hands in some respect. But treatment methodologies have just changed.”

 Galloway’s staff of five (not including himself) is certified in dry needle therapy, for example, and he admits his current facility might look like a “big empty space” to some, but that’s so large groups can take part in yoga, foam-rolling and resistive band work. “You’re not just treating the area that’s injured — you’re treating the area above and below it in the entire kinetic chain that makes up all the function of that particular body part. It’s turned into really a more holistic science,” he says.

“I feel like the profession, and the way we care for athletes, has gone from a very passive — sit down, lay down, put your legs up, hold this ice pack on here — to much more active. We want them moving as early as possible.”

Photo courtesy of the University of GeorgiaFlow

Athlete movement from one part of a sports medicine facility to another is its own key design consideration. Architects designing the latest renovation of Butts-Mehre Heritage Hall at the University of Georgia spent half a day with executive associate athletic director Ron Courson and his fellow athletic trainers on staff to hear their input, which initiated a back and forth that greatly influenced the facility’s ultimate layout.

“We wanted to make it as convenient as we could for athletes,” Courson says. “On the level I’m on, we have the sports medicine department, we have strength and conditioning next door, and we actually have glass between with connecting doors, so it makes it easy to communicate with strength and conditioning. I may have an athlete in ACL rehab doing some things with our equipment, some things with strength conditioning, and he can transition back and forth. The dining facility is right outside our hallway, which makes it nice because our athletes eat every meal there. I may have an athlete come and eat breakfast and immediately come to rehab or vice versa. Testing is connected. We have a door that opens immediately to the weight room, but we also have a door that opens to a testing room in the weight room. We do a lot of data collection, and we have ground reaction force plates. So, every Wednesday, our entire team comes in and does ground reaction force testing to help us determine how their level of fitness is holding up. Are we working too hard, or are we holding our own? We break our weight groups into smaller groups so that they can pop right through the door and rotate through. We wanted to try to make it as convenient as we could for the student-athletes and make it where we have a nice flow between departments, because we all work so closely together.”

Flow considerations got even more granular than that. Within the 20,000-square-foot sports medicine space itself, taping tables are positioned closest to the door to facilitate 5-minute, in-and-out visits, while treatment and rehab areas requiring more extended stays are situated deeper in the layout.

Even Courson’s own day-to-day circuit has been accommodated by the incorporation under the Butts-Mehre roof of a separate and once-remote Olympic athletic training facility, which occupies another 10,000 square feet under his purview. “I’m literally 400 feet away from the other training room.”

Photo courtesy of the University of GeorgiaModalities

Like Galloway, Courson employs dry needling and electric muscle stimulation, but the modalities at his disposal don’t end there. These include hydrotherapy, cryotherapy (both liquid nitrogen and electric chambers); ultrasound, laser and shock-wave treatments; diathermy (a therapy involving heat generated by high-frequency electric currents); Graston® devices (tools used to assess and treat soft-tissue injuries); Game Ready® hot and cold compression units; and sensory-deprivation tanks. “It’s like tools in a toolbox,” Courson says. “You don’t pull out a tool for every job. You do a detailed evaluation, and then identify your problems and solutions.”

The Texas Rangers’ athletic training staff embraces modern modalities to the point Jamie Reed, the club’s senior director of medical ops, designed the facilities at Globe Life Field to better accommodate things such as pulsed shockwave therapy. “It’s a bigger unit, and it needs more space,” says Reed, who specified 5 feet, 6 inches between his four treatment tables, as opposed to the more typical 4 feet. “We have the ability to put two lasers into treatment at the same time. We treat multiple players with ultrasound and muscle stim. We have multiple units, so that guys don’t have to wait until one modality frees up before they can get their treatment.”

At the same time, Reed took modalities designed for recovery, particularly important during an MLB schedule of 162 games played in 180 days, and moved them into their own wing. “The things that will really clog up an athletic training room are recovery tools,” he says. “In training rooms, at any given time, there may be three or four treatment tables being used for recovery, whether it’s Normatec compression sleeves or something else. So, we actually built into our new stadium, over in the sports science area, the recovery wing with an area for cryotherapy, it has an area for red light therapy, it has sleep pods so guys get that very useful 30 to 40 minutes of sleep in the afternoon as a recovery tool, and then we have a Normatec room. Guys who want to use any of their recovery tools can without clogging up the flow of treatments in the athletic training room.”

Photo courtesy of the University of GeorgiaNuance

Even when empty, an athletic training room should look clean and uncluttered. Adequate cabinetry for the storage of supplies is a must. Courson employs a series of half-walls that offer sliding doors and pullout drawers for modality storage while preserving sightlines across the room — a design he borrowed from the Chicago Bears. Vander Heiden prefers tables that power up and down (a big improvement over the static variety, which didn’t account for the different heights of athletic trainers), yet the tables still allow for storage of treatment modality units underneath. “From an OCD standpoint, if I’m being honest, and for just having everything kind of hidden away, the tables have come a long way now,” she says. “They used to be kind of open on the bottom. Now you can get them enclosed, where you can take some of your recovery tools — your Normatec boots, your Game Ready, different modalities like that — and actually house them inside the table.”

Something as simple as specifying a long-neck faucet has made filling Game Ready equipment with water easier in Georgia’s upgraded facilities, according to Courson, who also emphasized the importance of natural light in the space. “We talked about that just from a mental standpoint of having access to good sunlight,” he says. “One entire side of our training room is windows, so we’ve got great natural light coming in.”

Meanwhile, flooring selections should be given their due when designing an athletic training area. “You could have multiple types of flooring in the space, depending on if you want carpet tiles in a treatment or office space, if you had a triage area where you wanted ceramic or VCT for blood,” Galloway says. “But in the performance area, you’d love to have some type of performance flooring, like a Mondo, that provides not just the traction but support, and if you are going to use resistive weights or some type of equipment, the subfloor is protected.”

What an athletic training space looks like today may be entirely different from what represents the state of the art 10 years from now.

“As recently as five years ago, we iced everything after games, especially any acute injuries,” the Rangers’ Reed says. “Now, we might not go through one or two ice bags a game. It’s just that the trends and the science has moved us away from that. More treatments, more modalities and less ice are very much the themes of the day in athletic training rooms.”

That could (will likely?) change. “It’s ever-evolving. It’s ever-changing,” Vander Heiden says. “I think that the biggest trick — and we’re trying to be ahead of it, as I’m sure everyone is — when you build a new facility is you want to make sure that you are thinking ahead and are really forward thinkers in terms of what you’re going to put into it.”

One thing will remain constant: the mission of every athletic trainer, regardless of their resources and surroundings. “To have success on the field or court, you have to have health,” Courson says. “And there are so many variables involved in that success. There’s luck. There’s injuries. There’s a multitude of factors. But, definitely, our priority is the health, safety and welfare of every student-athlete. And the healthier that we can keep them allows them to be able to practice and perform.”