Athletic Training in Popular Sports Films: More than khakis, a polo, and a roll of tape?

Authors: Dr. Lindsey H. Schroeder, Dr. Alana N. Seaman

Corresponding Author:
Lindsey H. Schroeder Ed.D., LAT, ATC, CES
601 S. College Rd.
Wilmington NC, 28403-5956
schroederl@uncw.edu
910-962-7188

Dr. Lindsey Schroeder is an assistant professor at the University of North Carolina Wilmington in the Athletic Training Program. She is a licensed and certified athletic trainer and is also an alumnus of the United States Sports Academy. Dr. Alana Seaman, Ph.D. is an assistant professor at the University of North Carolina Wilmington in the Recreation, Sport Leadership & Tourism Management Program.

Athletic Training in Popular Sports Films: More than khakis, a polo, and a roll of tape?

ABSTRACT
Athletic trainers are vital to sport in the United States. These licensed, highly qualified, multi-skilled healthcare professionals provide essential medical care, emergency response, and advocacy for athletes in a myriad of sport settings. Their services are crucial to athlete health. However, all bachelor level athletic training programs in the United States will be replaced with a master’s curriculum by 2022, and in turn, the field will be forced to compete for students with other health care professions requiring the same prerequisites and level of training. Evidence suggests that a majority of athletic training students are drawn to the field because of its links to sports, yet public misconceptions about and a lack of respect for the field have been identified as factors keeping potential students from pursuing the profession. Given that film and television are widely recognized as powerful influencers of popular conceptions about professions, and as a result, career choice, particularly within other healthcare fields, a thorough understanding of how athletic trainers and the field of athletic training are depicted across these popular mediums is essential in working towards correcting misconceptions about the field and revealing how future professionals may be recruited into newly developed master’s degree programs. In order to provide a clear picture of how the profession is portrayed in on screen, a content analysis approach was employed in the examination of 20 of the most popular sport-themed films of the last 60 years. While a number of themes emerged, overall findings suggest that athletic trainers and the profession of athletic training were narrowly depicted on screen in turn perpetuating misconceptions, and inaccurate and outdated stereotypes about the profession, and minimizing the importance of athletic trainers in a sport setting.

Keywords: Athletic Trainers, Film and Television, Marketing, Popular Culture, Sports

INTRODUCTION
Athletic trainers are vital to sport in the United States. These licensed, highly qualified, multi-skilled healthcare professionals (46) provide essential medical care, emergency response, and advocacy for athletes in a myriad of sport settings. Their services are crucial to athlete health. However, the profession receives little reverence from other medical professionals, lacks third party reimbursement for services rendered, and offers few opportunities for advancement, undesirable working hours, and low wages relative to other healthcare careers (28, 39, 40). Despite these setbacks, all bachelor level athletic training programs in the United States will be replaced with a master’s curriculum by 2022 (11). In turn, the field will be forced to compete for students with other health care professions requiring the same prerequisites and level of training. These sweeping transformations will have substantial impacts on the field, yet the situation has received surprisingly little attention from scholars.

Evidence suggests that a majority of athletic training students are drawn to the field because of its links to sports (41), yet public misconceptions about and a lack of respect for the field have been identified as factors keeping potential students from pursuing the profession (6). Little else is known about how or why individuals choose to pursue athletic training either academically or professionally. However, on a broader scale, depictions in popular culture, particularly those images encountered through on-screen entertainment on television and in film, are widely recognized as powerful influencers of popular conceptions about professions, and as a result, career choice (1, 23, 61), particularly within other healthcare fields such as nursing (35, 50), internal medicine (33, 56), and surgery (21). Television shows and movies not only introduce audiences to people, places, and professions they may have never heard of before (1, 34), they also both create and reinforce stereotypes about various aspects of American culture including career choice (9, 66), and both permeate beyond viewership into many aspects of everyday life (29, 36, 53).

Given the challenges facing the field of athletic training, and the intimate links between television, motion pictures, and career choice (1, 23, 34, 35), there is a clear and immediate need to better understand how athletic trainers are depicted on screen. A thorough understanding of how athletic trainers and the field of athletic training are depicted across these popular mediums is essential in working towards correcting misconceptions about the field and revealing how future professionals may be recruited into newly developed master’s degree programs. Thus, in order to provide a clear picture of how the profession is portrayed on screen, a content analysis approach (2) was employed in the examination of 20 of the most popular sport-themed films of the last 60 years. The immense popularity of sport-themed films (3, 17, 30, 53, 54) and the numerous links between athletic training and sport (41) made sport-themed films ripe for examination.

LITERATURE REVIEW
Television, Film, and Career Choice
Film, television, and culture are intimately connected. On-screen entertainment is wildly popular and transcends past viewership permeating many aspects of popular culture (29, 36, 53). Together Amazon Prime and Netflix boasted more than 180 million subscribers worldwide in early 2018 (10, 65) and despite waning interest in movie going, theaters still sold a total of 1.24 billion tickets in 2017 in the U.S. alone (49). The vivid imagery, stylized characters and settings, captivating storylines, clever writing, and musical accompaniments of onscreen entertainment elicits emotions and allows audience members to identify with characters and their plights (42). Inspired by these renderings, viewers and non-viewers alike often adopt clothing and hairstyles worn by their favorite fictional friends (60), develop interests in new recreational and leisure pastimes portrayed on screen (6), and pick up language, mannerisms, and even traditions from iconic television shows and motion pictures (15). In this sense, television shows and movies are both a reflection of contemporary society and cultural values, and a powerful influencer of contemporary culture (5).

As streaming services and technology make television series and films more accessible, the distinctions between full-length motion pictures and serialized shows are disintegrating (31) yet both onscreen entertainment genres are becoming increasingly popular (10, 24). Like other forms of art and popular culture the depictions portrayed in television shows and films introduces people to places they have never been, things they have never heard of, and people they have never met before (1, 32). In this sense, onscreen scripted entertainment influences peoples’ social perceptions of behavior and dispositions, including specific professions, which in turn also influences career choice (21, 50, 51, 61, 64). In the same vein, film is credited with creating career awareness in youth (1, 15, 51, 62) and is recognized as a medium through which role models – both good and bad – are born (1, 10, 21, 22).

However, these portrayals are often narrowly depicted and highly dramatized providing viewers with either only a glimpse of the reality of a profession, or a complete fictionalization of the field all together (23, 35, 50). Tucciarone (2009) argues that, in turn, viewers are often unable to discern what is real on screen and what has been embellished for entertainment purposes (61). Thus, viewers are easily misinformed about the educational and training requirements needed for, the use of technology in, and the scope of, particular career fields (21, 35, 50). These narrow depictions also often perpetuate stereotypes about people in the profession (1, 5, 21, 58, 59, 66).

In fact, examinations of television shows and films in the last few decades have revealed a handful of heavily stereotyped professions. Advertising agents for example, were found to be widely depicted in film as competitive and materialistic (62). Physical education teachers were portrayed as negative and aggressive (16); educators as saints or savants; scientists as villains or fools; and lawyers as bad people (1). A number of studies focused on the profession of nursing in film and television found that nurses were often depicted as subordinates (35); sex objects (25, 26); and almost exclusively female (58, 59). Scholars argue that these powerful and recurring images are having detrimental impacts on related fields (9, 19) with fewer men currently working to become nurses (59, 66) and an overall nursing shortage due in part to demeaning images of the profession in popular culture (35).

See Her Movement
Recognizing the power of film and television to influence the behavior and aspirations of children and young adults (1, 23, 32, 35, 59); many in the film and television industry are calling for equal representation of women and people of color in various roles on screen (45, 52). Advocates for the women in science, math, engineering, and technology (STEM) fields, known as the #SeeHer movement, endorsed by the White House in 2018 recently called attention to the preconceived notions many children have about women in science but credit films such as Hidden Figures and Black Panther for working to break down male dominated STEM stereotypes (44). The See Her movement is rapidly gaining ground as the public’s interest in gender and racial equality in the workplace increases (38). As scripted on screen entertainment becomes more popular than ever, the need to understand how particular groups of people are being represented across the medium is growing.

Sports, Sport Films, and Culture
Sports, like television and film, are closely linked to popular culture (13). Sporting events captivate audiences by the tens of millions, family team allegiances dictate college educational choices, fans travel far and wide to attend games, and whole cities plan development and infrastructure around stadiums, arenas, and other sporting venues. Thus, it comes as no surprise that sport films represent a particularly popular on screen entertainment genre (14, 53, 54) that not only permeates popular culture, but does so with impressive longevity.

Almost half a century after the release of the tremendously popular Rocky film (1976) for example, people still visit Philadelphia’s iconic statue depicting the movie’s namesake boxer in droves. Museums like the National Baseball Hall of Fame and small towns like the tiny Dyersville, Iowa still regularly credit sports films such as A League of Their Own (released in 1992) and Field of Dreams (1989) for attracting tourists to, and in some cases aiding in the raising of funds for new or special exhibits almost 30 years later (37). The popular film The Mighty Ducks (1992) is credited with helping to create Anaheim, California’s NHL Team, originally known as the “Mighty Ducks of Anaheim”. A quarter of a century later, the team’s fan apparel still features images paying homage to the early 1990’s hockey film. Similarly, phrases such as “if you build it, they will come”; “there’s no crying in baseball”, and “show me the money” among other notable sport film one-liners have become a part of everyday vernacular. Moreover, single films have even been credited with inspiring thousands of youth to pursue (or not pursue) sports of all types (i.e. A League of Their Own and girls baseball and softball (55); Mighty Ducks and youth hockey (48); Concussion and the decline in popularity of youth football) (29, 55). Thus, the deep and meaningful relationship between contemporary culture, sports, and sport films cannot be understated.

Athletic Training History
Integral to the existence of sports is the health of the athletes competing. Athletic trainers are vital to athlete health, and have been since the earliest days of athletic competition. In order to fully understand the accuracy (or inaccuracy) of athletic trainer portrayals on film it is important to understand how the profession has evolved over the last two millennia. The profession of athletic training, while young in its official recognition, dates to early Greece. Herodicus of Megara has been noted as the most eminent of the Grecian athletic trainers. Athletic training soon vanished after the fall of Rome and would not return until the late 1800s. Athletic training in the 19th century was informal, sporadic, and disparate (18). As the popularity of intercollegiate sports increased, particularly football, concerns over the safety of sports also grew. In 1905, President Theodore Roosevelt even threatened to eliminate the sport citing the 18 deaths and 159 serious injuries that had been recorded during the previous season (18). This led to the creation of the National Collegiate Athletics Association (NCAA) in 1906; however, there were few athletic trainers at the time. Instead, local physicians and/or team coaches managed a majority of students’ athletic injuries. An early professional organization for athletic trainers was created in 1938. Even though this organization was named the National Athletic Trainers’ Association (NATA), it is not the same as the present one operating under the same moniker today. During World War II, athletic trainers found a new purpose, rehabilitating wounded veterans. However, due to the financial conditions caused by the war, the original NATA was dismantled in 1944 (18).

The current National Athletic Trainers’ Association (NATA) was founded in 1950 when approximately 200 athletic trainers convened in Kansas City, Missouri to discuss the future direction of the field. The NATA is the official advocacy, networking, and educational organization for the profession. At the time of the NATA’s founding, athletic trainers worked entirely in collegiate settings. Some 40 years later, in June 1991, athletic trainers were recognized by the American Medical Association as allied health care professionals (18), helping to legitimize the field and opening the door for employment of athletic trainers in a wider array of settings.

Over the last 70 years, athletic training education has evolved from weekend clinics to internships and finally into 4-year degrees. The original NATA had intended on teaching athletic training skills to high school students through a High School Trainers Plan (18), but this plan was quickly scrapped. Eventually in 1956, the newly created NATA appointed a committee with the sole purpose of determining what educational preparation should be required for professional athletic trainers. While the first standardized athletic training curriculum was introduced in 1959, it was another decade before any college or university applied for accreditation of an undergraduate athletic training degree program through the NATA. By 1970, four institutions had received NATA approval for undergraduate athletic training programs. Individual professional certification for athletic trainers began in 1971. Twenty-eight candidates took the first athletic training credentialing exam. By 1974, over 187 individuals had taken the exam (18). Between 2017 and 2018, 4,012 students took the BOC exam (7).

State of the field
While athletic training was founded in intercollegiate athletics (often considered the traditional practice setting), athletic trainers currently work in a number of diverse practice settings from secondary schools and hospitals to NASCAR, Cirque de Soleil, and industrial locations. Athletic trainers are licensed in 49 of 50 states with California currently the only state without professional regulation. According to the Centers for Disease Control and Prevention (8), all 50 states have a Return to Play law to address concussion management in pediatric and adolescent athletes . Several of these laws specifically mention athletic trainers as one of the few health care providers permitted to return an athlete to play following a concussion (20). Professional regulation and recognition in State legislation underscores the value and importance of athletic trainers in public and athletic safety.

Recently, the Athletic Training Strategic Alliance, consisting of the Board of Certification (BOC), the Commission on Accreditation of Athletic Training Education (CAATE), the NATA, and the NATA Research and Education Foundation, decided that all CAATE-accredited professional athletic training programs must move to a master’s level curriculum (46). Thus, baccalaureate programs may not admit, enroll, or matriculate students into athletic training programs after the start of the Fall term 2022 (11). In other words, students will no longer be able to become athletic trainers through an undergraduate degree route. Transitioning entry-level athletic training education programs to the master’s degree level will likely present program administration and faculty with challenges associated with recruitment, retention, and certification.

Nonetheless, athletic training is a vital component of contemporary sport, and future of the profession is integral to the health of athletes everywhere…particularly as injuries are an inherent part of competitive play. In addition to providing care, athletic trainers also advocate for both individual athletes and for overriding policies that regulate best practices in the daily prevention, treatment, and rehabilitation of sport-related injuries and illnesses. Founded on the basis of improving the safety of sports, this profession as a whole is dedicated to both reducing the risks associated with sport and preventing catastrophic injuries, and to helping athletes maintain, and in the wake of health concerns, improve their quality of life. In turn, athletic trainers are credited with improving treated athletes’ return to play time, and overall patient outcomes. Additionally, athletic trainers help to reduce the likelihood of a catastrophic on-field or in-practice event occurring (such as sudden cardiac death or secondary impact syndrome). The role of these specialized healthcare providers in sport is important and the field is projected by the U.S. Bureau of Labor Statistics to grow by 23% between 2016 and 2026; much faster than the average for all occupations (63).

Current master’s level athletic training programs are already competing with other disciplines for students. Fields such, as physical therapy, occupational therapy, physician assisting, and chiropractic medicine all require master’s degrees. Recruiting is currently done through a series of different methods. Many programs advertise to undergraduate programs (particularly public health and exercise science programs whose curriculums already incorporate the majority of the prerequisites for the athletic training), at both their institution and outside institutions. This advertising comes in many different forms from flyers and pamphlets to social media platforms and websites. Additionally, some programs attend conferences associated with those academic programs, such as American College of Sports Medicine (ACSM), to hand out advertising materials. Anecdotal evidence suggests that there have been few, if any, attempts to right misconceptions about or allude to popular images of the field within education program marketing campaigns.

METHODS
Film as a data source
Recognizing how onscreen scripted entertainment both reflects contemporary values and shapes aspects of popular culture (42), film provides a particularly apt data source for the study of career conceptualization. Film, like other artistic media, use various signs and symbols in concert with and contrast to one another to send a message (14, 57, 67). In this sense, signs and symbols gain meaning from relationships with other signs and symbols (12, 57). All cultural artifacts including onscreen entertainment consist of signs and symbols that communicate meaning and express cultural values. Semiotics or the study of these signs and symbols is based on the notion that these texts or collections of signs and symbols can be read and meaning made from them (12, 14). In the case of film, many of these messages are communicated through the use of film speed (i.e. slow motion), shot framing, lighting, music, and other artistic approaches (14, 42).

With this in mind, a semiotic-driven content analysis was conducted. This content analysis approach went beyond simply considering whether a specific symbol or sign was represented in a data set (2). Instead, the aim of this study was to examine both whether and how athletic trainers were depicted in popular sports films. Thus, a semiotic driven approach was adopted (2, 57). Similar content analysis approaches have been used in the examination of a number of professions including nursing (27, 66); advertising (62); accounting (5); and education (1, 16).

Determining the data set
Films were selected for the data set using multiple resources. Researchers Googled top sports films and used the following results to compile a master list: The Rolling Stones’ 30 Best Movies of All Time, Fox Sports’ 25 Greatest Sports Films of All Time, USA Today Sports’ Ranking the 25 Greatest Sports Movies of All Time, IMDb’s Top 20 Greatest Sports Movies of All Time (The Ultimate List), Time Magazine’s 30 of the Greatest Sports Movies of All Time, and Fandango’s the 15 Most Inspirational Sports Movies. These provided an initial list of sports films for the study. The combined master list was cross-referenced with personal lists the researchers had created independently by informally polled colleagues, students, friends, family, and acquaintances to assist in narrowing the initial list of 89 films. To determine the final data set, all films had to occur in the last 60 years to coincide with the official recognition of the modern field of athletic training. The data set included the following films: A League of their Own, Any Given Sunday, The Blindside, Breaking Away, Bull Durham, Caddyshack, Concussion, Endless Summer, Fields of Dreams, Friday Night Lights, He Got Game, Hoosiers, Jerry Maguire, Major League, The Natural, Remember the Titans, Rudy, The Sandlot, Tin Cup, and White Men Can’t Jump. Boxing-themed films and other movies depicting sports that do not traditionally employ athletic trainers were excluded from consideration, as were documentaries.

Data collection
In line with a semiotic approach, a data collection instrument was developed to track how athletic trainers were depicted relative to the other signs and symbols in a film. The instrument was organized into themes such as settings, physical appearance, athlete health, and other topics to draw researchers’ attention to the relationships between athletic trainers and these and other signs and symbols. The in-depth data collection instrument was used as a prompt to discover signs and symbols, not an exhaustive list of themes to be identified.

The two researchers watched films both together and separately using a number of screening platforms including Netflix and Amazon Prime online streaming services, on cable airings, and by checking out DVDs from the university library. All data was collected between November 2017 – March 2018.

Data analysis
Data was manually coded (4) and analyzed by individual film and in aggregate. Initially an open coding approach was used where the researchers examined data without any expectations about what might be found (2, 43). To ensure any inherent preconceived notions on behalf of the researchers did not inadvertently influence data analysis, both researchers engaged in reflexivity exercises to expose and avoid possible biases (2, 43).

Given that semiotics is based on the premise that signs and symbols work together to send a message (12), particular attention was paid to the ways in which athletic trainers were depicted relative to, and in contrast to settings, sport, the story line, other characters, and the like. In this initial data analysis stage, themes emerged and were recorded. After another closer examination of the data, initial themes were reconsidered and additional themes emerged. Next, themes and examples were considered in depth and from a variety of angles. Babbie (2) calls this axial coding (see also 43). The purpose of this approach was to glean overall meaning from the data set rather than delineate each individual example in depth.

Both researchers examined the data individually before jointly discussing themes and findings. Both researchers largely agreed about the initially identified themes and findings. This independent consensus is known as inter-coder reliability (43). However, additional concepts and codes were still discussed, and alternate explanations still explored to ensure both the validity and the reliability of the study (2).

RESULTS AND DISCUSSION
The following themes emerged surrounding the depiction of athletic training: sports were positioned as representative of larger intangible concepts but largely excluded athletic trainers as part of the phenomena; injuries were accepted as a part of sport; sport injuries were often accurately portrayed and played pivotal roles in character and storyline development; treatment of sport injuries on screen varied widely but formal on field sport injury medical assessments were rarely depicted; athletic trainers were predominantly portrayed by older white males, though they were largely indistinguishable from other team staff, and more often did not appear at all; athletes returned to the field (or sideline) after an injury in just a few scenes and little, if any, information was communicated about assessment or treatment; and mental health in athletes was depicted as a source of embarrassment or a source of humor, or both.

Sports were, as expected, depicted as tied closely to family, youth, life, patriotism, history, and personal identity (3, 30). Opening film sequences, which typically set a tone for an entire film (30), often included images of sport and famous athletes alongside footage of important moments in history, family gatherings, children laughing and playing, and various images of Americana, accompanied by narrations linking the forthcoming story and its characters to these larger themes. In A League of Their Own for example, women’s stepping in to take men’s place in baseball during World War II was depicted as patriotic. Field of Dreams featured an introductory montage of historic sport photos alongside images of soldiers shipping off to war, and talented athletes shown in the same sequence as political heroes. Even in the spoof comedy Major League, opening imagery included footage of the Cleveland Indians interjected with footage of children playing, historic still photos of the city conveying, like many other films, that sport is a transcendent experience; its meaning bigger than any one athlete, game, or season. No athletic trainers were depicted.

Of the films examined however, injury was widely accepted as an inherent part of sport. Capturing the essence of this theme was the first scene in The Blindside. In it, a voice (Sandra Bullock) narrating over footage of Joe Theismann’s career-ending injury, explains, “There’s a moment of orderly silence before a football play begins. Players are in position, linemen are frozen, and anything is possible. Then, like a traffic accident, stuff begins to randomly collide. From the snap of the ball to the snap of the first bone is closer to four seconds than five.” In this sense, both athletes and their loved ones appeared to be aware of and accepting of the notion, that pain is a part of every game. A character in Any Given Sunday for instance, after suffering a painful neck injury is told that one more hit could paralyze him. Recognizing his NFL career would end if he chose to forego playing (as doctors advised); he chooses to compete in the last games of the season. Upon sustaining a hard hit, the player is knocked unconscious, only to come to on a stretcher wheeled by paramedics to proclaim, “It was worth $1 million!” Likewise, athletes in The Sandlot, Rudy, and The Natural among others echoed the same acceptance of risk, thereby recognizing and accepting the possibility of injury during sport and implying the inevitable need for medical care. However, athletic trainers were noticeably absent from these conceptualizations.

Moreover, getting hurt while training or competing was depicted in many films as a rite of passage. Injuries allowed lowly and/or novice players to be seen by their teammates, coaches, friends, and even themselves as real athletes. This is clearly illustrated in The Sandlot after town newbie and novice baseball player, Smalls, is hit in the face by the ball resulting in a black eye. Historically a source of irritation for the local kids who take the sport seriously, Smalls is greeted upon his return to the field with admiration and respect and immediately becomes an integral part of the team. In A League of Their Own, Coach Jimmy Dugan (played by Tom Hanks) commemorates a female baseball player’s injury by taking pictures of the athlete’s large bruise as the rest of the team crowds around commiserating. His admiration symbolically deems her one of the guys (men being real athletes) and, implying that in turn he recognizes and respects her athletic abilities. Similarly, the NFL only recognizes Rod Tidwell’s talents after he sustains a scary hit in Jerry Maguire, and Big Mike is taken seriously as an athlete only after injuring an opposing player in The Blindside. In many cases, injury was not only accepted as an inherent part of sport, but also anticipated as a badge or scar to be worn proudly symbolic of a player’s courage and loyalty to a team and a sport… again with no allusions to the medical care that would often be required after the injury is sustained.

In almost every case of injury depicted in the data set, there was a long and building energy, tension, and/or character relationship on the brink (either with another character or with sport itself) leading to the event. Plot lines, character development, and cinematic effects such as framing, lighting, and background sounds and music often hinted at when injuries were about to arise for characters. Taking place at a pivotal point of in the storyline or positioned as a wrench in a character’s athletic or personal trajectory, emphasizing the meaning of the injury as a watershed moment in the film. Injury scenes were often shown in ultra-slow motion, and from multiple camera angles and character perspectives. When an opposing player, while scoring a game winning touchdown in Jerry Maguire, for example hit Rod Tidwell (Cuba Gooding Jr.), the scene slowed, and the hit was seen almost frame by frame. Most injuries were sustained by main or supporting characters in a sport setting, and often during a game of some importance.

Upon sustaining an injury, most films continued to focus on the injured athlete in slow, and sometimes still frames, that were either muted or where individual sounds had been blended to a white noise. In Friday Night Lights, an injured player lay on the field, people reacting around him, for several seconds time before the film speed returned to normal and the athlete was seen being wheeled from the stadium on a stretcher. A similar example can be seen in The Natural when the right fielder on the main character’s team dies after running head first into an outfield wall – the shot of the injury lingers. These recurring images seem to remind the audience of the brutality of sport thereby again reinforcing the idea that injury is inherent in sport and implying the inevitable need for future medical care.

In some films, help arrives in slow motion, the sound still silent or blurred. In others, the film speed returns to a normal (quick by comparison) speed as help arrives upsetting the rhythm of the film and/or the game and emphasizing the pivotal impact injuries can have on sports and vice versa. Panic and despair (dreams of winning crushed) on behalf of the fans, coaches, and other players ensues. While teammates were occasionally the first to respond (particularly when they were the first on-scene by being on the field, and often in non-sport settings as athletes were often depicted hanging out with one another), injured athletes were primarily assessed by unidentifiable, albeit, uniformed team staff members. Responders were predominantly older white males (aged approximately 60-65 years). Few athletic trainers were clearly identified as such, instead, many individuals providing medical care, or more accurately, responding to injured athletes, were only recognizable as possible health care providers by attempts to respond to athletes injured on the field.

This pattern is seen time and again in Friday Night Lights where the plot follows a team during a particularly tumultuous season of high school football in small town Texas. A number of games are played and slices of game action woven throughout the film. In line with the nature of sport, a number of injuries are sustained; however, each time the same two to three background actors, approximately 60-year-old men wearing tan pants, team color polo shirts, and white tennis shoes rushed to the injured athlete, yet no information about their identities or role with the team is conveyed. Similar anonymous khaki-ed and polo-ed men respond to injuries in Bull Durham, Major League, Rudy, and Remember the Titans. Anecdotal evidence suggests khaki shorts or pants, tennis shoes, and a team polo shirt is a typical uniform associated with the profession, however in this data set, the outfit was often the only indicator of a medical professionals’ presence on the field. Additionally, assistant coaches and other team staff were often clad in the same or similar clothing further blurring the distinction of athletic trainers.

Few women were depicted as health care providers in any of the films included with the exception of Breaking Away where the health care professionals providing medical care during the final bike race were women in nursing uniforms of the era complete with tights, dresses, and white hats, and in Tin Cup where the main supporting actor is Rene Russo who portrays Dr. Molly Griswold, a psychiatrist pursued by stubborn golfer Roy McAvoy (Kevin Costner). In both cases, the women were depicted as quite feminine in nature, in contrast to the brutish male athlete. The nurses in Breaking Away clearly flustered and furiously taping ankles in their pure whites are starkly juxtaposed against sweating, bleeding male athletes flying by in an annual cycling competition. Similarly, Russo’s Tin Cup character is portrayed wearing skirts and blouses, styled hair, and full make up and having little ability to hit a golf ball, while in contrast Costner’s McAvoy is rugged, immature, and an incredibly talented athlete.

In cases where a medical professional was clearly identified – either as an athletic trainer (which was exceedingly rare amongst the films examined) or as a doctor (often depicted in films where professional athletes or serious, life altering, injuries were part of the storyline) they were often depicted as a respected advice giver, reminiscent of a father or grandfather figure. Older, mostly Caucasian, men such as Dr. Rogers in Friday Night Lights, or Doc Buggins in Hoosiers gave advice that was considered by an athlete when no one else’s was. Both, similar to characters depicted in a number of other films, spoke to athletes honestly in warm but stern tones, usually conveying the severity of an injury. These male-dominated depictions of men both rendering aid juxtaposed against the rare but often feminized depiction of women as sport participants or healthcare providers convey outdated cultural stereotypes that reinforce both sports and medicine as men’s games where women are clearly out of their league by comparison.

For injuries that had an athletic trainer or health care professional respond, the assessment protocols appeared to be accurate and appropriate. In Jerry Maguire, for instance, an athletic trainer can be seen performing a neurological assessment by checking the pupils for being equally responsive to light as well as oculomotor function. Yet, depictions of these formal medical assessments were rare within the data set. Despite the use of proper sport injury assessment protocol in several films, most noticeably excluded proper protocol. An example of this was noted in Rudy when the namesake character almost appears to lose consciousness after one particularly vicious hit in football practice. Yet, no one pulls him out of the drill and he insists on staying in. Current concussion protocols would have required at least an evaluation to rule out a traumatic brain injury. However, in Any Given Sunday and several other films, when an athlete is unconscious, he is carted off the field and immediately assessed by someone who appears to be a team physician. Further, many films also failed to show the appropriate emergency medical equipment often employed by athletic trainers on the field. Instead, on-field personnel were often only equipped with either a small tape box as was the case in Hoosiers, or with nothing at all as noted in Friday Night Lights and Jerry Maguire amongst many others.

In a number of films, athletic trainers (and medical professionals in general) were glaringly absent. In The Blindside, The Natural, Major League, and He Got Game, no athletic trainers, doctors, medical equipment, or athletic training facilities were ever depicted. The most concerning instances were when severe injuries occurred and no one responded, such as when an outfielder dies after crashing into an outfield wall while attempting a catch in The Natural. While it is certainly possible for an athlete to die after such an event, it is worrisome that no medical response was shown as someone could have at least tried to render immediate aid. Another example can be found in Jerry Maguire’s nerve-wracking last scene where Rod Tidwell is on the receiving end of an excruciating hit only to lay on the field alone for what seems to the audience, and his on-screen family, like an eternity. In this sense, almost every film underrepresented the importance of athletic trainers as integral members of an athletic team and/or as vital on-site healthcare providers at sporting events thereby contributing to the misconceptions about the field of athletic training and undermining the importance of athletic trainers in sport.

By contrast, the injuries themselves were, for the most part, realistic and authentically portrayed. Further, injuries of varying degrees of severity were depicted. Common overuse injuries were depicted in many films such as Bull Durham and Rudy where athletes are seen getting ankles taped and shoulders massaged. While serious injuries such as fractures, concussions, and other potential neurological impairments were also noted in a number of films from The Sandlot to Concussion. From Dave’s legs cramping during the final race scene in the film Breaking Away (1979), a setback that regularly afflicts cyclists, to a player on opposing team losing an eyeball on a hard sack in Any Given Sunday (1999), a much more serious and uncommon wound, injuries accurately reflected the unpredictability of sports. However, in Bull Durham and Rudy amongst several other films, the majority of scenes that did depicted an athletic trainer showed them treating only overuse injuries and not illustrating the complete depth of an athletic trainer’s skill set and knowledge base.

After an initial on-site response to an injury, many films cut immediately to the next scene in a new setting where a coach, family member, or particularly close teammate is depicted still full of emotion before the injured athlete reappears on screen bruised and swollen, but fully bandaged, taped, braced, and sutured, and often back in play only moments later. In Hoosiers, for example, Everett, a key player on the namesake basketball team gets into an altercation during a sectionals playoff game and is slammed into a trophy case. He incurs a laceration on his shoulder and is quickly sutured by an older man we assume is a physician. The film, like many others in the data set, hardly shows the wound and does not show the response to the injury. Instead, Everett appears a short time later with a non-adherent pad taped to his shoulder. The coach references stitches and the medical provider responds that the injured athlete cannot continue to play, but Everett manages to go back into the sectional playoff game a short time later nonetheless. Similarly, an opposing player is tackled hard by Michael Orr in The Blindside and has to be assisted to the sideline by teammates yet returns to the game moments later with no explanation of his physical condition. Similar scenes glossing over the treatment of athletic injuries were noted in almost every film. Even Remember the Titans, in which one of the main characters (Bertier) is partially paralyzed in a horrific car accident shown in the film, almost entirely omits any references to the young athlete’s treatment or rehabilitation. In just a few frames, Bertier goes from high school football star – driving his car (pre-crash), to paraplegic- smiling and chatting with friends and family from his hospital bed as if nothing but the accident had taken place. Overall, there was extremely little information conveyed to the audience about the type of treatment or care an injured athlete received regardless of context.

While few injuries were treated in any manner on screen, much less in an athletic training facility, facilities themselves, when included, were well depicted. In Major League, Any Given Sunday, Rudy, and Bull Durham, athletic training facilities adjoined team locker rooms where character exchanges regularly took place and both medical equipment and manual therapy and rehabilitation tools could clearly be seen. Though little detail was visible, athletic training facilities depicted in the data set often included whirlpools, exam tables, and various ice packs, tapes, gauzes, and scissors.

In most cases, an injury (though not necessarily sports-related) either arose as a test of character for one of the main actors, or marked a shift in the plot or tone of the film. Interestingly, these plot changes, due to a serious and possibly catastrophic injury, occurred without an athletic trainer present. In both Rudy and The Natural the death of a friend changed the affected athlete’s attitude towards their sporting careers. Rudy was inspired to pursue his dream of playing football at Notre Dame after a friend lost his life in an explosion at the local steel mill where they worked. Aging minor league rookie, Roy Hobbs in The Natural, both finds his morals and makes baseball history, hitting the pennant winning homerun, after the loss of teammate Bump Bailey who suffered a cracked skull upon hitting the outfield wall going after a well-hit ball. In both cases among similar examples noted in several films, the athlete’s morality, tenacity, and dedication were tested in the wake of an injury. Yet, there was little acknowledgement of the role of healthcare providers, much the less athletic trainers, in the recovery of athletes physically or mentally.

In a number of films, overcoming an injury either allowed a player to be recognized as a real athlete as demonstrated by Smalls in The Sandlot and Dotty in A League of Their Own (as previously discussed), or to realize a sport/team was larger than their sense of self. This notion was often exemplified by an injury that resulted in a change in the pace of an important game, in turn invigorating the crowd and, many times, giving the team the momentum to win. This was evident in Major League when veteran ball player Taylor takes a pitch to the head in a division playoff game only to get up and call a homerun thereby igniting the crowd’s enthusiasm and inspiring him to hit the game winning grand slam. Similarly, in Hoosiers, the game shifts and the Hoosiers take the lead after Everett’s is injured in a fight with an opponent but plays through the pain symbolically sacrificing himself for the team. Similar situations where an athlete was injured, fought through the pain, and inspired their team to victory was observed in a number of other films including Breaking Away, Remember the Titans, and Friday Night Lights. Overall, injuries were an important feature of many of the films examined, often providing the grounds for a turning point in the storyline of the movie. Yet, despite the fact that athletic trainers would have provided aide and been a vital part of getting the athlete back on the field, these healthcare professionals were obviously absent from these pivotal character and storyline developments.

Also of note was athlete mental health. In many cases, the mental health of an athlete was recognized but received little attention as a medical condition. Few films depicted characters as having any real concern over an athlete’s mental health. In those that did, it was often the athlete’s family, friends, or teammates that questioned emotional or mental stability, not athletic trainers or medical professionals. Ray Kinsella’s (Kevin Costner) wife and brother-in-law in Field of Dreams for instance, question his sanity when the farmer tills under fields full of healthy corn to build a baseball field based on the voices he hears in his head. Similarly, it is Dave’s friends and father who express concerns over the young athlete’s obsession with cycling and the Italian national team he idolizes in Breaking Away. In Jerry Maguire, a number of friends, colleagues, and people close to Tom Cruise’s character ponder the sports agent’s overall emotional state after he makes a series of uncharacteristic life choices. Few medical professionals were depicted as making any serious references to an athlete’s mental health.

In the few cases where an athlete’s mental health was considered in more depth, it was often treated as either a source of embarrassment or a source of humor, or both. In Tin Cup, Roy McAvoy (Kevin Costner), seeks out a therapist in hopes of igniting a romantic relationship with her, but finds he really does need (or at least benefits from) psychiatric care. Upon revealing his treatment to his friends, which he is incredibly embarrassed about, Roy is teased relentlessly. Similarly, the mental state of groundskeeper Carl Spackler (Bill Murray) in Caddy Shack is toyed with for the entertainment of the other characters despite clear indications he is not well. While the film is a comedy clearly meant to be ridiculous, its treatment of mental health still has the potential to influence audience perception of this widely experienced health concern.

CONCLUSIONS
Considering the data set in its entirety, athletic trainers were largely overlooked in an otherwise accurate (albeit dramatized) portrayal of sports and sport injuries. Overall, the films perpetuated an inaccurate and narrow representation of athletic trainers and athlete health. Reinforcing stereotypes about the absence of women in STEM fields, particularly athletic training careers, many of the films examined depicted athletic trainers as older men in khaki pants and a polo. Aptly illustrating the general disregard for athletic trainers in the data set, Dr. Julian Bailes in Concussion, alludes to athletic trainers’ inability to handle concussions and sums up the profession by declaring that “all athletic trainers are good for is taping ankles.” These depictions are detrimental to the field as they likely muddle the profession’s intimate links to sport and contribute to the poor understanding of athletic training revealed by Benes and Mazerolle (6).

These findings beg the question, why? While considerable time, effort, and money are clearly put into filmmaking efforts to ensure that other aspects in a film are realistically depicted, why is it that the role and depiction of athletic trainers are so narrowly represented, if included at all? In other words, why present the audience with an accurate representation of sport but not of the role of athletic trainers in sport, particularly when athletic trainers are integral to many athletes’ success? Is it assumed audiences are not interested in the details of athlete health? This is somewhat counter-intuitive given the perennial popularity of medical themed television shows such as E.R., Chicago Hope, and Grey’s Anatomy, and films like Forrest Gump, Dallas Buyers Club, and The Fault in Our Stars that depicted a number of characters’ physical and mental health struggles more in depth. Is the choice to sideline athletic trainers simply a creative or an aesthetic decision? Or, perhaps is there a lack of knowledge about the field by writers, directors, and casting agents in the films examined? The latter seems odd given the fact that many of the films examined had an athletic trainer on the larger film crew, their presence disclosed in many films’ credits. Regardless, given their immense popularity (3), sport films have potential to correct these inaccurate depictions of athletic trainers, which are widely recognized as contributing to conceptualizations about the profession as a whole.

Further, the lack of diversity in athletic trainers (or those individuals presumed to be athletic trainers) in the sports films examined was grossly inaccurate. While 80.77% of NATA members are white (as accurately depicted in the data set), over half or 54.49% are female (46). Yet, a majority of the athletic trainers (or persons dealing with an athlete’s health) depicted in the films were older white men thus perpetuating the gendered culture of sports which is not reflective of the reality of the athletic training profession. This narrow and inaccurate depiction may give potential students the impression that the field is not open or friendly to women or people of color. These aptly timed findings coincide with the push for a greater and more diverse depiction of women in STEM careers in film. Athletic training is ready for more accurate representations in popular culture, particularly as the field is exciting, fast-paced, female-dominated and math and science-heavy. In other words, athletic training should work to capitalize on the #SeeHer, women in STEM movement already in motion. Recruiting and informational materials could include the hash tag and information on the movement and (though ambitious) advertisements for athletic training educational depicting a diverse group of student programs could be aired before, during, or after television screenings of popular sports films or before movie theatre screenings of sport films.

The absence of athletic trainers responding to injuries in film, especially in recent films, is also wholly unrealistic. As of 2017, 70% of public schools and 58% of private schools offer some level of athletic training services at the high school level (47). Most colleges, universities, and professional teams also employ athletic trainers. Even non-traditional settings such as rodeos, dance companies, and the X-games have athletic trainers. Yet these important and varied links between sport and the field of athletic training are not reflected in the films studied thereby perpetuating stereotypes and outdated cultural norms. With the change in athletic training education imminent, and added pressure to recruit new students, it is critical that the field works to educate the public about the reliance of athletes and sports as we know them on the profession. In light of these findings, athletic training programs should consider how to overcome these popular but largely incorrect images associated with the field through advertising and public outreach.

Further, this study highlights the need for the field as a whole to work to educate the public about its vital and lifesaving services. Perhaps this is a charge best suited for the NATA whose nation-wide network has an influence. Ideally, the NATA could act as a liaison, offering scriptwriters, directors, and producers consulting services to ensure an accurate portrayal of athletic trainers and depictions of only safe responses to sports injuries. More realistically, cohesive advertising and public education initiatives could be undertaken by the national organization aimed at correcting the misconceptions about athletic training perpetuated by film so that transitioning programs could support one another instead of becoming competitors to one another further complicating the situation and jeopardizing the future of the profession.

Given that U.S. Bureau of Labor Statistics projects the job market to grow 23% between 2016 and 2026 for this integral sport-related field, much faster than the average for all occupations (63), future studies should work to reveal how athletic training is portrayed across other mediums such as during live aired sporting events, on sports commentary platforms, and within the media in general. Studies should also be aimed at understanding how and why athletic training is chosen (or avoided) as a career choice in order to ensure the sustainability of this important sports related field.

APPLICATIONS IN SPORT
The lack of inclusion of and lack of detailed depictions of athletic trainers could also contribute to unsafe beliefs about the severity of injuries sustained during athletic endeavors. Younger athletes watching these sport films could get a false sense of realism in regards to the seriousness of sport-related injuries. The idea that an athlete could suffer a large cut, receive stitches on the sideline and return to play only minutes later a la Hoosiers and The Blindside is not only unrealistic, but also incredibly dangerous as stiches can pull out in turn further injuring the athlete and exposing the wound to infection, and exposing other players to bodily fluids. Minor head injuries, left untreated could result in traumatic brain injuries (TBI), and other untreated ailments could even result in death. Given the power of film to shape public perceptions of sport (29), filmmakers should address these serious health misrepresentations and distributors before ethical concerns arise.

ACKNOWLEDGMENTS
The authors would like to acknowledge, Dr. Adrian Anast, Ph.D., for her editorial support. There were also no financial conflicts of interest with this research. 

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2018-08-27T11:18:58+00:00September 6th, 2018|Research, Sports Management|Comments Off on Athletic Training in Popular Sports Films: More than khakis, a polo, and a roll of tape?