Evolution and Structure of Athlete Care Roles in U.S. Sports
Compiled by
Kimberly Quigley, MD, Onrise
Introduction
The landscape of athlete care in U.S. sports has transformed dramatically over the past century. Today’s athletes benefit from a comprehensive support network addressing both physical and mental health needs. This network includes a range of specialized professionals, from team physicians and athletic trainers to sport psychologists, therapists, psychiatrists and dietitians, all working in concert to ensure athletes perform at their best and remain healthy. The evolution of these roles reflects a shift from a time when injury care was ad hoc or left to coaches, to the modern era where an interdisciplinary sports medicine team is an integral part of any competitive program. This article explores the historical development of athlete care roles in the United States, describes the scope of practice of key professionals in physical and mental health domains, and examines how these roles are structured and collaborate in today’s sports environment.
Historical Development of Athlete Care in U.S. Sports
In the early 20th century, organized sports in America began to recognize the need for dedicated health professionals. Prior to this, coaches or untrained personnel often managed injuries. A turning point came in 1905, when a spate of severe injuries and fatalities in college football (18 deaths and 159 serious injuries that year) prompted President Theodore Roosevelt to demand reforms. This led universities to seek better medical care for athletes, planting the seeds for formal roles in athlete health care. By the 1910s, pioneers like Samuel Bilik, author of The Trainer’s Bible (1917), were defining the foundations of athletic training as a profession. Throughout the mid20th century, sports-related healthcare became more organized: the National Athletic Trainers’ Association (NATA) was founded in 1950, and the American College of Sports Medicine (ACSM) in 1954, establishing professional communities for those caring for athletes. In professional sports, early team medical support was often provided by general physicians or enthusiastic volunteers; over time, however, specialization grew. By the late twentieth century, new fields emerged within athlete care: the National Strength and Conditioning Association (NSCA) was established in 1978 to professionalize strength coaching, and sport-specific psychology organizations formed in the 1980s (the Association for Applied Sport Psychology in 1986 as mental aspects of performance gained recognition. Importantly, in 1990 the American Medical Association formally recognized athletic training as an allied health profession, underscoring its importance. Around the same time, sports medicine itself gained status as a board-certified medical subspecialty (with fellowship programs and certification established in the early 1990s). By the 2000s and into the 2020s, athlete care in the U.S. has expanded to include robust mental health support alongside physical health services. Leagues and collegiate athletic programs have introduced requirements or best practices to ensure athletes have access to doctoral level psychologists, mental health counselors, and psychiatrists especially as awareness of issues like anxiety, depression, and concussion-related effects has grown. This historical evolution shows a clear trend: U.S. sports have moved from minimal, informal medical assistance towards a sophisticated, multidisciplinary model of athlete care.
Key Milestones in the Evolution of Athlete Care:
• Late 19th – Early 20th Century: Emergence of athletic trainers and team doctors as college sports become popular. (e.g., Harvard established physical training programs by the 1890s;
college football’s injury crisis in 1905 spurs hiring of trainers and doctors at games.)
• 1910s – 1930s: Foundational works and early organization: publication of The Trainer’s Bible in 1917; promotion of injury prevention and first aid techniques; first attempt at a
national athletic trainers’ society in 1938 (paused by WWII).
• 1950s – 1970s: Professionalization: NATA (1950) and ACSM (1954) form, providing standards and education for athletic trainers and sports medicine physicians; first sports
medicine academic programs appear. The American Orthopaedic Society for Sports Medicine (AOSSM) is founded in 1972, reflecting growth in sports-specific surgical care. Athletic training education and certification formalize (curricula approved in late 1950s, first national certification exam in 1971). Strength and conditioning coaching emerges as a distinct role (the University of Nebraska hires the first full-time strength coach in 1969).
• 1980s – 1990s: Expansion of specialties: Clinical psychologists with sports expertise gain foothold (the U.S. Olympic Committee hires its first full-time sport psychologist in 1985; teams increasingly consult sport psychologists by the 1990s). Sports physical therapy becomes recognized with a board specialty (the American Physical Therapy Association approved sports physical therapy certification in 1981, with the first exams by 1987). Sports nutrition enters team sports (in 1976 the Denver Broncos became one of the first NFL teams to hire a dedicated nutrition consultant, and by the 1990s more teams followed suit). In 1990, the AMA formally recognizes athletic trainers as allied health professionals, and in 1992 sports medicine gains recognition as an official subspecialty for physicians, leading to an increase in fellowship-trained sports medicine doctors.
• 2000s – Present: Holistic and integrated care: Professional leagues and the NCAA place greater emphasis on mental health and wellness. By the late 2010s, leagues like the NBA
and NFL mandated that teams have licensed mental health professionals on staff. Most NCAA Division I athletic departments now employ sport dietitians and mental health counselors in addition to traditional sports medicine staff. Athlete care teams at the professional and collegiate levels commonly include a full roster of specialists (physicians, athletic trainers, physical therapists, strength coaches, dietitians, sports performance professionals, mental health therapists, psychiatrists, massage therapists, and more), all coordinating their efforts. The focus has expanded from injury treatment alone to injury prevention, performance enhancement, and overall well-being of athletes.
This historical progression highlights how each role gained prominence. Next, we delve into the specific roles within the physical health domain of athlete care, followed by those in the mental health domain, detailing their scope of practice and contributions.
Athlete Care Roles in the Physical Health Domain
Sports Medicine Physicians (Team Doctors)
Sports medicine physicians, often referred to as team doctors, are medical doctors who specialize in the care of athletes and sports-related injuries. Their scope of practice includes diagnosing and treating acute injuries (such as fractures, sprains, and concussions), managing chronic conditions (like overuse injuries or asthma in athletes), and overseeing rehabilitation plans. Uniquely, sports medicine physicians focus on helping athletes return to play safely and preventing future injuries. Traditionally, early team physicians in the U.S. were general practitioners or orthopedic surgeons with an interest in sports, sometimes serving part-time roles for a team. As the field evolved, formal training in sports medicine became available: many team physicians today complete fellowships in sports medicine (either via orthopedic surgery routes or primary care sports medicine routes) after their medical residency. Sports medicine became an officially recognized medical subspecialty in the 1990s, which standardizes the training and qualifications of these physicians.
In their role, team doctors lead the medical care team. They conduct pre-participation physical exams to ensure athletes are healthy to compete, make return-to-play decisions after injury or illness, and coordinate care among various specialists. For example, if an athlete suffers a knee injury, the team physician might perform or coordinate imaging and surgical treatment, work with physical therapists on post-operative rehab protocols, and communicate with coaches about the athlete’s status. Team physicians also play a key role in injury prevention – identifying risk factors (such as muscle imbalances or training errors) and implementing strategies in partnership with trainers and coaches to mitigate those risks. They often advise on training workloads, nutrition, hydration, and even psychological stress, recognizing that all these factors impact an athlete’s health. In the modern structure, a team physician is not limited to treating injuries; he or she is instrumental in crafting health policy for teams (for instance, concussion management protocols) and ensuring overall wellness of athletes.
Another important aspect is that sports medicine physicians emphasize ethical care – they must balance the competitive desires of athletes and teams with the medical imperative to protect athlete well-being. In practice, this means the team doctor has final authority to hold an athlete out of competition if health is at risk, even if coaches or the athlete want to play. Over the years, the presence of dedicated sports physicians has improved outcomes such as quicker injury recovery and reduced complications, thanks to advances in surgical techniques (like arthroscopy), better injury assessment tools, and a more proactive approach to athlete health. Today, every professional sports team and most collegiate programs in the U.S. have one or more team physicians (often including both orthopedic surgeons for musculoskeletal injuries and primary care sports medicine doctors for medical issues and general injuries). They work closely with the rest of the sports medicine staff, anchoring the collaborative care approach that defines modern athlete care.
Athletic Trainers (ATCs)
Athletic trainers are nationally certified and state-licensed allied health professionals who specialize in the prevention, immediate care, and rehabilitation of athletic injuries. They are often considered the cornerstone of day-to-day athlete healthcare in the U.S. sports system. An athletic trainer’s scope of practice is broad: on any given day, an AT might evaluate an athlete’s injury on the field, provide first aid or emergency care, design and supervise rehabilitation exercises, apply therapeutic treatments like taping, bracing or modalities, and counsel athletes on injury prevention exercises. Athletic trainers also serve as liaisons among athletes, coaches, and medical doctors – they communicate an injured athlete’s status and progress and ensure that the physician’s recommendations are implemented in daily training.
The role of athletic trainers has a rich history. The profession formally emerged in the late 19th and early 20th century as organized sports grew, but it wasn’t until 1950 that the National Athletic Trainers’ Association was founded, uniting practitioners under common standards. Early athletic trainers often learned through apprenticeship and were sometimes viewed as “assistant” to team doctors or coaches, focusing mainly on basic first aid and injury taping. However, as sports grew more competitive, and the science of sports medicine advanced, athletic trainers became highly specialized clinicians. Over decades, their education standards increased (today requiring a master’s degree in athletic training), and their expertise expanded to include things like concussion evaluation, therapeutic exercise, and even aspects of sport performance monitoring. A landmark moment was the AMA’s recognition of athletic training as an allied health profession in 1990, which solidified ATs’ status as healthcare providers rather than just assistants.
In practice, an athletic trainer is usually the first responder when an injury occurs during a practice or game. For instance, if an athlete collides and suffers a possible knee ligament injury, the AT will be on the field immediately to assess the situation, provide acute care (stabilizing the joint, managing pain, etc.), and determine if further medical evaluation is needed. They work under the direction of a physician (most states require a supervising or collaborating physician for AT practice), which means they refer severe injuries to the team doctor and follow protocols established by the medical team. They also coordinate rehabilitation, often conducting rehab sessions with athletes and then transitioning the athlete to sport-specific conditioning in tandem with strength coaches. Athletic trainers are also heavily involved in preventative care: they might lead programs for stretching, warming up, strength imbalance correction, and educate athletes on nutrition or hydration to avoid cramps and heat illness. In high school and collegiate settings, athletic trainers often take on an educational role as well, teaching athletes about injury risks and safe training practices.
Today, athletic trainers are present at virtually all colleges and professional sports teams, and there is a growing push to have them available in all high school athletic programs. Their value is evident in reduced injury severity (when promptly managed), thorough rehabilitation oversight, and being the consistent caregiver who knows each athlete’s medical history. In summary, athletic trainers have evolved into essential, highly skilled healthcare professionals in sports, with a scope that spans immediate care to long-term athlete health maintenance, all carried out in collaboration with physicians and other specialists.
Physical Therapists (Sports Physical Therapists)
Physical therapists (PTs) are experts in musculoskeletal rehabilitation who play a pivotal role when an athlete needs recovery from injuries or surgeries. While athletic trainers and physical therapists share some skills in rehabilitation, sports physical therapists typically handle post-acute and longterm rehab, especially for more serious injuries. In the general healthcare system, physical therapy became a formal profession in the early 20th century (for example, in rehabilitating soldiers after World War I and polio patients). The intersection of physical therapy and sports intensified in the late 20th century as surgical advances meant athletes could benefit from specialized rehab to return to play faster and safer. Recognizing this, the American Physical Therapy Association established a Sports Physical Therapy Section in 1973, and by 1981 the APTA approved a board certification in sports physical therapy (with the first certifications awarded mid-1980s). This created a cadre of PTs specifically trained to work with athletic populations and sports injuries.
In an athlete care team, a sports physical therapist’s scope includes designing individualized rehabilitation programs for injuries like ACL tears, Achilles tendon ruptures, shoulder dislocations, and so forth. After a team physician or surgeon treats the acute injury (possibly surgically), the PT takes the lead in guiding the athlete through stages of recovery: improving range of motion, rebuilding strength and neuromuscular control, and eventually restoring sport-specific skills. Physical therapists use techniques such as therapeutic exercise, manual therapy (hands-on
techniques to mobilize joints and soft tissue), and modalities (like ultrasound or electrical stimulation) to promote healing. They also conduct biomechanical assessments to understand how an injury occurred or to correct movement patterns that could cause re-injury. Sports PTs often work closely with athletic trainers; in some settings (like college sports medicine clinics or Olympic training centers), these roles overlap and PTs and ATs collaborate fluidly. For example, an athletic trainer might handle on-field care and early rehab, and then a physical therapist might take over for advanced post-surgical rehabilitation, before handing the athlete back to the AT and coaches for return-to-sport drills.
One distinguishing aspect of physical therapists is that they often manage rehabilitation in a clinical environment (such as a sports medicine clinic or training room) and may also see athletes from outside the team (community athletes, etc.), whereas an athletic trainer is usually embedded with a specific team or school. However, many professional teams also directly employ or consult physical therapists for their players, especially for complex cases. In terms of scope of practice, physical therapists are licensed to evaluate and treat movement dysfunctions; some states allow direct access (athletes can see a PT without a physician referral), but even in collaborative sports settings, PTs coordinate with team physicians to track progress and clearance. Importantly, sports PTs are trained in sports performance considerations – understanding the specific physical demands of each sport, which helps in tailoring rehab that truly prepares the athlete for competition, not just generic daily activities. As sports have embraced evidence-based injury rehab protocols, the role of the sports physical therapist has become indispensable for safe and effective return-to-play. Modern sports rehab, guided by PTs (often alongside ATs), has significantly shortened recovery times for many injuries and improved the quality of recovery, reducing the risk of re-injury. Together with athletic trainers and physicians, physical therapists form a triad at the core of physical health care for athletes.
Strength and Conditioning Coaches
Strength and conditioning coaches focus on the physical development of athletes – improving their strength, power, speed, endurance, and overall athleticism, while also reducing injury risk through proper training. Although they are not healthcare providers per se, their role is closely linked to athlete health and performance, making them key members of the athlete support structure. The concept of a dedicated strength coach in sports is relatively modern. Until the mid20th century, athletes and sport coaches handled conditioning on their own with little scientific
guidance. A landmark in the U.S. was in 1969, when the University of Nebraska hired Boyd Epley as the first full-time strength and conditioning coach for any collegiate sports program. Epley’s success (Nebraska’s football performance improved notably) demonstrated the impact structured, year-round strength program could have. This sparked a trend: by the late 1970s and 1980s, many college and pro teams began employing strength coaches, and the field grew formalized with the founding of the National Strength and Conditioning Association in 1978 to establish education and certification standards. Today, virtually every major sports team has one or more certified strength and conditioning coaches on staff.
The strength and conditioning coach’s scope of practice includes designing and implementing training programs that build athletic qualities specific to the sport. They conduct weight training sessions, conditioning drills, agility and flexibility training, and often oversee the periodization (seasonal planning) of athletes’ fitness regimes. A crucial part of their job is injury prevention: well-designed programs correct muscle imbalances, strengthen joints and connective tissues, and ensure athletes can withstand the physical demands of competition. For example, a strength coach might implement a program to strengthen hamstrings to prevent knee injuries or incorporate balance and core exercises to prevent ankle sprains. They also teach proper lifting techniques and monitor workloads to avoid overtraining.
Strength coaches work in close collaboration with athletic trainers and physicians, especially when athletes are returning from injury. If an athlete is rehabbing, the strength coach will coordinate with the athletic trainer or PT about what exercises are safe and which should be avoided or modified. They gradually reintroduce sport-specific conditioning as the athlete heals. Additionally, strength coaches often team up with sports nutritionists to optimize body composition and energy levels for training. Communication with sport coaches is also vital – strength coaches align their programs with the coach’s schedule and tactical needs (for instance, tapering training intensity during competition periods, or focusing on particular physical traits that a coach wants to develop in players).
Over time, strength and conditioning has evolved from a purely gym-based, weightlifting role to a sports science-informed profession. Many strength coaches collect and analyze data on player fitness, fatigue, and output (using tools like GPS trackers or jump tests) to tailor training and recovery. In the structure of athlete care, strength and conditioning coaches typically operate under an athletic department or team’s performance division and are seen as key figures in keeping athletes durable and enhancing performance. Their work reduces injuries by making athletes stronger and better conditioned, and when injuries do occur, their expertise helps athletes regain competitive shape after rehab. In summary, the strength and conditioning coach role exemplifies the proactive side of athlete care – rather than reacting to injuries, they aim to build athletes who are resilient and physically prepared, all while coordinating with medical staff to ensure training is safe and effective.
Sports Nutritionists and Dietitians
Proper nutrition is fundamental to athletic performance and health, and sports dietitians (nutritionists) have become an integral part of athlete care teams in the U.S. A sports dietitian is a registered dietitian (RD) with expertise in how food and hydration influence training, recovery, and competition. They work with athletes to develop individualized meal plans, educate them on nutrition strategies, and coordinate dietary support for teams (such as planning menus for training tables or road trips). Historically, the role of a nutrition specialist in sports was almost nonexistent until the late 20th century. Teams often left nutrition advice to coaches or pamphlets. One notable early example of change was in 1976, when the NFL’s Denver Broncos hired nutritionist Kathy King as a consultant – one of the first known instances of a professional sports team engaging a dedicated nutrition expert. Over subsequent decades, more teams and colleges realized that fueling and hydrating athletes properly could improve performance and recovery, and the presence of sports dietitians steadily grew. By the 2010s, most NFL and NBA teams, as well as major college athletic programs, had full-time sports dietitians or nutrition consultants, and in recent years professional associations like CPSDA (Collegiate and Professional Sports Dietitians Association) have emerged to support this specialization.
The scope of practice for sports nutritionists includes conducting nutritional assessments (measuring body composition, analyzing diets), counseling athletes on their specific needs (for example, a marathon runner’s carb-loading strategies vs. a weightlifter’s protein intake for muscle gain), and addressing special considerations such as food allergies, vegetarian diets, or making weight (in sports like wrestling). They also play a role in injury and illness recovery – proper nutrition can speed healing, so a dietitian might adjust an injured athlete’s diet to ensure adequate protein for tissue repair and include nutrients that reduce inflammation. Another critical area is hydration and electrolyte management, especially in endurance events or hot climates; nutritionists develop hydration protocols to prevent cramping and heat illness.
Sports dietitians often collaborate with other members of the athlete care team. For example, they coordinate with strength coaches to align nutrition plans with training goals (like gaining lean mass or cutting weight safely), and with medical staff if an athlete has a health issue (like diabetes, iron deficiency, or gastrointestinal problems) that nutrition can help manage. They also educate athletes on supplements, helping them choose safe and legal options and avoid banned or harmful substances. In team settings, nutritionists may oversee meal planning in dining facilities and create pre-game and post-game menus optimized for performance and recovery.
The inclusion of sports nutrition professionals in the structure of athlete care reflects a broader understanding that food is “fuel” and medicine for athletes. It’s not just about preventing starvation or weight loss; it’s about optimizing every aspect of diet to maximize energy, cognitive focus, muscle adaptation, and immune function. Athletes often find that working with a dietitian improves not only their performance metrics but also their general health and mood. Because of this, sports dietitians have become trusted advisors to athletes and an essential part of an
interdisciplinary sports performance team.
Other Allied Health and Specialty Roles
Beyond the major categories above, many sports programs include additional specialists to round out athlete care. Massage therapists and manual therapy specialists (such as chiropractors or soft-tissue therapists) are frequently utilized to help with muscle recovery, flexibility, and treatment of musculoskeletal pain. These professionals provide hands-on techniques (massage, adjustments, myofascial release, etc.) that can alleviate soreness, improve range of motion, and reduce injury risk. Their role in the athlete care structure is often adjunct and collaborative: for example, an athletic trainer or physician might refer an athlete for massage therapy as part of a post-game recovery protocol, or a chiropractor might be consulted if an athlete has spinal or joint discomfort. Another emerging role is that of sports scientists or biomechanists, who collect and analyze performance and health data (like running mechanics or workload statistics) to inform training and injury prevention decisions. While not “medical” staff, they work closely with coaches and medical professionals to apply scientific findings to athlete care – for instance, detecting when an athlete is fatigued and at higher risk of injury based on data trends.
Additionally, many teams now employ equipment managers with a player-safety mindset (ensuring gear like helmets and pads fit properly to prevent injuries) and sports medicine nurses or physician assistants who assist team doctors in clinics. At the highest levels, you may also find sports psychiatrists available for consultation if medication management of mental health conditions is required, complementing the work of psychologists and counselors. All these roles indicate how specialized and comprehensive athlete care has become. The exact composition of
the athlete care team can vary by sport and level – for instance, an Olympic team might have an extensive staff including exercise physiologists and recovery specialists, whereas a high school might have just an athletic trainer with a team doctor on call. The underlying structure, however, is consistent: a network of professionals, each with defined expertise, working together to cover every facet of an athlete’s well-being.
Athlete Care Roles in the Mental Health Domain
Peer Support in Athlete Mental Health
Peer support in sports mental health is a relatively recent yet increasingly influential development in the athlete care ecosystem. Its roots can be traced to broader peer support movements in behavioral health, especially those endorsed and codified by the Substance Abuse and Mental Health Services Administration (SAMHSA). Peer support is defined as the provision of emotional, social, and practical help by individuals who have lived experience of similar challenges. In sports, this translates to current or former athletes offering support to peers who may be struggling with mental health issues, identity loss, injury recovery, or performance-related stress.
The model gained legitimacy as mental health concerns among athletes became more visible in the 2010s. One of the earliest formal programs was Athletes Connected at the University of Michigan, launched in 2014 through a partnership between Michigan Athletics, the School of Public Health, and the Depression Center. Backed by NCAA funding, this program developed educational videos, peer-led workshops, and support structures that normalized mental health struggles among athletes. Evaluations showed measurable improvements in help-seeking attitudes and reduced stigma among participants.
Following the success of Athletes Connected, similar initiatives emerged nationally. Morgan’s Message, founded in memory of Duke lacrosse player Morgan Rodgers, and The Hidden Opponent, created by former USC athlete Victoria Garrick, established large peer ambassador networks across high schools and colleges. These organizations train athlete ambassadors to recognize signs of distress, start conversations about mental health, and guide peers toward professional help. Importantly, these roles do not provide clinical care – they act as early support contacts and culture changers within teams.
SAMHSA guidelines underscore the effectiveness of peer support in bridging gaps between need and care. Peer advocates reduce barriers such as stigma, mistrust of institutions, and fear of judgment. In athletic environments where toughness and silence have been normalized, peer supporters can break through in ways clinicians alone often cannot. Research outside of sport confirms the efficacy of peer programs in increasing service utilization and promoting recovery; these effects are now being replicated in sport-specific peer networks.
To ensure safety and effectiveness, peer programs in athletics increasingly include structured training in active listening, boundary-setting, and referral protocols. For example, many campuses offer Mental Health First Aid or similar programs to prepare athlete leaders. The NCAA, through its Mental Health Best Practices and Mind, Body and Sport initiatives, has recommended embedding peer support into campus mental health strategies. Some schools have now formalized this role within leadership teams, creating titles like Mental Health Captain or Peer Wellness Ambassador.
Peer support, when linked with professional care pathways, offers a scalable, sustainable enhancement to athlete mental health systems. It fosters an environment where athletes support each other proactively while knowing when and how to involve clinical professionals. In a comprehensive care model, peer support plays a foundational role in creating trust, accessibility, and cultural change around mental health in sport.
Near Peer Support: Former Athletes Supporting Current Athletes
Near peer support represents an innovative expansion of the traditional peer support model. Unlike current student-athlete peer programs, near peer support leverages the lived experiences of former collegiate and professional athletes to support those currently competing. These mentors—often recent graduates or retired professionals—offer credibility, insight, and relatability, but from a position that allows more perspective and training.
Organizations like Onrise have pioneered the formalization of near peer care. Onrise employs retired athletes, many of whom are credentialed in mental health or receive structured supervision, to deliver peer support to current athletes. This model fills a crucial gap: while clinicians offer therapy and current teammates provide emotional peer support, near peers are uniquely positioned to understand both the rigors of competition and the transition beyond sport. Their experience with injuries, setbacks, transitions, and the loss of athletic identity allows them to
connect with current athletes facing similar pressures.
Onrise provides peer support services as part of an integrated care platform, which also includes therapy, psychiatry, nutrition counseling, and 24/7 care coordination. Their approach is based on best practices from SAMHSA, and near peers operate under clinical oversight to ensure appropriate boundaries and referrals. This adds an important dimension to athlete mental health: culturally competent, credible support that is available when athletes may hesitate to engage with formal clinicians.
Professional organizations across sports—including the Professional Women’s Hockey League (PWHL), Major League Rugby (MLR), Pro Volleyball Federation (PVF), and the Jockeys’ Guild—have partnered with Onrise to deliver near peer support to their athletes. Early evidence from these partnerships suggests that athletes are more likely to engage with near peer providers than with traditional clinicians alone, and that the approach enhances trust, early identification of concerns, and continuity of care.
Near peer support reinforces the principle that no one understands athletes like other athletes— and that lived experience, when combined with training and structure, can be a powerful force in mental health support. It complements the clinical ecosystem by meeting athletes where they are, offering connection from those who have “been there,” and helping build a bridge to therapy, psychiatry, or other supports when needed.
Sport Psychologists (Non-clinical Mental Skills/Performance Coaches)
Competitive sports place significant psychological demands on athletes – from handling competitive pressure, focus and concentration, to maintaining confidence and motivation. Sport
psychologists are professionals who specialize in the mental aspects of sport and performance. Some sport psychologists are licensed psychologists with a doctoral degree, while others may be
mental skills coaches with specialized training in performance psychology (but not necessarily clinical licensure). The role of sport psychologists in athlete care has gained recognition gradually.
Early research in sport psychology dates back to the late 19th and early 20th centuries (for example, studies by Norman Triplett in 1898 and Coleman Griffith in the 1920s). However, it wasn’t
until the 1960s and 1970s that teams and athletes in the U.S. began to formally use sport psychology techniques. A pioneer in applied sport psychology was Bruce Ogilvie in the 1960s, who
worked with athletes and teams and is often called “the father of North American applied sport psychology.” By the 1980s, the U.S. Olympic teams started to incorporate sport psychologists:
notably, in 1985 the U.S. Olympic Committee hired its first full-time sport psychologist, signaling that mental training was as important as physical training at elite levels. Over subsequent years,
professional teams in sports like baseball, basketball, and football also began consulting sport psychologists to help athletes with mental preparation and coping strategies.
The scope of practice for sport psychologists (or mental skills coaches) in an athletic setting typically includes performance enhancement techniques – such as goal setting,
visualization/mental imagery, anxiety management, relaxation training, focus and concentration drills, and routines for consistency. They might help a basketball player develop a pre-free-throw
routine to reduce nervousness, or teach a golfer how to use visualization to rehearse shots, or work with an entire team on communication and cohesion. In addition to performance optimization,
sport psychologists address mental hurdles related to injury and setbacks. An athlete recovering from a major injury, for example, may struggle with fear of re-injury or loss of identity; a sport
psychologist can help them build confidence to return to play and maintain a positive mindset
during rehabilitation.
Sport psychologists often collaborate with coaches to integrate mental skills into daily practice – for example, designing pressure simulations in practice to teach athletes to perform under stress.
They also educate coaches on communication styles and motivational techniques that foster a healthier team climate. Importantly, while sport psychologists work on performance and mindset, if
they are licensed clinicians, they can also identify when an athlete’s challenges go beyond sport (for instance, if an athlete shows signs of clinical depression or anxiety disorders that require
medical intervention). In those cases, they might refer or work in tandem with clinical mental health professionals. Many large sports programs now have a “mental performance coach” or “director of sport psychology” whose job is to ensure athletes have access to these mental training resources just as readily as they have access to physical training equipment.
The presence of sport psychologists has become commonplace in elite sports. For instance, many NBA and NFL teams employ mental skills specialists, and collegiate athletic departments often
have sport psychology staff or consultants. Athletes have become more open about using psychological strategies as part of their training – it’s not uncommon to hear a champion discuss
how visualization or mindfulness gives them an edge. This reflects a cultural shift: once a stigma or skepticism surrounded sport psychology, but now mental training is viewed as a standard
component of comprehensive athlete care.
Clinical Mental Health Therapists (Clinical licensed psychologists, LCSWs, LPCs)
While sport psychologists (as described above) often concentrate on performance-related mental skills, there is an equally crucial aspect of athlete care focusing on general mental health and wellbeing. Athletes are not immune to the mental health challenges that affect the general population – in fact, the pressures of competition and unique lifestyle of athletes can sometimes exacerbate issues like anxiety, depression, eating disorders, or stress. Recognizing this, sports organizations in the U.S. have increasingly integrated clinical mental health professionals into their athlete care teams. These professionals may be clinical sport psychologists (licensed psychologists who can provide psychotherapy), licensed mental health counselors or social workers experienced with athletes, or even psychiatrists (medical doctors who can prescribe medications for mental health conditions).
The evolution of mental health care in sports has accelerated in the past decade. Historically, athletes were often expected to “tough out” mental struggles or were reluctant to seek help for fear of seeming weak. But high-profile cases and advocacy have spurred change. In 2013, the NCAA began emphasizing student-athlete mental health, and by 2016, an inter-association task force (including NCAA and medical groups) published Mental Health Best Practices recommending that collegiate athletic departments have a defined plan for mental health care, including screening, referrals, and having licensed providers available. Professional leagues followed suit: the NBA, for example, implemented a policy by 2019 requiring each team to have at least one full-time licensed mental health professional on staff and to retain a psychiatrist as a consultant as needed. The NFL and other leagues have similarly enhanced their mental health programs (the NFL Players Association and NFL agreed on improving mental health resources, with each team having a Behavioral Health Team Clinician). This structural shift demonstrates that mental health is now being treated with the same seriousness as physical health in athlete care.
The scope of practice for these mental health professionals includes providing confidential counseling and therapy to athletes dealing with personal or psychological issues. This could range from managing clinical conditions (like counseling a student-athlete with depression, or helping an athlete with an eating disorder in conjunction with nutrition staff) to simply providing a space to talk through stress, relationships, or the demands of balancing academics or personal life with sport. They also handle crisis situations – if an athlete is at risk of self-harm or experiencing a mental health crisis, these professionals intervene with appropriate care, just as a medical team would respond to a physical emergency. Another critical piece is education and prevention: mental health staff might lead workshops on topics like stress management, healthy sleep habits, or recognizing signs of mental distress in oneself and teammates. They train coaches and staff as well, so that the environment is supportive and stigma is reduced.
Sports Psychiatrists
Sports psychiatrists are medical doctors (MD or DO) who specialize in the psychiatric care of athletes. After completing medical school and a four-year residency in psychiatry, they are eligible for board certification by the American Board of Psychiatry and Neurology (ABPN). Some pursue additional specialization in sports psychiatry through the American Board of Sports and Performance Psychiatry or mentorship under established experts.
Psychiatrists bring unique expertise to athlete care by being able to prescribe medication, manage complex mental illnesses, and address psychiatric symptoms that affect performance. Their knowledge of medication effects on athletic performance, anti-doping considerations, and the interaction between physical and psychological symptoms makes them essential in cases where athletes experience conditions like ADHD, major depression, bipolar disorder, or eating disorders.
Sports psychiatrists work closely with sport psychologists, counselors, and physicians to ensure integrated care. For example, an athlete with performance anxiety and insomnia might receive
therapy from a psychologist and medication management from a psychiatrist. In elite sport environments, psychiatrists are often part-time consultants who support clinical teams during
high-stress periods or crises. As mental health in sports gains greater attention, sports psychiatrists are increasingly included in professional and Olympic-level care teams to ensure full-spectrum support for athlete wellness.
Interdisciplinary collaboration is key here too. A clinical sports psychologist or counselor will often coordinate with the sport psychologist (mental skills coach) if the athlete is also working on
performance issues, ensuring that efforts are complementary. They may also work with physicians if medication might be beneficial, or with the athletic trainer if, for example, a recovering injured athlete is struggling mentally – so that the treatment plan addresses both physical rehab and psychological coping. Privacy is a consideration: these professionals maintain confidentiality to build trust with athletes, only sharing information with the broader team if permitted or if it’s a safety concern. The presence of on-site mental health care has already shown positive impacts, with athletes more willing to seek help and report improved well-being.
In terms of structure, some large athletic programs have a Director of Athlete Mental Health or similar position, under which a team of counselors/psychologists operate. Others contract out to specialists or local clinics. What’s consistent is that mental health is now recognized as a pillar of athlete care. Athletes like Olympic swimmers, NBA players, and collegiate stars have publicly spoken about the importance of therapy or counseling in their lives, which further normalizes its use. This cultural evolution has made mental health professionals a permanent and vital part of the athlete support network, ensuring that athletes are not only physically fit but also mentally resilient and healthy.
Interdisciplinary Collaboration and Structure of Athlete Care Teams
Modern athlete care is characterized by a high degree of interdisciplinary collaboration. No single professional – no matter how skilled – can address all the needs of today’s athletes. Instead,
U.S. sports teams and athletic departments typically employ a collaborative model often referred to as the “sports medicine team” or the “athlete care team,” which brings together experts from multiple fields to share information and coordinate care. The structure of these teams can vary, but a common framework is as follows:
• Leadership: A senior medical professional usually heads the team – often the Head Team Physician (for professional teams) or the Director of Sports Medicine (in college settings,
sometimes this is an experienced athletic trainer or physician administrator). This leader is responsible for making high-level decisions about athlete health policies, overseeing staff, and being the ultimate authority on return-to-play decisions for injured athletes. In some settings, especially high-performance or Olympic programs, there might also be a High Performance Director who oversees sports medicine, sports science, and strength and conditioning under one umbrella to ensure all departments are aligned.
• Core Sports Medicine Stab: This includes team physicians, athletic trainers, and physical therapists, who handle most of the injury management continuum. They typically
communicate multiple times daily – for example, an athletic trainer will report to the physician about any new injuries or updates each day, and a rehab plan will be discussed
with the physical therapist. Many teams hold regular medical meetings (daily in pro sports, or weekly in college) where each injured or ill athlete is reviewed by the physician and training staff, ensuring everyone is on the same page regarding progress and next steps.
• Performance Stab: Strength and conditioning coaches and nutritionists fall under this category. They often coordinate with the medical/core staff to adjust training loads or diets based on an athlete’s current health. For instance, if an athlete is recovering from a hamstring strain, the athletic trainer and strength coach will collaborate on a modified workout plan that maintains fitness without aggravating the injury. Likewise, the nutritionist might add extra protein and nutrients to support healing for that athlete. In many setups, the performance staff attend the sports medicine meetings or have their own performance meetings where information is shared across disciplines.
• Mental Health and Sport Psychology Stab: These professionals integrate by providing input on athletes’ psychological readiness and well-being. A common practice now is to
include a sport psychologist or counselor in regular athlete support meetings. For example, if a normally high-performing athlete is underperforming and showing signs of distress, the
coach or AT might flag this, and the mental health professional can then reach out to assess and help the athlete. There’s also collaboration in cases like concussion management –
where not only do the physician and AT manage the physical recovery, but a psychologist might assist with the emotional impact of the injury and the gradual return-to-play protocol (since concussions can cause anxiety or mood effects).
• Communication and Confidentiality: Interdisciplinary work requires constant communication but also respect for privacy boundaries. Typically, with the athlete’s consent, key information is shared among team professionals so that everyone can do their job effectively. For instance, a nutritionist would need to know if an athlete has a medical condition like diabetes or if they are on certain medications, information the team doctor or AT can provide. Similarly, an athletic trainer should know if an athlete is going through mental health treatment that might affect things like their attendance or stress levels, without prying into personal details. Clear protocols are established about what can be shared and how, ensuring that the athlete’s well-being is central to any discussion.
• Integrated Care Plans: A hallmark of effective athlete care teams is developing integrated care or performance plans for each athlete, especially those with significant needs. Take
the example of a collegiate soccer player returning from ACL surgery: the surgeon (physician) and physical therapist design the rehab timeline, the athletic trainer helps
implement daily rehab exercises and monitors the athlete on the field during the later stages of recovery, the strength coach creates a re-conditioning program to rebuild sport specific fitness, the nutritionist advises on diet for healing and conditioning, and a sport psychologist might work on confidence-building and mental preparation for return to competition. All these efforts are coordinated so that at each phase, everyone knows the athlete’s status and goals. This coordination reduces duplication, avoids conflicting advice, and provides the athlete with a seamless support system.
The structure of athlete care roles can also be seen in the chain-of-command during emergencies or decision-making moments. For instance, if an athlete collapses during a game, the protocol might dictate that the athletic trainer and team physician take charge on the field (with the AT handling immediate first aid and the physician directing medical care). The paramedics might be involved if hospital transport is needed, but the team’s medical staff will provide critical information. Later, when it comes to deciding if and when that athlete can return to play, the physician’s decision is final from a medical standpoint, but it will be informed by input from the AT about how the athlete is doing in functional tests), the PT (if extensive rehab was done), and even the mental health professional (if the athlete is mentally ready or has any anxiety about returning).
Another aspect of modern interdisciplinary work is education and cross-training: the different professionals regularly educate each other (e.g., a nutritionist might give a talk to coaches and ATs about recognizing eating disorder signs; an athletic trainer might train coaching staff in basic injury first response; a psychologist might teach techniques to incorporate into team routines). This fosters a culture where everyone in the athlete’s environment has some literacy in key health and performance concepts, further protecting and enhancing the athlete’s well-being.
At the high school level or smaller organizations, the “team” might be just one or two individuals wearing multiple hats (often a lone athletic trainer working with perhaps a volunteer team
physician). Even then, they typically establish referral networks to cover areas like nutrition or mental health when needed. At elite levels, the staffing is larger, but the principle remains: success and health in sports come from a network of care. Interdisciplinary collaboration ensures that athletes are looked after in a 360-degree manner – physically, mentally, and emotionally.
Conclusion
The evolution and structure of athlete care roles in U.S. sports underscore a fundamental truth: maximizing athletic performance and safeguarding athlete health are two sides of the same coin. Over the past century, American sports have moved from a rudimentary model of care – where a single coach or doctor might have tended to injuries – to a sophisticated, multidisciplinary approach that is now the gold standard. Each role within the athlete care ecosystem, whether it be the athletic trainer on the sidelines, the sports medicine physician in the clinic, the strength coach in the weight room, the dietitian in the cafeteria, or the psychologist in the counseling office, has a distinct scope of practice and expertise. Equally importantly, all these professionals function as part of an integrated team with the athlete at the center.
This comprehensive approach has brought tangible benefits: athletes recover from injuries more safely and efficiently, careers are extended with better conditioning and preventative care, and mental health is no longer neglected but actively supported. An athlete under the care of a well structured team benefits from synchronized support – for example, when returning from injury, medical clearance, physical reconditioning, nutritional optimization, and mental readiness are all addressed in unison. The collaboration among diverse specialists reduces the risk of oversight (such as a physical issue being treated in isolation without recognizing psychological stress, or vice versa) and helps anticipate problems before they escalate (like catching signs of overtraining or burnout early through joint monitoring by coaches, trainers, and psychologists).
The U.S. sports model has increasingly embraced this holistic concept, and it continues to grow. Looking ahead, athlete care roles may evolve further with advances in technology and science – we may see more data analysts, AI-driven injury prediction tools, or virtual reality mental training as part of the team. However, the core will remain the human expertise and teamwork of the professionals involved. Ultimately, the well-being and success of athletes hinge on this network of care. The evolution of these roles has been driven by the ever-increasing demands of sports and the recognition that athletes are not just performers but whole persons with diverse needs.
The structure of athlete care teams, with clear roles yet collaborative overlap, ensures that these
needs are met comprehensively.
In conclusion, the modern athlete thrives best when supported by a team that bridges physical health and mental health, blending medical knowledge, training science, nutrition, and
psychology. The United States’ approach to structuring these athlete care roles serves as a model emphasizing that investing in a broad spectrum of athlete support not only prevents and treats injuries or illnesses but also elevates performance and enriches the sporting experience for athletes. As sports continue to advance, this integrated athlete-centric care approach will remain at the heart of nurturing champions, healthy in body and mind, on and off the field.
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