The Protector

Tampa Bay\'s Todd Toriscelli is in charge of caring for everything from nutrition to critical care for Buccaneer players.
by: Jane Musgrave
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When Tampa Bay Buccaneers defensive back Damien Robinson is asked how important athletic trainers are to his game, he whips out his cell phone.

"He is the No. 1 number," Robinson says of Bucs head trainer Todd Toriscelli. Once thought of as those guys who toted water or taped ankles, athletic trainers are now as important to winning football programs as quarterbacks with cannons for arms or receivers who can sprint downfield undetected to catch those powerful blasts.

"I think the importance of our profession has really increased as the competition in the NFL and college programs has increased," says Toriscelli.

"Seasons are made on who they lose and who teams keep. It becomes a battle of attrition."

And after spending more than a decade on the front lines in both professional and college football, Toriscelli knows all too well how difficult it can be to win the battle.

Having worked for some of the top coaches in the nation - Bill Snyder at Kansas State, Dennis Erickson when he was at the University of Miami, Tyrone Willingham at Stanford and now Tony Dungy at the Bucs - Toriscelli says he's been lucky. While a more varied group of personalities would be hard to find, each of the coaches have understood the importance of an athletic trainer and have given Toriscelli the resources he's needed to do his job right. But, he says, looking around the country, the same isn't true at all football programs. Many schools, even at the college level, refuse to spend the money necessary to make sure players are protected. "What most schools want is winning programs and they say they want top-level treatment and care of their athletes," he says. "But you can't just say that. You have to make a commitment to being good in that area. You have to commit the resources."

Often, instead of hiring a certified athletic trainer and giving that person a staff, schools will try to get by using graduate assistants, who by definition are inexperienced, extremely overworked and who will leave the program within a year or two to get real jobs.

The problem is even worse at the high school level where some schools don't even have certified trainers available to deal with injuries during games, much less during practice.

"Every high school in the country should have a certified athletic trainer at the games," Toriscelli says. Merely asking the local doctor to show up isn't enough. A trainer, who is familiar with the players, their medical history, the game and what types of injuries can occur is key to keeping players safe.

"Schools need to make a commitment not just to facilities but to staff as well," he says.

While there is no standard to determine how many trainers a school should have, at a minimum, each should have a full-time sports medical director. That person should analyze the sports offered and rank them based on risk of injury.

That's what Toriscelli he did when he arrived at Stanford in 1995 to be the school's head athletic trainer. With 33 sports, Toriscelli knew it would be impossible for him and his staff of six to be on hand for each and every practice and game for each and every sport - even with the help of graduate assistants. So, he sat down, looked at the incidence of injuries in each sport and decided which ones needed a trainer on site and which ones didn't. Football, wrestling, and men's and women's gymnastics clearly fell into the high-risk category and had to be staffed. Other sports, such as swimming, rowing and golf, didn't. While it might sound like common sense, it's important to have a plan and a justification for it, Toriscelli says. Then, all of the coaches and athletes know what to do when injuries inevitably occur.

"Stanford was unique because they gave us the tools we needed," he says. "They had great teams and they wanted to continue to be great and knew that to do that they had to take good care of their athletes."

While most good coaches recognize the value of trainers, misperceptions persist. Today's athletic trainers don't just treat injuries; they treat the entire player from health and fitness to nutrition to critical care. "I have to deal with everything from severe neck injuries to asthma," Toriscelli says. "I see them first whether they have the flu or they blow out a hamstring on the field."

And while trainers were once looking at X-Rays, they are now reading CT scans and MRIs to determine the extent of a player's injury and the treatment necessary, says Toriscelli, who has a master's degree in physical education with an emphasis in sports medicine from the University of North Carolina.

He works closely with the team's physicians, including specialists who are available to deal with the many medical and physical problems athletes face. But, he says, while the work in some ways has gotten more complicated, in other ways, it has gotten easier.

Sophisticated diagnostic testing can pinpoint the exact nature of a player's injury, enabling athletic trainers and doctors to better determine how to best treat it. "In the old days, you did it more or less by formula. If a player had a sprained ankle, he'd be out for three weeks," he says.

Today, athletic trainers can look at the results of the tests and determine whether surgery is necessary, whether rest and rehabilitation will repair the damage or whether an athlete can continue to play. The same diagnostic tests can also be used to monitor a player's progress; to determine if the treatment is working or if something else needs to be done.

Such precision testing has allowed him to "OK" a player to go back on the field with an injury or to recommend that surgery wait until the season ends.

"It allows us to be aggressive and safe at the same time," he says. Sometimes, however, too much information can be detrimental. Physicians will "over-read" the results of an MRI, he says. The doctor, for instance, will detect a tear in the cartilage of a player's knee or see that he has a herniated disk in his back. "Well, 70 percent of people who play football have herniated disks," Toriscelli says. Likewise, many have torn cartilage in their knees. In most cases, the maladies don't effect their play.

The important thing is not merely finding an injury, but determining if it is really causing the player problems.

He says he is blessed with being able to work with a good orthopedic surgeon who doesn't panic when he sees problems on an MRI that aren't related to an injury that is hurting a player and his performance. But, he says, the trick with diagnostic testing is making sure the results are interpreted correctly to benefit both the player and the team. And, as many advancements as there have been, there are still mysteries. One of the major problems he sees in football today is concussions. While helmet improvements have reduced the number of catastrophic injuries, not a lot is known about the cumulative effects of mild head injuries. Unfortunately, he says, a brain injury is not like a broken bone. With a broken bone, medical experts can see the bone healing. With a brain injury, the recover is often unclear. While a CT scan will look normal, a player will still experience symptoms, indicating that something is still wrong.

Researchers are now analyzing how players hit each other in hopes of minimizing the possibility of head injuries. Toriscelli is convinced it's a physicality issue. "The game is never going to change. Players are going to get hit," he says. "We can't predict how they are going to get hit, but we can predict that they will get hit."

That's why he is convinced that ultimately new helmets will be developed by the helmet manufacturers who are leading the way with thorough research and development. "We have to find a way to take the load off the brain," he says. Being aware of such developments, staying on top of medical breakthroughs, research and new solutions to old problems, is all part of the job of being an athletic trainer.

Some issues, like brain injuries, are life-threatening. Others, however, just help build better players. For instance, earlier this year, he asked researchers from the Gatorade Sports Science Laboratory to test the sweat of Alshermond Singleton. The linebacker had long been plagued by cramping and Toriscelli wanted to see if there was some physiological reason for it.

Researchers discovered that Singleton's sweat contains 2.5 times more sodium than the average athlete. Instead of going to his muscles, the sodium was being sweat out, which caused his muscles to cramp. The solution, it turned out, was simple: Drink a supplement to boost the amount of sodium in his body.

In May, Toriscelli accompanied another Buccaneer, running back Warrick Dunn, to the lab outside Chicago to see if researchers could find a reason for his equally perplexing game-day cramps. "We've tried many, many things," Toriscelli says of why he decided to take Dunn to the Gatorade clinic. "His problem is unique in that he doesn't cramp during training camp very much. His problem has been primarily in games, and we don't know if there's adrenaline involved or other issues." And, for an athletic trainers, it seems there's always other issues. Whether he's testing sweat, attending a combine and examining 329 NFL wannabes in one weekend, monitoring practice to make sure players aren't getting dehydrated in the relentless Florida heat or meeting with the strength coach to make sure an injured player is on the mend, there's always some issue out there that needs to be addressed. Because when it's all done, he has to face the one overriding question: Who's going to play Saturday? That's the pay-off question, Toriscelli says.

And the reality for athletic trainers is inescapable. "You can't be wrong very often."

Todd Toriscelli, 38, has been with the Tampa Bay Buccaneers since 1997. Before that, he worked for some of football's leading coaches. Here's what he has to say about them:

On Kansas State University head coach Bill Snyder:
"He was the most organized and driven individual I've ever met in my life. His capacity for work is unmatched and he expects your capacity for work to be unmatched as well. A master of organization and detail, Snyder wanted to know all of the details about a player's injury and the treatment plan. He had a good knowledge of medicine and asked lots of questions. Meetings were daily and lengthy."

On Dennis Erickson:
"He was a bottom-line kind of coach. He didn't want all the details - just who's in an who's out ... Of course, Miami had so much talent that if someone couldn't play, you could just plug in someone else. It takes a lot of pressure off a trainer."

On Stanford's Tyrone Willingham:
"He's also real detail-oriented and very organized and wanted a lot of information - not as much as Bill Snyder, but more than Dennis Erickson."

On the Tampa Bucs Tony Dungy:
"He's a bottom-line guy, too. He wants to know the plan, what you're doing with each player but he wants you to handle your own job. When there's a significant injury to a top player, he also meets with Tampa Bay general manager Richard McKay to discuss it While the stakes are higher, the life of an athletic trainer in the pros is easier than at the college level. In sheer numbers, a pro roster has 53 players compared to 85-90 in college. Further, in college, players can't take time out from practice. In college they beat the heck out of them through the wee and on Sunday. The work is very intense."

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