Introduction8 International Comparison of the Athletic Trainer System: A Medical Profession in the U.S. vs. a Support Role in Japan In contrast, university sports in Japan are seen more as a part of character development and education. Along with performance, hierarchical relationships, etiquette, and sustained efforts are highly valued. Joining a team is relatively open, allowing a wide range of students to participate, and the purpose and structure of each club can vary. Accordingly, how sports medicine is involved also differs depending on the school and level of competition. The curriculum covers musculoskeletal injuries, first aid, taping, and rehab support, but actual treatment and medical procedures are left to physicians and physical therapists. Thus, ATs in Japan tend to play a supplementary role and are often restricted in scope, especially regarding direct medical intervention. As a result, while ATs in the U.S. are granted broader responsibilities and legal authority as medical professionals, Japanese ATs generally remain in support roles without direct involvement in frontline treatment.The University of Texas at Tyler (U.S.)Yudai Watanabe I entered a US College on a tennis scholarship and played while receiving an athletic grant. In the U.S., athletic performance is directly tied to tuition support, so athletes are under constant pressure to deliver results in competitions. Moreover, college sports in the U.S. are viewed not only as part of education but also as a career path and business. As athletic performance affects university operations and visibility, sports medicine is systematically integrated to manage athletes’ conditions and respond to injuries. Athletic Trainers (ATs) are professionals who provide physical care, injury prevention, first aid, and rehabilitation support for athletes, serving as a bridge between medicine and sports. In the U.S., becoming an AT requires completing advanced specialized education at an accredited university or graduate school based on standards set by the National Athletic Trainers’ Association (NATA) and passing the Board of Certification (BOC) exam. Even after becoming certified, athletic trainers are required to complete continuing education (CEUs) to maintain and enhance their knowledge and skills. A high level of clinical competence is also expected. In practice, ATs in the U.S. perform manual therapy, conduct injury assessments, perform dry needling, operate therapeutic equipments, and provide emergency care. They often work alongside physical therapists and physicians. In many states, ATs are legally recognized as healthcare professionals, and their services may be covered by insurance. In contrast, in Japan, the AT qualification is a private certification issued by organizations like the Japan Sports Association (JSPO), not a national license. Comparison of Medical Support Systems in College Sports Between the United States and Japan
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