The Complete Pathway for Athletic Trainers (ATCs) to Earn an MSK Ultrasound Certification
- Carlos Jimenez
- Dec 8, 2025
- 3 min read
A Common Question With a Lot of Confusion
One of the most common questions we get from Athletic Trainers is:
“Can ATCs sit for the RMSK exam?”
And the short answer is:
No, ATCs are not eligible for the RMSK.
But that doesn’t mean ATCs don’t have a pathway.
In fact, ATCs can earn a respected MSK ultrasound credential just not through the RMSK.
Instead, they follow the ARDMS MSKS/RMSKS pathway, which was built specifically for sonographers and allied health clinicians involved in musculoskeletal imaging.
This guide walks ATCs through that pathway step-by-step.
Why ATCs Cannot Take the RMSK
The RMSK credential (through APCA) is classified as a physician-level certification.
According to APCA eligibility criteria, RMSK applicants must hold a qualifying medical license in one of the following:
MD / DO
DPM
MBBS
Nurse Practitioner
Physician Assistant
Doctor of Physical Therapy
Physical Therapist
Doctor of Chiropractic
Athletic Trainers are not listed.
This means ATCs cannot apply for the RMSK exam, regardless of experience or training.
But there is a certification designed for them.
The Correct Pathway for ATCs: MSKS / RMSKS (ARDMS)
ATCs are eligible for the Musculoskeletal Sonographer (MSKS/RMSKS) credential offered by ARDMS.
This certification focuses on:
✔ Anatomy
✔ Pathology
✔ Scanning technique
✔ Protocols
✔ Integration of clinical data
It is respected, nationally recognized, and directly applicable to ATC clinical environments.
RMSK (Physician-Level Exam – APCA)
Who it’s for:
MD, DO, DPM, DC, NP, PA, PT, DPT, MBBS
(Not available to ATCs)
Exam Domains & Percentages (RMSK)
Based on the MSK Examination Outline (APCA):
Domain | Percentage |
1. General Sonographic Anatomy | 26% |
2. General Sonographic Pathology | 23% |
3. Ultrasound-Guided Interventional Procedures | 18% |
4. Integration of Data | 7% |
5. Physics & Instrumentation | 26% |
Prerequisites:
✔ Licensed medical provider (PT, DC, NP, PA, MD, DO, etc.)
✔ 150 diagnostic MSK ultrasound studies (0% therapeutic)
✔ Within 36 months
✔ No SPI exam required
MSKS / RMSKS (Sonographer-Level Exam – ARDMS)
Who it’s for:
ATCs, Sonographers, Allied Health, Non-physician clinicians
(Not available to MD/DO/DC/NP/PA/PT, who must take RMSK instead)
Exam Domains & Percentages (MSKS/RMSKS)
From MSKS Content Outline V24.1:
Domain | Percentage |
1. General Anatomy & Physiology | 33% |
2. General Pathology | 42% |
3. Protocols & Integration of Data | 21% |
4. Interventional Procedure Support | 4% |
Step 1: Hold an Active Credential in a Health-Related Field
ARDMS requires applicants to hold a current credential or license in a health-related field.
Athletic Trainers meet this requirement.
Step 2: Pass the SPI Exam (Sonography Principles & Instrumentation)
Before applying for MSKS/RMSKS, ATCs must pass the SPI exam, which covers:
Physics of ultrasound
Image optimization
Transducer function
Doppler principles
Safety & quality assurance
This exam builds the physics foundation needed for the MSKS.
Complete 150 Diagnostic MSK Ultrasound Studies
This requirement is often misunderstood but it is absolutely mandatory.
According to the ARDMS General Prerequisites (RMSKS section):
“Performed a minimum of 150 musculoskeletal ultrasound studies within the preceding 36 months of application…
None of the studies may be therapeutic…
Must be completed on real patients in a clinical diagnostic setting.”
Why the 150-Case Requirement Matters
ARDMS uses this benchmark to ensure candidates have real-world competency with:
Multiple joints
Pathology identification
Dynamic scanning
Clinical reasoning
Protocol familiarity
It is not intended to be a barrier, it is intended to ensure safe, accurate scanning.
Step 4: Apply for the MSKS / RMSKS Exam
Once the SPI exam and 150 diagnostic scans are complete, ATCs may apply for the MSKS/RMSKS exam.
The MSKS exam includes the following domains:
General Anatomy & Physiology (33%)
General Pathology (42%)
Protocols & Integration of Data (21%)
Interventional Procedure Support (4%)
ATC → SPI Exam → 150 Diagnostic MSK Scans → MSKS/RMSKS Exam
This is the official, ARDMS-approved pathway for Athletic Trainers.
Why This Matters for Athletic Trainers
ATCs are increasingly involved in:
Acute sideline assessment
Differential diagnosis
Return-to-play decision-making
Tendon/ligament evaluation
Soft-tissue injury management
Ultrasound amplifies these capabilities dramatically.
The MSKS credential validates that skill in a nationally recognized, standardized way.
Want Support on Your MSKS Pathway?
At Pura Health, we help ATCs and allied clinicians build toward MSKS certification through:
🩻 2-Day Diagnostic Ultrasound Course
🦵 Lower Extremity Soft-Tissue Ultrasound Course
🎓 SPI + MSKS Mentorship Pathway
Small groups. Hands-on scanning. CEU-approved.
👉 Learn more at purahealth.net
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