When coaches condition their athletes they not only want to increase athletic performance but often to instill the values of toughness, discipline, and success through effort. However, this mindset about conditioning, especially football athletes, has come at a heavy price.
Unfortunately we do not have to look hard to find out that injury, illness, and even death have occurred, most recently at Kent State University, and over the past decade during conditioning sessions. According to the National Center for Catastrophic Sport Injury Research, 21 NCAA football players have died in conditioning sessions since 2001. Sixteen of those deaths occurred in Division 1 programs, where presumably full time strength and conditioning coaches are employed. 11 of the 21 deaths occurred on day one or two of the conditioning workouts Data also showed in 2011 five cases of heat stroke death at the high school level. The three most common causes of death associated with these cases were cardiac conditions death associated with sickle cell trait (note: Sickle cell trait is not sickle cell anemia) and exertional heat stroke (Fidler, 2012). No coach wants death to be a consequence of conditioning practice.
The major cause of the rise in serious illness and death may be attributed to coaches introducing workouts that are too much, too intense, and too soon. This puts athletes at an especially high risk for exertion-related illness, injury, or death. The combination of introducing workouts that are too much for athletes, in a hot environment with the potential of an athlete having a predisposed medical condition is a recipe for trouble. It is critical that conditioning workouts do not overexert athletes and lead to serious illness or death.
1. Progressive Acclimatization
If the current conditioning practices are not safe, what should high school coaches do? For many high school coaches, prescribing and administering conditioning drills and exercises are their responsibilities. They should follow the best practice recommendations for keeping athletes safe during conditioning sessions. The recommendations come from The Inter-Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions. These guidelines are intended to provide you best practices to help prevent sudden death, illness and injury. Unless otherwise noted the following recommendations are from Inter-Association Task Force for Preventing Sudden Death in CollegiateConditioning Sessions: Best Practices Recommendations. Journal of Athletic Training. 47 (4), 477–480.
Start light and progress slowly. It is important to slowly and progressively increase the volume, intensity and type of exercises and drills used to condition athletes. Introducing full-intensity workouts too quickly puts athletes at especially high risk for exertion- related health problems. It is important for coaches to avoid testing their athletes “mental toughness” or “character” with physical conditioning drills. Conditioning drills should be conducted for the purpose improving physical performance and not for tests of fortitude. Implementing workouts and drills in a gradual and progressive manner, for the appropriate purpose, encourages proper exercise acclimatization and minimizes the risk of adverse effects on athlete health.2. Introduce New Conditioning Drills Gradually
Any new exercise introduced into strength and conditioning program should be added in a deliberate and gradual manner. This guideline is true for any aspect of the conditioning program, however, is particularly important during the early stages of a conditioning program or season. Starting with a lower volume of work and repetitions and at a lower intensity and increasing or the course of several workout sessions will allow athletes to get used to the workload and not overexert themselves.3. DO NOT Use Exercise & Conditioning Drills as Punishment
Physical activity should not be used as retribution, for coercion, or as discipline for unsatisfactory behavior--athletic or academic performance. No additional physical burden should be placed on athletes that would increase the risk of injury, illness, or sudden death--under any circumstance.
4. Ensure Proper Education, Experience, and Credentialing
It is recommended that conditioning programs be designed and implemented by a certified strength and conditioning coach. However, the reality is that many schools, at the high school level, do not have a certified strength and conditioning professional on staff. Using resources available, coaches may be able to develop safe and effective programs in the absence of a certified professional. High school coaches can network and communicate with certified and reputable strength and conditioning coaches or become certified themselves. The National Strength and Conditioning Association (NSCA) has a variety of resources for coaches, as well as certification options. The National High School Strength Coaches Association (NHSSCA) is another good resource. Regardless, all coaches should maintain certification in First Aid, cardiopulmonary resuscitation (CPR), and use of an automated external defibrillator (AED).
5. Provide Appropriate Medical Coverage
A coach should be present during all strength and conditioning sessions and be prepared to provide First Aid as soon as an athlete shows signs of distress. The coach should be able to administer CPR, apply an AED, and activate the emergency action plan (EAP) if needed. An athletic trainer or team physician should be present during each high-risk conditioning session.
6. Develop an Emergency Action Plan (EAP)
Don’t assume anyone will know what to do in the event of a medical emergency. Plans should be developed with the help of medical professionals, sports medicine staff, athletic administration, and coaching staff. It is vital the EAP are routinely discussed and reviewed. Practice and conditioning sessions should not take place if those supervising the session are not familiar with the EAP.
7. Be Cognizant of Medical Conditions
The most prevalent medical conditions associated with sudden deaths during conditioning are atraumatic cardiac conditions, exertional heat stroke, exertional collapse associated with sickle-cell trait, and asthma. Coaches and designated medical supervisors need to be familiar with the characteristics of exertional collapse and the differential diagnosis of the conditions listed earlier. The National Athletic Trainers’ Association position statement on preventing sudden death in sport is a recommended resource for recognition and treatment of these conditions. This can be found at NATA.org.
At all levels, coaches understand the importance of conditioning their players. For teams to compete at a high level, athletes that are in excellent physical condition have the best chance for success. However, coaches must make athletes' health and safety their top priority and not let the values of making athletes tough, instilling discipline, and focusing on success at all costs cloud their judgment. The recommendations outlined should aid coaches in keeping athletes' health and safety a top priority while still working to develop athletes that are in excellent physical condition.
About the Author
Brian Lutter is the Director of Strength & Conditioning at Johnston High school in Johnston, IA. Brian designs the strength & speed / agility programs for the school’s athletics program and strength training classes. Brian is an assistant varsity football coach and physical education teacher. He has also coached varsity wrestling and varsity girls track. Brian received his Bachelor's Degree in Health and Human Performance from Iowa State University where he was also a member of the Cyclone Football team. He is a Certified Strength & Conditioning Specialist with the National Strength & Conditioning Association, USA Weightlifting Certified Sport Performance Coach and holds a Master’s Degree in Education from Drake University. Brian is also competitive powerlifter and a member of 22nd Street Barbell's powerlifting team His best competitive lifts to date are a 555 pound squat, 424 pound bench press and 650 pound deadlift. His best total is 1590 pounds. He resides in Grimes, IA with his wife Amy and two daughters Nora and Stella.
MS, CSCS, USAW