Roughly one year ago, Maryland football was going through a spring conditioning practice when 19-year-old Jordan McNair collapsed from heat stroke. He was not placed in an ice bath or any other cooling technique. When he was taken to the hospital, his temperature was 106 degrees. He later died from heat stroke. Rick Court, the strength and conditioning coach who was leading the session, ultimately resigned, and head football coach D.J. Durkin was later fired.
This is a difficult topic to write about, and one that I do not take lightly. But I believe now more than ever strength coaches need to be talking. We need to start the conversation about what we as strength coaches can do better. It is important to understand that Rick Court is not a bad strength and conditioning coach. It was not bad programming that caused Jordan McNair to suffer a heat stroke. The workout he performed was Ten 110s, which is a standard high-volume conditioning day for football. It is easy to be self righteous and assume you would never make the mistakes Rick Court made, but in reality, this could happen to anyone who trains athletes. If you have not prepared yourself to identify and handle exertion-based illnesses, then you are putting your athletes at risk. In this article, I will provide basic information on heat exhaustion and heat stroke, two of the most serious forms of heat illness, as well as what strength coaches can do to be proactive in preventing these illnesses.
A great resource for better understanding heat illnesses is this ACSM Position statement. The position statement gives etiology, risk factors, and recognition for heat stroke, heat exhaustion and heat cramps. I highly recommend all strength coaches take the time to read this and brush up on that information. This position statement provides a full detailed overview of these disorders in greater detail than I can offer here.
3 Things to Know About Heat Exhaustion and Heat Stroke
1. All Athletes Are Susceptible
Heat exhaustion is a body mechanism where the central nervous system stops the athlete from being able to continue exercising. This is thought to be a defense mechanism to stop the athlete from continuing to exercise, which would increase their risk of heat stroke. It can involve collapsing. Heat stroke, on the other hand, is when the athlete's core body temperature rises above 104 degrees Fahrenheit. It is associated with disturbances to the central nervous system as well as organ system failure. Heat exhaustion is essentially the last line of defense to stop an athlete from reaching heat stroke.
Humans have a number of mechanisms to stop the body from reaching the point of injury or illness. For example, the Golgi tendon organ (GTO) senses the tension in a muscle during contraction. If the muscle produces too much tension, the GTO will essentially shut off the muscle to prevent injury. The GTO works like an overprotective mother stopping the muscle from going anywhere near maximal muscle tension. As athletes train, the GTO allows the muscle to produce greater tension before shutting it off. This is a training adaptation that allows individuals to get stronger.
It is reasonable to believe that the same adaptation can occur in the CNS in regards to heat exhaustion. Athletes who are highly trained in the heat are able to withstand greater increases in internal temperature. Thus, the CNS defense mechanism of heat exhaustion may occur once it is already too late. This is evident in the ACSM Position statement, as the authors write "some individuals are able to experience prolonged hyperthermia without showing any signs of physical impairment." Temperatures as high as 107.4 degrees Fahrenheit have been seen in athletes that are not showing any physical signs of impairment. It is reasonable to assume that if you are training anything above youth level athletes, they may have developed the ability to increase their internal temperature without their body shutting down via heat exhaustion. The significance of this is that it is not only poorly-conditioned athletes who are at risk of heat stroke, but also well-trained or even elite athletes, as well.
2. The Line Between Heat Exhaustion and Heat Stroke Is Fuzzy
It is difficult to recognize the difference between a heat stroke and heat exhaustion. There is significant overlap in the symptoms. Symptoms that are found in both heat stroke and heat exhaustion include headache, dizziness, nausea, vomiting, diarrhea, irritability, loss of muscle coordination and collapse. In school, I was taught dry skin was a way to differentiate between heat exhaustion and heat stroke. During non-exertion-based heat stroke, individuals will typically have dry, hot and flushed skin. However, this doesn't hold up in environments of sport and training. During exertion-based heat stroke, individuals are almost always sweat-soaked at the time of collapse. If you cannot tell the difference between the two, it is always wise to err on the side of caution. It is far better to send an athlete over to the athletic trainer than to assume that they are simply out of shape and trying to "fake" their way out of the workout. I'd much rather give an athlete an ice bath who doesn't need it than not give one to someone who truly does.
3. It Doesn't Only Happen When It's Hot
It is a misconception that heat stroke only occurs when it's hot out. The risk does increase with greater temperatures, but heat stroke can and has occurred at temperatures as low as 45 degrees Fahrenheit. The greatest risk is when the wet bulb temperature is above 82 degrees Fahrenheit, but even on cooler conditioning days strength coaches need to be aware that heat stroke can still occur.
Now that you know a little more about these heat illnesses, what can we do to decrease the risk of them occurring? Beyond knowing the signs and symptoms and customizing workouts to the climate, here are:
3 Tips for Reducing Risk of Heat Illness
1. Communicate With the Training Staff
Strength and conditioning coaches should be in constant communication with the athletic training staff. It is important that strength coaches cultivate a positive work relationship with their athletic trainers. Strength coaches and athletic trainers have the same goal, which is to keep athletes healthy and on the field. They need to have mutual respect and communicate directly to one another. In regard to heat-based illnesses, strength coaches should communicate to the training staff what the conditioning workout is. This may seem like just extra busy work, but it's not. The training staff needs to know when the athletes are performing a higher-risk workout. If the workout is focusing on max speed with extended periods of time for recovery and rehydration, the risk of suffering a heat stroke is significantly lower than if it is a speed endurance or aerobic day with higher volumes and reduced recovery. Making the training staff aware of that can help to reduce the time it takes to start proper treatment and potentially prevent a tragedy from occurring.
2. Keep Learning
Nearly every strength coach has gone through a "recognition and evaluation of athletic injuries" type of course during their time in college. For most strength coaches, that is not our passion. We are passionate about seeing an athlete make strength, speed and power gains. We are passionate about taking a mediocre athlete and helping them become a starter. We don't get nearly as excited talking about injuries. That has begun to change as the strength and conditioning community has started emphasizing injury reduction equally with performance enhancement. This has primarily focused on musculoskeletal injuries, but it is important to stay up to date with your understanding of heat and exertion-based illnesses. Reading these type of articles is a good start, but we must do more.
I tell my athletes all the time that if you only work on what you are good at, then you will never truly get better. It is crucial that we become more well-rounded strength coaches to provide a better service to our athletes. For example, at your next conference, instead of going to another talk on speed training, why not go to the talk on Exertional Rhabdomyolysis (ER)? It may not be what excites you about training athletes, but it will make you a better coach. If you are looking for a good source of information on ER, Dr. Ben Gleason had a great research-based presentation on Exertional Rhabdomyolysis at the NSCA Coaches Conference this past year.
3. Consider Your Culture
This third point touches more on the strength coach's impact on the whole athlete, but because it was a major piece in the Maryland story, I feel it's necessary to address. There are reports that have come out of a "toxic culture" at Maryland that included shaming and degrading football players. On the other hand though, there have also been reports from former players saying how much they loved Coach Court and the way he challenged them. I am not here to comment specifically on the culture that existed within Maryland football, because I know nothing about it.
Instead, I want to challenge every coach to look at the culture they are cultivating. Most strength coaches were kings of the weight room during their athletic careers. I became a strength and conditioning coach because I loved my strength and conditioning experience as a college athlete and because I want to invest in the lives of young athletes. I believe most strength coaches would say something similar. I loved waking up at 5:30 a.m. to lift. I loved when the strength coach got on me, because that motivated me.
Early in my career, I attempted to emulate what I loved about my experience, but it didn't work for most of my athletes. I didn't realize until later on that not every athlete is motivated the same way. I had a hard time empathizing with athletes that didn't love to work hard and who were eager to wake up at 5:30 a.m. to do so. I learned that as a strength and conditioning coach, you really need to be a Swiss Army knife.
You need to get to know your athletes and understand what motivates each individual. The job of the strength and conditioning coach is to get the most out of every athlete who walks into their weight room. It is easy to get a lot out of highly motivated kids who love to work hard. It is a lot harder, and it takes a far superior coach, to find ways to challenge and motivate the kids who would prefer to sleep in or skip a lift.
If your culture involves degrading and belittling your athletes, that is your prerogative. But I want my athletes to know that I genuinely care for them. If they know that, then they will trust that everything I ask them to do is for their benefit.
Above all, I strive to remember what should be the No. 1 rule for any strength and conditioning coach: Do No Harm. If you do not know how to identify or prevent an injury, then the odds are higher that your athletes will run up against it. It is the same thing as allowing an athlete to deadlift with a rounded back. Every strength coach understands the risk of that, but many do not understand heat or exertion-based illnesses.
It is important that we continue to educate ourselves in order to continue to take the unnecessary risk out of training. No good strength coach would ever intentionally put their athlete's in harms way, but you cannot claim ignorance when tragedy occurs.
Photo Credit: TerryJ/iStock
- The Dangers of Heat Stress for Athletes
- Heat Injuries Can Be Deadly. Here's How to Recognize, Treat and Prevent Them
- How to Hydrate Properly to Maintain Your Performance in the Summer Heat